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ORIGINAL REPORTS
March 15, 2001

Differences in Risk Factors for Local and Distant Recurrence After Breast-Conserving Therapy or Mastectomy for Stage I and II Breast Cancer: Pooled Results of Two Large European Randomized Trials

Publication: Journal of Clinical Oncology

Abstract

PURPOSE: Risk factors for local and distant recurrence after breast-conserving therapy and mastectomy were compared to define guidelines for the decision making between both treatments.
PATIENTS AND METHODS: The data of two randomized clinical trials for stage I and II breast cancer patients were pooled. The total number of patients in the study was 1,772, of whom 879 underwent breast conservation, and 893, modified radical mastectomy. Representative slides of the primary tumor were available for histopathologic review in 1,610 cases (91%).
RESULTS: There were 79 patients with local recurrence after breast-conservation and 80 after mastectomy, the 10-year rates being 10% (95% confidence interval [CI], 8% to 13%) and 9% (95% CI, 7% to 12%), respectively. Age no more than 35 years (compared with age >60: hazard ratio [HR], 9.24; 95% CI, 3.74 to 22.81) and an extensive intraductal component (HR, 2.52; 95% CI, 1.26 to 5.00) were significantly associated with an increased risk of local recurrence after breast-conserving therapy. Vascular invasion was predictive of the risk of local recurrence, irrespective of the type of primary treatment (P < .01). Tumor size, nodal status, high histologic grade, and vascular invasion were all highly significant predictors of distant disease after breast-conserving therapy and mastectomy (P < .01). Age no more than 35 years and microscopic involvement of the excision margin were additional independent predictors of distant disease after breast-conserving therapy (P < .01).
CONCLUSION: Age no more than 35 years and the presence of an extensive intraductal component are associated with an increased risk of local recurrence after breast-conserving therapy. Vascular invasion causes a higher risk of local recurrence after mastectomy as well as after breast-conserving therapy and should therefore not be used for deciding between the two treatments.

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Published In

Journal of Clinical Oncology
Pages: 1688 - 1697
PubMed: 11250998

History

Published in print: March 15, 2001
Published online: September 21, 2016

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Adri C. Voogd
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.
Maja Nielsen
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.
Johannes L. Peterse
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.
Mogens Blichert-Toft
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.
Harry Bartelink
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.
Marie Overgaard
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.
Geertjan van Tienhoven
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.
Knud West Andersen
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.
Richard J. Sylvester
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.
Joop A. van Dongen
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.
for the Danish Breast Cancer Cooperative Group and the Breast Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer
From the Eindhoven Cancer Registry, Departments of Pathology, Radiation Oncology, and Surgery, the Netherlands Cancer Institute, Eindhoven; and Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands; Departments of Pathology and Surgery, Rigshospitalet, Copenhagen, and Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark; and European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium.

Notes

Address reprint requests to Joop van Dongen, MD, PhD, Department of Surgery, the Netherlands Cancer Institute/Antoni van Leeuwenhoekhuis, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; email: [email protected].

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Adri C. Voogd, Maja Nielsen, Johannes L. Peterse, Mogens Blichert-Toft, Harry Bartelink, Marie Overgaard, Geertjan van Tienhoven, Knud West Andersen, Richard J. Sylvester, Joop A. van Dongen, for the Danish Breast Cancer Cooperative Group and the Breast Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer
Journal of Clinical Oncology 2001 19:6, 1688-1697

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