Factors Predicting Locoregional Recurrence after Wide Local Excision � Experience from a Tertiary Centre

Patrick MY Chan, Sherwin Kuah, James WK Lee, Cheok Hon Lee, Jonathan KS Phua, Juliana JC Chen, Sarah QH Lu, Bernard CS Ho, Wee Yao Koh, Bok Ai Choo and Ern Yu Tan

Department of General Surgery, Tan Tock Seng Hospital, Singapore
Department of Pathology, Tan Tock Seng Hospital, Singapore
Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore

^*Correspondance to: Ern Yu Tan 

 PDF  Full Text DOI: 10.25107/2474-1647.2382

Abstract

Introduction: Locoregional Recurrence (LR) can still develop after breast conserving surgery despite adequate surgical margins and whole breast radiation, even with a boost to the tumour bed. In this study, we evaluated predictors of LR and examined its effect on survival.
Methods: Retrospective review was performed of 713 women diagnosed with breast cancer from 2004 to 2011.
Results: Locoregional recurrence developed in 74 women (10.4%) and occurred adjacent to the previous tumour bed in half the instances. Surgical margins (P<0.001), nodal involvement (P=0.002), radiation (P=0.003) and 5 years of hormonal therapy (P<0.001) were independent predictors of LR. While LR had no effect on overall survival in women with DCIS (P=0.756), it was associated with poorer distant recurrence-free and overall survival in women with invasive cancer (P<0.001, HR 114.200, 95% CI 40.630–320.900 and P<0.001, HR 14.210, 95% CI 5.651–35.720 respectively). Radiation and hormonal therapy improved survival, showing an additive effect. Radiation, without hormonal therapy, did not improve recurrence-free survival, both locoregional (P=0.190) and distant (P=0.189), nor overall survival (P=0.236) in node-positive disease. However, radiation conferred survival benefit even when given alone in node-negative disease.
Conclusion: The rate of locoregional recurrence after breast conserving surgery was 10.4%. Adequate surgical margins and nodal disease were independently associated with LR and both radiation and hormonal therapy improved survival. Survival benefit was greatest in women who completed both radiation and 5 years of hormonal therapy.

Keywords

Recurrence; Wide local excision; Radiation; Hormonal therapy

Cite the article

Chan PMY, Kuah S, Lee JWK, Lee CH, Phua JKS, Chen JJC, et al. Factors Predicting Locoregional Recurrence after Wide Local Excision � Experience from a Tertiary Centre. Clin Surg. 2019; 4: 2382.