PMID- 19349544 OWN - NLM STAT- MEDLINE DCOM- 20090605 LR - 20220410 IS - 1527-7755 (Electronic) IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 27 IP - 15 DP - 2009 May 20 TI - Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative breast cancer. PG - 2466-73 LID - 10.1200/JCO.2008.19.8424 [doi] AB - PURPOSE: Locoregional failure (LRF) after breast-conserving therapy (BCT) is associated with increased risk of distant disease and death. The magnitude of this risk has not been adequately characterized in patients with lymph node-negative disease. PATIENTS AND METHODS: Our study population included 3,799 women randomly assigned to five National Surgical Adjuvant Breast and Bowel Project protocols of node-negative disease (ie, B-13, B-14, B-19, B-20, and B-23) who underwent lumpectomy and whole breast irradiation with or without adjuvant systemic therapy. Cumulative incidences of ipsilateral breast tumor recurrence (IBTR) and other locoregional recurrence (oLRR) were calculated, along with distant-disease-free interval (DDFI) and overall survival (OS) after these events. Cox models were employed to model mortality by using clinical and pathologic factors jointly with these events. RESULTS: Four hundred nineteen patients (11.0%) experienced LRF: 342 (9.0%) experienced IBTR, and 77 (2.0%) experienced oLRR. The 12-year cumulative incidences of IBTR and oLRR in patients treated with adjuvant systemic therapy were 6.6% and 1.8%, respectively. Overall, 37.1% of IBTRs and 72.7% of oLRRs occurred within 5 years of diagnosis. Older age, black race, higher body mass index (BMI), larger tumors, and occurrence of IBTR or oLRR were significantly associated with increased mortality. The 5-year OS after IBTR and oLRR were 76.6% and 34.9%, respectively. Adjusted hazard ratios for mortality associated with IBTR and oLRR were significantly higher in estrogen receptor (ER)-negative patients than in ER-positive patients (P = .002 and P < .0001, respectively). Patients with early LRF had worse OS and DDFI than those with later-occurring LRF. CONCLUSION: Although LRF is uncommon in patients with node-negative breast cancer who are treated with lumpectomy, radiation, and adjuvant systemic therapy, those who do develop LRF have substantially worse OS and DDFI. FAU - Anderson, Stewart J AU - Anderson SJ AD - Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA. sja@pitt.edu FAU - Wapnir, Irene AU - Wapnir I FAU - Dignam, James J AU - Dignam JJ FAU - Fisher, Bernard AU - Fisher B FAU - Mamounas, Eleftherios P AU - Mamounas EP FAU - Jeong, Jong-Hyeon AU - Jeong JH FAU - Geyer, Charles E Jr AU - Geyer CE Jr FAU - Wickerham, D Lawrence AU - Wickerham DL FAU - Costantino, Joseph P AU - Costantino JP FAU - Wolmark, Norman AU - Wolmark N LA - eng GR - U10-CA-69651/CA/NCI NIH HHS/United States GR - U10-CA-37377/CA/NCI NIH HHS/United States GR - U10 CA012027/CA/NCI NIH HHS/United States GR - U10 CA069651/CA/NCI NIH HHS/United States GR - U10 CA069974/CA/NCI NIH HHS/United States GR - U10 CA037377/CA/NCI NIH HHS/United States GR - U10-CA-69974/CA/NCI NIH HHS/United States GR - U10-CA-12027/CA/NCI NIH HHS/United States PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural DEP - 20090406 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM CIN - J Clin Oncol. 2009 May 20;27(15):2422-3. PMID: 19349536 MH - Aged MH - Breast Neoplasms/mortality/*pathology/*therapy MH - Chemotherapy, Adjuvant MH - Combined Modality Therapy MH - Female MH - Humans MH - Kaplan-Meier Estimate MH - Mastectomy, Segmental/*statistics & numerical data MH - Middle Aged MH - Neoplasm Recurrence, Local/*mortality/pathology MH - Prognosis MH - Radiotherapy PMC - PMC2684852 COIS- Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article. EDAT- 2009/04/08 09:00 MHDA- 2009/06/09 09:00 PMCR- 2010/05/20 CRDT- 2009/04/08 09:00 PHST- 2009/04/08 09:00 [entrez] PHST- 2009/04/08 09:00 [pubmed] PHST- 2009/06/09 09:00 [medline] PHST- 2010/05/20 00:00 [pmc-release] AID - JCO.2008.19.8424 [pii] AID - 98424 [pii] AID - 10.1200/JCO.2008.19.8424 [doi] PST - ppublish SO - J Clin Oncol. 2009 May 20;27(15):2466-73. doi: 10.1200/JCO.2008.19.8424. Epub 2009 Apr 6.