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Ann Surg Oncol (2012) 19:11531159 DOI 10.1245/s10434-011-2084-6
ORIGINAL ARTICLE BREAST ONCOLOGY
Local Recurrence after Breast-Conserving Surgery: Multivariable Analysis of Risk Factors and the Impact of Young Age
Randy C. Miles, MD, MPH1, Rachel E. Gullerud, BA2, Christine M. Lohse, MS2, James W. Jakub, MD3, Amy C. Degnim, MD3, and Judy C. Boughey, MD3
1Mayo Medical School, Mayo Clinic, Rochester, MN; 2Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN; 3Department of Surgery, Mayo Clinic, Rochester, MN
ABSTRACTBackground. Local recurrence (LR) after breast conservation surgery (BCS) varies with risk factors. This study was designed to evaluate the impact of young age on LR.Methods. All patients (excluding those who received neoadjuvant chemotherapy) who underwent BCS from 19882001 at our institution were identied and evaluated for risk factors of LR.
Results. A total of 3,064 patients underwent 3,131 BCS. Mean age at surgery was 61 (range, 2198) years: 175(5.6%) patients were aged \40 years; 492 (15.7%) were 4049 years; 761 (24.3%) were 5059 years; 801 (25.6%)
were 6069 years; and 902 (28.8%) were age 70 ? years.
A total of 212 patients (6.8%) developed LR at a mean of4.5 (range, 0.114.4) years after BCS. Mean follow-up was8.9 (range, 020.2) years. The 5-year LR-free survival rate was 94.9%. The frequencies of LR by age group were: \40 years11.4%; 4049 years5.7%; 5059 years
6.2%; 6069 years7.6%; 70 years and older6.2%. The 5-year LR-free survival rates for these age groups were90.5%, 95.4%, 95.5%, 95.4%, and 94.7%, respectively (P = 0.09, log-rank test). On univariable analysis, patients aged \40 years were nearly twice as likely to experience
LR (hazards ratio (HR), 1.81; P = 0.012). Multivariable analysis of patients with complete data (n = 2,122) demonstrated that age \40 years and node positivity were
associated with increased risk of LR, whereas ER positivity and radiation therapy were associated with decreased risk. Conclusions. Risk factors for LR after BCS include age \40 years, node positivity, ER negativity, and absence of adjuvant radiation therapy. Patients younger than age 40 years are at increased risk of LR after BCS.
The lifetime prevalence of breast cancer among women in the United States is one in eight.1 Whereas mastectomy was initially the standard surgical therapy, breast conservation therapy (BCT) is now a standard and often preferred therapeutic option...