The recurrence rate, risk factors and recurrence patterns after surgery in 3700 patients with operable breast cancer / 한국유방암학회지

PURPOSE: This study was aimed at evaluating the recurrence rate and recurrence patterns after surgically treating for patients with operable breast cancer. METHODS: From 1992 to 2002, 3700 patients with breast cancer (stages 0-3) who underwent mastectomy or breast conservation surgery at Asan Medical Center, Seoul, were selected for this retrospective study. We analyzed the recurrence rate, the annual hazard rate, the risk factors, the time to recurrence and the recurrence patterns according to the clinicopathologic factors. RESULTS: During the median follow-up period of 45 months, 523 patients (14.1%) of the total 3700 patients developed recurrences: locoregional recurrences occurred in 148 patients (4.0%), distant recurrences occurred in 319 patients (8.6%), and both types occurred in 56 patients (1.5%). The 5-year and 10-year recurrence rates were 17.7% and 23.4%, respectively. The recurrence rate increased in proportion to the cancer stage. The annual hazard rate for recurrence had a peak at 2-years of follow-up. On multivariate analysis, the stage, progesterone receptor status, and c-erbB2 expression were the independent risk factors for recurrence. The median time to recurrence among the patients with recurrence was 24.0 months. 50.5% of recurrences were found within 2 years and 92.0% of recurrences were found within 5 years after surgery. A short time to recurrence was significantly associated with an increased stage, a negative progesterone receptor status, and locoregional recurrences. The common recurrence sites included the chest wall, SCLN and the axillary lymph nodes in a locoregional order, and the bone, lung and liver in a systemic order. Of note is that distant recurrences commonly occurred at multiple sites in a simultaneous manner. CONCLUSION: Our findings revealed that the 5 year-recurrence rate was 17.7% and the risk of recurrence was maintained 5 years later after surgery, although the annual hazard rate had the highest peak at 2 years after breast cancer surgery. Because the stage, progesterone receptor status, and c-erbB2 expression are independent risk factors, early detection of breast cancer is required for reducing recurrence.

Clinicopathological Characteristics of Invasive Lobular Carcinoma in the Breast: Multifocality and Difficulty in Preoperative Diagnosis

PURPOSE: Infiltrating lobular carcinoma (ILC) represents approximately 10% of all breast cancers. Its detection and staging for appropriate surgical planning may be difficult on account of its unique growth pattern, including a linear file arrangement of the tumor cells and a planar growth pattern and the resulting low density of the lesions. The purpose of this study was to evaluate the clinicopathological features of an ILC of the breast including multifocality, the preoperative accuracy of the pathological diagnostic tools, and its impact on the surgical procedure. METHODS: Between 1997 and 2003 at the Asan Medical Center, a group of 63 patients with a pathologically proven invasive lobular carcinoma who had undergone surgery were included. They were all in stage I~III, and their medical records, mammographic and sonographic results, and pathologic findings were reviewed retrospectively. RESULTS: Of the 63 patients with a mean age of 48 years (range 35 to 70), multifocal lesions were identified in 27.0% by a pathological examination. For a preoperative evaluation of a multifocal lesion, the sensitivity and positive prediction value were 21.4% and 50% by mammography, and 92.9% and 52.0% by ultrasonography, respectively. Only 27.0% of all patients were confirmed as having an ILC preoperatively; surgical excision or incision biopsies 75%, core-needle biopsy 36.4%, frozen biopsy 22.7%, FNA 5.9%. Conservative surgery was performed in only 14.3% and a mastectomy was performed on 85.5%. The mean tumor size was 3.0 cm, and according to the TNM stage, stage I was found in 22.2%, stage II in 58.7%, stage III in 19.1%. ER-positive was found in 83.9% and PR-positive was found in 74.2%. Seven out of 11 patients, who underwent the planed conserving surgery, had a positive resection margin, 1 case had re- excision, 2 cases underwent mastectomies, and 4 cases underwent radiation therapy without additional surgery. CONCLUSION: Since invasive lobular carcinomas have more often multifocal lesions and a preoperative accurate evaluation may be difficult pathologically or radiologically, a careful evaluation of the accurate tumor extent as well as the multifocal lesion is needed particularly for patients with an ILC considering conserving surgery.