Local Recurrences and Distant Metastases After Conservative Breast Cancer Treatments: Partly Independent Events

作者：U. Veronesi, Ettore Marubini, Massimo Del Vecchio, Antonia Manzari, Salvatore Ambrogio Andreola, Maria Raffaella Greco, Alberto Luini, Mirella Merson, Roberto Saccozzi, Franco O. Rilke, Bruno Salvadori · 发表于：JNCI Journal of the National Cancer Institute · 年份：1995 · DOI：10.1093/jnci/87.1.19 · 被引用次数：511 · 研究领域：Breast Cancer Treatment Studies、Breast Implant and Reconstruction、Male Breast Health Studies

BACKGROUND: Local disease recurrences are a concern in conservative breast cancer surgery, and many studies have attempted to identify risk factors for these events. It is important to distinguish local recurrences linked to increased risk of distant spread from those due to inadequate local treatment. PURPOSE: We evaluated the incidence of local and distant recurrences according to demographic, biological, and pathologic variables in a large series of women who were conservatively and uniformly treated for breast cancer, with the aim of identifying women in whom local failure is predictive for distant metastases and who are therefore candidates for aggressive systemic treatment. METHODS: Medical records of 2233 women who had been hospitalized at the Milan Cancer Institute from 1970 to 1987 were analyzed. All women received quadrantectomy and axillary lymph node dissection followed by radiotherapy for the breast. Quadrantectomy is breast-conserving removal of most of the affected quadrant by a radial incision that includes part of the skin. The end points considered were local failures (including local recurrences and new ipsilateral carcinomas) and distant metastases. Statistical analysis employed the competing risks and multiple failures approaches. RESULTS: There were 119 local recurrences, 32 new ipsilateral carcinomas, and 414 distant metastases as first events. The timing of local failures and distant metastases differed: The yearly probability for local failures was ap...