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Local recurrence and breast oncological surgery in young women with breast cancer: The POSH observational cohort study

Local recurrence and breast oncological surgery in young women with breast cancer: The POSH observational cohort study
Local recurrence and breast oncological surgery in young women with breast cancer: The POSH observational cohort study
Objective: To assess clinical and surgical factors affecting local recurrence and survival in young breast cancer patients in the Prospective study of Outcomes in Sporadic versus Hereditary breast cancer (POSH). Background: Emerging data suggest young age is a predictor of increased local recurrence. Methods: POSH is a prospective cohort of 3024 women of 18 to 40 years with breast cancer. Cohort characteristics were grouped by mastectomy or BCS. Endpoints were local-recurrence interval (LRI), distant disease-free interval (DDFI), and overall survival (OS); described using cumulative-hazard and Kaplan-Meier plots and multivariable analyses by Flexible Parametric and Cox regression models. Results: Mastectomy was performed in 1464 patients and breast-conserving surgery (BCS) in 1395. Patients undergoing mastectomy had larger tumors and higher proportions of positive family history, estrogen receptor+, progesterone receptor+, and/or human epidermal growth factor receptor 2+ tumors. Local events accounted for 15% of recurrences. LRI by surgical type varied over time with LRI similar at 18 months (1.0% vs 1.0%, P = 0.348) but higher for BCS at 5 and 10 years (5.3% vs 2.6%, P < 0.001; and 11.7% vs 4.9%, P < 0.001, respectively). Similar results were found in the adjusted model. Conversely, distant-metastases and deaths were lower for BCS but not after adjusting for prognostic factors. After mastectomy chest-wall radiotherapy was associated with improved LRI (hazard ratio, HR = 0.46, P = 0.015). Positive surgical margins, and development of local recurrence predicted for reduced DDFI (HR = 0.50, P < 0.001; and HR = 0.29, P = 0.001, respectively). Conclusions: Surgical extent appears less important for DDFI than completeness of excision or, where appropriate, chest-wall radiotherapy. Despite higher local-recurrence rates for BCS, surgical type does not influence DDFI or OS after adjusting for known prognostic factors in young breast cancer patients.
0003-4932
165-172
Maishman, Thomas
cf4259a4-0eef-4975-9c9d-a2c3d594f989
Cutress, Ramsey
68ae4f86-e8cf-411f-a335-cdba51797406
Hernandez, Aurea
d813e824-8ae4-41cf-8db7-1d33dc3b6955
Gerty, Susan
b2013815-27c9-4a7d-ad42-071f60a8000f
Copson, Ellen
a94cdbd6-f6e2-429d-a7c0-462c7da0e92b
Durcan, Lorraine
bd059b41-9e77-4afe-b271-9ac4c91a05c6
Eccles, Diana
5b59bc73-11c9-4cf0-a9d5-7a8e523eee23
Maishman, Thomas
cf4259a4-0eef-4975-9c9d-a2c3d594f989
Cutress, Ramsey
68ae4f86-e8cf-411f-a335-cdba51797406
Hernandez, Aurea
d813e824-8ae4-41cf-8db7-1d33dc3b6955
Gerty, Susan
b2013815-27c9-4a7d-ad42-071f60a8000f
Copson, Ellen
a94cdbd6-f6e2-429d-a7c0-462c7da0e92b
Durcan, Lorraine
bd059b41-9e77-4afe-b271-9ac4c91a05c6
Eccles, Diana
5b59bc73-11c9-4cf0-a9d5-7a8e523eee23

Maishman, Thomas, Cutress, Ramsey, Hernandez, Aurea, Gerty, Susan, Copson, Ellen, Durcan, Lorraine and Eccles, Diana (2017) Local recurrence and breast oncological surgery in young women with breast cancer: The POSH observational cohort study. Annals of Surgery, 266 (1), 165-172. (doi:10.1097/SLA.0000000000001930). (PMID:27455160)

Record type: Article

Abstract

Objective: To assess clinical and surgical factors affecting local recurrence and survival in young breast cancer patients in the Prospective study of Outcomes in Sporadic versus Hereditary breast cancer (POSH). Background: Emerging data suggest young age is a predictor of increased local recurrence. Methods: POSH is a prospective cohort of 3024 women of 18 to 40 years with breast cancer. Cohort characteristics were grouped by mastectomy or BCS. Endpoints were local-recurrence interval (LRI), distant disease-free interval (DDFI), and overall survival (OS); described using cumulative-hazard and Kaplan-Meier plots and multivariable analyses by Flexible Parametric and Cox regression models. Results: Mastectomy was performed in 1464 patients and breast-conserving surgery (BCS) in 1395. Patients undergoing mastectomy had larger tumors and higher proportions of positive family history, estrogen receptor+, progesterone receptor+, and/or human epidermal growth factor receptor 2+ tumors. Local events accounted for 15% of recurrences. LRI by surgical type varied over time with LRI similar at 18 months (1.0% vs 1.0%, P = 0.348) but higher for BCS at 5 and 10 years (5.3% vs 2.6%, P < 0.001; and 11.7% vs 4.9%, P < 0.001, respectively). Similar results were found in the adjusted model. Conversely, distant-metastases and deaths were lower for BCS but not after adjusting for prognostic factors. After mastectomy chest-wall radiotherapy was associated with improved LRI (hazard ratio, HR = 0.46, P = 0.015). Positive surgical margins, and development of local recurrence predicted for reduced DDFI (HR = 0.50, P < 0.001; and HR = 0.29, P = 0.001, respectively). Conclusions: Surgical extent appears less important for DDFI than completeness of excision or, where appropriate, chest-wall radiotherapy. Despite higher local-recurrence rates for BCS, surgical type does not influence DDFI or OS after adjusting for known prognostic factors in young breast cancer patients.

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Accepted/In Press date: 27 June 2016
e-pub ahead of print date: 26 July 2016
Published date: July 2017
Organisations: Cancer Sciences, Clinical Trials Unit

Identifiers

Local EPrints ID: 398331
URI: http://eprints.soton.ac.uk/id/eprint/398331
ISSN: 0003-4932
PURE UUID: ef677014-9a4f-43d4-ad98-dc02aee2703b
ORCID for Diana Eccles: ORCID iD orcid.org/0000-0002-9935-3169

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Date deposited: 03 Aug 2016 08:44
Last modified: 15 Mar 2024 02:40

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Contributors

Author: Thomas Maishman
Author: Ramsey Cutress
Author: Aurea Hernandez
Author: Susan Gerty
Author: Ellen Copson
Author: Lorraine Durcan
Author: Diana Eccles ORCID iD

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