A CASE-CONTROL STUDY ON RISK-FACTORS INVOLVED IN INFLAMMATORY BREAST RECURRENCE AFTER BREAST-CONSERVING SURGERY

Recurrence that poses the biggest problem after breast-conserving surg ery is local recurrence, Particularly, in the case of inflammatory bre ast recurrence which is rare but has a specific pathologic nature, it is important to elucidate the pathology and risk factors and to consid er appropriate countermeasures. In the present study, we classified 13 3 cases of recurrence following breast-conserving surgery, collected f rom 18 key hospitals/institutes in Japan. Recurrence types were divide d into three groups, namely, inflammatory breast recurrence, noninflam matory breast recurrence and distant metastasis only, and the risk fac tors involved in recurrence were investigated by the case control stud y allotting 2 controls to each case, The study population consisted of 9 cases of the inflammatory type, 64 cases of the noninflammatory typ e and 60 cases of distant metastasis, The significant risk factor for inflammatory breast recurrence was positive lymph node metastasis, whi ch was significantly more frequent in lymphatic invasion-positive case s unlike in the distant metastasis group, The positive surgical margin and nonradiation therapy which have been shown to be significant risk factors for noninflammatory breast recurrence were entirely unrelated with inflammatory breast recurrence. In addition, the inflammatory-ty pe recurrence time was as short as about 12 months irrespective of whe ther radiation therapy was performed or not. The inflammatory type was accompanied with local wide extension (cancerous embolus of the derma l lymphatic vessels), and distant metastasis (lymphangitis carcinomato sa) at the time of recurrence, and further surgery was impossible in m ost cases, with a significantly poorer prognosis than the other recurr ence types, These findings suggest that this recurrence corresponds to the so-called 'occult' case of primary inflammatory breast carcinoma. We think it important to predict this recurrence by close pathologica l examination, particularly in patients with lymph node metastasis, an d to consider appropriate measures.