High local recurrence risk after breast-conserving therapy in node-negative premenopausal breast cancer patients is greatly reduced by one course of perioperative chemotherapy: A European Organization for Research and Treatment of Cancer Breast Cancer Cooperative Group study

Purpose: Patients with invasive breast cancer may develop a local recurrenc e (LR) after breast-conserving therapy (BCT). Younger age has been found to be an independent risk factor for LR. Within a group of premenopausal node -negative breast cancer patients, we studied risk factors for BR and the ef fect of perioperative chemotherapy (PeCT) on LR. Patients and Methods: The European Organization for Research and Treatment of Cancer (EORTC) conducted a randomized trial (EORTC 10854) to compare sur gery followed by one course of PeCT (fluorouracil, doxorubicin, and cycloph osphamide) with surgery alone. From patients treated on this trial, we sele cted premenopausal patients with node-negative breast cancer who were treat ed with BCT to examine whether histologic characteristics and the expressio n of various proteins (estrogen receptor, progesterone receptor, p53, Ki-67 , bcl-2, CD31, c-erbB-2/neu) are risk factors for subsequent LR. Also, the effect of one course of PeCT on the LR risk (LRR) was studied. Results: Using multivariate analysis, age younger than 43 years (relative r isk [RR], 2.75; 95% confidence interval [CI], 1.46 to 5.18; P = .002), mult ifocal growth (RR, 3.34; 95% CI, 1.27 to 8.77; P = .014), and elevated leve ls of p53 (WR, 2.14; 95% CI, 1.13 to 4.05; P = .02) were associated with hi gher LRR. Also, PeCT was found to reduce LRR by more than 50% (RR, 0.47; 95 % CI, 0.25 to 0.86; P = .02). Patients younger than 43 years who received P eCT achieved similar LR rates as those of patients younger than 43 years wh o were treated with BCT alone. Conclusion: In premenopausal node-negative patients, age younger than 43 ye ars is the most important risk factor for LR after BCT; this risk is greatl y reduced by one course of PeCT. The main reason for administering systemic adjuvant treatment is to improve overall survival. The important reduction of LR after BCT is an additional reason for considering systemic treatment in young node-negative patients with breast cancer. J Clin Oncol 18:1075-1 083. (C) 2000 by American Society of Clinical Oncology.