The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy

Purpose: The objective of this study was to evaluate the influence of patho logic factors other than tumor size and number of involved axillary nodes o n the risk of locoregional recurrence (LRR) following mastectomy, Patients and Methods: We reviewed the medical records of 1031 patients treated with mastectomy and doxorubicin-based chemotherapy without radiation on 5 prospe ctive clinical trials. Median follow-up was 116 months (range, 6-262 months ), Results: Patients with gross multicentric disease were at increased risk of LRR (37% at 10 years). However, patients with multifocal disease and th ose with microscopic multicentric disease did not experience higher rates o f LRR than those with single lesions (1742 at 10 years), Patients with lymp h-vascular space invasion (LVSI) or involvement of the skin or nipple also experienced high rates of LRR (25%, 32%, and 50%, respectively). The presen ce of close (<5 mm) or positive margins was associated with an increased ri sk of LRR (45%), The increased risk of LRR observed for patients with pecto ral fascial invasion (33%) was not reduced when negative deep margins were obtained. On multivariate analysis, the presence of 4 or more involved axil lary nodes, tumor size of greater than 5 cm, close or positive surgical mar gins, and gross multicentric disease were found to be independent predictor s of LRR (all, p < 0.01). In a separate analysis including only patients wi th 1-3 involved axillary nodes, microscopic invasion of the skin or nipple, pectoral fascial invasion, and the presence of close or positive margins w ere significant predictors of LRR. Conclusion: In addition to the extent of primary and nodal disease, other factors that predict for high rates of LR R include the presence of LVSI, involvement of the skin, nipple or pectoral fascia, close or positive margins, or gross multicentric disease, These fa ctors predict for high LRR rates regardless of the number of involved axill ary nodes. (C) 2001 Elsevier Science Inc.