Matched pair analysis of survival after chest-wall recurrence compared to mammary recurrence: a long-term follow-up

Background: Local recurrence remains a major concern after primary treatmen t of breast cancer and has a major impact on subsequent survival. While mos t studies report a poorer survival rate in patients with a local recurrence after mastectomy than after breast conservation, it remains controversial whether different risk profiles at the time of primary diagnosis may accoun t for this difference. Method: Matched pair analysis of 134 patients with n ewly diagnosed locoregional recurrence of breast cancer without evidence of systemic disease. Matching criteria included the primary surgical treatmen t, tumor size, nodal status, and age. The significance of various prognosti c parameters at the time of primary diagnosis and at the time of recurrence were evaluated, by univariate and multivariate analyses, with respect to s urvival after recurrence. The median followup was 8.4 years. Results: Risk factors at the time of presentation, such as tumor size and lymph node stat us, were comparable between both groups. Local recurrence occurred on an av erage 9 months earlier in patients after mastectomy (P = 0.08). Univariate analysis showed that lymph node status (P = 0.0001) and disease-free interv al from primary treatment to local recurrence (P = 0.0002) were the most si gnificant single prognostic factors for subsequent survival after local rec urrence. The primary surgical treatment modality was shown to be of margina l statistical influence (only P = 0.05). Conclusion: Local recurrence after mastectomy seems to be associated with worse survival than after breast-co nserving therapy. Early onset of chest-wall recurrence, moreover, represent s the highest independent risk for cancer-associated death.