Different Annual Recurrence Pattern Between Lumpectomy and Mastectomy: Implication for Breast Cancer Surveillance After Breast-Conserving Surgery
Menée sur une cohorte de 6 135 patientes chinoises, cette étude rétrospective évalue le risque de récidive selon le type d'opération (exérèse locale du sein ou mastectomie) et en tire des leçons pour le suivi post-opératoire des patientes
Abstract Purpose. To investigate the recurrence pattern and annual recurrence risk after breast-conserving surgery and compare them with those after mastectomy.Methods. This retrospective analysis included 6,135 consecutive unilateral breast cancer patients undergoing surgery in 1998–2008, with 847 lumpectomy patients and 5,288 mastectomy patients. Recurrence patterns were scrutinized and annual recurrence rates were calculated. Furthermore, a literature-based review including seven relevant studies was subsequently performed to confirm our single-institution data-based observations.Results. After lumpectomy, 50.9% of recurrences occurred within 3 years and 30.2% of recurrences were detected at 3–5 years; after mastectomy, 64.9% of recurrences occurred within 3 years and 20.4% occurred at 3–5 years. The major locoregional recurrence pattern after lumpectomy was ipsilateral breast tumor recurrence, which mainly (81.3%) occurred ≤5 years postsurgery but with a low incidence of 37.5% ≤3 years postsurgery. Annual recurrence curves indicated that the relapse peak after mastectomy emerged in the first 2 years; however, recurrence after lumpectomy increased annually with the highest peak near 5 years. By reviewing relevant studies, we confirmed our finding of different annual recurrence patterns for lumpectomy and mastectomy patients. The hazard ratio of dying for those recurring ≤5 years postlumpectomy relative to patients relapsing >5 years postlumpectomy was 4.62 (95% confidence interval, 1.05–20.28; p = .042).Conclusions. Different recurrence patterns between mastectomy and lumpectomy patients imply that scheduling of surveillance visits should be more frequent during the 4–6 years after lumpectomy. Further prospective trials addressing the necessity of frequent and longer surveillance after lumpectomy are warranted.