Predictors of inflammatory local recurrence after breast-conserving therapy for breast cancer

Abstract

Inflammatory local recurrence(ILR) after breast-conserving surgery for noninflammatorybreast cancer (BC) is associated with dismal prognosis. Riskfactors for ILR are not well defined. Methods: Between 2001and 2010, twelve patients at our hospital developed ILR afterbreast-conserving surgery, adjuvant chemotherapy, and radiotherapyfor BC. We compared their clinico-pathological characteristicsto those of 24 patients with noninflammatory localrecurrence (non-ILR), 24 patients with distant metastases,and 48 disease-free controls, matched for age and observationperiod. Results: The median time to ILR was 10 months.In univariate analysis, extent of lymph node involvement(p < 0.05), multifocality (p < 0.05), c-erbB2 overexpression(p < 0.05), and lymphovascular invasion (LVI) (p < 0.001)affected the risk of ILR. Conditional logistic regression analysisshowed a significant association between ILR and combinedLVI and high histopathological grade. The odds ratio(OR) for ILR versus non-ILR was 6.14 (95% confidence interval[CI] 1.48-25.38) and for ILR versus distant metastases itwas 3.05 (95% CI 0.09-97.83) when both LVI and high histopathologicalgrade were present. Patients with family historyof BC were more likely to present with ILR than non-ILR(OR 5.47; 95% CI 1.55-19.31) or distant relapse (OR 5.62;95% CI 0.26-119.95). Conclusions: Pre- and postmenopausalwomen with high-grade BC and LVI are at increasedrisk to develop ILR, especially in the presence of family historyof BC. Identification of risk factors for this lethal form ofrecurrent BC may lead to more effective preventive treatmentstrategies in properly selected patients.