Synchronous Distant and Locoregional Recurrence in Stage II and III Breast Cancer
In a study of National Cancer Database data reported in the Journal of Clinical Oncology, Neuman et al found that synchronous distant recurrence was identified in 27% of women with stage II or III breast cancer experiencing locoregional recurrence.
Study Details
The study—an American College of Surgeons Commission on Cancer project—included a stage-stratified random sample of 11,046 patients with stage II to III breast cancer from 2006 to 2007.
Patients who experienced locoregional recurrence within 5 years of diagnosis and those with synchronous distant metastases, defined as occurring within 30 days of locoregional recurrence, were identified.
Distant Recurrence
Overall, locoregional recurrence occurred in 445 patients (4%). Synchronous distant metastases were identified in 120 (27%) of these patients. An additional 1,305 patients experienced distant recurrence without local recurrence during the study period.
On multivariate analysis, initial presenting stage (III vs II, P = .03), locoregional recurrence type (chest wall or lymph nodes vs ipsilateral breast, P = .040), and insurance status (uninsured, Medicaid, Medicare, or other government vs private insurance, P = .03) were associated with an increased risk of synchronous distant metastases.
Overall, 54% of women with locoregional recurrence underwent systemic staging imaging within 30 days of recurrence. The rate of synchronous metastases was highest among women with lymph node (35%), postmastectomy chest wall (30%), and in-breast (15%) recurrence.
The investigators concluded, “These findings support current recommendations for systemic imaging in the setting of locoregional recurrence, particularly for patients with lymph node or chest wall recurrences. Because most patients with isolated locoregional recurrence will be recommended locoregional treatment, early identification of distant metastases through routine systemic imaging may spare them treatments unlikely to extend their survival.”
The study was supported by the Patient-Centered Outcomes Research Institute, National Cancer Institute, and National Institutes of Health.
Heather B. Neuman, MD, of the University of Wisconsin School of Medicine and Public Health, is the corresponding author for the Journal of Clinical Oncology article.
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