Loco regional failure pattern after lumpectomy and breast irradiation in 4185 patients with T1 and T2 breast cancer. Implications for nodal irradiation

Figures & data

Table I.  Characteristics of the 4185 patients, University of Florence, 1980–2001.

Characteristic	N° of pz
Age
<40 ys	359 (8,1%)
≥40–49 ys	1006 (24%)
≥50–59 ys	1310 (31,3%)
≥60–69 ys	1101 (26,3%)
≥70–79 ys	400 (9,6%)
≥80 ys	29 (0,7%)
pT
T1	2779 (66,4%)
T2	1406 (33,6%)
Lymph node
Unknown	100 (2,4%)
Negative	2870 (68,6%)
N + 1–3	823 (19,7%)
N + > 3	392 (9,3%)
Histology
Ductal NOS	1917 (45,8%)
NOS + Lobular	473 (11,4%)
Lobular carcinoma	613 (14,7%)
Others	1135 (26,9%)
Unknown	47 (1,2%)
Hormonal Receptor Status
Negative	588 (14%)
Positive	2297 (55%)
Unknown	1300 (31%)

Figure 1.  Cause specific survival for the entire group was 96.9% (±0.2%SE), 93.1% (±0.4%SE) and 83.7 (±0.6%SE) at 3, 5 and 10 respectively.

Table II.  Site of recurrence in the 224 patients out of the 4185 developing loco-regional recurrence.

Site of recurrence	N° of patients	%
Breast
Non operated quadrant	46	16.9%
Index quadrant	110	36.4%
Unknown quadrant	8	3%
Multicentric relapse	2	0.7%
Supraclavicular area	33	14.8%
Axilla	14	6.1%
Internal mammary nodal chain	11	5%

Figure 2.  The 3, 5 and 10 years actuarial rate for any locoregional recurrence was 2.3% (±0.2%SE), 4.3% (±0.4%SE) and 7.4% (±0.5%SE) respectively.

Table III.  Correlation between age and LRR.

Age	N° of patients	BR	NR	SFR
<40 ys	339	44 (12%)	5 (1.4%)	2 (0.5%)
40–49	1006	65 (6.4%)	18 (1.7%)	11 (1%)
50–59	1310	36 (2.7%)	20 (1.5%)	10 (0.7%)
60–69	1101	19 (1.7%)	12 (1%)	8 (0.7%)
70–79	400	2 (0.5%)	3 (0.7%)	2 (0.05%)
>80	29	0	0	0

Figure 3.  Local disease free survival by axillary status. 1 = negative axillary nodes; 2 = 1-3 positive axillary nodes; 3 ≥ 3 axillary nodes.

Table IV.  Crude and actuarial results for each prognostic factor only in the subgroup of patients with 1 to 3 positive axillary nodes.

Factors	% LRR crude	% LRR 8 years	% NR crude	% NR 8 years	p-value
pT1	3.5%	4.7%(±1.1%)	1.2%	1.8%(±0.7%)	0.22 LRR
pT2	5.6%	6.7%(±1.6%)	2.4%	2.9%(±1.%)	0.28 NR
G1	1.3%	4%%(±3.9%)	0%	–	0.007 LRR
G2	0.6%	0%	0%	–	–NR
G3	5.7%	8.2%(±2.6%)	3.2%	4.7%(±0.2%)
*ALI
Present	3.8%	4.5%(±1.9%)	1,7%	2.7%(±1.3%)	0.9 LRR
No	4%	6.3%(±1.8%)	1.9%	2.4%(±1.6%)	0.63 NR
AGE (years)
< 40	9%	12%(±4.2%)	6%	3.6%(±2%)
40–49	6.6%	7.4%(±2.2%)	1.7%	2.4%(±1.7%)	0.04 LRR
50–59	3%	2.8%(±1.8%)	1.5%	2.2%(±1.5%)
60–69	2.2%	2.4%(±1.1%)	1.1%	0.9%(±0.8%)	0.5 NR
70–79	2.8%	3.6%(±2%)	2.8%	3.6%(±2%)
> 80	0%	–	0%	–

*ALI= angiolymphatic invasion.

Table V.  Multivariate analysis for LRR.

Parameter	p value	Hazard ratio	95% C.I.
G1		1
G2	0.54	1.3	0.5–3.2
G3	0.01	2.6	1.1–5.9
AGE
50–59 ys		1
< 40 ys	<0.001	2.2	1.6–3.1
40–49 ys	0.003	1.3	1–1.7
60–69 ys	0.01	0.6	0.4–0.9
70–79 ys	0.01	0.4	0.2–0.8
> 80 ys	0.45	0.4	0.4–7
Lymph node
Negative		1
N + 1–3	0.7	0.9	0.7–1.2
N + > 3	0.004	1.6	1.1–2.3
ALI*
No		1
Present	0.002	1.5	1.1–2.2
pT1		1
pT2	<0.001	1.4	1.1–1.8

*ALI = angiolymphatic invasion.

Table VI.  Multivariate analysis for NR.

Parameter	p-value	Hazard ratio	95% C.I.
Lymph node Negative
N + 1–3	0.11	1.7	0.8–3.2
N + > 3	<0.001	4.8	2.5–9.1
ALI*
No		1
Present	0.002	3.18	1.4–6.8
pT1		1
pT2	0.002	1.8	1.07–3.1

*ALI = angiolymphatic invasion.