| Objectives: This study was aimed to clarify the clinical characteristics of local regional recurrence(LRR)after breast surgery,investigate the correlation of LRR location and treatment with prognosis,and evaluate the clinical values of the coincidence rate of molecular markers between primary tumor and LRR lesion.Methods: A retrospective analysis was performed in 7823 breast cancer patients who underwent surgery in our center from January 2009 to August 2018 with complete diagnostic and therapeutic records,108 of whom had LRR during the follow-up period.All patients were female,with an average age of 49 years(range: 26-83 years),including 35 cases(32.4%)of ipsilateral breast cancer recurrence(IBTR),40 cases(37.0%)of chest wall recurrence(CR)and 33 cases(30.6%)of regional lymph node recurrence(LNR)after breast surgery.?2 test,Fisher's exact test and multiple logistic regression analysis were used to compare the difference of clinicopathological characteristics and adjuvant treatment in IBTR,CR and LNR groups.Kaplan-Meier curves were used to analyze prognosis.The expression of estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER2)and Ki-67 in primary tumors and LRR lesions were detected,and the consistency and its clinical value were assessed by Kappa test.Results: Univariated and multivariate analyses found that initial ALN status(P = 0.042)and postoperative DFI(P = 0.013)were associated with LRR sites.Compared with IBTR patients,the CR group(OR = 1.89,95% CI 0.34-10.41,P = 0.463)and LNR group(OR = 7.70,95% CI 1.30-45.61,P = 0.025)had a higher initial ALN positivity rate.CR group(OR = 0.17,95% CI 0.05-0.57,P = 0.004)and LNR group(OR = 0.43,95% CI 0.13-1.49,P = 0.184)had a shorter DFI after surgery,compared with IBTR patients.The positive rates of ER,PR,HER2 and Ki-67 in 56 LRR patients were 48.2%,25.0%,35.2% and 81.5%,respectively.The coincidence rates with the primary lesions were 76.8%,76.8%,89.1% and 77.8%,with kappa value 0.54,0.47,0.73,and 0.40,respectively.There were 20 patients with ER,PR or HER2 status changes: 9 patients with hormone receptor status changing from positive to negative,of which 4 patients did not receive follow-up endocrine therapy;4 patients with HER2 status changing from negative to positive,and 1 patient receiving follow-up targeted therapy.Patients in the IBTR,CR,and LNR groups had 0,8 and 5 deaths,respectively,and the 5-year overall survival rates were 100.0%,51.8%,and 73.5%,respectively(P = 0.021).The number of deaths in patients with LRR who underwent surgery and non-surgery after recurrence was 0 and 13 respectively,with a 5-year overall survival rate of 100.0% and 60.1%,respectively(P = 0.018).Conclusions: The location of LRR after breast surgery was correlated to initial lymph node invasion and disease-free interval,and the location of LRR or surgery treatment was related to the prognosis of patients.HER2 status was highly consistent between primary tumor and LRR lesion,while ER,PR and Ki-67 were moderately consistent.The changes of molecular biomarkers in LRR would guide the choice of follow-up treatment. |
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