TY - JOUR
T1 - Risk of synchronous distant recurrence at time of locoregional recurrence in patients with stage II and III breast cancer (AFT-01)
AU - Alliance/ American College of Surgeons Clinical Research Program Cancer Care Delivery Research Breast Cancer Surveillance Working Group
AU - Neuman, Heather B.
AU - Schumacher, Jessica R.
AU - Francescatti, Amanda B.
AU - Adesoye, Taiwo
AU - Edge, Stephen B.
AU - Vanness, David J.
AU - Yu, Menggang
AU - McKellar, Daniel
AU - Winchester, David P.
AU - Greenberg, Caprice C.
N1 - Funding Information:
Supported by a Patient-Centered Outcomes Research Institute award (CE-1304-6543) and the National Cancer Institute (Grant Nos. U10CA180821 to the Alliance for Clinical Trials in Oncology and U10CA180882 to the Alliance Statistics and Data Center). Additional funding from the Building Interdisciplinary Research Careers in Women's Health Scholar Program (National Institutes of Health Grant No. K12HD055894). We thank the cancer registrars and cancer physician liaisons at all participating CoC-accredited facilities and NCD staff for their contributions and dedication to this project. Other members of the Alliance/American College of Surgeons Clinical Research Program Cancer Care Delivery Research Patient-Centered Outcomes Research Institute Breast Cancer Surveillance Working Group are Karla Ballman; Ronald Chen; Patrick Gavin, RPh; Bettye Green; Jennifer Le-Rademacher; Ann Partridge; Jane Perlmutter; Rinaa Punglia; Kathryn Ruddy; Deborah Schrag; Ying Zhang; George Chang; and Benjamin Kozower.
Publisher Copyright:
© 2018 by American Society of Clinical Oncology.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Purpose National Comprehensive Cancer Network guidelines recommend systemic staging imaging at the time of locoregional breast cancer recurrence. Limited data support this recommendation. We determined the rate of synchronous distant recurrence at the time of locoregional recurrence in high-risk patients and identified clinical factors associated with an increased risk of synchronous metastases. Methods A stage-stratified random sample of 11,046 patients with stage II to III breast cancer in 2006 to 2007 was selected from the National Cancer Database for participation in a Commission on Cancer special study. From medical record abstraction of imaging and recurrence data, we identified patients who experienced locoregional recurrence within 5 years of diagnosis. Synchronous distant metastases (within 30 days of locoregional recurrence) were determined. We used multivariable logistic regression to identify factors associated with synchronous metastases. Results Four percent experienced locoregional recurrence (n = 445). Synchronous distant metastases were identified in 27% (n = 120). Initial presenting stage (P = .03), locoregional recurrence type (P = .01), and insurance status (P = .03) were associated with synchronous distant metastases. The proportion of synchronous metastases was highest for women with lymph node (35%), postmastectomy chest wall (30%), and in-breast (15%) recurrence; 54% received systemic staging imaging within 30 days of a locoregional recurrence. Conclusion 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.
AB - Purpose National Comprehensive Cancer Network guidelines recommend systemic staging imaging at the time of locoregional breast cancer recurrence. Limited data support this recommendation. We determined the rate of synchronous distant recurrence at the time of locoregional recurrence in high-risk patients and identified clinical factors associated with an increased risk of synchronous metastases. Methods A stage-stratified random sample of 11,046 patients with stage II to III breast cancer in 2006 to 2007 was selected from the National Cancer Database for participation in a Commission on Cancer special study. From medical record abstraction of imaging and recurrence data, we identified patients who experienced locoregional recurrence within 5 years of diagnosis. Synchronous distant metastases (within 30 days of locoregional recurrence) were determined. We used multivariable logistic regression to identify factors associated with synchronous metastases. Results Four percent experienced locoregional recurrence (n = 445). Synchronous distant metastases were identified in 27% (n = 120). Initial presenting stage (P = .03), locoregional recurrence type (P = .01), and insurance status (P = .03) were associated with synchronous distant metastases. The proportion of synchronous metastases was highest for women with lymph node (35%), postmastectomy chest wall (30%), and in-breast (15%) recurrence; 54% received systemic staging imaging within 30 days of a locoregional recurrence. Conclusion 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.
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U2 - 10.1200/JCO.2017.75.5389
DO - 10.1200/JCO.2017.75.5389
M3 - Article
C2 - 29384721
AN - SCOPUS:85045000560
SN - 0732-183X
VL - 36
SP - 975
EP - 980
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 10
ER -
