Loco-Regional Recurrence after Conservative Breast Surgery Followed by Radiotherapy versus Mastectomy Alone for T1-2 and N0-1 under the Umbrella of Modern Adjuvant Chemotherapy

Background: Breast cancer is one of the most commonly observed malignancies in women worldwide. The aim of this retrospective study is to identify and assess the risk factors that might predict loco-regional recurrence after breast conservative surgery (BCS) and modified radical mastectomy (MRM) after the introduction of modern adjuvant chemotherapy.Results: In this study 191 (65.2%) patients underwent MRM and 102 (34.8%) underwent BCS. Except for age and pathological T stage, the distribution of the other clinico-pathological parameters between the two procedures has not significant differences. Tumor size has a local recurrence risk by 4 folds after BCS in T2 stage compared to T1 stage (P=0.02). Lympho-vascular invasion (LVI) shows increase of risk of recurrence to 1.4 after MRM (P-0.02). It shows dramatic increase after BCS to 41 folds (P=0.000). The risk of local recurrence is equal to two folds for positive LVI after BCS compared with MRM (P=0.005). DCIS has increased local recurrence risk by 12 folds after BCS (P=0.001) which has been eliminated if MRM was performed.In bivariate analysis, negative DCIS has tendency to reverse the risk of local recurrence. After MRM, the risk of local recurrence in ER negative cases and PR negative cases is increased by about 4 folds and 2.7 folds respectively (p=0.005, 0.042 respectively). Conclusion: For BCS; T stage, Lympho-vascular invasion and DCIS are risk factors for LRR. For MRM; LVI, positive ER and PR are risk factors for LRR. Radiotherapy may have a role in decreasing the recurrence rate after BCS and may be recommended after MRM for T1-2, N0-1 stages.