Effective local control is associated with improved overall survival, particularly for women with early stage cancers. No other local therapy is typically offered to women with T1-2 N0 breast cancer after mastectomy, although in select women the 5 year local recurrence rate can be as high as 20%. Therefore, accurately predicting which women are at highest risk for recurrence after mastectomy will identify those who may benefit from more aggressive adjuvant treatment.
A systematic search was conducted up to May 2014 based on Pubmed/Medline, Cochrane Library, and Embase database. Twelve studies met inclusion criteria of evaluating locoregional recurrence for node-negative women post mastectomy with no adjuvant radiation.
Risk factors identified by these studies include age, menopausal status, receptor status, lymphvascular invasion (LVI), margin status, use of systemic therapy, size, grade, and genomic classifer score. While associations varied amongst studies, the risk factors most consistently identified were age < 40, LVI, positive/close margin, and larger size. In women with multiple high risk factors, risk of local recurrence was as high as 20% at 10 years.
Additional multicenter studies are needed to investigate risk factors for LRR after mastectomy without radiotherapy in T1-2N0 breast cancer. Consideration of additional adjuvant local therapy may be warranted in a subset of women at high risk of local recurrence.