Reply to Letter to the Editor "Late local recurrences in a randomized trial comparing conservative treatment with total mastectomy in early breast cancer patients: the impact of receptor status on local relapse" by Altundag et al. (Ann Oncol 2004: 15; 990)

R. Arriagada*,1, M. G. Lê2 and A. Dunant3

1 Institut Gustave-Roussy, Villejuif; 2 Institut National de la Santé et de la Recherche Médicale, Villejuif; 3 Department of Biostatistics, Institut Gustave-Roussy, Villejuif, France

*E-mail: arriagada@igr.fr

We thank Altundag et al. for their interest in our study on late local recurrence in patients with resected early breast cancer [1]. They raise the question of the potential role of hormonal receptors.

In our trial there was no systematic determination of hormonal receptors as it was conducted during the 1970s. Nevertheless, since the treatment was allocated randomly, we do not expect any imbalance in receptor status between the two arms, conservative treatment or total mastectomy. Moreover, we do not agree with their statement that receptor status is one of the most important prognostic factors for breast cancer patients. In a series of 3064 lymph-node negative breast cancer patients [2], the prognostic information added by the knowledge of progesterone receptors had a minor impact on recurrence rate, and oestrogen receptors did not add any prognostic information in the multivariate analyses.

Concerning specifically local recurrence, the prognostic role of receptor status has not been clearly documented. In a previous study of the Institut Gustave-Roussy including 959 patients integrally treated at this centre by conservative surgery and radiotherapy [3], oestrogen or progesterone receptors were not predictive of local recurrence (P = 0.87 and 0.24, respectively). In multivariate analyses, the only significant factors were younger age, histological grade and histological size.

Therefore, it is highly improbable that taking into account a factor which is a priori equally distributed in the two arms and has no recognised independent prognostic role would have changed our conclusion.

Of course, oestrogen receptors are, despite their lack of effect on prognosis, a very good predictor of treatment effect, as it has been shown regarding the effect of adjuvant tamoxifen [4].

Finally, we insist that the increased risk of local recurrence in younger patients has not shown until now a deleterious effect on long-term survival. This is recently supported by a study conducted on a population-based Danish breast cancer database including a cohort of 9285 premenopausal patients [5].

REFERENCES

1 Arriagada R, Lê MG, Guinebretière JM et al. Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients. Ann Oncol 2003; 14: 1617–1622.[Abstract/Free Full Text]

2 Arriagada R, Rutqvist LE, Skoog L et al. Prognostic factors and natural history in lymph node-negative breast cancer patients. Breast Cancer Res Treat 1992; 21: 101–109.[ISI][Medline]

3. Arriagada R, Goset K, Koscielny S. Patterns of failure in small breast cancers treated by conservative surgery and radiotherapy at the Institut Gustave-Roussy. In Bland KI, Copeland EM III (eds): The Breast. Comprehensive Management of Benign and Malignant Diseases, 2nd edition. Philadelphia, PA: Saunders 1998; 1183–1190.

4. Early Breast Cancer Collaborative Trialists’ Group. Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 1998; 351: 1451–1467.[CrossRef][ISI][Medline]

5 Kroman N, Holtveg H, Wohlfahrt J et al. Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma. Cancer 2004; 100: 688–693.[CrossRef][ISI][Medline]





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