Objective: To analyze the clinical features and prognosis of the ipsilateral
breast tumor recurrence (IBTR) after
breast conserving surgery. Methods: From 1999 to 2013, 63 women with IBTR after
breast conserving surgery were retrospectively reviewed. All patients had adequate information on
tumor location both at first presentation and at recurrence, with or without regional recurrence or distant
metastasis. The histologic changes between true local recurrence and elsewhere recurrence groups were compared. The local recurrence, the overall survival after IBTR (IBTR-OS), the disease-free survival after IBTR (IBTR-DFS) were also compared. Results: All patients had undergone
lumpectomy, including 38 cases with additional axillary
lymph node dissection and 13 cases with sentinel lymph node biopsy. There were 11.3% (7/63) cases received
neoadjuvant systemic therapy, 68.3% (
43/63) had
adjuvant radiotherapy, 60.3% (38/63) underwent
adjuvant chemotherapy and 47.6% (30/63) received hormonal
therapy. Forty-five cases (71.4%) had recurrence in the same quadrant, and 18 cases (28.6%) had elsewhere recurrence. Compared with histology at presentation, 10.3% of the patients (6/58) had different ones at recurrence and 28.9% of patients (13/45) had different molecular subtypes. The conversion rate of
estrogen receptor status (33.3% vs 9.5%, P=0.012) and
progesterone receptor status (56.3% vs 19.0%, P=0.005) in patients with elsewhere recurrence was significantly higher than that in patients with same quadrant recurrence. Fifty-nine cases had undergone surgery after IBTR, with 48 cases of secondary
breast-conserving surgery and 11 cases of salvage
mastectomy. The median time to IBTR of same quadrant recurrence and elsewhere recurrence groups were 26 months and 62 months (P=0.012), respectively. There were 84.4% and 44.4% cases who had local recurrence within 5 years after
breast conserving surgery, respectively. Of all cases, the overall 5-year IBTR-OS and 5-year IBTR-DFS rates were 79.4% and 60.4%, respectively. There were no significant differences in 5-year IBTR-OS (77.4% vs. 83.6%, P=0.303) or 5-year IBTR-DFS (60.0% vs. 62.8%, P=0.780) between same quadrant recurrence and elsewhere recurrence groups. Univariate analysis showed that pN0-1 (P<0.001),
luminal subtype (P=0.026), adjuvant endocrine
therapy (P=0.007) at first presentation, recurrent
tumor < 3 cm (P=0.036) and having surgery after IBTR(P=0.002) were favorable factors of IBTR-OS. pN0-1 (P<0.001) at first presentation, recurrent
tumor stage Ⅰ-Ⅱ (P<0.001) and having surgery after IBTR(P=0.001) were favorable factors of IBTR-DFS. There was no significant difference between second
breast-conserving surgery and salvage
mastectomy in IBTR-OS and IBTR-DFS (P>0.05). Conclusions: The IBTR after
breast conserving surgery mainly occurred at the original quadrant. Second
breast-conserving surgery did not affect patient's prognosis. There were significant differences in biological features between the same quadrant recurrence and elsewhere recurrence, requiring different therapeutic strategies in the future.