The effect of hormone receptor status on recurrence and intraoperative re-excision rates in breast cancer

ABSTRACT Background: To determine whether hormone receptor (HR) status predicts locoregional recurrence (LR/LRR) and intraoperative re-excision in invasive breast cancer. Methods: We retrospectively analyzed 137 surgically treated patients at a single tertiary center (2007-2025). Clinicopathologic variables (age, radiologic tumor size, grade, LVI/PNI, Ki-67, subtype), margin status/width, and surgical type were recorded. Time-to-event outcomes were evaluated with Kaplan-Meier; determinants were modeled using multivariable logistic/Cox regression (p=0.05). Results: Median age was 53.5 years; mean tumor size 23.0±14.2 mm (median 20 mm). Subtypes: Luminal B 50%, Luminal A 35%, HER2-enriched 4.4%, TNBC 10.6%. Mean Ki-67 was 27.3% (median 20%); LVI 50.4%, PNI 33%. Surgery: BCS 58.4%, MRM 23.4%, simple mastectomy 18.2%. Recurrence occurred in 33% and mortality in 26%. Increasing Ki-67 independently predicted recurrence (OR 1.05 per 1% increase, 95%CI 1.00–1.11; p=0.047). Larger radiologic tumor size independently predicted mortality (OR 1.12 per mm, 95%CI 1.03–1.29; p=0.041). HR subgroups and margin width were not independent predictors. BCS and mastectomy didn't show any significant differences for recurrence/re-excision. Re-excision rate was 40% and increased with age (OR 1.05 per year; p=0.050); MRM was associated with a lower re-excision risk versus simple mastectomy (OR 0.06; p=0.041). Survival curves suggested more favorable courses with 2-5 mm margins without statistical significance (p=0.112); LVI was adverse in univariable analyses (p=0.005) but not retained multivariably. Conclusions: HR status alone does not predict recurrence or re-excision. Proliferation index (Ki-67) for recurrence and tumor size for survival carry independent prognostic value. Once negative margins are achieved, wider excisions add limited benefit. Follow-up and adjuvant strategies should be individualized based on biological aggressiveness - particularly in PR-negative and/or high-Ki-67 luminal disease. The single-center, retrospective design and sample size may limit generalizability; multicenter validation with robust time-dependent modeling is warranted. Keywords: Breast neoplasms; hormone receptors; Ki-67; locoregional recurrence; surgical margins; re-excision.