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01-12-2013 | Clinical trial

Comparing the outcome between multicentric and multifocal breast cancer: what is the impact on survival, and is there a role for guideline-adherent adjuvant therapy? A retrospective multicenter cohort study of 8,935 patients

Authors: R. Wolters, A. Wöckel, W. Janni, I. Novopashenny, F. Ebner, R. Kreienberg, M. Wischnewsky, L. Schwentner, For the BRENDA Study Group

Published in: Breast Cancer Research and Treatment | Issue 3/2013

Abstract

Multifocal (MF) and multicentric (MC) breast cancers have been comprehensively studied, and their outcomes have been compared with unifocal (UF) tumors. We attempted to answer the following questions: (1) Does MF/MC presentation influence the outcome concerning BC mortality?, (2) Is there an impact of guideline-adherent adjuvant treatment in these BC subtypes?, and (3)What is the influence of guideline violations concerning surgery (breast-conserving surgery versus mastectomy) on the survival of MF/MC BC patients? Between 1992 and 2008, we retrospectively analyzed 8,935 breast cancer patients from 17 participating breast cancer centers within the BRENDA study group. Of 8,935 breast cancer patients, 7,073 (79.2 %) had UF tumors, 1,398 (15.6 %) had MF tumors, and 464 (5.2 %) had MC tumors. RFS was significantly worse for MF/MC BC patients compared to patients with UF tumors (MF p = 0.007; MC p = 0.019). OAS was significantly worse for MC patients but not for MF patients compared to patients with UF tumors (MF p = 0.321; MC p = 0.001). Guideline adherence was significantly lower in patients with MF (n = 580; 41.5 %) and MC (n = 204; 44.0 %) compared to patients with UF (n = 3,871; 54.7 %) (p < 0.001) tumors. Guideline violations were associated with a highly significant deterioration in survival throughout all subgroups except for MC, with respect to RFS and OAS. For 100 %-guideline-adherent patients, we could not find any significant differences in RFS and OAS after adjusting by nodal status, grade, and tumor size. Furthermore, we could not find any significant differences in RFS and OAS in patients with MF or MC stratified by breast-conserving therapy (BCT lumpectomy and radiation therapy) and mastectomy. There is a strong association between improved RFS and OAS in patients with MF/MZ BC. There are no significant differences in RFS and OAS for patients with breast-conserving therapy or mastectomy.

Rakha EA, Ellis IO (2009) Triple-negative/basal-like breast cancer: review. Pathology 41(1):40–47PubMedCrossRef

Ihemelandu CU, Lefall LD Jr, Dewitty RL, Naab TJ, Mezghebe HM, Makambi KH, Adams-Campbell L, Frederick WA (2007) Molecular breast cancer subtypes in premenopausal and postmenopausal African-American women: age-specific prevalence and survival. J Surg Res 143(1):109–118PubMedCrossRef

Wiechmann L, Sampson M, Stempel M, Jacks LM, Patil SM, King T, Morrow M (2009) Presenting features of breast cancer differ by molecular subtype. Ann Surg Oncol 16(10):2705–2710PubMedCrossRef

Ibrahim E, Al-Gahmi AM, Zeenelin AA, Zekri JM, Elkhodary TR, Gaballa HE, Fawzy EE, El Sayed ME, Alzahrani MS (2009) Basal vs. luminal A breast cancer subtypes: a matched case-control study using estrogen receptor, progesterone receptor, and Her-2 as surrogate markers. Med Oncol 26(3):372–378PubMedCrossRef

Lynch SP, Lei X, Chavez-MacGregor M, Hsu L, Meric-Bernstam F, Buchholz TA, Zhang A, Hortobagyi GN, Valero V, Gonzalez-Angulo AM (2012) Multifocality and multicentricity in breast cancer and survival outcomes. Ann Oncol 23(12):3063–3069PubMedCrossRef

Yerushalmi R, Kennecke H, Woods R, Olivotto IA, Speers C, Gelmon KA (2009) Does multicentric/multifocal breast cancer differ from unifocal breast cancer? An analysis of survival and contralateral breast cancer incidence. Breast Cancer Res Treat 117(2):365–370PubMedCrossRef

Egan RL (1982) Multicentric breast carcinomas: clinical-radiographic-pathologic whole organ studies and 10-year survival. Cancer 49:1123–1130PubMedCrossRef

Wilkinson LS, Given-Wilson R, Hall T, Potts H, Sharma AK, Smith E (2005) Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound. Clin Radiol 60(5):573–578PubMedCrossRef

Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G, Lattanzio V, Del Maschio A (2004) Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol 183:1149–1157PubMedCrossRef

10.

Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, Irwig L (2008) Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 26(19):3248–3258PubMedCrossRef

11.

Cabioglu N, Ozmen V, Kaya H, Tuzlali S, Igci A, Muslumanoglu M, Kecer M, Dagoglu T (2009) Increased lymph node positivity in multifocal and multicentric breast cancer. J Am Coll Surg 208(1):67–74PubMedCrossRef

12.

Andea AA, Wallis T, Newman LA, Bouwman D, Dey J, Visscher DW (2002) Pathologic analysis o tumor size and lymph node status in multifocal/multicentric breast carcinoma. Cancer 94(5):1383–1390PubMedCrossRef

13.

Pedersen L, Gunnarsdottir KA, Rasmussen BB, Moeller S, Lanng C (2004) The prognostic influence of multifocality in breast cancer patients. Breast 13(3):188–193PubMedCrossRef

14.

Weissenbacher TM, Zschage M, Janni W, Jeschke U, Dimpfl T, Mayr D, Rack B, Schindlbeck C, Friese K, Dian D (2010) Multicentric and multifocal versus unifocal breast cancer: is the tumor-node-metastasis classification justified? Breast Cancer Res Treat 122(1):27–34PubMedCrossRef

15.

Rezo A, Dahlstrom J, Shadbolt B, Rodins K, Zhang Y, Davis AJ (2011) Tumor size and survival in multicentric and multifocal breast cancer. Breast 20(3):259–263PubMedCrossRef

16.

Tot T, Gere M, Pekar G, Tarjan M, Hofmeyer S, Hellberg D, Lindquist D, Chen TH, Yen AM, Chiu SY, Tabar L (2011) Breast cancer multifocality, disease extent, and survival. Human Pathol 42:1761–1769CrossRef

17.

Litton JK, Eralp Y, Gonzalez-Angulo AM, Broglio K, Uyei A, Hortobagyi GN, Arun B (2007) Multifocal breast cancer in women < or =35 years old. Cancer 110(7):1445–1450PubMedCrossRef

18.

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (2010) AJCC Cancer staging manual. Springer, New York

19.

Lester SC, Bose S, Chen YY, Connolly JL, de Baca ME, Fitzgibbons PL, Hayes DF, Kleer C, O`Malley FP, Page DL, Smith BL, Tan LK, Weaver DL, Winer E (2009) Protocol for the examination of specimens from patients with invasive carcinoma of the breast. Arch Pathol Lab Med 133:1515–1538PubMed

20.

Schouten LJ, Jager JJ, van den Brandt PA (1993) Quality of cancer registry data: a comparison of data provided by clinicians with those of registrations personnel. Br J Cancer 68(5):974–977PubMedCrossRef

21.

Wolters R, Regierer AC, Schwentner L, Geyer V, Possinger K, Kreienberg R, Wischnewsky MB, Wöckel A (2012) A comparision of international breast cancer guidelines-Do the national guidelines differ in treatment recommendations? Eur J Cancer 48(1):1–11PubMedCrossRef

22.

Kreienberg R, Kopp I, Albert U et al (2008) Interdisciplinary S3 guideline for diagnosis and therapy of breast cancer in women. German Cancer Society, Berlin

23.

Boyages J, Jayasinghe UW, Coombs N (2010) Multifocal breast cancer and survival: each focus does matter particularly for larger tumors. Eur J Cancer 46:1990–1996PubMedCrossRef

24.

Hamaker ME, Schreurs WH, Uppelschoten JM, Smorenburg CH (2009) Breast cancer in the elderly: retrospective study on diagnosis and treatment according to national guidelines. Breast J 15:26–33PubMedCrossRef

25.

Schwentner L, Wolters R, Wischnewsky MB, Kreienberg R, Wöckel A (2012) Survival of patients with bilateral versus unilateral breast cancer and impact of guideline adherent adjuvant treatment: a multi-centre cohort study of 5,292 patients. Breast 21(2):171–177PubMedCrossRef

26.

Schwentner L, Wolters R, Koretz K, Wischnewsky MB, Kreienberg R, Rottscholl R, Wöckel A (2012) Triple-negative breast cancer: the impact of guideline-adherent adjuvant treatment on survival-a retrospective multi-centre cohort study. Breast Cancer Res Treat 132(3):1073–1080PubMedCrossRef

27.

Hancke K, Denkinger MD, König J, Kurzeder C, Wöckel A, Herr D, Blettner M, Kreienberg R (2010) Standard treatment of female patients with breast cancer decreases substantially for women aged 70 years and older: a German Clinical Cohort Study. Ann Oncol 21(4):748–753PubMedCrossRef

28.

Janssen-Heijnen ML, Maas HA, Lemmens VE, Houterman S, Louwman WJ, Verheij CD, Coebergh JW (2005) The correlation of age and comorbidity with therapy and survival in cancer patients in North-Brabant and North-Limburg, 1995–2001. Ned Tijdschr Geneeskd 149(30):1686–1690PubMed

29.

DeMichele A, Putt M, Zhang Y, Glick JH, Norman S (2003) Older age predicts a decline in adjuvant chemotherapy recommendations for patients with breast carcinoma: evidence from a tertiary care cohort of chemotherapy-eligible patients. Cancer 97(9):2150–2159PubMedCrossRef

30.

Craft PS, Buckingham JM, Dahlstrom JE, Beckmann KR, Zhang Y, Stuart-Harris R, Jacob G, Roder D, Tait N (2010) Variation in the management of early breast cancer in rural and metropolitan centres: implications fort he organisation of rural cancer services. Breast 19(5):396–401PubMedCrossRef

31.

Hebert-Croteau N, Brisson J, Latreille J, Rivard M, Abdelaziz N, Martin G (2004) Compliance with consensus recommendations for systemic therapy is associated with improved survival of women with nodal negative breast cancer. J Clinical Oncol 22:3685–3693CrossRef

32.

Gentilini O, Botteri E, Rotmensz N, Da Lima L, Caliskan M, Garcia-Etienne CA, Sosnovskikh I, Intra M, Mazzarol G, Musmeci S, Veronesi P, Galimberti V, Luini A, Viale g, Goldhirsch A, Veronesi U (2009) Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat 113(3):577–583

33.

Yerushalmi R, Tyldesley S, Woods R, Kennecke HF, Speers C, Gelmon KA (2012) Is breast-conserving therapy a safe option for patients with tumor multicentricity and multifocality? Ann Oncol 23(4):876–881

34.

Bauman L, Barth RJ, Rosenkranz KM (2010) Breast conservation in women with multifocal-multicentric breast cancer: is it feasible? Ann Surg Oncol 17(3):325–329

35.

Chung AP, Huynh K, Kidner T, Mirzadehgan P, Sim MS, Giuliano AE (2012) Comparision of outcomes of breast conserving therapy in multifocal and unifocal invasive breast cancer. J Am Coll Surg 215(1):137–146

Title: Comparing the outcome between multicentric and multifocal breast cancer: what is the impact on survival, and is there a role for guideline-adherent adjuvant therapy? A retrospective multicenter cohort study of 8,935 patients
Authors: R. Wolters
A. Wöckel
W. Janni
I. Novopashenny
F. Ebner
R. Kreienberg
M. Wischnewsky
L. Schwentner
For the BRENDA Study Group
Publication date: 01-12-2013
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 3/2013
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-013-2772-y

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