Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Surgery
Published in: BMC Surgery 1/2015

Open Access 01-12-2015 | Research article

“Clinical significance of multifocal and multicentric breast cancers and choice of surgical treatment: a retrospective study on a series of 1158 cases”

Authors: Alessandro Neri, Daniele Marrelli, Tiziana Megha, Francesca Bettarini, Damiana Tacchini, Lorenzo De Franco, Franco Roviello

Published in: BMC Surgery | Issue 1/2015

Login to get access

Abstract

Background

The biological and clinical significance of multifocal and multicentric (MF/MC) breast cancers and the choice of appropriate surgical treatment for these tumors are still debated.

Methods

1158 women operated on for a stage I-III breast cancer were included in this retrospective study; clinical and pathological data were obtained from the institutional database of the Department of Oncology of the University of Siena, Italy. The impact of MF/MC breast cancers on patterns of recurrence and breast cancer specific survival (BCSS) was investigated in relation to the type of surgical treatment.

Results

MF and MC cancers were present in 131 cases (11.3%) and 60 cases (5.2%) respectively and were more frequently treated with mastectomy (55 MF and 60 MC cancers, 81.2%) than with breast conserving surgery (36 MF cancers, 18.9%; p < 0.001). MF and MC breast cancers were associated with a worse prognosis with a BCSS of 154 months compared to 204 months of unicentric cancers (p < 0.001). In multivariate analysis, MF/MC cancers were independent prognostic factors for BCSS together with higher number of metastatic axillary nodes, absence of estrogen receptors and high proliferative activity. MF and MC cancers were related to a significantly shorter BCSS in patients submitted to mastectomy as well as those submitted to breast conserving surgery. Relapse at any site was higher in the subgroup of MF and MC cancers but the incidence of loco-regional and distant recurrences did not differ between patients treated with mastectomy or breast conserving surgery.

Conclusions

Our results indicate that MF/MC cancers have a negative impact on prognosis and are related to higher loregional and distant relapse independently from the type of surgery performed. Adjuvant therapies did not modify the poorer outcome, but in patients receiving adjuvant anthacyclines, the differences with unicentric tumors were reduced. Our data support the hypothesis that MF/MC tumors may have a worse biological behavior and that the presence of multiple foci should be considered in planning adjuvant treatments.
Literature
1.
Qualheim RE, Gall EA: Breast carcinoma with multiple sites of origin.Cancer 1957, 10:460–8. 10.1002/1097-0142(195705/06)10:3<460::AID-CNCR2820100307>3.0.CO;2-ECrossRefPubMed
2.
Atkins H, Hayward JL, Klugman DJ, Wayte AB: Treatment of early breast cancer: a report after 10 years of a clinical trial.Br Med J 1972, 2:423–9. 10.1136/bmj.2.5811.423CrossRefPubMedPubMedCentral
3.
Veronesi U, Saccozzi R, Del Vecchio M, Banfi A, Clemente C, De Lena M, et al.: Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast.New Engl J Med 1981, 305:6–11. 10.1056/NEJM198107023050102CrossRefPubMed
4.
Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, et al.: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer.New Engl J Med 1985, 312:665–73. 10.1056/NEJM198503143121101CrossRefPubMed
5.
Middleton LP, Vlastos G, Mirza NQ, Eva S, Sahin AA: Multicentric mammary carcinoma: evidence of monoclonal proliferation.Cancer 2002, 94:1910–6. 10.1002/cncr.10452CrossRefPubMed
6.
Holland R, Veling SH, Mravunac M, Hendriks JH: Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery.Cancer 1985, 56:979–990. 10.1002/1097-0142(19850901)56:5<979::AID-CNCR2820560502>3.0.CO;2-NCrossRefPubMed
7.
Tot T: Axillary lymph node status in unifocal, multifocal and diffuse breast carcinomas: differences are related to macrometastatic disease.Ann Surg Oncol 2012. doi:10.1245/s10434–012–2346-y
8.
Egan LR: Multicentric breast carcinoma: clinical-radiographic-pathologic whole organ studies and 10-year survival.Cancer 1982, 49:1123–30. 10.1002/1097-0142(19820315)49:6<1123::AID-CNCR2820490610>3.0.CO;2-RCrossRefPubMed
9.
Winchester PD, Cox JD: Standards for diagnosis and management of invasive breast carcinoma. American College of Radiology. American College of Surgeons. College of American Pathologists. Society of Surgical Oncology.CA Cancer J Clin 1998, 48:83–107. 10.3322/canjclin.48.2.83CrossRefPubMed
10.
Kurtz JM, Jacquemier J, Amalric R, Brandone H, Ayme Y, Hans D, et al.: Breast-conserving therapy for macroscopically multiple cancers.Ann Surg 1990, 212:38–44. 10.1097/00000658-199007000-00006CrossRefPubMedPubMedCentral
11.
Wilson LD, Beinfield M, McKhann CF, Hafty BG: Conservative surgery and radiation in the treatment of synchronous ipsilateral breast cancers.Cancer 1993, 72:137–42. 10.1002/1097-0142(19930701)72:1<137::AID-CNCR2820720126>3.0.CO;2-ECrossRefPubMed
12.
Gentilini O, Botteri E, Rotmensz N, Da Lima L, Caliskan M, Garcia-Etienne CA, et al.: Conservative surgery in patients with multifocal/multicentric breast cancer.Breast Cancer Res Treat 2009, 113:577–583. 10.1007/s10549-008-9959-7CrossRefPubMed
13.
Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, et al.: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer.Radiology 2004, 233:830–49. 10.1148/radiol.2333031484CrossRefPubMed
14.
Wilkinson LS, Given-Wilson R, Potts H, Potts H, Sharma AK, Smith E: Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound.Clin Radiol 2005, 60:573–8. 10.1016/j.crad.2004.10.015CrossRefPubMed
15.
Bendifallah S, Werkoff G, Borie-Moutafoff C, Antoine M, Chopier J, Gligorov J, Uzan S, Coutant C, Rouzier R: Multiple synchronous (multifocal and multicentric) breast cancer: Clinical implications.Surg Oncol 2010, 19:e115–23. 10.1016/j.suronc.2010.06.001CrossRefPubMed
16.
Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, et al.: Accuracy and surgical impact of magnetic resonance imaging in breast cancer: systematic review and meta-analysis in detection of multifocal and multicentric cancer.J Clin Oncol 2008, 26:3248–58. 10.1200/JCO.2007.15.2108CrossRefPubMed
17.
Turnbull L, Brown S, Harvey I, Olivier C, Drew P, Napp V, et al.: Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomized controlled trial.Lancet 2010, 375:563–571. 10.1016/S0140-6736(09)62070-5CrossRefPubMed
18.
Anderson SJ, Wapnir I, Dignam JJ, Fisher B, Mamounas EP, Jeong JH, et al.: Prognosis after ipsilateral breast tumor recurrence and locoregional recurrences in patients treated by breast-conserving therapy in five national surgical adjuvant breast and bowel project protocols of node-negative breast cancer.J Clin Oncol 2009, 15:2466–2473.CrossRef
19.
Early Breast Cancer Trialists’ Group: Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10801 women in 17 randomised trials.Lancet 2011, 378:1707–1716.CrossRef
20.
Fisher B: The role of science in the treatment of breast cancer when tumor multicentricity is present.J Natl Cancer Inst 2011, 103:1292–8. 10.1093/jnci/djr240CrossRefPubMed
21.
Sobin LH, Gospodarowicz MK, Wittekind C: TNM Classification Of Malignant Tumors. 7th edition. New York: Wiley and Blackwell ed; 2009.
22.
Vlastos G, Rubio IT, Mirza NQ, Newman LA, Aurora R, Alderfer J, et al.: Impact of multicentricity on clinical outcome in patients with T1–2, N0, M0 breast canser.Ann Surg Oncol 2000, 7:581–7. 10.1007/BF02725337CrossRefPubMed
23.
Litton JK, Eralp Y, Gonzales-Angulo A, Broglio K, Uyei A, Hortobagyi GN, et al.: Multifocal breast cancer in women ≤ 35 years old.Cancer 2007, 110:1445–50. 10.1002/cncr.22928CrossRefPubMed
24.
Joergensen LE, Gunnarsdottir KA, Lanng C, Moeller S, Rasmussen BB: Multifocality as a prognostic factor in breast cancer patients registered in Danish Breast Cooperative Group (DBCG) 1996–2001.Breast 2008, 17:587–591. 10.1016/j.breast.2008.06.004CrossRefPubMed
25.
Yerushalmi R, Kennecke H, Woods R, Olivotto IA, Speers C, Gelmon KA: Does multicentric/multifocal breast cancer differ from unifocal breast cancer? An analysis of survival and contralateral breast incidence.Breast Cancer Res Treat 2009, 117:365–370. 10.1007/s10549-008-0265-1CrossRefPubMed
26.
Weissenbacher TM, Zschage M, Janni W, Jeschke U, Dimpfl T, Mayr D, et al.: Multicentric and multifocal versus unifocal breast cancer: is the tumor-node-metastasis classification justified?Breast Cancer Res Treat 2010, 122:27–34. 10.1007/s10549-010-0917-9CrossRefPubMed
27.
Tavassoli FA, Devilee P: World Health Organization Classification of Tumours. Pathology and genetics of tumours of the breast and female genital organs. Lyon: IARC Press; 2003.
28.
Elston CW, Ellis IO: Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up.Histopathology 1991, 19:403–410. 10.1111/j.1365-2559.1991.tb00229.xCrossRefPubMed
29.
Neri A, Marrelli D, Pedrazzani C, Caruso S, De Stefano A, Mariani F, et al.: Prognostic relevance of proliferative activity evaluated by Mib-1 immunostaining in node negative breast cancer.Eur J Surg Oncol 2008, 34:1299–1303. 10.1016/j.ejso.2007.11.009CrossRefPubMed
30.
Boyages J, Jayashinge UW, Coombs N: Multifocal breast cancer and survival: each focus does matter particularly for larger tumors.Eur J Cancer 2010, 46:1990–6. 10.1016/j.ejca.2010.03.003CrossRefPubMed
31.
O'Daly BJ, Sweeney KJ, Ridgway PF, Quinn C, McDermott EW, O'Higgins NJ, et al.: The accuracy of combined versus largest diameter in staging multifocal breast cancer.J Am Coll Surg 2007, 204:282–5. 10.1016/j.jamcollsurg.2006.11.005CrossRefPubMed
32.
Andea AA, Bouwman D, Wallis T, Visscher DW: Correlation of tumor volume and surface area with lymph node status in patients with multifocal/multicentre breast caercinoma.Cancer 2004, 100:20–7. 10.1002/cncr.11880CrossRefPubMed
Metadata
Title
“Clinical significance of multifocal and multicentric breast cancers and choice of surgical treatment: a retrospective study on a series of 1158 cases”
Authors
Alessandro Neri
Daniele Marrelli
Tiziana Megha
Francesca Bettarini
Damiana Tacchini
Lorenzo De Franco
Franco Roviello
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2015
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/1471-2482-15-1

Other articles of this Issue 1/2015

BMC Surgery 1/2015 Go to the issue

Case report

Nonfunctional adrenocortical carcinoma initially presenting as retroperitoneal hemorrhage

Case report

En-bloc resection of thoracic calcified meningioma with inner dural layer in recapping T-saw laminoplasty: a case report

Research article

Frequency and severity of globus pharyngeus symptoms in patients undergoing thyroidectomy: a pre-post short term cross-sectional study

Research article

Binocular stereo-navigation for three-dimensional thoracoscopic lung resection

Research article

Autotransplantation of parathyroid grafts into the tibialis anterior muscle after parathyroidectomy: a novel autotransplantation site

Research article

A solution to the negative effects of splenectomy during colorectal trauma and surgery: an experimental study on splenic autotransplantation to the groin area