S P Lynch1, X Lei2, M Chavez-MacGregor3, L Hsu3, F Meric-Bernstam4, T A Buchholz5, A Zhang6, G N Hortobagyi3, V Valero3, A M Gonzalez-Angulo7. 1. Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA. 2. Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA. 3. Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 4. Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 5. Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. 6. Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA. 7. Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: agonzalez@mdanderson.org.
Abstract
BACKGROUND: The clinicopathological characteristics and the prognostic significance of multifocal (MF) and multicentric (MC) breast cancers are not well established. PATIENTS AND METHODS: MF and MC were defined as more than one lesion in the same quadrant or in separate quadrants, respectively. The Kaplan-Meier product limit was used to calculate recurrence-free survival (RFS), breast cancer-specific survival (BCSS), and overall survival (OS). Cox proportional hazards models were fit to determine independent associations of MF/MC disease with survival outcomes. RESULTS: Of 3924 patients, 942 (24%) had MF (n = 695) or MC (n = 247) disease. MF/MC disease was associated with higher T stages (T2: 26% versus 21.6%; T3: 7.4% versus 2.3%, P < 0.001), grade 3 disease (44% versus 38.2%, P < 0.001), lymphovascular invasion (26.2% versus 19.3%, P < 0.001), and lymph node metastases (43.1% versus 27.3%, P < 0.001). MC, but not MF, breast cancers were associated with a worse 5-year RFS (90% versus 95%, P = 0.02) and BCSS (95% versus 97%, P = 0.01). Multivariate analysis shows that MF or MC did not have an independent impact on RFS, BCSS, or OS. CONCLUSIONS: MF/MC breast cancers were associated with poor prognostic factors, but were not independent predictors of worse survival outcomes. Our findings support the current TNM staging system of using the diameter of the largest lesion to assign T stage.
BACKGROUND: The clinicopathological characteristics and the prognostic significance of multifocal (MF) and multicentric (MC) breast cancers are not well established. PATIENTS AND METHODS: MF and MC were defined as more than one lesion in the same quadrant or in separate quadrants, respectively. The Kaplan-Meier product limit was used to calculate recurrence-free survival (RFS), breast cancer-specific survival (BCSS), and overall survival (OS). Cox proportional hazards models were fit to determine independent associations of MF/MC disease with survival outcomes. RESULTS: Of 3924 patients, 942 (24%) had MF (n = 695) or MC (n = 247) disease. MF/MC disease was associated with higher T stages (T2: 26% versus 21.6%; T3: 7.4% versus 2.3%, P < 0.001), grade 3 disease (44% versus 38.2%, P < 0.001), lymphovascular invasion (26.2% versus 19.3%, P < 0.001), and lymph node metastases (43.1% versus 27.3%, P < 0.001). MC, but not MF, breast cancers were associated with a worse 5-year RFS (90% versus 95%, P = 0.02) and BCSS (95% versus 97%, P = 0.01). Multivariate analysis shows that MF or MC did not have an independent impact on RFS, BCSS, or OS. CONCLUSIONS: MF/MCbreast cancers were associated with poor prognostic factors, but were not independent predictors of worse survival outcomes. Our findings support the current TNM staging system of using the diameter of the largest lesion to assign T stage.
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Authors: Siobhan P Lynch; Xiudong Lei; Limin Hsu; Funda Meric-Bernstam; Thomas A Buchholz; Hong Zhang; Gabriel N Hortobágyi; Ana M Gonzalez-Angulo; Vicente Valero Journal: Oncologist Date: 2013-10-17