Breast Cancer Research and Treatment

, Volume 142, Issue 1, pp 143–151

Do alternative methods of measuring tumor size, including consideration of multicentric/multifocal disease, enhance prognostic information beyond TNM staging in women with early stage breast cancer: an analysis of the NCIC CTG MA.5 and MA.12 clinical trials

  • J. F. Hilton
  • N. Bouganim
  • B. Dong
  • J. W. Chapman
  • A. Arnaout
  • F. O’Malley
  • K. A. Gelmon
  • R. Yerushalmi
  • M. N. Levine
  • V. H. C. Bramwell
  • T. J. Whelan
  • K. I. Pritchard
  • L. E. Shepherd
  • M. Clemons
Epidemiology

DOI: 10.1007/s10549-013-2714-8

Cite this article as:
Hilton, J.F., Bouganim, N., Dong, B. et al. Breast Cancer Res Treat (2013) 142: 143. doi:10.1007/s10549-013-2714-8

Abstract

The AJCC staging criteria consider tumor size to be the largest dimension of largest tumor. Some case series suggest using summation of all tumor dimensions in patients with multicentric/multifocal (MC/MF) disease. We used data from NCIC CTG MA.5 and MA.12 clinical trials to examine alternative methods of assessing tumor size on breast-cancer-free-interval (BCFI). The 710 MA.5 pre-/peri-menopausal node positive and 672 MA.12 pre-menopausal node-negative/-positive patients have 10-year median follow-up. All patients received adjuvant chemotherapy. Tumors were centrally reviewed for grade, hormone receptor, and HER2 status. Continuous pathologic tumor size was: (1) largest dimension of largest tumor (cm); (2) tumor area (cm2); (3) volume of tumor (cm3); (4) with MC/MF disease, summation of (1)–(3) for up to 3 foci. We examined univariate and multivariate effects of tumor size on BCFI utilizing (un)stratified Cox regression and the Wald test statistic. In univariate analysis, larger tumor dimension was significantly associated with worse BFCI in node positive patients: p < 0.0001 for MA.5; p = 0.01 for MA.12. In MA.5 multivariate analysis, larger summation of largest tumor dimensions was associated with worse BCFI (p = 0.0003), while larger single dimension was associated with worse BCFI (p = 0.02) for MA.12. Presence of MC/MF and other tumor size measurements were not associated (p > 0.05) with BFCI. While physicians could consider the largest diameter of the largest focus of disease or the sum of the largest diameters of all foci in their T-stage determination, it appears that the current method of T-staging offers equivalent determinations of prognosis.

Keywords

Breast cancer Alternative methods of staging Breast cancer free interval (BCFI) 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • J. F. Hilton
    • 1
    • 2
  • N. Bouganim
    • 2
  • B. Dong
    • 1
  • J. W. Chapman
    • 1
  • A. Arnaout
    • 3
  • F. O’Malley
    • 4
  • K. A. Gelmon
    • 5
  • R. Yerushalmi
    • 5
  • M. N. Levine
    • 6
  • V. H. C. Bramwell
    • 7
  • T. J. Whelan
    • 8
  • K. I. Pritchard
    • 9
  • L. E. Shepherd
    • 1
  • M. Clemons
    • 2
  1. 1.NCIC Clinical Trials GroupQueens UniversityKingstonCanada
  2. 2.Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, Ottawa General HospitalUniversity of OttawaOttawaCanada
  3. 3.Department of Surgery, The Ottawa Hospital Cancer CentreUniversity of OttawaOttawaCanada
  4. 4.Department of Pathology, Mt. Sinai HospitalUniversity of TorontoTorontoCanada
  5. 5.Department of Oncology, BC Cancer AgencyUniversity of British ColumbiaVancouverCanada
  6. 6.Department of Oncology, Juravinski Cancer CentreMcMaster UniversityHamiltonCanada
  7. 7.Department of Oncology, Tom Baker Cancer CentreUniversity of CalgaryCalgaryCanada
  8. 8.Department of Radiation Oncology, Juravinski Cancer CentreMcMaster UniversityHamiltonCanada
  9. 9.Sunnybrook Odette Cancer CentreUniversity of TorontoTorontoCanada