Multicentric and multifocal versus unifocal breast cancer: is the tumor-node-metastasis classification justified?
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For classification of breast cancer (BC), tumor-node-metastasis (TNM) staging has been considered state of the art for more than 50 years. The T category is well defined, and in multicentric and multifocal tumors, tumor size is assessed by the largest tumor focus. The aim of this study was to compare multicentric/multifocal tumor spread in breast cancer with unifocal disease and to evaluate the diagnostic relevance of multifocality. A retrospective analysis was performed on survival related events in a series of 5,691 breast cancer patients between 1963 and 2007. By matched-pair analysis, patients were entered into two comparable groups of 288 patients after categorizing them as having multifocal/multicentric or unifocal breast cancers. Matching criteria were tumor size, grading, and hormone receptor status, which were equally distributed between both groups (P = 1.000 each). Disease free survival and the occurrence of relapse or of metastatic disease were evaluated. Cox’s regression analysis was used for multivariate analysis. In the unifocal group, the mean breast cancer-specific survival time was 221.6 months as opposed to 203.3 months in the multicentric/multifocal group (P < 0.001, log-rank test). The occurrence of local relapse and distant metastasis was significantly increased in the multifocal group in comparison to the unifocal equivalent group (P < 0.001 and P < 0.003, respectively). Cox regression analysis for multivariate analyses demonstrated focality and centricity to be highly significant predictors for reduced overall survival (P = 0.016), local relapse (P = 0.001) and distant metastasis (P = 0.038). Tumor size, histopathological grading, hormone receptor status, and staging of lymph nodes are well-established prognostic parameters. Additionally, the number of foci should be considered as an independent prognostic parameter, which is currently not reflected in the TNM classification. We conclude that multicentric/multifocal BC is an independent BC risk factor and should be included in the risk assessment by re-evaluating the current TNM classification of the UICC.
KeywordsBreast cancer Overall survival Multicentric Multifocal Prognostic factor Prognosis
We would like to thank Dr. Steven S. Witkin (Weill Cornell Medical College, New York, USA) for his help with the manuscript.
- 9.Garcia-Vilanova Comas A, Garcia Vilanova A, Fuster-Diana E, Martinez-Alzamora N, Fernandez-Tena J, Garcia-Vilanova Comas J, Garcia-Vilanova Comas M (2006) Prognostic value of the interpectoral lymph nodes in breast cancer. A 20-year survival study. Clin Transl Oncol 8(2):108–118CrossRefPubMedGoogle Scholar
- 14.Altmann U, Haeberlin V, Tafazzoli A, Dudeck J (1997) Application of a standard methodology for the development of messages and aspects of realization in the area of tumour documentation. Stud Health Technol Inf 43 Pt B:776–780Google Scholar
- 17.Savran VR, Fetsych TH, Savran VV, Tril OV, Myshakivs’kyi OM (2006) Stages of breast cancer. Lik Sprava 3:11–17Google Scholar
- 23.Fowble B, Yeh IT, Schultz DJ, Solin LJ, Rosato EF, Jardines L, Hoffman J, Eisenberg B, Weiss MC, Hanks G (1993) The role of mastectomy in patients with stage I–II breast cancer presenting with gross multifocal or multicentric disease or diffuse microclassifications. Int J Radiat Oncol Biol Phys 27(3):567–573PubMedGoogle Scholar
- 31.Oh JL, Dryden MJ, Woodward WA, Yu TK, Tereffe W, Strom EA, Perkins GH, Middleton L, Hunt KK, Giordano SH et al (2006) Locoregional control of clinically diagnosed multifocal or multicentric breast cancer after neoadjuvant chemotherapy and locoregional therapy. J Clin Oncol 24(31):4971–4975CrossRefPubMedGoogle Scholar