Annals of Surgical Oncology

, Volume 22, Issue 4, pp 1118–1127 | Cite as

Impact of Multifocal or Multicentric Disease on Surgery and Locoregional, Distant and Overall Survival of 6,134 Breast Cancer Patients Treated With Neoadjuvant Chemotherapy

  • Beyhan AtasevenEmail author
  • Bianca Lederer
  • Jens U. Blohmer
  • Carsten Denkert
  • Bernd Gerber
  • Jörg Heil
  • Thorsten Kühn
  • Sherko Kümmel
  • Mahdi Rezai
  • Sibylle Loibl
  • Gunter von Minckwitz
Breast Oncology



The impact of tumor focality on type of surgery, local recurrence rate, and survival after neoadjuvant chemotherapy (NACT) for breast cancer is not fully understood. This study aimed to compare local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) according to focality stratified by type of surgery and pathologic complete response (pCR), with a focus on breast conservation.


Participants (n = 6,134) in the GeparTrio, GeparQuattro, and GeparQuinto trials with operable or locally advanced tumors receiving NACT were classified as having unifocal (1 lesion), multifocal (≥2 lesions in 1 quadrant), or multicentric (≥1 lesion in ≥2 quadrants) disease. The study investigated LRFS, DFS, and OS according to focality stratified by type of surgery and pathologic complete response.


The patients were classified as having unifocal (n = 4,733, 77.1 %), multifocal (n = 820, 13.4 %), or multicentric (n = 581, 9.5 %) tumors. The respective pCR rates were 19.4, 16.5, and 14.4 %. Breast conservation was performed for 71.6, 58.5, and 30 % of these patients, respectively (P < 0.001). The LRFS rate was 92.9 % for the unifocal, 95.1 % for the multifocal, and 90.4 % for the multicentric tumors (P = 0.002). The patients with multicentric tumors but not the patients with multifocal tumors had worse DFS (P < 0.001) and OS (P = 0.009) than the patients with unifocal tumors. However, LRFS, DFS, and OS were not inferior for the patients with multicentric or multifocal tumors if pCR was achieved or breast conservation was performed after NACT.


Breast conservation is feasible for clinically multifocal or multicentric breast cancer patients who undergo NACT without worsening LRFS if tumor-free margins can be attained or if patients achieve a pCR.


Pathologic Complete Response Breast Conservation Multifocal Disease Multifocal Tumor Multicentric Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.




Supplementary material

10434_2014_4122_MOESM1_ESM.docx (123 kb)
Supplemental Table 1: Details on the trial designs (DOCX 123 kb)
10434_2014_4122_MOESM2_ESM.pptx (69 kb)
Supplental Fig. 1: Consort diagram (PPTX 69 kb)


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Beyhan Ataseven
    • 1
    Email author
  • Bianca Lederer
    • 2
  • Jens U. Blohmer
    • 3
  • Carsten Denkert
    • 4
  • Bernd Gerber
    • 5
  • Jörg Heil
    • 6
  • Thorsten Kühn
    • 7
  • Sherko Kümmel
    • 8
  • Mahdi Rezai
    • 9
  • Sibylle Loibl
    • 2
  • Gunter von Minckwitz
    • 2
  1. 1.Department of Gynecology and Gynecologic OncologyKliniken Essen-MitteEssenGermany
  2. 2.Headquarter, German Breast GroupNeu-IsenburgGermany
  3. 3.Department of Gynecology and ObstetricsSt. Gertrauden HospitalBerlinGermany
  4. 4.Institute for Pathology, Charite´BerlinGermany
  5. 5.Department of Gynecology and ObstetricsUniversity HospitalRostockGermany
  6. 6.Department for Gynecology and ObstetricsInterdisciplinary Breast CenterEsslingenGermany
  7. 7.Department of Gynecology and ObstetricsUniversity Women’s ClinicHeidelbergGermany
  8. 8.Breast CenterLuisenkrankenhausDüsseldorfGermany
  9. 9.Department of SenologyKliniken Essen-MitteEssenGermany

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