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

Annals of Surgical Oncology volume 22, pages 1118–1127 (2015)Cite this article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany

    Beyhan Ataseven MD

  2. Headquarter, German Breast Group, Neu-Isenburg, Germany

    Bianca Lederer MD, Sibylle Loibl MD, PhD & Gunter von Minckwitz MD, PhD

  3. Department of Gynecology and Obstetrics, St. Gertrauden Hospital, Berlin, Germany

    Jens U. Blohmer MD, PhD

  4. Institute for Pathology, Charite´, Berlin, Germany

    Carsten Denkert MD, PhD

  5. Department of Gynecology and Obstetrics, University Hospital, Rostock, Germany

    Bernd Gerber MD, PhD

  6. Department for Gynecology and Obstetrics, Interdisciplinary Breast Center, Esslingen, Germany

    Jörg Heil MD

  7. Department of Gynecology and Obstetrics, University Women’s Clinic, Heidelberg, Germany

    Thorsten Kühn MD, PhD

  8. Breast Center, Luisenkrankenhaus, Düsseldorf, Germany

    Sherko Kümmel MD

  9. Department of Senology, Kliniken Essen-Mitte, Essen, Germany

    Mahdi Rezai MD

Authors
  1. Beyhan Ataseven MD
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  2. Bianca Lederer MD
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  3. Jens U. Blohmer MD, PhD
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  10. Sibylle Loibl MD, PhD
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  11. Gunter von Minckwitz MD, PhD
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Correspondence to Beyhan Ataseven MD.

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Ataseven, B., Lederer, B., Blohmer, J.U. et al. Impact of Multifocal or Multicentric Disease on Surgery and Locoregional, Distant and Overall Survival of 6,134 Breast Cancer Patients Treated With Neoadjuvant Chemotherapy. Ann Surg Oncol 22, 1118–1127 (2015). https://doi.org/10.1245/s10434-014-4122-7

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  • DOI: https://doi.org/10.1245/s10434-014-4122-7

Keywords

  • Pathologic Complete Response
  • Breast Conservation
  • Multifocal Disease
  • Multifocal Tumor
  • Multicentric Disease