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Eur J Cancer. 2010 Jul;46(11):1990-6. doi: 10.1016/j.ejca.2010.03.003. Epub 2010 Apr 10.

Multifocal breast cancer and survival: each focus does matter particularly for larger tumours.

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1
Westmead Breast Cancer Institute, University of Sydney, Westmead Hospital, Westmead, NSW 2145, Australia. johnb@bci.org.au

Abstract

PURPOSE:

The objective of this study is to determine whether the aggregate tumour size of every focus in multifocal breast cancer more accurately predicts 10-year survival than current staging systems which use the largest or dominant tumour size.

PATIENTS AND METHODS:

This study examined the original histological reports of 848 consecutive patients with invasive breast cancer treated in New South Wales (NSW), Australia between 1 April 1995 and 30 September 1995. Multifocal tumours were assessed using two estimates of pathologic tumour size: largest tumour focus diameter and the aggregate diameter of every tumour focus. The 10-year survival of patients with multifocal tumours measured in both ways was compared to that with unifocal tumours.

RESULTS:

At a median follow-up of 10.4 years, 27 of 94 patients (28.7%) with multifocal breast cancer have died of breast cancer compared to 141 of 754 (18.7%) with unifocal breast cancer (P=.022). Ten-year survival was not affected by size for tumours measuring 20mm or less, whether or not dominant tumour size (87.9%) or aggregate tumour size (87.0%) was used for multifocal tumours, compared to unifocal tumours (88.1%). For tumours larger than 20mm, 10-year survival was 72.1% for unifocal tumours compared to 54.7% (P=.008) for multifocal tumours using dominant tumour size, but this was 69.5% and not significant when multifocal tumours were classified using aggregate tumour size (P=.49). Multivariate analysis also confirmed the above-mentioned results after adjustment for important prognostic factors.

CONCLUSION:

Aggregate size of every focus should be considered along with other prognostic factors for metastasis when treatment is planned. The current convention of using the largest (dominant) lesion as a measure of stage and associated breast cancer survival needs further validation.

PMID:
20385484
DOI:
10.1016/j.ejca.2010.03.003
[Indexed for MEDLINE]
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