Frauenklinik, Klinikum der Ludwig-Maximilians-Universitaet, Munich, Germany.
Breast Cancer Res Treat. 2010 Jul;122(1):27-34. doi: 10.1007/s10549-010-0917-9. Epub 2010 May 8.
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.
对于乳腺癌（BC）的分类，肿瘤-淋巴结-转移（TNM）分期已经被认为是 50 多年来的标准。T 分期定义明确，在多中心和多灶性肿瘤中，肿瘤大小通过最大肿瘤焦点来评估。本研究旨在比较乳腺癌的多中心/多灶性肿瘤扩散与单灶性疾病，并评估多灶性的诊断相关性。对 1963 年至 2007 年间 5691 例乳腺癌患者的生存相关事件进行了回顾性分析。通过配对分析，将患者分为多灶/多中心组和单灶组，每组 288 例，然后进行两组比较。匹配标准为肿瘤大小、分级和激素受体状态，两组之间分布均匀（P=1.000 各）。评估无病生存和复发或转移疾病的发生情况。采用 Cox 回归分析进行多变量分析。在单灶组中，乳腺癌特异性生存时间的平均值为 221.6 个月，而多灶/多中心组为 203.3 个月（P<0.001，对数秩检验）。与单灶等效组相比，多灶组局部复发和远处转移的发生率显著增加（P<0.001 和 P<0.003）。多变量分析的 Cox 回归分析表明，肿瘤的多灶性和中心性是总生存率（P=0.016）、局部复发（P=0.001）和远处转移（P=0.038）降低的高度显著预测因子。肿瘤大小、组织病理学分级、激素受体状态和淋巴结分期是公认的预后参数。此外，病灶数量也应被视为独立的预后参数，目前这并未反映在 TNM 分类中。我们得出结论，多中心/多灶性 BC 是独立的 BC 危险因素，应通过重新评估 UICC 目前的 TNM 分类来纳入风险评估。
