Department of Mathematics and Computer Science, University Bremen, Universitätsallee, 28359, Bremen, Germany.
Breast Cancer Res Treat. 2013 Dec;142(3):579-90. doi: 10.1007/s10549-013-2772-y. Epub 2013 Nov 21.
Multifocal (MF) and multicentric (MC) breast cancers have been comprehensively studied, and their outcomes have been compared with unifocal (UF) tumors. We attempted to answer the following questions: (1) Does MF/MC presentation influence the outcome concerning BC mortality?, (2) Is there an impact of guideline-adherent adjuvant treatment in these BC subtypes?, and (3)What is the influence of guideline violations concerning surgery (breast-conserving surgery versus mastectomy) on the survival of MF/MC BC patients? Between 1992 and 2008, we retrospectively analyzed 8,935 breast cancer patients from 17 participating breast cancer centers within the BRENDA study group. Of 8,935 breast cancer patients, 7,073 (79.2 %) had UF tumors, 1,398 (15.6 %) had MF tumors, and 464 (5.2 %) had MC tumors. RFS was significantly worse for MF/MC BC patients compared to patients with UF tumors (MF p = 0.007; MC p = 0.019). OAS was significantly worse for MC patients but not for MF patients compared to patients with UF tumors (MF p = 0.321; MC p = 0.001). Guideline adherence was significantly lower in patients with MF (n = 580; 41.5 %) and MC (n = 204; 44.0 %) compared to patients with UF (n = 3,871; 54.7 %) (p < 0.001) tumors. Guideline violations were associated with a highly significant deterioration in survival throughout all subgroups except for MC, with respect to RFS and OAS. For 100 %-guideline-adherent patients, we could not find any significant differences in RFS and OAS after adjusting by nodal status, grade, and tumor size. Furthermore, we could not find any significant differences in RFS and OAS in patients with MF or MC stratified by breast-conserving therapy (BCT lumpectomy and radiation therapy) and mastectomy. There is a strong association between improved RFS and OAS in patients with MF/MZ BC. There are no significant differences in RFS and OAS for patients with breast-conserving therapy or mastectomy.
多灶性 (MF) 和多中心性 (MC) 乳腺癌已得到全面研究，并对其与单灶性 (UF) 肿瘤的结局进行了比较。我们试图回答以下问题：(1)MF/MC 表现是否会影响乳腺癌死亡率的结果？(2)辅助治疗的指南依从性对这些乳腺癌亚型有何影响？(3) 手术（保乳手术与乳房切除术）指南违反对 MF/MC 乳腺癌患者的生存有何影响？在 1992 年至 2008 年间，我们回顾性分析了 BRENDA 研究组 17 个参与的乳腺癌中心的 8935 例乳腺癌患者。在 8935 例乳腺癌患者中，7073 例（79.2%）为 UF 肿瘤，1398 例（15.6%）为 MF 肿瘤，464 例（5.2%）为 MC 肿瘤。MF/MC 乳腺癌患者的 RFS 明显差于 UF 肿瘤患者（MF p=0.007；MC p=0.019）。与 UF 肿瘤患者相比，MC 患者的 OAS 明显较差，但 MF 患者的 OAS 无明显差异（MF p=0.321；MC p=0.001）。MF（n=580；41.5%）和 MC（n=204；44.0%）患者的指南依从性明显低于 UF（n=3871；54.7%）患者（p<0.001）。MF 或 MC 患者的 100% 指南依从性患者在调整淋巴结状态、分级和肿瘤大小后，RFS 和 OAS 无显著差异。此外，我们在 MF 或 MC 分层的患者中，也没有发现保乳治疗（乳房切除术和放射治疗）和乳房切除术的 RFS 和 OAS 有显著差异。MF/MZ BC 患者的 RFS 和 OAS 改善与生存的改善密切相关。保乳治疗或乳房切除术患者的 RFS 和 OAS 无显著差异。
