A retrospective study on multifocal and multicentric vs. unifocal breast cancer. Preliminary results

A. Milulescu, S. Ilie, A. Toesca, A. Filipescu, N. Clim, M. Mitran, R. Vladareanu

Abstract: Multifocal (MF) and multicentric (MC) breast cancers have been comprehensively studied, but they still remain a controversial subject for many senologists in regards to the best treatment options. Conservatory approach is reserved preponderantly to unifocal localization of the invasive breast carcinoma while in MF and MC the radically techniques are still the main option. The real impact of MC and MF breast cancers on survival is still unknown, but it is presumed to be worse. MF and MC breast cancers are currently over treated by radical mastectomy (RM). The AMAROS trial and also the Z0011 trial recently demonstrated that less surgery does not necessarily mean less local control or worse survival outcomes. About 450 women that underwent surgery for breast cancers stages I-III were included in this monocentric retrospective study; clinical and pathological data were obtained from the database of the Institute of Oncology ”Prof. Dr. Alexandru Trestioreanu” Bucharest. Our primary objective was to see if there is any difference in disease free survival in early breast cancer patients primary treated by conservative surgery according to unifocal (UF) vs. MF vs. MC feature of the invasive component. Our secondary objectives were to identify if there is any correlation between the conservative or radical type of surgery and other clinical and histologcal characterstics; if there is any differences in survival between UF vs. MF vs. MC breast carcinoma. Median follow-up was of 51 months. MC and MF cancers were present in 38 patients (8.4%) and 13 (2.9%) respectively and most of them were treated with mastectomy (6 MF and 19 MC) rather than with breast conservative surgery (BCS). In the entire data analyzed there was no statistical difference between event free survival (EFS) in the subgroup that underwent BCS vs. radical surgery (RS): 21 events (16.4%) vs. 53 events (16.61% ) (p=0.957), median EFS 99.79 mo 95% CI [92.67-106.91] mo vs. 98.19 95% CI [92.81-103.56] mo (p=0.773). We found a significant correlation between recurrence and a family history of cancer (p=0.035), the tumor/node/metastasis (p<0.001), type of surgery (p= 0.035). Relapse rate wasn’t significantly different whatever the type of surgery done. Median EFS wasn’t different between patients that underwent BCS and those that underwent RS. BCS is a reasonable option in selected UF/MC/MF cancers, particularly in younger women with small breast tumors.
DOI:10.18643/gieu.2017.59

Keywords: breast conserving surgery, multicentric/multifocal breast cancer, survival, unifocal, relapse, recurrence.