title: Conservative surgery in patients with multifocal/multicentric breast cancer.
abstract: OBJECTIVE
  Many physicians recommend mastectomy in case of multifocal (MF) or multicentric (MC) breast cancer due to a theoretical risk of poor local control with less extensive surgery. We retrospectively evaluate outcome of patients with MF/MC cancers who had breast conservation with specific attention on local control and predictive factors of recurrence.
  
  
  METHODS
  Four hundred and seventy six patients with either MF (n = 421) or MC (n = 55) breast cancer, underwent breast-conserving surgery between 1997 and 2002 in a single institution. Median follow up was 73 months (range 11-118).
  
  
  RESULTS
  Median age was 53 years (range 23-86). Invasive lobular carcinoma was found in 88 patients (18.5%) and mixed ductal-lobular cancer in 27 (5.7%) patients. Two hundred and sixty-seven patients (76.7%) had two identified tumor foci, 55 patients (15.3%) had three and 29 patients (8.0%) had four or more. Two hundred and sixty-one patients (55.3%) had nodal involvement. The 5-year cumulative incidence of local relapse was 5.1%. At the multivariate analysis, over-expression of HER2/neu and lack of both estrogen and progesterone receptors (HR: 3.2, 95% C.I. 1.01-10.0, and HR: 2.7, 95% C.I. 1.06-7.7, respectively) were associated with a higher ipsilateral breast cancer reappearance rate. Involvement of four or more lymph nodes and lack of estrogen and progesterone receptors (HR: 2.7, 95% C.I. 1.06-6.7, and HR: 4.7, 95% C.I. 2.1-10.4, respectively) were associated with poorer overall survival.
  
  
  CONCLUSIONS
  In selected patients with MF/MC breast cancer, wide conservative surgery is not associated with poor local disease control and can be considered whenever acceptable cosmetic results can be achieved.
authors.affiliation: Division of Breast Surgery, European Institute of Oncology, Milan, Italy. oreste.gentilini@ieo.it
authors.forename: Oreste
authors.initials: O
authors.lastname: Gentilini
authors.forename: Edoardo
authors.initials: E
authors.lastname: Botteri
authors.forename: Nicole
authors.initials: N
authors.lastname: Rotmensz
authors.forename: Luciana
authors.initials: L
authors.lastname: Da Lima
authors.forename: Mujgan
authors.initials: M
authors.lastname: Caliskan
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Garcia-Etienne
authors.forename: Irina
authors.initials: I
authors.lastname: Sosnovskikh
authors.forename: Mattia
authors.initials: M
authors.lastname: Intra
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mazzarol
authors.forename: Simona
authors.initials: S
authors.lastname: Musmeci
authors.forename: Paolo
authors.initials: P
authors.lastname: Veronesi
authors.forename: Viviana
authors.initials: V
authors.lastname: Galimberti
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Viale
authors.forename: Aron
authors.initials: A
authors.lastname: Goldhirsch
authors.forename: Umberto
authors.initials: U
authors.lastname: Veronesi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult