title: The importance of multifocal/multicentric tumor on the disease-free survival of breast cancer patients: single center experience.
abstract: OBJECTIVE
  Multifocal/multicentric breast cancers have been comprehensively studied and their outcomes have been compared with unifocal tumors. We evaluated the impact of multifocality and multicentricity on the disease-free survival (DFS) and overall survival of breast cancer patients and tried to analyze the correlation between multifocality/multicentricity (M/M) and other prognostic factors.
  
  
  METHODS
  Between 1994 and 2009, we analyzed retrospectively 697 breast cancer patients. Multicentric and multifocal breast cancer were defined as the presence of 2 or more invasive tumor foci within the different quadrants of the same breast or within a same quadrant of the breast, respectively. M/M and other prognostic factors were evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  Multifocal/multicentric tumors were seen in 107 (15.4%) of the 697 breast cancer patients. pT and pN stage were related with the presence of multifocal/multicentric tumors. As tumor size increased and the number of axillary lymph nodes metastasis increased, the incidence of M/M increased significantly (P=0.003 vs. P=0.02, respectively). Overall, the median DFS time of patients with multifocal/multicentric tumors was significantly worse than that of the unifocal tumors (55 vs. 137 mo, P<0.001). Multivariate analysis showed that the presence of M/M was the most important prognostic factor for DFS (P=0.001, hazard ratio (HR): 0.33; 95% confidence interval (CI), 0.18-0.58), as were pN stage and extracapsular extension of the tumor (P=0.01, HR: 1.74; 95% CI, 1.13-2.69) (P=0.03, HR: 1.9; 95% CI, 1.04-3.47, respectively). M/M were not also statistically significant prognostic factors in breast cancer for overall survival (P=0.06).
  
  
  CONCLUSIONS
  M/M imparts an unfavorable prognosis on the DFS of breast cancer patients in comparison to unifocal tumors and the presence of multifocal/multicentric tumors were associated with advanced pT and pN stages.
authors.affiliation: Departments of Medical Oncology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey. basakoven@yahoo.com
authors.forename: Basak Oven
authors.initials: BO
authors.lastname: Ustaalioglu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bilici
authors.forename: Umut
authors.initials: U
authors.lastname: Kefeli
authors.forename: Mesut
authors.initials: M
authors.lastname: Şeker
authors.forename: Mustafa
authors.initials: M
authors.lastname: Oncel
authors.forename: Cem
authors.initials: C
authors.lastname: Gezen
authors.forename: Mahmut
authors.initials: M
authors.lastname: Gumus
authors.forename: Fuat
authors.initials: F
authors.lastname: Demirelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D047368:Tumor Burden; D055815:Young Adult