Time to breast cancer relapse predicted by primary tumour characteristics, not lymph node involvement.

INTRODUCTION: The risk of breast cancer recurrence has been linked to tumour size, grade, oestrogen (ER) receptor status, and degree of lymph node (LN) involvement. However, the role of these variables in predicting time to relapse is not well defined. This study was designed to identify patient and primary tumour characteristics that predict risk periods for breast cancer recurrence within our institution, to enable more tailored surveillance strategies. METHODS: We retrospectively studied a cohort of 473 patients who presented to The Queen Elizabeth Hospital, Adelaide, Australia, with recurrent breast cancer between 1968 and 2008. Patient and primary tumour characteristics were collected, including age, menopausal status, tumour grade, size, ER and progesterone receptor (PR) status, and LN involvement and modeled against time to relapse using Kaplan-Meier survival curves. RESULTS: High tumour grade, size ≥ 20 mm, ER negativity, and PR negativity were shown on univariate analysis to correlate significantly with earlier recurrence (P < 0.0001, P = 0.0012, P = 0.0006, and P = 0.006). Multivariate analysis identified tumour grade and size as significant predictors of timing of relapse after adjustment for other variables. LN involvement, menopausal status, and age did not significantly correlate with earlier recurrence. CONCLUSIONS: High tumour grade and larger size were shown to independently predict earlier breast cancer relapse. While LN involvement increases absolute recurrence risk, our study proposes that it does not influence timing of relapse. Use of these predictors will enable key risk periods for onset of relapse to be characterised according to tumour profile with more appropriate discharge to primary care providers for ongoing surveillance.

Disease recurrence and survival in patients with multifocal breast cancer: a follow-up study with 7-year results.

BACKGROUND: Few studies have shown that multifocal breast cancer (MBC) has poorer outcomes compared with unifocal breast cancer (UBC). Currently, there is no long-term data on disease recurrence and survival in patients with MBC. The aim of this study is to evaluate whether patients with MBC have worse outcomes compared with UBC in respect to disease recurrence and survival. METHODS: This is a retrospective study of patients diagnosed with stage I-III MBC from 2000 to 2007 in comparison with UBC with a median follow-up of 7 years. Prognostic factors were prospectively collected from the breast cancer unit database. Univariate and multivariable analyses for disease recurrence and survival were performed as well as Kaplan-Meier curves. RESULTS: A total of 152 patients were included; 75 with MBC, 77 with UBC. The multifocal group was treated more aggressively with mastectomy (73% versus 25%, P < 0.0001) and chemotherapy (53% versus 42%). Breast cancer recurred in nine (11.7%) patients in the UBC group and nine (12%) patients in the MBC group respectively (hazard ratio (HR): 1.13, 95% confidence interval (CI): 0.45-2.86, P = 0.794). There were 10 (13%) mortalities in the unifocal group as compared with 11 (14.7%) in the multifocal group (HR: 1.02, 95% CI: 0.42-2.48, P = 0.969). There were no statistically significant differences in the all-cause mortality and disease recurrence rates between both groups. DISCUSSION: There were no statistically significant differences in disease recurrence or mortality rates between MBC and UBC at a median follow-up of 7 years. However, patients in the MBC group received more aggressive treatment than the unifocal group.

Dilemma in multifocal breast cancer ­ largest versus aggregate diameter.

BACKGROUND: Several studies have shown that multifocal breast cancer has higher risks of lymph node metastases compared to unifocal cancer. This has a significant impact on prognosis and treatment options. We investigated whether this was true in our institution. METHODS: This was a retrospective study involving 75 patients with multifocal breast cancer from the year 2000 to 2007. The data recorded were largest, aggregate and extent diameter, and outcomes measured were lymph node metastases, disease recurrence and mortality rate.We randomly selected 77 age-matched subjects with unifocal cancer from the same time period for comparison. RESULTS: The average age was 57 and 58 years for the unifocal and multifocal groups, respectively. In the multifocal group, there were 54.6% ductal, 26.7% lobular and 17.3% mixed/other cancers. The unifocal group consisted of 84.4% ductal, 6.5% lobular and 9.1% mixed/other cancers. In the multifocal group, largest diameter was available for 74 patients averaging 22.1 mm. The average diameter in unifocal cancer was 18.4 mm. Fifty-two per cent of the multifocal subjects had positive lymph nodes compared with 36% in the unifocal group. CONCLUSION: Our data showed that multifocality was associated with a higher rate of lymph node metastases. This might indicate that multifocal breast cancer reflected a heavier disease burden than unifocal cancer and should be treated more aggressively.