Multifocal and multicentric breast cancer: Does each focus matter?
Multifocal and multicentric breast cancer: Does each focus matter?
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DOI：
10.1200/jco.2005.02.1147
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发表时间：
2005-10-20
影响因子：
45.3
通讯作者：
Boyages, J
中科院分区：
文献类型：
--
作者：
Coombs, NJ;Boyages, J
目的：与分期相似的单灶性疾病相比，乳腺多发肿瘤的识别与淋巴结累及增加有关。本研究比较了两种评估肿瘤大小的方法，以预测多灶性和多中心性乳腺癌患者肿瘤大小与腋窝淋巴结累及之间的关系。方法对1995年4月至1995年9月在新南威尔士州接受治疗的所有多灶性乳腺癌患者的组织学报告进行分析。使用两种大小估计来评估肿瘤：(1)最大肿瘤病灶直径和(2)所有肿瘤病灶的总直径。与单灶性肿瘤和淋巴结阳性进行比较。结果848例女性中94例（11.1%）有多灶性乳腺癌，其中49例（52.1%）有腋窝淋巴结受累，而单灶性乳腺癌为37.5% （P = .007）。在较晚期的多灶性肿瘤中，使用聚集维数对其进行了重新分类。与单灶性分期匹配的乳腺癌相比，使用这种方法来分期癌症，而不是最大的肿瘤大小，可以去除多余的淋巴结阳性。结论乳腺肿瘤的转移倾向是肿瘤总负荷的反映。未能测量由多个小病灶提供的额外肿瘤负担可能会低估女性疾病的分期。如果忽略小病灶对淋巴结阳性发生率和生存率的贡献，这可能会剥夺患者接受辅助治疗的机会。
Purpose The identification of multiple tumors in the breast is associated with increased nodal involvement when compared with similar staged unifocal disease. This study compares two methods of tumor size assessment to predict tumor behavior in the relationship between size and axillary node involvement for patients with multifocal and multicentric breast cancer.Methods The histologic reports of every patient with multifocal breast cancer treated in New South Wales between April 1995 and September 1995 were examined. Tumors were assessed using two size estimates: (1) largest tumor focus diameter and (2) the aggregate diameters of all tumor foci. The dimensions were compared with unifocal tumors and against node positivity.Results Ninety-four (11.1%) of 848 women had multifocal breast cancer and of these 49 women (52.1%) had axillary node involvement compared with 37.5% with unifocal breast cancer (P = .007). The use of aggregate dimension reclassified significant numbers of multifocal tumors at a more advanced stage. Use of this method to stage cancers, rather than the largest tumor size, removed the excess node positivity when compared with unifocal, stage-matched breast carcinomas.Conclusion The tendency of breast tumors to metastasize is a reflection of the total tumor load. Failure to measure the additional tumor burden provided by multiple small foci may understage a woman's disease. This may deny patients the opportunity of adjuvant therapies if the contribution of the smaller foci to the incidence of node positivity and survival is ignored.