321PD - Impact of multifocal or multicentric disease on surgical, locoregional, and distant survival after neoadjuvant chemotherapy in 3562 breast cancer pa...

Date 29 September 2012
Event ESMO Congress 2012
Session Breast cancer, early stage
Topics Anti-Cancer Agents & Biologic Therapy
Breast Cancer, Locally Advanced
Surgery and/or Radiotherapy of Cancer
Presenter Beyhan Ataseven
Authors B. Ataseven1, J.U. Blohmer2, C. Denkert3, B. Gerber4, J. Heil5, T. Kühn6, S. Kümmel7, M. Rezai8, S. Loibl9, G. von Minckwitz10
  • 1Rotkreuzklinikum München, München/DE
  • 2Gynäkologie Und Geburtshilfe, Sankt Gertrauden-Krankenhaus, Berlin/DE
  • 3Institut Für Pathologie, Charité Universitätsmedizin Berlin, Berlin/DE
  • 4Frauenklinik, Uniklinik Rostock, Rostock/DE
  • 5Universitäts-brustzentrum, Universitäts-Frauenklinik, Heidelberg/DE
  • 6Brustzentrum, Frauenklinik, Gifhorn/DE
  • 7Brustzentrum, Kliniken Essen Mitte, Essen/DE
  • 8Brustzentrums, Luisenkrankenhaus, Düsseldorf/DE
  • 9Medicine And Research, German Breast Group, 63263 - Neu-Isenburg/DE
  • 10Managing Director, GBG Forschungs GmbH, 63263 - Neu-Isenburg/DE

Abstract

Purpose

To evaluate patients outcome with multifocal or multicentric breast cancer after neoadjuvant chemotherapy by type of surgery.

Patients and methods

Participants of the GeparTrio and GeparQuattro trials with operable or locally advanced tumors received anthracycline-taxane (+/- anti-HER2-based neoadjuvant chemotherapy and were classified as having unifocal (one lesion detected by physical examination, sonography, and mammography ± MRI), multifocal (≥2 lesions in one breast quadrant), or multicentric (≥ 1 lesion in ≥2 quadrants) disease. Breast conservation was allowed when tumor-free margins were achieved.

Results

Tumors of 3,562 participants were classified as unifocal (N = 2793; 78.4%), multifocal (N = 429; 12.0%), and multicentric (N = 340; 9.5%). Breast conservation was performed in 71.7%, 56.2%, and 35.1%, respectively (P < 0.0001). At surgery pathological complete response (pCR) rates were 18.7%, 14.1%, and 14.9%, respectively (P = 0.047). After median follow up of 46.3 months locoregional and distant-relapse-free survival were worse in patients with multicentric disease versus uni- or multifocal disease treated with mastectomy (P = 0.007 and 0.061, respectively), but not when treated by breast conservation (P = 0.634 and 0.650, respectively). Patients with pCR showed a low locoregional relapse rate irrespective of focality (P = 0.713) but a higher distant relapse rate in case of multicentric disease (P = 0.003). Prognostic factors for locoregional recurrence in multivariable analysis were tumor and nodal status at surgery, grading, hormone-receptor status, and type of surgery, but not focality of the tumor. Overall survival was not statistically different through all focality groups.

Conclusions

Breast conservation for multifocal or multicentric breast cancer after neoadjuvant chemotherapy is feasible and seems not to impair outcome if tumor-free margins were achieved.

Disclosure

All authors have declared no conflicts of interest.