Avtor/Urednik		Vera-Badillo, Francisco Emilio; Napoleone, Marc; Ocaña, Alberto; Templeton, Arnoud J.; Šeruga, Boštjan; Al-Mubarak, Mustafa; Al Hashem, Hashem Yashem; Tannock, Ian; Amir, Eitan
Naslov		Effect of multifocality and multicentricity on outcome in early stage breast cancer
Tip		članek
Vol. in št.		Letnik 146, št. 2
Leto izdaje		2014
Obseg		str. 235-244
ISSN		1573-7217 - Breast cancer research and treatment
Jezik		eng
Abstrakt		Women with multifocal or multicentric breast tumors (multifocality henceforth) have been reported to have greater probability of nodal metastasis and relapse and worse survival than women with unifocal tumors. However, these associations have been inconsistent and multifocality is not taken into account by staging guidelines and prognostic models. A systematic review of electronic databases identified publications exploring the association between multifocality and overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and loco-regional relapse (LRR). The hazard ratios (HRs) for OS and DFS for multifocal compared to unifocal tumors were extracted from multivariable analyses and included in a meta-analysis. For studies not reporting multivariable analyses, odds ratios (OR) were estimated from Kaplan-Meier curves for all endpoints at 5 and 10 years. Twenty-two studies comprising 67,557 women were included. Multifocality was reported in 9.5 % of patients. Classical prognostic factors were well balanced between unifocal and multifocal populations. In multivariable analyses, multifocality was associated with significantly worse OS (HR 1.65; P = 0.02), and a non-significant association with worse DFS (HR 1.96; P = 0.07). In univariable analyses, multifocality was associated with worse OS, DFS, DSS, and LRR at 5 years (OR 1.39, P = 0.02; OR 1.52, P = 0.02; OR 1.56, P = 0.03; and OR 3.23, P = 0.02, respectively). Similar estimates were observed at 10 years, but statistical significance was only reached for DSS and LRR. Mutifocality appears to be associated with a worse prognosis, however, substantial inter-study heterogeneity limits the precise determination of increased risk. Further validation of the independent prognostic impact of multifocality is warranted.
Proste vsebinske oznake		rak dojke preživetje zgodnje odkritje breast cancer multifocality multicentricity