Progress of breast conserving therapy in patients with multifocal/multicentric breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHOU Xuejiao , ZHANG Yifan , CHEN Ying , REN Shuying ,  JIANG Yi

Department of Breast Surgery, The Second Hospital of Jilin University, Changchun 130041, P. R. China;

Corresponding author：

JIANG Yi, Email: jiangyi1025@yahoo.com

Keywords：

multifocal/multicentric breast cancer; breast conserving therapy; mastectomy; local recurrence

DOI：

10.7507/1007-9424.202006011

Video：

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Objective To discuss the feasibility and security of breast conserving surgery (BCS) in patients with multifocal/multicentric breast cancer (MMBC).Method The clinical trials about BCS in patients with MMBC at home and abroad in recent years were searched and reviewed.Results The results of most retrospective clinical trials showed that BCS in patients with MMBC could achieve similar or at least as good results as mastectomy. However, for there were some inevitable bias in retrospective studies, the conclusion should be analyzed modestly. Two prospective multicenter randomized controlled trials, the MIAMI UK trial and the ACOSOG Z11102 trial, were still ongoing, of which results were expected to confirm these conclusions further. Conclusions Under the premise of mastering the indications, BCS would be a reasonable option for MMBC when incisal margin is negative and cosmetic result is satisfactory. In addition, the lack of standard classification and definition for multifocality and multicentricity increases the difficulty of the research, and the distance of the cancer foci and the ratio of tumor to breast volume in patients with MMBC might be the key factors affecting the efficacy of BCS. Therefore, more rational-designed prospective studies and accurate subgroup analysis are expected to provide impelling evidence for application of BCS in patients with MMBC.

Citation： ZHOU Xuejiao, ZHANG Yifan, CHEN Ying, REN Shuying, JIANG Yi. Progress of breast conserving therapy in patients with multifocal/multicentric breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(3): 415-420. doi: 10.7507/1007-9424.202006011 Copy

1.	张汉臣, 林卓琛, 王红莉, 等. 多灶性多中心性乳腺癌与单一病灶性乳腺癌临床病理特征差异性分析. 中山大学学报(医学版), 2019, 40(3): 423-430.
2.	van la Parra RF, de Roos WK, Contant CM, et al. A prospective validation study of sentinel lymph node biopsy in multicentric breast cancer: SMMaC trial. Eur J Surg Oncol, 2014, 40(10): 1250-1255.
3.	Shaikh T, Tam TY, Li T, et al. Multifocal and multicentric breast cancer is associated with increased local recurrence regardless of surgery type. Breast J, 2015, 21(2): 121-126.
4.	Houvenaeghel G, Tallet A, Jalaguier-Coudray A, et al. Is breast conservative surgery a reasonable option in multifocal or multicentric tumors? World J Clin Oncol, 2016, 7(2): 234-242.
5.	郎志强, 张廷国. 多灶性/多中心性乳腺癌转移相关分子标签的初步筛选及鉴定. 山东大学, 2018.
6.	Lai HW, Chen CJ, Lin YJ, et al. Does breast magnetic resonance imaging combined with conventional imaging modalities decrease the rates of surgical margin involvement and reoperation? A case-control comparative analysis. Medicine (Baltimore), 2016, 95(22): e3810.
7.	Bakhtavar K, Saran M, Behzadifar M, et al. Magnetic resonance mammography in comparison with mammography in the discovery of multifocal, multicentric and bilateral lesions of breast cancer. Electron Physician, 2017, 9(8): 5083-5087.
8.	Desmedt C, Fumagalli D, Pietri E, et al. Uncovering the genomic heterogeneity of multifocal breast cancer. J Pathol, 2015, 236(4): 457-466.
9.	McCrorie AD, Ashfield S, Begley A, et al. Multifocal breast cancers are more prevalent in BRCA2 versus BRCA1 mutation carriers. J Pathol Clin Res, 2020, 6(2): 146-153.
10.	Ilić IR, Petrović A, Živković VV, et al. Immunohistochemical features of multifocal and multicentric lobular breast carcinoma. Adv Med Sci, 2017, 62(1): 78-82.
11.	Weissenbacher T, Hirte E, Kuhn C, et al. Multicentric and multifocal versus unifocal breast cancer: differences in the expression of E-cadherin suggest differences in tumor biology. BMC Cancer, 2013, 13: 361.
12.	Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage Ⅰ–Ⅱ breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol, 2012, 13(4): 412-419.
13.	van Maaren MC, de Munck L, Jobsen JJ, et al. Breast-conserving therapy versus mastectomy in T1-2N2 stage breast cancer: a population-based study on 10-year overall, relative, and distant metastasis-free survival in 3 071 patients. Breast Cancer Res Treat, 2016, 160(3): 511-521.
14.	van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol, 2016, 17(8): 1158-1170.
15.	邵志敏. 乳腺癌保乳手术的进展与评述. 肿瘤防治研究, 2018, 45(5): 269-273.
16.	Nijenhuis MV, Rutgers EJ. Conservative surgery for multifocal/multicentric breast cancer. Breast, 2015, 24(Suppl 2): S96-S99.
17.	陈香蓉, 权毅. 多灶性多中心性乳腺癌的临床病理特征分析. 临床外科杂志, 2019, 27(1): 55-58.
18.	Neri A, Marrelli D, Megha T, et al. Clinical significance of multifocal and multicentric breast cancers and choice of surgical treatment: a retrospective study on a series of 1 158 cases. BMC Surg, 2015, 15(1): 1.
19.	Lang Z, Wu Y, Li C, et al. Multifocal and multicentric breast carcinoma: a significantly more aggressive tumor than unifocal breast cancer. Anticancer Res, 2017, 37(8): 4593-4598.
20.	Djordjevic-Jovanovic L, Karanikolic A, Bojic T, et al. Characteristics and outcomes of patients with multifocal/multicentric and unifocal breast cancer. J BUON, 2017, 22(3): 652-657.
21.	Karakas Y, Dizdar O, Aksoy S, et al. The effect of total size of lesions in multifocal/multicentric breast cancer on survival. Clin Breast Cancer, 2018, 18(4): 320-327.
22.	Fushimi A, Yoshida A, Yagata H, et al. Prognostic impact of multifocal and multicentric breast cancer versus unifocal breast cancer. Surg Today, 2019, 49(3): 224-230.
23.	Kuan LL, Tiong LU, Parkyn R, et al. Disease recurrence and survival in patients with multifocal breast cancer: a follow-up study with 7-year results. ANZ J Surg, 2017, 87(10): E125-E128.
24.	Tan MP, Sitoh NY, Sitoh YY. Perspectives of cosmesis following breast conservation for multifocal and multicentric breast cancers. Int J Breast Cancer, 2015, 2015: 126793.
25.	Tan MP, Sitoh NY, Sitoh YY. Does the classification system for multifocal and multicentric breast cancers alter breast conservation rates? Breast J, 2019, 25(4): 772-774.
26.	Rosenkranz KM, Ballman K, McCall L, et al. The feasibility of breast-conserving surgery for multiple ipsilateral breast cancer: an initial report from ACOSOG Z11102(Alliance) trial. Ann Surg Oncol, 2018, 25(10): 2858-2866.
27.	Curigliano G, Burstein HJ, Winer EP, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol, 2018, 29: 2153.
28.	Winters Z, Cutress R, Greenwood R, et al. Reaching a national consensus on the surgical management of multiple ipsilateral breast cancers (MIBCs): Perceptions by patients, healthy volunteers, surgeons and breast cancer associations. Eur J Surg Oncol, 2015, 41(6): S37.
29.	Winters ZE, Bernaudo L. Evaluating the current evidence to support therapeutic mammoplasty or breast-conserving surgery as an alternative to mastectomy in the treatment of multifocal and multicentric breast cancers. Gland Surg, 2018, 7(6): 525-535.
30.	Kurtz JM, Jacquemier J, Amalric R, et al. Breast-conserving therapy for macroscopically multiple cancers. Ann Surg, 1990, 212(1): 38-44.
31.	Fang M, Zhang X, Zhang H, et al. Local control of breast conservation therapy versus mastectomy in multifocal or multicentric breast cancer: a systematic review and meta-analysis. Breast Care (Basel), 2019, 14(4): 188-193.
32.	Nos C, Bourgeois D, Darles C, et al. Conservative treatment of multifocal breast cancer: a comparative study. Bull Cancer, 1999, 86(2): 184-188.
33.	Gentilini O, Botteri E, Rotmensz N, et al. Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat, 2009, 113(3): 577-583.
34.	Lim W, Park EH, Choi SL, et al. Breast conserving surgery for multifocal breast cancer. Ann Surg, 2009, 249(1): 87-90.
35.	Yerushalmi R, Tyldesley S, Woods R, et al. Is breast-conserving therapy a safe option for patients with tumor multicentricity and multifocality? Ann Oncol, 2012, 23(4): 876-881.
36.	Kadioğlu H, Yücel S, Yildiz S, et al. Feasibility of breast conserving surgery in multifocal breast cancers. Am J Surg, 2014, 208(3): 457-464.
37.	Tan MP, Sitoh NY, Sitoh YY. Optimising breast conservation treatment for multifocal and multicentric breast cancer: A worthwhile endeavour? World J Surg, 2016, 40(2): 315-322.
38.	Corso G, Magnoni F, Provenzano E, et al. Multicentric breast cancer with heterogeneous histopathology: a multidisciplinary review. Future Oncol, 2020, 16(8): 395-412.
39.	Winters Z, Roberts N, McCartan N, et al. Can patients with multiple breast cancers in the same breast avoid mastectomy by having multiple lumpectomies to achieve equivalent rates of local breast cancer recurrence? A randomized controlled feasibility trial called MIAMI UK (NCT03514654). Eur J Surg Oncol, 2019, 45(5): 881.
40.	Winters ZE, Benson JR; MIAMI (Multiple Ipsilateral breast conserving surgery versus mastectomy) Trial Management Group. Surgical treatment of multiple ipsilateral breast cancers. Br J Surg, 2018, 105(5): 466-468.
41.	中华医学会外科学分会乳腺外科学组. 早期乳腺癌保留乳房手术中国专家共识(2019版). 中华外科杂志, 2019, 57(2): 81-84.
42.	Kanumuri P, Hayse B, Killelea BK, et al. Characteristics of multifocal and multicentric breast cancers. Ann Surg Oncol, 2015, 22(8): 2475-2482.
43.	Koppiker CB, Noor AU, Dixit S, et al. Extreme oncoplastic surgery for multifocal/multicentric and locally advanced breast cancer. Int J Breast Cancer, 2019, 2019: 4262589.

1. 张汉臣, 林卓琛, 王红莉, 等. 多灶性多中心性乳腺癌与单一病灶性乳腺癌临床病理特征差异性分析. 中山大学学报(医学版), 2019, 40(3): 423-430.
2. van la Parra RF, de Roos WK, Contant CM, et al. A prospective validation study of sentinel lymph node biopsy in multicentric breast cancer: SMMaC trial. Eur J Surg Oncol, 2014, 40(10): 1250-1255.
3. Shaikh T, Tam TY, Li T, et al. Multifocal and multicentric breast cancer is associated with increased local recurrence regardless of surgery type. Breast J, 2015, 21(2): 121-126.
4. Houvenaeghel G, Tallet A, Jalaguier-Coudray A, et al. Is breast conservative surgery a reasonable option in multifocal or multicentric tumors? World J Clin Oncol, 2016, 7(2): 234-242.
5. 郎志强, 张廷国. 多灶性/多中心性乳腺癌转移相关分子标签的初步筛选及鉴定. 山东大学, 2018.
6. Lai HW, Chen CJ, Lin YJ, et al. Does breast magnetic resonance imaging combined with conventional imaging modalities decrease the rates of surgical margin involvement and reoperation? A case-control comparative analysis. Medicine (Baltimore), 2016, 95(22): e3810.
7. Bakhtavar K, Saran M, Behzadifar M, et al. Magnetic resonance mammography in comparison with mammography in the discovery of multifocal, multicentric and bilateral lesions of breast cancer. Electron Physician, 2017, 9(8): 5083-5087.
8. Desmedt C, Fumagalli D, Pietri E, et al. Uncovering the genomic heterogeneity of multifocal breast cancer. J Pathol, 2015, 236(4): 457-466.
9. McCrorie AD, Ashfield S, Begley A, et al. Multifocal breast cancers are more prevalent in BRCA2 versus BRCA1 mutation carriers. J Pathol Clin Res, 2020, 6(2): 146-153.
10. Ilić IR, Petrović A, Živković VV, et al. Immunohistochemical features of multifocal and multicentric lobular breast carcinoma. Adv Med Sci, 2017, 62(1): 78-82.
11. Weissenbacher T, Hirte E, Kuhn C, et al. Multicentric and multifocal versus unifocal breast cancer: differences in the expression of E-cadherin suggest differences in tumor biology. BMC Cancer, 2013, 13: 361.
12. Litière S, Werutsky G, Fentiman IS, et al. Breast conserving therapy versus mastectomy for stage Ⅰ–Ⅱ breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol, 2012, 13(4): 412-419.
13. van Maaren MC, de Munck L, Jobsen JJ, et al. Breast-conserving therapy versus mastectomy in T1-2N2 stage breast cancer: a population-based study on 10-year overall, relative, and distant metastasis-free survival in 3 071 patients. Breast Cancer Res Treat, 2016, 160(3): 511-521.
14. van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. Lancet Oncol, 2016, 17(8): 1158-1170.
15. 邵志敏. 乳腺癌保乳手术的进展与评述. 肿瘤防治研究, 2018, 45(5): 269-273.
16. Nijenhuis MV, Rutgers EJ. Conservative surgery for multifocal/multicentric breast cancer. Breast, 2015, 24(Suppl 2): S96-S99.
17. 陈香蓉, 权毅. 多灶性多中心性乳腺癌的临床病理特征分析. 临床外科杂志, 2019, 27(1): 55-58.
18. Neri A, Marrelli D, Megha T, et al. Clinical significance of multifocal and multicentric breast cancers and choice of surgical treatment: a retrospective study on a series of 1 158 cases. BMC Surg, 2015, 15(1): 1.
19. Lang Z, Wu Y, Li C, et al. Multifocal and multicentric breast carcinoma: a significantly more aggressive tumor than unifocal breast cancer. Anticancer Res, 2017, 37(8): 4593-4598.
20. Djordjevic-Jovanovic L, Karanikolic A, Bojic T, et al. Characteristics and outcomes of patients with multifocal/multicentric and unifocal breast cancer. J BUON, 2017, 22(3): 652-657.
21. Karakas Y, Dizdar O, Aksoy S, et al. The effect of total size of lesions in multifocal/multicentric breast cancer on survival. Clin Breast Cancer, 2018, 18(4): 320-327.
22. Fushimi A, Yoshida A, Yagata H, et al. Prognostic impact of multifocal and multicentric breast cancer versus unifocal breast cancer. Surg Today, 2019, 49(3): 224-230.
23. Kuan LL, Tiong LU, Parkyn R, et al. Disease recurrence and survival in patients with multifocal breast cancer: a follow-up study with 7-year results. ANZ J Surg, 2017, 87(10): E125-E128.
24. Tan MP, Sitoh NY, Sitoh YY. Perspectives of cosmesis following breast conservation for multifocal and multicentric breast cancers. Int J Breast Cancer, 2015, 2015: 126793.
25. Tan MP, Sitoh NY, Sitoh YY. Does the classification system for multifocal and multicentric breast cancers alter breast conservation rates? Breast J, 2019, 25(4): 772-774.
26. Rosenkranz KM, Ballman K, McCall L, et al. The feasibility of breast-conserving surgery for multiple ipsilateral breast cancer: an initial report from ACOSOG Z11102(Alliance) trial. Ann Surg Oncol, 2018, 25(10): 2858-2866.
27. Curigliano G, Burstein HJ, Winer EP, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol, 2018, 29: 2153.
28. Winters Z, Cutress R, Greenwood R, et al. Reaching a national consensus on the surgical management of multiple ipsilateral breast cancers (MIBCs): Perceptions by patients, healthy volunteers, surgeons and breast cancer associations. Eur J Surg Oncol, 2015, 41(6): S37.
29. Winters ZE, Bernaudo L. Evaluating the current evidence to support therapeutic mammoplasty or breast-conserving surgery as an alternative to mastectomy in the treatment of multifocal and multicentric breast cancers. Gland Surg, 2018, 7(6): 525-535.
30. Kurtz JM, Jacquemier J, Amalric R, et al. Breast-conserving therapy for macroscopically multiple cancers. Ann Surg, 1990, 212(1): 38-44.
31. Fang M, Zhang X, Zhang H, et al. Local control of breast conservation therapy versus mastectomy in multifocal or multicentric breast cancer: a systematic review and meta-analysis. Breast Care (Basel), 2019, 14(4): 188-193.
32. Nos C, Bourgeois D, Darles C, et al. Conservative treatment of multifocal breast cancer: a comparative study. Bull Cancer, 1999, 86(2): 184-188.
33. Gentilini O, Botteri E, Rotmensz N, et al. Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat, 2009, 113(3): 577-583.
34. Lim W, Park EH, Choi SL, et al. Breast conserving surgery for multifocal breast cancer. Ann Surg, 2009, 249(1): 87-90.
35. Yerushalmi R, Tyldesley S, Woods R, et al. Is breast-conserving therapy a safe option for patients with tumor multicentricity and multifocality? Ann Oncol, 2012, 23(4): 876-881.
36. Kadioğlu H, Yücel S, Yildiz S, et al. Feasibility of breast conserving surgery in multifocal breast cancers. Am J Surg, 2014, 208(3): 457-464.
37. Tan MP, Sitoh NY, Sitoh YY. Optimising breast conservation treatment for multifocal and multicentric breast cancer: A worthwhile endeavour? World J Surg, 2016, 40(2): 315-322.
38. Corso G, Magnoni F, Provenzano E, et al. Multicentric breast cancer with heterogeneous histopathology: a multidisciplinary review. Future Oncol, 2020, 16(8): 395-412.
39. Winters Z, Roberts N, McCartan N, et al. Can patients with multiple breast cancers in the same breast avoid mastectomy by having multiple lumpectomies to achieve equivalent rates of local breast cancer recurrence? A randomized controlled feasibility trial called MIAMI UK (NCT03514654). Eur J Surg Oncol, 2019, 45(5): 881.
40. Winters ZE, Benson JR; MIAMI (Multiple Ipsilateral breast conserving surgery versus mastectomy) Trial Management Group. Surgical treatment of multiple ipsilateral breast cancers. Br J Surg, 2018, 105(5): 466-468.
41. 中华医学会外科学分会乳腺外科学组. 早期乳腺癌保留乳房手术中国专家共识(2019版). 中华外科杂志, 2019, 57(2): 81-84.
42. Kanumuri P, Hayse B, Killelea BK, et al. Characteristics of multifocal and multicentric breast cancers. Ann Surg Oncol, 2015, 22(8): 2475-2482.
43. Koppiker CB, Noor AU, Dixit S, et al. Extreme oncoplastic surgery for multifocal/multicentric and locally advanced breast cancer. Int J Breast Cancer, 2019, 2019: 4262589.

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