Evaluation of recurrence and survival in multifocal versus unifocal breast cancer patients at a tertiary center: A case-control study

Abstract

Purpose

Breast cancer, a significant contributor to global cancer incidence, presents varying clinical and pathological profiles. This study aimed to compare clinical and pathological characteristics, survival rates, and recurrence patterns between patients with multifocal (MF) and unifocal (UF) breast cancer who underwent breast-conserving surgery, to identify potential differences that could inform clinical management and treatment strategies.

Methods

The study was a retrospective case-control analysis. Patient records from 2006 to 2015 at the Breast Cancer Research Center of Shahid Beheshti University of Medical Sciences were examined. Inclusion criteria encompassed informed consent, stage I-III breast cancer diagnosis, and breast-conserving surgery. Neoadjuvant chemotherapy recipients, patients with incomplete records, and those with treatment non-compliance were excluded. Demographic data, clinical parameters, and pathological findings were collected and analyzed. Patients were categorized into MF and UF groups based on tumor nodule count. Survival and recurrence rates were assessed using Kaplan-Meier analysis and the Log-Rank test.

Results

While mean age did not significantly differ between MF (47.36 years) and UF (49.97 years) breast cancer patients, a significant disparity in menarche age was observed (MF: 13.14 years vs. UF: 12.98 years, p= 0.03). Tumor size significantly varied (MF: 3.68 cm vs. UF: 3.21 cm, p= 0.01). However, menopausal status, hormone receptor (ER and PR) status, mortality, in vitro fertilization history, breastfeeding history, recurrence rates, HER2 status, and pathologic grade showed no significant differences between groups. The 5-year overall survival (OS) rates were 89.2 % for MF and 90.5 % for UF (p= 0.45), and the 5-year recurrence-free survival (RFS) rates were 84.7 % for MF and 86.1 % for UF (p= 0.52).

Conclusion

This study suggests that multifocal breast cancer is associated with earlier menarche and larger tumor size compared to unifocal breast cancer. Other clinical and pathological parameters, as well as survival and recurrence rates, did not significantly differ between these two groups. These findings highlight the importance of considering multifocality in clinical decision-making, particularly about tumor size and menarche age, while reassuring that survival and recurrence outcomes remain comparable between MF and UF breast cancer patients.