Site of primary tumor has a prognostic role in operable breast cancer: The International Breast Cancer Study Group experience

Marco Colleoni, David Zahrieh, Richard D. Gelber, Stig B. Holmberg, Jan E. Mattsson, Carl Magnus Rudenstam, Jurij Lindtner, Darja Eržen, Raymond Snyder, John Collins, Martin F. Fey, Beat Thürlimann, Diana Crivellari, Elizabeth Murray, Caesar Mendiola, Olivia Pagani, Monica Castiglione-Gertsch, Alan S. Coates, Karen Price, Aron Goldhirsch

Research output: Contribution to journalArticle

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Abstract

Purpose: Cancer presenting at the medial site of the breast may have a worse prognosis compared with tumors located in external quadrants. For medial tumors, axillary lymph node staging may not accurately reflect the metastatic potential of the disease. Patients and Methods: Eight-thousand four-hundred twenty-two patients randomly assigned to International Breast Cancer Study Group clinical trials between 1978 and 1999 were classified as medial site (1,622; 19%) or lateral, central, and other sites (6,800; 81%). Median follow-up was 11 years. Results: A statistically significant difference was observed for patients with medial tumors versus those with nonmedial tumors in disease-free survival (DFS; 10-year DFS, 46% v 48%; HR, 1.10; 95% CI, 1.02 to 1.18; P = .01) and overall survival (10-year OS 59% v 61%; HR, 1.09; 1.01 to 1.19; P = .04). This difference increased after adjustment for other prognostic factors (HR, 1.22; 95% CI, 1.13 to 1.32 for DFS; and HR, 1.24; 95% CI, 1.14 to 1.35 for OS; both P = .0001). The risk of relapse for patients with medial presentation was largest for the node-negative cohort and for patients with tumors larger than 2 cm. In the subgroup of 2,931 patients with negative axillary lymph nodes, 10-year DFS was 61% v 67%, and OS was 73% v 80% for medial versus nonmedial sites, respectively (HR 1.33; 95% CI, 1.15 to 1.54; P = .0001 for DFS; and HR 1.40; 95% CI, 1.17 to 1.67; P = .0003 for OS). Conclusion: Tumor site has a significant prognostic utility, especially for axillary lymph node-negative disease, that should be considered in therapeutic algorithms. New staging procedures such as biopsy of the sentinel internal mammary nodes or novel imaging methods should be further studied in patients with medial tumors.

Original languageEnglish (US)
Pages (from-to)1390-1400
Number of pages11
JournalJournal of Clinical Oncology
Volume23
Issue number7
DOIs
StatePublished - Dec 1 2005
Externally publishedYes

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Breast Neoplasms
Neoplasms
Lymph Nodes
Breast
Disease-Free Survival
Clinical Trials
Biopsy
Recurrence
Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Site of primary tumor has a prognostic role in operable breast cancer : The International Breast Cancer Study Group experience. / Colleoni, Marco; Zahrieh, David; Gelber, Richard D.; Holmberg, Stig B.; Mattsson, Jan E.; Rudenstam, Carl Magnus; Lindtner, Jurij; Eržen, Darja; Snyder, Raymond; Collins, John; Fey, Martin F.; Thürlimann, Beat; Crivellari, Diana; Murray, Elizabeth; Mendiola, Caesar; Pagani, Olivia; Castiglione-Gertsch, Monica; Coates, Alan S.; Price, Karen; Goldhirsch, Aron.

In: Journal of Clinical Oncology, Vol. 23, No. 7, 01.12.2005, p. 1390-1400.

Research output: Contribution to journalArticle

Colleoni, M, Zahrieh, D, Gelber, RD, Holmberg, SB, Mattsson, JE, Rudenstam, CM, Lindtner, J, Eržen, D, Snyder, R, Collins, J, Fey, MF, Thürlimann, B, Crivellari, D, Murray, E, Mendiola, C, Pagani, O, Castiglione-Gertsch, M, Coates, AS, Price, K & Goldhirsch, A 2005, 'Site of primary tumor has a prognostic role in operable breast cancer: The International Breast Cancer Study Group experience', Journal of Clinical Oncology, vol. 23, no. 7, pp. 1390-1400. https://doi.org/10.1200/JCO.2005.06.052
Colleoni, Marco ; Zahrieh, David ; Gelber, Richard D. ; Holmberg, Stig B. ; Mattsson, Jan E. ; Rudenstam, Carl Magnus ; Lindtner, Jurij ; Eržen, Darja ; Snyder, Raymond ; Collins, John ; Fey, Martin F. ; Thürlimann, Beat ; Crivellari, Diana ; Murray, Elizabeth ; Mendiola, Caesar ; Pagani, Olivia ; Castiglione-Gertsch, Monica ; Coates, Alan S. ; Price, Karen ; Goldhirsch, Aron. / Site of primary tumor has a prognostic role in operable breast cancer : The International Breast Cancer Study Group experience. In: Journal of Clinical Oncology. 2005 ; Vol. 23, No. 7. pp. 1390-1400.
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abstract = "Purpose: Cancer presenting at the medial site of the breast may have a worse prognosis compared with tumors located in external quadrants. For medial tumors, axillary lymph node staging may not accurately reflect the metastatic potential of the disease. Patients and Methods: Eight-thousand four-hundred twenty-two patients randomly assigned to International Breast Cancer Study Group clinical trials between 1978 and 1999 were classified as medial site (1,622; 19{\%}) or lateral, central, and other sites (6,800; 81{\%}). Median follow-up was 11 years. Results: A statistically significant difference was observed for patients with medial tumors versus those with nonmedial tumors in disease-free survival (DFS; 10-year DFS, 46{\%} v 48{\%}; HR, 1.10; 95{\%} CI, 1.02 to 1.18; P = .01) and overall survival (10-year OS 59{\%} v 61{\%}; HR, 1.09; 1.01 to 1.19; P = .04). This difference increased after adjustment for other prognostic factors (HR, 1.22; 95{\%} CI, 1.13 to 1.32 for DFS; and HR, 1.24; 95{\%} CI, 1.14 to 1.35 for OS; both P = .0001). The risk of relapse for patients with medial presentation was largest for the node-negative cohort and for patients with tumors larger than 2 cm. In the subgroup of 2,931 patients with negative axillary lymph nodes, 10-year DFS was 61{\%} v 67{\%}, and OS was 73{\%} v 80{\%} for medial versus nonmedial sites, respectively (HR 1.33; 95{\%} CI, 1.15 to 1.54; P = .0001 for DFS; and HR 1.40; 95{\%} CI, 1.17 to 1.67; P = .0003 for OS). Conclusion: Tumor site has a significant prognostic utility, especially for axillary lymph node-negative disease, that should be considered in therapeutic algorithms. New staging procedures such as biopsy of the sentinel internal mammary nodes or novel imaging methods should be further studied in patients with medial tumors.",
author = "Marco Colleoni and David Zahrieh and Gelber, {Richard D.} and Holmberg, {Stig B.} and Mattsson, {Jan E.} and Rudenstam, {Carl Magnus} and Jurij Lindtner and Darja Eržen and Raymond Snyder and John Collins and Fey, {Martin F.} and Beat Th{\"u}rlimann and Diana Crivellari and Elizabeth Murray and Caesar Mendiola and Olivia Pagani and Monica Castiglione-Gertsch and Coates, {Alan S.} and Karen Price and Aron Goldhirsch",
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T1 - Site of primary tumor has a prognostic role in operable breast cancer

T2 - The International Breast Cancer Study Group experience

AU - Colleoni, Marco

AU - Zahrieh, David

AU - Gelber, Richard D.

AU - Holmberg, Stig B.

AU - Mattsson, Jan E.

AU - Rudenstam, Carl Magnus

AU - Lindtner, Jurij

AU - Eržen, Darja

AU - Snyder, Raymond

AU - Collins, John

AU - Fey, Martin F.

AU - Thürlimann, Beat

AU - Crivellari, Diana

AU - Murray, Elizabeth

AU - Mendiola, Caesar

AU - Pagani, Olivia

AU - Castiglione-Gertsch, Monica

AU - Coates, Alan S.

AU - Price, Karen

AU - Goldhirsch, Aron

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N2 - Purpose: Cancer presenting at the medial site of the breast may have a worse prognosis compared with tumors located in external quadrants. For medial tumors, axillary lymph node staging may not accurately reflect the metastatic potential of the disease. Patients and Methods: Eight-thousand four-hundred twenty-two patients randomly assigned to International Breast Cancer Study Group clinical trials between 1978 and 1999 were classified as medial site (1,622; 19%) or lateral, central, and other sites (6,800; 81%). Median follow-up was 11 years. Results: A statistically significant difference was observed for patients with medial tumors versus those with nonmedial tumors in disease-free survival (DFS; 10-year DFS, 46% v 48%; HR, 1.10; 95% CI, 1.02 to 1.18; P = .01) and overall survival (10-year OS 59% v 61%; HR, 1.09; 1.01 to 1.19; P = .04). This difference increased after adjustment for other prognostic factors (HR, 1.22; 95% CI, 1.13 to 1.32 for DFS; and HR, 1.24; 95% CI, 1.14 to 1.35 for OS; both P = .0001). The risk of relapse for patients with medial presentation was largest for the node-negative cohort and for patients with tumors larger than 2 cm. In the subgroup of 2,931 patients with negative axillary lymph nodes, 10-year DFS was 61% v 67%, and OS was 73% v 80% for medial versus nonmedial sites, respectively (HR 1.33; 95% CI, 1.15 to 1.54; P = .0001 for DFS; and HR 1.40; 95% CI, 1.17 to 1.67; P = .0003 for OS). Conclusion: Tumor site has a significant prognostic utility, especially for axillary lymph node-negative disease, that should be considered in therapeutic algorithms. New staging procedures such as biopsy of the sentinel internal mammary nodes or novel imaging methods should be further studied in patients with medial tumors.

AB - Purpose: Cancer presenting at the medial site of the breast may have a worse prognosis compared with tumors located in external quadrants. For medial tumors, axillary lymph node staging may not accurately reflect the metastatic potential of the disease. Patients and Methods: Eight-thousand four-hundred twenty-two patients randomly assigned to International Breast Cancer Study Group clinical trials between 1978 and 1999 were classified as medial site (1,622; 19%) or lateral, central, and other sites (6,800; 81%). Median follow-up was 11 years. Results: A statistically significant difference was observed for patients with medial tumors versus those with nonmedial tumors in disease-free survival (DFS; 10-year DFS, 46% v 48%; HR, 1.10; 95% CI, 1.02 to 1.18; P = .01) and overall survival (10-year OS 59% v 61%; HR, 1.09; 1.01 to 1.19; P = .04). This difference increased after adjustment for other prognostic factors (HR, 1.22; 95% CI, 1.13 to 1.32 for DFS; and HR, 1.24; 95% CI, 1.14 to 1.35 for OS; both P = .0001). The risk of relapse for patients with medial presentation was largest for the node-negative cohort and for patients with tumors larger than 2 cm. In the subgroup of 2,931 patients with negative axillary lymph nodes, 10-year DFS was 61% v 67%, and OS was 73% v 80% for medial versus nonmedial sites, respectively (HR 1.33; 95% CI, 1.15 to 1.54; P = .0001 for DFS; and HR 1.40; 95% CI, 1.17 to 1.67; P = .0003 for OS). Conclusion: Tumor site has a significant prognostic utility, especially for axillary lymph node-negative disease, that should be considered in therapeutic algorithms. New staging procedures such as biopsy of the sentinel internal mammary nodes or novel imaging methods should be further studied in patients with medial tumors.

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