Quality of life in patients with multicentric breast cancer

One of the main issues in the treatment of multicentric breast cancer (BC) is to choose the type of surgery (paying attention to the tendency to reduce the volume of surgical interventions). Many studies have demonstrated an adverse effect of this form of BC on long‑term survival outcomes (increased risk of recurrence, decreased overall survival rates, etc.). However, none of the studies examined the effect of surgery extent on the quality of life of these patients.

Objective. To assess the effect of the surgery type on the quality of life of patients with multicentric BC.

Materials and methods. 190 patients were included in the study. The median follow‑up was 72 (7–116) months. Age ranged from 27 to 76 years. The majority of patients (150 women, 78.9 %) had luminal HER2‑negative tumors, while «aggressive» (HER2‑overexpressing, triple negative) subtypes were detected in 40 (21.1 %) of them. 134 patients underwent radical mastectomy (40 of which also had immediate breast reconstruction), 56 received breast‑conserving surgery. Statistically significant differences were not observed among stages III and I–II BC (p = 0.125). The quality of life was assessed with the use of EORTC QLQ-C30 and EORTC QLQ-BR23 scales at ≥ 12 months after performing surgical treatment.

Results. The quality of life was assessed depending on the type of surgical intervention. The patients after breastconserving surgery and immediate breast reconstruction demonstrated a significant advantage, primarily in the general perception of one's own health (p < 0.05) and emotional status (p < 0.05). Also, there were no significant differences in quality of life between the groups of patients after breast‑ conserving surgery and immediate breast reconstruction.

Conclusion. Due to the increase in the life expectancy of breast cancer patients, the issues of maintaining a high quality of life are becoming increasingly important. From this point of view, performing breast‑ conserving and reconstructive surgeries is preferable for patients with multicentric BC.

1. Каприн А. Д., В. В. Старинский В. В., Петрова Г. В. Злокачественные новообразования в России в 2018 году (заболеваемость и смертность) — М.: МНИОИ им. П. А. Герцена — филиал ФГБУ «НМИЦ радиологии» Минздрава России, — 2019. — илл. — 250 с.

2. Каприн А. Д., В. В. Старинский В. В., Петрова Г. В. Состояние онкологической помощи населению России в 2018 году. — М.: МНИОИ им. П. А. Герцена — филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2019. илл.— 236 с.

3. Coombs N. J. Multifocal and Multicentric Breast Cancer: Does Each Focus Matter? / N. J. Coombs, J. Boyages // Journal of Clinical Oncology.— 2005.— Vol. 23.— № 30.— P. 7497–7502.

4. Egan R. L. Multicentric breast carcinomas: Clinical ‑ radiographic‑ pathologic whole organ studies and 10‑year survival / R. L. Egan // Cancer.— 1982.— Vol. 49.— № 6.— P. 1123–1130.

5. Fang M. Local Control of Breast Conservation Therapy versus Mastectomy in Multifocal or Multicentric Breast Cancer: A Systematic Review and Meta‑Analysis / M. Fang, X. Zhang, H. Zhang, et al. // Breast Care.— 2019.— Vol. 14.— № 4.— P. 188–193.

6. Houssami N. Accuracy and Surgical Impact of Magnetic Resonance Imaging in Breast Cancer Staging: Systematic Review and Meta‑Analysis in Detection of Multifocal and Multicentric Cancer / N. Houssami, S. Ciatto, P. Macaskill, et al. // Journal of Clinical Oncology.— 2008.— Vol. 26.— № 19.— P. 3248–3258.

7. Lagios M. D. Multicentricity of breast carcinoma demonstrated by routine correlated serial multicentric breast carcinoma subgross and radiographic examination / M. D. Lagios // Cancer.— 1977.— Vol. 40.— № 4.— P. 1726–1734.

8. Rosen P. P. «Residual» mammary carcinoma following simulated partial mastectomy / P. P. Rosen, A. A. Fracchia, J. A. Urban, et al. // Cancer.— 1975.— Vol. 35.— № 3.— P. 739–747.

9. Lim W. Breast Conserving Surgery for Multifocal Breast Cancer: / W. Lim, E.‑H. Park, S.‑L. Choi, et al. // Annals of Surgery.— 2009.— Vol. 249.— № 1.— P. 87–90.

10. Neri A. «Clinical significance of multifocal and multicentric breast cancers and choice of surgical treatment: a retrospective study on a series of 1158 cases» / A. Neri, D. Marrelli, T. Megha, et al. // BMC Surgery.— 2015.— Vol. 15.— № 1.

11. Joergensen L. E. Multifocality as a prognostic factor in breast cancer patients registered in Danish Breast Cancer Cooperative Group (DBCG) 1996–2001 / L. E. Joergensen, K. A. Gunnarsdottir, C. Lanng, et al. // The Breast.— 2008.Vol. 17.— № 6.— P. 587–591.

12. Fayers P., Aarson N., Bjordal K., Sullivan M. EORTC QLQ-C30 scoring manual. EORTC Study Group on Quality of Life. Brussels, 1995.

13. Sprangers, M. A. G., Groenvold, M., Arraras, J. I., et al. (1996). the EORTC breast cancer‑ specific quality‑ of‑life questionnaire module: First results from a three‑ country field study. J Clin Oncol / 1996 Oct;14 (10):2756–68. doi: 10.1200/JCO.1996.14.10.2756.

14. Arndt V. Quality of life over 5 years in women with breast cancer after breast‑ conserving therapy versus mastectomy: a population ‑based study / V. Arndt, C. Stegmaier, H. Ziegler, et al. // Journal of Cancer Research and Clinical Oncology.— 2008.— Vol. 134.— № 12.— P. 1311–1318.

15. Engel J. Quality of Life Following Breast‑ Conserving Therapy or Mastectomy: Results of a 5‑Year Prospective Study / J. Engel, J. Kerr, A. Schlesinger‑Raab, et al. // The Breast Journal.— 2004.— Vol. 10.— № 3.— P. 223–231.

16. Howes B. H. L. Quality of life following total mastectomy with and without reconstruction versus breast‑ conserving surgery for breast cancer: A case‑ controlled cohort study / B. H. L. Howes, D. I. Watson, C. Xu, et al. // Journal of Plastic, Reconstructive & Aesthetic Surgery.— 2016.— Vol. 69.— № 9.— P. 1184–1191.

17. Shi H. Y. Two ‑year quality of life after breast cancer surgery: A comparison of three surgical procedures / H. Y. Shi, Y. H. Uen, L. C. Yen, et al. // European Journal of Surgical Oncology (EJSO).— 2011.— Vol. 37.— № 8.— P. 695–702.

18. Szutowicz ‑Wydra B. Same Quality of Life for Polish Breast Cancer Patients Treated with Mastectomy and Breast Reconstruction or Breast‑ Conserving Therapy. / B. Szutowicz‑Wydra, J. Wydra, W. Kruszewski, et al.— 2016.— Vol. 88.— № 5.— P. 264–269.

19. Janz N. K. Population‑based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer / N. K. Janz, M. Mujahid, P. M. Lantz, et al. // Quality of Life Research.— 2005.— Vol. 14.— № 6.— P. 1467–1479.

20. Heneghan H. M. Quality of life after immediate breast reconstruction and skin‑ sparing mastectomy — A comparison with patients undergoing breast conserving surgery / H. M. Heneghan, R. S. Prichard, R. Lyons, et al. // European Journal of Surgical Oncology (EJSO).— 2011.— Vol. 37.— № 11.— P. 937–943.

21. Zehra S. Health‑related quality of life following breast reconstruction compared to total mastectomy and breastconserving surgery among breast cancer survivors: a systematic review and meta‑analysis / S. Zehra, F. Doyle, M. Barry, et al. // Breast Cancer.— 2020.