<p>Tumor location of the central and nipple portion is associated with impaired survival for women with breast cancer</p>

Abstract

Background Tumor location in the breast varies, with the highest frequency in the upper outer quadrant and lowest frequency in the lower inner quadrant. Nevertheless, tumors in the central and nipple portion (TCNP) are poorly studied types of breast cancer; therefore, we aimed to clarify the clinicopathological characteristics and prognostic features of TCNP. Methods Using the Surveillance, Epidemiology, and End Results database, we identifed 105,037 patients diagnosed with tumor in the breast peripheral quadrant (TBPQ) (n=97,046) or TCNP (n=7,991). The chi-squared test was used to compare categorical variables across TCNP and TBPQ. Cox proportional hazard models with hazard ratios were applied to estimate the factors associated with prognosis. Results The median follow-up was over 43 months. Compared with TBPQ, TCNP patients were signifcantly older (age ≥66 years: 40.4% vs 34.1%, P<0.001), with larger tumor sizes (>20 mm size: 46.9% vs 37.3%, P<0.001), higher proportions of TNM stage II–III (18.6% vs 9.9%, P<0.001), and more mastectomies (58.1% vs 37.8%, P<0.001). The breast cancer-specifc survival (BCSS)/overall survival (OS) rate was signifcantly worse for TCNP than for TBPQ. Multivariate Cox analysis showed a higher hazard ratios for TCNP over TBPQ (BCSS: hazard ratios =1.160, P=0.005, 95% CI: 1.046–1.287; OS: hazard ratios =1.301, P<0.001, 95% CI: 1.211–1.398). A subgroup analysis revealed inferior outcomes for TCNP in TNM stage II–III and breast subtype subgroup. Multivariate logistic regression indicated that TCNP was an independent contributing factor to LN metastasis. Conclusions TCNP was associated with older age, larger tumor size, higher TNM stage, and lymph node metastasis. Compared with TBPQ, TCNP had adverse impacts on BCSS and OS.

Predictive Factors Among Clinicopathological Characteristics for Sentinel Lymph Node Metastasis in T1-T2 Breast Cancer

“…17 Previous studies have shown that breast cancer located closer to the nipple has a higher incidence of ALN metastasis than that located farther away. 5,7,9 In our study, an NTD of 20 mm was found to be the threshold value, and 22/180 (12.2%) of patients with an NTD <20 mm and 31/124 (25.0%) of those with an NTD ≥20 mm had SLN metastasis. The NTD was easily measured using slide calipers on a routine physical examination and was found to be a predictive factor of SLN metastasis.…”

“…Previous studies have also shown that the tumor size is a strong predictor of SLN and ALN metastasis. [5][6][7][8][9][10][11] It is reasonable to conclude that tumors closer to the rich plexus of lymphatics in the subareolar locations are likely to have strong access to the lymphatic network, thereby resulting in a greater risk of lymphatic dissemination and consequently ALN metastases. 17 Previous studies have shown that breast cancer located closer to the nipple has a higher incidence of ALN metastasis than that located farther away.…”

“…Previous studies have shown that clinicopathological features such as the tumor size, age at the diagnosis, body mass index (BMI), tumor location, etc., are related to SLN metastasis. [5][6][7][8][9][10][11] The association between cancer and diabetes has been reported by the American Diabetes Association and the American Cancer Society, including the relationship between diabetes and the cancer morbidity or prognosis, common risk factors for diabetes and cancer, and molecular mechanisms linking diabetes and cancer. 12,13 Diabetes is reportedly associated with an increased risk of breast cancer.…”

Primary Tumor Location is Associated with Prognosis for Women with Breast Cancer

“…Our nding is similar to Gill's study [14], which concluded that the HR of central tumors for overall survival was 1.46 mostly due to their more advanced stages. Besides, Ji et al also demonstrated tumors in the central and nipple portion is an independent adverse factor for BCSS and OS [13].…”

“…Meanwhile, patients with non-UOQ tumors especially lower inner quadrant (LIQ) have been demonstrated with worse survival [11,12]. Moreover, tumors in central portion have been veri ed to have a worse prognosis in some reports [13,14]. Furthermore, Kroman et al [15] found the risk of dying increased signi cantly (up to 21%) with increasing distance of tumor location from the axilla.…”