The impact of primary tumor site on breast cancer prognosis post breast-conserving surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHOU Dan , YIN Ansi , LI Yixian ,  ZUO Huaiquan

Department of Breast Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

ZUO Huaiquan, Email: 13982772996@163.com

Keywords：

breast cancer; primary tumor location; breast-conserving surgery; prognosis

DOI：

10.7507/1007-9424.202503041

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective The aim of this study is to investigate the impact of primary tumor location on the prognosis of breast cancer patients undergoing breast-conserving surgery. Methods Patient’s data were retrospectively collected from medical records of individuals who underwent breast-conserving surgery at the Affiliated Hospital of Southwest Medical University between January 2018 and December 2019. Results A total of 148 patients were included in this study. The distribution of tumors by location was as follows: the upper outer quadrant accounted for 52.0% (77/148), the lower outer quadrant for 14.2% (21/148), the upper inner quadrant for 14.9% (22/148), the lower inner quadrant for 12.2% (18/148), and the central region for 6.7% (10/148). No statistically significant differences were observed in the comparison of clinicopathological characteristics among breast cancer patients with tumors at different locations (P>0.05). Univariate survival analysis revealed significant correlations between patient prognosis and tumor location, size, molecular classification, WHO grading, as well as endocrine and radiotherapy treatments (P<0.05). Multivariate Cox proportional hazards regression analysis was conducted, and the results demonstrated that the location of the primary tumor serves as a prognostic factor for recurrence, metastasis, and death subsequent to breast-conserving surgery. Notably, in comparison with patients having tumors located in the upper outer quadrant, those with tumors positioned in the upper inner quadrant ［disease-free survival (DFS): HR=3.810, 95%CI (1.101, 13.192), P=0.035; overall survival (OS): HR=10.466, 95%CI (1.775, 61.723), P=0.009］ as well as those with tumors in the lower inner quadrant ［DFS: HR=4.296, 95%CI (1.423, 17.055), P=0.012; OS: HR=17.867, 95%CI (1.832, 174.224), P=0.013］ manifested higher risks of recurrence, metastasis, and death. Conclusions This study suggests that the location of the primary tumor in the inner quadrants is associated with an increased risk of recurrence, metastasis, and death in breast cancer patients following breast-conserving surgery. It is recommended that attention should be paid to this aspect in clinical decision-making.

Citation： ZHOU Dan, YIN Ansi, LI Yixian, ZUO Huaiquan. The impact of primary tumor site on breast cancer prognosis post breast-conserving surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(10): 1331-1338. doi: 10.7507/1007-9424.202503041 Copy

1.	Tian R, Zheng Y, Liu R, et al. Efficacy and safety of oncoplastic breast-conserving surgery versus conventional breast-conserving surgery: an updated meta-analysis. Breast, 2024, 77: 103784. doi: 10.1016/j.breast.2024.103784.
2.	赵乙壑. 中国早期乳腺癌保乳手术开展现状多中心调查研究. 济南: 山东大学, 2020.
3.	NIH consensus conference. Treatment of early-stage breast cancer. JAMA, 1991, 265(3): 391-395.
4.	Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet, 2011, 378(9804): 1707-1716.
5.	Si M, Jiao Y, Xu L, et al. Long-term outcomes of skin-sparing mastectomy and nipple-sparing mastectomy versus traditional mastectomy in breast cancer: a case-control study based on preoperative ultrasound and clinical indicators. World J Surg Oncol, 2025, 23(1): 52. doi: 10.1186/s12957-025-03695-4.
6.	Siotos C, McColl M, Psoter K, et al. Tumor site and breast cancer prognosis. Clin Breast Cancer, 2018, 18(5): e1045-e1052. doi: 10.1016/j.clbc.2018.05.007.
7.	Hwang KT, Kim J, Kim EK, et al. Poor prognosis of lower inner quadrant in lymph node-negative breast cancer patients who received no chemotherapy: a study based on nationwide Korean breast cancer registry database. Clin Breast Cancer, 2017, 17(4): e169-e184. doi: 10.1016/j.clbc.2016.12.011.
8.	Yang J, Tang S, Zhou Y, et al. Prognostic implication of the primary tumor location in early-stage breast cancer: focus on lower inner zone. Breast Cancer, 2018, 25(1): 100-107.
9.	Jayasinghe UW, Boyages J. Tumour location is not an independent prognostic factor for survival following a diagnosis of breast cancer. Breast, 2009, 18(1): 41-46.
10.	吴炜璐. 肿瘤位置对腋窝淋巴结阴性乳腺癌患者预后的影响. 桂林: 桂林医学院, 2020.
11.	王雨婷. 原发肿瘤位置对根治术后乳腺癌患者预后的影响. 天津: 天津医科大学, 2019.
12.	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2017年版). 中国癌症杂志, 2017, 27(9): 695-759.
13.	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2019年版). 中国癌症杂志, 2019, 29(8): 609-679.
14.	Giuliano AE, Connolly JL, Edge SB, et al. Breast cancer-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin, 2017, 67(4): 290-303.
15.	Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. Ⅰ. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology, 1991, 19(5): 403-410.
16.	中国抗癌协会乳腺癌专业委员会, 中华医学会肿瘤学分会乳腺肿瘤学组, 邵志敏. 中国抗癌协会乳腺癌诊治指南与规范 (2024年版). 中国癌症杂志, 2023, 33(12): 1092-1186.
17.	樊怡豪, 周逸倩, 杨玉丹, 等. 我国恶性肿瘤发病现状及流行趋势. 中国普外基础与临床杂志, 2025, 32(6): 669-676.
18.	Lei S, Zheng R, Zhang S, et al. Global patterns of breast cancer incidence and mortality: a population-based cancer registry data analysis from 2000 to 2020. Cancer Commun (Lond), 2021, 41(11): 1183-1194.
19.	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.
20.	Jagsi R, Li Y, Morrow M, et al. Patient-reported quality of life and satisfaction with cosmetic outcomes after breast conservation and mastectomy with and without reconstruction: results of a survey of breast cancer survivors. Ann Surg, 2015, 261(6): 1198-1206.
21.	Desai AA, Hoskin TL, Day CN, et al. Effect of primary breast tumor location on axillary nodal positivity. Ann Surg Oncol, 2018, 25(10): 3011-3018.
22.	Tan PH, Ellis I, Allison K, et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology, 2020, 77(2): 181-185.
23.	Ji F, Xiao WK, Yang CQ, et al. Tumor location of the central and nipple portion is associated with impaired survival for women with breast cancer. Cancer Manag Res, 2019, 11: 2915-2925.
24.	Song X, Zhang Q. The poor prognosis of lower-inner quadrant breast cancer in patients who received neoadjuvant chemotherapy. Ann Palliat Med, 2020, 9(4): 1859-1871.
25.	Wu S, Zhou J, Ren Y, et al. Tumor location is a prognostic factor for survival of Chinese women with T1-2N0M0 breast cancer. Int J Surg, 2014, 12(5): 394-398.
26.	申东星, 尚宇光, 韩慧娜, 等. 初诊乳腺癌内乳淋巴结转移的危险因素及临床意义. 中华肿瘤防治杂志, 2023, 30(17): 1040-1045.
27.	Gong J, Yu Y, Wu G, et al. Should internal mammary lymph node sentinel biopsy be performed in breast cancer: a systematic review and meta-analysis. World J Surg Oncol, 2019, 17(1): 135. doi: 10.1186/s12957-019-1683-8.
28.	毕钊, 邱鹏飞. 乳腺癌内乳区淋巴结诊疗的研究进展. 中国肿瘤临床, 2017, 44(21): 1104-1107.
29.	Suami H, Pan WR, Mann GB, et al. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol, 2008, 15(3): 863-871.
30.	Fu WD, Wang XH, Lu KK, et al. Real-world outcomes for Chinese breast cancer patients with tumor location of central and nipple portion. Front Surg, 2022, 9: 993263. doi: 10.3389/fsurg.2022.993263.
31.	Sohn VY, Arthurs ZM, Sebesta JA, et al. Primary tumor location impacts breast cancer survival. Am J Surg, 2008, 195(5): 641-644.
32.	Jung W, Kang E, Kim SM, et al. Factors associated with re-excision after breast-conserving surgery for early-stage breast cancer. J Breast Cancer, 2012, 15(4): 412-419.
33.	Shahar KH, Buchholz TA, Delpassand E, et al. Lower and central tumor location correlates with lymphoscintigraphy drainage to the internal mammary lymph nodes in breast carcinoma. Cancer, 2005, 103(7): 1323-1329.
34.	中华医学会外科学分会乳腺外科学组. 初诊MO伴内乳淋巴结和(或)锁骨上淋巴结转移乳腺癌临床诊治指南 (2023版). 中国实用外科杂志, 2023, 43(4): 384-386, 390.
35.	邱鹏飞, 王永胜. 乳腺癌内乳淋巴结精准分期与个体化治疗. 中国肿瘤外科杂志, 2020, 12(4): 306-310, 315.
36.	Qiu PF, Liu YB, Wang YS. Internal mammary sentinel lymph node biopsy: abandon or persist?. Onco Targets Ther, 2016, 9: 3879-3882.
37.	Kaidar-Person O, Giasafaki P, Boersma L, et al. Mapping the location of local and regional recurrences according to breast cancer surgery and radiation therapy: results from EORTC 22922/10925. Radiother Oncol, 2023, 185: 109698. doi: 10.1016/j.radonc.2023.109698.
38.	Gradishar WJ, Moran MS, Abraham J, et al. Breast cancer, version 3. 2024, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2024, 22(5): 331-357.
39.	Dominici L, Hu J, Zheng Y, et al. Association of local therapy with quality-of-life outcomes in young women with breast cancer. JAMA Surg, 2021, 156(10): e213758. doi: 10.1001/jamasurg.2021.3758.
40.	Aljarrah A, Nos C, Nasr R, et al. Updated follow-up of patients treated with the oncoplastic “Crescent” technique for breast cancer. Breast, 2012, 21(4): 475-479.
41.	Vrieling C, Collette L, Fourquet A, et al. The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC ‘boost vs. no boost’ trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. Radiother Oncol, 2000, 55(3): 219-232.
42.	Haloua MH, Volders JH, Krekel NM, et al. Intraoperative ultrasound guidance in breast-conserving surgery improves cosmetic outcomes and patient satisfaction: results of a multicenter randomized controlled trial (COBALT). Ann Surg Oncol, 2016, 23(1): 30-37.
43.	中国抗癌协会乳腺癌专业委员会, 中国医师协会外科医师分会乳腺外科医师委员会, 上海市抗癌协会乳腺癌专业委员会. 乳腺肿瘤整形与乳房重建专家共识 (2022年版). 中国癌症杂志, 2022, 32(9): 836-924.
44.	殷竹鸣, 尹健. 我国乳腺肿瘤整形外科的临床研究进展. 中国肿瘤临床, 2020, 47(5): 245-248.
45.	Moon JS, Lee YJ, Yoo TK, et al. Impact of tumor-to-nipple distance on outcomes in robotic nipple-sparing mastectomy and reconstruction. Discov Oncol, 2025, 16(1): 890. doi: 10.1007/s12672-025-02736-4.

1. Tian R, Zheng Y, Liu R, et al. Efficacy and safety of oncoplastic breast-conserving surgery versus conventional breast-conserving surgery: an updated meta-analysis. Breast, 2024, 77: 103784. doi: 10.1016/j.breast.2024.103784.
2. 赵乙壑. 中国早期乳腺癌保乳手术开展现状多中心调查研究. 济南: 山东大学, 2020.
3. NIH consensus conference. Treatment of early-stage breast cancer. JAMA, 1991, 265(3): 391-395.
4. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet, 2011, 378(9804): 1707-1716.
5. Si M, Jiao Y, Xu L, et al. Long-term outcomes of skin-sparing mastectomy and nipple-sparing mastectomy versus traditional mastectomy in breast cancer: a case-control study based on preoperative ultrasound and clinical indicators. World J Surg Oncol, 2025, 23(1): 52. doi: 10.1186/s12957-025-03695-4.
6. Siotos C, McColl M, Psoter K, et al. Tumor site and breast cancer prognosis. Clin Breast Cancer, 2018, 18(5): e1045-e1052. doi: 10.1016/j.clbc.2018.05.007.
7. Hwang KT, Kim J, Kim EK, et al. Poor prognosis of lower inner quadrant in lymph node-negative breast cancer patients who received no chemotherapy: a study based on nationwide Korean breast cancer registry database. Clin Breast Cancer, 2017, 17(4): e169-e184. doi: 10.1016/j.clbc.2016.12.011.
8. Yang J, Tang S, Zhou Y, et al. Prognostic implication of the primary tumor location in early-stage breast cancer: focus on lower inner zone. Breast Cancer, 2018, 25(1): 100-107.
9. Jayasinghe UW, Boyages J. Tumour location is not an independent prognostic factor for survival following a diagnosis of breast cancer. Breast, 2009, 18(1): 41-46.
10. 吴炜璐. 肿瘤位置对腋窝淋巴结阴性乳腺癌患者预后的影响. 桂林: 桂林医学院, 2020.
11. 王雨婷. 原发肿瘤位置对根治术后乳腺癌患者预后的影响. 天津: 天津医科大学, 2019.
12. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2017年版). 中国癌症杂志, 2017, 27(9): 695-759.
13. 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2019年版). 中国癌症杂志, 2019, 29(8): 609-679.
14. Giuliano AE, Connolly JL, Edge SB, et al. Breast cancer-major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin, 2017, 67(4): 290-303.
15. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. Ⅰ. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology, 1991, 19(5): 403-410.
16. 中国抗癌协会乳腺癌专业委员会, 中华医学会肿瘤学分会乳腺肿瘤学组, 邵志敏. 中国抗癌协会乳腺癌诊治指南与规范 (2024年版). 中国癌症杂志, 2023, 33(12): 1092-1186.
17. 樊怡豪, 周逸倩, 杨玉丹, 等. 我国恶性肿瘤发病现状及流行趋势. 中国普外基础与临床杂志, 2025, 32(6): 669-676.
18. Lei S, Zheng R, Zhang S, et al. Global patterns of breast cancer incidence and mortality: a population-based cancer registry data analysis from 2000 to 2020. Cancer Commun (Lond), 2021, 41(11): 1183-1194.
19. 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.
20. Jagsi R, Li Y, Morrow M, et al. Patient-reported quality of life and satisfaction with cosmetic outcomes after breast conservation and mastectomy with and without reconstruction: results of a survey of breast cancer survivors. Ann Surg, 2015, 261(6): 1198-1206.
21. Desai AA, Hoskin TL, Day CN, et al. Effect of primary breast tumor location on axillary nodal positivity. Ann Surg Oncol, 2018, 25(10): 3011-3018.
22. Tan PH, Ellis I, Allison K, et al. The 2019 World Health Organization classification of tumours of the breast. Histopathology, 2020, 77(2): 181-185.
23. Ji F, Xiao WK, Yang CQ, et al. Tumor location of the central and nipple portion is associated with impaired survival for women with breast cancer. Cancer Manag Res, 2019, 11: 2915-2925.
24. Song X, Zhang Q. The poor prognosis of lower-inner quadrant breast cancer in patients who received neoadjuvant chemotherapy. Ann Palliat Med, 2020, 9(4): 1859-1871.
25. Wu S, Zhou J, Ren Y, et al. Tumor location is a prognostic factor for survival of Chinese women with T1-2N0M0 breast cancer. Int J Surg, 2014, 12(5): 394-398.
26. 申东星, 尚宇光, 韩慧娜, 等. 初诊乳腺癌内乳淋巴结转移的危险因素及临床意义. 中华肿瘤防治杂志, 2023, 30(17): 1040-1045.
27. Gong J, Yu Y, Wu G, et al. Should internal mammary lymph node sentinel biopsy be performed in breast cancer: a systematic review and meta-analysis. World J Surg Oncol, 2019, 17(1): 135. doi: 10.1186/s12957-019-1683-8.
28. 毕钊, 邱鹏飞. 乳腺癌内乳区淋巴结诊疗的研究进展. 中国肿瘤临床, 2017, 44(21): 1104-1107.
29. Suami H, Pan WR, Mann GB, et al. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol, 2008, 15(3): 863-871.
30. Fu WD, Wang XH, Lu KK, et al. Real-world outcomes for Chinese breast cancer patients with tumor location of central and nipple portion. Front Surg, 2022, 9: 993263. doi: 10.3389/fsurg.2022.993263.
31. Sohn VY, Arthurs ZM, Sebesta JA, et al. Primary tumor location impacts breast cancer survival. Am J Surg, 2008, 195(5): 641-644.
32. Jung W, Kang E, Kim SM, et al. Factors associated with re-excision after breast-conserving surgery for early-stage breast cancer. J Breast Cancer, 2012, 15(4): 412-419.
33. Shahar KH, Buchholz TA, Delpassand E, et al. Lower and central tumor location correlates with lymphoscintigraphy drainage to the internal mammary lymph nodes in breast carcinoma. Cancer, 2005, 103(7): 1323-1329.
34. 中华医学会外科学分会乳腺外科学组. 初诊MO伴内乳淋巴结和(或)锁骨上淋巴结转移乳腺癌临床诊治指南 (2023版). 中国实用外科杂志, 2023, 43(4): 384-386, 390.
35. 邱鹏飞, 王永胜. 乳腺癌内乳淋巴结精准分期与个体化治疗. 中国肿瘤外科杂志, 2020, 12(4): 306-310, 315.
36. Qiu PF, Liu YB, Wang YS. Internal mammary sentinel lymph node biopsy: abandon or persist?. Onco Targets Ther, 2016, 9: 3879-3882.
37. Kaidar-Person O, Giasafaki P, Boersma L, et al. Mapping the location of local and regional recurrences according to breast cancer surgery and radiation therapy: results from EORTC 22922/10925. Radiother Oncol, 2023, 185: 109698. doi: 10.1016/j.radonc.2023.109698.
38. Gradishar WJ, Moran MS, Abraham J, et al. Breast cancer, version 3. 2024, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2024, 22(5): 331-357.
39. Dominici L, Hu J, Zheng Y, et al. Association of local therapy with quality-of-life outcomes in young women with breast cancer. JAMA Surg, 2021, 156(10): e213758. doi: 10.1001/jamasurg.2021.3758.
40. Aljarrah A, Nos C, Nasr R, et al. Updated follow-up of patients treated with the oncoplastic “Crescent” technique for breast cancer. Breast, 2012, 21(4): 475-479.
41. Vrieling C, Collette L, Fourquet A, et al. The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC ‘boost vs. no boost’ trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. Radiother Oncol, 2000, 55(3): 219-232.
42. Haloua MH, Volders JH, Krekel NM, et al. Intraoperative ultrasound guidance in breast-conserving surgery improves cosmetic outcomes and patient satisfaction: results of a multicenter randomized controlled trial (COBALT). Ann Surg Oncol, 2016, 23(1): 30-37.
43. 中国抗癌协会乳腺癌专业委员会, 中国医师协会外科医师分会乳腺外科医师委员会, 上海市抗癌协会乳腺癌专业委员会. 乳腺肿瘤整形与乳房重建专家共识 (2022年版). 中国癌症杂志, 2022, 32(9): 836-924.
44. 殷竹鸣, 尹健. 我国乳腺肿瘤整形外科的临床研究进展. 中国肿瘤临床, 2020, 47(5): 245-248.
45. Moon JS, Lee YJ, Yoo TK, et al. Impact of tumor-to-nipple distance on outcomes in robotic nipple-sparing mastectomy and reconstruction. Discov Oncol, 2025, 16(1): 890. doi: 10.1007/s12672-025-02736-4.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The impact of primary tumor site on breast cancer prognosis post breast-conserving surgery

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