P3-14-16: Molecular Phenotype and the Use of HER-2 Targeted Agents Influence the Accuracy of Breast MRI after Neoadjuvant Chemotherapy

Background: Improved understanding of factors affecting the accuracy of breast magnetic resonance imaging (MRI) after neoadjuvant systemic therapy (NST) can lead to more tailored use of MRI in deciding surgical extent after NST.

Materials and Methods: We analyzed the imaging and clinicopathologic data of 463 patients who underwent NST. We aimed to investigate whether the molecular subtypes, as well as the use of targeted therapies, were associated with changes in the accuracy of MRI predicting residual tumor extent.

Results: The accuracy of MRI predicting the residual tumor extent was most accurate in triple negative breast cancer and was least accurate in Luminal A subtype (Pearson's correlation coefficient of 0.754 and 0.531, respectively). Multivariate analysis suggested estrogen receptor status as an independent factor influencing the MRI accuracy. In HER2−amplified tumors, the use of HER2−targeted agents was associated with less accurate MRI prediction. Dual HER2−blockade by using trastuzumab and pertuzumab resulted in lowest MRI accuracy among the patients treated with HER2−targeted agents.

Conclusion: The accuracy of MRI in predicting residual tumor extent was lowest in ER positive tumors treated with NST. In HER2 positive tumors, the use of HER2−targeted agents resulted in less accurate MRI after NST.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-14-16.

P2-08-12: Additional Lesion Found in Preoperative Breast MRI; Is Routine Use Justified?

Preoperative breast MRI has been increasingly performed in patients with newly diagnosed breast cancer due to its high sensitivity in assessing the extent and additional malignant foci. But due to it's low specificity, role of routine preoperative breast MRI has become an issue. In this study we aught to analyze the characteristics of the additional lesion found in preoperative breast MRI and to evaluate the clinicopathological factors in association with likelihood of having additional malignancy.

We retrospectively reviewed 2491 patients who undergone surgery due to breast cancer in Seoul National University Hospital(SNUH) between Jan 2006 and Dec 2010. Neoadjuvant chemotherapy cases, patients undergone initial sonography in other center or ones with prior excision were excluded and total 1068 patients were analyzed. The additional lesion was defined as the lesion not found in initial sonography and detected in preoperative breast MRI. The pathology of the additional lesion was reviewed and the association between the clinicopathologic factors and additional malignancy were evaluated. Accuracy of breast MRI was estimated regarding cancer yield, positive predictive value(PPV).

Mean age at diagnosis was 50.9 years (21 to 85 years). Overall detection rate of additional lesion was 26.2%(280 out of 1068). Mean size of the additional lesion was 9.8mm(3-51). Additional lesions consist of 99(35.4% of 280) C4 or higher, 174(62.1% of 280) below C4, 7(2.5% of 280) C0 lesions. Among them 100 patients undergone onstage surgery. 5(55% of 100) lesions were in ipsilateral breast and 45(45% of 100) in contralateral breast. Breast conserving surgery and mastectomy rate of the 100 onstage-operation group was 36% versus 64% and 64.6% versus 35.4% in total 1068 patients, showing no significant change of operation method of the primary cancer owing to additional lesion.

Among the 100 patients, 54(19.3% of 280) were benign, 3(1.1% of 280) were atypical ductal hyperplasia, 13(4.6% of 280) were in situ carcinoma, 19(6.8% of 280) were invasive carcinoma and 11(3.9% of 280) were unknown. Cancer yield was 2.99%(32 out of 1068) and PPV of preoperative breast MRI was 39.0%(31 out of 82).

In univariate analysis, young age and premenopausal patients showed to have higher rate of additional cancer found in MRI(p=0.022, p=0.036). Breast density, size and LN status of the primary cancer didn't show significancy and neither the hormone receptor status with each p value 0.705, 0.381, 0.973, 0.375 respectively. Lobular carcinoma(ILC or mixed IDC with ILC) and low grade carcinoma showed significancy of having additional malignancy (p=0.019, 0.022). In multivariate analysis age, low grade carcinoma and lobular carcinoma showed independent association with p value 0.014, 0.039, 0.035 respectively(HR 0.95, 95%CI:0.94 o 0.99),(HR 0.39, 95%CI:0.16 to 0.96),(HR 5.66, 95%CI:1.13 to 28.39).

Routine preoperative breast MRI use can result in overtreatment also with delay in surgical management. In our data, younger age, low grade carcinoma, lobular carcinoma showed independent association having additional malignant foci in breast MRI. With the basis of mammography and sonography, preoperative breast MRI should only be done when additional gain is considered to overcome the flaws.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-12.

CYP2D6 and ESR genotypes in adjuvant tamoxifen treatment for early breast cancer

142

Background: The pharmacokinetics and pharmacodynamics of tamoxifen may influence the clinical outcome and tolerability of adjuvant treatment with tamoxifen in breast cancer. We investigated the effects of polymorphisms of CYP2D6, ESR1, and ESR2 for tamoxifen therapy in early stage breast cancer patients.

Methods: Tissue DNA from 187 patients who received tamoxifen only as an adjuvant systemic therapy between 1997 and 2002 were extracted and genotyped for polymorphisms of CYP2D6 (*2A, *10, *14, *41) and estrogen receptor (ESR1, ESR2). While CYP2D6*10, *14 and *41 have been reported to be associated with decreased activation of tamoxifen, CYP2D6*2A, ESR1 PvuII CC and ESR2-02 GG have been associated with enhanced activity of tamoxifen. Statistical analyses include Fisher exact test, Chi-square and Kaplan-Meier analyses.

Results: Median age was 43 years (range 25-49). Most of the patients (170/187) were stage I, while other patients were stage 0 (1/187) and stage II (17/187). None of the patients had nodal metastasis. Median follow-up was 100 months (7-166). Allele frequencies were as follows: CYP2D6*10, 0.69; *14, 0.02; *41, 0.01; *2A, 0.64; ESR1 PvuII C allele, 0.25; ESR2-02 G allele, 0.98. Each genotype group did not show significant differences in age, stage, pT, tumor size and follow up period. Twelve percent (24/187) had received tamoxifen therapy for less than 24 months. Of the 24 patients, 67% (16) discontinued tamoxifen therapy related to tolerability issues. Recurrence occurred in 12 patients (6.4%). There was no association between genotypes with either recurrence or tamoxifen duration < 2 years. Although statistically nonsignificant, patients with either CYP2D6*2A homozygote, ESR1 PvuII CC genotype, ESR2-02 GG genotype tended to have a longer DFS when compared concomitantly to wild-type (p=0.445).

Conclusions: Polymorphsims for CYP2D6*2A,*10, *14, *41, ESR1 PvuII, ESR2-02 did not show significant associations with either recurrence or tamoxifen duration > 2 years. However, grouped analysis for CYP2D6*2A, ESR1 PvuII, ESR2-0210 genotypes need further evaluation regarding with tamoxifen outcome.

Risk factor for axillary lymph node metastases in microinvasive breast cancer

17

Background: Sentinel lymph node biopsy (SLNB) in patients with ductal carcinoma in situ (DCIS) was controversial. Usually we didn’t SLNB when we performed conserving operation with small sized DCIS. But sometimes we can find DCIS with microinvasive breast cancer (MIC) after operation. Must do reoperation in all patients? We determined the incidence of positive axillary lymph node (ALN) in patients with MIC and the predictive factors of ALN metastases in these patients.

Methods: Between July 1989 and December 2008, 9.635 patients had operation on invasive breast cancer in Asan Medical Center. Among these patients 319 patients had MIC. The research conducted on the 293 patients except who didn’t performed axillary lymph node dissection or SLN biopsy. We retrospectively checked clinical and pathologic variables.

Results: There were 22 cases of ALN metastases identified in this group of patients (7.5%). Lymphatic invasion (p<0.001) and positive estrogen receptor status (p=0.03) were independent significant predictors of axillary metastases.

Conclusions: Microinvasive breast cancer is associated with a low rate of lymph node metastases. Some breast cancer patients with MIC at low likelihood of lymph node metastases may be spared lymph node evaluation.

Change of serum vitamin D according to the breast cancer treatment

172

Background: Vitamin D deficiency is associated with increased breast cancer risk and decreased breast cancer survival. The purpose of this study was to determine the effect of breast cancer adjuvant treatment to the vitamin D status, as measured by the serum hydroxyvitamin D (25OHD) in breast cancer patients.

Methods: For 589 patients who was diagnosed as a non metastatic breast cancer in 2009 at the asan medical center, blood was prospectively analyzed in batches for serum 25 OHD level at basal and at 6 and 12month. We excluded the patients who took a vitamin D supplementation and got a neoadjuvant chemotherapy. Vitamin D sufficiency was defined as serum as 30ng/ml or greater, insufficiency as 20 to 29 ng/ml and insufficiency as less than 20ng/ml.

Results: At baseline, mean serum 25OHD was greater in summer (April to Oct) than Winter (Nov to May ) (28.2ng/ml vs 32.9ng/ml respectively, p=0.000). The patients who did not get a chemotherapy and anti-hormonal therapy as baseline, the patient with chemotherapy showed decreased serum 25OHD level than who without chemotherapy in 6 month but not in 12 month (p=0.003, vs p=0.156 respectively). The patients who had taken anti-hormonal therapy showed significant increasing serum 25OHD in 6 month and 12 months (p=0.000 both). For the patients who got both chemotherapy and anti-hormonal therapy, the changes of serum 25OHD level is smaller than the patients who got a chemotherapy only. For the patients who got a chemotherapy, 57% of patients were vitamin D sufficient at baseline, but 27% of patients in 6 month and 49% in 12 month (p=0.001).

Conclusions: Vitamin D status was worse during chemotherapy but recovered after chemotherapy. Antihormonal therapy make the serum vitamin D level increased. The translational research about the effect of chemotherapy and antihormonal therapy to the vitamin D status should be warranted.

LED-based interferometric reflectance imaging sensor for quantitative dynamic monitoring of biomolecular interactions

Label-free optical biosensors have been established as proven tools for monitoring specific biomolecular interactions. However, compact and robust embodiments of such instruments have yet to be introduced in order to provide sensitive, quantitative, and high-throughput biosensing for low-cost research and clinical applications. Here we present the Interferometric Reflectance Imaging Sensor (IRIS) using an inexpensive and durable multi-color LED illumination source to monitor protein-protein and DNA-DNA interactions. We demonstrate the capability of this system to dynamically monitor antigen-antibody interactions with a noise floor of 5.2 pg/mm(2) and DNA single mismatch detection under denaturing conditions in an array format. Our experiments show that this platform has comparable sensitivity to high-end label-free biosensors at a much lower cost with the capability to be translated to field-deployable applications.

Prognostic Effect of Sesrum 25 Hydroxyvitamin D Levels in Breast Cancer Patients

BackgroundThere is increasing evidence that vitamin D has been linked to breast cancer risk, but prognosis effect are unknown. We investigated the possible association between vitamin D and breast cancer prognosis by comparing serum vitamin D levelMethodsFrom June to December 2006, serum 25 OHD were measured in 310 Korean women with breast cancer at the Asan Medical Center. Clinical, Pathologic, and dietary data were accessed to examine prognostic effects of serum 25 OHDResultsMean age was 48.7 years, mean serum 25OHD was 31.4±16.1ng/ml. 25OHD levels were deficient(&lt;20ng/ml) in 24.2%, insufficient (20-29ng/ml) in 30.6%, and sufficient(30-150ng/ml) in 24.0%. Mean follow up was 30 months: 31 had recurrences. Women with deficient 25 OHD levels had an increased risk of recurrence(HR=2.93;95% CI=1.27 to 6.77) compared with those with sufficient levels. 25OHD levels were inversely associated with prognosis of hormone receptor positive tumors, but not with hormone receptor negative tumors(HR=5.73 95CI=1.82 to 18.06 for hormone receptor positive tumor, HR=1.142, 95%CI =0.33 to 3.92 for hormone receptor negative tumor). The association remained after individual adjustment for age, tumor size, nodal status, estrogen receptor status (HR=4.13 95%CI=1.77 to 9.61) .ConclusionVitamin D deficiency may be associated with poor outcomes in hormone receptor positive breast cancer patients.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1052.

Impact of Primary Site Surgical Resection on Survival in Stage IV Breast Cancer

Background: Currently, primary treatments for stage IV breast cancer are radiation and systemic therapy which include chemotherapy, endocrine therapy and targeted therapy. Surgical resection of primary tumor is usually done for tumor-related complications. A recent review suggested that surgery may improve long-term survival in stageIV breast cancer patients. We evaluated the impact of primary site surgical resection on survival in such patients.Material and Methods: We reviewed the records of stage IV breast cancer patients treated at Seoul National University Hospital between 1992 and 2008. Clinical and tumor characteristics, systemic and local treatments were compared for the surgically versus nonsurgically treated patients.Results: Of 199 patients identified, 111(55.8%) recevied surgical excision of their primary tumor and 88(44.2%) did not. The mean survival of surgically treated patients was 67 months versus 52 months for patients those who did not(p=0.0276). In multivariate analysis, after adjustment for ER status, visceral metastasis, number of metastatic sites and herceptin treatment, surgery remained an independent factor associated with improved survival(HR 0.547[95%CI 0.359-0.971] p=0.001).Discussion: Surgical resection of the primary tumor in stage IV breast cancer patient was independently associated with improved survival, even after adjustment for other factors associated with survival. Randomized prospective trials are needed to validate these findings.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3117.

Triple Negative Breast Cancer Has a Worse Prognosis within 3 Years after Treatment Compared to Non-Triple Negative Breast Cancer

BackgroundTriple negative breast cancers (TNBC) become known as poor prognosis generally. Our purpose was to compare the clinical features and outcomes for TNBC with other subtypes of breast cancers in Korea.MethodsWe included 2,907 patients who diagnosed breast cancer and treated at Asan Medical Center from 2003 to 2005. Clinical and pathologic parameters, disease-free survival (DFS) and overall survival (OS) were compared between patients with TNBC and non-TNBC. All features were reviewed throughout medical records retrospectively.Results622 patients (21.4%) had TNBC. TNBC patients was associated with younger age, larger size, positive nodal involvement, overweight, family history, elevation of CaAg15-3, high tumor grade, positive p53 compared non-TNBC. The patients were followed for a median of 54 months (range 1-76 months). Relapse-free survival was 86.3% and 92.6% for TNBC and non-TNBC, respectively, with significant difference (P&lt;0.0001). Overall survival was also 88.9% and 96.1% for TNBC and non-TNBC (P&lt;0.0001). Compared with non-TNBC patients, TNBC had an increased likelihood of recurrence and death within 3 years after diagnosis but not thereafter. In non-TNBC, the recurrence risk and death risk seemed to be relatively constant. In univariate analysis for worse prognostic factors of TNBC associated with DFS and OS revealed that statistically significant in large tumor size, nodal status, CA15-3, Lymphovascular invasion. In multivariate analysis, nodal status was a prognostic factor for DFS (P=0.06, HR=2.28; 95% CI, 0.92-3.04) and OS (P&lt;0.0001, HR=5.22; 95% CI, 2.11-12.96) of TNBC. Lymphovascular invasion was only poor prognostic factor for DFS (P=0.026, HR=10.2, 95% CI, 1.31-76.8), not for OS.ConclusionsTNBC has a worse prognosis than non-TNBC patients, but this effect is limited within 3 years after diagnosis. The most competent prognostic factor of recurrence and death for TNBC is a nodal status. We plan that perform analysis for prognosis according to hormone receptor and HER-2 receptor status sooner.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4044.

Can We Skip Sentinel Lymph Node Biopsy in Patients Who Have Microinvasive Breast Cancer?

Background: Sentinel lymph node(SLN) biopsy in patients with ductal carcinoma in situ(DCIS) was controversial. We may skip SLN biopsy when we performed conserving operation with small sized DCIS. But sometimes we can find DCIS with micro-invasive breast cancer (MIC) after operation. Should another operation be performed? We determined the incidence of positive axillary lymph node (ALNs) in patients with MIC, and the predictive factors of ALNs metastasis in these patients. Methods: Between July 1989 and January 2008, 9046 patients had operations performed on invasive breast cancers at Asan Medical Center. From July1989 to February 2003, ALND was performed to surgically stage the axilla. Since May 2003, SNB has been routinely performed for all cases. Patients who were treated with neoadjuvant chemotherapy and those who had no identifiable ALNs at surgery were excluded from the study. We retrospectively checked clinical and pathologic variables including diagnosis, patient demographics, size of DCIS, grade, multi-focal lesion, hormone receptor status, lymphatic invasion status etc. Results: 265 patients were identified with microinvasive (pathologic stage T1mic) breast cancer. Among these patients, 12 patients didn't have ALN study. 2 patients had bilateral MIC. The research was conducted on the remaining 255 cases. There were 13 cases of ALN metastases identified in this group of patients(5%). Young age (p=0.006), multifocal lesion (p=0.040) and lymphatic invasion (p&lt;0.0001) were predictive factors for ALN metastases. There was no incidence of metastatic ALNs among the old age (≥50) patients of this group. Conclusion: As the incidence of ALN metastases in MIC patients is very small, particularly in those who had no lymphatic invasion, single lesion and among old age patients. So we think conservative treatment is one of the available options for these patients. However, due to the size of the subject group in this study, it needs to be validated through extensive prospective research.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1019.

Clinical features and course of brain metastases in triple-negative breast cancer: Comparison with HER2+ and other type

1064

Background: Incidences and clinical aggressiveness of intracranial metastasis in triple negative (TN) breast cancer have not been well delineated compared to HER2+ subtype. Methods: Patients (pts) who were diagnosed with primary breast cancer at Asan Medical Center from January 1990 to July 2006 were screened (Lee SS, Breast Cancer Res Treat. 2008). All pts with brain metastases, identified by CT or MRI, were included and classified into three subtypes (TN, HER2+ and other). The clinical features and course of brain metastases with TN breast cancer, defined according to immunohistochemical staining and HER2 FISH analysis, were reanalyzed and compared among three groups. Results: Of 7,872 breast cancer pts, 198 pts developed brain metastases and 61 pts with unknown ER, PR, or HER2 status were excluded. Of 137 pts, incidences of TN, HER2+ and other group were 32% (44), 50% (69), and 18% (24), respectively. The median age at the time of brain metastases was 46 years (yr) (range 29–70 yr) in TN group, 48 yr (range 27–78 yr) in HER2 group, and 37 yr (range 25–62 yr) in other group with no significant difference. Clinical parameters such as performance status, previous adjuvant chemotherapy or radiotherapy, was similarly distributed among groups except that pts with earlier stages (I, II) were more prevalent in TN group compared to other two groups (59% vs 36% vs 38%, p = 0.01). With a median follow-up duration of 99 months (m), the median time from initial diagnosis of primary breast cancer to brain metastases was significantly shorter in TN group, compared with other two groups (TN, HER2, other; 20 m vs 32 m vs 45 m, p = 0.01) and the one from diagnosis of primary cancer to the first distant metastases at any sites was also shorter (16 m vs 23 m vs 23 m, p = 0.005). The median overall survival from diagnosis of primary cancer was significantly shorter in TN group (31 m vs 39 m vs 57 m, p = 0.02) and however, the one after brain metastases was not different among 3 groups (5.9 m vs 5.2 m vs 8.8 m, p = 0.31). Conclusions: TN breast cancer showed earlier brain metastases, earlier distant metastases at any sites and shorter overall survival in spite of high proportion of early stages, compared with other phenotypes. Preventive and therapeutic strategies of brain metastases in TN breast cancer are urgently needed.

No significant financial relationships to disclose.

Nipple areola skin-sparing mastectomy with TRAM flap reconstruction: Single-center study

632

Background: Cosmetic aspect of breast cancer treatment becomes important. The originally described technique of Skin sparing mastectomy (SSM) included the removal of gland, nipple areola complex (NAC), and biopsy scar. However, the risk of tumor involvement of NAC in patients with breast cancer has been overestimated. The purpose of this study is to evaluate the oncological safety and technical outcomes of nipple areola skin sparing mastectomy (NA-SSM) compared with SSM. Methods: This retrospective study includes 522 patients who underwent immediate breast reconstruction using pedicled transverse rectus abdominis musculocutaneous (TRAM) flap between July 2001 and December 2006. The indication of NA-SSM in this study was defined as being for any stage, any tumor size and any tumor areola distance. Briefly, NAC was preserved when palpation and the outlook of the nipple was normal. 364 patients underwent SSM with immediate TRAM flap reconstruction and 152 underwent NA-SSM with immediate TRAM flap reconstruction. We compared complication rate, local recurrence rate (LRR), disease-free survival (DFS), and overall survival (OS) Between NA-SSM and SSM with immediate TRAM reconstruction cases. Results: Median follow up of NA-SSM and SSM was 60 and 67 months respectively. Complete or partial nipple areola necrosis developed in 26 (17.1%; complete, partial 15). The 5 year DFS was 89% for NA SSM and 87.4% for SSM (log rank p = 0.20), The 5 year OS was 99.3% for NA SSM and 98.3 % (log rank p = 0.33) The local failure occurred in 3 (2%) of 152 underwent NA SSM, 3 (0.8%) of 364 patients underwent SSM (p = 0.27). There were 2 (1.3%) nipple areola recurrence. Cosmetic outcome of NA SSM was better than that of SSM in the majority of patients. Conclusions: Our study demonstrates that NA-SSM with immediate TRAM reconstruction is oncologically as safe as SSM with immediate TRAM reconstruction and provides a good cosmetic outcome.

No significant financial relationships to disclose.

Predictive role of 18F-FDG-PET/CT 1 month before and after hypofractionated stereotactic body radiation therapy for stage I non-small cell lung cancer

7569

Background: To know the predictive role of 18F-FDG-PET/CT 1month before and after stereotactic body radiation therapy (SBRT) to stage I non-small cell lung cancer (NSCLC). Methods: Between 2004 and 2007, 20 patients received SBRT with 48 Gy for 4 consecutive days and checked two times of FDG- PET/CT and chest CT with contrast-enhancement at 1 month before and after SBRT. Change of maximal SUV (SUVmax) on FDG-PET/CT and the longest tumor diameter on chest CT before and after SBRT was measured. Patients only with high FDG uptake, SUVmax 3.0 or above, on FDG-PET/CT before SBRT and tumor diameter below 5 cm were analyzed in this study. Change of tumor diameter was classified to PR (partial response), SD (stable disease), and DP (disease progression) as RECIST criteria and change of SUVmax was described as % change. Chest CT was checked at every 3 or 6 months during follow-up. Results: Mean time intervals from SBRT to FDG-PET/CT and chest CT were 32 and 30 days respectively. Mean longest tumor diameter was changed from 2.59 cm (1.36–3.93) to 2.17 cm (1.18–3.41), and its reduction rate was -16.2%. By RECIST criteria, 4 patients showed PR, 15 patients showed SD, and other 1 patient showed DP. Mean decrease rate of SUVmax on FDG-PET/CT was -52.1% and its mean value was changed from 7.1 (3.2–13.1) to 3.4 (0.3–9.8). Median follow-up time was 16 months. Local tumor progression developed in 2 (10%) patients and time to progression was 3.4, 6.1 months. Tumor responses on post-SBRT chest CT were PR in 1 and SD in the other 1 patient, and SUVmax changes were -31.9%, -25.5% in each. Most of patients showing no response, SD or DP, didn't recur after SBRT, and so chest CT at 1 month could not predict actuarial tumor response. On the contrary to chest CT, no patients showing SUVmax decreases over 40% experienced tumor progression after SBRT. High decrease rate of SUVmax over 40% decrease on FDG-PET/CT 1 month after SBRT could warrant good actuarial local tumor control earlier. Conclusions: Change of SUVmax on FDG-PET/CT 1 month before and after SBRT could predict actuarial local tumor control of stage I NSCLC earlier and 1 month after SBRT was adequate timing for the earlier evaluation of tumor response.

No significant financial relationships to disclose.

Characteristics of bone mineral density at the time of diagnosis in postmenopausal breast cancer patients

e22187

Background: Bone mass has been proposed as a marker of cumulative exposure to estrogen in women. We have studied the association between bone mass and breast cancer in postmenopausal women. Methods: We investigated the association between bone mineral density(BMD), as measured at the lumbar spine and femoral neck and the breast cancer in women age 50 or older, who were received an initial diagnosis of stage 0-III breast cancer, confirmed by pathologic assessment of breast tissue. We recruited 718 women with newly diagnosed breast cancer in a Asan Medical Center from 1, Jun. 2006 to 31, Dec. 2007. BMD was measured by lunar EXPERT-XL for breast cancer patients Results: Median age at diagnosis was 58 (range 47–82). Patients with higher BMD at lumbar spine were found to have low grade disease (p<0.005). The patients with hormone receptor positive breast tumor showed higher BMD at lumbar spine and lower serum 25(OH)D than hormone receptor negative tumor. Serum estradiol level did not show a relation to BMD. There were no significant differences between breast cancer stage and serum 25(OH)D and BMD. Conclusions: The patients who have hormone receptor positive breast cancer had higher Lumbar spine BMD and lower 25(OH)D than hormone receptor negative patients.

No significant financial relationships to disclose.

Do stem cell markers have significant implication in breast cancer? Immunohistochemical study for CD44 and CD24

Abstract #5058

Background: We reported that breast cancer expressing CD44+CD24-/low showed a favorable prognosis in contrary to the in vitro/in vivo studies. We further followed this data up to 99 months and analyzed it according to CD44 expression, CD24 expression and hormone expression.&#x2028; Design: immunohistochemical stainings for CD44s and CD24 as well as prognostic markers including estrogen receptor, progesterone receptor, p53, and Her2/neu were done using tissue microarray blocks containing 645 consecutive cases of invasive breast carcinomas from 1993 to 1998. Mean follow up periods were 99.5 months. Cases were categorized into four subgroups (CD44-/CD24+, CD44+/CD24+, CD44-/CD24-, CD44+/CD24-) based on the immunohistochemical staining results and compared them with clinicopathologic parameters. Immunostainings for CD44s and CD24 interpreted as positive if at least 1% of tumor cells show distinct membranous and/or cytoplasmic stainings. In the positive group of CD24, we categorized it as three subgroups according to the degree of positivity.&#x2028; Results: CD44+CD24-/low group showed inversely associated with lymph node metastasis and the tumor stage than other subgroups (p=0.001 and p=0.018, respectively). And CD44+CD24-/low group was showed an increase in disease free survival and overall survival (p=0.003, p=0.002) In the subgroup analysis of CD24 expression (0, grade 1, grade 2, grade 3), the incidence of metastasis and death was more frequently observed in the cases with the higher expression of CD24. (DFS: p=0.03, OS: p=0.001). With respect to the CD44, CD44- group showed frequent metastasis and death (p=0.01, both) however, for the receptor positive groups, not CD44 but CD24 expression resulted negatively to the overall survival significantly(p=0.01, Relative risk=1.90) on multivariate analysis. For the receptor negative groups, especially triple negative group, lack of CD44 expression made overall decreased to 50%(p=0.03, hazard ratio=0.5)&#x2028; Conclusion: In contrast to cell line studies, CD44+CD24-/low phenotype is considered a favorable prognostic subgroup of breast cancer associated with less frequent nodal metastasis, lower tumor stage and infrequent distant metastasis. For receptor positive breast caner, CD24 expression effect DFS, OS significantly, and For receptor negative group, especially triple negative breast cancer, Lack of CD44 expression made and effect OS inversely.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5058.