Resumption or persistence of menstruation after cytotoxic chemotherapy is a prognostic factor for poor disease-free survival in premenopausal patients with early breast cancer

BACKGROUND

We investigated the relationship between resumption or persistence of menstruation after cytotoxic chemotherapy (RM) and disease-free survival (DFS) in premenopausal patients with early breast cancer.

METHODS

Medical records from 872 patients who received cytotoxic chemotherapy for stage I to III breast cancer were retrospectively reviewed.

RESULTS

The median patient age was 41 years (range, 21-54) and the median follow-up duration was 6.2 years (range, 0.7-10.4). Six hundred ninety-two patients (79.4%) were hormone receptor (HR) positive and the majority of these received tamoxifen therapy after completing chemotherapy. The chemotherapy-induced amenorrhea (CIA) rate was 76.7% (n = 669), and 51.8% (n = 452) experienced RM during the follow-up period. One hundred twenty-one (13.9%) patients had persistent menstruation without CIA. DFS was significantly affected by younger age at diagnosis (≤35 years) (P = 0.013), tumor size > 2 cm (P < 0.001), node positivity (P < 0.001), HR negativity (P < 0.001), HER2 positivity (P = 0.010), and RM (P < 0.001). HR negativity [hazard ratio 1.7, 95% confidence interval (CI) 1.2-2.4, P = 0.006], tumor size > 2 cm (hazard ratio 2.1, 95% CI 1.4-3.0, P < 0.001), node positivity (hazard ratio 3.0, 95% CI 2.0-4.7, P < 0.001), and RM (hazard ratio 1.8, 95% CI 1.2-2.7, P = 0.004) remained significant factors for DFS on multivariate analysis.

CONCLUSIONS

A considerable proportion of premenopausal patients treated with chemotherapy experienced RM after CIA. RM was a poor prognostic factor for DFS in premenopausal patients with early breast cancer.

Phase II trial of galiximab (anti-CD80 monoclonal antibody) plus rituximab (CALGB 50402): Follicular Lymphoma International Prognostic Index (FLIPI) score is predictive of upfront immunotherapy responsiveness

BACKGROUND

This phase II CALGB trial evaluated the activity and safety of an extended induction schedule of galiximab (G) plus rituximab (R) in untreated follicular lymphoma (FL).

PATIENTS AND METHODS

Patients with previously untreated FL (grades 1, 2, 3a) received 4 weekly infusions of G + R, followed by an additional dose every 2 months four times. International Workshop Response Criteria were used to evaluate response.

RESULTS

Sixty-one patients were treated and antibody infusions were well tolerated. The overall response rate (ORR) is 72.1% (95% confidence interval 59.2% to 82.9%): 47.6% complete response (CR)/unconfirmed complete response (CRu) and 24.6% partial response. At a median follow-up time of 4.3 years (range, 0.3-5.3 years) median progression-free survival (PFS) is 2.9 years. Notably, Follicular Lymphoma International Prognostic Index (FLIPI) correlated with ORR, CR rate, and PFS, and the low-risk FLIPI group (n = 12) achieved a 92% ORR, 75% CR/CRu rate, and 75% 3-year PFS.

CONCLUSIONS

An extended induction schedule of G + R in previously untreated FL is well tolerated and appears particularly efficacious in those patients with low-risk FLIPI scores. In addition, this trial served as the initial platform for additional CALGB 'doublet' combination regimes of rituximab plus other novel targeted agents.

Experimental evaluation of immediate recanalization effect and recanalization efficacy of a new thrombus retriever for acute stroke treatment in vivo

BACKGROUND AND PURPOSE

Currently, several new stent retriever devices for acute stroke treatment are under development and early clinical evaluation. Preclinical testing under standardized conditions is an important first step to evaluate the technical performance and potential of these devices. The aim of this study was to evaluate the immediate recanalization effect, recanalization efficacy, thrombus-device interaction, and safety of a new stent retriever intended for thrombectomy in patients with acute stroke.

MATERIAL AND METHODS

The pREset thrombectomy device (4 × 20 mm) was evaluated in 16 vessel occlusions in an established swine model. Radiopaque thrombi (10-mm length) were used for visualization of thrombus-device interaction during application and retrieval. Flow-restoration effect immediately after deployment and after 5-minute embedding time before retrieval, recanalization rate after retrieval, thromboembolic events, and complications were assessed. High-resolution FPCT was performed to illustrate thrombus-device interaction during the embedding time.

RESULTS

Immediate flow restoration was achieved in 75% of occlusions. An increase or stable percentage of recanalizations during embedding time before retrieval was seen in 56.3%; a decrease, in 12.5%; reocclusion of a previously recanalized vessel, in 18.8%; and no recanalization effect at all, in 12.5%. Complete recanalization (TICI 3) after retrieval was achieved in 93.8%; partial recanalization (TICI 2b), in 6.2%. No distal thromboembolic events were observed. High-resolution FPCT illustrated entrapment of the thrombus between the stent struts and compression against the contralateral vessel wall, leading to partial flow restoration. During retrieval, the thrombus was retained in a straight position within the stent struts.

CONCLUSIONS

In this experimental study, the pREset thrombus retriever showed a high recanalization rate in vivo. High-resolution FPCT allows detailed illustration of the thrombus-device interaction during embedding time and is advocated as an add-on tool to the animal model used in this study.

[Validity of digital templating in total hip arthroplasty: impact of stem design and planner's experience]

INTRODUCTION

Preoperative planning in total hip arthroplasty decreases the risk of implant oversizing and facilitates intraoperative orientation. The size of the acetabular and femural components can be estimated. The aim of the present study was to determine the validitiy of digital templating. Furthermore, we compared the accuracy of three planners with different clinical experience and the effect of two different femoral component designs on planning accuracy.

METHODS

On 60 a. p. pelvis radiographs, 60 unilateral, non-cemented total hip arthroplasties using the planning tool "AGFA-Orthopaedic-Tools Version V2.10®" (Fa. Agfa Health Care, Mertsel, Belgium) were repeatedly planned by three orthopaedic surgeons (planner A fifth year, planner B third year, planner C second year of training). All 60 patients received pressfit acetabular components, a straight stem was implanted in 28 (CLS-Spotorno™, Fa. Zimmer) and a short stem (Fitmore™, Fa. Zimmer) in 32 patients. The planned sizes of the components and the offset-variations were compared to the implanted sizes.

RESULTS

The percental accuracy and ICC planning for the straight stem were 42.9 %/0.906 for planner A, 39.3 %/0.833 for planner B, and 28.6 %/0.836 for planner C. Planning the short stem, the percental accuracy and ICC were 34.4 %/0,886 for planner A, 21.9 %/0.708 for planner B, and 12.5 %/0.681 for planner C. The accuracy and ICC of templating the acetabular components were 35 %/0.796 for planner A, 30 %/0.725 for planner B, and 26.8 %/0.511 for planner C. Planning the sizes of both femoral components showed significant differences between planner A and C and planner B and C in Wilcoxon's signed-rank test.

CONCLUSION

A lower level of experience showed no effect on the planning results of the acetabular components, but there were considerable and significant differences on planning the femoral components. Furthermore, the design of the femoral component had an impact on planning accuracy.

Comparison between a guaiac and three immunochemical faecal occult blood tests in screening for colorectal cancer

BACKGROUND

The aim of this study was to compare the performance of the guaiac-based faecal occult blood test (G-FOBT), with that of three immunochemical faecal occult blood tests (I-FOBT) which allow automatic interpretation.

PATIENTS AND METHODS

Under the French organised screening programme, 85,149 average-risk individuals aged 50-74 participating in the third screening round, performed both the G-FOBT (Hemoccult-II test) and one of the I-FOBTs: FOB-Gold, Magstream and OC-Sensor.

RESULTS

Given the chosen threshold, the positivity ratio between the different I-FOBTs and the G-FOBT was 2.4 for FOB-Gold, 2.0 for Magstream and 2.2 for OC-Sensor (P=0.17). The three I-FOBTs were superior to the G-FOBT for colorectal cancer (CRC) detection. The ratios for detection rates were 1.6 (FOB-Gold), 1.7 (Magstream) and 2.1 (OC-Sensor) (P=0.74). For non-invasive CRC they were, respectively, 2.5, 3.0 and 4.0 (P=0.83) and for advanced adenomas 3.6, 3.1 and 4.0 (P=0.39).

CONCLUSIONS

This study provides further evidence that I-FOBT is superior to G-FOBT. None of the three I-FOBTs studied appeared to be significantly better than the others.

A feasibility study on gamma-ray tomography by Monte Carlo simulation for development of portable tomographic system

The electron beam X-ray tomographic scanner has been used in industrial and medical field since it was developed two decades ago. However, X-ray electron beam tomography has remained as indoor equipment because of its bulky hardware of X-ray generation devices. By replacing X-ray devices of electron beam CT with a gamma-ray source, a tomographic system can be a portable device. This paper introduces analysis and simulation results on industrial gamma-ray tomographic system with scanning geometry similar to electron beam CT. The gamma-ray tomographic system is introduced through the geometrical layout and analysis on non-uniformly distributed problem. The proposed system adopts clamp-on type device to actualize portable industrial system. MCNPx is used to generate virtual experimental data. Pulse height spectra from F8 tally of MCNPx are obtained for single channel counting data of photo-peak and gross counting. Photo-peak and gross counting data are reconstructed for the cross-sectional image of simulation phantoms by ART, Total Variation algorithm and ML-EM. Image reconstruction results from Monte Carlo simulation show that the proposed tomographic system can provide the image solution for industrial objects. Those results provide the preliminary data for the tomographic scanner, which will be developed in future work.

Susceptibility-weighted MR imaging for diagnosis of capillary telangiectasia of the brain

BACKGROUND AND PURPOSE

BCT is a benign entity, whose appearance on conventional MR imaging makes its differentiation from neoplastic, inflammatory, or subacute ischemic disease challenging. SWI is sensitive to susceptibility effects from deoxyhemoglobin with excellent spatial resolution. Only scarce case reports have described the utility of SWI in cases of BCT. Our aim was to show the diagnostic value of SWI applied to a larger series of cases.

MATERIALS AND METHODS

This was an observational retrospective study of 33 BCTs in 27 consecutive patients examined from August 2009 to January 2011 with MR imaging, including SWI. Morphology, signal intensity characteristics, and additional vascular malformations were analyzed. Preceding or follow-up examinations were available in 18 patients with a median time interval of 14.5 months (range, 2-115 months).

RESULTS

Twenty-five pontine and 8 supratentorial BCTs demonstrated distinct signal-intensity loss on SWI in combination with postcontrast enhancement. Mean lesion diameter was 4.9 mm (range, 1.5-17 mm). Thirty-nine percent showed slight signal-intensity changes on T1 and/or T2; the remainder were isointense to normal brain. In 30%, a prominent draining vessel was observed. Additional cerebral vascular malformations were found in 5 patients.

CONCLUSIONS

SWI represents a valuable tool for confirmation of presumed BCT. Demonstration of signal-intensity loss on SWI in an enhancing focal brain lesion, otherwise unremarkable on conventional MR images, is highly specific for BCT, thus excluding serious pathology and reassuring the patient and referring physician. This is particularly helpful for BCT in less typical locations.

P4-01-13: Biology of Aggressiveness and Tamoxifen Resistance in Hormone Receptor-Positive Very Young Age Breast Cancer

It has been known that young breast cancer patients have worse outcomes compared with older premenopausal or postmenopausal patients. Survival difference between young and older breast cancer patients is evident only in hormone receptor positive breast cancer regardless of tamoxifen treatment according to our previous report. However, the biology of aggressiveness and endocrine resistance of breast cancer in very young women is largely unknown. The purpose of this study is to find molecular characteristics of hormone receptor positive breast cancers of very young age women (&lt;35) compared with those of older premenopausal women.

We extracted mRNA from fresh frozen hormone receptor positive primary breast cancer tissues of 24 young age breast cancer patients (&lt;35 years) and 31 older premenopausal women (40 to 49 years) by standard method. All tumor specimens analyzed contained more than 50% tumor cells. Hormone receptor status was determined by immunohistochemistry (IHC). Gene expression microarray experiment was done in the 55 samples using Illumina HumanRef-8 v3 Expression BeadChip (Illumina, Inc., San Diego, CA). Functional and pathway analysis of differentially expressed genes were done using DAVID (http://david.abcc.ncifcrf.gov/home.jsp) and Ingenuity pathway analysis (IPA, http://www.ingenuity.com). Ki-67 assay was done using IHC in 4,957 ER+ breast cancer patients of Seoul National University cohort and 1,863 ER+ patients from National Cancer Center, Korea.

355 genes were upregulated (&gt;1.5 fold) and 209 genes were down-regulated in breast cancer tissues of young age patients (&lt;35) compared with those of older patients. In pathway analysis of the highly expressed genes in young patients, cell cycle function and pathway was significantly activated. The genes of central role in this pathway were MYC and CCND1. In IHC assay for 4,957 ER+ Seoul National University dataset, the proportion of high Ki-67 expression (&gt;=10%) was positively correlated with decreasing age: 26.4%, 24.0%, 21.3%, 14.8%, 12.0% of women aged &lt;30, 30–34, 35–39, 40–49, 50–59, respectively (p&lt;0.001). The same correlation pattern between younger age and high Ki-67 expression was also seen in another 1,863 patient cohort.

In conclusion, we showed that genes involved in cell cycle pathway were upregulated in very young age (&lt;35) ER+ breast cancer using microarray study. It was validated in large data set using Ki-67 IHC assay. High proliferation and fast cell cycle could be a mechanism of worse outcome and tamoxifen resistance of ER+ very young age breast cancer patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-01-13.

Infectious agents and B cell tolerance breakdown

The role of infectious agents in autoimmune diseases genesis is still a matter of debate. Several observations have suggested that autoimmune diseases may be initiated or worsened by infections (review by Kivity et al., 2009). However, there is no clear understanding of the underlying mechanisms. In particular, autoantibody production during infections could be the result of the non specific activation of “natural” autoreactive B cells that produce only low-affinity antibodies (Lacroix-Desmazes et al., 1998). A relevant hypothesis making the link between infections and autoimmune diseases could be the progressive genesis of more affine autoreactive B cells that could be involved in different pathogenic conditions. The major purpose of our work is therefore to study the breakdown of B cell tolerance and the ability for autoreactive B cells,especially low reactive B cells, to engage in an affinity maturation process during infections.We have created a new autoreactive B cell model allowing a relevant study of affinity maturation process. In this intermediate affinity SWHEL X HEL2x autoreactive model, knock-in B cells (Taki etal., 1993) express a B cell receptor highly specific for Hen-Egg Lysozyme (HEL) that recognizes HEL2x mutated auto-antigen with intermediate affinity (Phan et al., 2003; SWHEL model).Phenotypic analysis revealed that these autoreactive B cells are in a state of partial tolerance compared to the high affinity model (Phan et al., 2003; SWHEL X ML5 model) characterized by a strong anergy of HEL positive B cells.Experimental infections were performed with Borrelia burgdorferi, a Gram-negative spirochete,leading to sustained lymph nodes polyclonal B cell activation and hypergammaglobulinemia (Soulas et al., 2005). In SWHEL X HEL2x infected mice, in the presence of their auto-antigen,intermediate affinity autoreactive B cells are able to proliferate, to be activated, to enter into lymph nodes germinal centers and to produce IgM and IgG autoantibodies, although in low amounts.Moreover, IgG auto-antibodies in infected mice appear somatically mutated in the auto-antigen recognizing area. These data are consistent with a partial tolerance breakdown and the next experimental step will consist in checking the long-term survival of such activated autoreactive B cells and the impact of the observed mutations

Nanometrology of delignified Populus using mode synthesizing atomic force microscopy

The study of the spatially resolved physical and compositional properties of materials at the nanoscale is increasingly challenging due to the level of complexity of biological specimens such as those of interest in bioenergy production. Mode synthesizing atomic force microscopy (MSAFM) has emerged as a promising metrology tool for such studies. It is shown that, by tuning the mechanical excitation of the probe-sample system, MSAFM can be used to dynamically investigate the multifaceted complexity of plant cells. The results are argued to be of importance both for the characteristics of the invoked synthesized modes and for accessing new features of the samples. As a specific system to investigate, we present images of Populus, before and after a holopulping treatment, a crucial step in the biomass delignification process.

Orthognathic surgery in Melnick-Needles-Syndrome. Case report and review of the literature

Melnick-Needles Syndrome (MNS) is a congenital syndrome associated with severe architectural disorder of the skeletal system that can cause significant effects on the craniofacial skeleton including poor aesthetics, impaired speech and masticatory problems. The authors report a case of a female patient who experienced masticatory constraint, hindered speech and functional problems related to a severe bite dysfunction due to the mandibular hypoplasia and the underlying bony architectural disorder associated with MNS. The patient underwent bilateral sagittal split osteotomy (BSSO) to correct her skeletal malocclusion and improve the characteristic aesthetics and speech. The inherent bony abnormalities with their altered collagen structure presented unique challenges to orthognathic surgery in this patient with an unpredictable bone healing process. In MNS patients a fragile trabecular bone structure and an increased bleeding tendency is thought to delay or forestall wound healing. The patient was treated successfully with BSSO and monocortical plate fixation following a well-established algorithm from orthodontic preparation to surgical protocol. A very satisfying outcome has been achieved, concerning functional rehabilitation and aesthetic improvement. A review of the literature revealed that little is known about bone regeneration and fracture healing in cases with MNS.

Precuneus hypoperfusion plays an important role in memory impairment of patients with systemic lupus erythematosus

The present study was designed to identify regional cerebral blood flow (rCBF) abnormalities in systemic lupus erythematosus (SLE) patients with memory impairments. Nineteen SLE patients (mean age 36.1 ± 8.6 years, range 17-47) with subjective memory complaints underwent brain single-photon emission computed tomography (SPECT). The Korean Wechsler Adult Intelligence Scale (K-WAIS) and the Rey-Kim Memory Test (RKMT) were used objectively to evaluate cognitive functions in these patients. On the basis of the Intelligence Quotient-Memory Quotient (IQ-MQ) difference score, patients were classified into two groups: those with below one standard deviation (SD) from the mean for normal subjects of comparable age and education (memory impairment, n = 6) and those with without memory impairment (non-memory impairment, n = 13). Their brain SPECT images were analyzed by statistical parametric mapping (SPM) for group comparisons. The group of SLE patients with memory impairment showed significant hypoperfusion in the right precuneus compared with those with non-memory impairment (p < 0.001). Hypoperfusion of the precuneus may play a significant role in the memory function of SLE patients. SPM analysis of brain SPECT images could be a useful and objective tool for identifying abnormal rCBF in SLE patients with memory impairment.

Perioperative morbidity and outcome of secondary cytoreduction for recurrent epithelial ovarian cancer

BACKGROUND

Despite radical surgical and chemotherapeutic treatment of ovarian cancer, the majority of patients develop recurrent disease. Secondary cytoreductive surgery can result in favourable outcome in selected patients, but information regarding feasibility, safety and perioperative outcome of these often complex procedures is limited.

METHODS

Surgical parameters in patients with recurrent epithelial ovarian cancer selected for secondary cytoreduction were analysed and compared to patients undergoing primary cytoreduction.

RESULTS

In total, 222 patients undergoing radical cytoreduction were analysed (48 patients for relapsed disease and 174 patients at primary diagnosis of advanced ovarian cancer). The range of surgical procedures was similar in both groups. In 48% of secondary cytoreductions 'optimal surgical results' (residual tumour <1 cm) were obtained and 33% of the patients had no residual disease compared to 82% and 58% at primary cytoreduction. There was no significant difference in perioperative complication rates. The duration of surgery was shorter and the number of transfused blood products was smaller at secondary cytoreduction (p < 0.001 and p = 0.001).

CONCLUSION

Secondary cytoreduction in relapsed ovarian cancer is safe and feasible and perioperative outcome is not inferior compared to primary cytoreduction. Surgery-associated morbidity should represent a minor aspect in the selection and counselling of patients regarding treatment options for recurrent ovarian cancer.

Both matrix proteins of Ebola virus contribute to the regulation of viral genome replication and transcription

Ebola virus (EBOV) causes severe hemorrhagic fevers in humans and non-human primates. While the role of the EBOV major matrix protein VP40 in morphogenesis is well understood, nothing is known about its contributions to the regulation of viral genome replication and/or transcription. Similarly, while it was reported that the minor matrix protein VP24 impairs viral genome replication, it remains unclear whether it also regulates transcription, since all common experimental systems measure the combined products of replication and transcription. We have developed systems that allow the independent monitoring of viral transcription and replication, based on qRT-PCR and a replication-deficient minigenome. Using these systems we show that VP24 regulates not only viral genome replication, but also transcription. Further, we show for the first time that VP40 is also involved in regulating these processes. These functions are conserved among EBOV species and, in the case of VP40, independent of its budding or RNA-binding functions.

Anti-Emetic Effect of Midazolam Added to Morphine Patient-Controlled Analgesia After Total Abdominal Hysterectomy

Nausea and vomiting are frequent adverse effects of patient-controlled analgesia with opioids. This study was designed to compare the effect of midazolam to that of ondansetron for prevention of nausea and vomiting during morphine patient-controlled analgesia. In a randomised, double-blind, prospective trial, 90 patients were allocated to one of three groups of 30 each, to receive one of three patient-controlled analgesia regimens to manage postoperative pain: a combination of midazolam and morphine (group M), a mixture of ondansetron and morphine (group O) or morphine alone (group C). Patients were assessed for the incidence of nausea and vomiting, the degree of sedation (awake, mild, moderate, deep) and other side-effects during the first 24 hours after the operation. The frequency of nausea and vomiting was significantly lower in groups M (27%) and O (37%) compared with group C (70%) (P <0.05). The incidence of mild sedation in group M was significantly higher than that in groups O or C (P <0.05). We conclude that midazolam is as effective as ondansetron in preventing opioid-induced nausea and vomiting following total abdominal hysterectomy and has acceptable side-effects.

Optimum condition of anisotropic plasma etching for improving bending properties of ionic polymer-metal composites

We presented an anisotropic plasma etching technique by reactive ion etcher (RIE) as a new pretreatment method of fabrication of ionic polymer-metal composite (IPMC). We already found that the new technique provided large displacement to the fabricated IPMC in the presence of low applied voltage. However, we did not examine the optimum condition for the anisotropic plasma etching. In this research, we tried to figure out optimum treatment condition of film in etcher. Nafion (by DuPont) films were etched using various etching time and shadow masks with various slit and space sizes. The etched samples were plated with Pt at top and bottom side by Oguro's reduction method. The surface morphology of fabricated IPMCs was characterized by SEM. And, we've measured surface resistance, bending displacement, and driving force in order to check the IPMC properties out. Here, we found that optimum condition for pre-treatment of Nafion was 1 min for etching time under shadow mask with 200 microm slit and 100 microm space.

Effects of calcium and pressure treatment on thermal gelation of soybean protein

The effect of calcium and high-pressure (HP) treatment on the heat gelation of soybean proteins was investigated. In the presence of calcium (2 to 25 mM), the gelation of dispersions of soybean protein isolate (SPI), a beta-conglycinin-enriched fraction (7SEF), and a glycinin-enriched fraction (11SEF) started with protein having a lower degree of denaturation. The gels from these dispersions had greater stiffness than the samples without added calcium. HP treatment had different effects on heat-induced gelation depending on the presence of calcium and on the nature of the proteins. In the absence of calcium, gels with low stiffness were formed after HP treatment, compared with untreated samples, and regardless of the sample type (SPI, 7SEF, 11SEF). In the presence of calcium, gel stiffness was increased after HP treatment of dispersions containing beta-conglycinin (SPI and 7SEF), while the opposite effect was observed for 11SEF. In the presence of calcium, HP treatment promoted a greater contribution of hydrophobic interactions in SPI and 7SEF. In the dispersions containing beta-conglycinin, these conditions also promoted the appearance of a heterogeneous distribution of molecular sizes, from enormous aggregates to dissociated species. Our results suggest that, in the presence of calcium, HP treatment has an opposite effect on the ability of glycinin and beta-conglycinin to participate in the formation of a 3-dimensional network upon heating.

Prognostic Factors for Locoregional Recurrence in Operable Breast Cancer Patients Treated with Preoperative Systemic Chemotherapy

Background: We aimed to evaluate the clinicopathologic factors affecting locoregional recurrence (LRR) in potentially operable breast cancer patients receiving preoperative systemic chemotherapy (PST).Methods: We reviewed the records of 316 breast cancer patients treated with PST (doxorubicin/cyclophosphamide, 101; docetaxel /capecitabine, 103; paclitaxel/gemcitabine, 43; doxorubicin/docetaxel, 69) followed by surgery and adjuvant radiotherapy between 2002 and 2006. The majority of patients had clinical positive axillary lymph nodes. To define the prognostic factors for LRR, age, clinical stage, hormone receptor (HR) and HER2 status, clinical and pathologic response, type of operation, pathological characteristics including tumor size, tumor grade, nodal status, number of positive axillary nodes, size of metastatic lymph node and status of resection margin and tumor multiplicity before and after PST were analyzed.Results: Overall 52 patients (16.5%) in the primary tumor and 87 patients (27.5%) in the axillary nodes achieved a pathologic complete response (pCR), and 206 patients (65.2%) underwent breast conserving surgery (BCS). With a median follow-up of 52.4 month (range: 4.7 - 89.4), total 18 (5.7%) patients developed LRR; 2 of 110 (1.8%) patients with mastectomy vs. 16 of 206 (7.7%) patients with BCS (p=0.04). Other significant factors in the univariate analysis were clinical T stage, HR status, clinical response and tumor multiplicity. A pCR in the primary tumor or node was not a prognostic factor for LRR in this study. In multivariate analysis, clinical T stage (T3/4, HR 7.8; 95% CI, 2.33-26.24; P=0.001), hormone receptor status (negative, HR 6.2; 95% CI, 1.91-20.22; P=0.002) and type of surgery (BCS, HR 9.5; 95% CI, 1.97-46.37; P=0.005) were independent prognostic factors. Among patients with BCS, advanced clinical T stage (HR 12.4; 95% CI, 3.45-44.56; P&lt;0.001), negative hormone receptor (HR 4.74; 95% CI, 1.33-16.96; P=0.02), non-responding disease (HR 6.54; 95% CI, 1.07-40.12; P=0.04) and multiple tumors (HR 4.36; 95% CI, 1.06-17.90; P=0.04) developed more frequent LRR.Conclusions: Significantly more patients with advanced clinical T stage, negative HR status and BCS developed LRR in operable breast cancer treated with PST. Moreover, in patients with BCS after PST, clinically non-responding disease and multiple tumors showed unfavorable prognosis besides the larger tumors and negative hormone receptor.Partly supported by NCC Grant No 0610240

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1095.

Prognosis of Metaplastic Breast Cancer: Poorer Than the Rest of Triple-Negative Breast Cancer

Background: The biologic behavior of metaplastic breast cancer (MBC) has not been well elucidated due to its rarity and heterogeneity. This study was designed to assess the clinical and tumor characteristics and outcomes of MBC patients as compared with invasive ductal carcinoma (IDC) in general and the triple-negative (TN) subtype.Materials and methods: This study included 35 MBC and 2,839 IDC patients diagnosed at the National Cancer Center, Korea between 2000 and 2008. We, retrospectively, reviewed the clinicopathologic characteristics and clinical outcomes.Results: The mean age was 47.4 years for MBC group and 48.3 years for IDC group. The MBC group presented with larger tumors (≥ T2, 78.8% vs 41.0%; P&lt;0.001), higher histologic grade (grade 3, 92.0% vs 44.6%; P&lt;0.001), fewer ER and PgR positivity (ER+, 14.3% vs 69.0% ; P&lt;0.001 and PgR+, 25.7% vs 66.1%; P&lt;0.001), higher Ki-67 expression (35.5%±26.2% vs 20.6% ±19.8%; P=0.024) and more TN subtypes (48.6% vs 11.9%; P&lt;0.001) than IDC group. Excluding de novo stage IV patients, 14 of 32 (43.7%) MBC patients and 260 of 2782 (9.4%) IDC patents developed disease recurrence with a median follow-up of 36.2 months (range, 4.9-117.8 months). MBC was a poor prognostic factor for disease recurrence in univariate and multivariate analysis (HR 5.19; 95% CI, 2.04-13.18; P=0.001). MBC patients demonstrated aggressive pathologic features and experienced more disease recurrence (HR 4.77; 95% CI, 1.99-11.44; P=0.001) even when compared with 330 patients with TN subtype.Conclusions:Patients with metaplastic breast carcinoma appeared to have inherent aggressive tumor biology with poorer clinical outcomes than those with IDC in general and TN subtype.Partly supported by NCC Grant No 0610240

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4057.