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Kangleon-Tan HL, Sim J, You JY, Lee ES, Lee H, Yang SM, Seong MK, Park EH, Nam SJ, Park MH, Lee S, Park WC, Kangleon RG, Dy CB, Bae SY, Jung SP. Omission of chemotherapy for hormone receptor-positive and human epidermal growth factor receptor 2-negative breast cancer: patterns of treatment and outcomes from the Korean Breast Cancer Society Registry. Ann Surg Treat Res 2022; 103:313-322. [PMID: 36601341 PMCID: PMC9763778 DOI: 10.4174/astr.2022.103.6.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/13/2022] [Accepted: 10/07/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Although adjuvant chemotherapy (CTx) is still recommended for high-risk patients with hormone receptor-positive and human epidermal receptor (HER)-2-negative breast cancer, recent studies found that selected patients with low disease burden may be spared from CTx and receive hormonal treatment (HT) alone. This study aims to evaluate the trends of treatment (CTx + HT vs. HT alone) in Korea and to assess the impact on overall survival (OS) according to treatment pattern. Methods The Korean Breast Cancer Society Registry was queried (2000 to 2018) for women with pT1-2N0-1 hormone receptor-positive and HER2-negative disease who underwent surgery and adjuvant systemic treatment (CTx and HT). Clinicopathologic factors, change in pattern of treatment over time, and OS for each treatment option were analyzed. Results A total of 40,938 women were included in the study; 20,880 (51.0%) received CTx + HT, while 20,058 (49.0%) received HT only. In recent years, there has been a steady increase in the use of HT alone, from 21.0% (2000) to 64.6% (2018). In Cox regression analysis, age, type of breast and axillary operations, T and N stages, body mass index, histologic grade, and presence of lymphovascular invasion were prognostic indicators for OS. There was no significant difference between CTx + HT and HT alone in terms of OS (P = 0.126). Conclusion Over the years, there has been a shift from CTx + HT to HT alone without a significant difference in OS. Therefore, HT alone could be a safe treatment option in selected patients, even those with T2N1 disease.
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Affiliation(s)
| | - Jongmin Sim
- Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Young You
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun-Shin Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Haemin Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sun Moon Yang
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Min-Ki Seong
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Eun Hwa Park
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Seok Jin Nam
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Seokwon Lee
- Department of Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Woo-Chan Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Crisostomo B. Dy
- Department of Surgery, Chong Hua Hospital-Cebu, Cebu City, Philippines
| | - Soo Youn Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Pil Jung
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Investigation of SRP9 protein expression in breast cancer. Mol Biol Rep 2021; 49:531-537. [PMID: 34727289 DOI: 10.1007/s11033-021-06910-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Signal recognition particle (SRP) promotes co-translational translocation of the proteins through or into the endoplasmic reticulum membrane and it also has elongation arrest function. SRP9 is one of the six protein subunits of SRP and functions in elongation arrest activity by forming a heterodimeric structure with SRP14. It is one of the substrates of ADAR, which has been found to have a role in breast cancer. This study was conducted to investigate the SRP9 protein expression in normal and tumor tissues of patients with breast cancer and determine its prognostic significance. METHODS AND RESULTS A total of 32 female patients who were diagnosed as having primary breast cancer and underwent surgery were included in the study. Western Blotting was performed to detect SRP9 protein expression levels in normal and tumor tissue samples. Clinical and pathologic characteristics were analyzed to assess the prognostic significance. SRP9 protein expression was statistically higher in the breast cancer tissue samples compared to normal matched tissue, and the mean SRP9 protein expression levels of breast cancer tissue normal tissue samples were 1.019 ± 1.011 and 0.551 ± 0.456, respectively (p = 0.001). SRP9 protein expression levels in tumor tissue of patients with lymph node metastasis, tumor size > 2 cm, estrogen receptor-positive, progesterone receptor-positive, and HER-2 negative were statistically higher than in normal tissue (p < 0.05). CONCLUSIONS It is vital to clarify the roles of molecules such as SRP9 in understanding the pathogenesis of breast cancer. In our study, we showed that SRP9 expression increased in breast cancer and was associated with disease-related parameters.
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Cognetti F, Biganzoli L, De Placido S, del Mastro L, Masetti R, Naso G, Pruneri G, Santini D, Tondini CA, Tinterri C, Tonini G, Barni S. Multigene tests for breast cancer: the physician's perspective. Oncotarget 2021; 12:936-947. [PMID: 33953847 PMCID: PMC8092339 DOI: 10.18632/oncotarget.27948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
Breast cancer is the most common tumour in women and the first cause of death for cancer in the female population. Preserving the quality of life has therefore become an important objective in the management of the disease. The benefits of adjuvant chemotherapy in patients with HR+ HER2- early breast cancer should always be balanced against its potential short and long-term adverse effects, and identifying the appropriate patients for whom chemotherapy can offer the highest clinical benefit is critical. Besides clinical and pathological factors, today four multigene tests able to guide the choice of the adjuvant therapy early breast cancer are available in Italy: Oncotype DX®, EndoPredict®, MammaPrint® e Prosigna®. This review evaluates the main characteristics of these diagnostic tests, the studies on clinical utility, their economic impact and their inclusion in international and national guidelines. The Oncotype DX Breast Recurrence Score® test is the only multigene test validated, with level IA evidence, to guide the adjuvant therapy decisions: hormone therapy alone for most patients with RS results 0-25, and chemotherapy for patients with RS results 26-100. Clinical data demonstrate that the Oncotype DX test is able to significantly impact therapeutic decisions, reducing chemotherapy use up to 49% and supporting the use of chemotherapy (up to 12%) in potentially under-treated patients. Based on the level of clinical evidence and established clinical utility, several multigene tests have been included in the main international guidelines, with recommendations ranging from "strong" to "moderate".
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Affiliation(s)
- Francesco Cognetti
- Scuola di specializzazione di Oncologia, La Sapienza University, Rome, Italy
| | - Laura Biganzoli
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Sabino De Placido
- Università Degli Studi di Napoli Federico II Dipartimento di Medicina clinica e Chirurgia Professore di Oncologia Medica, Napoli, Italy
| | - Lucia del Mastro
- Oncology, IRCCS AOU San Martino - IST Istituto Nazionale per la Ricerca del Cancro, Genova, Italy
| | | | - Giuseppe Naso
- Department of Radiology, Pathology and Oncology, La Sapienza University, Rome, Italy
| | - Giancarlo Pruneri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Donatella Santini
- Department of Pathology, IRCCS Azienda Ospedaliera Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | | | | | - Giuseppe Tonini
- Medical Oncology, School University Campus Bio-Medico, Rome, Italy
| | - Sandro Barni
- Emeritus, Department of Oncology, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
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Characteristics and clinical outcome of pT1a-b node-negative breast cancer. North Clin Istanb 2021; 8:124-129. [PMID: 33851075 PMCID: PMC8039097 DOI: 10.14744/nci.2020.06332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/07/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: Tumor size, along with other clinicopathological characteristics, has a prognostic role in breast cancer. Recurrence risk tends to rise as tumor size increases. Early T-stage portends a good prognosis. We aimed to investigate the recurrence-free interval rates of T1abN0 group of early breast cancer. METHODS: Patients diagnosed with pT1a and T1b, lymph node metastasis-negative breast cancer were included in the study. Clinicopathologic characteristics including recurrence, distant metastasis, and final status of the patients were obtained retrospectively from the patient files. RESULTS: A total of 84 patients included. Twenty-six patients (31%) had T1a and 58 patients (69%) had T1b tumors. The 5-year distant relapse-free survival (DRFS) rate of T1ab tumors was 95.2%. The DRFS rate of T1a tumors was 96.2%, while the rate of T1b tumors was 94.8% (p=0.555). The 5-year RFS rate of T1ab tumors was 90.5%. The RFS rate of T1a tumors was 84.6%, whereas the rate of T1b tumors was 93.1% (p=0.359). The 5-year DRFS rate of hormone receptor positive group was 97%, Her-2 positive group was 81.8%, and triple negative group was 100% (p=0.041). The 5-year RFS rate of the hormone receptor positive group was 97%, Her-2 positive group was 72.7%, and triple negative group was 57.1% (p=0.001). CONCLUSION: The results of the study provided that both T1a and T1b tumors have a good and similar prognosis.
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Han Y, Wang J, Sun Y, Yu P, Yuan P, Ma F, Fan Y, Luo Y, Zhang P, Li Q, Cai R, Chen S, Li Q, Xu B. Prognostic Model and Nomogram for Estimating Survival of Small Breast Cancer: A SEER-based Analysis. Clin Breast Cancer 2020; 21:e497-e505. [PMID: 33277191 DOI: 10.1016/j.clbc.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Different clinicopathologic characteristics could contribute to inconsistent prognoses of small breast neoplasms (T1a/T1b). This study was done to conduct a retrospective analysis and establish a clinical prediction model to predict individual survival outcomes of patients with small carcinomas of the breast. MATERIALS AND METHODS Based on the Surveillance, Epidemiology, and End Results (SEER) database, eligible patients with small breast carcinomas were analyzed. Univariate analysis and multivariate analysis were performed to clarify the indicators of overall survival. Pooling risk factors enabled nomograms to be constructed and further predicted 3-year, 5-year, and 10-year survival of patients with small breast cancer. The model was internally validated for discrimination and calibration. RESULTS A total of 17,543 patients with small breast neoplasms diagnosed between 2013 and 2016 were enrolled. Histologic grade, lymph node stage, estrogen receptor or progesterone receptor status, and molecular subtypes of breast cancer were regarded as the risk factors of prognosis in a Cox proportional hazards model (P < .05). A nomogram was constructed to give predictive accuracy toward individual survival rate of patients with small breast neoplasms. CONCLUSIONS This prognostic model provided a robust and effective method to predict the prognosis of patients with small breast cancer.
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Affiliation(s)
- Yiqun Han
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yanxia Sun
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei Yu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peng Yuan
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Fan
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pin Zhang
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Li
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruigang Cai
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanshan Chen
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiao Li
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Shea EKH, Koh VCY, Tan PH. Invasive breast cancer: Current perspectives and emerging views. Pathol Int 2020; 70:242-252. [PMID: 32039524 DOI: 10.1111/pin.12910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/21/2020] [Indexed: 12/18/2022]
Abstract
Invasive breast cancer constitutes a heterogeneous group of tumors. They comprise various histological types that differ in clinical presentation, imaging features, histopathological characteristics, biomarker profiles, prognostic and predictive parameters. The current classification of invasive breast cancer is based primarily on histopathological features. Invasive carcinoma of no special type accounts for the majority, with some rare entities also being described. With recent research and advances, there are emerging concepts, including new genetic insights of invasive breast cancer and the role of the stromal microenvironment. With greater understanding of the pathogenesis of invasive breast cancer, changes based on the correlation of histologic and genetic findings have been incorporated in the latest World Health Organization classification of breast tumors. Medullary carcinomas are subsumed as invasive carcinoma of no special type with basal-like and medullary features, regarded as part of the spectrum of tumor infiltrating lymphocyte-rich breast cancers. Tall cell carcinoma with reversed polarity is proposed as a distinct entity in recognition of unique IDH2 mutations. This article reviews conventional prognostic parameters, new histological entities, and updates on breast cancer classification, with inclusion of some genetic insights into breast cancer and the role of tumor infiltrating lymphocytes.
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Affiliation(s)
- Eric Ka Ho Shea
- Department of Clinical Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong.,Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Valerie Cui Yun Koh
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
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7
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Clarke GM, Holloway CMB, Zubovits JT, Nofech-Mozes S, Murray M, Liu K, Wang D, Kiss A, Yaffe MJ. Three-dimensional tumor visualization of invasive breast carcinomas using whole-mount serial section histopathology: implications for tumor size assessment. Breast Cancer Res Treat 2019; 174:669-677. [PMID: 30612274 DOI: 10.1007/s10549-018-05122-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/26/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Linear tumor size (T-size) estimated with conventional histology informs breast cancer management. Previously we demonstrated significant differences in margin and focality estimates using conventional histology versus digital whole-mount serial sections (WMSS). Using WMSS we can measure T-size or volume. Here, we compare WMSS T-size with volume, and with T-size measured conventionally. We also compare the ellipsoid model for calculating tumor volume to direct, WMSS measurement. METHODS Two pathologists contoured regions of invasive carcinoma and measured T-size from both WMSS and (simulated) conventional sections in 55 consecutive lumpectomy specimens. Volume was measured directly from the contours. Measurements were compared using the paired t-test or Spearman's rank-order correlation. A five-point 'border index' was devised and assigned to each case to parametrize tumor shape considering 'compactness' or cellularity. Tumor volumes calculated assuming ellipsoid geometry were compared with direct, WMSS measurements. RESULTS WMSS reported significantly larger T-size than conventional histology in the majority of cases [61.8%, 34/55; means = (2.34 cm; 1.99 cm), p < 0.001], with a 16.4% (9/55) rate of 'upstaging'. The majority of discordances were due to undersampling. T-size and volume were strongly correlated (r = 0.838, p < 0.001). Significantly lower volume was obtained with WMSS versus ellipsoid modeling [means = (1.18 cm3; 1.45 cm3), p < 0.001]. CONCLUSIONS Significantly larger T-size is measured with WMSS than conventionally, due primarily to undersampling in the latter. Volume and linear size are highly correlated. Diffuse tumors interspersed with normal or non-invasive elements may be sampled less extensively than more localized masses. The ellipsoid model overestimates tumor volume.
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Affiliation(s)
- G M Clarke
- Physical Sciences Platform, Sunnybrook Research Institute, Room C7-27c 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - C M B Holloway
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Surgery, Sunnybrook Health Sciences Centre, Room T2-015 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - J T Zubovits
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Pathology, Scarborough and Rouge Hospital, 3030 Birchmount Road, Toronto, ON, M1W 3W3, Canada
| | - S Nofech-Mozes
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, Room E423a 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - M Murray
- Physical Sciences Platform, Sunnybrook Research Institute, Room C7-48a 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - K Liu
- Physical Sciences Platform, Sunnybrook Research Institute, Room C7-27a 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - D Wang
- Physical Sciences Platform, Sunnybrook Research Institute, Room C7-27a 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - A Kiss
- Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Room G106 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - M J Yaffe
- Departments of Medical Biophysics and Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Physical Sciences Platform, Sunnybrook Research Institute, Room S6-57 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Gori S, Turazza M, Modena A, Duranti S, Zamboni G, Alongi F, Carbognin G, Massocco A, Salgarello M, Inno A. When and how to treat women with HER2-positive, small (pT1a-b), node-negative breast cancer? Crit Rev Oncol Hematol 2018; 128:130-138. [DOI: 10.1016/j.critrevonc.2018.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/30/2018] [Accepted: 03/21/2018] [Indexed: 01/06/2023] Open
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He KW, Sun JJ, Liu ZB, Zhuo PY, Ma QH, Liu ZY, Yu ZY. Prognostic significance of lymphatic vessel invasion diagnosed by D2-40 in Chinese invasive breast cancers. Medicine (Baltimore) 2017; 96:e8490. [PMID: 29095309 PMCID: PMC5682828 DOI: 10.1097/md.0000000000008490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lymphatic vessel invasion (LVI) is promising in determining prognosis and treatment strategies, but the application of LVI as a histopathological criterion in breast cancer patients especially those of different subgroups is controversial. This research aims to evaluate the prognostic value of LVI assessed by D2-40 not only in patients with early invasive breast cancer but also in lymph node-negative, lymph node-positive, luminal A-like, luminal B-like, HER2-enriched, and triple-negative subgroups.The study cohort included 255 patients with a median follow-up of 101 months. Immunohistochemical staining for D2-40 was performed to identify LVI.LVI was present in 64 (25.1%), 15 (12.1%), 49 (37.4%), 19 (20.9%), 23 (27.7%), 13 (31.7%), and 9 (22.5%), respectively, in the whole cohort, lymph node-negative, lymph node-positive, luminal A-like, luminal B-like, HER2-enriched, and triple-negative patients. LVI was associated with large tumor size (P = .04), high histological grade (P = .004), involved lymph node (P < .001), and high expression of Ki-67 (P = .003). No significant difference was found among patients with different subtypes and LVI status. The presence of LVI was significantly associated with adverse disease-free survival in the whole cohort (P < .001), lymph node-negative (P < .001), lymph node-positive (P < .001), luminal A-like (P < .001), and luminal B-like patients (P < .001) in both of the univariate and multivariate survival analysis.This study indicated that the presence of LVI stained by D2-40 provided independent prognostic information not only in the whole cohort but also in the subgroup of patients with lymph node-negative, lymph node-positive, luminal A-like, and luminal B-like diseases, which may make a case for routine clinical assessment of LVI using D2-40.
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Affiliation(s)
- Ke-Wen He
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Science, Jinan
- Department of Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Ju-Jie Sun
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Zai-Bo Liu
- Department of Surgery, Haiyang People's Hospital, Yantai, Shandong, China
| | - Pei-Ying Zhuo
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Qing-Hua Ma
- Department of Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Zhao-Yun Liu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Science, Jinan
- Department of Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Zhi-Yong Yu
- Department of Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
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Nakamura K, Iwazawa R, Yoshioka Y. Introduction to a new cell transplantation platform via recombinant peptide petaloid pieces and its application to islet transplantation with mesenchymal stem cells. Transpl Int 2016; 29:1039-50. [PMID: 27306931 DOI: 10.1111/tri.12810] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/14/2016] [Accepted: 06/09/2016] [Indexed: 02/04/2023]
Abstract
Cell death cluster in transplanted cells remains a critical obstacle for regeneration strategies. This study describes a novel platform for cell transplantation (CellSaic) consisting of human mesenchymal stem cells (hMSCs) and petaloid pieces of recombinant peptide (RCP), which can prevent cell death by arranging the cells in a mosaic. When hMSC CellSaics were subcutaneously implanted into NOD/SCID mice, hMSC CellSaics prevented cell death and accelerated angiogenesis in the graft, compared to the findings obtained on solely implanting cell spheroids. Additionally, we examined the application of CellSaic for subcutaneous cotransplantation of 200 rat islets with 2 × 10(5) hMSCs into diabetic mice. As the results of blood glucose levels at 1 m, the islet-only group was 398 ± 30 mg/dl and the islets with hMSCs group were 180 ± 65 mg/dl. On the other hand, the islets with hMSCs CellSaic group showed 129 ± 15 mg/dl and significantly improved glucose tolerance (P < 0.05). Additionally, we showed that the surface texture of the RCP petaloid pieces played an important role in graft survival and angiogenesis. It is anticipated that CellSaic will be used as a new platform for cell transplantation and tissue regeneration.
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Affiliation(s)
- Kentaro Nakamura
- Regenerative Medicine Research Laboratories, FUJIFILM Corporation, Kanagawa, Japan
| | - Reiko Iwazawa
- Regenerative Medicine Research Laboratories, FUJIFILM Corporation, Kanagawa, Japan
| | - Yasuhiro Yoshioka
- Regenerative Medicine Research Laboratories, FUJIFILM Corporation, Kanagawa, Japan
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Park CK, Jung WH, Koo JS. Pathologic Evaluation of Breast Cancer after Neoadjuvant Therapy. J Pathol Transl Med 2016; 50:173-80. [PMID: 27068026 PMCID: PMC4876080 DOI: 10.4132/jptm.2016.02.02] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 11/17/2022] Open
Abstract
Breast cancer, one of the most common cancers in women, has various treatment modalities. Neoadjuvant therapy (NAT) has been used in many clinical trials because it is easy to evaluate the treatment response to therapeutic agents in a short time period; consequently, NAT is currently a standard treatment modality for large-sized and locally advanced breast cancers, and its use in early-stage breast cancer is becoming more common. Thus, chances to encounter breast tissue from patients treated with NAT is increasing. However, systems for handling and evaluating such specimens have not been established. Several evaluation systems emphasize a multidisciplinary approach to increase the accuracy of breast cancer assessment. Thus, detailed and systematic evaluation of clinical, radiologic, and pathologic findings is important. In this review, we compare the major problems of each evaluation system and discuss important points for handling and evaluating NAT-treated breast specimens.
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Affiliation(s)
- Cheol Keun Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Hee Jung
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Seung Koo
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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Spielmann M, Dalenc F, Pointreau Y, Azria D, Classe JM, Dromain C, Facchini T, Gonçalves A, Liegeois P, Namer M, Pivot X, Vincent-Salomon A. [Perception of pT1a,b pN0 breast tumor prognosis by the French oncology community: Results of the EURISTIC national survey]. Bull Cancer 2015; 103:154-63. [PMID: 26652718 DOI: 10.1016/j.bulcan.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 10/05/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
The prognosis of infracentimetric breast cancers (BC) is heterogeneous. The EURISTIC survey describes how French oncology specialists perceive the prognosis of pT1a,b pN0 BCs. A self-administered questionnaire has been sent to over 2000 French BC specialists. Six hundred and sixty-three physicians responded. Fifty-eight percent do not consider tumor size as a key prognostic criterion. They consider that the cutoff for poor prognosis is 22mm, 10mm and 7mm for hormone receptors (HRs)+, HER2+ and triple-negative (TN) tumors respectively. Eighty-three percent of respondents consider that a HR+ pT1a,b tumor has a good prognosis (21% and 8% for HER2+ and TN respectively). Factors perceived as most detrimental are: HER2 overexpression (29% of respondents); HR- (20%); high grade (20%); TN status (14%); high KI67 (5%); presence of lymphovascular invasion (3%); young age (2%) and high mitotic index (1%). For French specialists, immunohistochemical characteristics, in particular hormone and HER2 status, are strong prognostic factors in BCs below 1cm.
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Affiliation(s)
- Marc Spielmann
- Institut Gustave-Roussy, department of medical oncology, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - Florence Dalenc
- Institut Claudius-Regaud, department of medical oncology, 20-24, rue du Pont-Saint-Pierre, 31052 Toulouse, France
| | - Yoann Pointreau
- Centre Jean-Bernard, clinique Victor-Hugo, department of radiation oncology, 18, rue Victor-Hugo, 72000 Le Mans, France; Centre hospitalier régional universitaire, department of radiation oncology, 37044 Tours cedex 9, France
| | - David Azria
- ICM centre Val-d'Aurelle, department of radiation oncology, 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - Jean-Marc Classe
- Site hospitalier Nord, centre René-Gauducheau, department of surgery, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France
| | - Clarisse Dromain
- Institut Gustave-Roussy, department of medical oncology, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - Thomas Facchini
- Clinique Courlancy, department of medical oncology, 38, rue de Courlancy, 51100 Reims, France
| | - Anthony Gonçalves
- Institut Paoli-Calmettes, department of medical oncology, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Philippe Liegeois
- Institut du sein de l'Orangerie, department of surgery, 11, rue Silbermann, 67000 Strasbourg, France
| | - Moïse Namer
- Clinique Saint-Georges, department of medical oncology, 2, avenue de Rimiez, 06100 Nice cedex 2, France
| | - Xavier Pivot
- Centre hospitalier universitaire, department of medical oncology, 2, place Saint-Jacques, 25000 Besançon, France
| | - Anne Vincent-Salomon
- Institut Curie, department of pathology, 26, rue d'Ulm, 75248 Paris cedex 05, France
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KAMMORI MAKOTO, SUGISHITA YOSHIYUKI, OKAMOTO TAKAHIRO, KOBAYASHI MAKIO, YAMAZAKI KAZUKO, YAMADA EMIKO, YAMADA TETSU. Telomere shortening in breast cancer correlates with the pathological features of tumor progression. Oncol Rep 2015; 34:627-32. [DOI: 10.3892/or.2015.4063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/02/2015] [Indexed: 11/06/2022] Open
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14
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Small breast cancers: When and how to treat. Cancer Treat Rev 2014; 40:1129-36. [DOI: 10.1016/j.ctrv.2014.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/23/2014] [Accepted: 09/25/2014] [Indexed: 12/20/2022]
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15
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Sonnenblick A, Fumagalli D, Azim HA, Sotiriou C, Piccart M. New strategies in breast cancer: the significance of molecular subtypes in systemic adjuvant treatment for small T1a,bN0M0 tumors. Clin Cancer Res 2014; 20:6242-6. [PMID: 25336696 DOI: 10.1158/1078-0432.ccr-14-1086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Awareness of breast cancer heterogeneity has strikingly increased in the past decade in parallel with the development of high-throughput molecular tests. Beyond the clear usefulness of antiestrogen treatment in luminal tumors and trastuzumab in HER2-positive tumors, breast cancer subtypes may have additional clinical and predictive roles that can be relevant to clinical practice. In this article, we discuss the significance of molecular subtypes in the systemic treatment of early-stage breast tumors smaller than 1 cm (T1a,bN0M0) and suggest new strategies for future treatment recommendations for these patients.
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Affiliation(s)
- Amir Sonnenblick
- BrEAST Data Center, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium. Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Debora Fumagalli
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Hatem A Azim
- BrEAST Data Center, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Martine Piccart
- BrEAST Data Center, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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16
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Manfrin E, Remo A, Pancione M, Cannizzaro C, Falsirollo F, Pollini GP, Pellini F, Molino A, Brunelli M, Vendraminelli R, Ceccarelli M, Pagnotta SM, Simeone I, Bonetti F. Comparison between invasive breast cancer with extensive peritumoral vascular invasion and inflammatory breast carcinoma: a clinicopathologic study of 161 cases. Am J Clin Pathol 2014; 142:299-306. [PMID: 25125618 DOI: 10.1309/ajcpoxkx67kraovm] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Extensive peritumoral neoplastic lymphovascular invasion (ePVI) is a marker of aggressiveness in invasive breast carcinoma (BC). METHODS We explored the impact of ePVI on different BC subtypes. In a total of 2,116 BCs, 91 ePVI-BCs, 70 inflammatory breast carcinomas (IBCs), and 114 casual BCs as a control group (CG-BC) were recruited. RESULTS Patients affected by ePVI-BC were younger, had larger tumors, higher histologic grade, elevated Ki-67 score, Her2/neu overexpressed, and more lymph node metastases compared with CG-BC (P < .001). Interestingly, only younger mean age at diagnosis differentiated patients with ePVI-BC from patients affected by IBC. ePVI-BC showed a clinical outcome intermediate between the prognoses of IBC and CG-BC. CONCLUSIONS Results suggest that ePVI-BC and IBC may share some pathologic processes, providing a novel perspective on the heterogeneity of BC. Epidemiologic data and molecular studies on gene expression features are needed to rationally classify these tumors into their identified subtypes.
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Affiliation(s)
- Erminia Manfrin
- Department of Pathology and Diagnosis, University of Verona, Verona, Italy
| | - Andrea Remo
- Department of Pathology, Mater Salutis Hospital, Legnago, Italy
| | - Massimo Pancione
- Department of Sciences and Technologies, University of Sannio, Avellino, Italy
| | - Claudia Cannizzaro
- Department of Pathology and Diagnosis, University of Verona, Verona, Italy
| | | | | | | | | | - Matteo Brunelli
- Department of Pathology and Diagnosis, University of Verona, Verona, Italy
| | | | - Michele Ceccarelli
- Department of Sciences and Technologies, University of Sannio, Avellino, Italy
- Bioinformatics Laboratory, BIOGEM, Ariano Irpino, Avellino, Italy
| | | | - Ines Simeone
- Bioinformatics Laboratory, BIOGEM, Ariano Irpino, Avellino, Italy
| | - Franco Bonetti
- Department of Pathology and Diagnosis, University of Verona, Verona, Italy
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17
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Schroeder MC, Lynch CF, Abu-Hejleh T, Chrischilles EA, Thomas A. Chemotherapy use and surgical treatment by receptor subtype in node-negative T1a and T1b female breast cancers, Iowa SEER Registry, 2010 to 2012. Clin Breast Cancer 2014; 15:e27-34. [PMID: 25245424 DOI: 10.1016/j.clbc.2014.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/16/2014] [Accepted: 07/29/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with small node-negative breast tumors who are younger or who have human epidermal growth factor receptor 2-positive (HER2(+)) or triple-negative breast cancer (TNBC) subtypes are at increased risk of recurrence. Concurrently, systemic treatment recommendations have evolved. Less is known about how frequently cytotoxic chemotherapy is given to these patients. Mastectomy rates have also increased. This study reports the recent incidence of T1a,bN0M0 breast cancer and the characteristics associated with chemotherapy delivery and the surgery selected. PATIENTS AND METHODS This retrospective cohort is composed of invasive female breast cancers diagnosed with American Joint Committee on Cancer (AJCC) stage T1a,bN0M0 during 2010 to 2012 from the Iowa Surveillance, Epidemiology, and End Results (SEER) Cancer Registry. Chemotherapy use and surgery were identified by the registry. Univariate and multivariate analyses were performed to determine patient differences across subtype and factors associated with treatment. RESULTS The study included 1687 patients. This represented 27.6% of all AJCC stages I(a-c) to III breast cancer in 2010 to 2012, up from 18% in 1990 (P < .0001). Of 1456 patients with known subtype, 8.8% and 6.4% had HER2(+) and TNBC disease, respectively. Chemotherapy was given to 7.5% of women with T1aN0M0 and 12.7% of T1bN0M0 tumors. The likelihood of systemic treatment was associated with breast cancer subtype, tumor differentiation, and age in a multivariate model. The mastectomy rate was 31.8%. CONCLUSION Small node-negative breast cancers continue to grow significantly as a percentage of invasive breast cancer diagnoses. In 2010 to 2012 in Iowa, systemic chemotherapy correlated with risk factors associated with recurrence: age, subtype, and tumor differentiation. Relatively high rates of mastectomy were seen.
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Affiliation(s)
- Mary C Schroeder
- Department of Pharmacy Practice and Science, College of Pharmacy, Iowa City, IA
| | - Charles F Lynch
- Department of Epidemiology, College of Public Health, Iowa City, IA
| | - Taher Abu-Hejleh
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, Iowa City, IA
| | | | - Alexandra Thomas
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, Iowa City, IA.
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18
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Gorshein E, Klein P, Boolbol SK, Shao T. Clinical significance of HER2-positive and triple-negative status in small (≤ 1 cm) node-negative breast cancer. Clin Breast Cancer 2014; 14:309-14. [PMID: 24703318 DOI: 10.1016/j.clbc.2014.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data regarding the clinical significance of HER2(+) and TN status in patients with small node-negative tumors are limited and conflicting. It remains unclear who, among those with small lesions, might benefit from more aggressive adjuvant therapy. PATIENTS AND METHODS We identified all node-negative breast cancer patients with tumor size ≤ 1 cm diagnosed between January 1, 1995 and December 31, 2008 using our institutional breast service database. Patients were classified according to their receptor status into 3 groups: (1) hormone receptor (HR)-positive (estrogen receptor [ER]- or progesterone receptor [PR]-positive, HER2(-)); (2) HER2(+) (immunohistochemistry 3(+) or fluorescence in situ hybridization amplification ≥ 2); and (3) TN (ER(-), PR(-), and HER2(-)). RFS was calculated using Kaplan-Meier methods. RESULTS Among 656 patients with tumors ≤ 1 cm, 494 (75%) of the patients were HR(+), 107 (16%) were HER2(+), and 55 (9%) were TN. Median age was 59 years (range, 27-92 years). Median follow-up was 3.5 years. The 5-year RFS rates were 98.2%, 97.1%, and 83.5% in patients with HR(+), HER2(+), and TN tumors, respectively (P < .001). In multivariate analysis, TN status was associated with worse RFS (hazard ratio, 6.70; 95% confidence interval [CI], 3.02-14.86), and HER2(+) was not (hazard ratio, 1.64; 95% CI, 0.73-3.69). CONCLUSION TN, but not HER2(+) status, was associated with worse RFS in patients with T1abN0 tumors, and adjuvant chemotherapy might be considered in patients with TN breast cancer.
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Affiliation(s)
- Elan Gorshein
- Beth Israel Medical Center, Mount Sinai Health System, New York, NY
| | - Paula Klein
- Beth Israel Medical Center, Mount Sinai Health System, New York, NY
| | - Susan K Boolbol
- Beth Israel Medical Center, Mount Sinai Health System, New York, NY
| | - Theresa Shao
- Beth Israel Medical Center, Mount Sinai Health System, New York, NY.
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19
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Houvenaeghel G, Goncalves A, Classe JM, Garbay JR, Giard S, Charytensky H, Cohen M, Belichard C, Faure C, Uzan S, Hudry D, Azuar P, Villet R, Gimbergues P, Tunon de Lara C, Martino M, Lambaudie E, Coutant C, Dravet F, Chauvet MP, Chéreau Ewald E, Penault-Llorca F, Esterni B. Characteristics and clinical outcome of T1 breast cancer: a multicenter retrospective cohort study. Ann Oncol 2014; 25:623-628. [PMID: 24399079 PMCID: PMC4433506 DOI: 10.1093/annonc/mdt532] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A subgroup of T1N0M0 breast cancer (BC) carries a high potential of relapse, and thus may require adjuvant systemic therapy (AST). PATIENTS AND METHODS Retrospective analysis of all patients with T1 BC, who underwent surgery from January 1999 to December 2009 at 13 French sites. AST was not standardized. RESULTS Among 8100 women operated, 5423 had T1 tumors (708 T1a, 2208 T1b and 2508 T1c 11-15 mm). T1a differed significantly from T1b tumors with respect to several parameters (lower age, more frequent negative hormonal status and positive HER2 status, less frequent lymphovascular invasion), exhibiting a mix of favorable and poor prognosis factors. Overall survival was not different between T1a, b or c tumors but recurrence-free survival was significantly higher in T1b than in T1a tumors (P = 0.001). In multivariate analysis, tumor grade, hormone therapy and lymphovascular invasion were independent prognostic factors. CONCLUSION Relatively poor outcome of patients with T1a tumors might be explained by a high frequency of risk factors in this subgroup (frequent negative hormone receptors and HER2 overexpression) and by a less frequent administration of AST (endocrine treatment and chemotherapy). Tumor size might not be the main determinant of prognosis in T1 BC.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM.
| | - A Goncalves
- Department of Oncology, Institut Paoli Calmettes, Aix Marseille Université, Marseille
| | - J M Classe
- Department of Surgery, Institut René Gauducheau, Nantes
| | - J R Garbay
- Department of Surgery, Institut Gustave Roussy, Villejuif
| | - S Giard
- Department of Surgery, Centre Oscar Lambret, Lille
| | - H Charytensky
- Department of Surgery, Centre Claudius Regaud, Toulouse
| | - M Cohen
- Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM
| | - C Belichard
- Department of Surgery, Centre René Huguenin, Saint Cloud
| | - C Faure
- Department of Surgery, Centre Léon Bérard, Lyon
| | - S Uzan
- Department of Surgery, Hôpital Tenon, Paris
| | - D Hudry
- Department of Surgery, Centre Georges François Leclerc, Dijon
| | - P Azuar
- Department of Surgery, Hôpital de Grasse, Grasse
| | - R Villet
- Department of Surgery, Hôpital des Diaconnesses, Paris
| | - P Gimbergues
- Department of Surgery, Centre Jean Perrin, Clermont Ferrand
| | | | - M Martino
- Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM
| | - E Lambaudie
- Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM
| | - C Coutant
- Department of Surgery, Centre Georges François Leclerc, Dijon
| | - F Dravet
- Department of Surgery, Institut René Gauducheau, Nantes
| | - M P Chauvet
- Department of Surgery, Centre Oscar Lambret, Lille
| | - E Chéreau Ewald
- Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM; Department of Surgery, Hôpital Tenon, Paris
| | | | - B Esterni
- Biostatistic, Department of Surgery, Institut Paoli Calmettes, Marseilleand CRCM, France
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20
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Gujam FJ, Going JJ, Edwards J, Mohammed ZM, McMillan DC. The role of lymphatic and blood vessel invasion in predicting survival and methods of detection in patients with primary operable breast cancer. Crit Rev Oncol Hematol 2014; 89:231-41. [DOI: 10.1016/j.critrevonc.2013.08.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/21/2013] [Accepted: 08/30/2013] [Indexed: 01/03/2023] Open
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21
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Kapoor A, Vogel VG. Prognostic factors for breast cancer and their use in the clinical setting. Expert Rev Anticancer Ther 2014; 5:269-81. [PMID: 15877524 DOI: 10.1586/14737140.5.2.269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Breast cancer is the second leading cause of cancer deaths in US women today. This year, approximately 216,000 US women will be diagnosed with invasive breast cancer and another 60,000 with in situ disease. Numerous factors can quantify individual risks for breast cancer, guide therapy and predict outcome. This review focuses on the clinical, pathologic, molecular and genetic prognostic tools available for use in patients with breast cancer, and their impact on clinical decisions and treatment selection.
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Affiliation(s)
- Avina Kapoor
- University of Pittsburgh School of Medicine, Department of Medicine, Magee-Womens Hospital, 300 Halket Street, Room 3524, Pittsburgh, PA 15213-3180, USA.
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23
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Abstract
Invasive breast cancers constitute a heterogeneous group of lesions. Although the most common types are ductal and lobular, this distinction is not meant to indicate the site of origin within the mammary ductal system. The main purpose of the identification of specific types of invasive breast carcinoma is to refine the prediction of likely behavior and response to treatment also offered by the other major prognostic factors, including lymph node stage, histologic grade, tumor size, and lymphovascular invasion.
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Affiliation(s)
- Adriana D Corben
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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24
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Adams AL, Dabbs DJ. Commonly encountered dilemmas in breast cancer reporting and staging. Semin Diagn Pathol 2012; 29:109-15. [PMID: 23062418 DOI: 10.1053/j.semdp.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Treatment modalities for common malignancies such as breast carcinoma have become increasingly complex, necessitating more rigorous documentation by pathologists of the histopathologic features required for staging and therapy. In 2009 the American Joint Committee on Cancer published the most recent update to its Cancer Staging Manual, the most salient points of which are readily available on the College of American Pathologists' Web site. Based on these guidelines, herein we summarize some of the more commonly encountered dilemmas in breast cancer reporting, with emphasis on tumor size, lymph node status, determination of mitotic count for tumor grade, and skin/chest wall involvement (pathologic stage T4).
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Affiliation(s)
- Amy L Adams
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
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25
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Provencher L, Diorio C, Hogue JC, Doyle C, Jacob S. Does breast cancer tumor size really matter that much? Breast 2012; 21:682-5. [PMID: 22835917 DOI: 10.1016/j.breast.2012.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/19/2012] [Accepted: 07/04/2012] [Indexed: 10/28/2022] Open
Abstract
Tumor size should be taken into consideration when planning treatments, but final decisions should also be made on the basis of the biological characteristics of the tumor in order to achieve a personalized approach to each individual cancer and to offer the best possible treatment to each patient.
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Affiliation(s)
- Louise Provencher
- Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Quebec City, QC, Canada G1S 4L8.
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Implications of HER2 amplification in small, node-negative breast cancers: do Asians differ? World J Surg 2012; 36:287-94. [PMID: 22105650 DOI: 10.1007/s00268-011-1353-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND We investigated the implications of HER2 amplification in Asian women with small, node-negative breast cancer in low- and middle-income countries (LMCs). METHODS We reviewed the charts patients treated between 1989 and 2009 with breast conservation therapy for node-negative breast cancers measuring ≤ 2 cm. Disease-free survival (DFS), ipsilateral breast tumor recurrence (IBTR), distant disease-free survival (DDFS), and overall survival (OS) rates were estimated using the Kaplan-Meier method and were compared by the log-rank test. Potential covariates-age, tumor grade, hormone receptor status--were analyzed by multivariate analysis. RESULTS A total of 519 patients were studied including 204 (39%) and 315 (61%) patients diagnosed with pT1ab and pT1c tumors, respectively. Median follow-up was 57 months. HER2 amplification was found in 17.1% of all patients and in 16.7% patients with pT1ab tumors. Among patients with T1ab tumors, 73.0 and 9.3% underwent adjuvant hormonal and chemotherapy, respectively; 3 of 34 T1ab patients with HER2-amplified tumors received trastuzumab. HER2 amplification was associated with poorer 5-year DFS (83.7% vs. 95.5%, P < 0.0001), DDFS (87.5% vs. 97.9%, P < 0.0001), and IBTR (8.6% vs. 2.1%, P < 0.0001) rates in patients with pT1 tumors. Multivariate analysis showed that HER2 amplification remained a significant negative prognostic factor for DFS [hazard ratio (HR) 4.1, 95% confidence interval (CI) 2.1-7.8, P < 0.0001], DDFS (HR 6.3, 95% CI 2.4-17.0, P < 0.0001), and IBTR (HR 4.5, 95% CI 2.0-10.0, P < 0.0001) rates. In the pT1ab subgroup, univariate analysis showed that HER2 amplification prognosticated for DFS (85.1% vs. 95.7%, P = 0.022) and IBTR (14.9% vs. 3.5%, P = 0.004) rates but not for the OS (100% vs. 99.2%, P = 0.487) rate. Similar results were obtained after excluding patients given trastuzumab. CONCLUSIONS The decision to use trastuzumab in HER2-amplified pT1ab tumors must balance their poor outcome against intrinsic financial limitations in LMCs. Patient selection criteria needs fine-tuning, and resource-sensitive regimens must be explored.
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Gori S, Clavarezza M, Siena S, Foglietta J, Tarenzi E, Giordano M, Molino A, Graiff C, Fusco V, Alabiso O, Baldini E, Gamucci T, Altavilla G, Dondi D, Venturini M. Adjuvant chemotherapy of pT1a and pT1b breast carcinoma: results from the NEMESI study. BMC Cancer 2012; 12:158. [PMID: 22545982 PMCID: PMC3404902 DOI: 10.1186/1471-2407-12-158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 04/30/2012] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The prognosis of pT1a-pT1b breast cancer (BC) used to be considered very good, with a 10-y RFS of 90%. However, some retrospective studies reported a 10-y RFS of 81%-86% and suggested benefit from adjuvant systemic therapy. METHODS To evaluate the variables that determined the choice of adjuvant chemotherapy and the type of chemotherapy delivered in pT1a-pT1b BC, we analysed the small tumours enrolled in the NEMESI study. RESULTS Out of 1,894 patients with pathological stage I-II BC enrolled in NEMESI, 402 (21.2%) were pT1a-pT1b. Adjuvant chemotherapy was delivered in 127/402 (31.59%). Younger age, grading G3, high proliferative index, ER-negative and HER2-positive status were significantly associated with the decision to administer adjuvant chemotherapy. An anthracycline without taxane regimen was administered in 59.1% of patients, anthracycline with taxane in 24.4%, a CMF-like regimen in 14.2% and taxane in 2.4%. Adjuvant chemotherapy was administered in 88.4% triple-negative and 73.46% HER2-positive pT1a-pT1b BC. Adjuvant trastuzumab was delivered in 30/49 HER2-positive BC (61.2%). CONCLUSIONS Adjuvant chemotherapy was delivered in 31.59% T1a-pT1b BC treated at 63 Italian oncological centres from January 2008 to June 2008. The choice to deliver chemotherapy was based on biological prognostic factors. Anthracycline-based chemotherapy was administered in 83.5% patients.
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Affiliation(s)
- Stefania Gori
- Oncologia Medica, Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy
- Division of Medical Oncology, Ospedale S. Maria della Misericordia, Azienda Ospedaliera Perugia, via Dottori 1, Perugia, 06122, Italy
| | | | - Salvatore Siena
- Struttura Complessa di Oncologia Falck, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | - Jennifer Foglietta
- Oncologia Medica, Ospedale Santa Maria della Misericordia, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Emiliana Tarenzi
- Struttura Complessa di Oncologia Falck, Ospedale Niguarda Ca’ Granda, Milan, Italy
| | | | - Annamaria Molino
- U.O.C. di Oncologia dell’Ospedale Civile Maggiore, Azienda Ospedaliera-Universitaria di Verona, Verona, Italy
| | | | - Vittorio Fusco
- Oncologia, Azienda Ospedaliera di Alessandria, Alessandria, Italy
| | - Oscar Alabiso
- SC Oncologia, Azienda Ospedaliero-Universitaria “Maggiore della Carità”, Novara, Italy
| | | | - Teresa Gamucci
- UO Oncologia Medica, Ospedale S.S. Trinità, Sora (FR), Sassari, Italy
| | | | - Davide Dondi
- Medical & Scientific Department, Sanofi-Aventis, Milan, Italy
| | - Marco Venturini
- Oncologia, Ospedale Sacro Cuore-Don Calabria, Negrar, (VR), Italy
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Park YH, Im SA, Cho EY, Choi YL, Lee JE, Nam SJ, Yang JH, Ahn JS, Im YH. Small node-negative (T1b-cN0) invasive hormone receptor-positive breast cancers: Is there a subpopulation that might have benefit from adjuvant chemotherapy? Breast Cancer Res Treat 2012; 133:247-55. [DOI: 10.1007/s10549-012-1956-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 01/09/2012] [Indexed: 12/16/2022]
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Durak MG, Gonzalez-Angulo AM, Hanrahan EO, Broglio KR, Valero V, Hortobagyi GN, Hunt KK, Sahin AA. Age and associated fibrocystic changes are prognostically significant in patients with small node-negative (T1a,bN0) invasive breast cancer. Breast J 2011; 17:462-9. [PMID: 21726347 DOI: 10.1111/j.1524-4741.2011.01116.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Some patients with small (≤1.0 cm) node-negative (T1a,bN0) invasive breast cancer (IBC) who undergo only local therapy experience recurrences. There is limited information on prognostic factors in these patients. We sought to identify prognostic factors associated with disease-free survival (DFS) and overall survival (OS) in patients with T1a,bN0 IBC. Histologic sections from 273 T1a,bN0 IBC patients treated at M. D. Anderson Cancer Center (MDACC) between 1980 and 1999 were reviewed. Microscopic tumor size; multifocality; histologic type, grade of tumor; presence, type, grade of associated ductal carcinoma in situ (DCIS); presence of fibrocystic changes (FCC) with/without atypia; and lymphovascular invasion were identified. The Kaplan-Meier method was used to evaluate DFS and OS. Median patient age was 58 years, median follow-up period was 10.8 years, and median tumor size was 0.8 cm. Multifocal disease was identified in 26% of cases. At 10 years, the DFS and OS rates were 91% and 88%, respectively. Twenty-one percent of patients had extensive (>50%), and 30% had grade 3 DCIS. Nonproliferative FCC and proliferative FCC with/without atypia were present in 80%, 36%, and 38% of patients, respectively. In univariate analysis, age at diagnosis (p < 0.0001), grade (p = 0.015), and percent (p = 0.046) of DCIS were significantly associated with DFS; presence of FCC was associated with longer DFS and OS. In multivariable models, age and presence of FCC remained significantly associated with survival. Age at diagnosis and associated FCC are significant factors in predicting recurrence in patients with T1a,bN0 IBC. Adjuvant systemic therapy should be discussed with and considered for young patients with T1a,bN0 IBC.
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Affiliation(s)
- Merih Guray Durak
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA
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Prognostic significance of molecular subtype in T1N0M0 breast cancer: Korean experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2011; 37:629-34. [DOI: 10.1016/j.ejso.2011.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 03/20/2011] [Accepted: 04/25/2011] [Indexed: 11/21/2022]
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Abstract
Trastuzumab has revolutionised the treatment of HER2-positive early-stage breast cancer and is now standard of care in combination with chemotherapy for patients with tumours larger than 1 cm. However, 5 years after publication of the landmark trials establishing the efficacy of the drug, the management of small (≤1 cm), HER2-positive tumours remains difficult. Most small breast cancers have a good prognosis and adjuvant chemotherapy is not routinely recommended. However, retrospective data suggest that some small HER2-positive cancers might have a worse clinical outcome than others. This notion raises the key clinical question of whether patients with small HER2-positive cancers should be offered adjuvant trastuzumab and chemotherapy. The pivotal adjuvant trastuzumab trials did not include patients with tumours smaller than 1 cm, but a subset analysis of one trial showed that patients with tumours 1-2 cm in size derived at least as much clinical benefit from 1 year of adjuvant trastuzumab as did the overall cohort. Clinicians face the dilemma of whether the potential reduction in risk of recurrence in this patient group warrants the toxic effects and risks of adjuvant chemotherapy and trastuzumab. In this review, we discuss the evidence for prognosis of small HER2-positive cancers, and for possible benefit from adjuvant trastuzumab. We suggest potential treatment strategies and clinical trial designs to address this important issue. On the basis of present evidence, we recommend that the benefits and risks of adjuvant trastuzumab should be discussed with patients with small, HER2-positive breast cancer.
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Sánchez-Muñoz A, Pérez-Ruiz E, Jurado JM, Ribelles N, Márquez A, Miramón J, Maíz M, Pajares B, Gallego E, Scholtz V, Jiménez B, Soler C, Molina M, García-Ríos I, Alba E. Outcome of Small Invasive Breast Cancer with No Axillary Lymph Node Involvement. Breast J 2010; 17:32-8. [DOI: 10.1111/j.1524-4741.2010.01026.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Lai HW, Kuo SJ, Chen LS, Chi CW, Chen ST, Chang TW, Chen DR. Prognostic significance of triple negative breast cancer at tumor size 1 cm and smaller. Eur J Surg Oncol 2010; 37:18-24. [PMID: 21093206 DOI: 10.1016/j.ejso.2010.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 10/11/2010] [Accepted: 10/26/2010] [Indexed: 12/15/2022] Open
Abstract
AIMS The purpose of this study was to clarify the prognostic significance of triple-negative breast cancer (TNBC) with a tumor size ≤ 1 cm. MATERIALS AND METHODS Patients with primary operable breast cancer with a tumor size ≤ 1 cm were enrolled at Changhua Christian Hospital and National Cheng-Kung University Hospital. Tumors negative for ER, PR, and HER-2 were classified as TNBCs and compared with tumors with any receptor positivity (non-TNBC) for disease-free survival (DFS) and cancer-specific survival (CSS). RESULTS From 1995 to 2006, a total of 377 patients with tumor size ≤ 1 cm were enrolled. Compared with non-TNBC patients, TNBC patients with a tumor size ≤ 1 cm as a whole or in a lymph node-positive subgroup were not associated with a poorer 5-year DFS and CSS. In lymph node-negative patients (pT1a-bN0M0), TNBC was associated with a poorer 5-year CSS but not DFS. Compared with the hormone receptor-positive, HER-2-negative subgroup, TNBC was associated with poorer DFS and CSS. In the multivariate Cox regression hazard analysis, lymph node invasion was the most important cause of disease recurrence and cancer-specific death. CONCLUSION TNBC is very likely an independent risk factor in small (≤1 cm) node-negative invasive breast cancer. With tumors 1 cm and smaller, lymph node invasion was the single most important prognostic factor.
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Affiliation(s)
- H W Lai
- Department of Surgery, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, Taiwan
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Purdom M, Cibull ML, Stratton TD, Samayoa LM, Romond EH, McGrath PC, Karabakhtsian RG. Should Histologic Grade Be Incorporated into the TNM Classification System for Small (T1, T2) Node-Negative Breast Adenocarcinomas? PATHOLOGY RESEARCH INTERNATIONAL 2010; 2011:825627. [PMID: 21151541 PMCID: PMC2989652 DOI: 10.4061/2011/825627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/08/2010] [Indexed: 01/26/2023]
Abstract
Prognosis of invasive ductal carcinoma (IDC) strongly correlates with tumor grade as determined by Nottingham combined histologic grade. While reporting grade as low grade/favorable (G1), intermediate grade/moderately favorable (G2), and high grade/unfavorable (G3) is recommended by American Joint Committee on Cancer (AJCC) staging system, existing TNM (Primary Tumor/Regional Lymph Nodes/Distant Metastasis) classification does not directly incorporate these data. For large tumors (T3, T4), significance of histologic grade may be clinically moot as those are nearly always candidates for adjuvant therapy. However, for small (T1, T2) node-negative (N0) tumors, grade may be clinically relevant in influencing treatment decisions, but data on outcomes are sparse and controversial. This retrospective study analyzes clinical outcome in patients with small N0 IDC on the basis of tumor grade. Our results suggest that the grade does not impact clinical outcome in T1N0 tumors. In T2N0 tumors, however, it might be prognostically significant and relevant in influencing decisions regarding the need for additional adjuvant therapy and optimal management.
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Affiliation(s)
- Mathew Purdom
- Department of Pathology & Laboratory Medicine, Chandler Medical Center, College of Medicine, University of Kentucky, 800 Rose Street, MS 129, Lexington, KY 40536, USA
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Kwon JH, Kim YJ, Lee KW, Oh DY, Park SY, Kim JH, Chie EK, Kim SW, Im SA, Kim IA, Kim TY, Park IA, Noh DY, Bang YJ, Ha SW. Triple negativity and young age as prognostic factors in lymph node-negative invasive ductal carcinoma of 1 cm or less. BMC Cancer 2010; 10:557. [PMID: 20946688 PMCID: PMC2966467 DOI: 10.1186/1471-2407-10-557] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 10/15/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether a systemic adjuvant treatment is needed is an area of controversy in patients with node-negative early breast cancer with tumor size of ≤1 cm, including T1mic. METHODS We performed a retrospective analysis of clinical and pathology data of all consecutive patients with node-negative T1mic, T1a, and T1b invasive ductal carcinoma who received surgery between Jan 2000 and Dec 2006. The recurrence free survival (RFS) and risk factors for recurrence were identified. RESULTS Out of 3889 patients diagnosed with breast cancer, 375 patients were enrolled (T1mic:120, T1a:93, T1b:162). Median age at diagnosis was 49. After a median follow up of 60.8 months, 12 patients developed recurrences (T1mic:4 (3.3%), T1a:2 (2.2%), T1b:6 (3.7%)), with a five-year cumulative RFS rate of 97.2%. Distant recurrence was identified in three patients. Age younger than 35 years (HR 4.91; 95% CI 1.014-23.763, p = 0.048) and triple negative disease (HR 4.93; 95% CI 1.312-18.519, p = 0.018) were significantly associated with a higher rate of recurrence. HER2 overexpression, Ki-67, and p53 status did not affect RFS. CONCLUSIONS Prognosis of node-negative breast cancer with T1mic, T1a and T1b is excellent, but patients under 35 years of age or with triple negative disease have a relatively high risk of recurrence.
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Affiliation(s)
- Ji Hyun Kwon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Park YH, Kim ST, Cho EY, Choi YL, Ok ON, Baek HJ, Lee JE, Nam SJ, Yang JH, Park W, Choi DH, Huh SJ, Ahn JS, Im YH. A risk stratification by hormonal receptors (ER, PgR) and HER-2 status in small (< or = 1 cm) invasive breast cancer: who might be possible candidates for adjuvant treatment? Breast Cancer Res Treat 2010; 119:653-61. [PMID: 19957028 DOI: 10.1007/s10549-009-0665-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 11/21/2009] [Indexed: 10/20/2022]
Abstract
As the use of screening mammography expands, the proportion of invasive breast cancer > or = 1 cm is increasing. The aims of this study were: (1) to identify risk factors for systemic metastases in patients with > or = 1 cm invasive breast cancer and (2) to investigate the patient groups at the greatest risk for metastases with such small tumors. Data were collected retrospectively from the breast cancer registry of our institution for patients with invasive breast cancer from October 1994 to December 2004. Of 4,036 patients who received curative breast cancer surgery, we identified 427 patients who had T1a or T1b breast cancer excluding 39 patients who received neoadjuvant chemotherapy. Ipsilateral axillary lymph node involvement was found in 13% (57/427) of patients at the time of surgery. A multivariate analysis was conducted in 370 (T1aN0, T1bN0) patients without lymph node involvement. In a Cox-regression model, HER-2 positive and triple negative (TN) groups were identified as independent risk factors to predict distant relapse-free survival (DRFS) [Hazard ratio (HR) 8.8, P = 0.003 for HER-2 positive group; HR 5.1, P = 0.026 for TN group] in T1bN0 tumors. Statistical significance was not maintained when the analysis was limited to T1aN0 tumors. Even though T1aN0 and T1bN0 tumors have a relatively low risk of systemic failure, antiHER-2-directed therapy for HER-2 group and new innovative adjuvant systemic treatment for TNBC patients with T1bN0 tumors should be considered. Prospective adjuvant trials are warranted in these subgroups of patients.
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Affiliation(s)
- Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea
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38
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Mittendorf EA, Sahin AA, Tucker SL, Meric-Bernstam F, Yi M, Nayeemuddin KM, Babiera GV, Ross MI, Feig BW, Kuerer HM, Hunt KK. Lymphovascular invasion and lobular histology are associated with increased incidence of isolated tumor cells in sentinel lymph nodes from early-stage breast cancer patients. Ann Surg Oncol 2008; 15:3369-77. [PMID: 18815841 DOI: 10.1245/s10434-008-0153-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 07/19/2008] [Accepted: 08/18/2008] [Indexed: 12/26/2022]
Abstract
BACKGROUND Isolated tumor cells (ITC) are more likely to be identified when serial sectioning and immunohistochemical staining are used to evaluate sentinel lymph nodes (SLN). Our goal was to identify clinicopathologic features associated with ITC in patients undergoing sentinel lymph node dissection (SLND). METHODS We reviewed clinicopathologic data for 3557 patients with no clinical evidence of lymph node metastases undergoing SLND between November 1993 and March 2007. Patients were staged according to the 6th edition of the American Joint Committee on Cancer staging system, with metastasis <or=.2 mm classified as ITC. RESULTS A SLN was identified in 3475 patients (97.7%), including 2518 (72.4%) with negative nodes and 169 (4.9%) with ITC. A statistically significant association existed between lobular histology and the identification of ITC; 13.6% of patients with ITC had lobular histology versus 7.3% of patients with a negative SLN (P = .003). The presence of lymphovascular invasion (LVI) was also associated with ITC; 18.3% of patients with ITC had LVI in the primary tumor versus 8.5% of patients with a negative SLN (P < .001). No difference existed between patients with and without ITC with respect to T stage, grade, estrogen receptor, progesterone receptor, HER2/neu status, or biopsy method. CONCLUSION The association between ITC and LVI, a known predictor of poor outcome, suggests ITC may have clinical relevance. The relationship between lobular histology and ITC is consistent with the known pattern of lobular metastases, which frequently present as small foci requiring immunohistochemistry for detection. Longer follow-up is needed to determine whether ITC have prognostic significance.
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Affiliation(s)
- Elizabeth A Mittendorf
- Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Abstract
The purpose of the study is to develop a mouse ocular melanoma model with human uveal melanoma cells that forms hepatic micrometastases. Human uveal melanoma Mel290 cells were transfected with a lentiviral-enhanced green fluorescent protein (EGFP) expression vector. Proliferation assays were performed by comparing Mel290-EGFP and Mel290 cells. After stable expression of EGFP and proliferation was ascertained, 1 x 10 Mel290-EGFP cells were introduced into NU/NU mice by posterior compartment (PC) inoculation or tail vein injection. Control groups were inoculated or injected with Mel290 cells. Ocular and hepatic frozen sections were examined by fluorescence microscopy, and the number of hepatic micrometastases was determined. EGFP expression was observed at 24 h after transfection. At 72 h after transfection, more than 70% of Mel290 cells expressed EGFP. At 45 days (six passages), 90% of Mel290 cells stably expressed EGFP. Histologic examination showed that Mel290-EGFP cells formed hepatic micrometastases after either PC inoculation or tail vein injection. A significant difference in the number of hepatic micrometastases between PC inoculation and tail vein injection (P<0.01) was observed. Mel290-EGFP cells stably expressed green fluorescent protein in vitro at 45 days (six passages). These cells formed hepatic micrometastases in NU/NU mice after PC inoculation or tail vein injection, with significantly more micrometastases developing in the PC inoculation model than after tail vein injection.
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40
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Fisher ER, Costantino JP, Leon ME, Bandos H, Palekar AS, Fisher B, Wolmark N. Pathobiology of small invasive breast cancers without metastases (T1a/b, N0, M0): National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol B-21. Cancer 2007; 110:1929-36. [PMID: 17896781 DOI: 10.1002/cncr.23011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Uncertainties continue to exist concerning the outcomes and management of small (T1a/b N0 M0) invasive breast cancers. METHODS A central pathology review was performed of 638 such lesions from National Surgical Adjuvant Breast and Bowel Project (NSABP) clinical trial B-21. RESULTS Univariate analysis revealed a high risk for ipsilateral breast tumor recurrence with tumors exhibiting a ductal carcinoma in situ component or poor nuclear grade. The converse (protective effect) was found with tumors arising in radial scars, those of tubular histologic type, and those with moderate/marked tumor stroma. The correlations were generally similar for disease-free survival. However, only nuclear grade was found to be independently significant for both of these outcomes. Only lymphatic tumor extension was univariately and multivariately significant for overall survival. CONCLUSIONS The long-term results of follow-up (median, 11.2 years) from the current trial continue to support the need for local breast irradiation and adjuvant therapy in the management of patients with these small cancers.
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Affiliation(s)
- Edwin R Fisher
- National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, Pennsylvania, USA.
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41
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Hanrahan EO, Gonzalez-Angulo AM, Giordano SH, Rouzier R, Broglio KR, Hortobagyi GN, Valero V. Overall survival and cause-specific mortality of patients with stage T1a,bN0M0 breast carcinoma. J Clin Oncol 2007; 25:4952-60. [PMID: 17971593 DOI: 10.1200/jco.2006.08.0499] [Citation(s) in RCA: 210] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE With mammographic screening, the frequency of diagnosis of stage T1a,bN0M0 breast cancer has increased. Prognosis after locoregional therapy and benefit from adjuvant systemic therapy are poorly defined. We reviewed T1a,bN0M0 breast cancer cases registered in the Surveillance, Epidemiology, and End Results (SEER) Program to investigate the impact of prognostic factors on breast cancer-specific (BCSM) and non-breast cancer-related mortality. METHODS We identified T1a,bN0M0 breast cancer cases registered in the SEER Program from 1988 to 2001, and used the Kaplan-Meier product limit method to describe overall survival (OS). We estimated the probabilities of death resulting from breast cancer and from other causes, and analyzed associations of patient and tumor characteristics with OS, BCSM, and non-breast cancer-related mortality using the log-rank test, Cox proportional hazards models, and a competing-risk model. We constructed nomograms to assist physicians in adjuvant therapy decision making. RESULTS We identified 51,246 T1a,bN0M0 cases. Median follow-up was 64 months (range, 1 to 167 months). Median age at diagnosis was 65 years (range, 20 to 101 years). Ten-year probabilities of all-cause mortality and BCSM were 24% and 4%, respectively. Characteristics associated with increased probability of BCSM included age younger than 50 years at diagnosis, high tumor grade, estrogen receptor-negative status, progesterone receptor-negative status, and fewer than six nodes removed at axillary dissection. The constructed nomograms allow a comparison of predicted breast cancer-specific survival and non-breast cancer-specific survival in individual patients. CONCLUSION Overall, the prognosis of patients with T1a,bN0M0 breast cancer is excellent. However, subgroups of patients who are at higher risk of BCSM and who should be considered for adjuvant systemic therapy can be identified.
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Affiliation(s)
- Emer O Hanrahan
- Departments of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Unit 10, Houston, TX 77030, USA.
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Naeim A, Sawhney R, MacLean CH, Sanati H. Quality Indicators for the Care of Breast Cancer in Vulnerable Elders. J Am Geriatr Soc 2007; 55 Suppl 2:S258-69. [PMID: 17910546 DOI: 10.1111/j.1532-5415.2007.01331.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
MESH Headings
- Aged
- Aromatase Inhibitors/therapeutic use
- Bone Neoplasms/diagnosis
- Bone Neoplasms/secondary
- Bone Neoplasms/therapy
- Breast Neoplasms/diagnosis
- Breast Neoplasms/metabolism
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/therapy
- Chemotherapy, Adjuvant
- Comorbidity
- Diphosphonates/therapeutic use
- Evidence-Based Medicine
- Female
- Frail Elderly
- Humans
- Lymphatic Metastasis
- Mammography
- Mastectomy
- Neoplasm Staging
- Process Assessment, Health Care
- Quality Indicators, Health Care
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
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Affiliation(s)
- Arash Naeim
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA.
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Livi L, Saieva C, Paiar F, Simontacchi G, Galardi A, De Luca Cardillo C, Mangoni M, Paoletti L, Ponticelli P, Biti GP. Use of tamoxifen in pT1a–pT1b, pN0 breast cancer. Eur J Surg Oncol 2007; 33:271-5. [PMID: 16831531 DOI: 10.1016/j.ejso.2006.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 05/31/2006] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate if in low-risk breast cancer patients (pT1a-pT1b, pN0) tamoxifen can reduce local recurrence and improve survival. METHODS Retrospectively 700 patients were analyzed. All patients were treated from 1980 to 2003 with conservative surgery plus radiotherapy at the University of Florence. No patients were treated with adjuvant chemotherapy. Tamoxifen was prescribed in 359 patients (51.3%). The crude probability of survival (or local recurrence) was estimated by using Kaplan-Meier method, and survival (or local recurrence) comparisons were carried out using Cox proportional hazard regression models. RESULTS The univariate analysis for specific survival showed that only histological type and local recurrence were significant prognostic factors (log rank test: p=0.02 and p<0.0001, respectively). The Cox regression model by stepwise selection confirmed lobular histological type (p=0.008; HR: 3.83, 95% CI: 1.31-11.21) and local recurrence (p<0.001; HR: 9.05, 95% CI: 3.05-26.82) as independent prognostic factors for disease specific survival. For local disease free survival, multivariate analysis did not show any significant parameters. CONCLUSION In our series tamoxifen did not seem to improve disease specific survival and local disease specific survival. The number of events in terms of death for cancer or in terms of local recurrence is too small in this group of patients. However, according to our results we suggest not to prescribe tamoxifen in patients affected by pT1a-pT1b, pN0 breast cancer.
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Affiliation(s)
- L Livi
- Department of Radiotherapy-Oncology, University of Florence, Viale Morgagni No. 85, 50134 Florence, Italy.
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Hanrahan EO, Valero V, Gonzalez-Angulo AM, Hortobagyi GN. Prognosis and Management of Patients With Node-Negative Invasive Breast Carcinoma That Is 1 cm or Smaller in Size (stage 1; T1a,bN0M0): A Review of the Literature. J Clin Oncol 2006; 24:2113-22. [PMID: 16648513 DOI: 10.1200/jco.2005.02.8035] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeMammographic screening has led to an increase in the number of small, node-negative breast cancers being diagnosed. Node-negative breast cancers that are ≤ 1 cm are stage T1a,bN0M0. Controversy surrounds the prognosis of these patients with locoregional therapy only and the need for adjuvant systemic therapy.MethodsWe performed a comprehensive review of the literature describing outcome and prognostic factors in stage T1a,bN0M0 breast cancer. We also reviewed current guidelines for systemic therapy in these patients.ResultsEarly studies reported 10-year relapse-free survival (RFS) rates higher than 90% without adjuvant systemic therapy, but some more recent data suggest inferior outcomes. High tumor grade is the most consistent factor associated with poor prognosis. Other adverse prognostic factors are younger age, lymphovascular invasion (LVI), high Ki-67, and larger tumors within the T1a,b subgroup. Patients with high-grade tumors and/or LVI may have 10-year RFS rates of less than 75% in the absence of systemic therapy. The prognostic significance of hormone receptor status is unclear. Current guidelines for the systemic management of early-stage breast cancer differ when applied to stage T1a,bN0M0, reflecting the controversial nature of the issue.ConclusionAdjuvant systemic therapy is advisable for most patients with stage T1a,bN0M0 breast cancer who have grade 3 tumors and/or LVI. Other T1a,bN0M0 cases should be considered for systemic therapy based on clinicopathologic factors with known prognostic significance and assessment of the risk-benefit ratio. More reliable tools are needed to assess the prognosis of patients with stage T1a,bN0M0 breast cancer and their potential to benefit from specific therapeutic agents.
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Affiliation(s)
- Emer O Hanrahan
- Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1439, USA
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Takeuchi H, Ueo H, Tsuji K, Tokunaga E, Baba H, Maehara Y. Prediction of survival from first recurrence of breast carcinoma in Japanese women. Breast 2006; 15:226-31. [PMID: 16005234 DOI: 10.1016/j.breast.2005.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2004] [Revised: 02/09/2005] [Accepted: 03/03/2005] [Indexed: 11/27/2022] Open
Abstract
The clinical courses of patients with recurrent breast carcinoma vary greatly. We retrospectively examined data on 1863 Japanese patients treated for a breast carcinoma from 1981 to 2000. Among them, 345 (18.5%) who had clearly died of recurrence were reviewed. Patients died most frequently (63.2%) up to 30 months after the first recurrence. Based on multivariate analysis, the four factors that were most predictive of survival after the first recurrence were disease-free interval, site of recurrence, progesterone receptor (PgR) status, and vascular involvement. These findings showed that the intrinsic tumor biology of the initial primary tumor plays a critical role in determining survival after the first recurrence in patients with a breast carcinoma. The combined analysis of disease-free interval, site of recurrence, PgR status, and vascular involvement may assist in estimating the median survival after first recurrence, and may assist with the designing of new therapeutic strategies for patients with recurrence for whom there is an unfavorable prognosis.
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Affiliation(s)
- Hideya Takeuchi
- Department of Surgery, Oita Prefectural Hospital, Bunyo 476, Oita 870-8511, Japan.
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Takeuchi H, Baba H, Kano T, Maehara Y. The time-related changes of the importance of prognostic factors in breast cancer. A sequential multivariate analysis of 1423 Japanese patients. Breast Cancer Res Treat 2005; 94:273-8. [PMID: 16261405 DOI: 10.1007/s10549-005-9014-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The value of individual prognostic factors may change dependent on the length of the follow-up period, if some factors have their greatest prognostic potential immediately after operation. It is not clear how long these factors keep their prognostic relevance. We retrospectively examined data on 1423 surgically treated Japanese patients with primary breast cancer between 1983 and 2002. Survival analysis was done starting at 2.5-yearly intervals after operation and follow-up in the first analysis started at the time of the operation. The changing importance of the prognostic factors during different follow-up periods was investigated by univariate and multivariate analysis. Based on multivariate analysis, tumor size retained its prognostic value even up to 7.5 years after operation, whereas the age, vascular involvement, ER and PgR showed a changing influence on prognosis dependent on the length of the follow-up period. The prognosis of patients some years after operation is necessarily different from the initial prognosis established after operation. Detecting the changing importance of prognostic factors could provide new biological insights that might otherwise be missed, and may help determine the most appropriate clinical use of various factors.
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Affiliation(s)
- Hideya Takeuchi
- Department of Surgery, Oita Prefectural Hospital, 870-8511, Oita, Japan.
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Arihiro K. Pathological approach to evolving prognostic and predictive factors of breast cancer. Breast Cancer 2005; 11:343-9. [PMID: 15604989 DOI: 10.1007/bf02968041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Among the evolving concepts of prognostic and predictive factors in breast carcinoma pathology are those relating to lymph node status, tumor size, histological type, histological grade, bone marrow micrometastasis, and lymphatic and blood vessel involvement. Correct identification based on a uniform and complete pathological evaluation of tumor specimens is vital to correctly decide treatment. In addition we describe inflammatory cell infiltrates in breast carcinoma as not only prognostic and predictive factors but also pleiotropic regulators and/or effectors.
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Affiliation(s)
- Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Minami-ku, Hiroshima 734-8551, Japan.
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Abstract
Identification of early-stage breast cancers has increased over the past 2 decades primarily because of mammographic screening. The general guidelines to management of breast cancer may not apply to the smallest of these tumors, as their metastatic potential may be smaller than larger tumors. Tumors < 5 mm (T1a) carry an excellent prognosis, despite a variety of treatment approaches. However, some patients' cancer returns. There appear to be some histologic features that can predict a higher risk of axillary metastases, and therefore, a higher risk of distant metastases. Controversy exists over the extent of treatment, as to whether less than conventional treatment, such as mastectomy, axillary evaluation, and breast-conserving surgery and radiation, can be done. T1a lesions associated with extensive ductal carcinoma in situ and T1a lesions in young patients should be treated with caution if less than conventional breast treatment is to be considered. In older patients with good histologic features, axillary assessment may not be necessary. Very wide excision alone may be appropriate for some patients, but partial breast irradiation is under study and may provide a reasonable compromise. Systemic therapy for node-negative patients is not recommended. Recurrences within the breast occur later in early-stage breast cancers than with extensive-stage breast cancers, requiring annual imaging and evaluation for many years.
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Affiliation(s)
- Krystyna D Kiel
- Department of Radiation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Singletary SE, Allred C, Ashley P, Bassett LW, Berry D, Bland KI, Borgen PI, Clark GM, Edge SB, Hayes DF, Hughes LL, Hutter RVP, Morrow M, Page DL, Recht A, Theriault RL, Thor A, Weaver DL, Wieand HS, Greene FL. Staging system for breast cancer: revisions for the 6th edition of the AJCC Cancer Staging Manual. Surg Clin North Am 2003; 83:803-19. [PMID: 12875597 DOI: 10.1016/s0039-6109(03)00034-3] [Citation(s) in RCA: 223] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Since its inception, the AJCC staging system for breast cancer has been in an almost constant state of evolution, striving with each revision to reflect the most up-to-date clinical research as well as the widespread consensus among physicians about appropriate diagnostic and treatment standards. To date, these revisions have essentially represented a "fine-tuning" of the initial judgment that tumor size, lymph node status, and presence of distant metastases are the most significant prognostic factors for breast cancer. With the problems of standardization and reproducibility being resolved, it is likely that histologic grade will join this group of independent markers and be incorporated into the AJCC staging system in the near future. Over the last 15 years. considerable attention has been focused on the discovery of new markers visualized with immunohistochemistry and RT-PCR that may be validated as independent prognostic indicators (reviewed by Mirza et al). To date, the usefulness of many of these markers has been limited by lack of standardization in measurement techniques, but several show great promise for the future. By increasing the number of prognostic markers that can give independent information about patient outcome, physicians will be better able to determine optimal treatment approaches for individual patients.
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Affiliation(s)
- S Eva Singletary
- Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 106, Houston, TX 77030-4009, USA.
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Russell CA. Adjuvant systemic therapy for lymph node-negative breast cancer less than or equal to 1 cm. Curr Oncol Rep 2003; 5:72-7. [PMID: 12493154 DOI: 10.1007/s11912-003-0090-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Routine screening mammography has increased the incidence of stage I breast cancers. Many more women are being diagnosed with lymph node-negative tumors that are less than or equal to 1 cm in greatest diameter. The National Surgical Adjuvant Breast and Bowel Project recently performed a retrospective analysis of 10,302 women participating in one of five clinical trials, including women with lymph node-negative breast cancer. Of these women, 1259 had tumors less than or equal to 1 cm. The analysis of the women with tumors less than or equal to 1 cm revealed an improved relapse-free survival (RFS) if tamoxifen was given after surgery, compared with surgery alone, for women with estrogen receptor (ER)-positive tumors; and for women with ER-negative tumors, RFS was improved by delivering chemotherapy after surgery. The authors suggested that adjuvant systemic therapy should be considered for anyone with an invasive breast cancer, regardless of the size of the tumor. This paper reviews the data presented in that important, historic article, and discusses their conclusions. Also reviewed are the most recent recommendations for treatment of primary breast cancer from the International Consensus Panel that convened at the Seventh International Conference on Adjuvant Therapy of Primary Breast Cancer in St. Gallen, Switzerland. That panel also addressed the issue of adjuvant systemic therapy in women considered to have a minimal or low risk of developing recurrent disease.
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Affiliation(s)
- Christy A Russell
- Department of Medicine-Oncology, Keck School of Medicine, University of Southern California, NOR 3448, MC 9173, Los Angeles, CA 90089, USA.
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