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Nontherapeutic Risk Factors of Different Grouped Stage IIIC Breast Cancer Patients’ Mortality: A Study of the US Surveillance, Epidemiology, and End Results Database. Breast J 2022; 2022:6705052. [PMID: 36111212 PMCID: PMC9448578 DOI: 10.1155/2022/6705052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/05/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Objectives Stage IIIC breast cancer, as a local advanced breast cancer, has a poor prognosis compared with that of early breast cancer. We further investigated the risk factors of mortality in stage IIIC primary breast cancer patients and their predictive value. Methods We extracted data from the US Surveillance, Epidemiology, and End Results (SEER) database of female patients with stage IIIC primary breast cancer (n = 1673) from January 2011 to December 2015. Results Hormone receptor negativity (P ≤ 0.001 and P ≤ 0.001, respectively), aggressive molecular typing (P ≤ 0.001 and P ≤ 0.001, respectively), high T stage (P ≤ 0.001 and P ≤ 0.001, respectively), a high number of positive lymph nodes (≥14) (P=0.005 and P=0.001, respectively), and lymph node ratio (≥0.8148) (P ≤ 0.001 and P ≤ 0.001, respectively) were associated with poor disease-specific survival. The indicators of disease-specific survival included estrogen receptor status, progesterone receptor status, molecular typing, T stage, number of positive lymph nodes, and lymph node ratio (P ≤ 0.001,P ≤ 0.001,P ≤ 0.001,P ≤ 0.001, P=0.002, and P ≤ 0.001, respectively). Conclusion Hormone receptor negativity, aggressive molecular typing, high T stage, high number of positive lymph nodes, and lymph node ratio are poor prognostic factors patients with stage IIIC primary breast cancer. The efficient indicators of disease-specific survival include estrogen receptor status, progesterone receptor status, molecular typing, T stage, number of positive lymph nodes, and lymph node ratio.
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Ai X, Liao X, Li J, Tang P, Jiang J. Clinical Outcomes of N3 Breast Cancer: A Real-World Study of a Single Institution and the US Surveillance, Epidemiology, and End Results (SEER) Database. Cancer Manag Res 2020; 12:5331-5343. [PMID: 32753951 PMCID: PMC7342555 DOI: 10.2147/cmar.s246162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background Although stage IIIC (any TN3M0) breast cancer is known to have a dismal prognosis, the clinical outcome of current standard management and the prognostic differences between N3a, N3b and N3c remain to be further investigated. Material and Methods Data from our center on pathologic N3 (pN3) (n=284) breast cancer and the US Surveillance, Epidemiology, and End Results (SEER) database on clinical N3 (cN3) (n=15,291) and M1 (n=23,623) breast cancer between January 2004 and December 2015 were systematically analyzed for clinicopathological characteristics and survival outcomes. Results In our institution, patients with pN3c had the worst survival, with 5-year OS and DFS rates of 52.4% and 41.5%, respectively. Patients with pN3b had a relatively good prognosis, with a 5-year OS rate of 75.3% vs 63.9% for the pN3a group (p=0.045). For DFS, the 5-year survival rate was 63.1% in the pN3b group compared with 40.3% in the pN3a group (p=0.030). In the US SEER database, patients with cN3c had the worst survival in the cN3 group, but the prognosis of cN3c was much better than that of M1. Similarly, patients with cN3b had a better prognosis compared with patients in other groups, with a 5-year OS rate of 68.9% vs 61.9% for the cN3a group (p<0.001) and a 5-year BCSS rate of 73.4% vs 67.1% for the cN3a group (p<0.001). Conclusion Breast cancer patients with N3c had the worst clinical outcomes, while the prognosis of N3b patients was better than that of N3a patients.
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Affiliation(s)
- Xiang Ai
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
| | - Xin Liao
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
| | - Junyan Li
- Department of Breast Surgery, People's Hospital of DeYang City, Deyang 618000, People's Republic of China
| | - Peng Tang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
| | - Jun Jiang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing 400038, People's Republic of China
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Hur MH, Ko S. Metastatic axillary node ratio predicts recurrence and poor long-term prognosis in patients with advanced stage IIIC (pN3) breast cancer. Ann Surg Treat Res 2017; 92:340-347. [PMID: 28480179 PMCID: PMC5416925 DOI: 10.4174/astr.2017.92.5.340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/28/2017] [Accepted: 05/15/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose Patients with stage IIIC breast cancer are classified as having pathologic nodal stage 3 (pN3) according to the 7th American Joint Committee on Cancer Tumor Node Metastasis (AJCC TNM) staging system. However, the prognosis of patients with this stage is still highly variable. This study was carried out to investigate the validity of metastatic axillary lymph node ratio (mALNR) as a predictor of long-term prognosis in stage IIIC breast cancer. Methods Medical records of 297 patients who underwent surgery with more than level II axillary dissection for breast cancer and who were diagnosed with pN3 by pathology between 1990 and 2010, were reviewed. Clinicopathologic variables were evaluated as prognostic factors of disease-free and overall survival by univariate and multivariate analyses. Results A preliminary analysis revealed the cutoff value of mALNR to be 0.65 (Low65 group vs. High65 group). The mean mALNR was 0.62 (0.16–1.0) and was the most significant independent predictor of disease-free and overall survival on multivariate analysis. The rates of recurrence were significantly different according to mALNR (Low65, 40.3%; High65, 63.0%; P < 0.001). The 10-year disease-free (Low65, 57.0%; High65, 35.0%) and overall (Low65, 64.2%; High65, 38.3%) survival rates decreased significantly with increased mALNR (P < 0.001). Conclusion Patients with stage IIIC breast cancer can be subdivided into subgroups with significantly different long-term prognoses. Our data suggest that the mALNR is an independent risk factor of recurrence and mortality. The mALNR is a valuable prognostic factor to predict the long-term prognosis of stage IIIC breast cancer patients.
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Affiliation(s)
- Min Hee Hur
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - SeungSang Ko
- Department of Surgery, Cheil General Hospital, Dankook University College of Medicine, Seoul, Korea
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Grassadonia A, Vici P, Gamucci T, Moscetti L, Pizzuti L, Mentuccia L, Iezzi L, Scognamiglio MT, Zilli M, Giampietro J, Graziano V, Natoli C, Tinari N. Long-term outcome of breast cancer patients with pathologic N3a lymph node stage. Breast 2017; 32:79-86. [DOI: 10.1016/j.breast.2016.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/22/2016] [Accepted: 12/25/2016] [Indexed: 01/10/2023] Open
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Kim SW, Choi DH, Huh SJ, Park W, Nam SJ, Kim SW, Lee JE, Im YH, Ahn JS, Park YH. Lymph Node Ratio as a Risk Factor for Locoregional Recurrence in Breast Cancer Patients with 10 or More Axillary Nodes. J Breast Cancer 2016; 19:169-75. [PMID: 27382393 PMCID: PMC4929258 DOI: 10.4048/jbc.2016.19.2.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We analyzed the association of lymph node ratio (LNR) wth locoregional control (LRC) in breast cancer patients with ≥10 involved axillary lymph nodes who underwent multimodality treatment. METHODS We retrospectively analyzed 234 breast cancer patients with ≥10 involved axillary lymph nodes between 2000 and 2011. All patients received adjuvant chemotherapy and radiotherapy (RT) after radical surgery. The cutoff value of LNR was obtained using receiver operating characteristic curve analysis. The majority of patients (87.2%) received chemotherapeutic regimen including taxane. RT consisted of tangential fields to the chest wall or intact breast, delivered at a median dose of 50 Gy, and a single anterior port to the supraclavicular lymph node area, delivered at a median dose of 50 Gy. For patients who underwent breast-conserving surgery, an electron boost with a total dose of 9 to 15 Gy was delivered to the tumor bed. RESULTS Within a median follow-up period of 73.5 months (range, 11-183 months), locoregional recurrence (LRR) occurred in 30 patients (12.8%) and the 5-year LRC rate was 88.8%. After multivariate analysis, LNR ≥0.7 was the only independent factor significantly associated with LRC (hazard ratio, 2.06; 95% confidence interval, 0.99-4.29; p=0.05). CONCLUSION An aggressive multimodal treatment approach showed favorable locoregional outcome in patients with ≥10 involved axillary lymph nodes. However, patients with a high LNR ≥0.7 still had an increased risk for LRR, even in the setting of current local treatments.
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Affiliation(s)
- Sang-Won Kim
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Jae Huh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Won Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Hyuck Im
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hee Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Yu JI, Park W, Choi DH, Huh SJ, Nam SJ, Kim SW, Lee JE, Kil WH, Im YH, Ahn JS, Park YH, Cho EY. Clinical Outcomes and Prognostic Factors of Pathologic N3 Breast Cancer Treated With Modern Standard Treatments. Clin Breast Cancer 2015; 15:512-8. [DOI: 10.1016/j.clbc.2015.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/11/2015] [Indexed: 01/25/2023]
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Turker I, Arslan UY, Yazici O, Uyeturk U, Oksuzoglu B, Budakoglu B, Özdemir N, Sonmez OU, Helvaci K, Esbah O, Bal O, Ekinci AS, Zengin N. Prognostic Factors in Operated Stage IIIC, Pathological N3a Breast Cancer Patients. ACTA ACUST UNITED AC 2015; 9:421-7. [PMID: 25759625 DOI: 10.1159/000366438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the prognostic factors in patients operated for stage IIIC breast carcinoma who had > 10 positive axillary lymph nodes (pN3a). PATIENTS AND METHODS The medical records of 302 operated N3a breast cancer patients without distant metastasis followed up in 2 medical oncology clinics in Ankara between January 1998 and June 2013 were evaluated retrospectively. RESULTS The median age was 50 (21-83) years. The median follow-up time was 43 (5-191) months. The patients were divided into 4 subgroups according to hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. There were 151 (50.0%) patients in the HR+/HER2- group, 80 (26.5%) patients in the HR+/HER2+ group, 42 (13.9%) patients in the HR-/HER2+ group, and 29 (9.6%) patients in the triple negative (TN) group. At the time of analysis, 155 (51.3%) patients had recurrent disease and 117 (38.7%) patients had died. The median disease-free survival (DFS) and overall survival (OS) times were 46.0 and 78.0 months, respectively. Both the DFS and OS in the HR+/HER2- group were longer than in the other groups (log-rank p = 0.034 and p = 0.016, respectively). Menopausal status, progesterone receptor (PgR) status, and lymph node ratio (LNR; defined as the number of positive lymph nodes compared to the total number of removed lymph nodes) were found to be independent prognostic factors (p = 0.019, p = 0.001, and p = 0.012, respectively). CONCLUSION Menopausal status, PgR status, and LNR were independent prognostic factors in operated N3a breast cancer patients, who are underrepresented in breast cancer trials.
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Affiliation(s)
- Ibrahim Turker
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ulku Y Arslan
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ozan Yazici
- Medical Oncology Department, Ankara Numune Training and Research Hospital, Turkey
| | - Ummugul Uyeturk
- Medical Oncology Department, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Berna Oksuzoglu
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Burcin Budakoglu
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Nuriye Özdemir
- Medical Oncology Department, Ankara Numune Training and Research Hospital, Turkey
| | - Ozlem U Sonmez
- Medical Oncology Department, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Kaan Helvaci
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Onur Esbah
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Oznur Bal
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ahmet S Ekinci
- Medical Oncology Department, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Nurullah Zengin
- Medical Oncology Department, Ankara Numune Training and Research Hospital, Turkey
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Zeichner SB, Cavalcante L, Suciu GP, Ruiz AL, Hirzel A, Krill-Jackson E. Long-term survival of women with locally advanced breast cancer with ≥ 10 involved lymph nodes at diagnosis. Asian Pac J Cancer Prev 2015; 15:3435-41. [PMID: 24870735 DOI: 10.7314/apjcp.2014.15.8.3435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Axillary lymph node status at diagnosis remains the strongest predictor of long-term survival in breast cancer. Patients with more than ten axillary lymph nodes at diagnosis have a poor long-term survival. In this single institutional study, we set out to evaluate the prognosis of this high-risk group in the era of multimodality therapy. MATERIALS AND METHODS In this retrospective study, we looked at all breast cancer patients with greater than ten axillary lymph nodes diagnosed at Mount Sinai Medical Center (MSMC) from January 1st 1990 to December 31st 2007 (n=161). In the univariate analysis, descriptive frequencies, median survival, and 5- and 10-year survival rates were estimated for common prognostic factors. A multivariate prognostic analysis for time-to-event data, using the extended Cox regression model was carried out. RESULTS With a median and mean follow-up of 70 and 89.9 months, respectively, the overall median survival was estimated to be 99 months. The five-year disease-free survival (DFS) was 59.3% and the ten-year DFS was 37.9%, whereas the five- and ten-year overall survival (OS) was 66.6% and 43.9%, respectively. Multivariate analysis revealed a significant improvement in DFS among black patients compared to whites (p=0.05), improved DFS and OS among young patients (ages 21-45) compared to elderly patients (age greater than 70) (p=0.00176, p=0.0034, respectively), and improved DFS and OS among patients whose tumors were ER positive (p=0.049, p=0.0034). CONCLUSIONS In this single institution study of patients with greater than 10 positive axillary nodes, black patients had a significantly improved DFS compared with white patients. Young age and ER tumor positivity was associated with improved outcomes. Using multivariate analysis, there were no other variables associated with statistically significant improvements in DFS or OS including date of diagnosis. Further work is needed to improve breast cancer survival in this subgroup of patients.
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Li Q, Wu S, Zhou J, Sun J, Li F, Lin Q, Guan X, Lin H, He Z. Risk factors for locoregional recurrence after postmastectomy radiotherapy in breast cancer patients with four or more positive axillary lymph nodes. ACTA ACUST UNITED AC 2014; 21:e685-90. [PMID: 25302039 DOI: 10.3747/co.21.2000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND We investigated risk factors for locoregional recurrence (lrr) in breast cancer patients with 4 or more positive axillary lymph nodes receiving postmastectomy radiotherapy (pmrt). METHODS Medical records (1998-2007) were retrospectively reviewed for the population of interest. The Kaplan-Meier method was used to calculate the survival rate; Cox regression models were used for univariate and multivariate analysis of predictors of breast cancer lrr. RESULTS The study enrolled 439 patients. Median duration of follow-up was 54 months. The 5-year rates of locoregional recurrence-free survival (lrrfs), distant metastasis-free survival (dmfs), and breast cancer-specific survival (bcss) were 87.8%, 59.5%, and 70.7% respectively. In patients with lrr and no concomitant metastasis, and in those without lrr, the 5-year rates of dmfs were 21.1% and 65.7% respectively (p < 0.001), and the 5-year rates of bcss were 34.5% and 76.4% respectively (p < 0.001). Univariate analysis showed that menopausal status (p = 0.041), pN stage (p = 0.006), and positivity for her2 [human epidermal growth factor receptor 2 (p = 0.003)] or the triple-negative disease subtype (p < 0.001) were determinants of lrrfs. Multivariate analysis showed that pN3 stage [hazard ratio (hr): 2.241; 95% confidence interval (ci): 1.270 to 3.957; p = 0.005], her2 positivity (hr: 2.705; 95% ci: 1.371 to 5.335; p = 0.004), and triple-negative disease subtype (hr: 4.617; 95% ci: 2.192 to 9.723; p < 0.001) were independent prognostic factors of lrrfs. CONCLUSIONS In breast cancer patients with 4 or more positive axillary lymph nodes who undergo pmrt for breast cancer, lrr significantly influences survival. Patients who developed lrr carried a high risk for distant metastasis and death. Pathologic stage (pN3), her2 positivity, and the triple-negative disease subtype are risk factors that significantly influence lrrfs.
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Affiliation(s)
- Q Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - S Wu
- Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, PR China
| | - J Zhou
- Xiamen Cancer Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Xiamen, PR China
| | - J Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - F Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - Q Lin
- Xiamen Cancer Center, Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, PR China
| | - X Guan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - H Lin
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
| | - Z He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, PR China
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Genetic heterogeneity of breast cancer metastasis may be related to miR-21 regulation of TIMP-3 in translation. Int J Surg Oncol 2013; 2013:875078. [PMID: 23936642 PMCID: PMC3723359 DOI: 10.1155/2013/875078] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 06/01/2013] [Indexed: 12/17/2022] Open
Abstract
Purpose. MicroRNAs are noncoding RNA molecules that posttranscriptionally regulated expression of target gene and implicate the progress of cancer proliferation, differentiation, and apoptosis. The aim of this study is to determine whether microRNA-21 (miR-21), a specific microRNA implicated in multiple aspects of carcinogenesis, promoted breast cancer metastasis by regulating the tissue inhibitor of metalloproteinase 3 (TIMP-3) gene. Methods. miR-21 of serum and tissue from 40 patients (30 patients with breast cancer) were detected by real-time quantitative reverse transcriptase polymerase chain reaction (RT-qPCR). TIMP-3 of tissue from the patient was tested by real-time RT-qPCR. Protein expression of TIMP-3 was evaluated by western blotting. Correlation analysis was performed between miR-21 and TIMP-3. Results. Of the 40 samples from tissue and serum analyzed, the miR-21 expression was significantly higher in high invasion metastasis group (HIMG) that in low invasion metastasis group (LIMG); the latter was higher than that in normal group (NG). Additionally, the TIMP-3 expression was significantly lower in HIMG than in LIMG; the latter was lower than that in NG. There was significantly inverse correlation between miR-21 and TIMP-3 extracted from tissue. Conclusion. Our data suggest that miR-21 could promote metastasis in breast cancer via the regulation of TIMP3 translation, and there was consistency between miR-21 of serum and miR-21 in tissue.
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Koca E, Kuzan TY, Dizdar O, Babacan T, Sahin I, Ararat E, Altundag K. Outcomes of locally advanced breast cancer patients with ≥ 10 positive axillary lymph nodes. Med Oncol 2013; 30:615. [PMID: 23729267 DOI: 10.1007/s12032-013-0615-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/17/2013] [Indexed: 11/30/2022]
Abstract
Breast cancers with 10 or more positive lymph nodes at the time of diagnosis are staged as pathological N3a (pN3a) and they have poor prognosis. Recent studies showed five-year disease-free survival (DFS) and overall survival (OS) rates of N3a disease as 43-66 and 58-81 %, respectively. We herein present outcomes of our patients with stage pN3a breast cancer. Among 2,578 patients diagnosed with invasive breast carcinoma at Hacettepe University Hospital between 2002 and 2012, 218 patients (8.4 %) had pN3a disease and were included and analyzed retrospectively in this study. Patients with internal mammary, infraclavicular, and supraclavicular node metastasis or distant metastasis at initial diagnosis were excluded. Demographic features, tumor characteristics, treatment regimens, and patient outcomes in terms of DFS and OS were analyzed. Lymph node ratio was defined as the ratio of positive to total removed lymph nodes. The median age was 49. Most common histological subtype was ductal carcinoma (82.1 %). About 82.6 % of patients had stage T2/T3 cancers and 47.7 % (104) had grade III cancers. Estrogen and progesterone receptors were positive in 133 (61 %) and 121 (55.5 %) patients, respectively. HER2 status was known for 213 patients and was positive in 87 (39.9 %) patients. A total of 27 (12.6 %) patients had triple-negative tumors. Lymphovascular invasion, extracapsular extension, and perineural invasion were present in 106 (48.6 %), 105 (48.2 %), 20 (9.2 %) cases, respectively. A total of 18 patients (8.3 %) received neoadjuvant and 200 patients (91.7 %) received adjuvant chemotherapy, mostly with anthracycline- (95 %) and taxane (60 %)-containing regimens. A total of 210 patients (96.3 %) received radiotherapy. Median follow-up was 39.5 months. A total of 96 patients relapsed on follow-up and 64 patients died. Nineteen of the relapses were locoregional and 77 were distant relapses. The 5-year DFS rate was 46.2 % and the OS rate was 69.8 %. In multivariate Cox regression analysis, grade III disease (HR 1.899, 95 % CI 1.196-3.017, P = 0.007), perineural invasion (HR 2.519, 95 % CI 1.341-4.731, P = 0.004), and lymph node ratio (≥ 0.9 vs. <0.9) (HR 2.290, 95 % CI 1.368-3.835, P = 0.002) were significantly associated with DFS, and grade III disease (HR 2.679, 95 % CI 1.500-4.782, P = 0.001) and lymph node ratio (≥ 0.9 vs. <0.9) (HR 2.182, 95 % CI 1.211-3.932, P = 0.009) were significantly associated with OS. Patients with pN3a disease in our cohort have comparable survival rates with other reports in the literature. Within this high risk group of patients, those with grade III disease, perineural invasion, and lymph node ratio ≥ 0.9 seem to confer poorer prognosis.
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Affiliation(s)
- Emre Koca
- Hacettepe University Cancer Institute, Ankara, Turkey
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