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Prognostic Role of Lymphovascular Invasion in Patients with Early Breast Cancer. Indian J Surg Oncol 2021; 12:671-677. [DOI: 10.1007/s13193-021-01367-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/02/2021] [Indexed: 11/26/2022] Open
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Morkavuk ŞB, Güner M, Çulcu S, Eroğlu A, Bayar S, Ünal AE. Relationship between lymphovascular invasion and molecular subtypes in invasive breast cancer. Int J Clin Pract 2021; 75:e13897. [PMID: 33280209 DOI: 10.1111/ijcp.13897] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/30/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the relation between LVI and molecular subtypes in invasive breast cancers and to find out whether LVI which is a histopathologic indicator has a role in subtype classification or not. METHODS One hundred and seventy-six patients who had mastectomy for breast cancer between 2013 and 2018 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University were retrospectively analysed. One hundred and thirty-two patients who had LVI, ER, PR, Her 2 and Ki-67 index status information provided in their pathology results were included in the study. The relationship between molecular subtypes and LVI was investigated. RESULTS One hundred and thirty-two patients were analysed retrospectively. Eighty-two patients had LVI and 50 patients had not. We found a relationship between Luminal B with Her2(-) and LVI, basal like and LVI (P = .00). No significant statistical difference was found between LVI and other molecular subtypes. We confirmed these results with multiple variable analysis (%77.3 correlation). CONCLUSIONS As a result, we found that LVI can affect molecular subtypes. This showed that a histopathological factor may affect tumour biology. In other words, breast cancer is a heterogeneous disease with many different predictors and prognostic variables.
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Affiliation(s)
| | - Murat Güner
- Department of General Surgery, Usak Research and Training Hospital, Usak, Turkey
| | - Serdar Çulcu
- Department of General Surgery, Dr. Abdurrahman Yurtaslan Research and Training Hospital, Ankara, Turkey
| | - Aydan Eroğlu
- Department of Surgical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sancar Bayar
- Department of Surgical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ali Ekrem Ünal
- Department of Surgical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Wang SY, Abujarad F, Chen T, Evans SB, Killelea BK, Mougalian SS, Fraenkel L, Gross CP. "Radiotherapy for older women (ROW)": A risk calculator for women with early-stage breast cancer. J Geriatr Oncol 2019; 11:850-859. [PMID: 31899199 DOI: 10.1016/j.jgo.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/30/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Among older adult women with early-stage breast cancer who undergo lumpectomy, the benefits of radiotherapy vary according to tumor characteristics and life expectancy. We aimed to develop a risk calculator to predict individualized probability of long-term survival and local recurrence, accounting for these factors. METHODS We developed a simulation model to estimate an individual patient's risk of local recurrence and all-cause mortality according to age, comorbidities, functional status, tumor characteristics, and radiotherapy status. We integrated two existing prediction models, the Early Breast Cancer Trialist's Collaborative Group prediction model for breast cancer specific outcomes and ePrognosis for life expectancy. An online risk calculator "Radiotherapy for Older Women (ROW)" was developed through an iterative multi-stage process, that included individual consultation and group meetings with an advisory committee (AC) comprised of patients, advocates, clinicians, and researchers. RESULTS We developed the tool over 40 months and had 15 group meetings. The risk calculator developed as a simulation model with 16 factors (5 tumor-related, 3 demographic, 4 comorbidities, and 4 functional statuses). Across 56,700 simulated scenarios, the benefit of RT in terms of absolute 10-year local recurrence reduction, ranged from 0% to 34%, depending on individual characteristics. Based on feedback from the AC, overall survival and local recurrence were chosen as the output for ROW, with these outcomes displayed numerically (percentages and natural frequencies) and graphically (pictographs). CONCLUSIONS This tool "ROW" could facilitate shared decision making regarding receipt of radiotherapy for older women with early breast cancer. Additional studies to examine usability testing are underway.
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Affiliation(s)
- Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, United States of America; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, United States of America.
| | - Fuad Abujarad
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Tiange Chen
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, United States of America
| | - Suzanne B Evans
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, United States of America; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, United States of America
| | - Brigid K Killelea
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, United States of America; Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Sarah S Mougalian
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, United States of America; Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Liana Fraenkel
- Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, CT, United States of America; Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
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Can a subgroup at high risk for LRR be identified from T1-2 breast cancer with negative lymph nodes after mastectomy? A meta-analysis. Biosci Rep 2019; 39:BSR20181853. [PMID: 31484798 PMCID: PMC6753322 DOI: 10.1042/bsr20181853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 04/24/2019] [Accepted: 07/10/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose: To identify a subgroup at high risk for loco-regional recurrence (LRR) from T1-2 breast cancer with negative lymph nodes (N0) after mastectomy by using a meta-analysis.Methods and materials: Published studies on the relationship between clinical features and LRR of breast cancer were identified from public databases, including PubMed, EMBASE, and the Cochrane Library. High-risk features for LRR in this patient population were defined based on the pooled results of meta-analysis.Results: For the meta-analysis, a total of 11244 breast cancers with pT1-2N0 after mastectomy from 20 publications were included for analysis. The pooled results indicated that age (hazard ratio (HR) 1.77, P=0.001), lymphovascular invasion (LVI) (HR 2.23, P<0.001), histologic grade (HR 1.66, P<0.001), HER2 status (HR 1.65, P=0.027), menopausal status (HR 1.36, P=0.015), and surgical margins (HR 2.56, P=0.014) were associated with a significantly increased risk of developing LRR in this patient population group, but not for tumor size (HR 1.32, P=0.23), systematic therapy (HR 1.67, P=0.20), and hormonal receptor status (HR 1.04, P=0.73).Conclusion: In the current study, patients with young age, positive LVI, high histologic grade, HER-2 positive, premenopausal, and positive surgical margins have an increased risk of developing LRR. Further prospective trials are needed to clearly define the role of adjuvant postmastectomy radiotherapy in T1-2N0 breast cancer at high risk of developing LRR.
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Frandsen JE, Cannon G, Kokeny KE, Gaffney DK, Matsen C, Wright M, Poppe MM. Is radiation indicated for young women with early stage, node-negative breast cancer after mastectomy? A multi-institution, retrospective review. Breast J 2017; 24:7-11. [DOI: 10.1111/tbj.12827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/26/2016] [Accepted: 05/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathan E. Frandsen
- Department of Radiation Oncology; Huntsman Cancer Hospital; University of Utah School of Medicine; Salt Lake City UT USA
| | - George Cannon
- Department of Radiation Oncology; Intermountain Medical Center; Murray UT USA
| | - Kristine E. Kokeny
- Department of Radiation Oncology; Huntsman Cancer Hospital; University of Utah School of Medicine; Salt Lake City UT USA
| | - David K. Gaffney
- Department of Radiation Oncology; Huntsman Cancer Hospital; University of Utah School of Medicine; Salt Lake City UT USA
| | - Cindy Matsen
- Department of General Surgery; Huntsman Cancer Hospital; University of Utah School of Medicine; Salt Lake City UT USA
| | - Melissa Wright
- Oncology Clinical Program; Intermountain Healthcare; Salt Lake City UT USA
| | - Matthew M. Poppe
- Department of Radiation Oncology; Huntsman Cancer Hospital; University of Utah School of Medicine; Salt Lake City UT USA
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Cheon H, Kim HJ, Lee SM, Cho SH, Shin KM, Kim GC, Park JY, Kim WH. Preoperative MRI features associated with lymphovascular invasion in node-negative invasive breast cancer: A propensity-matched analysis. J Magn Reson Imaging 2017; 46:1037-1044. [PMID: 28370761 DOI: 10.1002/jmri.25710] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/07/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE In node-negative disease, the presence of lymphovascular invasion (LVI) is reported to be an unfavorable prognostic factor. Thus, the aim of this study was to evaluate whether preoperative breast MRI features are associated with LVI in patients with node-negative invasive breast cancer by a propensity-matched analysis. MATERIALS AND METHODS Among 389 patients with node-negative invasive ductal breast cancer who had preoperative breast 3.0 Tesla MRI with precontrast T2-weighted fat-suppressed, pre- and dynamic postcontrast T1-weighted fat-suppressed sequences, 61 patients with LVI (LVI group) were matched with 183 patients without LVI (no LVI group) at a ratio of 1:3 in terms of age, histologic grade, tumor size, and hormone receptor status. Two radiologists reviewed the MRI features, following profiles of focal breast edema (peritumoral, prepectoral, subcutaneous), intratumoral T2 signal intensity, adjacent vessel sign, and increased ipsilateral whole-breast vascularity, in addition to 2013 Breast Imaging Reporting and Data System lexicon. RESULTS The presence of peritumoral edema (45.9% [28/61] versus 30.6% [56/183], P = 0.030) and adjacent vessel sign (82.0% [50/61] versus 68.3% [125/183], P = 0.041) was significantly associated with LVI. Prepectoral edema was also more frequently observed in the LVI group than in the no LVI group with borderline significance (26.2% [16/61] versus 15.3% [28/183], P = 0.055). In cases of nonmass enhancement, regional enhancement was more frequently found in the LVI group than in the no LVI group (60.0% [3/4] versus 5.9% [1/4], P = 0.042). CONCLUSION Preoperative breast MRI features may be associated with LVI in patients with node-negative invasive breast cancer. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1037-1044.
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Affiliation(s)
- Hyejin Cheon
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - So Mi Lee
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Kyung Min Shin
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Gab Chul Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Ji Young Park
- Department of Pathology, Kyungpook National University Medical Center, Daegu, Korea
| | - Won Hwa Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
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Fujii T, Yajima R, Morita H, Hirakata T, Miyamoto T, Fujisawa T, Tsutsumi S, Ynagita Y, Iijima M, Kuwano H. Impact of Vascular Invasion of a Primary Tumor as a Strong Risk Factor for Disease Recurrence in Patients with Node-Positive Breast Cancer. Am Surg 2015. [DOI: 10.1177/000313481508100537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The presence of lymph node metastasis is considered to be the most significant indicator of prognosis. However, in some cases with node-positive breast cancer, cancer cell dissemination is localized to the lymphatic systems. It is, therefore, important to develop selection criteria for strong adjuvant therapy in patients with node-positive breast cancer. This study was undertaken to evaluate the presence of vascular invasion that may reflect systemic disease as a predictor of disease recurrence in node-positive breast cancer. We retrospectively evaluated the cases of 134 consecutive female patients with breast cancer with lymph node metastasis who underwent radical breast operations. We examined the relationship between recurrence and clinicopathological factors, particularly vascular invasion. The presence of vascular invasion was found to be significant in a univariate analysis. The presence of vascular invasion was the independent risk factor in a multivariate analysis. Among the 66 patients without vascular invasion, four (6.1%) had disease recurrence. On the other hand, among the 68 patients with vascular invasion, 15 (22.1%) had a recurrence. It is interesting to note that despite the presence of lymph node metastasis, the group without vascular invasion had few patients with distant metastases. Our results suggest that the presence of vascular invasion could be an indicator of high biological aggressiveness and may be a strong prognostic factor for node-positive breast cancer.
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Affiliation(s)
- Takaaki Fujii
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan and the Departments of
| | - Reina Yajima
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan and the Departments of
| | - Hiroki Morita
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan and the Departments of
| | | | | | | | - Soichi Tsutsumi
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan and the Departments of
| | - Yasuhiro Ynagita
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan and the Departments of
| | - Misa Iijima
- Pathology, Gunma Prefectural Cancer Center, Ota, Gunma, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan and the Departments of
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D'Alfonso TM, Hannah J, Chen Z, Liu Y, Zhou P, Shin SJ. Axl receptor tyrosine kinase expression in breast cancer. J Clin Pathol 2014; 67:690-6. [PMID: 24904064 DOI: 10.1136/jclinpath-2013-202161] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS Triple-negative breast cancer comprises a clinically aggressive group of invasive carcinomas. We examined a published gene expression screen of a panel of breast cancer cell lines to identify a potential triple-negative breast cancer-specific gene signature, and attempted to verify our findings by performing immunohistochemical analysis on tissue microarrays containing a large cohort of invasive breast carcinomas. METHODS The microarray dataset for a panel of human breast cancer cell lines was interrogated for triple-negative breast cancer-specific genes. Membranous immunohistochemical expression of the protein product of the AXL gene was assessed semiquantitatively in 569 invasive breast carcinomas grouped according to molecular subgroup by immunohistochemistry. RESULTS AXL was significantly upregulated in triple-negative/basal B cell lines compared with luminal or basal A cell lines. No significant difference was observed in the level of immunohistochemical expression of Axl protein between triple-negative breast cancers and other molecular subgroups (p=0.257). Axl expression was significantly associated with lymphovascular invasion (LVI) in all subgroups combined (p=0.033), and within the luminal A (p=0.002) and triple-negative breast cancer subgroups (p=0.026). CONCLUSIONS Despite preferential upregulation of AXL in triple-negative/basal B cell lines, analysis of Axl protein expression in a large series of patients' breast tumours revealed no association between Axl expression and triple-negative breast cancer or other subtype. The association of Axl expression with LVI supports previous work that implicates Axl as a promoter of invasiveness in breast cancer cell lines. Further studies are necessary to explore whether Axl expression of individual breast cancer tumours can be clinically useful.
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Affiliation(s)
- Timothy M D'Alfonso
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Jeffrey Hannah
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Zhengming Chen
- Department of Public Health, Weill Cornell Medical College, New York, USA
| | - Yifang Liu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Pengbo Zhou
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Sandra J Shin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
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Deneve JL, Hoefer RA, Harris EER, Laronga C. Accelerated Partial Breast Irradiation: A Review and Description of an Early North American Surgical Experience with the Intrabeam Delivery System. Cancer Control 2012; 19:295-308. [DOI: 10.1177/107327481201900406] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jeremiah L. Deneve
- Department of Women's Oncology H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Richard A. Hoefer
- Dorothy G. Hoefer Comprehensive Breast Center, Sentara Cancer Network, Newport News, Virginia
| | - Eleanor E. R. Harris
- Radiation Oncology Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Christine Laronga
- Department of Women's Oncology H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Rakha EA, Martin S, Lee AHS, Morgan D, Pharoah PDP, Hodi Z, Macmillan D, Ellis IO. The prognostic significance of lymphovascular invasion in invasive breast carcinoma. Cancer 2011; 118:3670-80. [PMID: 22180017 DOI: 10.1002/cncr.26711] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/04/2011] [Accepted: 10/24/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although lymphovascular invasion (LVI) has been associated with a poor outcome in patients with breast cancer, it is not included in most internationally recognized staging systems, including the American Joint Committee on Cancer tumor, lymph node, metastasis (TNM) classification. This is mainly because it remains unclear whether the presence of LVI is an independent, high-risk criterion in clinically relevant staging subgroups. METHODS The current study was based on a large and well characterized consecutive series of patients who had operable (pathologic T1 [pT1]-pT2, pathologic N0 [pN0]-pN3, M0) breast cancer (3812 informative cases) who were treated according to standard protocols at a single institution and who had long-term follow-up to assess the prognostic value of definite LVI in clinically and molecularly relevant staging subgroups. RESULTS LVI was strongly associated with both breast cancer-specific survival (BCSS) and distant metastasis-free survival (DMFS) in the entire series and in different subgroups. Multivariate analyses identified LVI as an independent predictor of both BCSS and DMFS in patients with operable breast cancer overall; in the TNM clinical subgroups pT1a-pT1c/pN0 and pT2/pN0; and in the molecular classes estrogen receptor (ER)-positive, ER-negative, human epidermal growth factor 2 [HER2]-negative, and triple-negative. In patients who had lymph node-negative tumors, LVI could be used as a high-risk criterion providing survival disadvantage equivalent to that provided by 1 or 2 involved lymph nodes (pN0 to pN1) and to that provided by 1 size category (pT1 to pT2). The use of immunohistochemistry for detecting an endothelial-specific marker contributed to the prognostic significance of LVI when applied to routine LVI negative/possible cases. CONCLUSIONS LVI provided a strong predictor of outcome in patients with invasive breast cancer and should be incorporated into breast cancer staging systems.
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Affiliation(s)
- Emad A Rakha
- Department of Histopathology, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom.
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Abi-Raad R, Boutrus R, Wang R, Niemierko A, Macdonald S, Smith B, Taghian AG. Patterns and risk factors of locoregional recurrence in T1-T2 node negative breast cancer patients treated with mastectomy: implications for postmastectomy radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81:e151-7. [PMID: 21420245 DOI: 10.1016/j.ijrobp.2011.01.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/29/2010] [Accepted: 01/10/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Postmastectomy radiation therapy (PMRT) can reduce locoregional recurrences (LRR) in high-risk patients, but its role in the treatment of lymph node negative (LN-) breast cancer remains unclear. The aim of this study was to identify a subgroup of T1-T2 breast cancer patients with LN- who might benefit from PMRT. METHODS AND MATERIALS We retrospectively reviewed 1,136 node-negative T1-T2 breast cancer cases treated with mastectomy without PMRT at the Massachusetts General Hospital between 1980 and 2004. We estimated cumulative incidence rates for LRR overall and in specific subgroups, and used Cox proportional hazards models to identify potential risk factors. RESULTS Median follow-up was 9 years. The 10-year cumulative incidence of LRR was 5.2% (95% CI: 3.9-6.7%). Chest wall was the most common (73%) site of LRR. Tumor size, margin, patient age, systemic therapy, and lymphovascular invasion (LVI) were significantly associated with LRR on multivariate analysis. These five variables were subsequently used as risk factors for stratified analysis. The 10-year cumulative incidence of LRR for patients with no risk factors was 2.0% (95% CI: 0.5-5.2%), whereas the incidence for patients with three or more risk factors was 19.7% (95% CI: 12.2-28.6%). CONCLUSION It has been suggested that patients with T1-T2N0 breast cancer who undergo mastectomy represent a favorable group for which PMRT renders little benefit. However, this study suggests that select patients with multiple risk factors including LVI, tumor size ≥2 cm, close or positive margin, age ≤50, and no systemic therapy are at higher risk of LRR and may benefit from PMRT.
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Affiliation(s)
- Rita Abi-Raad
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Shin HJ, Kim HH, Huh MO, Kim MJ, Yi A, Kim H, Son BH, Ahn SH. Correlation between mammographic and sonographic findings and prognostic factors in patients with node-negative invasive breast cancer. Br J Radiol 2010; 84:19-30. [PMID: 20682592 DOI: 10.1259/bjr/92960562] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to correlate sonographic and mammographic findings with prognostic factors in patients with node-negative invasive breast cancer. METHODS Sonographic and mammographic findings in 710 consecutive patients (age range 21-81 years; mean age 49 years) with 715 node-negative invasive breast cancers were retrospectively evaluated. Pathology reports relating to tumour size, histological grade, lymphovascular invasion (LVI), extensive intraductal component (EIC), oestrogen receptor (ER) status and HER-2/neu status were reviewed and correlated with the imaging findings. Statistical analysis was performed using logistic regression analysis and intraclass correlation coefficient (ICC). RESULTS On mammography, non-spiculated masses with calcifications were associated with all poor prognostic factors: high histological grade, positive LVI, EIC, HER-2/neu status and negative ER. Other lesions were associated with none of these poor prognostic factors. Hyperdense masses on mammography, the presence of mixed echogenicity, posterior enhancement, calcifications in-or-out of masses and diffusely increased vascularity on sonography were associated with high histological grade and negative ER. Associated calcifications on both mammograms and sonograms were correlated with EIC and HER-2/neu overexpression. The ICC value for the disease extent was 0.60 on mammography and 0.70 on sonography. CONCLUSION Several sonographic and mammographic features can have a prognostic value in the subsequent treatment of patients with node-negative invasive breast cancer. Radiologists should pay more attention to masses that are associated with calcifications because on both mammography and sonography associated calcifications were predictors of positive EIC and HER-2/neu overexpression.
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Affiliation(s)
- H J Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan, Songpa-Gu, Seoul, Korea
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Polgár C, Van Limbergen E, Pötter R, Kovács G, Polo A, Lyczek J, Hildebrandt G, Niehoff P, Guinot JL, Guedea F, Johansson B, Ott OJ, Major T, Strnad V. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 2010; 94:264-73. [PMID: 20181402 DOI: 10.1016/j.radonc.2010.01.014] [Citation(s) in RCA: 444] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 01/04/2010] [Accepted: 01/23/2010] [Indexed: 01/08/2023]
Abstract
PURPOSE To give recommendations on patient selection criteria for the use of accelerated partial-breast irradiation (APBI) based on available clinical evidence complemented by expert opinion. METHODS AND MATERIALS Overall, 340 articles were identified by a systematic search of the PubMed database using the keywords "partial-breast irradiation" and "APBI". This search was complemented by searches of reference lists of articles and handsearching of relevant conference abstracts and book chapters. Of these, 3 randomized and 19 prospective non-randomized studies with a minimum median follow-up time of 4 years were identified. The authors reviewed the published clinical evidence on APBI, complemented by relevant clinical and pathological studies of standard breast-conserving therapy and, through a series of personal communications, formulated the recommendations presented in this article. RESULTS The GEC-ESTRO Breast Cancer Working Group recommends three categories guiding patient selection for APBI: (1) a low-risk group for whom APBI outside the context of a clinical trial is an acceptable treatment option; including patients ageing at least 50 years with unicentric, unifocal, pT1-2 (<or=30 mm) pN0, non-lobular invasive breast cancer without the presence of an extensive intraductal component (EIC) and lympho-vascular invasion (LVI) and with negative surgical margins of at least 2mm, (2) a high-risk group, for whom APBI is considered contraindicated; including patients ageing <or=40 years; having positive margins, and/or multicentric or large (>30 mm) tumours, and/or EIC positive or LVI positive tumours, and/or 4 or more positive lymph nodes or unknown axillary status (pNx), and (3) an intermediate-risk group, for whom APBI is considered acceptable only in the context of prospective clinical trials. CONCLUSIONS These recommendations will provide a clinical guidance regarding the use of APBI outside the context of a clinical trial before large-scale randomized clinical trial outcome data become available. Furthermore they should promote further clinical research focusing on controversial issues in the treatment of early-stage breast carcinoma.
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Affiliation(s)
- Csaba Polgár
- Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary.
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Mohammed RAA, Ellis IO, Lee AHS, Martin SG. Vascular invasion in breast cancer; an overview of recent prognostic developments and molecular pathophysiological mechanisms. Histopathology 2009; 55:1-9. [PMID: 19016903 DOI: 10.1111/j.1365-2559.2008.03169.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vascular invasion (VI) is an essential step in breast cancer metastasis and the main cause of morbidity and mortality from the disease. Detection of VI in the primary tumour is a marker of metastatic potential. The prognostic value of VI in breast cancer has been known for more than four decades, but its application in clinical practice is still fraught with difficulties due to the limited number of studies conducted on large numbers of well-characterized patients with long-term follow-up. Detection of VI in the primary tumour is currently assessed using sections stained with haematoxylin and eosin, which has some disadvantages. A number of vascular markers have been used to improve detection of VI; however, their sensitivity and specificity, as endothelial markers, vary considerably. In this review we describe the evolution of the prognostic importance of VI and the recent pathomolecular mechanisms that contribute to the ability of breast cancers to invade through vessels, in addition to the types, locations and methods of detection of vascular invasion.
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Affiliation(s)
- R A A Mohammed
- Clinical Oncology, University of Nottingham, University Hospitals, Nottingham, UK
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Margelí Vila M. Supervivencia tras la primera recidiva en cáncer de mama, ¿se puede individualizar? Med Clin (Barc) 2009; 133:506-7. [DOI: 10.1016/j.medcli.2009.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 05/19/2009] [Indexed: 11/15/2022]
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Karlsson P, Cole BF, Price KN, Coates AS, Castiglione-Gertsch M, Gusterson BA, Murray E, Lindtner J, Collins JP, Holmberg SB, Fey MF, Thürlimann B, Crivellari D, Forbes JF, Gelber RD, Goldhirsch A, Wallgren A. The role of the number of uninvolved lymph nodes in predicting locoregional recurrence in breast cancer. J Clin Oncol 2007; 25:2019-26. [PMID: 17420511 DOI: 10.1200/jco.2006.09.8152] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To identify groups of early breast cancer patients with substantial risk (10-year risk > 20%) for locoregional failure (LRF) who might benefit from postmastectomy radiotherapy (RT). PATIENTS AND METHODS Prognostic factors for LRF were evaluated among 6,660 patients (2,588 node-negative patients, 4,072 node-positive patients) in International Breast Cancer Study Group Trials I to IX treated with chemotherapy and/or endocrine therapy, and observed for a median of 14 years. In total, 1,251 LRFs were detected. All patients were treated with mastectomy without RT. RESULTS No group with 10-year LRF risk exceeding 20% was found among patients with node-negative disease. Among patients with node-positive breast cancer, increasing numbers of uninvolved nodes were significantly associated with decreased risk of LRF, even after adjustment for other prognostic factors. The highest quartile of uninvolved nodes was compared with the lowest quartile. Among premenopausal patients, LRF risk was decreased by 35% (P = .0010); among postmenopausal patients, LRF risk was decreased by 46% (P < .0001). The 10-year cumulative incidence of LRF was 20% among patients with one to three involved lymph nodes and fewer than 10 uninvolved nodes. Age younger than 40 years and vessel invasion were also associated significantly with increased risk. Among patients with node-positive disease, overall survival was significantly greater in those with higher numbers of uninvolved nodes examined (P < .0001). CONCLUSION Patients with one to three involved nodes and a low number of uninvolved nodes, vessel invasion, or young age have an increased risk of LRF and may be candidates for a similar treatment as those with at least four lymph node metastases.
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Affiliation(s)
- Per Karlsson
- Department of Oncology, University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden.
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Cheng SH, Horng CF, Clarke JL, Tsou MH, Tsai SY, Chen CM, Jian JJ, Liu MC, West M, Huang AT, Prosnitz LR. Prognostic index score and clinical prediction model of local regional recurrence after mastectomy in breast cancer patients. Int J Radiat Oncol Biol Phys 2006; 64:1401-9. [PMID: 16472935 DOI: 10.1016/j.ijrobp.2005.11.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2005] [Revised: 11/15/2005] [Accepted: 11/15/2005] [Indexed: 11/16/2022]
Abstract
PURPOSE To develop clinical prediction models for local regional recurrence (LRR) of breast carcinoma after mastectomy that will be superior to the conventional measures of tumor size and nodal status. METHODS AND MATERIALS Clinical information from 1,010 invasive breast cancer patients who had primary modified radical mastectomy formed the database of the training and testing of clinical prognostic and prediction models of LRR. Cox proportional hazards analysis and Bayesian tree analysis were the core methodologies from which these models were built. To generate a prognostic index model, 15 clinical variables were examined for their impact on LRR. Patients were stratified by lymph node involvement (<4 vs. >or =4) and local regional status (recurrent vs. control) and then, within strata, randomly split into training and test data sets of equal size. To establish prediction tree models, 255 patients were selected by the criteria of having had LRR (53 patients) or no evidence of LRR without postmastectomy radiotherapy (PMRT) (202 patients). RESULTS With these models, patients can be divided into low-, intermediate-, and high-risk groups on the basis of axillary nodal status, estrogen receptor status, lymphovascular invasion, and age at diagnosis. In the low-risk group, there is no influence of PMRT on either LRR or survival. For intermediate-risk patients, PMRT improves LR control but not metastases-free or overall survival. For the high-risk patients, however, PMRT improves both LR control and metastasis-free and overall survival. CONCLUSION The prognostic score and predictive index are useful methods to estimate the risk of LRR in breast cancer patients after mastectomy and for estimating the potential benefits of PMRT. These models provide additional information criteria for selection of patients for PMRT, compared with the traditional selection criteria of nodal status and tumor size.
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Affiliation(s)
- Skye Hongiun Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
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Lee AHS, Pinder SE, Macmillan RD, Mitchell M, Ellis IO, Elston CW, Blamey RW. Prognostic value of lymphovascular invasion in women with lymph node negative invasive breast carcinoma. Eur J Cancer 2006; 42:357-62. [PMID: 16377180 DOI: 10.1016/j.ejca.2005.10.021] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Revised: 10/14/2005] [Accepted: 10/16/2005] [Indexed: 11/19/2022]
Abstract
This study aimed to test the hypothesis that lymphovascular invasion adds prognostic information to histological grade and tumour size in node-negative invasive carcinoma of the breast. Lymphovascular invasion was assessed in haematoxylin and eosin tumour sections from 2760 patients with node-negative invasive breast carcinoma treated with definitive surgery. Patients were divided into two groups: 990 in the no adjuvant therapy series (diagnosed in 1974-1988) with median follow-up of 13 years; and 1765 in the selective adjuvant therapy series (1988-2000) with median follow-up of 6.8 years. Lymphovascular invasion was identified in 19% of tumours and was associated with larger tumour size, higher histological grade and younger age. Overall, survival was associated on multivariate analysis with lymphovascular invasion, histological grade and tumour size in both patient series, and with histological type in the no adjuvant therapy series. In conclusion, lymphovascular invasion is an independent prognostic factor in node-negative breast cancer and should be considered in decisions about adjuvant treatment in this group of women.
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Affiliation(s)
- A H S Lee
- Department of Histopathology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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Bae JS, Song BJ, Kim ML, Chang SH, Kim HS, Park WC, Kim JS, Jung SS. Clinicopathologic factor and Lymphovascular Invasion in Breast cancer. J Breast Cancer 2006. [DOI: 10.4048/jbc.2006.9.4.317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Korea
| | - Byung Joo Song
- Department of Surgery, College of Medicine, The Catholic University of Korea, Korea
| | - Mi la Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Korea
| | - Seok Hyo Chang
- Department of Surgery, College of Medicine, Inje University, Korea
| | - Han Seong Kim
- Department of Pathology, College of Medicine, Inje University, Korea
| | - Woo Chan Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Korea
| | - Sang Seol Jung
- Department of Surgery, College of Medicine, The Catholic University of Korea, Korea
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Truong PT, Yong CM, Abnousi F, Lee J, Kader HA, Hayashi A, Olivotto IA. Lymphovascular invasion is associated with reduced locoregional control and survival in women with node-negative breast cancer treated with mastectomy and systemic therapy. J Am Coll Surg 2005; 200:912-21. [PMID: 15922205 DOI: 10.1016/j.jamcollsurg.2005.02.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Revised: 01/05/2005] [Accepted: 02/02/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The impact of lymphovascular invasion (LVI) on postmastectomy locoregional relapse (LRR) and its use in guiding locoregional therapy in node-negative breast cancer are unclear. This study evaluates the association of LVI with relapse and survival in a cohort of women with early-stage breast cancer. STUDY DESIGN The study cohort comprised 763 women with pT1-2, pN0 breast cancer referred from 1989 to 1999 and treated with mastectomy and adjuvant systemic therapy without radiotherapy. Kaplan-Meier LRR, distant relapse, and overall survival rates at 7 years were compared between patients with and without LVI. Cox regression analyses were performed to evaluate the prognostic significance of LVI for relapse and survival. RESULTS Median followup was 7.0 years (range 0.34 to 14.9 years). LVI was present in 210 (27.5%) patients. In log-rank comparisons of Kaplan-Meier curves stratified by LVI status, LVI-positive disease was associated with significantly higher risks of LRR (p = 0.006), distant relapse (p = 0.04), and lower overall survival (p = 0.02). In the multivariable Cox regression analysis, LVI was significantly associated with LRR (relative risk [RR] = 2.32; 95% CI, 1.26-4.27; p = 0.007), distance relapse (RR = 1.53; 95% CI, 1.00-2.35; p = 0.05), and overall survival (RR = 1.46; 95% CI, 1.04-2.07; p = 0.03). In patients with one of the following characteristics: age younger than 50 years, premenopausal status, grade III histology, or estrogen receptor-negative disease, 7-year LRR risks increased threefold from 3% to 5% when LVI was absent, to 15% to 20% in the presence of LVI. CONCLUSIONS LVI is an adverse prognostic factor for relapse and survival in node-negative patients treated with mastectomy and systemic therapy. LVI, in combination with age older than 50 years, premenopausal status, grade III histology, or estrogen receptor-negative disease, identified patient subsets with 7-year LRR risks of approximately 15% to 20%. Prospective research is required to define the role of adjuvant radiotherapy in these patients.
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Affiliation(s)
- Pauline T Truong
- British Columbia Cancer Agency-Vancouver Island Centre and the Department of Surgery, University of British Columbia, Victoria, BC, Canada
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Utrillas-Martínez AC, del Val-Gil JM, López-Bañeres MF, Rebollo-López J, Minguillón-Serrano A, González-Penabad M, Bermejo-Zapatero A, Sanz-Gómez M, Ángel Muniesa-Soriano J. ¿Resultan útiles los marcadores tumorales CEA y CA 15.3 en el seguimiento del cáncer de mama? Revisión de 196 casos. Cir Esp 2003. [DOI: 10.1016/s0009-739x(03)72208-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Haffty BG. Molecular and genetic markers in the local-regional management of breast cancer. Semin Radiat Oncol 2002; 12:329-40. [PMID: 12382191 DOI: 10.1053/srao.2002.35252] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The clinical application of molecular markers in the diagnosis, staging, and management of breast cancer continues to expand. Although the use of molecular markers in local-regional disease does not approach the level of their application in the systemic management of breast cancer, a growing body of rature supports the potential for molecular and genetic factors in clinical decision making regarding the local-regional management of breast cancer. As with conventional clinical and histopathologic factors, data regarding molecular and genetic factors as they relate to local-regional relapse may be conflicting and are subject to the usual limitations of predominantly retrospective studies. There are, however, some consistent data suggesting associations between local-regional control of disease and several molecular markers, including hormone receptor status, HER2/neu, p53, proliferative markers, and others. Interpretation of these data and how to use this information in clinical practice remains challenging. The available rature regarding the use of genetic and molecular markers in the local-regional management of breast cancer is summarized in this review.
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Affiliation(s)
- Bruce G Haffty
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520-8040, USA.
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