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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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Cuyún Carter G, Mohanty M, Stenger K, Morato Guimaraes C, Singuru S, Basa P, Singh S, Tongbram V, Kuemmel S, Guarneri V, Tolaney SM. Prognostic Factors in Hormone Receptor-Positive/Human Epidermal Growth Factor Receptor 2-Negative (HR+/HER2-) Advanced Breast Cancer: A Systematic Literature Review. Cancer Manag Res 2021; 13:6537-6566. [PMID: 34447271 PMCID: PMC8384149 DOI: 10.2147/cmar.s300869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Advanced breast cancer is a heterogeneous disease with several well-defined subtypes, among which, hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) is most prevalent. Determination of HR and HER2 status influences prognosis and, thus, disease management. Although literature on these prognostic factors exist, especially in the early breast cancer setting, it remains unclear to what extent these factors can guide clinical decision-making in the advanced disease setting. Therefore, we sought to identify the strength and consistency of evidence for prognostic factors in patients with HR+/HER2- advanced breast cancer. METHODS A systematic literature review (SLR) of the major electronic databases was conducted in November 2018 for primary research studies published since 2010. Endpoints of interest were tumor response, progression-free survival (PFS), overall survival (OS), and breast cancer-specific survival (BCSS). RESULTS Seventy-nine studies were included wherein all patients were diagnosed with advanced breast cancer and ≥50% of the population were HR+/HER2-. OS was the most commonly assessed endpoint (n=67) followed by PFS (n=33), BCSS (n=5) and tumor response (n=3). The prognostic factors with strongest evidence of association with worse OS were negative progesterone receptor status, higher tumor grade, higher circulating tumor cell (CTC) count and higher Ki67 level, number of metastatic sites (eg multiple vs single) and sites of metastases (eg presence of liver metastases vs absence), shorter time to recurrence or progression to advanced breast cancer, poor performance status, prior therapy attributes in the early or metastatic setting (type of therapy, treatment line, response of prior therapy), and race (black vs white). The prognostic factors that had strongest evidence of association with PFS included CTC count, number and sites of metastases, and absence of prior therapy or higher lines of therapy in the early or metastatic setting. The directionality of association was consistent for all prognostic factors except between lymph node and OS, and de novo metastatic breast cancer and PFS. CONCLUSION Multiple disease, treatment, and patient-related prognostic factors impact survival, particularly OS, in patients with HR+/HER2- advanced breast cancer. Treatment outcomes can vary considerably due to these factors. Understanding poorer prognostic factors for patients can result in improved clinical decision-making.
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Affiliation(s)
| | - Maitreyee Mohanty
- Global Health Economics and Outcomes Research, ICON Plc, New York, NY, USA
| | | | | | - Shivaprasad Singuru
- Global Health Economics and Outcomes Research, ICON Plc, Bangalore, Karnataka, India
| | - Pradeep Basa
- Global Health Economics and Outcomes Research, ICON Plc, Bangalore, Karnataka, India
| | - Sheena Singh
- Global Health Economics and Outcomes Research, ICON Plc, Bangalore, Karnataka, India
| | - Vanita Tongbram
- Global Health Economics and Outcomes Research, ICON Plc, New York, NY, USA
| | - Sherko Kuemmel
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte (KEM), Essen, Germany
- Charité – Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, PD, Italy; Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, PD, Italy
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Ai X, Liao X, Wang M, Hu Y, Li J, Zhang Y, Tang P, Jiang J. Prognostic Value of Lymph Node Ratio in Breast Cancer Patients with Adequate Pathologic Evidence After Neoadjuvant Chemotherapy. Med Sci Monit 2020; 26:e922420. [PMID: 32348295 PMCID: PMC7204429 DOI: 10.12659/msm.922420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prognostic role of axillary lymph node ratio (LNR) after neoadjuvant chemotherapy (NAC) in breast cancer has not been illuminated. This study was designed to investigate the prognostic role of LNR in breast cancer compared with traditional ypN stage. MATERIAL AND METHODS A total of 306 breast cancer patients diagnosed with positive axillary lymph nodes from January 2007 to December 2014 were eligible for this retrospective analysis. All enrolled patients were treated with a median of 4 cycles of NAC followed by mastectomy and level I, II, and III axillary lymph node dissection (ALND). RESULTS The median duration of follow-up was 78 months (range, 7-147 months). Univariate analysis indicated that both the LNR category (P<0.001) and ypN stage (P<0.001) were significant associated with event-free survival (EFS) and overall survival (OS). However, multivariate analysis indicated that the LNR category was independently associated with EFS (P<0.001) and OS (P<0.001), while the ypN stage showed no statistical effect on EFS (P=0.391) or OS (P=0.081). On additional analyses stratified by molecular subtypes, we found that the prognosis of triple negative breast cancer could be better discriminated when the cutoff value of LNR was set at 0.15. CONCLUSIONS LNR showed a superior predictive value in evaluating prognosis of breast cancer patients after NAC. In addition, the LNR cutoff point 0.15 can accurately discriminate survival outcomes for different triple negative breast cancer subtypes.
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Affiliation(s)
- Xiang Ai
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China (mainland)
| | - Xin Liao
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China (mainland)
| | - Minghao Wang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China (mainland)
| | - Ying Hu
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China (mainland)
| | - Junyan Li
- Department of Breast Surgery, People's Hospital of DeYang City, Deyang, Sichuan, China (mainland)
| | - Yi Zhang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China (mainland)
| | - Peng Tang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China (mainland)
| | - Jun Jiang
- Breast Disease Center, Southwest Hospital, The Army Military Medical University, Chongqing, China (mainland)
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van Nijnatten TJA, Moossdorff M, de Munck L, Goorts B, Vane MLG, Keymeulen KBMI, Beets-Tan RGH, Lobbes MBI, Smidt ML. TNM classification and the need for revision of pN3a breast cancer. Eur J Cancer 2017; 79:23-30. [PMID: 28458119 DOI: 10.1016/j.ejca.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 03/09/2017] [Accepted: 04/03/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND According to the seventh edition of tumour-node-metastasis (TNM) classification, pN3a status in breast cancer patients consists of presence of an infraclavicular lymph node metastasis (LNM) and/or presence of ≥10 axillary LNMs. The aim of this study was to determine whether prognosis of pN3a based on at least an infraclavicular LNM differs from ≥10 axillary LNMs. METHODS Data were obtained from the Netherlands Cancer Registry. All patients were diagnosed between 2005 and 2008 with primary invasive epithelial breast cancer and pN2a or pN3a status as pathologic result. Patients with pN3a were subdivided in pN3a based on at least an infraclavicular LNM or ≥10 axillary LNMs. Disease-free survival (DFS) included any local, regional or contralateral recurrence, distant metastasis or death within 5 years. Kaplan-Meier curves provided information on 5-year DFS and 8-year overall survival (OS). In addition, Cox proportional hazards model was used to measure the effect of relevant clinicopathological variables on DFS and OS. RESULTS A total of 3400 patients with pN2a and 1788 patients with pN3a were included. In 83 patients, pN3a was based on at least an infraclavicular LNM (4.6%) and in 1705 patients because of ≥10 axillary LNMs (95.4%). After multivariable analyses, DFS and OS were inferior in patients with pN3a based on ≥10 axillary LNMs compared to infraclavicular LNM (DFS 48.8% versus 63.8%, hazard ratio [HR] 1.59, p = 0.036; OS 46.6% versus 63.9%, HR 1.46, p = 0.042). Furthermore, pN2a and pN3a based on infraclavicular LNM had comparable DFS and OS. CONCLUSION PN3a status based on an at least an infraclavicular LNM is rare, yet its prognosis is superior to ≥10 axillary LNMs. Reclassification of infraclavicular LNM in the next TNM should therefore be considered into pN2a.
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Affiliation(s)
- T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - M Moossdorff
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - L de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - B Goorts
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M L G Vane
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - K B M I Keymeulen
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - R G H Beets-Tan
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Radiology, The Netherlands Cancer Center, Amsterdam, The Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M L Smidt
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
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Resected pN1 non-small cell lung cancer: recurrence patterns and nodal risk factors may suggest selection criteria for post-operative radiotherapy. Radiol Med 2016; 121:696-703. [DOI: 10.1007/s11547-016-0648-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/09/2016] [Indexed: 12/11/2022]
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