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Nguyen VC, Nguyen TQ, Vu TNH, Phung TH, Nguyen TPH, Nguyen ND, Le DR. Application of St Gallen Categories in Predicting Survival for Patients With Breast Cancer in Vietnam. Cancer Control 2019; 26:1073274819862794. [PMID: 31307207 PMCID: PMC6636225 DOI: 10.1177/1073274819862794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Breast cancer is a heterogeneous disease with different tumor subtypes. Identifying risk categories will help make better treatment decisions. Hence, this study aimed to predict the survival outcomes of invasive breast cancer in Vietnam, using St Gallen 2007 classification. This study was conducted on 501 patients with breast cancer who had surgical operations, but had not received neoadjuvant chemotherapy, from 2011 to 2013. The clinicopathological characteristics were recorded. Immunohistochemistry staining was performed on ER, PR, HER2/neu, and Ki67 markers. For HER2/neu(2+), fluorescence in situ hybridization was used as the test. All patients with breast cancer were stratified according to 2007 St Gallen categories. Kaplan-Meier and log-rank models were used to analyze survival rates. There were 3.8% cases classified as low risk (LR), 72.1% as intermediate risk (IR1: 60.1% and IR2: 12.0%), and 24.1% as high risk (HR1: 11.8% and HR2: 12.3%). Patients who were LR had the best prognosis, with a 5-year overall survival (OS) rate of 100%. Intermediate-risk patients were at 92.3%. High-risk patients had the worst prognosis, with a 5-year OS proportion of 69.3% (P < .05). For disease-free survival (DFS), risk categories were categorized as LR: 100%, IR: 90.3%, and HR: 69.3% (P < .05). Three main risk categories of breast cancer had a distinct OS and DFS. These findings suggest that the 2007 St Gallen risk category could be used to stratify patients with breast cancer into different risk groups in Vietnam.
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Affiliation(s)
- Van Chu Nguyen
- 1 Department of Quan Su Pathology, National Cancer Hospital, Hanoi, Vietnam
| | - Tien Quang Nguyen
- 2 Department of Optional A Treatment, National Cancer Hospital, Hanoi, Vietnam
| | | | - Thi Huyen Phung
- 4 Department of Quan Su Internal Medicine, National Cancer Hospital, Hanoi, Vietnam
| | | | - Ngoc Duong Nguyen
- 1 Department of Quan Su Pathology, National Cancer Hospital, Hanoi, Vietnam
| | - Dinh Roanh Le
- 5 Center for Research and Early Detection of Cancer, Vietnam
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Optimal duration of adjuvant chemotherapy for high-risk node-negative (N–) breast cancer patients: 6-year results of the prospective randomised multicentre phase III UNICANCER-PACS 05 trial (UCBG-0106). Eur J Cancer 2017; 79:166-175. [DOI: 10.1016/j.ejca.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/27/2017] [Accepted: 03/06/2017] [Indexed: 11/18/2022]
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van Dalum G, van der Stam GJ, Tibbe AGJ, Franken B, Mastboom WJB, Vermes I, de Groot MR, Terstappen LWMM. Circulating tumor cells before and during follow-up after breast cancer surgery. Int J Oncol 2014; 46:407-13. [PMID: 25339612 DOI: 10.3892/ijo.2014.2694] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/30/2014] [Indexed: 11/06/2022] Open
Abstract
The presence of circulating tumor cells (CTC) is an independent prognostic factor for progression-free and overall survival for patients with metastatic and newly diagnosed breast cancer. The present study was undertaken to explore whether the presence of CTC before and during follow-up after surgery is associated with recurrence free survival (RFS) and overall survival (OS). In a prospective single center study, CTC were enumerated with the CellSearch system in 30 ml of peripheral blood of 403 stage I-III patients before undergoing surgery for breast cancer (A) and if available 1 week after surgery (B), after adjuvant chemo- and/or radiotherapy or before start of long-term hormonal therapy (C), one (D), two (E) and three (F) years after surgery. Patients were stratified into unfavorable (CTC≥1) and favorable (CTC=0) prognostic groups. >1 CTC in 30 ml blood was detected in 75/403 (19%) at A, 66/367 (18%) at B, 40/263 (15%) at C, 30/235 (12%) at D, 18/144 (11%) at E and 11/83 (13%) at F. RFS and OS was significantly lower for unfavorable CTC as compared to favorable CTC before surgery (p=0.022 and p=0.006), after adjuvant therapy (p<0.001 and p=0.018) and one (p=0.006 and p=0.013) and two (p<0.001 and p=0.045) years after surgery, but not 1 week post-surgery. The presence of CTC in blood drawn pre and one and two years after surgery, but not post-surgery is associated with shorter RFS and OS for stage I-III breast cancer.
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Affiliation(s)
- Guus van Dalum
- Medical Cell BioPhysics Group, MIRA Institute, University of Twente, Enschede, The Netherlands
| | - Gert Jan van der Stam
- Medical Cell BioPhysics Group, MIRA Institute, University of Twente, Enschede, The Netherlands
| | - Arjan G J Tibbe
- Medical Cell BioPhysics Group, MIRA Institute, University of Twente, Enschede, The Netherlands
| | - Bas Franken
- Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Ivan Vermes
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marco R de Groot
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Leon W M M Terstappen
- Medical Cell BioPhysics Group, MIRA Institute, University of Twente, Enschede, The Netherlands
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Abstract
The use of regimens with adjuvant taxanes reduces the risk of recurrence and improves survival in patients with node-positive breast cancer, but the use of taxanes in node-negative breast cancer is still to be defined. The aim of this study is to evaluate the role of taxanes in high-risk node-negative breast cancer. Two categories of studies were reviewed: studies that evaluated both node-positive and node-negative breast cancers, and studies that included only high-risk node-negative breast cancers. Three phase-III studies that evaluated both negative and positive nodes did not show any benefit of the use of taxanes according to the node-negative subgroup analyses, versus two studies (European Cooperative Trial in Operable Breast Cancer [ECTO] et Grupo Español de Investigación del Cáncer de Mama [GEICAM]) that showed a significant difference in disease-free survival. In view of these studies, the role of taxanes in node-negative breast cancer is still controversial and the results of the ongoing trials may respond to this subject.
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Franken B, de Groot MR, Mastboom WJB, Vermes I, van der Palen J, Tibbe AGJ, Terstappen LWMM. Circulating tumor cells, disease recurrence and survival in newly diagnosed breast cancer. Breast Cancer Res 2012; 14:R133. [PMID: 23088337 PMCID: PMC4053111 DOI: 10.1186/bcr3333] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 10/15/2012] [Indexed: 02/05/2023] Open
Abstract
Introduction The presence of circulating tumor cells (CTC) is an independent prognostic factor for progression-free survival and breast cancer-related death (BRD) for patients with metastatic breast cancer beginning a new line of systemic therapy. The current study was undertaken to explore whether the presence of CTC at the time of diagnosis was associated with recurrence-free survival (RFS) and BRD. Methods In a prospective single center study, CTC were enumerated with the CellSearch system in 30 ml of peripheral blood of 602 patients before undergoing surgery for breast cancer. There were 97 patients with a benign tumor, 101 did not meet the inclusion criteria of which there were 48 patients with DCIS, leaving 404 stage I to III patients. Patients were stratified into unfavorable (CTC ≥1) and favorable (CTC = 0) prognostic groups. Results ≥1 CTC in 30 ml blood was detected in 15 (15%) benign tumors, in 9 DCIS (19%), in 28 (16%) stage I, 32 (18%) stage II and in 16 (31%) patients with stage III. In stage I to III patients 76 (19%) had ≥1 CTC of whom 16 (21.1%) developed a recurrence. In 328 patients with 0 CTC 38 (11.6%) developed a recurrence. Four-year RFS was 88.4% for favorable CTC and 78.9% for unfavorable CTC (P = 0.038). A total of 25 patients died of breast cancer-related causes and 11 (44%) had ≥1 CTC. BRD was 4.3% for favorable and 14.5% for unfavorable CTC (P = 0.001). In multivariate analysis ≥1 CTC was associated with distant disease-free survival, but not for overall recurrence-free survival. CTC, progesterone receptor and N-stage were independent predictors of BRD in multivariate analysis. Conclusions Presence of CTC in breast cancer patients before undergoing surgery with curative intent is associated with an increased risk for breast cancer-related death.
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Use of ER/PR/HER2 subtypes in conjunction with the 2007 St Gallen Consensus Statement for early breast cancer. BMC Cancer 2010; 10:228. [PMID: 20492696 PMCID: PMC2886044 DOI: 10.1186/1471-2407-10-228] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 05/21/2010] [Indexed: 12/28/2022] Open
Abstract
Background The 2007 St Gallen international expert consensus statement describes three risk categories and provides recommendations for treatment of early breast cancer. The set of recommendations on how to best treat primary breast cancer is recognized and used by clinicians worldwide. We now examine the variability of five-year survival of the 2007 St Gallen Risk Classifications utilizing the ER/PR/HER2 subtypes. Methods Using the population-based California Cancer Registry, 114,786 incident cases of Stages 1-3 invasive breast cancer diagnosed between 2000 and 2006 were identified. Cases were assigned to Low, Intermediate, or High Risk categories. Five-year-relative survival was computed for the three St Gallen risk categories and for the ER/PR/HER2 subtypes for further differentiation. Results and Discussion There were 9,124 (13%) cases classified as Low Risk, 44,234 (65%) cases as Intermediate Risk, and 14,340 (21%) as High Risk. Within the Intermediate Risk group, 33,735 (76%) were node-negative (Intermediate Risk 2) and 10,499 (24%) were node-positive (Intermediate Risk 3). For the High Risk group, 6,149 (43%) had 1 to 3 positive axillary lymph nodes (High Risk 4) and 8,191 (57%) had four or more positive lymph nodes (High Risk 5). Using five-year relative survival as the principal criterion, we found the following: a) There was very little difference between the Low Risk and Intermediate Risk categories; b) Use of the ER/PR/HER2 subtypes within the Intermediate and High Risk categories separated each into a group with better five-year survival (ER-positive) and a group with worse survival (ER-negative), irrespective of HER2-status; c) The heterogeneity of the High Risk category was most evident when one examined the ER/PR/HER2 subtypes with four or more positive axillary lymph nodes; (d) HER2-positivity did not always translate to worse survival, as noted when one compared the triple positive subtype (ER+/PR+/HER2+) to the triple negative subtype (ER-/PR-/HER2-); and (e) ER-negativity appeared to be a stronger predictor of poor survival than HER2-positivity. Conclusion The use of ER/PR/HER2 subtype highlights the marked heterogeneity of the Intermediate and High Risk categories of the 2007 St Gallen statements. The use of ER/PR/HER2 subtypes and correlation with molecular classification of breast cancer is recommended.
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Gene profiling in breast cancer. Indian J Surg Oncol 2010; 1:14-8. [PMID: 22930613 DOI: 10.1007/s13193-010-0006-x] [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: 07/16/2009] [Accepted: 09/09/2009] [Indexed: 10/19/2022] Open
Abstract
Breast cancer is a heterogenous disease which shows a great variation in presentation and response to treatment. Currently, the most commonly used prognostic criteria are patient age, tumor size, lymph node status, tumor grade and hormone receptor status. These are however not very accurate. This is partly explained by the fact that they do not demonstrate the inherent genetic variability of breast cancer, which determines the aggressive nature and metastatic potential of the disease. Recent advances in molecular biology have demonstrated that breast cancer is not a single disease. The new diagnostic and prognostic tests based on molecular biology methods have helped identify molecular subtypes of breast cancer that are sensitive to chemotherapy and others that are resistant. This could provide valuable critical information and predict which patients would really benefit from chemo and/or hormonal therapy. Molecular biology will become increasingly important in clinical decision making and as the understanding of molecular processes within cancer cells grow, new targets for therapy will be discovered.
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Blancas I, Gómez FJ, Bermejo B, Hennessy BT, Chirivella I, Magro A, Caballero A, Ferrer J, Valero V, Lluch A. Outcome differences between patients with node-negative breast cancer classified according to the st. Gallen risk categories. Clin Breast Cancer 2009; 9:231-6. [PMID: 19933078 DOI: 10.3816/cbc.2009.n.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to compare the 2007 St. Gallen risk categories with the outcomes of patients with node-negative breast cancer (NNBC). PATIENTS AND METHODS We retrospectively reviewed the medical records of 1500 women with pathologically T1-T3 NNBC treated at the Clinic Hospital, Valencia University (Spain) from 1982 to 2000. Systemic adjuvant treatment was administered to 89.9% of the patients in the whole sample (37% received only hormonal therapy and 52.9% chemotherapy). The 2007 St. Gallen criteria were used to divide the whole sample into 1201 patients with intermediate risk (with > or = 1 of the following: pathologic tumor size > 2 cm, grade 2-3, estrogen receptor and progesterone receptor absent, HER2/neu gene overexpressed or amplified, or age < 35 years) and 299 patients with low risk. Of the 1201 patients with intermediate risk, 56% received adjuvant chemotherapy. The intermediate- and low-risk groups were compared for relapse-free survival (RFS) and breast cancer-specific survival (BCSS). RESULTS Median follow-up of the entire sample was 61 months (range, 2-251 months). At 5 years, the overall RFS rate was 86%, and the BCSS rate was 95%. For low-risk patients, the RFS rate was 92%, and the BCSS rate was 98%. For intermediate-risk patients, the RFS rate was 84%, and the BCSS rate was 94%. There was a statistically significant difference between the 2 groups in terms of RFS (P = .006) and BCSS (P = .041) independent of received treatment. CONCLUSION Using the St. Gallen risk categories resulted in significantly different outcomes for patients with NNBC. The St. Gallen classification might be a valuable clinical tool when assessing patients with NNBC.
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Affiliation(s)
- Isabel Blancas
- Department of Oncology and Hematology, Clinic Hospital, Valencia, Spain.
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Schmidt M, Victor A, Bratzel D, Boehm D, Cotarelo C, Lebrecht A, Siggelkow W, Hengstler J, Elsäßer A, Gehrmann M, Lehr HA, Koelbl H, von Minckwitz G, Harbeck N, Thomssen C. Long-term outcome prediction by clinicopathological risk classification algorithms in node-negative breast cancer—comparison between Adjuvant!, St Gallen, and a novel risk algorithm used in the prospective randomized Node-Negative-Breast Cancer-3 (NNBC-3) trial. Ann Oncol 2009; 20:258-64. [DOI: 10.1093/annonc/mdn590] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bueno-de-Mesquita JM, Linn SC, Keijzer R, Wesseling J, Nuyten DSA, van Krimpen C, Meijers C, de Graaf PW, Bos MMEM, Hart AAM, Rutgers EJT, Peterse JL, Halfwerk H, de Groot R, Pronk A, Floore AN, Glas AM, Van't Veer LJ, van de Vijver MJ. Validation of 70-gene prognosis signature in node-negative breast cancer. Breast Cancer Res Treat 2008; 117:483-95. [PMID: 18819002 DOI: 10.1007/s10549-008-0191-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 09/08/2008] [Indexed: 01/19/2023]
Abstract
PURPOSE The 70-gene prognosis signature (van't Veer et al., Nature 415(6871):530-536, 2002) may improve the selection of lymph node-negative breast cancer patients for adjuvant systemic therapy. Optimal validation of prognostic classifiers is of great importance and we therefore wished to evaluate the prognostic value of the 70-gene prognosis signature in a series of relatively recently diagnosed lymph node negative breast cancer patients. METHODS We evaluated the 70-gene prognosis signature in an independent representative series of patients with invasive breast cancer (N = 123; <55 years; pT1-2N0; diagnosed between 1996 and 1999; median follow-up 5.8 years) by classifying these patients as having a good or poor prognosis signature. In addition, we updated the follow-up of the node-negative patients of the previously published validation-series (Van de Vijver et al., N Engl J Med 347(25):1999-2009, 2002; N = 151; median follow-up 10.2 years). The prognostic value of the 70-gene prognosis signature was compared with that of four commonly used clinicopathological risk indexes. The endpoints were distant metastasis (as first event) free percentage (DMFP) and overall survival (OS). RESULTS The 5-year OS was 82 +/- 5% in poor (48%) and 97 +/- 2% in good prognosis signature (52%) patients (HR 3.4; 95% CI 1.2-9.6; P = 0.021). The 5-years DMFP was 78 +/- 6% in poor and 98 +/- 2% in good prognosis signature patients (HR 5.7; 95% CI 1.6-20; P = 0.007). In the updated series (N = 151; 60% poor vs. 40% good), the 10-year OS was 51 +/- 5% and 94 +/- 3% (HR 10.7; 95% CI 3.9-30; P < 0.01), respectively. The DMFP was 50 +/- 6% in poor and 86 +/- 5% in good prognosis signature patients (HR 5.5; 95% CI 2.5-12; P < 0.01). In multivariate analysis, the prognosis signature was a strong independent prognostic factor in both series, outperforming the clinicopathological risk indexes. CONCLUSION The 70-gene prognosis signature is also an independent prognostic factor in node-negative breast cancer patients for women diagnosed in recent years.
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Affiliation(s)
- J M Bueno-de-Mesquita
- Department of Pathology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Martín M, Mahillo E, Llombart-Cussac A, Lluch A, Munarriz B, Pastor M, Alba E, Ruiz A, Antón A, Bermejo B. The «El Álamo» project (1990–1997): two consecutive hospital-based studies of breast cancer outcomes in Spain. Clin Transl Oncol 2006; 8:508-18. [PMID: 16870541 DOI: 10.1007/s12094-006-0051-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The "Alamo" project is a retrospective analysis of 14,854 patients diagnosed of breast cancer between 1990 and 1997 in 50 Spanish hospitals. METHODS Alamo I (AI) consisted of 4,532 patients diagnosed with breast cancer between 1990 and 1993. Data were collected in 2000. Alamo II (AII) consisted of 10,322 patients diagnosed between 1994 and 1997. Data were collected in 2003. RESULTS At presentation, there were (AI vs. AII) 17.6% vs. 24.3% at stage I; 55.5% vs. 53.1% at stage II; 18.7% vs. 15% at stage III; 7.2% vs. 5.9 at stage IV. Median age was 57 (AI) vs. 58 years (AII) and 65.9% vs. 67.2% (AI vs. AII) were post-menopausal. Firstline treatment for disease stages I, II and III was surgery in 91% of patients in both studies. Breast conserving surgery rate increased from 20.2% (AI) to 32.7% (AII). Adjuvant systemic treatments were administered to 87.6% (AI) and 92.8% (AII) of patients. Recurrence rate diminished from 36.6% (AI) to 22.5% (AII) and the 9-year survival rate increased from 63.2% (95% CI: 61.5-64.9) to 70.1% (95% CI: 68.5-71.8). CONCLUSION Breast cancer outcomes in Spain have improved from 1990-1993 to 1994-1997, likely because of breast cancer screening program implementation and new therapies.
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Affiliation(s)
- M Martín
- Hospital Clínico Universitario San Carlos, Madrid, Spain.
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Jung SY, Han W, Shin HJ, Lee JE, Hwang KT, Hwang SE, Oh SK, Youn YK, Kim SW, Noh DY. Usefulness of Ki-67 as a prognostic Factor in Lymph Node-Negative Breast Cancer. J Breast Cancer 2006. [DOI: 10.4048/jbc.2006.9.1.41] [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)
- So-Youn Jung
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk Jai Shin
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Tae Hwang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Eun Hwang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Keun Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yeo-Kyu Youn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Won Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Biganzoli E, Boracchi P. Old and new markers for breast cancer prognosis: the need for integrated research on quantitative issues. Eur J Cancer 2004; 40:1803-6. [PMID: 15288279 DOI: 10.1016/j.ejca.2004.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2004] [Accepted: 04/23/2004] [Indexed: 10/26/2022]
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