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Sasada S, Kondo N, Hashimoto H, Takahashi Y, Terata K, Kida K, Sagara Y, Ueno T, Anan K, Suto A, Kanbayashi C, Takahashi M, Nakamura R, Ishiba T, Tsuneizumi M, Nishimura S, Naito Y, Hara F, Shien T, Iwata H. Prognostic impact of adjuvant endocrine therapy for estrogen receptor-positive and HER2-negative T1a/bN0M0 breast cancer. Breast Cancer Res Treat 2023; 202:473-483. [PMID: 37688665 PMCID: PMC10564809 DOI: 10.1007/s10549-023-07097-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE Mammography screening has increased the detection of subcentimeter breast cancers. The prognosis for estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-negative T1a/bN0M0 breast cancers is excellent; however, the necessity of adjuvant endocrine therapy (ET) is uncertain. METHODS We evaluated the effectiveness of adjuvant ET in patients with ER-positive and HER2-negative T1a/bN0M0 breast cancer who underwent surgery from 2008 to 2012. Standard ET was administrated after surgery. The primary endpoint was the cumulative incidence of distant metastasis. All statistical tests were 2-sided. RESULTS Adjuvant ET was administered to 3991 (83%) of the 4758 eligible patients (1202 T1a [25.3%] and 3556 T1b [74.7%], diseases). The median follow-up period was 9.2 years. The 9-year cumulative incidence of distant metastasis was 1.5% with ET and 2.6% without ET (adjusted subdistribution hazard ratio [sHR], 0.54; 95% CI, 0.32-0.93). In multivariate analysis, the independent risk factors for distant metastasis were no history of ET, mastectomy, high-grade, and lymphatic invasion. The 9-year overall survival was 97.0% and 94.4% with and without ET, respectively (adjusted HR, 0.57; 95% CI, 0.39-0.83). In addition, adjuvant ET reduced the incidence of ipsilateral and contralateral breast cancer (9-year rates; 1.1% vs. 6.9%; sHR, 0.17, and 1.9% vs. 5.2%; sHR, 0.33). CONCLUSIONS The prognosis was favorable in patients with ER-positive and HER2-negative T1a/bN0M0 breast cancer. Furthermore, adjuvant ET reduced the incidence of distant metastasis with minimal absolute risk difference. These findings support considering the omission of adjuvant ET, especially for patients with low-grade and no lymphatic invasion disease.
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Affiliation(s)
- Shinsuke Sasada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroya Hashimoto
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuko Takahashi
- Department of Breast and Endocrine Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Kaori Terata
- Department of Breast and Endocrine Surgery, Akita University Hospital, Akita, Japan
| | - Kumiko Kida
- Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Yasuaki Sagara
- Department of Breast and Thyroid Surgical Oncology, Social medical corporation Hakuaikai, Sagara Hospital, Kagoshima, Japan
| | - Takayuki Ueno
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keisei Anan
- Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Akihiko Suto
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Chizuko Kanbayashi
- Department of Breast Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Mina Takahashi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Rikiya Nakamura
- Department of Breast Surgery, Chiba Cancer Center, Chiba, Japan
| | - Toshiyuki Ishiba
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Michiko Tsuneizumi
- Department of Breast Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Seiichiro Nishimura
- Department of Breast Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yoichi Naito
- Department of General Internal Medicine, National Cancer Center Hospital East, Chiba, Japan
| | - Fumikata Hara
- Breast Oncology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tadahiko Shien
- Department of Breast and Endocrine Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, 700-8558, Okayama, Japan.
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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Williams AD, Solis O, Sterbling HM, Murray A, Sogunro O, De La Cruz LM. Are We Overtreating Patients With T1a HER2+ Breast Cancer? An Analysis of the National Cancer Database. Clin Breast Cancer 2022; 22:828-839. [PMID: 36151019 DOI: 10.1016/j.clbc.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The potential benefit of systemic therapy in patients with T1a HER2+ cancers is not well understood, and no consensus guidelines exist. We sought to investigate practice patterns of chemotherapy use in this population. METHODS From the National Cancer Database (2013-2018), we identified female patients with HER2+ cancers staged as cT1aN0 or pT1aN0 and stratified by receipt of chemotherapy. Using univariate and multivariable analyses we assessed the clinicopathologic features associated with the receipt of chemotherapy. We also compared rates of overall survival (OS). RESULTS Of 5176 women with cT1aN0 HER2+ cancers, 88 (2%) received neoadjuvant chemotherapy. Younger age and hormone-receptor (HR) negative tumors were factors independently associated with receipt of neoadjuvant chemotherapy (all P < .001). Of 11,688 women with pT1aN0 HER2+ cancers, 5,588 (48%) received adjuvant chemotherapy. Rates of use increased over the analysis period from 39% in 2013 to 53% in 2018 (P < .001). Factors independently associated with receipt of adjuvant chemotherapy included younger age, having a poorly differentiated tumor, exhibiting lymphovascular invasion, undergoing adjuvant radiation (all P < .001). There were no differences in OS when comparing those who did and did not receive chemotherapy in either group. CONCLUSIONS The use of chemotherapy in patients with HER2+ T1a cancers is increasing over time and is, as expected, more common among patients with unfavorable clinicopathologic features. Since no prognostic algorithm currently exists, more prospective data is needed to understand which of these patients may derive benefit from systemic therapy and which may safely avoid the morbidity of chemotherapy.
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Affiliation(s)
- Austin D Williams
- Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY
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Shen K, Yao L, Zhu J, Gu X, Wang J, Qian W, Zheng Z, Fu D, Wu S. Impact of adjuvant chemotherapy on T1N0M0 breast cancer patients: a propensity score matching study based on SEER database and external cohort. BMC Cancer 2022; 22:863. [PMID: 35941565 PMCID: PMC9358893 DOI: 10.1186/s12885-022-09952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background There is no clear consensus on the benefits of adjuvant chemotherapy for tumor-node-metastasis (TNM) stage T1 (T1N0M0) breast cancer (BC). Our study investigated the effects of adjuvant chemotherapy on T1N0M0 BC patients. Methods Seventy-five thousand one hundred thirty-nine patients diagnosed with T1N0M0 BC were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate Cox analyses were performed to investigate the effects of adjuvant chemotherapy on T1a, T1b, and T1cN0M0 BC, including various tumor grades, and four molecular subtypes. Propensity score matching (PSM) was used to eliminate confounding factors and further compare the results between adjuvant chemotherapy and no adjuvant chemotherapy. Additionally, 545 T1N0M0 BC patients treated at the Northern Jiangsu People’s Hospital were included as an independent external validation cohort. Univariate and multivariate Cox analyses were used to confirm the effects of adjuvant chemotherapy in T1a, T1b, and T1cN0M0 BC. Survival curves for the different tumor grades and molecular subtypes were plotted using the Kaplan–Meier method. Results Adjuvant chemotherapy demonstrated a statistically significant improvement in overall survival (OS) in T1b and T1c BC, but not in T1a BC. Within T1b BC, adjuvant chemotherapy was found to have effects on grade III, and hormone receptor + (HoR +)/human epidermal growth factor receptor 2 + (HER2 +), HoR-/HER2 + , and HoR-/HER2- molecular subtypes, respectively. Adjuvant chemotherapy was beneficial to OS for grade II/III and T1c BC. Identical results were obtained after PSM. We also obtained similar results with external validation cohort, except that adjuvant chemotherapy made a difference in grade II and T1b BC of the external validation dataset. Conclusions Partial T1N0M0 BC patients with grade III T1bN0M0, patients with tumor grade II and III T1cN0M0, and excluding those with HoR + /HER2- subtype tumors, could obtain OS benefits from adjuvant chemotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09952-z.
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Affiliation(s)
- Kaiwen Shen
- Department of General Surgery, Traditional Chinese Medicine Hospital of Kunshan, Suzhou, 215000, Jiangsu, China
| | - Longdi Yao
- Department of General Surgery, Changxing Hospital of Traditional Chinese Medicine, Huzhou, 313100, Zhejiang, China
| | - Jingyuan Zhu
- Department of General Surgery, Traditional Chinese Medicine Hospital of Kunshan, Suzhou, 215000, Jiangsu, China
| | - Ximing Gu
- Department of General Surgery, Traditional Chinese Medicine Hospital of Kunshan, Suzhou, 215000, Jiangsu, China
| | - Jie Wang
- Department of General Surgery, Traditional Chinese Medicine Hospital of Kunshan, Suzhou, 215000, Jiangsu, China
| | - Wei Qian
- Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Zhijian Zheng
- Department of General Surgery, The First People's Hospital of Wenling, Wenling, 317500, Zhejiang, China
| | - Deyuan Fu
- Department of Thyroid and Breast Surgery, Northern Jiangsu People's Hospital, Yangzhou University Medical Academy, Guangling District, Nantong Xi Road, Yangzhou, 225001, Jiangsu, China.
| | - Song Wu
- Department of Thyroid and Breast Surgery, The First People's Hospital of Wenling, Chuanan Nan Road, Chengxi Street, Wenling, 317500, Zhejiang, China.
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Han D, Shen R, Yue M, Zhao M, Yu Y, Yao J, Liu Y. Relationship between the changes of positivity rate of HER2 expression and the diameter of invasive lesions in early breast cancer and its clinical significance. Pathol Res Pract 2022; 233:153877. [DOI: 10.1016/j.prp.2022.153877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/27/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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Villasco A, Actis S, Bounous VE, Borella F, D’Alonzo M, Ponzone R, De Sanctis C, Benedetto C, Biglia N. The Role of Trastuzumab in Patients with HER2 Positive Small (pT1mi/a) Breast Cancers, a Multicenter Retrospective Study. Cancers (Basel) 2021; 13:cancers13225836. [PMID: 34830989 PMCID: PMC8616482 DOI: 10.3390/cancers13225836] [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: 09/27/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Treatment of small HER2+ breast cancers with adjuvant Trastuzumab is still controversial. This study aims to measure the effect of Trastuzumab in early stages of breast cancer (pT1mic/a pN0/1mi) in terms of disease recurrence and to identify which factors most affect the prognosis of small HER2+ tumors. We retrospectively selected and reviewed 100 HER2+ pT1mic-pT1a breast cancer patients with a median follow-up of 86 months. In our study the primary outcome was the disease recurrence rate, which appeared to be significantly lower among patients who received adjuvant Trastuzumab. Among the patients who did not receive adjuvant Trastuzumab, HR− HER2+ tumors showed a risk seven times higher of relapse. The results of our study indicate that adjuvant Trastuzumab reduces the risk of developing a disease recurrence even in small HER2+ tumors. Adjuvant targeted therapy should be considered in patients with HR− HER2+ tumors, the category with the highest risk of recurrence. Abstract The treatment with adjuvant Trastuzumab in patients diagnosed with HER2+ small breast cancers is controversial: limited prospective data from randomized trials is available. This study aims to measure the effect of Trastuzumab in the early stages of breast cancer (pT1mic/a pN0/1mi) in terms of disease recurrence and to identify which are the factors that most affect the prognosis of small HER2+ tumors. One hundred HER2+ pT1mic-pT1a breast cancer patients who were treated in three Turin Breast Units between January 1998 and December 2018 were retrospectively selected and reviewed. Trastuzumab was administered to 23 patients. Clinicopathological features and disease-free survival (DFS) were compared between different subgroups. The primary outcome was the disease recurrence rate. Median follow-up time was 86 months. Compared to pT1a tumors, pT1mic lesions had a higher tumor grade (84% of pT1mic vs. 55% of pT1a; p = 0.003), a higher Ki-67 index (81% vs. 46%; p = 0.007) and were more frequently hormone receptor (HR) negative (69% vs. 36%, p = 0.001). Disease recurrence rate was significantly lower among patients who received adjuvant Trastuzumab (p = 0.02), with this therapy conferring an 85% reduction in the risk of relapse (HR 0.15; p = 0.02). Among the patients who did not receive adjuvant Trastuzumab, the only factor significantly associated with an increased risk of developing a recurrence was the immunohistochemical (IHC) subtype: in fact, HR− HER2+ tumors showed a risk seven times higher of relapsing (HR 7.29; p = 0.003). Adjuvant Trastuzumab appears to reduce the risk of disease recurrence even in small HER2+ tumors. The adjuvant targeted therapy should be considered in patients with HR− HER2+ tumors since they have the highest risk of recurrence, independently from size and grade.
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Affiliation(s)
- Andrea Villasco
- Academic Division of Obstetrics and Gynaecology-A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (A.V.); (S.A.); (V.E.B.); (M.D.)
| | - Silvia Actis
- Academic Division of Obstetrics and Gynaecology-A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (A.V.); (S.A.); (V.E.B.); (M.D.)
| | - Valentina Elisabetta Bounous
- Academic Division of Obstetrics and Gynaecology-A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (A.V.); (S.A.); (V.E.B.); (M.D.)
| | - Fulvio Borella
- Gynaecology and Obstetrics 1-City of Health and Science, University of Turin, 10126 Turin, Italy; (F.B.); (C.B.)
| | - Marta D’Alonzo
- Academic Division of Obstetrics and Gynaecology-A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (A.V.); (S.A.); (V.E.B.); (M.D.)
| | - Riccardo Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy;
| | - Corrado De Sanctis
- Breast Unit, Department of Gynecology and Obstetrics, City of Health and Science, University of Turin, 10126 Turin, Italy;
| | - Chiara Benedetto
- Gynaecology and Obstetrics 1-City of Health and Science, University of Turin, 10126 Turin, Italy; (F.B.); (C.B.)
| | - Nicoletta Biglia
- Academic Division of Obstetrics and Gynaecology-A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (A.V.); (S.A.); (V.E.B.); (M.D.)
- Correspondence:
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van Dooijeweert C, van Diest PJ, Ellis IO. Grading of invasive breast carcinoma: the way forward. Virchows Arch 2021; 480:33-43. [PMID: 34196797 PMCID: PMC8983621 DOI: 10.1007/s00428-021-03141-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
Histologic grading has been a simple and inexpensive method to assess tumor behavior and prognosis of invasive breast cancer grading, thereby identifying patients at risk for adverse outcomes, who may be eligible for (neo)adjuvant therapies. Histologic grading needs to be performed accurately, on properly fixed specimens, and by adequately trained dedicated pathologists that take the time to diligently follow the protocol methodology. In this paper, we review the history of histologic grading, describe the basics of grading, review prognostic value and reproducibility issues, compare performance of grading to gene expression profiles, and discuss how to move forward to improve reproducibility of grading by training, feedback and artificial intelligence algorithms, and special stains to better recognize mitoses. We conclude that histologic grading, when adequately carried out, remains to be of important prognostic value in breast cancer patients.
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Affiliation(s)
- C van Dooijeweert
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Internal Medicine, Meander Medical Center, Amersfoort, Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands.
| | - I O Ellis
- Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
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Impact of adjuvant endocrine therapy on prognosis in small hormone receptor-positive, HER2-negative early breast cancer. Breast Cancer 2021; 28:1087-1095. [PMID: 33886077 DOI: 10.1007/s12282-021-01245-w] [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: 11/11/2020] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The efficacy of adjuvant endocrine therapy for hormone receptor-positive breast cancer has been previously established. However, significant adverse events related to endocrine therapy cannot be ignored. T1 breast cancer is expected to have a good prognosis. Therefore, adjuvant endocrine therapy for T1a breast cancer patients is controversial. Thus, in this study, we examined the effect of endocrine therapy on the prognosis of T1N0 hormone receptor-positive, HER2-negative breast cancer patients in each tumor size group, and re-considered the application of endocrine therapy. METHODS We retrospectively obtained clinical and pathological data from medical records of 7635 patients who underwent surgery for breast cancer at Aichi Cancer Hospital between January 2000 and December 2017. The primary end point of our analysis was disease-free survival (DFS). The secondary end points were distant disease-free survival (DDFS), overall survival (OS), and breast cancer-specific survival (BCSS). The log-rank test, cumulative survival generated curves with Kaplan-Meier methods and the hazard ratio (HR) calculated with a Cox regression model were used to assess the effects of endocrine therapy on prognosis. RESULTS The 5-year DFS was worse in the non-endocrine therapy (non-ET) group (78%) than the endocrine therapy (ET) group (95%) in the T1c population (p < 0.001, HR 0.25). However, there was no statistically significant difference in DFS between the ET and the non-ET groups in T1a (ET 96% vs non-ET 93%, p = 0.9314, HR 0.94) and T1b (ET 96% vs non-ET 93%, p = 0.1481HR 0.53) breast cancer. The OS, DDFS, and BCSS of the patients also showed that endocrine therapy was associated with improvement of the prognosis in the T1c group, but not in the T1a and T1b groups. CONCLUSIONS Adjuvant endocrine therapy may be essential for T1c breast cancer patients. In contrast, this therapy should be discussed for T1a and T1b luminal breast cancer patients under some circumstances, such as suffering from adverse events.
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Zhu S, Li Y, Chen W, Fei X, Shen K, Chen X. Molecular Subtype May Be More Associated With Prognosis and Chemotherapy Benefit Than Tumor Size in T1N0 Breast Cancer Patients: An Analysis of 2,168 Patients for Possible De-Escalation Treatment. Front Oncol 2021; 11:636266. [PMID: 33680973 PMCID: PMC7933524 DOI: 10.3389/fonc.2021.636266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose Breast cancer (BC) patients with T1N0 tumors have relatively favorable clinical outcomes. However, it remains unclear whether molecular subtypes can aide in prognostic prediction for such small, nodal-negative BC cases and guide decision-making about escalating or de-escalating treatments. Patients and Methods T1N0 BC patients diagnosed between 2009 and 2017 were included and classified into three subgroups according to receptor status: 1) hormonal receptor (HR)+/human epidermal growth factor receptor-2 (HER2)−; 2) HER2+; and 3) triple negative (TN) (HR−/HER2−). Patients’ characteristics and relapse events were reviewed. Kaplan–Meier analysis and Cox regression were used to assess the iDFS and BCSS. The effects of risk factors and adjuvant treatment benefits were evaluated by calculating hazard ratios (HRs) for invasive disease-free survival (iDFS) and breast cancer-specific survival (BCSS) with Cox proportional hazards models. Results In total, 2,168 patients (1,435 HR+/HER2−, 427 HER2+, 306 TN) were enrolled. The 5-year iDFS rates were 93.6, 92.7, and 90.6% for HR+/HER2−, HER2+, and TN patients, respectively (P = 0.039). Multivariate analysis demonstrated that molecular subtype (P = 0.043), but not tumor size (P = 0.805), was independently associated with iDFS in T1N0 BC. TN patients [HRs = 1.77, 95% confidence interval (CI) = 1.11–2.84, P = 0.018] had a higher recurrence risk than HR+/HER2− patients. Adjuvant chemotherapy benefit was not demonstrated in all T1N0 patients but interacted with molecular subtype status. TN (adjusted HRs = 2.31, 95% CI = 0.68–7.54) and HER2+ (adjusted HRs = 2.26, 95% CI = 0.95–5.63) patients receiving chemotherapy had superior iDFS rates. Regarding BCSS, molecular subtype tended to be related to outcome (P = 0.053) and associated with chemotherapy benefit (P = 0.005). Conclusion Molecular subtype was more associated with disease outcome and chemotherapy benefit than tumor size in T1N0 BC patients, indicating that it may guide possible clinical de-escalating therapy in T1N0 BC.
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Affiliation(s)
- Siji Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yafen Li
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiguo Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Han Y, Wang J, Sun Y, Yu P, Yuan P, Ma F, Fan Y, Luo Y, Zhang P, Li Q, Cai R, Chen S, Li Q, Xu B. Prognostic Model and Nomogram for Estimating Survival of Small Breast Cancer: A SEER-based Analysis. Clin Breast Cancer 2020; 21:e497-e505. [PMID: 33277191 DOI: 10.1016/j.clbc.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Different clinicopathologic characteristics could contribute to inconsistent prognoses of small breast neoplasms (T1a/T1b). This study was done to conduct a retrospective analysis and establish a clinical prediction model to predict individual survival outcomes of patients with small carcinomas of the breast. MATERIALS AND METHODS Based on the Surveillance, Epidemiology, and End Results (SEER) database, eligible patients with small breast carcinomas were analyzed. Univariate analysis and multivariate analysis were performed to clarify the indicators of overall survival. Pooling risk factors enabled nomograms to be constructed and further predicted 3-year, 5-year, and 10-year survival of patients with small breast cancer. The model was internally validated for discrimination and calibration. RESULTS A total of 17,543 patients with small breast neoplasms diagnosed between 2013 and 2016 were enrolled. Histologic grade, lymph node stage, estrogen receptor or progesterone receptor status, and molecular subtypes of breast cancer were regarded as the risk factors of prognosis in a Cox proportional hazards model (P < .05). A nomogram was constructed to give predictive accuracy toward individual survival rate of patients with small breast neoplasms. CONCLUSIONS This prognostic model provided a robust and effective method to predict the prognosis of patients with small breast cancer.
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Affiliation(s)
- Yiqun Han
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yanxia Sun
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei Yu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peng Yuan
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Fan
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pin Zhang
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Li
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruigang Cai
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanshan Chen
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiao Li
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Jaraj D, Höijer J, Widman L, Ahlgren J, Arnesson LG, Einbeigi Z, Klintman M, Vikhe Patil E, Sund M, Fredriksson I, Bergh J, Andreas P. Long-Term Prognostication for 20 114 Women With Small and Node-Negative Breast Cancer (T1abN0). JNCI Cancer Spectr 2020; 5:pkaa084. [PMID: 33442658 PMCID: PMC7791632 DOI: 10.1093/jncics/pkaa084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/22/2020] [Indexed: 11/14/2022] Open
Abstract
Background Although small, node-negative breast cancer (ie, T1abN0) constitutes 20% of all newly diagnosed breast cancers, data on prognosis and prognostic factors are limited. Methods We conducted a population-based cohort study including 20 114 Swedish women treated for T1abN0 breast cancer from 1977 onward. Patient and tumor data were collected from Swedish breast cancer registries. Cohort subjects were followed through linkage to the Cause of Death Register. We calculated the cumulative incidence of breast cancer–specific and overall death and used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results During a median follow-up of 9.1 years (range = 0-38), 915 women died of breast cancer and 5416 of any cause. The 10-, 20-, and 30-year cumulative incidences of breast cancer death were 3.4% (95% CI = 3.1% to 3.7%), 7.6% (95% CI = 7.1% to 8.2%), and 10.5% (95% CI = 9.6% to 11.4%), respectively. The multivariable hazard ratios and 95% confidence intervals of breast cancer death were 0.92 (95% CI = 0.88 to 0.97) for each additional calendar year of diagnosis, 4.38 (95% CI = 2.79 to 6.87) for grade 3 vs grade 1 tumors, 0.43 (95% CI = 0.31 to 0.62) for progesterone receptor–positive vs progesterone receptor–negative disease, and 2.01 (95% CI = 0.99 to 4.07) for HER2-positive vs HER2-negative disease. Women with grade 3 vs grade 1 tumors had a 56% increased risk of death from any cause (HR = 1.56, 95% CI = 1.30 to 1.88). Conclusions The risk of breast cancer death in T1abN0 disease continues to increase steadily beyond 10 years after diagnosis, has improved over time, and varies substantially by tumor characteristics.
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Affiliation(s)
- David Jaraj
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Capio St Görans Hospital, Stockholm, Sweden
| | - Jonas Höijer
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Linnea Widman
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ahlgren
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Regional Cancer Centre, Uppsala Örebro Health Care Region, Uppsala, Sweden
| | | | - Zakaria Einbeigi
- Department of Medicine, Southern Älvsborg Hospital, Borås, Sweden.,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Klintman
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Eva Vikhe Patil
- Department of Surgery, University Hospital, Linköping, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Irma Fredriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast, Endocrine and Sarcoma Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Breast, Endocrine and Sarcoma Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Pettersson Andreas
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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11
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Bonneau C, Eliès A, Kieffer Y, Bourachot B, Ladoire S, Pelon F, Hequet D, Guinebretière JM, Blanchet C, Vincent-Salomon A, Rouzier R, Mechta-Grigoriou F. A subset of activated fibroblasts is associated with distant relapse in early luminal breast cancer. Breast Cancer Res 2020; 22:76. [PMID: 32665033 PMCID: PMC7362513 DOI: 10.1186/s13058-020-01311-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022] Open
Abstract
Background Early luminal breast cancer (BC) represents 70% of newly diagnosed BC cases. Among them, small (under 2 cm) BC without lymph node metastasis (classified as T1N0) have been rarely studied, as their prognosis is generally favorable. Nevertheless, up to 5% of luminal T1N0 BC patients relapse with distant metastases that ultimately prove fatal. The aim of our work was to identify the mechanisms involved in metastatic recurrence in these patients. Methods Our study addresses the role that autonomous and non-autonomous tumor cell features play with regard to distant recurrence in early luminal BC patients. We created a cohort of T1N0 luminal BC patients (tumors between 0.5–2 cm without lymph node metastasis) with metastatic recurrence (“cases”) and corresponding “controls” (without relapse) matched 1:1 on main prognostic factors: age, grade, and proliferation. We deciphered different characteristics of cancer cells and their tumor micro-environment (TME) by deep analyses using immunohistochemistry. We performed in vitro functional assays and highlighted a new mechanism of cooperation between cancer cells and one particular subset of cancer-associated fibroblasts (CAF). Results We found that specific TME features are indicative of relapse in early luminal BC. Indeed, quantitative histological analyses reveal that “cases” are characterized by significant accumulation of a particular CAF subset (CAF-S1) and decrease in CD4+ T lymphocytes, without any other association with immune cells. In multivariate analysis, TME features, in particular CAF-S1 enrichment, remain significantly associated with recurrence, thereby demonstrating their clinical relevance. Finally, by performing functional analyses, we demonstrated that CAF-S1 pro-metastatic activity is mediated by the CDH11/osteoblast cadherin, consistent with bones being a major site of metastases in luminal BC patients. Conclusions This study shows that distant recurrence in T1N0 BC is strongly associated with the presence of CAF-S1 fibroblasts. Moreover, we identify CDH11 as a key player in CAF-S1-mediated pro-metastatic activity. This is independent of tumor cells and represents a new prognostic factor. These results could assist clinicians in identifying luminal BC patients with high risk of relapse. Targeted therapies against CAF-S1 using anti-FAP antibody or CDH11-targeting compounds might help in preventing relapse for such patients with activated stroma.
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Affiliation(s)
- Claire Bonneau
- Stress and Cancer Laboratory, Equipe labelisée Ligue Nationale Contre le Cancer, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France.,Inserm U830, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France.,Department of Surgery, Institut Curie Hospital Group, 35 rue Dailly, 92210, Saint-Cloud, France
| | - Antoine Eliès
- Stress and Cancer Laboratory, Equipe labelisée Ligue Nationale Contre le Cancer, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France.,Inserm U830, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France.,Department of Surgery, Institut Curie Hospital Group, 35 rue Dailly, 92210, Saint-Cloud, France
| | - Yann Kieffer
- Stress and Cancer Laboratory, Equipe labelisée Ligue Nationale Contre le Cancer, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France.,Inserm U830, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France
| | - Brigitte Bourachot
- Stress and Cancer Laboratory, Equipe labelisée Ligue Nationale Contre le Cancer, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France.,Inserm U830, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France
| | - Sylvain Ladoire
- Inserm U1231, Chemotherapy and immune response, Center Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Floriane Pelon
- Stress and Cancer Laboratory, Equipe labelisée Ligue Nationale Contre le Cancer, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France.,Inserm U830, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France
| | - Delphine Hequet
- Department of Surgery, Institut Curie Hospital Group, 35 rue Dailly, 92210, Saint-Cloud, France
| | - Jean-Marc Guinebretière
- Department of Pathology, Institut Curie Hospital Group, 35 rue Dailly, 92210, Saint-Cloud, France
| | - Christophe Blanchet
- Inserm U1231, Chemotherapy and immune response, Center Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Anne Vincent-Salomon
- Department of Pathology, Institut Curie Hospital Group, 26, rue d'Ulm, 75248, Paris, France
| | - Roman Rouzier
- Department of Surgery, Institut Curie Hospital Group, 35 rue Dailly, 92210, Saint-Cloud, France.,Inserm U900, Cancer et génome : bioinformatique, biostatistiques et épidémiologie, Institut Curie, 35 rue Dailly, 92210, Saint-Cloud, France.,UR 7285, Risques cliniques et sécurité en santé des femmes et en santé périnatale, Versailles Saint Quentin en Yvelines University, 2 avenue de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France
| | - Fatima Mechta-Grigoriou
- Stress and Cancer Laboratory, Equipe labelisée Ligue Nationale Contre le Cancer, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France. .,Inserm U830, Institut Curie, PSL Research University, 26, rue d'Ulm, F-75005, Paris, France.
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12
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van Dooijeweert C, van Diest PJ, Willems SM, Kuijpers CCHJ, van der Wall E, Overbeek LIH, Deckers IAG. Significant inter- and intra-laboratory variation in grading of invasive breast cancer: A nationwide study of 33,043 patients in the Netherlands. Int J Cancer 2020; 146:769-780. [PMID: 30977119 PMCID: PMC6916412 DOI: 10.1002/ijc.32330] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/18/2022]
Abstract
Accurate, consistent and reproducible grading by pathologists is of key-importance for identification of individual patients with invasive breast cancer (IBC) that will or will not benefit from adjuvant systemic treatment. We studied the laboratory-specific grading variation using nationwide real-life data to create insight and awareness in grading variation. Synoptic pathology reports of all IBC resection-specimens, obtained between 2013 and 2016, were retrieved from the nationwide Dutch Pathology Registry (PALGA). Absolute differences in laboratory-proportions of Grades I-III were compared to the national reference. Multivariable logistic regression provided laboratory-specific odds ratios (ORs) for high- vs. low-grade IBC. 33,792 IBC pathology reports of 33,043 patients from 39 laboratories were included, of which 28.1% were reported as Grade I (range between laboratories 16.3-43.3%), 47.6% as Grade II (38.4-57.8%), and 24.3% as Grade III (15.5-34.3%). Based on national guidelines, the indication for adjuvant chemotherapy was dependent on histologic grade in 29.9% of patients. After case-mix correction, 20 laboratories (51.3%) showed a significantly deviant OR. Significant grading differences were also observed among pathologists within laboratories. In this cohort of 33,043 breast cancer patients, we observed substantial inter- and intra-laboratory variation in histologic grading. It can be anticipated that this has influenced outcome including exposure to unnecessary toxicity, since choice of adjuvant chemotherapy was dependent on grade in nearly a third of patients. Better standardization and training seems warranted.
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Affiliation(s)
| | - Paul J. van Diest
- Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Stefan M. Willems
- Department of PathologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Elsken van der Wall
- Department of Medical OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Lucy I. H. Overbeek
- Foundation PALGA (the nationwide network and registry of histo‐ and cytopathology in The Netherlands)HoutenThe Netherlands
| | - Ivette A. G. Deckers
- Foundation PALGA (the nationwide network and registry of histo‐ and cytopathology in The Netherlands)HoutenThe Netherlands
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13
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99mTc-rituximab as a tracer for sentinel lymph node biopsy in breast cancer patients: a single-center analysis. Breast Cancer Res Treat 2017; 168:365-370. [DOI: 10.1007/s10549-017-4591-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 01/06/2023]
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14
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Saito M, Goto A, Abe N, Saito K, Maeda D, Ohtake T, Murakami Y, Takenoshita S. Decreased expression of CADM1 and CADM4 are associated with advanced stage breast cancer. Oncol Lett 2017; 15:2401-2406. [PMID: 29434950 DOI: 10.3892/ol.2017.7536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/23/2017] [Indexed: 11/06/2022] Open
Abstract
Cell adhesion molecule (CADM) genes encode immunoglobulin superfamily molecules, which are involved in cell-cell adhesion in a number of human epithelia. Through the maintenance of epithelia, CADM genes protect against malignant conversion and metastasis. Whilst numerous in vitro studies have investigated the molecular characteristics of CADM1 and CADM4 and in vivo studies have investigated CADM1 and CADM4 expression in a number of tumor types, the roles of CADM1 and CADM4 have yet to be elucidated. Therefore, in the present study, CADM1 and CADM4 expression levels were evaluated using immunohistochemistry staining in 208 patients with breast cancer and compared with clinicopathological factors. CADM1 and CADM4 expression levels were negative in 160 (76.9%) and 166 (79.8%) of the 208 cases, respectively. The lack of expression in these cases was associated with advanced tumor stage, suggesting that inactivation of CADM1 and CADM4 promotes breast cancer development. The prognostic role of CADM1 and CADM4 in breast cancer was also evaluated and the expression of CADM1 and CADM4 were not associated with cancer-specific survival or overall survival rate in the cohort of patients in the present study. Whilst these results suggested that CADM1 and CADM4 possess tumor suppressive roles, further functional experiments are required to address the important mechanisms involving CADM1 and CADM4.
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Affiliation(s)
- Motonobu Saito
- Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.,Division of Genome Biology, National Cancer Center Research Institute, Tokyo 104-0045, Japan
| | - Akiteru Goto
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Noriko Abe
- Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Katsuharu Saito
- Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Daichi Maeda
- Department of Cellular and Organ Pathology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Tohru Ohtake
- Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yoshinori Murakami
- Division of Molecular Pathology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
| | - Seiichi Takenoshita
- Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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15
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Pathobiology of HER 2 positive small invasive (T1a,b) breast cancer: “A wolf in sheep’s clothing”. Pathol Res Pract 2017; 213:1510-1514. [DOI: 10.1016/j.prp.2017.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/18/2017] [Accepted: 09/27/2017] [Indexed: 12/26/2022]
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16
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Daly B, Olopade OI, Hou N, Yao K, Winchester DJ, Huo D. Evaluation of the Quality of Adjuvant Endocrine Therapy Delivery for Breast Cancer Care in the United States. JAMA Oncol 2017; 3:928-935. [PMID: 28152150 DOI: 10.1001/jamaoncol.2016.6380] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Randomized trials in breast cancer have demonstrated the clinical benefits of adjuvant endocrine therapy (AET) in preventing recurrence and death. The examination of concordance with AET guidelines at a national level as a measure of quality of care is important. Objective To investigate temporal trends and factors related to receipt of AET for breast cancer. Design, Setting, and Participants This retrospective cohort study included 981 729 women with breast cancer in the National Cancer Database from January 1, 2004, to December 31, 2013. Women with stages I to III breast cancer who received all or part of their treatment at the reporting institution were included in the analysis. Main Outcomes and Measures Temporal changes in AET receipt (estimating the annual percentage change) and AET practice patterns (using logistic regression) and the effect of AET guideline concordance on survival of women with hormone receptor-positive (HR+) breast cancer (using the multivariable Cox proportional hazards model). Results Of the 981 729 eligible patients (mean [SD] age, 60.8 [13.3] years), 818 435 had HR+ and 163 294 had HR-negative (HR-) cancer. Among the patients with HR+ cancer, receipt of AET increased over time, from 69.8% in 2004 to 82.4% in 2013. Among patients with HR- cancer, receipt decreased from 5.2% in 2004 to 3.4% in 2013. Hospital-level adherence (≥80% of patients with HR+ cancer received AET) increased from 40.2% in 2004 to 69.2% in 2013. Receipt of AET varied significantly by age (lower in patients ≥80 years), race (lower in African American and Hispanic participants), geographic location (lower in West South Central, Mountain, and Pacific census regions), and receptor status (lower in patients with estrogen receptor-negative and progesterone receptor-positive cancer). Surgery and radiotherapy were the factors most significantly associated with appropriate AET receipt (only 45.0% in patients who received lumpectomy without radiotherapy). Receipt of AET was associated with a 29% relative risk reduction in mortality. Based on this effectiveness estimate, if all patients with HR+ cancer received AET, approximately 14 630 lives would have been saved over 10 years. Conclusions and Relevance From 2004 to 2013, underuse and misuse of AET have decreased for patients with breast cancer, but optimal use has not been achieved, and significant variation in care remains. The involvement of surgery and radiotherapy were among the most significant factors associated with optimal use, which underscores the benefits of team-based care to support guideline-concordant therapy.
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Affiliation(s)
- Bobby Daly
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Ningqi Hou
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Katharine Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | - David J Winchester
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
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17
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Shen SC, Ueng SH, Yang CK, Yu CC, Lo YF, Chang HK, Lin YC, Chen SC. Impact of Detection Method and Accompanying Ductal Carcinoma in Situ on Prognosis of T1a,bN0 Breast Cancer. J Cancer 2017; 8:2328-2335. [PMID: 28819437 PMCID: PMC5560152 DOI: 10.7150/jca.19293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/01/2017] [Indexed: 11/05/2022] Open
Abstract
Background: T1a,bN0 breast cancer is not easily detected. Before mammography became widespread, most cases were discovered only after the development of symptoms. The presence of ductal carcinoma in situ (DCIS) affects the detectability of associated invasive cancer; however, the prognostic value of concomitant DCIS is controversial. This study compared the characteristics of screening-detected and symptom-detected T1a,bN0 breast cancer, and investigated the impact of accompanying DCIS on detection and prognosis. Patients and Methods: Data were collected from a single hospital between 2000 and 2009. Of 5,690 primary breast cancers patients, 438 met the criteria for T1a,bN0M0. Logistic regression models were used to identify prognostic indicators and their association with the detection method. Survival analyses were performed to estimate distant relapse-free survival (DRFS) and breast cancer-specific survival (BCSS). Results: Tumors in 79 and 359 patients were detected by screening and development of symptoms, respectively. Symptomatic cancer patients were younger, more likely to receive a mastectomy, and had larger accompanying DCIS lesions; their 10-year DRFS rates were worse than those of patients with screening-detected tumors (91.1% vs. 100% respectively, p=0.049). Patients with large accompanying DCIS (≥2 cm) had markedly worse 10-year DRFS (77.1% vs. 97.4%, p<0.001) and BCSS (94.3% vs. 98.9%, p<0.001). Conclusion: T1a,bN0 breast cancers detected owing to symptoms are more likely to have larger accompanying DCIS. T1a,bN0 patients with large accompanying DCIS have worse DRFS and BCSS. It is important to consider associated DCIS size when evaluating prognosis in T1a,bN0 breast cancer patients.
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Affiliation(s)
- Shih-Che Shen
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Chan-Keng Yang
- Department of Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Chi-Chang Yu
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Yung-Feng Lo
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Hsien-Kun Chang
- Department of Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Yung-Chang Lin
- Department of Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Shin-Cheh Chen
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
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18
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Management of small T1a/b breast cancer by tumor subtype. Breast Cancer Res Treat 2017; 163:111-118. [DOI: 10.1007/s10549-017-4168-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/16/2017] [Indexed: 12/22/2022]
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19
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Dalenc F, Penault-Llorca F, Cohen M, Houvenaeghel G, Piat JM, Liegeois P, Puyuelo L, Suchaud JP, Zouai M, Lacroix-Triki M, Radosevic-Robin N, Benkanoun C, Attar-Rabia H, Chauvet MP, Gligorov J, Belkacemi Y. Daily Practice Management of pT1a-b pN0 Breast Carcinoma: A Prospective French ODISSEE Cohort Study. Clin Breast Cancer 2016; 17:107-116. [PMID: 27856201 DOI: 10.1016/j.clbc.2016.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/29/2016] [Accepted: 08/20/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most breast cancer (BC) tumors ≤10 mm have an excellent prognosis. The subgroups with a higher risk for distant recurrence requiring adjuvant systemic therapy are not precisely defined in current international guidelines. PATIENTS AND METHODS The OBSERVATOIRE DES PETITS CANCERS DU SEIN HER2 +/- (ODISSEE) study was a prospective, multicenter, cohort study that aimed to describe the daily adjuvant management and outcome of 616 patients with unifocal, invasive pT1a-b pN0 nonmetastatic BC who underwent surgery. RESULTS At the time of diagnosis, the median age of patients was 61 years. Tumor was detected on imaging or during a screening program in 397 patients (64.6%). Most patients (96%) underwent conservative surgery with sentinel node biopsy (89%), completed with axillary lymph node dissection in 15%. At inclusion, 82% of tumors were pT1b, 73% were pN0 (i-), 53% were Scarff-Bloom-Richardson Grade I, 91% were estrogen receptor (ER)-positive, 5% overexpressed/amplified HER2, and 5% were triple negative (TNBC). Adjuvant treatments were radiotherapy (95%), hormone therapy (82%), chemotherapy (7%), and trastuzumab (3.5%). In patients with TNBC and HER2-positive BC, chemotherapy and trastuzumab (if needed) were administered in 45% and 68%, respectively. After 5 years of follow-up, 7 patients had contralateral BC, 7 had locoregional recurrence, and 1 had distant metastasis. At 5 years, overall survival, disease-free survival, and recurrence-free survival were: 98.4% (96.9%-99.1%), 94.7% (92.4%-96.3%), and 97.1% (95.2%-98.2%), respectively. CONCLUSION This prospective cohort study showed that in France, the routine practice in pT1a-b pN0 breast cancers follows international standard guidelines for practice including conservative surgery followed by radiotherapy and endocrine therapy for ER-positive patients. Adjuvant chemotherapy with or without trastuzumab was used but their benefit in breast cancer of ≤10 mm remains controversial.
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Affiliation(s)
- Florence Dalenc
- Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse (UICT)-Oncopole, Department of Medical Oncology and Inserm UMR 1037, Team "Cholesterol Metabolism and Therapeutic Innovations", Cancer Research Center, Toulouse, France
| | | | - Monique Cohen
- Department of Surgery, Private Institute, Aubagne, France
| | | | | | | | - Laurent Puyuelo
- Department of Breast and Gynecologic Surgery, Union Clinic, Saint Jean, France
| | | | - Mohammed Zouai
- Department of Radiotherapy, Marie Curie Institute, Valence, France
| | - Magali Lacroix-Triki
- Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse (UICT)-Oncopole, Department of Medical Oncology and Inserm UMR 1037, Team "Cholesterol Metabolism and Therapeutic Innovations", Cancer Research Center, Toulouse, France
| | | | | | | | - Marie-Pierre Chauvet
- Department of Breast Surgery, Oscar Lambret Anti-Cancer Center-UNICANCER, Lille, France
| | - Joseph Gligorov
- Assistance Publique Hôpitaux de Paris (AP-HP), Department of Medical Oncology, Tenon Hospital, and University of Pierre et Marie Curie (UPMC), Paris
| | - Yazid Belkacemi
- Assistance Publique Hôpitaux de Paris (AP-HP), Department of Radiation Oncology and Henri Mondor Breast Center, INSERM U955 E07, and University of Paris-Est Créteil (UPEC), France.
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Fu SW, Kirolikar SP, Ginsburg E, Tan X, Schwartz A, Simmens SJ, Man YG, Pinzone JJ, Teal C, Awate S, Vonderhaar BK, Berg PE. Beta protein 1 homeoprotein induces cell growth and estrogen-independent tumorigenesis by binding to the estrogen receptor in breast cancer. Oncotarget 2016; 7:53204-53216. [PMID: 27449292 PMCID: PMC5288179 DOI: 10.18632/oncotarget.10633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 07/06/2016] [Indexed: 12/18/2022] Open
Abstract
Expression of Beta Protein 1 (BP1), a homeotic transcription factor, increases during breast cancer progression and may be associated with tumor aggressiveness. In our present work, we investigate the influence of BP1 on breast tumor formation and size in vitro and in vivo. Cells overexpressing BP1 showed higher viability when grown in the absence of serum (p < 0.05), greater invasive potential (p < 0.05) and formed larger colonies (p < 0.004) compared with the controls. To determine the influence of BP1 overexpression on tumor characteristics, MCF-7 cells transfected with either empty vector (V1) or overexpressor plasmids (O2 and O4) were injected into the fat pads of athymic nude mice. Tumors grew larger in mice receiving O2 or O4 cells than in mice receiving V1 cells. Moreover, BP1 mRNA expression levels were positively correlated with tumor size in patients (p = 0.01). Interestingly, 20% of mice injected with O2 or O4 cells developed tumors in the absence of estrogen, while no mice receiving V1 cells developed tumors. Several mechanisms of estrogen independent tumor formation related to BP1 were established. These data are consistent with the fact that expression of breast cancer anti-estrogen resistance 1 (BCAR1) was increased in O2 compared to V1 cells (p < 0.01). Importantly, O2 cells exhibited increased proliferation when treated with tamoxifen, while V1 cells showed growth inhibition. Overall, BP1 overexpresssion in MCF-7 breast cancer cells leads to increased cell growth, estrogen-independent tumor formation, and increased proliferation. These findings suggest that BP1 may be an important biomarker and therapeutic target in ER positive breast cancer.
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Affiliation(s)
- Sidney W Fu
- Department of Medicine, Division of Genomic Medicine, George Washington University, Washington, DC 20037, USA
| | - Saurabh P Kirolikar
- Department of Biochemistry and Molecular Medicine, George Washington University, Washington, DC 20037, USA
| | - Erika Ginsburg
- Mammary Biology and Tumorigenesis Laboratory, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Xiaohui Tan
- Department of Medicine, Division of Genomic Medicine, George Washington University, Washington, DC 20037, USA
| | - Arnold Schwartz
- Department of Pathology, George Washington University Medical Center, Washington, DC 20037, USA
| | - Samuel J Simmens
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC 20037, USA
| | - Yan-Gao Man
- Department of Gynecologic and Breast Pathology, Armed Forces Institute of Pathology, Washington, DC 20306, USA
| | - Joseph J Pinzone
- David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Christine Teal
- Department of Surgery, George Washington University, Washington, DC 20037, USA
| | - Sanket Awate
- Department of Biochemistry and Molecular Medicine, George Washington University, Washington, DC 20037, USA
| | - Barbara K Vonderhaar
- Mammary Biology and Tumorigenesis Laboratory, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Patricia E Berg
- Department of Biochemistry and Molecular Medicine, George Washington University, Washington, DC 20037, USA
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Navarro-Rodríguez E, Díaz-Jiménez N, Ruiz-Rabelo J, Gómez-Luque I, Bascuñana-Estudillo G, Rioja-Torres P, Torres-Lorite M, Ciria-Bru R, Álvarez-Benito M, Briceño-Delgado J. Factors Associated With Disease Recurrence in Breast Cancer Patients With Negative Sentinel Lymph Node Biopsy. Clin Breast Cancer 2016; 16:e181-e186. [PMID: 27498119 DOI: 10.1016/j.clbc.2016.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/21/2016] [Accepted: 06/17/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The objective of our study was to assess recurrence after negative sentinel lymph node biopsy (SLNB) and to determine the risk factors related to local and distant recurrence in this group of patients. MATERIALS AND METHODS We conducted a prospective observational study from 2006 to 2011. It included 607 patients with early-stage breast cancer and negative SLNB with a 5-year follow-up period. RESULTS The disease-free survival rate was 98.5% and 96.5% at 2 and 5 years, respectively. Multivariate analysis identified the following prognostic factors for disease recurrence: tumor necrosis (hazard ratio [HR], 4.89; 95% confidence interval [CI], 1.61-14.89; P = .005), lymphovascular invasion (HR, 3.46; 95% CI, 1.14-10.55; P = .029), T2 tumor size (HR, 4.35; 95% CI, 1.40-13.52; P = .011), and moderate to severe lymphoplasmacytic stromal infiltration (HR, 3.06; 95% CI, 1.18-7.96; P = .022). CONCLUSION Recurrence in patients with negative SLNB was satisfactorily low. Nevertheless, determining the prognostic factors related to a greater recurrence rate could help identify high-risk patients and influence systemic adjuvant therapy.
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Affiliation(s)
| | | | - Juan Ruiz-Rabelo
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | - Irene Gómez-Luque
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | | | | | | | - Rubén Ciria-Bru
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
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Crochet P, Molinari N, Darmon JC, Cutuli B, Serin D. Follow-up of Patients Treated for pT1aN0M0 Breast Cancer: 10-year Survival and Prognostic Factors. Breast J 2016; 22:363-5. [PMID: 26932725 DOI: 10.1111/tbj.12587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Patrice Crochet
- Department of Obstetrics and Gynecology, La Conception Hospital, Aix Marseille Université, France
| | - Nicolas Molinari
- IMAG, Department of Biostatistics, University of Montpellier, CHU Montpellier, Montpellier, France
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Spielmann M, Dalenc F, Pointreau Y, Azria D, Classe JM, Dromain C, Facchini T, Gonçalves A, Liegeois P, Namer M, Pivot X, Vincent-Salomon A. [Perception of pT1a,b pN0 breast tumor prognosis by the French oncology community: Results of the EURISTIC national survey]. Bull Cancer 2015; 103:154-63. [PMID: 26652718 DOI: 10.1016/j.bulcan.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 10/05/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
The prognosis of infracentimetric breast cancers (BC) is heterogeneous. The EURISTIC survey describes how French oncology specialists perceive the prognosis of pT1a,b pN0 BCs. A self-administered questionnaire has been sent to over 2000 French BC specialists. Six hundred and sixty-three physicians responded. Fifty-eight percent do not consider tumor size as a key prognostic criterion. They consider that the cutoff for poor prognosis is 22mm, 10mm and 7mm for hormone receptors (HRs)+, HER2+ and triple-negative (TN) tumors respectively. Eighty-three percent of respondents consider that a HR+ pT1a,b tumor has a good prognosis (21% and 8% for HER2+ and TN respectively). Factors perceived as most detrimental are: HER2 overexpression (29% of respondents); HR- (20%); high grade (20%); TN status (14%); high KI67 (5%); presence of lymphovascular invasion (3%); young age (2%) and high mitotic index (1%). For French specialists, immunohistochemical characteristics, in particular hormone and HER2 status, are strong prognostic factors in BCs below 1cm.
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Affiliation(s)
- Marc Spielmann
- Institut Gustave-Roussy, department of medical oncology, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - Florence Dalenc
- Institut Claudius-Regaud, department of medical oncology, 20-24, rue du Pont-Saint-Pierre, 31052 Toulouse, France
| | - Yoann Pointreau
- Centre Jean-Bernard, clinique Victor-Hugo, department of radiation oncology, 18, rue Victor-Hugo, 72000 Le Mans, France; Centre hospitalier régional universitaire, department of radiation oncology, 37044 Tours cedex 9, France
| | - David Azria
- ICM centre Val-d'Aurelle, department of radiation oncology, 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - Jean-Marc Classe
- Site hospitalier Nord, centre René-Gauducheau, department of surgery, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France
| | - Clarisse Dromain
- Institut Gustave-Roussy, department of medical oncology, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - Thomas Facchini
- Clinique Courlancy, department of medical oncology, 38, rue de Courlancy, 51100 Reims, France
| | - Anthony Gonçalves
- Institut Paoli-Calmettes, department of medical oncology, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Philippe Liegeois
- Institut du sein de l'Orangerie, department of surgery, 11, rue Silbermann, 67000 Strasbourg, France
| | - Moïse Namer
- Clinique Saint-Georges, department of medical oncology, 2, avenue de Rimiez, 06100 Nice cedex 2, France
| | - Xavier Pivot
- Centre hospitalier universitaire, department of medical oncology, 2, place Saint-Jacques, 25000 Besançon, France
| | - Anne Vincent-Salomon
- Institut Curie, department of pathology, 26, rue d'Ulm, 75248 Paris cedex 05, France
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Morris GJ, Dawood S, Cortes J, Ward JH, Vaklavas C, Forero A, Ward S, Toppmeyer D. Sub-centimeter HER2-Positive Breast Cancer: How Small Is Too Small to Treat? Semin Oncol 2015; 42:e67-79. [PMID: 26320071 DOI: 10.1053/j.seminoncol.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Small breast cancers: When and how to treat. Cancer Treat Rev 2014; 40:1129-36. [DOI: 10.1016/j.ctrv.2014.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/23/2014] [Accepted: 09/25/2014] [Indexed: 12/20/2022]
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Endocrine sensitivity is decisive for patient outcome in small node-negative breast cancers (BC) (pT1a,b) - results from the Munich Cancer Registry. Breast 2014; 24:24-31. [PMID: 25543874 DOI: 10.1016/j.breast.2014.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/25/2014] [Accepted: 10/24/2014] [Indexed: 11/23/2022] Open
Abstract
PURPOSE In clinical routine, adjuvant systemic therapy in small node-negative (N0) BC is controversial, in particular in HER2-positive disease. We aimed to evaluate outcome of consecutive patients with small N0 BC in a population-based cancer registry and thus consequently substantiate indications for chemotherapy in those patient subgroups at increased relapse risk or poor survival. METHODS From 2002 to 2009 (median follow-up 6 years), 9707 primary breast cancer patients with N0 tumors <2 cm (pTis, pT1N0M0) were reported to the Munich Cancer Registry. Patients with pTis tumors (n = 1870) served as internal comparator. Time to progression, observed (OS) and relative survival rates (Kaplan-Meier estimates) are presented. Cox regression analysis was used to assess the influence of tumor size, age, HR-, and HER2-status. RESULTS 10-year-OS for pTis was 94.0%. In HR-positive tumors it was 91.9% in pT1a, 90.6% in pT1b, and 86.8% in pT1c. In HR-negative tumors, rates were 91.7%, 86.8%, and 86.8%, respectively. In HER2-positive tumors it was 81.2%, 88.1%, and 86.7%, in HER2-negative 93.1%, 90.6%, and 86.0%, respectively. In the multivariate model, age, tumor size, and HR-status showed a significant impact on OS (HRneg. vs. HRpos.: hazard ratio 1.50 (95% CI; 1.12-1.99), while HER2-status was not an independent prognostic factor. CONCLUSION Prognosis of N0 tumors <1 cm is excellent, especially if they are HR-positive, even in HER2-positive cases. Weighing potential benefits vs. side-effects, there seems to be no need for chemotherapy in tumors <0.5 cm. In pT1b chemotherapy may be considered, if tumors are triple negative or HER2-positive and HR-negative. In pT1c guideline-based adjuvant therapy using all therapeutic options seems to be warranted.
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Sonnenblick A, Fumagalli D, Azim HA, Sotiriou C, Piccart M. New strategies in breast cancer: the significance of molecular subtypes in systemic adjuvant treatment for small T1a,bN0M0 tumors. Clin Cancer Res 2014; 20:6242-6. [PMID: 25336696 DOI: 10.1158/1078-0432.ccr-14-1086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Awareness of breast cancer heterogeneity has strikingly increased in the past decade in parallel with the development of high-throughput molecular tests. Beyond the clear usefulness of antiestrogen treatment in luminal tumors and trastuzumab in HER2-positive tumors, breast cancer subtypes may have additional clinical and predictive roles that can be relevant to clinical practice. In this article, we discuss the significance of molecular subtypes in the systemic treatment of early-stage breast tumors smaller than 1 cm (T1a,bN0M0) and suggest new strategies for future treatment recommendations for these patients.
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Affiliation(s)
- Amir Sonnenblick
- BrEAST Data Center, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium. Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Debora Fumagalli
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Hatem A Azim
- BrEAST Data Center, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Martine Piccart
- BrEAST Data Center, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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Manfrin E, Remo A, Pancione M, Cannizzaro C, Falsirollo F, Pollini GP, Pellini F, Molino A, Brunelli M, Vendraminelli R, Ceccarelli M, Pagnotta SM, Simeone I, Bonetti F. Comparison between invasive breast cancer with extensive peritumoral vascular invasion and inflammatory breast carcinoma: a clinicopathologic study of 161 cases. Am J Clin Pathol 2014; 142:299-306. [PMID: 25125618 DOI: 10.1309/ajcpoxkx67kraovm] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Extensive peritumoral neoplastic lymphovascular invasion (ePVI) is a marker of aggressiveness in invasive breast carcinoma (BC). METHODS We explored the impact of ePVI on different BC subtypes. In a total of 2,116 BCs, 91 ePVI-BCs, 70 inflammatory breast carcinomas (IBCs), and 114 casual BCs as a control group (CG-BC) were recruited. RESULTS Patients affected by ePVI-BC were younger, had larger tumors, higher histologic grade, elevated Ki-67 score, Her2/neu overexpressed, and more lymph node metastases compared with CG-BC (P < .001). Interestingly, only younger mean age at diagnosis differentiated patients with ePVI-BC from patients affected by IBC. ePVI-BC showed a clinical outcome intermediate between the prognoses of IBC and CG-BC. CONCLUSIONS Results suggest that ePVI-BC and IBC may share some pathologic processes, providing a novel perspective on the heterogeneity of BC. Epidemiologic data and molecular studies on gene expression features are needed to rationally classify these tumors into their identified subtypes.
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Affiliation(s)
- Erminia Manfrin
- Department of Pathology and Diagnosis, University of Verona, Verona, Italy
| | - Andrea Remo
- Department of Pathology, Mater Salutis Hospital, Legnago, Italy
| | - Massimo Pancione
- Department of Sciences and Technologies, University of Sannio, Avellino, Italy
| | - Claudia Cannizzaro
- Department of Pathology and Diagnosis, University of Verona, Verona, Italy
| | | | | | | | | | - Matteo Brunelli
- Department of Pathology and Diagnosis, University of Verona, Verona, Italy
| | | | - Michele Ceccarelli
- Department of Sciences and Technologies, University of Sannio, Avellino, Italy
- Bioinformatics Laboratory, BIOGEM, Ariano Irpino, Avellino, Italy
| | | | - Ines Simeone
- Bioinformatics Laboratory, BIOGEM, Ariano Irpino, Avellino, Italy
| | - Franco Bonetti
- Department of Pathology and Diagnosis, University of Verona, Verona, Italy
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Jaffer S, Bleiweiss IJ, Nayak A. Are cytokeratin-positive cells in sentinel lymph nodes of patients with invasive breast carcinomas up to 5 mm usually insignificant? Histopathology 2014; 66:283-8. [PMID: 25130504 DOI: 10.1111/his.12504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/12/2014] [Indexed: 11/26/2022]
Abstract
AIMS It is known that sentinel lymph nodes (SLN) may be falsely positive due to displaced epithelial cells, particularly in cases with an underlying intraductal papilloma. Given the low metastatic rate in pT1a carcinomas, we aimed to investigate the effect of this phenomenon on staging. METHODS AND RESULTS Using morphology and immunohistochemistry, we classified the epithelial cells in the SLN in 39 cases of pT1a carcinoma as positive for carcinoma in six, negative in 26 and undetermined in seven. Comparative morphology and immunohistochemistry (using oestrogen receptor, ER) showed complete concordance between the primary carcinoma and SLN in the positive cases, and discordance in the negative cases. The primary tumours in the negative cases were ER-positive except one, in contrast to the SLN cytokeratin-positive (CK(+) ) cells, which were ER-negative. The exception was a case with a Her2-positive primary, in which the SLN CK(+) cells did not stain for Her2. In these cases considered SLN-negative, either displacement (19 cases) or an intraductal papilloma (20 cases) was identified. Two cases showed displacement of benign and malignant cells in the biopsy. Seven cases were indeterminate due to the small number of SLN CK(+) cells, precluding comparison with the primary. CONCLUSION Given the low rate of metastases in pT1a carcinomas, the significance of SLN CK(+) cells should be resolved by comparative morphology and immunohistochemistry to prevent erroneous upstaging.
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30
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Clinicopathological features of early failure of neoadjuvant chemotherapy in locally advanced breast cancer. Cancer Chemother Pharmacol 2014; 74:521-9. [DOI: 10.1007/s00280-014-2542-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/11/2014] [Indexed: 01/19/2023]
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31
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The Levels of Ki-67 Positive are Positively Associated with Lymph Node Metastasis in Invasive Ductal Breast Cancer. Cell Biochem Biophys 2014; 70:1145-51. [DOI: 10.1007/s12013-014-0034-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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32
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Houvenaeghel G, Goncalves A, Classe JM, Garbay JR, Giard S, Charytensky H, Cohen M, Belichard C, Faure C, Uzan S, Hudry D, Azuar P, Villet R, Gimbergues P, Tunon de Lara C, Martino M, Lambaudie E, Coutant C, Dravet F, Chauvet MP, Chéreau Ewald E, Penault-Llorca F, Esterni B. Characteristics and clinical outcome of T1 breast cancer: a multicenter retrospective cohort study. Ann Oncol 2014; 25:623-628. [PMID: 24399079 PMCID: PMC4433506 DOI: 10.1093/annonc/mdt532] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A subgroup of T1N0M0 breast cancer (BC) carries a high potential of relapse, and thus may require adjuvant systemic therapy (AST). PATIENTS AND METHODS Retrospective analysis of all patients with T1 BC, who underwent surgery from January 1999 to December 2009 at 13 French sites. AST was not standardized. RESULTS Among 8100 women operated, 5423 had T1 tumors (708 T1a, 2208 T1b and 2508 T1c 11-15 mm). T1a differed significantly from T1b tumors with respect to several parameters (lower age, more frequent negative hormonal status and positive HER2 status, less frequent lymphovascular invasion), exhibiting a mix of favorable and poor prognosis factors. Overall survival was not different between T1a, b or c tumors but recurrence-free survival was significantly higher in T1b than in T1a tumors (P = 0.001). In multivariate analysis, tumor grade, hormone therapy and lymphovascular invasion were independent prognostic factors. CONCLUSION Relatively poor outcome of patients with T1a tumors might be explained by a high frequency of risk factors in this subgroup (frequent negative hormone receptors and HER2 overexpression) and by a less frequent administration of AST (endocrine treatment and chemotherapy). Tumor size might not be the main determinant of prognosis in T1 BC.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM.
| | - A Goncalves
- Department of Oncology, Institut Paoli Calmettes, Aix Marseille Université, Marseille
| | - J M Classe
- Department of Surgery, Institut René Gauducheau, Nantes
| | - J R Garbay
- Department of Surgery, Institut Gustave Roussy, Villejuif
| | - S Giard
- Department of Surgery, Centre Oscar Lambret, Lille
| | - H Charytensky
- Department of Surgery, Centre Claudius Regaud, Toulouse
| | - M Cohen
- Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM
| | - C Belichard
- Department of Surgery, Centre René Huguenin, Saint Cloud
| | - C Faure
- Department of Surgery, Centre Léon Bérard, Lyon
| | - S Uzan
- Department of Surgery, Hôpital Tenon, Paris
| | - D Hudry
- Department of Surgery, Centre Georges François Leclerc, Dijon
| | - P Azuar
- Department of Surgery, Hôpital de Grasse, Grasse
| | - R Villet
- Department of Surgery, Hôpital des Diaconnesses, Paris
| | - P Gimbergues
- Department of Surgery, Centre Jean Perrin, Clermont Ferrand
| | | | - M Martino
- Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM
| | - E Lambaudie
- Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM
| | - C Coutant
- Department of Surgery, Centre Georges François Leclerc, Dijon
| | - F Dravet
- Department of Surgery, Institut René Gauducheau, Nantes
| | - M P Chauvet
- Department of Surgery, Centre Oscar Lambret, Lille
| | - E Chéreau Ewald
- Department of Surgery, Institut Paoli Calmettes, Aix Marseille Université, Marseilleand CRCM; Department of Surgery, Hôpital Tenon, Paris
| | | | - B Esterni
- Biostatistic, Department of Surgery, Institut Paoli Calmettes, Marseilleand CRCM, France
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Petits cancers du sein surexprimant HER2 : quel pronostic et quel traitement adjuvant ? Bull Cancer 2013; 100:847-56. [DOI: 10.1684/bdc.2013.1799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rom J, Schumacher C, Gluz O, Höfler J, Eidt S, Domschke C, Marmé F, Nitz U, Sohn C, Schneeweiss A. Association of HER2 Overexpression and Prognosis in Small (T1N0) Primary Breast Cancers. Breast Care (Basel) 2013; 8:208-14. [PMID: 24415972 PMCID: PMC3728630 DOI: 10.1159/000352094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is some controversy regarding the precise role and need for adjuvant therapy in patients with pT1a/pT1bN0 breast cancer, although studies have indicated that a HER2-positive status is one of the most powerful poor prognostic factors. PATIENTS AND METHODS We retrospectively evaluated disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) among 960 patients diagnosed between 2000 and 2008 with T1N0 primary breast cancer treated at 3 German centers, and determined prognostic risk factors. Univariate analysis was used to determine associations with potential risk factors. RESULTS With a median follow-up of 23 months, DFS was 94.8%, DDFS 96.3%, and OS 97.5%. Risk factors for decreased 1-year DFS were: peritumoral lymphatic invasion (L1) (p = 0.031), negative hormone receptor status (p = 0.003), non-use of hormonal therapy (p = 0.001), and a positive HER2 status (p = 0.003). Amongst the HER2-positive patients only 2.7% (n = 1/37) of those treated with trastuzumab had a DFS event compared with 20% (n = 10/50) without trastuzumab. CONCLUSION Patients with HER2-positive T1 breast cancer should be considered for inclusion in prospective trials of trastuzumab in combination with chemotherapy to determine the risk-to-benefit ratio and association with other prognostic factors.
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Affiliation(s)
- Joachim Rom
- Universitäts-Frauenklinik, Universität Heidelberg, Deutschland
| | | | - Oleg Gluz
- Brustzentrum, Bethesda Krankenhaus, Wuppertal, Deutschland
| | | | - Sebastian Eidt
- Institut für Pathologie, St. Elisabeth Krankenhaus, Köln, Deutschland
| | | | - Frederik Marmé
- Universitäts-Frauenklinik, Universität Heidelberg, Deutschland
- National Centrum für Tumorerkrankungen, Universität Heidelberg, Deutschland
| | - Ulrike Nitz
- Brustzentrum, Bethesda Krankenhaus, Wuppertal, Deutschland
| | - Christof Sohn
- Universitäts-Frauenklinik, Universität Heidelberg, Deutschland
| | - Andreas Schneeweiss
- Universitäts-Frauenklinik, Universität Heidelberg, Deutschland
- National Centrum für Tumorerkrankungen, Universität Heidelberg, Deutschland
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Hama Y, Nakagawa K. Early distant relapse in early stage triple-negative breast cancer: usefulness of FDG-PET for diagnosis of distant metastases. Breast Cancer 2013; 20:191-3. [PMID: 20082162 DOI: 10.1007/s12282-009-0195-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 12/21/2009] [Indexed: 02/05/2023]
Abstract
Triple-negative breast cancer is extremely aggressive and more likely to metastasize than other subtypes of breast cancer. Better understanding of the distinct patterns of relapse and early detection will help identify patients who need aggressive treatment. Here we report a case of early stage triple-negative breast cancer with no lymph node metastasis at the time of breast-conserving surgery in a 46-year-old woman. She developed distant metastases immediately after completing adjuvant chemotherapy following surgery, which were detected by an [18F] 2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan. Although routine use of FDG-PET is not recommended for early stage breast cancer, FDG-PET might be useful for the early detection of distant metastasis among patients with triple-negative breast cancer.
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Affiliation(s)
- Yukihiro Hama
- Department of Radiology, Tokyo Edogawa Cancer Center, Edogawa Hospital, 2-24-18 Higashikoiwa, Edogawaku, Tokyo, 133-0052, Japan.
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36
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Rodrigues M, Peron J, Frénel JS, Vano YA, Wassermann J, Debled M, Picaud F, Albiges L, Vincent-Salomon A, Cottu P. Benefit of adjuvant trastuzumab-based chemotherapy in T1ab node-negative HER2-overexpressing breast carcinomas: a multicenter retrospective series. Ann Oncol 2013; 24:916-24. [DOI: 10.1093/annonc/mds536] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Migdady Y, Sakr BJ, Sikov WM, Olszewski AJ. Adjuvant chemotherapy in T1a/bN0 HER2-positive or triple-negative breast cancers: application and outcomes. Breast 2013; 22:793-8. [PMID: 23489757 DOI: 10.1016/j.breast.2013.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 11/16/2012] [Accepted: 02/11/2013] [Indexed: 10/27/2022] Open
Abstract
We assessed practice patterns and the impact of systemic adjuvant therapy on human epidermal growth factor receptor 2 (HER2)-positive or triple-negative, node-negative breast cancers up to 10 mm in size. Records of 161 patients identified among 1415 cases diagnosed in our institutions between 2000 and 2010 were assessed for factors associated with recommendation for chemotherapy and survival outcomes. Adjuvant chemotherapy was recommended in 53% of patients, more commonly in patients with younger age, stage T1b, high grade, HER2+/ER- status and diagnosis after 2006. With a median follow-up of 54 months, the 5-year cumulative incidence of recurrence was 5.3% and overall survival was 93.2%. Age less than 40 and presence of lymphovascular invasion (LVI) were associated with higher risk of recurrence. In a univariate analysis administration of adjuvant chemotherapy was not associated with a significantly better recurrence rate (P = 0.33).
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Affiliation(s)
- Yazan Migdady
- The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA; The Cancer Center at Memorial Hospital of Rhode Island, 111 Brewster St., Pawtucket, RI 02860, USA
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38
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Olszewski AJ, Migdady Y, Boolbol SK, Klein P, Boachie-Adjei K, Sakr BJ, Sikov W, Shao T. Effects of adjuvant chemotherapy in HER2-positive or triple-negative pT1ab breast cancers: a multi-institutional retrospective study. Breast Cancer Res Treat 2013; 138:215-23. [DOI: 10.1007/s10549-013-2423-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 01/17/2013] [Indexed: 11/28/2022]
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39
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Reduction in rate of node metastases with breast screening: consistency of association with tumor size. Breast Cancer Res Treat 2012; 137:653-63. [DOI: 10.1007/s10549-012-2384-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
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40
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Maynadier M, Chambon M, Basile I, Gleizes M, Nirde P, Gary-Bobo M, Garcia M. Estrogens promote cell-cell adhesion of normal and malignant mammary cells through increased desmosome formation. Mol Cell Endocrinol 2012; 364:126-33. [PMID: 22963885 DOI: 10.1016/j.mce.2012.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 08/24/2012] [Accepted: 08/27/2012] [Indexed: 11/26/2022]
Abstract
The association of estrogen receptor alpha (ERα) expression with differentiated breast tumors presenting a lower metastasis risk could be explained by the estrogen modulation of cell adhesion, motility and invasiveness. Since desmosomes play a crucial role in cell-cell adhesion and may interfere in tumor progression, we studied their regulation by estrogens in human breast cancer and normal mammary cells. Estrogens increased the formation of desmosomes in normal and malignant cells. Furthermore, four desmosomal proteins (desmocollin, γ-catenin, plakophilin and desmoplakin) appeared significantly up-regulated by estrogens in three ERα-expressing cancer cell lines and this effect was reversed by a pure antiestrogen. Finally, silencing of ERα or desmoplakin expression by specific siRNA revealed that estrogen-modulated desmosomal proteins are essential for the estrogenic control of intercellular adhesion. This estrogen modulation of desmosome formation could contribute to the lower invasiveness of ERα-positive tumors and to the integrity of epithelial layers in estrogen target tissues.
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Affiliation(s)
- Marie Maynadier
- Institut des Biomolécules Max Mousseron, UMR 5247 CNRS, Université Montpellier 1, Université Montpellier 2, Montpellier, France
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41
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Koelwyn GJ, Khouri M, Mackey JR, Douglas PS, Jones LW. Running on empty: cardiovascular reserve capacity and late effects of therapy in cancer survivorship. J Clin Oncol 2012; 30:4458-61. [PMID: 23045598 DOI: 10.1200/jco.2012.44.0891] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Graeme J Koelwyn
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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42
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van Wely B, van den Wildenberg F, Gobardhan P, van Dalen T, Borel Rinkes I, Theunissen E, Wijsman J, Ernst M, van der Pol C, Madsen E, Vles W, Wauters C, de Wilt J, Strobbe L. “Axillary recurrences after sentinel lymph node biopsy: A multicentre analysis and follow-up of sentinel lymph node negative breast cancer patients”. Eur J Surg Oncol 2012; 38:925-31. [DOI: 10.1016/j.ejso.2012.04.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/15/2012] [Accepted: 04/29/2012] [Indexed: 11/29/2022] Open
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43
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Near-Diploid Hyperploidy in Early Breast Cancer (T1a,b) is Associated with Higher Risk of Lymph Node Involvement. Pathol Oncol Res 2012; 19:71-7. [DOI: 10.1007/s12253-012-9559-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
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44
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Kurebayashi J, Kanomata N, Shimo T, Yamashita T, Aogi K, Nishimura R, Shimizu C, Tsuda H, Moriya T, Sonoo H. Marked lymphovascular invasion, progesterone receptor negativity, and high Ki67 labeling index predict poor outcome in breast cancer patients treated with endocrine therapy alone. Breast Cancer 2012; 21:214-22. [DOI: 10.1007/s12282-012-0380-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 05/17/2012] [Indexed: 01/03/2023]
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45
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Rakha EA, Morgan D, Macmillan D. The prognostic significance of early stage lymph node positivity in operable invasive breast carcinoma: number or stage. J Clin Pathol 2012; 65:624-30. [PMID: 22523340 DOI: 10.1136/jclinpath-2012-200755] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM The earlier detection of breast cancer through mammographic screening has resulted in a shift in stage distribution with patients who are node-positive tending to present with a lower number of positive lymph nodes (LN). This study aims to assess the prognostic value of absolute number of positive nodes in the pN1 TNM stage (1-3 positive LN) and whether the prognostic value of the number of nodes in this clinically important stage justifies its consideration in management decisions. METHODS This study is based on a large and well-characterised consecutive series of operable breast cancer (3491 cases), treated according to standard protocols in a single institution, with a long-term follow-up. RESULTS LN stages and the absolute number of LN are associated with both breast cancer specific survival (BCSS) and distant metastasis free survival (DMFS). In the pN1 stage, patients with three positive LN (14% of pN1) show shorter BCSS (HR=1.9, (95% CI 1.3 to 2.6)) and shorter DMFS (HR=2.2, (95% CI 1.6 to 2.9)) when compared with one and/or two positive nodes. This effect is noted in the whole series as well as in different subgroups based on tumour size (pT1c and pT2), histological grade (grade 2 and 3), vascular invasion and oestrogen receptor status (both positive and negative). Multivariable analyses showed that three positive LN, compared with one and two positive LN, are an independent predictor of shorter BCSS and DMFS. CONCLUSION The number of LN in the pN1 stage yielded potentially informative risk assignments with three positive LN providing an independent predictor of poorer outcome.
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Affiliation(s)
- Emad A Rakha
- Department of Histopathology, The University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK.
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46
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Petrelli F, Barni S. Role of HER2-neu as a prognostic factor for survival and relapse in pT1a-bN0M0 breast cancer: a systematic review of the literature with a pooled-analysis. Med Oncol 2012; 29:2586-93. [PMID: 22415399 DOI: 10.1007/s12032-012-0201-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 02/23/2012] [Indexed: 01/03/2023]
Abstract
High levels of human epidermal growth receptor 2 (HER2) expression are associated with recurrence and death in breast cancer (BC) patients. We have performed a systematic review and meta-analysis in order to evaluate the prognosis for HER2+ pT1a-bN0M0 BC patients. A search of PubMed and Embase was performed. Studies were included if they reported hazard ratios (HRs) with a 95% confidence interval (CI) for multivariate analyses of relapse or survival in pT1a-bN0M0, HER2+ BC patients treated with surgery and chemotherapy and/or endocrine therapy, but not with trastuzumab. A total of 764 patients from seven studies were included in the meta-analysis. In the pooled analysis, HER2 had a detrimental effect on relapse-free (HR 4.68, 95% CI 3.05-7.18; p<0.00001) and distant relapse-free survival, with a HR of 5.6 (95% CI 2.65-11.85; p<0.00001). HER2+ status was also linked to increased risk of death (HR 3.4, 95% CI 0.86-13.41; p=0.08) and worst BC-specific survival (HR 2.61, 95% CI 1.51-4.51; p=0.0006), but these data were presented in few studies. HER2+ pT1a-bN0M0 BC is associated with a dismal prognosis. In these patients, HER2 has to be taken into account when deciding on adjuvant therapy, and trastuzumab should be considered.
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Affiliation(s)
- F Petrelli
- Medical Oncology Unit, Oncology Department, Azienda Ospedaliera Treviglio-Caravaggio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
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Krekel N, Zonderhuis B, Muller S, Bril H, van Slooten HJ, de Lange de Klerk E, van den Tol P, Meijer S. Excessive resections in breast-conserving surgery: a retrospective multicentre study. Breast J 2012; 17:602-9. [PMID: 22050281 DOI: 10.1111/j.1524-4741.2011.01198.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The main determinant of cosmetic outcomes following breast-conserving surgery (BCS) for breast cancer is the volume of resection. The importance of achieving optimal oncological control may lead to an unnecessarily large resection of breast tissue. The aim of this study is to evaluate excess resection volume in BCS for cancer by determining a calculated resection ratio (CRR). This retrospective study was conducted in four affiliated institutions and involved 726 consecutive patients with T1-T2 invasive breast cancer treated by BCS between January 2006 and 2009. The pathology reports were reviewed for tumor palpability, tumor size, surgical specimen size, and oncological margin status. The optimal resection volume (ORV) was defined as the spherical tumor volume with an added 1.0 cm margin of healthy breast tissue. The total resection volume (TRV) was defined as the ellipsoid volume of the surgical specimen. CRR was determined by dividing the TRV by the ORV. Of all tumors, 72% (525/726) were palpable, and 28% (201/726) were nonpalpable. The tumor stage was T1 in 492 patients (67.8%) and T2 in 234 patients (32.2%). The median CRR was 2.5 (0.01-42.93). Margin status was positive or focally positive in 153 patients (21.1%). Lower tumor stage was associated with a higher CRR (factor 0.61 [p < 0.0001] and a lower positive margin rate [p = 0.064]). Accordingly, the median CRR of the nonpalpable lesions was higher than that of the palpable lesions (3.1 and 2.2, respectively; p < 0.01), and the involved margin rate was lower (17.4% and 22.5%, respectively; p = 0.13). Of patients with a CRR >4.0, 10.7% still had tumor involved margins. This study clearly shows that BCS is associated with excessive resection of healthy breast tissue while clear margins are not assured. Surgical factors should be modified to improve surgical accuracy.
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Affiliation(s)
- Nicole Krekel
- Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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48
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Iturbe J, Zwenger A, Leone JP, Verdera PP, Vallejo C, Romero A, Perez J, Machiavelli M, Leone B. Treatment of early breast cancer, a long-term follow-up study: the GOCS experience. Breast J 2012; 17:630-7. [PMID: 22050282 DOI: 10.1111/j.1524-4741.2011.01157.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Most cases of breast cancer are diagnosed at early stage of disease; therefore, treatment is oriented to increase the disease-free interval (DFI) and overall survival (OS). The prognosis, in comparison with other malignancies, has improved in the last decades as a result of mammographic screening. The aim of the study was to report the incidence of local and distant recurrence, DFI and OS in patients (pts) with stage I and stage II breast cancer over a period of 26 years divided into three groups. From January 1978 to December 2004, 927 women with early breast cancer (EBC) were included, 350 were stage I and 577 Stage II (AJCC 2002). Patients were divided according to the year of diagnosis into three periods of 10 years: Group A (1978-1987) 135 pts, Group B (1988-1997) 412 pts, and Group C (1998-2004) 380 pts. DFI was analyzed from the date of initial diagnosis to the date of local or distant recurrence. OS was estimated from the date of initial diagnosis to the last follow-up or date of death. Median age was 51 years (28-92). Conservative surgery was performed in 69% of pts, adjuvant radiation therapy in 78%, adjuvant chemotherapy in 29%, and adjuvant hormone therapy in 18%. The median follow-up was 8.4 years (0.3-30). The mean tumor size in Group A was 2.7 cm, in Group B 2.2 cm, and in Group C 1.94 cm (p = 0.0001). The percentage of pts with stage I increased from 13% in Group A to 38% in Group B and to 47% in Group C (p = 0.0001). Local recurrence was documented in 5% of all pts, whereas 28% developed metastatic disease. The DFI and OS showed a statistically significant difference among the three groups (p = 0.005). DFI rate at 5, 10, 15, 20, and 25 years was 71%, 67%, 65%, 65%, and 64%, respectively. OS at 5, 10, 15, 20, and 25 years was 82%, 62%, 49%, 39%, and 28%, respectively. Factors that had an effect in OS demonstrated by the multivariate regression analysis were: Tumor size, ER status, and nodal involvement (p < 0.001). Clinical outcomes in EBC in our experience are similar to those reported in international literature. The DFI and OS showed a statistically significant difference among the three groups. This group of pts continues to have a good prognosis as shown by the OS rate at 5, 10, 15, 20, and 25 years, although a high percentage of pts still to have recurrence and die from breast cancer after 5, 10, 15, 20, and 25 years of follow-up.
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Affiliation(s)
- Julián Iturbe
- Grupo Oncológico Cooperativo del Sur (GOCS), Neuquén, Argentina
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49
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Abstract
T1ab N0 breast cancer generally has excellent prognosis. Adverse prognostic factors include HER2+ disease, ER-negative disease, high-grade histology, T1b, and young age of patient. These patients are largely excluded from most trials, and to date, no prospective studies for this group yet reported. Treatment guidelines are vague and treatment inconsistent. As yet, in the HER2+ population, little experience with targeted therapy has been reported. Prospective trials are needed.
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Affiliation(s)
- Anthony D Elias
- From the University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, CO
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50
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IENI A, GIUFFRÈ G, LANZAFAME S, NUCIFORO G, CURDUMAN M, VILLARI L, ROZ E, CERTO G, CABIBI D, SALOMONE E, LABATE A, MESSINA D, FRANCO V, ADAMO V, TUCCARI G. Morphological and biomolecular characteristics of subcentimetric invasive breast carcinomas in Sicily: A multicentre retrospective study in relation to trastuzumab treatment. Oncol Lett 2012; 3:141-146. [PMID: 22740870 PMCID: PMC3362342 DOI: 10.3892/ol.2011.425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 08/30/2011] [Indexed: 11/06/2022] Open
Abstract
Little information from clinical trials is available regarding the efficacy of trastuzumab treatment in subcentimetric breast carcinomas (BCs). The aim of this study was to verify the existence of correlations between HER2 and hormone receptor status, Ki67 values, grade, histotype and node involvement in a cohort of pT1a,b BCs from an area not widely covered by screening campaigns. A total of 410 pT1a,b BC formalin-fixed paraffin-embedded samples collected from eight Sicilian Anatomo-Pathological Units (APUs) were classified according to the WHO classification and tumour grading was established. Estrogen and progesterone receptor status, Ki67 labelling index and HER2 status were available. Relationships between immunohistochemical data and clinicopathological characteristics were investigated using the Chi-square test; the cohort was analysed with respect to pT1a and pT1b BC as well as to node status. Ductal infiltrating carcinoma was the prevalent histotype in the pT1a and pT1b stages; G2 was a more common tumour grade, with a range between 64.6% and 70% of pT1a and pT1b, respectively. Taking into consideration the lymph node involvement of pT1a,b BC, only 17.1% cases were node-positive without a relevant difference between pT1a and pT1b. No significant differences between pT1a and pT1b BC cases emerged in relation to Ki67 LI, hormone receptors and HER2 status. T1a,b BC cases were stratified by node involvement and a significant relationship was observed with grade as well as with HER2 status. A significant relationship for pT1a cases emerged only for tumour grade, while pT1b cases showed a significant correlation exclusively with HER2 status. Our data clearly support the operative guidelines of the National Comprehensive Cancer Network. Therefore, the combined treatment with trastuzumab plus chemotherapy should be administered only to patients with pT1b or larger BCs. In small HER2-positive pT1a or microinvasive BC, this therapy should be considered on a case-by-case basis, considering tumour grade as the first characteristic.
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Affiliation(s)
- A. IENI
- Department of Human Pathology, University of Messina, A.O.U. Polyclinic G. Martino, Messina
| | - G. GIUFFRÈ
- Department of Human Pathology, University of Messina, A.O.U. Polyclinic G. Martino, Messina
| | - S. LANZAFAME
- Department of Diagnostic-Forensic Pathology and Public Health, University of Catania, Polyclinic G. Rodolico, Catania
| | | | | | | | - E. ROZ
- La Maddalena Oncology Hospital, Palermo
| | - G. CERTO
- Cappellani Pathology Division, Messina
| | - D. CABIBI
- Department of Human Pathology, University of Palermo, A.O.U. Polyclinic Giaccone, Palermo
| | | | - A. LABATE
- Cappellani Pathology Division, Messina
| | - D. MESSINA
- Pathology Division, Sant’Antonio Abate Hospital, Trapani, Italy
| | - V. FRANCO
- Department of Human Pathology, University of Palermo, A.O.U. Polyclinic Giaccone, Palermo
| | - V. ADAMO
- Department of Human Pathology, University of Messina, A.O.U. Polyclinic G. Martino, Messina
| | - G. TUCCARI
- Department of Human Pathology, University of Messina, A.O.U. Polyclinic G. Martino, Messina
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