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Mathelin C, Brousse S, Schmitt M, Taris N, Uzan C, Molière S, Vaysse C. [Updated surgical indications and quality and safety indicators in the management of infiltrative breast carcinoma]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:125-131. [PMID: 38122844 DOI: 10.1016/j.gofs.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Breast surgery is the cornerstone of breast cancer treatment. Its indications and procedures are constantly evolving. To update best practices, four questions were submitted to the Senology Commission (SC) of the Collège national des gynécologues et obstétriciens français (CNGOF), covering the indications and modalities of tumor surgery: (1) initially, (2) following neoadjuvant systemic treatment, (3) in case of local recurrence, and (4) the quality and safety of care indicators applicable to this surgery. METHODS The CNGOF SC essentially based its responses on the clinical practice recommendations and guidelines of the French Cancer Institute concerning invasive carcinomas of the breast. Exclusion criteria were carcinoma in situ, sarcoma and axillary surgery. RESULTS To define the type of breast surgery, knowledge of four parameters is essential: the patient's level of risk, the presence of metastases, the size of the breast tumor and its focality (assessed by the clinical/mammography/ultrasound tripod). (1) In the case of initial management, the 6 indications for mastectomy are patient choice (particularly in case of high risk), contraindication to radiotherapy, inflammatory cancer (T4d), surgery with positive margins (after several surgical intervention), surgery that cannot be performed as a monobloc in the case of tumors with multiple foci, and poor expected aesthetic results. All other situations should be treated conservatively. (2) The same criteria apply after neoadjuvant systemic treatment, with conservative treatment still possible whatever the size (excluding carcinomatous mastitis) and focality of the initial tumor. (3) In case of local recurrence, total mastectomy is the reference treatment, with a second conservative treatment reserved for patients with no risk factors for a second recurrence, and no poor prognostic factors, after validation in a multidisciplinary meeting. (4) Four quality and safety indicators apply to breast surgery: it must be performed after obtaining a histological diagnosis, within less than 6 weeks of mammography, in a single surgery in over 80% of cases, and followed by local radiotherapy in the case of conservative treatment. CONCLUSION The indications and modalities of breast surgery are evolving rapidly. To improve aesthetic results, oncoplastic techniques, immediate breast reconstruction, and preservation of the skin or nipple-areolar complex need to be further developed and evaluated in the long-term. These developments must necessarily be accompanied in France by a training policy for breast surgeons.
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Affiliation(s)
- Carole Mathelin
- Service de chirurgie, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; CHRU, avenue Molière, 67200 Strasbourg, France.
| | - Susie Brousse
- Service de chirurgie, centre Eugène-Marquis, avenue de la Bataille Flandres-Dunkerque, 35042 Rennes cedex, France.
| | - Martin Schmitt
- Service de radiothérapie, CHR Metz-Thionville, hôpital de Mercy, 1, allée du Château, 57085 Metz cedex, France.
| | - Nicolas Taris
- Service d'onco-génétique, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France.
| | - Catherine Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, Sorbonne université, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Sébastien Molière
- Service d'imagerie de la femme, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; Service de radiologie B, CHU de Strasbourg, avenue Molière, 67200 Strasbourg, France.
| | - Charlotte Vaysse
- Service de chirurgie gynécologique oncologique, IUCT-Oncopole, CHU de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
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Dayan D, Lukac S, Rack B, Ebner F, Fink V, Leinert E, Veselinovic K, Schütze S, El Taie Z, Janni W, Friedl TWP. Effect of histological breast cancer subtypes invasive lobular versus non-special type on survival in early intermediate-to-high-risk breast carcinoma: results from the SUCCESS trials. Breast Cancer Res 2023; 25:153. [PMID: 38098086 PMCID: PMC10722735 DOI: 10.1186/s13058-023-01750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Invasive lobular breast carcinomas (ILC) have different histological features compared to non-special type carcinomas (NST), but the effect of histological subtypes on survival is controversial. In this study, we compared clinicopathological characteristics and outcomes between ILC and NST based on a large pooled data set from three adjuvant breast cancer trials (SUCCESS A, B, and C) and investigated a potential differential effect of recurrence risk related to nodal stage on survival. METHODS From 2005 to 2017, the large randomized controlled SUCCESS A, B, and C trials enrolled 8190 patients with primary, intermediate-to-high-risk breast carcinoma. All patients received adjuvant chemotherapy, and endocrine and/or HER2-targeted treatment was given where appropriate. Survival outcomes in terms of disease-free survival (DFS), overall survival (OS), breast cancer-specific survival (BCSS), and distant disease-free survival (DDFS) were estimated using the Kaplan-Meier method and analyzed using log-rank tests as well as univariable and adjusted multivariable Cox regression models. RESULTS In the SUCCESS trials, 6284 patients had NST and 952 had ILC. The median follow-up time was 64 months. ILC patients were older, more likely to receive mastectomy, and more likely to have larger tumor sizes, lymph node infiltration, hormone receptor-positive, HER2neu-negative, and luminal A-like tumors than NST patients. In the overall cohort, no significant differences between ILC and NST were detectable regarding the four survival endpoints, with hazard ratios obtained in adjusted multivariable cox regressions of 0.96 (95% CI 0.77-1.21, p = 0.743) for DFS, 1.13 (95% CI 0.85-1.50, p = 0.414) for OS, 1.21 (95% CI 0.89-1.66, p = 0.229) for BCSS, and 0.95 (95% CI 0.73-1.24, p = 0.689) for DDFS. However, a differential effect of nodal stage on survival was observed, with better survival for ILC patients with pN0/pN1 tumors and worse survival for ILC patients with pN2/pN3 tumors compared to NST patients. CONCLUSIONS Our results revealed that ILC was associated with worse survival compared to NST for patients at high risk of recurrence due to advanced lymph node infiltration. These findings should be taken into account for treatment decisions and monitoring.
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Affiliation(s)
- Davut Dayan
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany.
| | - Stefan Lukac
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Florian Ebner
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
- Gyn-Freising, Freising, Germany
| | - Visnja Fink
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Kristina Veselinovic
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Sabine Schütze
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Ziad El Taie
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstraße 43, 89075, Ulm, Germany
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Ramalingam K, Clelland E, Rothschild H, Mujir F, Record H, Kaur M, Mukhtar RA. Successful Breast Conservation After Neoadjuvant Chemotherapy in Lobular Breast Cancer: The Role of Menopausal Status in Response to Treatment. Ann Surg Oncol 2023; 30:7099-7106. [PMID: 37561345 PMCID: PMC10562340 DOI: 10.1245/s10434-023-14075-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND While neoadjuvant chemotherapy (NAC) has been shown to increase rates of breast conservation surgery (BCS) for breast cancer, response rates in invasive lobular carcinoma (ILC) appear lower than other histologic subtypes. Some data suggest higher response rates to NAC in premenopausal versus postmenopausal patients, but this has not been studied in ILC. We evaluated the rates of successful BCS after NAC in patients with ILC stratified by menopausal status. PATIENTS AND METHODS We analyzed data from a single-institution cohort of 666 patients with stage I-III hormone receptor positive HER-2 negative ILC. We used t-tests, chi-squared tests, and multivariable logistic regression to investigate rates of NAC use, attempted BCS, and associations between NAC and successful BCS by menopausal status. RESULTS In 217 premenopausal and 449 postmenopausal patients, NAC was used more often in the premenopausal group (15.2% vs. 9.8%, respectively, p = 0.041). Among those who attempted breast conservation (51.3% of pre- and 64.8% of postmenopausal cohorts), NAC was not associated with successful BCS in either group. Interestingly, for postmenopausal patients, receipt of NAC was significantly associated with increased rates of completion mastectomy in those who had positive margins at the first attempt at BCS. CONCLUSION NAC was not associated with successful BCS in either premenopausal or postmenopausal patients with ILC. Although premenopausal patients were more likely to receive NAC, these data suggest that menopausal status may not be a good predictor of response to chemotherapy. Better predictors of response and more efficacious treatment for patients with ILC are needed.
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MESH Headings
- Humans
- Female
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/surgery
- Carcinoma, Lobular/pathology
- Breast Neoplasms/drug therapy
- Breast Neoplasms/surgery
- Breast Neoplasms/pathology
- Neoadjuvant Therapy
- Mastectomy
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/pathology
- Mastectomy, Segmental
- Menopause
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Affiliation(s)
| | | | | | | | | | - Mandeep Kaur
- University of California, San Francisco, CA, USA
| | - Rita A Mukhtar
- University of California, San Francisco, CA, USA.
- Department of Surgery, Carol Franc Buck Breast Care Center, San Francisco, CA, USA.
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Mitchell MC, Pollock J, Downs MB, Stephen D. Metastatic Leptomeningeal Carcinomatosis From Primary Lobular Breast Cancer Found in a Medical School Cadaveric Dissection. Cureus 2023; 15:e44533. [PMID: 37790014 PMCID: PMC10544739 DOI: 10.7759/cureus.44533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Leptomeningeal carcinomatosis (LC) is an uncommon sequelae of metastatic cancer affecting the pia and arachnoid mater. It has been postulated that recent improvements in cancer patient survival time have increased the frequency of LC and other rare metastatic conditions that patients previously would not have lived long enough to experience. LC carries a universally poor prognosis with a mean survival of between two to four months if treated; however, the recent increase in incidence has allowed for further research into the condition and potential treatments. Options for administering chemotherapy have been limited in the past, but recent developments in surgical chemotherapeutic ports have allowed for intrathecal delivery of drugs like methotrexate without systemic exposure. In fact, innovative delivery systems undergoing clinical trials can deliver these drugs in a metronomic fashion to limit the leukoencephalopathy complications of methotrexate. Primary breast cancer is the most common source of metastatic leptomeningeal lesions, and such a lesion was observed by the authors in the cadaver of a 70-year-old Caucasian female with unspecified breast cancer in a medical school anatomic laboratory. The cause of death was listed as "complication of malignant neoplasm of unspecified site of unspecified female breast." Through this case report, we seek to develop our understanding of this rare metastatic phenomenon and highlight the importance of student cadaveric dissection.
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Affiliation(s)
- Mary C Mitchell
- Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - James Pollock
- Medical School, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - Mary B Downs
- Anatomy, Edward Via College of Osteopathic Medicine, Auburn, USA
| | - David Stephen
- Pathology, Edward Via College of Osteopathic Medicine, Auburn, USA
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5
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Kawaguchi S, Kinowaki K, Tamura N, Masumoto T, Nishikawa A, Shibata A, Tanaka K, Kobayashi Y, Ogura T, Sato J, Kawabata H. High-accuracy prediction of axillary lymph node metastasis in invasive lobular carcinoma using focal cortical thickening on magnetic resonance imaging. Breast Cancer 2023:10.1007/s12282-023-01457-2. [PMID: 37020090 PMCID: PMC10075493 DOI: 10.1007/s12282-023-01457-2] [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: 01/22/2023] [Accepted: 04/02/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Invasive lobular carcinoma (ILC) grows diffusely in a single-cell fashion, sometimes presenting only subtle changes in preoperative imaging; therefore, axillary lymph node (ALN) metastases of ILC are difficult to detect using magnetic resonance imaging (MRI). Preoperative underestimation of nodal burden occurs more frequently in ILC than in invasive ductal carcinoma (IDC), however, the morphological assessment for metastatic ALNs of ILC have not fully been investigated. We hypothesized that the high false-negative rate in ILC is caused by the discrepancy in the MRI findings of ALN metastases between ILC and IDC and aimed to identify the MRI finding with a strong correlation with ALN metastasis of ILC. METHOD This retrospective analysis included 120 female patients (mean ± standard deviation age, 57.2 ± 11.2 years) who underwent upfront surgery for ILC at a single center between April 2011 and June 2022. Of the 120 patients, 35 (29%) had ALN metastasis. Using logistic regression, we constructed prediction models based on MRI findings: primary tumor size, focal cortical thickening (FCT), cortical thickness, long-axis diameter (LAD), and loss of hilum (LOH). RESULTS The area under the curves were 0.917 (95% confidence interval [CI] 0.869-0.968), 0.827 (95% CI 0.758-0.896), 0.754 (95% CI 0.671-0.837), and 0.621 (95% CI 0.531-0.711) for the FCT, cortical thickness, LAD, and LOH models, respectively. CONCLUSIONS FCT may be the most relevant MRI finding for ALN metastasis of ILC, and although its prediction model may lead to less underestimation of the nodal burden, rigorous external validation is required.
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Affiliation(s)
- Shun Kawaguchi
- Department of Breast and Endocrinology Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan.
| | | | - Nobuko Tamura
- Department of Breast and Endocrinology Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Tomohiko Masumoto
- Department of Diagnostic Radiology, Toranomon Hospital, Tokyo, Japan
| | - Aya Nishikawa
- Department of Breast and Endocrinology Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Akio Shibata
- Department of Breast and Endocrinology Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Kiyo Tanaka
- Department of Breast and Endocrinology Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Yoko Kobayashi
- Department of Breast and Endocrinology Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Takuya Ogura
- Department of Breast and Endocrinology Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Junichiro Sato
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Hidetaka Kawabata
- Department of Breast and Endocrinology Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
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Nasrazadani A, Li Y, Fang Y, Shah O, Atkinson JM, Lee JS, McAuliffe PF, Bhargava R, Tseng G, Lee AV, Lucas PC, Oesterreich S, Wolmark N. Mixed invasive ductal lobular carcinoma is clinically and pathologically more similar to invasive lobular than ductal carcinoma. Br J Cancer 2023; 128:1030-1039. [PMID: 36604587 PMCID: PMC10006180 DOI: 10.1038/s41416-022-02131-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Mixed invasive ductal lobular carcinoma (mDLC) remains a poorly understood subtype of breast cancer composed of coexisting ductal and lobular components. METHODS We sought to describe clinicopathologic characteristics and determine whether mDLC is clinically more similar to invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC), using data from patients seen at the University of Pittsburgh Medical Center. RESULTS We observed a higher concordance in clinicopathologic characteristics between mDLC and ILC, compared to IDC. There is a trend for higher rates of successful breast-conserving surgery after neoadjuvant chemotherapy in patients with mDLC compared to patients with ILC, in which it is known to be lower than in those with IDC. Metastatic patterns of mDLC demonstrate a propensity to develop in sites characteristic of both IDC and ILC. A meta-analysis evaluating mDLC showed shared features with both ILC and IDC with significantly more ER-positive and fewer high grades in mDLC compared to IDC, although mDLCs were significantly smaller and included fewer late-stage tumours compared to ILC. CONCLUSIONS These findings support clinicopathologic characteristics of mDLC driven by individual ductal vs lobular components and given the dominance of lobular pathology, mDLC features are often more similar to ILC than IDC. This study exemplifies the complexity of mixed disease.
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Affiliation(s)
- Azadeh Nasrazadani
- Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
| | - Yujia Li
- Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Yusi Fang
- Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Osama Shah
- Graduate Program in Integrated Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer M Atkinson
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Joanna S Lee
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Priscilla F McAuliffe
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee-Womens Research Institute, Pittsburgh, PA, USA
- Division of Surgical Oncology, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rohit Bhargava
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - George Tseng
- Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Adrian V Lee
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee-Womens Research Institute, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Magee Women's Hospital, Suite 4628, 300 Halket Street, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter C Lucas
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Magee Women's Hospital, Suite 4628, 300 Halket Street, Pittsburgh, PA, USA
- NSABP Foundation, Inc, Pittsburgh, PA, USA
| | - Steffi Oesterreich
- Women's Cancer Research Center, UPMC Hillman Cancer Center, Magee-Womens Research Institute, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Magee Women's Hospital, Suite 4628, 300 Halket Street, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Norman Wolmark
- UPMC Hillman Cancer Center, Magee Women's Hospital, Suite 4628, 300 Halket Street, Pittsburgh, PA, USA
- NSABP Foundation, Inc, Pittsburgh, PA, USA
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Mamtani A, Grabenstetter A, Sevilimedu V, Morrow M, Gemignani ML. Do non-classic invasive lobular carcinomas derive a benefit from neoadjuvant chemotherapy? Breast Cancer Res Treat 2023; 197:417-423. [PMID: 36394689 PMCID: PMC10118744 DOI: 10.1007/s10549-022-06813-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Invasive lobular breast cancers (ILCs) respond poorly to neoadjuvant chemotherapy (NAC). The degree of benefit of NAC among non-classic ILC (NC-ILC) variants compared with classic ILCs (C-ILCs) is unknown. METHODS Consecutive patients with Stage I-III ILC treated from 2003 to 2019 with NAC and surgery were identified, and grouped as C-ILC or NC-ILC as per the original surgical pathology report, with pathologist (A.G.) review performed if original categorization was unclear. A subset of similarly treated invasive ductal cancers (IDCs) was identified for comparison. Clinicopathologic characteristics and pathologic complete response (pCR) rates were evaluated. RESULTS Of 145 patients with ILC, 101 (70%) were C-ILC and 44 (30%) were NC-ILC (IDC cohort: 1157 patients). ILC patients were older, more often cT3/T4 and cN2/N3, and less often high-grade compared to IDC patients. Those with NC-ILC were less often ER+/HER2- (55% versus 93%), and more often HER2 + (25% versus 7%) and TN (21% versus 0%, all p < 0.001). Breast pCR was more common among NC-ILC, but most frequent in IDC. Nodal pCR rates were also lowest among C-ILC patients, but similar among NC-ILC and IDC patients. On multivariable analysis, C-ILC (OR 0.09) and LVI (OR 0.51) were predictive of lack of breast pCR; non-ER+/HER2- subtypes and breast pCR were predictive of nodal pCR. When our analysis was repeated with patients stratified by receptor subtype, histology was not independently predictive of either breast or nodal pCR. CONCLUSION NC-ILC patients were significantly more likely to achieve breast and nodal pCR compared with C-ILC patients, but when stratified by subtype, histology was not independently predictive of breast or nodal pCR.
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Affiliation(s)
- Anita Mamtani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, 10065, USA.
| | - Anne Grabenstetter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, 10065, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66 Street, New York, NY, 10065, USA
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8
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Kuba MG, Brogi E. Update on lobular lesions of the breast. Histopathology 2023; 82:36-52. [PMID: 36482279 PMCID: PMC9752180 DOI: 10.1111/his.14829] [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: 09/18/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
The current histological classification of in-situ and invasive lobular carcinomas (ILCs) includes different morphological variants, some of which have been recently described. In this review, we will focus upon: (i) the diagnostic criteria of non-invasive lobular neoplasia and treatment implications across different countries; (ii) utility and limitations of immunohistochemistry; (iii) recently described variants of ILC; and (iv) the significance of lobular differentiation in invasive carcinoma for clinical management.
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Affiliation(s)
- Maria Gabriela Kuba
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edi Brogi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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9
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Davey MG, Keelan S, Lowery AJ, Kerin MJ. The Impact of Chemotherapy Prescription on Long-Term Survival Outcomes in Early-Stage Invasive Lobular Carcinoma - A Systematic Review and Meta-Analysis. Clin Breast Cancer 2022; 22:e843-e849. [PMID: 36229335 DOI: 10.1016/j.clbc.2022.09.005] [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: 06/04/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Invasive lobular carcinoma (ILCs) are typically endocrine responsive breast cancers which respond poorly to chemotherapy. The long-term survival advantage of prescribing chemotherapy in such cases remains unclear. To perform a systematic review and meta-analysis assessing, the impact of prescribing chemotherapy in such patients on long-term disease-free (DFS) and overall (OS) survival outcomes. METHODS A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Ten-year DFS and OS were pooled as odds ratios (ORs) with 95% confidence intervals (CI) using the Mantel-Haenszel method. Time-to-effect modelling was performed using the generic inverse variance method. RESULTS Overall, 9 studies including 28,218 patients were included. The mean follow-up was 74 months (range: 0-150 months) and mean age was 60 years (range: 22-90 years). Of these, 34.7% received chemotherapy (9,797/28,218) and 66.3% did not receive chemotherapy (18,421/28,218). Chemotherapy prescription failed to improve 10-year DFS (OR: 0.89, 95% CI: 0.65-1.23) and OS (OR: 0.92, 95% CI: 0.72-1.18). When using time-to-effect modelling, chemotherapy prescription failed to improve DFS (hazard ratio (HR): 1.01, 95% CI: 0.78-1.31) and OS (HR: 1.07, 95% CI: 0.89-1.27, I2= 67%). CONCLUSION This meta-analysis illustrates no long-term survival advantage associated with chemotherapy prescription in the setting of early-stage ILC. In the absence of well-designed, prospective clinical trials evaluating the impact of chemotherapy on long-term outcomes in ILC, these results should be considered by the multidisciplinary team when deciding on the value of systemic chemotherapy prescription in ILC.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland.
| | - Stephen Keelan
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
| | - Aoife J Lowery
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
| | - Michael J Kerin
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Republic of Ireland
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Interactive exploration of a global clinical network from a large breast cancer cohort. NPJ Digit Med 2022; 5:113. [PMID: 35948579 PMCID: PMC9365762 DOI: 10.1038/s41746-022-00647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/27/2022] [Indexed: 11/08/2022] Open
Abstract
Despite unprecedented amount of information now available in medical records, health data remain underexploited due to their heterogeneity and complexity. Simple charts and hypothesis-driven statistics can no longer apprehend the content of information-rich clinical data. There is, therefore, a clear need for powerful interactive visualization tools enabling medical practitioners to perceive the patterns and insights gained by state-of-the-art machine learning algorithms. Here, we report an interactive graphical interface for use as the front end of a machine learning causal inference server (MIIC), to facilitate the visualization and comprehension by clinicians of relationships between clinically relevant variables. The widespread use of such tools, facilitating the interactive exploration of datasets, is crucial both for data visualization and for the generation of research hypotheses. We demonstrate the utility of the MIIC interactive interface, by exploring the clinical network of a large cohort of breast cancer patients treated with neoadjuvant chemotherapy (NAC). This example highlights, in particular, the direct and indirect links between post-NAC clinical responses and patient survival. The MIIC interactive graphical interface has the potential to help clinicians identify actionable nodes and edges in clinical networks, thereby ultimately improving the patient care pathway.
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11
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Mouabbi JA, Hassan A, Lim B, Hortobagyi GN, Tripathy D, Layman RM. Invasive lobular carcinoma: an understudied emergent subtype of breast cancer. Breast Cancer Res Treat 2022; 193:253-264. [DOI: 10.1007/s10549-022-06572-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 12/22/2022]
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12
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Tan BY, Lim EH, Tan PH. Special Histologic Type and Rare Breast Tumors - Diagnostic Review and Clinico-Pathological Implications. Surg Pathol Clin 2022; 15:29-55. [PMID: 35236633 DOI: 10.1016/j.path.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Breast cancer is the most common malignant tumor in females. While most carcinomas are categorized as invasive carcinoma, no special type (NST), a diverse group of tumors with distinct pathologic and clinical features is also recognized, ranging in incidence from relatively more common to rare. So-called "special histologic type" tumors display more than 90% of a specific, distinctive histologic pattern, while a spectrum of tumors more often encountered in the salivary gland may also arise in the breast. Metaplastic carcinomas can present diagnostic challenges. Some uncommon tumors harbor pathognomonic genetic alterations. This article provides an overview of the key diagnostic points and differential diagnoses for this group of disparate lesions, as well as the salient clinical characteristics of each entity.
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Affiliation(s)
- Benjamin Yongcheng Tan
- Department of Anatomical Pathology, Singapore General Hospital, Level 10, Academia, 20 College Road, Singapore 169856, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Level 7, Diagnostics Tower, Academia, 20 College Road, Singapore 189856, Singapore.
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13
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Ploumen RAW, Keymeulen KBMI, Kooreman LFS, van Kuijk SMJ, Siesling S, Smidt ML, van Nijnatten TJA. The percentage of residual DCIS in patients diagnosed with primary invasive breast cancer treated with neoadjuvant systemic therapy: A nationwide retrospective study. Eur J Surg Oncol 2021; 48:60-66. [PMID: 34756527 DOI: 10.1016/j.ejso.2021.10.016] [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: 09/22/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Neoadjuvant systemic therapy (NST) is increasingly applied in breast cancer to improve surgical and oncological outcome. Approximately 21% of patients receiving NST achieve pathological complete response (pCR) of the breast. There is disagreement on the definition of pCR with respect to residual DCIS (ypT0 versus ypT0/is). The aim of this retrospective study was to determine the percentage of breast pCR (ypT0) and residual DCIS (ypTis), and its association with clinicopathological variables, in patients treated with NST and surgery. MATERIALS AND METHODS Patients with invasive breast cancer treated with neoadjuvant chemotherapy, with or without targeted therapy, in the period of 2010-2019 were selected from the Netherlands Cancer Registry (NCR). Descriptive statistics and multivariable logistic regression analyses were used to analyse the percentage of ypT0 and ypTis and its association with clinicopathological variables. RESULTS From the NCR database, 20495 patients were included, of whom 5847 (28.5%) achieved breast pCR (ypT0) and 881 (4.3%) showed residual DCIS (ypTis). The percentage of ypTis was highest in HER2+ tumour subtypes (ER+HER2+ 7.9%, ER-HER2+ 9.8%, ER+HER2- 2.1%, triple negative 3.3%, p < 0.001). Multivariable logistic regression analyses demonstrated high tumour grade (OR 2.00, p = 0.003) and HER2+ tumour subtype (ER+HER2+ OR 3.58, ER-HER2+ OR 4.37, p < 0.001) as independent predictors for ypTis. CONCLUSION pCR (ypT0) was achieved in 5847 (28.5%) patients receiving NST and residual DCIS (ypTis) was found in 881 (4.3%) patients. Consequently, the rate of pCR may be affected by ypTis when not excluded from the definition. The percentage of ypTis is highest in HER2+ subtypes.
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Affiliation(s)
- R A W Ploumen
- Department of Surgery, Maastricht University Medical Centre+, 6202 AZ, Maastricht, the Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6200 MD, Maastricht, the Netherlands.
| | - K B M I Keymeulen
- Department of Surgery, Maastricht University Medical Centre+, 6202 AZ, Maastricht, the Netherlands.
| | - L F S Kooreman
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6200 MD, Maastricht, the Netherlands; Department of Pathology, Maastricht University Medical Centre+, 6202 AZ, Maastricht, the Netherlands.
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, 6202 AZ, Maastricht, the Netherlands.
| | - S Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7522 NH, Enschede, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, 3511 DT, Utrecht, the Netherlands.
| | - M L Smidt
- Department of Surgery, Maastricht University Medical Centre+, 6202 AZ, Maastricht, the Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6200 MD, Maastricht, the Netherlands.
| | - T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, 6202 AZ, Maastricht, the Netherlands.
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14
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van der Noordaa MEM, Ioan I, Rutgers EJ, van Werkhoven E, Loo CE, Voorthuis R, Wesseling J, van Urk J, Wiersma T, Dezentje V, Vrancken Peeters MJTFD, van Duijnhoven FH. Breast-Conserving Therapy in Patients with cT3 Breast Cancer with Good Response to Neoadjuvant Systemic Therapy Results in Excellent Local Control: A Comprehensive Cancer Center Experience. Ann Surg Oncol 2021; 28:7383-7394. [PMID: 33978889 DOI: 10.1245/s10434-021-09865-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Many cT3 breast cancer patients are treated with mastectomy, regardless of response to neoadjuvant systemic therapy (NST). We evaluated local control of cT3 patients undergoing breast-conserving therapy (BCT) based on magnetic resonance imaging (MRI) evaluation post-NST. In addition, we analyzed predictive characteristics for positive margins after breast-conserving surgery (BCS). METHODS All cT3 breast cancer patients who underwent BCS after NST between 2002 and 2015 at the Netherlands Cancer Institute were included. Local recurrence-free interval (LRFI) was estimated using the Kaplan-Meier method, and predictors for positive margins were analyzed using univariable analysis and multivariable logistic regression. RESULTS Of 114 patients undergoing BCS post-NST, 75 had negative margins, 16 had focally positive margins, and 23 had positive margins. Of those with (focally) positive margins, 12 underwent radiotherapy, 6 underwent re-excision, and 21 underwent mastectomy. Finally, 93/114 patients were treated with BCT (82%), with an LRFI of 95.9% (95% confidence interval [CI] 91.5-100%) after a median follow-up of 7 years. Predictors for positive margins in univariable analysis were hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) subtype, lobular carcinoma, and non-mass enhancement (NME) on pre-NST MRI. MRI response was not correlated to positive margins. In multivariable regression, the odds of positive margins were decreased in patients with HER2-positive (HER2+; odds ratio [OR] 0.27, 95% CI 0.10-0.73; p = 0.01) and TN tumors (OR 0.17, 95% CI 0.03-0.82; p = 0.028). A trend toward positive margins was observed in patients with NME (OR 2.38, 95% CI 0.98-5.77; p = 0.055). CONCLUSION BCT could be performed in 82% of cT3 patients in whom BCT appeared feasible on post-NST MRI. Local control in these patients was excellent. In those patients with HR+/HER2- tumors, NME on MRI, or invasive lobular carcinoma, the risk of positive margins should be considered preoperatively.
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Affiliation(s)
| | - Ileana Ioan
- Department of Radiology, Policlinico San Donato, Milan, Italy
| | - Emiel J Rutgers
- Department of Surgical Oncology, NKI-AVL, Amsterdam, The Netherlands.,Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Claudette E Loo
- Department of Radiology, NKI-AVL, Amsterdam, The Netherlands
| | - Rosie Voorthuis
- Department of Surgical Oncology, NKI-AVL, Amsterdam, The Netherlands
| | - Jelle Wesseling
- Department of Pathology, NKI-AvL and Leiden University Medical Center, Amsterdam, The Netherlands
| | - Japke van Urk
- Department of Radiology, NKI-AVL, Amsterdam, The Netherlands
| | - Terry Wiersma
- Department of Radiation Oncology, NKI-AVL, Amsterdam, The Netherlands
| | - Vincent Dezentje
- Department of Medical Oncology, NKI-AVL, Amsterdam, The Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgical Oncology, NKI-AVL, Amsterdam, The Netherlands.,Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
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15
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Hovis KK, Lee JM, Hippe DS, Linden H, Flanagan MR, Kilgore MR, Yee J, Partridge SC, Rahbar H. Accuracy of Preoperative Breast MRI Versus Conventional Imaging in Measuring Pathologic Extent of Invasive Lobular Carcinoma. JOURNAL OF BREAST IMAGING 2021; 3:288-298. [PMID: 34061121 PMCID: PMC8139612 DOI: 10.1093/jbi/wbab015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether invasive lobular carcinoma (ILC) extent is more accurately depicted with preoperative MRI (pMRI) than conventional imaging (mammography and/or ultrasound). METHODS After IRB approval, we retrospectively identified women with pMRIs (February 2005 to January 2014) to evaluate pure ILC excluding those with ipsilateral pMRI BI-RADS 4 or 5 findings or who had neoadjuvant chemotherapy. Agreement between imaging and pathology sizes was summarized using Bland-Altman plots, absolute and percent differences, and the intraclass correlation coefficient (ICC). Rates of underestimation and overestimation were evaluated and their associations with clinical features were explored. RESULTS Among the 56 women included, pMRI demonstrated better agreement with pathology than conventional imaging by mean absolute difference (1.6 mm versus -7.8 mm, P < 0.001), percent difference (10.3% versus -16.4%, P < 0.001), and ICC (0.88 versus 0.61, P = 0.019). Conventional imaging more frequently underestimated ILC span than pMRI using a 5 mm difference threshold (24/56 (43%) versus 10/56 (18%), P < 0.001), a 25% threshold (19/53 (36%) versus 10/53 (19%), P = 0.035), and T category change (17/56 (30%) versus 7/56 (13%), P = 0.006). Imaging-pathology size concordance was greater for MRI-described solitary masses than other lesions for both MRI and conventional imaging (P < 0.05). Variability of conventional imaging was lower for patients ≥ the median age of 62 years than for younger patients (SD: 12 mm versus 22 mm, P = 0.012). CONCLUSION MRI depicts pure ILC more accurately than conventional imaging and may have particular value for younger women.
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Affiliation(s)
- Keegan K Hovis
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Janie M Lee
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Daniel S Hippe
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Hannah Linden
- Seattle Cancer Care Alliance, Seattle, WA, USA
- University of Washington School of Medicine, Department of Medical Oncology, Seattle, WA, USA
| | - Meghan R Flanagan
- Seattle Cancer Care Alliance, Seattle, WA, USA
- University of Washington School of Medicine, Department of Surgery, Seattle, WA, USA
| | - Mark R Kilgore
- Seattle Cancer Care Alliance, Seattle, WA, USA
- University of Washington School of Medicine, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Janis Yee
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Savannah C Partridge
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
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16
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Shaikh A, Tariq MU, Khan SM, Idress R, Vohra LM, Shaikh SF, Waheed H. Concordance Between Clinical and Pathological Response Assessment After Neo-Adjuvant Chemotherapy in Patients With Invasive Lobular Carcinoma. Cureus 2021; 13:e14341. [PMID: 33972899 PMCID: PMC8103980 DOI: 10.7759/cureus.14341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Neo-adjuvant chemotherapy (NAC) is frequently administered in breast carcinoma patients. The clinical response to NAC guides further treatment. The pathological response is not only an independent prognostic factor, but it also guides further treatment and prognosis. Objectives The aim of our study was to find the degree of concordance between clinical and pathological response assessments after NAC in Invasive lobular Carcinoma (ILC) cases by using World Health Organization (WHO) criteria and different pathological systems, respectively. We also tried to identify any useful parameter of clinical assessment that could better correlate with pathologic assessment and provide a better estimation of residual tumor. Methods This retrospective study was conducted on 26 ILC tumors diagnosed in 24 patients who were treated with NAC followed by surgical resection between January 2009 and December 2020. Medical records and microscopy glass slides were reviewed for clinical and pathological response assessments, respectively. Results The pre-treatment tumor area ranged from 1.8-255 cm2 and the mean±SD was 52.2±66.8 cm2. After NAC, complete clinical response was observed in four (15.3%) cases. The clinically assessed mean tumor area significantly reduced from 52.2±66.8 cm2 to 17.2±22.6 cm2 (p-value<0.001). The pathologically assessed mean tumor area (27.4±24.1 cm2) didn't differ significantly from the clinically assessed mean tumor area (17.2±22.6 cm2) (p-value=0.114). Pathologically, the majority of the cases showed partial response, and a complete pathological response was achieved in only two (7.7%) cases. The concordance rates between clinical assessment by the WHO method and pathological assessment of the breast using the Sataloff method, Miller-Payne (MP) system, Residual Cancer Burden system, and Chevallier method were 26.7%, 15.8%, 9%, and 3.5%, respectively, with insignificant p-values. Percentage reduction in clinical size and percentage reduction in tumor cellularity differed significantly (p-value=0.038). Conclusion Clinical response assessment provides a less accurate estimation of residual disease, as it shows poor concordance with pathological assessment using different assessment systems/methods.
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Affiliation(s)
- Aisha Shaikh
- Surgery, Aga Khan University Hospital, Karachi, PAK.,Surgery, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | - Muhammad Usman Tariq
- Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | | | - Romana Idress
- Histopathology, Aga Khan University Hospital, Karachi, PAK
| | | | | | - Hira Waheed
- Radiology, Aga Khan University Hospital, Karachi, PAK
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17
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Mukhtar RA, Hoskin TL, Habermann EB, Day CN, Boughey JC. Changes in Management Strategy and Impact of Neoadjuvant Therapy on Extent of Surgery in Invasive Lobular Carcinoma of the Breast: Analysis of the National Cancer Database (NCDB). Ann Surg Oncol 2021; 28:5867-5877. [PMID: 33687613 PMCID: PMC8460506 DOI: 10.1245/s10434-021-09715-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/26/2021] [Indexed: 11/19/2022]
Abstract
Background Given reports of low response rates to neoadjuvant chemotherapy (NAC) in invasive lobular carcinoma (ILC), we evaluated whether use of alternative strategies such as neoadjuvant endocrine therapy (NET) is increasing. Additionally, we investigated whether NET is associated with more breast conservation surgery (BCS) and less extensive axillary surgery in those with ILC. Patients and Methods We queried the NCDB from 2010 to 2016 and identified all women with stage I–III hormone receptor positive, human epidermal growth factor receptor-2 negative (HR+/HER2−) ILC who underwent surgery. We used Cochrane–Armitage tests to evaluate trends in utilization of the following treatment strategies: NAC, short-course NET, long-course NET, and primary surgery. We compared rates of BCS and extent of axillary surgery stratified by clinical stage and tumor receptor subtype for each treatment strategy. Results Among 69,312 cases of HR+/HER2− ILC, NAC use decreased slightly (from 4.7 to 4.2%, p = 0.007), while there was a small but significant increase in long-course NET (from 1.6 to 2.7%, p < 0.001). Long-course NET was significantly associated with increased BCS in patients with cT2–cT4 disease and less extensive axillary surgery in clinically node positive patients with HR+/HER2− tumors. Conclusions Primary surgery remains the most common treatment strategy in patients with ILC. However, NAC use decreased slightly over the study period, while the use of long-course NET had a small increase and was associated with more BCS and less extensive axillary surgery.
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Affiliation(s)
- Rita A Mukhtar
- Department of Surgery, University of California, San Francisco, CA, USA.
| | - Tanya L Hoskin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth B Habermann
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Courtney N Day
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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18
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Torrisi R, Marrazzo E, Agostinetto E, De Sanctis R, Losurdo A, Masci G, Tinterri C, Santoro A. Neoadjuvant chemotherapy in hormone receptor-positive/HER2-negative early breast cancer: When, why and what? Crit Rev Oncol Hematol 2021; 160:103280. [PMID: 33667658 DOI: 10.1016/j.critrevonc.2021.103280] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 02/17/2021] [Accepted: 02/27/2021] [Indexed: 12/13/2022] Open
Abstract
Indication for neoadjuvant chemotherapy (NACT) in HR+/HER2-negative tumors is controversial. Pathological complete response (pCR) rates range from 0 to 18 % while breast-conserving surgery (BCS) is achievable in up to 60 % of tumors. No pathological feature definitely predicts pCR; lobular and molecular luminal A tumors are less likely to achieve pCR although experiencing better outcomes. Luminal B subtype, high proliferation, lack of progesterone receptor, high tumor-infiltrating lymphocytes are positively associated with increased pCR rates but worse outcomes and the prognostic role of pCR is inconsistent across studies. Molecular intrinsic subtyping and genomic signatures appear as more accurate predictors of benefit from NACT, but larger studies are needed. Anthracycline and taxane-based chemotherapy remains the standard NACT; however, CDK 4/6 inhibitors and immune checkpoint inhibitors are under evaluation. In conclusion, NACT may be proposed for luminal tumors requiring downsizing for BCS after multidisciplinary evaluation, provided that other contraindications to BCS are excluded.
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Affiliation(s)
- Rosalba Torrisi
- IRCCS Humanitas Research Hospital, Dept of Medical Oncology and Hematology Unit, via Manzoni 56, Rozzano, Milan, 20089, Italy.
| | - Emilia Marrazzo
- IRCCS Humanitas Research Hospital, Breast Unit, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Elisa Agostinetto
- IRCCS Humanitas Research Hospital, Dept of Medical Oncology and Hematology Unit, via Manzoni 56, Rozzano, Milan, 20089, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20090, Italy
| | - Rita De Sanctis
- IRCCS Humanitas Research Hospital, Dept of Medical Oncology and Hematology Unit, via Manzoni 56, Rozzano, Milan, 20089, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20090, Italy
| | - Agnese Losurdo
- IRCCS Humanitas Research Hospital, Dept of Medical Oncology and Hematology Unit, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Giovanna Masci
- IRCCS Humanitas Research Hospital, Dept of Medical Oncology and Hematology Unit, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Corrado Tinterri
- IRCCS Humanitas Research Hospital, Breast Unit, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Dept of Medical Oncology and Hematology Unit, via Manzoni 56, Rozzano, Milan, 20089, Italy; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20090, Italy
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19
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Laas E, Bresset A, Féron JG, Le Gal C, Darrigues L, Coussy F, Grandal B, Laot L, Pierga JY, Reyal F, Hamy AS. HER2-Positive Breast Cancer Patients with Pre-Treatment Axillary Involvement or Postmenopausal Status Benefit from Neoadjuvant Rather than Adjuvant Chemotherapy Plus Trastuzumab Regimens. Cancers (Basel) 2021; 13:cancers13030370. [PMID: 33498405 PMCID: PMC7864202 DOI: 10.3390/cancers13030370] [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: 12/08/2020] [Revised: 01/10/2021] [Accepted: 01/16/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Neoadjuvant chemotherapy strategy (NAC) is a standard of care for Human Epidermal Growth Factor Receptor-2 (HER2)-positive early breast cancer but there is no proven beneficial evidence in terms of survival compared to the adjuvant chemotherapy strategy. Our retrospective study found a survival benefit in NAC strategy particularly in clinical Nodepositive and postmenopausal patients. Abstract Background: No survival benefit has yet been demonstrated for neoadjuvant chemotherapy (NAC) against HER2-positive tumors in patients with early breast cancer (BC). The objective of this study was to compare the prognosis of HER2-positive BC patients treated with NAC to that of patients treated with adjuvant chemotherapy (AC). Materials and methods: We retrospectively analyzed disease-free (DFS) and overall survival (OS) in 202 HER2-positive patients treated with NAC and 701 patients treated with AC. All patients received trastuzumab in addition to chemotherapy. Patient data were weighted by a propensity score to overcome selection bias. Results: After inverse probability of treatment weights (IPTW) adjustment, no difference in DFS (p = 0.3) was found between treatments for the total population. However, after multivariate analysis, an interaction was found between cN status and chemotherapy strategy (IPTW-corrected corrected Hazard ratio cHR = 0.52, 95% CI (0.3–0.9), pinteraction = 0.08) and between menopausal status and chemotherapy (CT) strategy (cHR = 0.35, 95%CI (0.18–0.7)) pinteraction < 0.01). NAC was more beneficial than AC strategy in cN-positive patients and in postmenopausal patients. Moreover, after IPTW adjustment, the multivariate analysis showed that the neoadjuvant strategy conferred a significant OS benefit (cHR = 0.09, 95%CI [0.02–0.35], p < 0.001). Conclusion: In patients with HER2-positive BC, the NAC strategy is more beneficial than the AC strategy, particularly in cN-positive and postmenopausal patients. NAC should be used as a first-line treatment for HER2-positive tumors.
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Affiliation(s)
- Enora Laas
- Department of Surgery, Institut Curie, 5 rue d’Ulm, 75005 Paris, France; (E.L.); (J.-G.F.); (C.L.G.); (L.L.)
| | - Arnaud Bresset
- Gynecology Department, Beaujon Hospital, 92210 Clichy, France;
| | - Jean-Guillaume Féron
- Department of Surgery, Institut Curie, 5 rue d’Ulm, 75005 Paris, France; (E.L.); (J.-G.F.); (C.L.G.); (L.L.)
| | - Claire Le Gal
- Department of Surgery, Institut Curie, 5 rue d’Ulm, 75005 Paris, France; (E.L.); (J.-G.F.); (C.L.G.); (L.L.)
| | - Lauren Darrigues
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 75005 Paris, France; (L.D.); (B.G.); (A.-S.H.)
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, 75005 Paris, France; (F.C.); (J.-Y.P.)
| | - Beatriz Grandal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 75005 Paris, France; (L.D.); (B.G.); (A.-S.H.)
| | - Lucie Laot
- Department of Surgery, Institut Curie, 5 rue d’Ulm, 75005 Paris, France; (E.L.); (J.-G.F.); (C.L.G.); (L.L.)
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, 75005 Paris, France; (F.C.); (J.-Y.P.)
| | - Fabien Reyal
- Department of Surgery, Institut Curie, 5 rue d’Ulm, 75005 Paris, France; (E.L.); (J.-G.F.); (C.L.G.); (L.L.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 75005 Paris, France; (L.D.); (B.G.); (A.-S.H.)
- Correspondence: ; Tel.: +33-(0)-6-15-27-19-80
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 75005 Paris, France; (L.D.); (B.G.); (A.-S.H.)
- Department of Medical Oncology, Institut Curie, 75005 Paris, France; (F.C.); (J.-Y.P.)
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20
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Devane LA, Baban CK, O'Doherty A, Quinn C, McDermott EW, Prichard RS. The Impact of Neoadjuvant Chemotherapy on Margin Re-excision in Breast-Conserving Surgery. World J Surg 2021; 44:1547-1551. [PMID: 32002582 DOI: 10.1007/s00268-020-05383-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) can improve cosmesis by reducing resection volume. Breast-conserving surgery (BCS) aims to achieve clear excision margins while optimizing cosmesis. However, the influence of NAC on margin re-excision after BCS is unclear. This study examines the rate and determinants of margin re-excision in patients undergoing BCS following NAC in our institution. METHODS From 2011-2015, all patients treated with NAC prior to BCS were identified from a prospectively maintained database. Mann-Whitney and Fisher's exact test tests were used to compare variables in patients who did and did not require re-excision. Patients undergoing primary surgical treatment in 2015 comprised an unmatched comparison group. RESULTS Of 211 patients treated with NAC, 69 initially underwent BCS. The re-excision rate was 32% (n = 22) compared to 17% in the primary operable group (38 of 221, p = 0.02). Re-excision rates were lowest in triple-negative and HER2+ tumors (0% and 10%, respectively). Lobular carcinoma and ER+ tumors had a significantly higher rate of re-excision (100% and 42%, respectively). Of 22 patients undergoing re-excision, 9 had further BCS and 13 had a mastectomy. CONCLUSION The re-excision rate following NAC is almost twice that of patients who underwent primary operative management. Her2+ and triple-negative tumors have lower re-excision rates and may represent a selected cohort most suitable for BCS. Patients with invasive lobular carcinoma or ER+ disease have significantly higher rates of margin positivity, and these patients should be considered for a cavity shave during primary surgery to reduce the rates of re-excision.
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Affiliation(s)
- Liam A Devane
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Chwanrow K Baban
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A O'Doherty
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Cecily Quinn
- Department of Pathology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Enda W McDermott
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ruth S Prichard
- Department of Breast Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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21
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Yang C, Lei C, Zhang Y, Zhang J, Ji F, Pan W, Zhang L, Gao H, Yang M, Li J, Wang K. Comparison of Overall Survival Between Invasive Lobular Breast Carcinoma and Invasive Ductal Breast Carcinoma: A Propensity Score Matching Study Based on SEER Database. Front Oncol 2020; 10:590643. [PMID: 33415073 PMCID: PMC7783385 DOI: 10.3389/fonc.2020.590643] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/13/2020] [Indexed: 11/22/2022] Open
Abstract
Objective Invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) account for most breast cancers. However, the overall survival (OS) differences between ILC and IDC remain controversial. This study aimed to compare nonmetastatic ILC to IDC in terms of survival and prognostic factors for ILC. Methods This retrospective cohort study used data from the Surveillance, Epidemiology and End Results (SEER) Cancer Database (www.seer.cancer.gov). Women diagnosed with nonmetastatic ILC and IDC between 2006 and 2016 were included. A propensity score matching (PSM) method was used in our analysis to reduce baseline differences in clinicopathological characteristics and survival outcomes. Kaplan-Meier curves and log-rank test were used for survival analysis. Results Compared to IDC patients, ILC patients were diagnosed later in life with poorly differentiated and larger lesions, as well as increased expression of estrogen receptors (ERs) and/or progesterone receptors (PRs). A lower rate of radiation therapy and chemotherapy was observed in ILC. After PSM, ILC, and IDC patients exhibited similar OS (HR=1.017, p=0.409, 95% CI: 0.967–1.069). In subgroup analysis of HR-negative, AJCC stage III, N2/N3 stage patients, or those who received radiotherapy, ILC patients exhibited worse OS compared to IDC patients. Furthermore, multivariate analysis revealed a 47% survival benefit for IDC compared to ILC in HR-negative patients who received chemotherapy (HR=1.47, p=0.01, 95% CI: 1.09–1.97). Conclusions Our results demonstrated that ILC and IDC patients had similar OS after PSM. However, ILC patients with high risk indicators had worse OS compared to IDC patients by subgroup analysis.
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Affiliation(s)
- Ciqiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chuqian Lei
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Breast and Thyroid Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yi Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Junsheng Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fei Ji
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weijun Pan
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liulu Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongfei Gao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mei Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jieqing Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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22
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Kim J, Kim JY, Lee HB, Lee YJ, Seong MK, Paik N, Park WC, Park S, Jung SP, Bae SY. Characteristics and prognosis of 17 special histologic subtypes of invasive breast cancers according to World Health Organization classification: comparative analysis to invasive carcinoma of no special type. Breast Cancer Res Treat 2020; 184:527-542. [PMID: 32794061 DOI: 10.1007/s10549-020-05861-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Breast cancer is a heterogeneous disease with various histopathologic subtypes. Except for invasive carcinoma of no special type (NST), other subtypes are rare with limited data. The purpose of this study was to analyze the characteristics and prognosis of special histopathologic subtypes of breast cancer compared to NST. METHODS A total of 136,140 patients were analyzed using the Korean Breast Cancer Society Registry database between January 1996 and March 2019. The clinicopathologic features and survival outcomes of special type breast carcinoma were compared with those of NST. RESULTS The prevalence of special subtypes other than NST was 13.7% (n = 18,633). Compared to NST, patients with lobular, medullary, metaplastic, and micropapillary carcinoma had larger tumors (p < 0.001). Patients with mucinous, tubular, medullary, metaplastic, and cribriform carcinoma presented with less node metastasis (p < 0.001), contrary to patients with micropapillary carcinoma. Patients with lobular, mucinous, tubular, papillary, and cribriform carcinoma presented as luminal A subtype much more often (p < 0.001). Micropapillary carcinoma included more luminal B subtype (p < 0.001). Typically, medullary and metaplastic carcinoma included more triple-negative subtypes (p < 0.001). In survival analysis, only medullary (Hazard Ratio (HzR) 0.542, 95% CI 0.345 to 0.852, p = 0.008) and metaplastic carcinoma (HzR 1.655, 95% CI 1.317 to 2.080, p < 0.001) showed significantly different overall survival from NST by multivariate analysis. CONCLUSION Breast cancer had distinct clinicopathologic features according to histopathologic subtype. However, special types of breast cancer had similar survival outcomes compared to NST when adjusting for other prognostic factors, except for metaplastic carcinoma and medullary carcinoma.
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Affiliation(s)
- Jiyoung Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, South Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Young Joo Lee
- Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Min-Ki Seong
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Namsun Paik
- Ewha Womans University Cancer Center Hospital for Women, Seoul, South Korea
| | - Woo-Chan Park
- Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Sungmin Park
- Department of Breast Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju-si, Republic of Korea
| | - Seung Pil Jung
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Soo Youn Bae
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea.
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23
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Tasdöven I, Karadeniz Çakmak G, Emre AU, Engin H, Bahadır B, Bakkal HB, Güllüoğlu MB. Intraoperative ultrasonography-guided surgery: An effective modality for breast conservation after neo-adjuvant chemotherapy. Breast J 2020; 26:1680-1687. [PMID: 33443786 DOI: 10.1111/tbj.13992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/05/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Abstract
Margin status is one of the significant prognostic factors for recurrence in breast-conserving surgery (BCS). The issue that merits consideration for oncologic safety and cost-effectiveness about the modalities to assure clear margins at initial surgical intervention remains controversial after neo-adjuvant chemotherapy (NAC). The presented study aimed to assess the impact of intraoperative ultrasound (IOUS)-guided surgery on accurate localization of tumor site, adequacy of excision with clear margins, and healthy tissue sacrifice in BCS after NAC. Patients who had IOUS-guided BCS ater NAC were reviewed. No patient had preoperative localization with wire or radiotracer. Intraoperative real-time sonographic localization, sonographic margin assessment during resection, macroscopic and sonographic examination of specimen, and cavity shavings (CS) were done as the standard procedure. No frozen assessment was performed. One hundred ninety-four patients were included, in which 42.5% had pCR. IOUS-guided surgery accomplished successful localization of the targeted lesions in all patients. Per protocol, all inked margins on CS specimens were reported to be tumor-free in permanent histopathology. No re-excision or mastectomy was required. For a setting without CS, the negative predictive value (NPV) of IOUS rate was 96%. IOUS was found to over and underestimate tumor response to NAC both in 2% of patients. IOUS-guided surgery seems to be an efficient modality to perform adequate BCS after NAC with no additional localization method. Especially, when CS is integrated as a standard to BCS, IOUS seems to provide safe surgery for patients with no false negativity and a high rate of NPV.
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Affiliation(s)
- Ilhan Tasdöven
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Güldeniz Karadeniz Çakmak
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Ali Ugur Emre
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Hüseyin Engin
- Department of Oncology, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Burak Bahadır
- Department of Pathology, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Hakan Bekir Bakkal
- Department of Radiation Oncology, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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24
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Reig B, Heacock L, Lewin A, Cho N, Moy L. Role of MRI to Assess Response to Neoadjuvant Therapy for Breast Cancer. J Magn Reson Imaging 2020; 52. [DOI: 10.1002/jmri.27145] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Beatriu Reig
- Department of Radiology New York University Grossman School of Medicine New York New York USA
- New York University Laura and Isaac Perlmutter Cancer Center New York New York USA
| | - Laura Heacock
- Department of Radiology New York University Grossman School of Medicine New York New York USA
- New York University Laura and Isaac Perlmutter Cancer Center New York New York USA
| | - Alana Lewin
- Department of Radiology New York University Grossman School of Medicine New York New York USA
- New York University Laura and Isaac Perlmutter Cancer Center New York New York USA
| | - Nariya Cho
- Department of Radiology Seoul National University Hospital Seoul Republic of Korea
- Department of Radiology Seoul National University College of Medicine Seoul Republic of Korea
| | - Linda Moy
- Department of Radiology New York University Grossman School of Medicine New York New York USA
- New York University Laura and Isaac Perlmutter Cancer Center New York New York USA
- Bernard and Irene Schwartz Center for Biomedical Imaging Department of Radiology, New York University Grossman School of Medicine New York New York USA
- Center for Advanced Imaging Innovation and Research (CAI2 R) New York University Grossman School of Medicine New York New York USA
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25
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Hu G, Hu G, Zhang C, Lin X, Shan M, Yu Y, Lu Y, Niu R, Ye H, Wang C, Xu C. Adjuvant chemotherapy could not bring survival benefit to HR-positive, HER2-negative, pT1b-c/N0-1/M0 invasive lobular carcinoma of the breast: a propensity score matching study based on SEER database. BMC Cancer 2020; 20:136. [PMID: 32085753 PMCID: PMC7035707 DOI: 10.1186/s12885-020-6614-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/07/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The benefit of adjuvant chemotherapy in invasive lobular carcinoma (ILC) is still unclear. The objective of the current study was to elucidate the effectiveness of adjuvant chemotherapy in hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, pT1b-c/N0-1/M0 ILC. METHODS Based on Surveillance, Epidemiology, and End-Results (SEER) database, we identified original 12,334 HR-positive, HER2-negative, pT1b-c/N0-1/M0 ILC patients, who were then divided into adjuvant chemotherapy group and control group. End-points were overall survival (OS) and breast cancer-specific mortality (BCSM). Aiming to minimize the selection bias of baseline characteristics, Propensity Score Matching (PSM) method was used. RESULTS In a total of 12,334 patients with HR-positive, HER2-negative, pT1b-c/N0-1/M0 ILC, 1785 patients (14.5%) were allocated into adjuvant chemotherapy group and 10,549 (85.5%) into control group. Used PSM, the 1785 patients in adjuvant chemotherapy group matched to the 1785 patients in control group. By Kaplan-Meier survival analyses, we observed no beneficial effect of adjuvant chemotherapy on OS in both original samples (P = 0.639) and matched samples (P = 0.962), however, ineffective or even contrary results of adjuvant chemotherapy on BCSM both in original samples (P = 0.001) and in matched samples (P = 0.002). In both original and matched multivariate Cox models, we observed ineffectiveness of adjuvant chemotherapy on OS (hazard ratio (HR) for overall survival = 0.82, 95% confidence interval (CI) [0.62-1.09]; P = 0.172 and HR = 0.90, 95%CI [0.65-1.26]; P = 0.553, respectively), unexpectedly promoting effect of adjuvant chemotherapy on BCSM (HR = 2.33, 95%CI [1.47-3.67]; P = 0.001 and HR = 2.41, 95%CI [1.32-4.39]; P = 0.004, respectively). Standard surgery was beneficial to the survival of patients. Lymph node metastasis was detrimental to survival and radiotherapy brought survival benefit in original samples, but two issues had unobvious effect in matched samples. CONCLUSION In this study, adjuvant chemotherapy did not improve survival for patients with HR-positive, HER2-negative pT1b-c/N0-1/M0 ILC.
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Affiliation(s)
- Guangfu Hu
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangxia Hu
- Department of Pathology, Binzhong People's Hospital, Affiliated to First Shandong Medical University, Binzhong, China
| | - Chengjiao Zhang
- Department of Psychological Measurement, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyan Lin
- Department of Breast Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Shan
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanmin Yu
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongwei Lu
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijie Niu
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Ye
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng Wang
- Department of Breast Surgery, Huangpu Branch, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Cheng Xu
- Department of Breast Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
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26
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Present clinical practice of breast cancer radiotherapy in Italy: a nationwide survey by the Italian Society of Radiotherapy and Clinical Oncology (AIRO) Breast Group. Radiol Med 2020; 125:674-682. [DOI: 10.1007/s11547-020-01147-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
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27
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Klarenbeek S, Doornebal CW, Kas SM, Bonzanni N, Bhin J, Braumuller TM, van der Heijden I, Opdam M, Schouten PC, Kersten K, de Bruijn R, Zingg D, Yemelyanenko J, Wessels LFA, de Visser KE, Jonkers J. Response of metastatic mouse invasive lobular carcinoma to mTOR inhibition is partly mediated by the adaptive immune system. Oncoimmunology 2020; 9:1724049. [PMID: 32117586 PMCID: PMC7028325 DOI: 10.1080/2162402x.2020.1724049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/14/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022] Open
Abstract
Effective treatment of invasive lobular carcinoma (ILC) of the breast is hampered by late detection, invasive growth, distant metastasis, and poor response to chemotherapy. Phosphoinositide 3-kinase (PI3K) signaling, one of the major druggable oncogenic signaling networks, is frequently activated in ILC. We investigated treatment response and resistance to AZD8055, an inhibitor of mammalian target of rapamycin (mTOR), in the K14-cre;Cdh1Flox/Flox;Trp53Flox/Flox (KEP) mouse model of metastatic ILC. Inhibition of mTOR signaling blocked the growth of primary KEP tumors as well as the progression of metastatic disease. However, primary tumors and distant metastases eventually acquired resistance after long-term AZD8055 treatment, despite continued effective suppression of mTOR signaling in cancer cells. Interestingly, therapeutic responses were associated with increased expression of genes related to antigen presentation. Consistent with this observation, increased numbers of tumor-infiltrating major histocompatibility complex class II-positive (MHCII+) immune cells were observed in treatment-responsive KEP tumors. Acquisition of treatment resistance was associated with loss of MHCII+ cells and reduced expression of genes related to the adaptive immune system. The therapeutic efficacy of mTOR inhibition was reduced in Rag1−/- mice lacking mature T and B lymphocytes, compared to immunocompetent mice. Furthermore, therapy responsiveness could be partially rescued by transplanting AZD8055-resistant KEP tumors into treatment-naïve immunocompetent hosts. Collectively, these data indicate that the PI3K signaling pathway is an attractive therapeutic target in invasive lobular carcinoma, and that part of the therapeutic effect of mTOR inhibition is mediated by the adaptive immune system.
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Affiliation(s)
- Sjoerd Klarenbeek
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Netherlands.,Experimental Animal Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Chris W Doornebal
- Oncode Institute, Utrecht, The Netherlands.,Division of Tumor Biology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjors M Kas
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Netherlands
| | - Nicola Bonzanni
- Oncode Institute, Utrecht, The Netherlands.,Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,ENPICOM, 's-Hertogenbosch, The Netherlands
| | - Jinhyuk Bhin
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Netherlands.,Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tanya M Braumuller
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Netherlands
| | - Ingrid van der Heijden
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Netherlands
| | - Mark Opdam
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Philip C Schouten
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kelly Kersten
- Oncode Institute, Utrecht, The Netherlands.,Division of Tumor Biology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Roebi de Bruijn
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Netherlands.,Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniel Zingg
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Netherlands
| | - Julia Yemelyanenko
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Netherlands
| | - Lodewyk F A Wessels
- Oncode Institute, Utrecht, The Netherlands.,Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of EEMCS, Delft University of Technology, Delft, The Netherlands
| | - Karin E de Visser
- Oncode Institute, Utrecht, The Netherlands.,Division of Tumor Biology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos Jonkers
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Oncode Institute, Utrecht, The Netherlands
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28
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Low total pathologic complete response rate to preoperative chemotherapy in patients with invasive lobular carcinomaof the breast. Contemp Oncol (Pozn) 2020; 23:247-250. [PMID: 31992958 PMCID: PMC6978764 DOI: 10.5114/wo.2019.91546] [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: 06/27/2019] [Accepted: 09/29/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Total pathologic complete response (tpCR; ypT0/is ypN0) after preoperative chemotherapy (PCT) is associated with better outcome in locally advanced breast cancers. However, the tpCR rate according to histology is not usually considered in trials. Material and methods Patients with invasive lobular breast carcinoma (ILC), who were included in three phase II trials (AT, ATX, and TXH), were eligible. Expression of markers and clinical phenotypes (CPh) were determined by immunohistochemistry. The primary endpoint was tpCR rate in patients with ILC. Secondary endpoints were breast-conserving surgery rate (BCSR), event-free survival (EFS), and overall survival (OS). Results In the subgroup of patients with ILC (n = 16) the median age was 50 years, 56.25% were premenopausal, median tumour size was 5 cm, and 68.75% had clinically node involvement. Six patients (37.5%) had clinical stage II, and 10 (62.5%) had clinical stage III. Hormone receptor-positive disease was present in 93.75% of the patients, and median Ki-67 was 25%. CPh were Luminal A-like in 37.5%, Luminal B-like in 50%, HER2-positive in 6.25%, and triple negative in 6.25% of tumours. Only one patient (6.25%) had a tpCR, and another patient had a pathologic complete response (pCR) only in the breast. With a median follow-up of 146 months, median EFS was 120 months (95% CI: 68–139), and median OS was not reached. Ten-year EFS and OS probability were 47% and 60%, respectively. BCSR was only 12.5%. Conclusions PCT in patients with ILC is associated with low tpCR rate because the majority of these patients have Luminal tumours with low chemo-sensitivity.
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29
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Thornton MJ, Williamson HV, Westbrook KE, Greenup RA, Plichta JK, Rosenberger LH, Gupta AM, Hyslop T, Hwang ES, Fayanju OM. Neoadjuvant Endocrine Therapy Versus Neoadjuvant Chemotherapy in Node-Positive Invasive Lobular Carcinoma. Ann Surg Oncol 2019; 26:3166-3177. [PMID: 31342392 DOI: 10.1245/s10434-019-07564-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) is often recommended for patients with node-positive invasive lobular carcinoma (ILC) despite unclear benefit in this largely hormone receptor-positive (HR+) group. We sought to compare overall survival (OS) between patients with node-positive ILC who received neoadjuvant endocrine therapy (NET) and those who received NACT. METHODS Women with cT1-4c, cN1-3 HR+ ILC in the National Cancer Data Base (2004-2014) who underwent surgery following neoadjuvant therapy were identified. Kaplan-Meier curves and Cox proportional hazards modeling were used to estimate unadjusted and adjusted overall survival (OS), respectively. RESULTS Of the 5942 patients in the cohort, 855 received NET and 5087 received NACT. NET recipients were older (70 vs. 54 years) and had more comorbidities (Charlson-Deyo score ≥ 1: 21.1% vs. 11.5%), lower cT classification (cT3-4: 44.2% vs. 51.0%), lower rates of mastectomy (72.5% vs. 82.2%), lower rates of pathologic complete response (0% vs. 2.5%), and lower rates of postlumpectomy (73.2% vs. 91.0%) and postmastectomy (60.0% vs. 80.8%) radiation versus NACT recipients (all p < 0.001). NACT recipients had higher unadjusted 10-year OS versus NET recipients (57.9% vs. 36.0%), but after adjustment, there was no significant difference in OS between the two groups (p = 0.10). CONCLUSIONS Patients with node-positive ILC who received NET presented with smaller tumors, older age, and greater burden of comorbidities versus NACT recipients but had similar adjusted OS. While there is evidence from clinical trials supporting efficacy of NET in HR+ breast cancer, our findings suggest the need for further, histology-specific investigation regarding the optimal inclusion and sequence of endocrine therapy and chemotherapy in ILC.
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Affiliation(s)
- M J Thornton
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - H V Williamson
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - K E Westbrook
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - R A Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - J K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - L H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - A M Gupta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - T Hyslop
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - E S Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - O M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, NC, USA. .,Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA. .,Durham VA Medical Center, Durham, NC, USA.
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Baker GM, King TA, Schnitt SJ. Evaluation of Breast and Axillary Lymph Node Specimens in Breast Cancer Patients Treated With Neoadjuvant Systemic Therapy. Adv Anat Pathol 2019; 26:221-234. [PMID: 31149907 DOI: 10.1097/pap.0000000000000237] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Breast and axillary lymph node specimens from breast cancer patients treated with neoadjuvant systemic therapy are being encountered by pathologists with increasing frequency. Evaluation of these specimens presents challenges that differ from those encountered during the examination of other types of breast specimens. This article reviews the key issues regarding the gross and microscopic evaluation of post-neoadjuvant systemic therapy breast and lymph node specimens, and emphasizes the importance of accurate specimen evaluation in assessing treatment response.
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Tamirisa N, Williamson HV, Thomas SM, Westbrook KE, Greenup RA, Plichta JK, Rosenberger LH, Hyslop T, Hwang ESS, Fayanju OM. The impact of chemotherapy sequence on survival in node-positive invasive lobular carcinoma. J Surg Oncol 2019; 120:132-141. [PMID: 31062375 DOI: 10.1002/jso.25492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/22/2019] [Accepted: 04/21/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES We sought to evaluate the impact of chemotherapy sequence on survival by comparing node-positive invasive lobular carcinoma (ILC) patients who received neoadjuvant (NACT) and adjuvant (ACT) chemotherapy. METHODS cT1-4c, cN1-3 ILC patients in the National Cancer Data Base (2004-2013) who underwent surgery and chemotherapy were divided into NACT and ACT cohorts. Kaplan-Meier curves and Cox proportional hazards modeling were used to estimate unadjusted and adjusted overall survival (OS), respectively. RESULTS Five thousand five hundred fifty-one (35.6%) of 15 573 ILC patients treated with chemotherapy received NACT. NACT patients had similar rates of pT3/4 disease (26.6% vs 26.2%), nodal involvement (median 3 vs 4), and number of lymph nodes examined (median 13 vs 14) but higher rates of mastectomy (81.8% vs 74.5%, P < 0.001) vs ACT patients. 3.4% of NACT patients experienced pathologic complete response (pCR). Unadjusted 10-year OS was worse for NACT vs ACT patients (65.1% vs 54.4%, log-rank P < 0.001). After adjustment for known covariates, NACT continued to be associated with worse OS (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.25-1.52). CONCLUSIONS In node-positive ILC, NACT yielded low rates of pCR, was not associated with lower rates of mastectomy or less extensive axillary surgery, and was associated with worse survival vs ACT, suggesting limited benefit for these patients.
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Affiliation(s)
- Nina Tamirisa
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hannah V Williamson
- Biostatistics Shared Resource, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | - Samantha M Thomas
- Biostatistics Shared Resource, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | - Kelly E Westbrook
- Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Women's Cancer Program, Duke Cancer Institute, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Women's Cancer Program, Duke Cancer Institute, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Women's Cancer Program, Duke Cancer Institute, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Women's Cancer Program, Duke Cancer Institute, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Terry Hyslop
- Biostatistics Shared Resource, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | - Eun-Sil Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Women's Cancer Program, Duke Cancer Institute, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Durham VA Medical Center, Durham, North Carolina.,Women's Cancer Program, Duke Cancer Institute, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
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Chen XH, Zhang WW, Wang J, Sun JY, Li FY, He ZY, Wu SG. 21-gene recurrence score and adjuvant chemotherapy decisions in patients with invasive lobular breast cancer. Biomark Med 2019; 13:83-93. [PMID: 30565472 DOI: 10.2217/bmm-2018-0396] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: To determine the effect of the 21-gene recurrence score (RS) on outcome and chemotherapy decision in breast invasive lobular carcinoma (ILC). Materials & methods: We included 6467 patients with early stage and estrogen receptor–positive ILC from the Surveillance, epidemiology, and end results database. Results: A total of 9.1, 31.4, and 70.1% of patients with low-, intermediate-, and high-risk RS groups received chemotherapy, respectively. A higher RS was independently associated with poor breast cancer-specific survival, and receipt of chemotherapy was not related to better breast cancer-specific survival in low-, intermediate-, or high-risk RS groups. Conclusion: The 21-gene RS could impact chemotherapy decision making in early-stage ILC. However, adjuvant chemotherapy does not appear to improve outcome in high-risk RS cohort.
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Affiliation(s)
- Xiang-Hong Chen
- Department of Breast Surgery, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Jun Wang
- Department of Radiation Oncology, Xiamen Cancer Hospital, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Feng-Yan Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, PR China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China
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Wang K, Zhu GQ, Shi Y, Li ZY, Zhang X, Li HY. Long-Term Survival Differences Between T1-2 Invasive Lobular Breast Cancer and Corresponding Ductal Carcinoma After Breast-Conserving Surgery: A Propensity-Scored Matched Longitudinal Cohort Study. Clin Breast Cancer 2018; 19:e101-e115. [PMID: 30502219 DOI: 10.1016/j.clbc.2018.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/01/2018] [Accepted: 10/24/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The role of histology subtype on the prognosis of T1-2 breast cancer patients receiving breast-conserving surgery (BCS) is not clear. METHODS The Surveillance, Epidemiology, and End Results (SEER) Program was used to compare overall survival, second primary cancer-free survival (CFS), and local recurrence risk (LR) for patients with invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC), both receiving BCS. RESULTS The study enrolled 196,688 patients with T1-2 disease receiving BCS, including 12,906 with ILC and 183,782 with IDC. Patients with IDC showed higher unadjusted annual rates of BCS than ILC. Five- and 10-year estimated survival rates were, respectively, 92.06% and 86.14% in ILC, compared to 90.50% and 85.26% in IDC (P = .12). In multivariable Cox regression, ILC patients showed advantage over IDC in overall survival (hazard ratio [HR] = 0.93, P = .001), whereas no significant differences in CFS (HR = 1.03, P = .33) and LR (HR = 1.17, P = .06) were found, which were consistent with results from matched cohort. In subgroup analyses, patients with grade III ILC had poorer CFS (HR = 1.23, P = .009) and higher LR (HR = 1.59, P = .01) than IDC. CONCLUSION Histologic type is of prognostic importance in T1-2 patients receiving BCS, and surgeons should be cautious in performing BCS for individuals with grade III ILC.
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Affiliation(s)
- Kang Wang
- Department of Endocrine and Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China, Fudan University, Shanghai, China
| | - Gui-Qi Zhu
- Liver Cancer Institute, Zhong Shan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
| | - Yang Shi
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA; Department of Epidemiology and Biostatistics, West China School of Public Health, West China Hospital, Sichuan University, Chengdu, China
| | - Zhu-Yue Li
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China; Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Zhang
- Department of Endocrine and Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China, Fudan University, Shanghai, China.
| | - Hong-Yuan Li
- Department of Endocrine and Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China, Fudan University, Shanghai, China.
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Riba LA, Russell T, Alapati A, Davis RB, James TA. Characterizing Response to Neoadjuvant Chemotherapy in Invasive Lobular Breast Carcinoma. J Surg Res 2018; 233:436-443. [PMID: 30502283 DOI: 10.1016/j.jss.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 07/08/2018] [Accepted: 08/02/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) for breast cancer is associated with improved survival and facilitates conservative surgical strategies. Invasive lobular carcinoma (ILC) has been observed to have decreased response to NCT compared with invasive ductal carcinoma (IDC). This study seeks to evaluate national trends in the use of NCT for ILC compared with IDC, and determine if there is a subset of ILC patients who demonstrate favorable response rates. METHODS This is a study using the National Cancer Database. The cohort consisted of patients with stage 1-3 ILC treated between 2010 and 2014, and a reference cohort of patient with IDC. For patients receiving NCT, pCR was assessed and clinically relevant variables were used in multivariable logistic regression models for each histologic subtype, modeling for pCR achievement. Survival analysis was performed for each histologic group to evaluate potential survival benefits of achieving pCR. RESULTS Our study cohort consisted of 384,887 women, of which 9.7% had ILC. A significantly lower rate of pCR after NCT was found in the cases of ILC compared with those of IDC (8.7% versus 23.2%). Increased response was seen in ILC patients with HER2-positive and TNBC subtypes. A survival benefit was demonstrated in patients with ILC who achieved pCR. CONCLUSIONS While response to NCT in patients with ILC is uncommon, our findings demonstrate a selective benefit for patients with HER2-positive tumors and TNBC. In addition, pCR is correlated with a clear survival advantage in ILC.
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Affiliation(s)
- Luis A Riba
- Department of Surgery/BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Teresa Russell
- Department of Surgery/BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amulya Alapati
- Department of Surgery/BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Roger B Davis
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ted A James
- Department of Surgery/BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Neoadjuvant therapy for breast cancer treatment: an expert panel recommendation from the Brazilian Society of Breast Surgeons 2018. Breast Cancer Res Treat 2018; 172:265-272. [DOI: 10.1007/s10549-018-4912-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 01/30/2023]
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36
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Vijayaraghavan GR, Vedantham S, Santos-Nunez G, Hultman R. Unifocal Invasive Lobular Carcinoma: Tumor Size Concordance Between Preoperative Ultrasound Imaging and Postoperative Pathology. Clin Breast Cancer 2018; 18:e1367-e1372. [PMID: 30131246 DOI: 10.1016/j.clbc.2018.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND We systematically analyzed the extent of disease in unifocal invasive lobular carcinoma (ILC) using ultrasonography, with the histopathologic findings as the reference standard. PATIENTS AND METHODS In the present single-institution retrospective study, 128 cases of ILC were identified during a 5-year period. After exclusions, the analyzed cohort included 66 cases. Ultrasound measurements of the tumor extent along 3 axes were obtained. The tumor size was determined as the largest extent among the 3 axes and the tumor volume by ellipsoidal approximation. Pathology review provided the tumor size and volume. Correlation and regression analyses of tumor size and volume from the ultrasound and pathologic examinations were performed. The tumor stage from the ultrasound and pathologic examinations were used for the concordance analyses. RESULTS The median and quartiles (Q1, Q3) of tumor size from ultrasonography and pathology were 12.5 mm (Q1, 9 mm; Q3, 19 mm) and 17 mm (Q1, 12 mm; Q3, 25 mm), respectively. The corresponding data for tumor volume were 0.52 cm3 (Q1, 0.18 cm3; Q3, 1.92 cm3) and 1.04 cm3 (Q1, 0.45 cm3; Q3, 2.49 cm3). The ultrasound measurements correlated with the pathology-reported tumor size (Spearman ρ = 0.678; P < .0001) and volume (Spearman ρ = 0.699; P < .0001). The ultrasound-measured size and volume differed from the pathology-reported size and volume (P < .0001; Wilcoxon signed ranks test). Concordance between the clinical tumor size stage from ultrasound (cT) and pathology tumor size stage (pT) varied with the pT stage (P = .0003, Fisher's exact test), with the greatest concordance rate of 95.7% (95% confidence limit, 85.2%-99.5%) observed for pT1 tumors. CONCLUSION Ultrasonography underestimates the tumor size and volume, with the underestimation increasing for larger tumors. Hence, the concordance rate in tumor size stage between ultrasonography and pathology is tumor size dependent, with the greatest concordance rate observed for pT1 tumors.
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Vugts G, Van den Heuvel F, Maaskant-Braat AJG, Voogd AC, Van Warmerdam LJC, Nieuwenhuijzen GAP, Van der Sangen MJ. Predicting breast and axillary response after neoadjuvant treatment for breast cancer: The role of histology vs receptor status. Breast J 2018; 24:894-901. [DOI: 10.1111/tbj.13085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/21/2017] [Accepted: 10/31/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Guusje Vugts
- Department of Surgery; Catharina Hospital; Eindhoven The Netherlands
- Department of Research; Netherlands Comprehensive Cancer Organisation; Utrecht The Netherlands
| | - Faizah Van den Heuvel
- Department of Surgery; Catharina Hospital; Eindhoven The Netherlands
- Department of Epidemiology; Maastricht University; Maastricht The Netherlands
| | | | - Adri C. Voogd
- Department of Research; Netherlands Comprehensive Cancer Organisation; Utrecht The Netherlands
- Department of Epidemiology; Maastricht University; Maastricht The Netherlands
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Abstract
Invasive lobular carcinoma (ILC) is the second most common type of breast cancer, with a unique pathogenesis and distinct clinical biology. ILCs display a characteristic loss of E-cadherin, are largely estrogen receptor positive, HER2 negative, and low to intermediate grade. These features portend a favorable prognosis, but there is a tendency for late recurrences and atypical metastases. ILCs tend to be insidious and infiltrative, which can pose a challenge for diagnosis, and emerging data suggest they may have a propensity for a differing response to standard therapies.
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Affiliation(s)
- Anita Mamtani
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tari A King
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston MA 02215, USA; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA 02215, USA.
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Gogia A, Raina V, Deo SVS, Shukla NK, Mathur S, Sharma DN. Neoadjuvant chemotherapy in locally advanced invasive lobular carcinoma: A limited institutional experience. South Asian J Cancer 2018; 7:64-65. [PMID: 29600240 PMCID: PMC5865103 DOI: 10.4103/sajc.sajc_17_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Raina
- Department of Medical Oncology, FMRI, Gurgaon, Haryana, India
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - N K Shukla
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Sharma
- Department of Radiation, All India Institute of Medical Sciences, New Delhi, India
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Tsung K, Grobmyer SR, Tu C, Abraham J, Budd GT, Valente SA. Neoadjuvant systemic therapy in invasive lobular breast cancer: Is it indicated? Am J Surg 2018; 215:509-512. [DOI: 10.1016/j.amjsurg.2017.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/29/2017] [Accepted: 11/01/2017] [Indexed: 11/15/2022]
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Breast-conserving surgery following neoadjuvant therapy-a systematic review on surgical outcomes. Breast Cancer Res Treat 2017; 168:1-12. [PMID: 29214416 PMCID: PMC5847047 DOI: 10.1007/s10549-017-4598-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/07/2017] [Indexed: 01/14/2023]
Abstract
Purpose Neoadjuvant chemotherapy (NACT) is increasingly used in breast cancer treatment. One of the main goals of NACT is to reduce the extent of local surgery of the breast and axilla. The aim of this study was to determine surgical outcomes for patients receiving breast-conserving therapy (BCT) after NACT, including margin status plus secondary surgeries, excision volumes, and cosmetic outcomes. Methods A systematic review was performed in accordance with PRISMA principles. Pubmed, MEDLINE, Embase, and the Cochrane Library were searched for studies investigating the results of BCT following NACT. The main study outcomes were margin status, additional local therapies, excision volumes, and cosmetic outcomes. Non-comparative studies on NACT were also included. Exclusion criteria were studies with less than 25 patients, and studies excluding secondary mastectomy patients. Findings Of the 1219 studies screened, 26 studies were deemed eligible for analysis, including data from 5379 patients treated with NACT and 10,110 patients treated without NACT. Included studies showed wide ranges of tumor-involved margins (2–39.8%), secondary surgeries (0–45.4%), and excision volumes (43.2–268 cm3) or specimen weight (26.4–233 g) after NACT. Most studies were retrospective, with a high heterogeneity and a high risk of bias. Cosmetic outcomes after NACT were reported in two single-center cohort studies. Both studies showed acceptable cosmetic outcomes. Interpretation There is currently insufficient evidence to suggest that NACT improves surgical outcomes of BCT. It is imperative that clinical trials include patient outcome measures in order to allow monitoring and meaningful comparison of treatment outcomes in breast cancer.
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Boyages J. Radiation therapy and early breast cancer: current controversies. Med J Aust 2017; 207:216-222. [PMID: 28987136 DOI: 10.5694/mja16.01020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/04/2016] [Indexed: 12/22/2022]
Abstract
Radiation therapy (RT) is an important component of breast cancer treatment. RT reduces local recurrence and breast cancer mortality after breast conservation for all patients and for node-positive patients after a mastectomy. Short courses of RT over 3-4 weeks are generally as effective as longer courses. A patient subgroup where RT can be avoided after conservative surgery has not been consistently identified. A radiation boost reduces the risk of a recurrence in the breast but may be omitted for older patients with good prognosis tumours with clear margins. Axillary recurrences can take a long time to appear, with 35% occurring after 5 years. Leaving disease untreated in regional nodes is associated with reduced survival. Not all patients require radiation after neoadjuvant chemotherapy and a subsequent mastectomy. Modern RT equipment and techniques will further improve survival rates.
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Cain H, Macpherson I, Beresford M, Pinder S, Pong J, Dixon J. Neoadjuvant Therapy in Early Breast Cancer: Treatment Considerations and Common Debates in Practice. Clin Oncol (R Coll Radiol) 2017; 29:642-652. [DOI: 10.1016/j.clon.2017.06.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 01/16/2023]
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Impact of the 21-gene recurrence score on outcome in patients with invasive lobular carcinoma of the breast. Breast Cancer Res Treat 2017. [DOI: 10.1007/s10549-017-4355-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Breast magnetic resonance imaging use in patients undergoing neoadjuvant chemotherapy is associated with less mastectomies in large ductal cancers but not in lobular cancers. Eur J Cancer 2017; 81:74-80. [PMID: 28618304 DOI: 10.1016/j.ejca.2017.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/29/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND To assess the impact of breast magnetic resonance imaging (MRI) use on surgical outcome per histological breast cancer subtype in patients treated with neoadjuvant chemotherapy. PATIENTS AND METHODS All patients aged 18-70 years who underwent neoadjuvant chemotherapy for stage I-III invasive breast cancer in the Netherlands in the years 2011-2013 were identified from the Netherlands Cancer Registry. Patients with cT4 tumours were excluded from the analysis. Use of breast MRI and impact on surgical treatment, resection margins and detection of contralateral breast cancer were analysed by multivariable analyses. RESULTS Breast MRI was performed in 2879 (83.9%) out of 3433 patients treated with neoadjuvant chemotherapy. Younger age (odds ratio [OR] 1.42; 95% confidence interval [CI] 1.17-1.71 for 18-50 years compared with 50-70 years), larger tumour stage (OR 1.46 [95% CI 1.15-1.86] for cT3, compared to cT1-2 tumours) and multifocality (OR 1.30; 95% CI 1.04-1.61, versus unifocality) were associated with increased breast MRI use. In ductal breast cancer, after stratification for cT-status, breast MRI use is associated with a significant lower OR for mastectomy as final surgery in cT3 tumours (OR 0.45, 95% CI 0.21-0.99). Resection margin involvement and detection of contralateral breast cancer were not associated with breast MRI use. CONCLUSION In patients treated with neoadjuvant chemotherapy, the use of breast MRI was associated with a reduced mastectomy rate, particularly in patients with large invasive ductal breast tumours but not in patients with lobular breast cancer.
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Petruolo OA, Pilewskie M, Patil S, Barrio AV, Stempel M, Wen HY, Morrow M. Standard Pathologic Features Can Be Used to Identify a Subset of Estrogen Receptor-Positive, HER2 Negative Patients Likely to Benefit from Neoadjuvant Chemotherapy. Ann Surg Oncol 2017; 24:2556-2562. [PMID: 28560596 DOI: 10.1245/s10434-017-5898-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The benefit of neoadjuvant chemotherapy (NAC) in patients with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancers and in invasive lobular carcinoma (ILC) is uncertain due to the low rates of pathologic complete response (pCR). OBJECTIVE The aim of this study was to determine if pathologic features can identify subsets likely to benefit from NAC. METHODS Patients with stage I-III ER+, HER2- breast cancer receiving NAC were retrospectively reviewed. Endpoints were downstaging to breast-conserving surgery (BCS) and nodal pCR after NAC. Patients were grouped by progesterone receptor (PR) status and grade/differentiation (high grade or poor [HP] vs. non-HP). RESULTS From 2007 to 2016, 402 ER+/HER2- cancers in patients receiving NAC were identified. Median age was 50 years, 98% were clinical stage II-III, and 75% were cN+. Overall pCR rate was 5%; breast pCR in 7% and nodal pCR in 15% of cN+ patients (p < 0.0001). Patients with ILC initially ineligible for BCS (n = 56) were less likely to downstage than those with invasive ductal carcinoma (IDC; n = 183, 16 vs. 48%, p ≤ 0.0001), with a similar trend in the axilla (p = 0.086). The rates of BCS eligibility after NAC were highest in PR-/HP patients (62%) and lowest in PR+/non-HP patients (29%) [p = 0.005]. In the axilla, nodal pCR among cN+ patients (n = 301) ranged from 0 to 35% (p < 0.0001) within these groups, and was most frequent in PR-/HP patients. CONCLUSIONS ER+/HER2- patients most likely to benefit from NAC are those with PR- and HP tumors. Patients with ILC are unlikely to downstage in the breast or axilla compared with IDC. The use of these criteria can assist in defining the initial treatment approach.
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Affiliation(s)
- Oriana A Petruolo
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea V Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Hannah Y Wen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
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Marmor S, Hui JYC, Huang JL, Kizy S, Beckwith H, Blaes AH, Rueth NM, Tuttle TM. Relative effectiveness of adjuvant chemotherapy for invasive lobular compared with invasive ductal carcinoma of the breast. Cancer 2017; 123:3015-3021. [PMID: 28382636 DOI: 10.1002/cncr.30699] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) have distinct clinical, pathologic, and genomic characteristics. The objective of the current study was to compare the relative impact of adjuvant chemotherapy on the survival of patients with ILC versus those with IDC. METHODS Women with estrogen receptor (ER)-positive, human epidermal growth factor receptor 1 (HER2) -negative, stage I/II IDC and ILC who received endocrine therapy were identified from the 2000 to 2014 California Cancer Registry. Patient, tumor, and treatment characteristics were collected. Ten-year overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional-hazards modeling. RESULTS In total, 32,997 women with IDC and 4638 with ILC were identified. The receipt of chemotherapy significantly decreased during the study for both subtypes. For patients with IDC, the 10-year OS rate was 95% among those who received endocrine therapy alone versus 93% (P < .01) among those who received endocrine therapy plus chemotherapy. For patients with ILC, the 10-year OS rate was 94% among those who received endocrine therapy alone versus 92% (P < .01) among those who received endocrine therapy plus chemotherapy. After adjusting for patient and treatment factors, adjuvant chemotherapy was significantly associated with a decreased 10-year hazard of death for patients with IDC (hazard ratio, 0.83; 95% confidence interval, 0.74-0.92). In contrast, adjuvant chemotherapy was not independently associated with the adjusted 10-year hazard of death for patients with ILC (hazard ratio, 1.14; 95% confidence interval, 0.90-1.46). CONCLUSIONS Adjuvant chemotherapy was not associated with improved OS for patients with ER-positive, HER2-negative, stage I/II ILC. Avoidance of ineffective chemotherapy will markedly reduce the adverse effects and economic burden of breast cancer treatment for a large proportion of patients with breast cancer. Cancer 2017;123:3015-21. © 2017 American Cancer Society.
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Affiliation(s)
- Schelomo Marmor
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | | | - Jing Li Huang
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Scott Kizy
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Heather Beckwith
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Anne H Blaes
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Natasha M Rueth
- Department of Surgical Oncology, Abbot Northwestern Hospital, Minneapolis, Minnesota
| | - Todd M Tuttle
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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Truin W, Roumen RMH, Siesling S, van de Vijver KK, Tjan-Heijnen VCG, Voogd AC. Estrogen and progesterone receptor expression levels do not differ between lobular and ductal carcinoma in patients with hormone receptor-positive tumors. Breast Cancer Res Treat 2017; 164:133-138. [PMID: 28365833 PMCID: PMC5487722 DOI: 10.1007/s10549-017-4220-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 11/29/2022]
Abstract
Background Differences in estrogen (ER) and progesterone (PR) expression between invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) could be an underlying reason for the difference in chemo-sensitivity and response to hormonal therapy between ILC and IDC. The aim of this study was to investigate the differences in ER and PR expression levels between postmenopausal patients with hormonal receptor-positive ILC and IDC. Methods We included all ER and/or PR receptor-positive ILC and IDC, diagnosed between January 2011 and December 2013 from the population-based Netherlands Cancer Registry. A semi-quantitative classification was used to analyze differences in ER/PR expression, which consisted of three ER expression classes: 10–69, 70–89, and ≥90%. Differences in ER and PR expression levels between IDC and ILC were analyzed according to age group, tumor size, axillary nodal status, grade, and HER2 status. Results In total, 26,339 ER and/or PR-positive breast cancers were included in the study, of which 17% were ILC and 83% IDC. In patients with IDC, 86% of the tumors showed an ER expression level of 90% or more, compared to 84% in those with ILC. In both IDC and ILC a PR expression level of 90% or more was observed in 54% of the tumors. In postmenopausal patients aged 50–69 years no significant differences could be observed in ER and PR expression levels between ILC and IDC. Conclusion Patients with ER and PR-positive ILC and IDC have similar quantitative ER and PR expression profiles, implicating that ER/PR expression is unlikely to be a confounding factor in studies concerning chemo-sensitivity of ILC and IDC.
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MESH Headings
- Aged
- Breast Neoplasms/diagnosis
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/pathology
- Diagnosis, Differential
- Estrogens/genetics
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Middle Aged
- Netherlands
- Progesterone/genetics
- Receptors, Estrogen/genetics
- Receptors, Progesterone/genetics
- Treatment Outcome
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Affiliation(s)
- Wilfred Truin
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Koen K van de Vijver
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Adri C Voogd
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
- Department of Epidemiology, Maastricht University Medical Center, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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Ataseven B, von Minckwitz G. The Impact of Neoadjuvant Treatment on Surgical Options and Outcomes. Ann Surg Oncol 2016; 23:3093-9. [DOI: 10.1245/s10434-016-5364-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 11/18/2022]
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Lobbezoo D, Truin W, Voogd A, Roumen R, Vreugdenhil G, Dercksen MW, van den Berkmortel F, Smilde T, van de Wouw A, van Kampen R, van Riel J, Peters N, Peer P, Tjan-Heijnen VC. The role of histological subtype in hormone receptor positive metastatic breast cancer: similar survival but different therapeutic approaches. Oncotarget 2016; 7:29412-9. [PMID: 27121067 PMCID: PMC5045405 DOI: 10.18632/oncotarget.8838] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/28/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This study describes the differences between the two largest histological breast cancer subtypes (invasive ductal carcinoma (IDC) and invasive (mixed) lobular carcinoma (ILC) with respect to patient and tumor characteristics, treatment-choices and outcome in metastatic breast cancer. RESULTS Patients with ILC were older at diagnosis of primary breast cancer and had more often initial bone metastasis (46.5% versus 34.8%, P = 0.01) and less often multiple metastatic sites compared to IDC (23.7% versus 30.9%, P = 0.11). Six months after diagnosis of metastatic breast cancer, 28.1% of patients with ILC and 39.8% of patients with IDC had received chemotherapy with a longer median time to first chemotherapy for those with ILC (P = 0.001). After six months 84.8% of patients with ILC had received endocrine therapy versus 72.5% of patients with IDC (P = 0.0001). Median overall survival was 29 months for ILC and 25 months for IDC (P = 0.53). MATERIALS AND METHODS We included 437 patients with hormone receptor-positive IDC and 131 patients with hormone receptor-positive ILC, all diagnosed with metastatic breast cancer between 2007-2009, irrespective of date of the primary diagnosis. Patient and tumor characteristics and data on treatment and outcome were collected. Survival curves were obtained using the Kaplan-Meier method. CONCLUSIONS Treatment strategies of hormone receptor-positive metastatic breast cancer were remarkably different for patients with ILC and IDC. Further research is required to understand tumor behavior and treatment-choices in real-life.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/mortality
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Kaplan-Meier Estimate
- Middle Aged
- Receptor, ErbB-2
- Receptors, Estrogen
- Receptors, Progesterone
- Treatment Outcome
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Affiliation(s)
- Dorien Lobbezoo
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - Wilfred Truin
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Adri Voogd
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rudi Roumen
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Gerard Vreugdenhil
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | | | | | - Tineke Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Agnes van de Wouw
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Roel van Kampen
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, Atrium-Orbis, Sittard, The Netherlands
| | - Johanna van Riel
- Department of Internal Medicine, St Elisabeth Hospital, Tilburg, The Netherlands
| | - Natascha Peters
- Department of Internal Medicine, St Jans Hospital, Weert, The Netherlands
| | - Petronella Peer
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vivianne C.G. Tjan-Heijnen
- GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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