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Muhammad N, Azeem A, Bakar MA, Prajzendanc K, Loya A, Jakubowska A, Hamann U, Rashid MU. Contribution of constitutional BRCA1 promoter methylation to early-onset and familial breast cancer patients from Pakistan. Breast Cancer Res Treat 2023; 202:377-387. [PMID: 37528266 DOI: 10.1007/s10549-023-07068-x] [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: 05/19/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Constitutional BRCA1 promoter methylation has been identified as a potential risk factor for breast cancer (BC) in the Caucasian population. However, this data is lacking for BC patients of Asian origin. Therefore, we assessed the contribution of constitutional BRCA1 promoter methylation in Pakistani BC patients. METHODS A total of 385 BRCA1/2-negative index BC patients (197 early-onset BC (≤ 30 years), 152 familial BC, 17 familial BC and ovarian cancer, 19 male BC) and 107 healthy controls were screened for the constitutional BRCA1 promoter methylation by methylation-sensitive high-resolution melting assay. Overall, 131 patients displayed triple-negative BC (TNBC) and 254 non-TNBC phenotypes. The prevalence of BRCA1 promoter methylation was calculated based on clinicopathological characteristics using univariable and multivariable logistic regression models. RESULTS Constitutional BRCA1 promoter methylation was identified in 19.5% (75/385) of BC patients and 13.1% (14/107) of controls. The frequency of methylation was higher in early-onset BC (23.4% vs. 13.1%, P = 0.035) and TNBC patients (29.0% vs. 13.1%, P = 0.004) compared to controls. Methylation was also more prevalent in patients with high-grade than low-grade tumors (21.7% vs. 12.2%, P = 0.034) and progesterone receptor (PR)-negative than PR-positive tumors (26.0% vs. 13.9%, P = 0.004). Constitutional BRCA1 promoter methylation remained independently associated with TNBC phenotype (odds ratio 1.99; 95% CI 1.12-3.54; P = 0.02) after adjusting for BC diagnosis age, tumor grade, ER, and PR status. CONCLUSION Constitutional BRCA1 promoter methylation is associated with TNBC and can serve as a non-invasive blood-based biomarker for Pakistani TNBC patients.
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Affiliation(s)
- Noor Muhammad
- Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), 7-A, Block R-3, Johar Town, Lahore, 54770, Pakistan
| | - Ayesha Azeem
- Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), 7-A, Block R-3, Johar Town, Lahore, 54770, Pakistan
| | - Muhammad Abu Bakar
- Department of Cancer Registry and Clinical Data Management, SKMCH&RC, Lahore, Pakistan
| | - Karolina Prajzendanc
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Asif Loya
- Department of Pathology, SKMCH&RC, Lahore, Pakistan
| | - Anna Jakubowska
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
- Independent Laboratory of Molecular Biology and Genetic Diagnostics, Pomeranian Medical University, Szczecin, Poland
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Muhammad Usman Rashid
- Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), 7-A, Block R-3, Johar Town, Lahore, 54770, Pakistan.
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2
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Sghaier I, Zidi S, El-Ghali RM, Daldoul A, Aimagambetova G, Almawi WY. Unique ESR1 and ESR2 estrogen receptor gene variants associated with altered risk of triple-negative breast cancer: A case-control study. Gene 2023; 851:146969. [DOI: 10.1016/j.gene.2022.146969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
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3
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Chu QD, Hsieh MC, Yi Y, Lyons JM, Wu XC. Outcomes of Breast-Conserving Surgery Plus Radiation vs Mastectomy for All Subtypes of Early-Stage Breast Cancer: Analysis of More Than 200,000 Women. J Am Coll Surg 2022; 234:450-464. [PMID: 35290264 DOI: 10.1097/xcs.0000000000000100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent large retrospective studies suggest that breast-conserving therapy (BCT) plus radiation yielded better outcomes than mastectomy (MST) for women with early-stage breast cancer (ESBC). Whether this is applicable to the different subtypes is unknown. We hypothesize that BCT yielded better outcomes than MST, regardless of subtypes of ESBC. STUDY DESIGN Data on women diagnosed with first primary stage I to II breast cancer between 2010 and 2017 who underwent either BCT or MST were from the population-based 18 Surveillance, Epidemiology, and End Results cancer registries. The Kaplan-Meier method was used to estimate unadjusted 5-year overall survival and cause-specific survival. Univariable and multivariable Cox proportional regression models were used to determine the impact of surgical approaches on the hazard ratios adjusted for relevant demographic and clinical variables for molecular subtype (luminal A, luminal B, triple-negative, and HER2 enriched). RESULTS Of the 214,128 patients with breast cancer, 41.6% received MST. For the different subtypes, BCT yielded better 5-year overall survival and cause-specific survival than MST. After adjusting for demographic and clinical factors, the risk of overall survival and cause-specific survival was still statistically significantly higher among MST recipients than BCT recipients for all subtypes. CONCLUSIONS BCT yielded better survival rates than mastectomy for women with all subtypes of ESBC. The role of mastectomy for women with ESBC should be reassessed in future clinical trials.
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Affiliation(s)
- Quyen D Chu
- From the Departments of Surgery at LSU Health Sciences Center-Shreveport, Louisiana (Chu)
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health at LSU Health Sciences Center-New Orleans, Louisiana (Hsieh, Yi, Wu)
| | - Yong Yi
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health at LSU Health Sciences Center-New Orleans, Louisiana (Hsieh, Yi, Wu)
| | - John M Lyons
- Our Lady of the Lake-Mary Bird Perkins Cancer Center, Baton Rouge, Louisiana (Lyons)
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry and Epidemiology Program, School of Public Health at LSU Health Sciences Center-New Orleans, Louisiana (Hsieh, Yi, Wu)
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De-la-Cruz-Ku G, Luyo M, Morante Z, Enriquez D, Möller MG, Chambergo-Michilot D, Flores L, Luque R, Saavedra A, Eyzaguirre-Sandoval ME, Luján-Peche MG, Noel N, Calderon H, Razuri C, Fuentes HA, Cotrina JM, Neciosup SP, Araujo J, Lema A, Pinto J, Gomez HL, Valcarcel B. Triple-negative breast cancer in Peru: 2000 patients and 15 years of experience. PLoS One 2020; 15:e0237811. [PMID: 32833983 PMCID: PMC7444821 DOI: 10.1371/journal.pone.0237811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background Epidemiological studies commonly identify the clinical characteristics and survival outcomes of patients with breast cancer at five years. Our study aims to describe the sociodemographic, clinicopathological characteristics and determine the long-term event-free survival (EFS) and overall survival (OS) of a Peruvian population with triple-negative breast cancer. Methods We reviewed the medical records of new cases treated at a single institution in the period 2000–2014. The survival analysis included patients with stages I-IV. Survival estimates at 10 years were calculated with the Kaplan-Meier method and compared with the Log-rank test. We further used multivariate Cox regression analysis to calculate prognostic factors of recurrence and mortality. Results Among the 2007 patients included, the median age at diagnosis was 49 years (19–95 years). Most patients presented histologic grade III (68.7%), tumor stage II (34.2%), and III (51.0%) at diagnosis. Local and distant relapse was present in 31.9 and 51.4% of the patients, respectively. The most frequent sites of metastasis were the lungs (14.5%), followed by bone (9.7%), brain (9.6%), and liver (7.9%). The median follow-up was 153 months. At 3, 5, and 10 years, the EFS of the population was 55%, 49%, and 41%, respectively, while the OS was 64%, 56%, and 47%, respectively. Moreover, an N3 lymph node status was the most important prognostic factor for both disease relapse (HR: 2.54, 95% CI: 2.05–3.15) and mortality (HR: 2.51, 95% CI: 2.01–3.14) at ten years. An older age and higher T staging were associated with a worse OS, while patients who received radiotherapy and adjuvant chemotherapy had better survival rates. Conclusion The sociodemographic features of Peruvian patients with TNBC are similar to those of other populations. However, our population was diagnosed at more advanced clinical stages, and thus, EFS and OS were lower than international reports while prognostic factors were similar to previous studies.
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Affiliation(s)
| | | | - Zaida Morante
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | - Mecker G. Möller
- Division of Surgical Oncology, University of Miami Miller School of Medicine, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, Miami, FL, United States of America
| | - Diego Chambergo-Michilot
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
- Tau-RELAPED Group, Trujillo, Peru
| | - Lucero Flores
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
| | - Renato Luque
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Humana (SCIEM UCSUR), Lima, Peru
| | - Antonella Saavedra
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Humana (SCIEM UCSUR), Lima, Peru
| | - Miguel E. Eyzaguirre-Sandoval
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Humana (SCIEM UCSUR), Lima, Peru
| | - María G. Luján-Peche
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Humana (SCIEM UCSUR), Lima, Peru
| | - Naysha Noel
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
| | - Hafid Calderon
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Humana (SCIEM UCSUR), Lima, Peru
| | | | | | | | | | - Jhajaira Araujo
- Unidad de Investigación Básica y Translacional, Oncosalud-AUNA, Lima, Peru
| | - Alexandra Lema
- Health Sciences Faculty, Universidad de Cuenca, Cuenca, Ecuador
| | - Joseph Pinto
- Unidad de Investigación Básica y Translacional, Oncosalud-AUNA, Lima, Peru
| | - Henry L. Gomez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Bryan Valcarcel
- Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
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Delineation of the Germline and Somatic Mutation Interaction Landscape in Triple-Negative and Non-Triple-Negative Breast Cancer. Int J Genomics 2020; 2020:2641370. [PMID: 32724790 PMCID: PMC7364202 DOI: 10.1155/2020/2641370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background Breast cancer development and progression involve both germline and somatic mutations. High-throughput genotyping and next-generation sequencing technologies have enabled discovery of genetic risk variants and acquired somatic mutations driving the disease. However, the possible oncogenic interactions between germline genetic risk variants and somatic mutations in triple-negative breast cancer (TNBC) and non-triple-negative breast cancer (non-TNBC) have not been characterized. Here, we delineated the possible oncogenic interactions between genes containing germline and somatic mutations in TNBC and non-TNBC and investigated whether there are differences in gene expression and mutation burden between the two types of breast cancer. Methods We addressed this problem by integrating germline mutation information from genome-wide association studies with somatic mutation information from next-generation sequencing using gene expression data as the intermediated phenotype. We performed network and pathway analyses to discover molecular networks and signalling pathways enriched for germline and somatic mutations. Results The investigation revealed signatures of differentially expressed and differentially somatic mutated genes between TNBC and non-TNBC. Network and pathway analyses revealed functionally related genes interacting in gene regulatory networks and multiple signalling pathways enriched for germline and somatic mutations for each type of breast cancer. Among the signalling pathways discovered included the DNA repair and Androgen and ATM signalling pathways for TNBC and the DNA damage response, molecular mechanisms of cancer, and ATM and GP6 signalling pathways for non-TNBC. Conclusions The results show that integrative genomics is a powerful approach for delineating oncogenic interactions between genes containing germline and genes containing somatic mutations in TNBC and non-TNBC and establishes putative functional bridges between genetic and somatic alterations and the pathways they control in the two types of breast cancer.
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6
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De-la-Cruz-Ku G, Valcarcel B, Morante Z, Möller MG, Lizandro S, Rebaza LP, Enriquez D, Luque R, Luján-Peche MG, Eyzaguirre-Sandoval ME, Saavedra A, Razuri C, Pinto JA, Fuentes HA, Neciosup SP, Gomez HL. Breast-conserving surgery vs. total mastectomy in patients with triple negative breast cancer in early stages: A propensity score analysis. Breast Dis 2020; 39:29-35. [PMID: 31903977 DOI: 10.3233/bd-190391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Breast-conserving surgery (BCS) as an alternative to total mastectomy (TM) in patients with early-stage triple-negative breast cancer (TNBC) is not widely spread. OBJECTIVE We aimed to compare the overall survival (OS) and disease-free survival (DFS) between both surgical approaches in early-stage TNBC patients at 10 years. METHODS We conducted a retrospective cohort study in TNBC female patients with stage I-IIa, treated at a single-center during the period of 2000-2014. We estimated and compared the survival rates with the Kaplan Meier and Long-rank test. Propensity scores were calculated with the generalized boosted regression model and were used in the multivariate Cox regression analysis with the covariate adjustment method. RESULTS We included 288 patients, 111 in the BCS vs. 177 in the TM group. The median follow-up was 102 months. Moreover, the patients in the BCS group had superior OS (85% vs. 81%, p = 0.56) and DFS (83% vs. 80%, p = 0.42) at 10 years. In the multivariate Cox analysis, BCS decreased the mortality risk (HR: 0.79, 95% CI: 0.37-1.67, p = 0.538), and the locoregional or distant recurrence risk (HR: 0.67, 95% CI: 0.32-1.41, p = 0.294), albeit with no statistical significance. CONCLUSION BCS is a safe alternative to TM in Latin-American patients with early-stage TNBC.
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Affiliation(s)
| | - Bryan Valcarcel
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
| | - Zaida Morante
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Mecker G Möller
- Division of Surgical Oncology, University of Miami Miller School of Medicine, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Sofia Lizandro
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
| | - Lia P Rebaza
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Daniel Enriquez
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Renato Luque
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
- Sociedad científica de estudiantes de Medicina Humana (SCIEM UCSUR), Lima, Peru
| | - María G Luján-Peche
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
- Sociedad científica de estudiantes de Medicina Humana (SCIEM UCSUR), Lima, Peru
| | - Miguel E Eyzaguirre-Sandoval
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
- Sociedad científica de estudiantes de Medicina Humana (SCIEM UCSUR), Lima, Peru
| | - Antonella Saavedra
- School of Medicine, Universidad Científica del Sur (UCSUR), Lima, Peru
- Sociedad científica de estudiantes de Medicina Humana (SCIEM UCSUR), Lima, Peru
| | | | - Joseph A Pinto
- Unidad de Investigación Básica y Translacional, Oncosalud-AUNA, Lima, Peru
| | - Hugo A Fuentes
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Silvia P Neciosup
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Henry L Gomez
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
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7
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Kumar S, Furrukh M, Al-Baimani K, Al-Ajmi A, Burney IA, Al-Moundhri MS. Outcomes of Women with Non-Metastatic Triple-Negative Breast Cancer in Oman: A single-centre experience. Sultan Qaboos Univ Med J 2019; 19:e209-e216. [PMID: 31728218 PMCID: PMC6839675 DOI: 10.18295/squmj.2019.19.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/11/2019] [Accepted: 03/22/2019] [Indexed: 12/31/2022] Open
Abstract
Objectives Triple-negative breast cancer (TNBC) is one of the most aggressive and heterogeneous variants of breast cancer. However, little is known regarding the prevalence and outcome of this entity in the Middle East. This study aimed to evaluate the outcomes of TNBC patients at a university hospital in Oman. Methods This retrospective study took place at the Sultan Qaboos University Hospital, Muscat, Oman, in May 2017. All patients diagnosed with non-metastatic TNBC between December 2000 and December 2015 were included. The patients’ electronic medical records were reviewed to identify their clinical and pathological characteristics as well as survival outcomes. Results A total of 79 patients were diagnosed with non-metastatic TNBC during the study period. The median age was 46 years, with approximately one-third of patients (31.6%) under 40 years of age. Almost half had an advanced tumour size (49.4%) or node-positive disease (48.1%) at presentation and only 16.6% demonstrated a complete pathological response (pCR) to neoadjuvant chemotherapy. The median survival for all patients was not reached within the study period; however, the median overall survival for stage III patients was 44.6 months. The five-year overall survival for all patients was 64%, increasing to 100% and 72% for patients with stage I and II, respectively, and dropping to 47% for those with stage III disease. Conclusion The findings of this study indicate that the majority of women with TNBC in Oman present at an advanced stage; moreover, such women have low rates of pCR to neoadjuvant chemotherapy and poor five-year survival.
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Affiliation(s)
- Shiyam Kumar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Muhammad Furrukh
- Department of Radiation Oncology, Shifa Cancer Center, Islamabad, Pakistan
| | - Khalid Al-Baimani
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Adil Al-Ajmi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ikram A Burney
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mansour S Al-Moundhri
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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8
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Supakalin N, Pesee M, Thamronganantasakul K, Promsensa K, Supaadirek C, Krusun S. Comparision of Different Radiotherapy Planning Techniques for Breast Cancer after Breast Conserving Surgery. Asian Pac J Cancer Prev 2018; 19:2929-2934. [PMID: 30362326 PMCID: PMC6291061 DOI: 10.22034/apjcp.2018.19.10.2929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives:To compare different radiotherapy planning techniques for breast cancer after breast conserving surgery.
Materials and methods: Eighteen patients with breast cancer who underwent breast conserving surgery were selected.
For each patient four different whole breast irradiation techniques including Tan, fIMRT, iIMRT and VMAT were
compared to the conventional tangential technique (Tan). Results: Mean maximum point dose (Dmax) for Tan, fIMRT,
iIMRT and VMAT were 110.17% (±1.87), 105.89% (±1.13), 106.47% (±0.92) and 106.99% (±1.16) (p<0.001). Mean
minimum point dose (Dmin) from Tan was 84.02% (±3.68) which was significantly higher than those from fIMRT,
iIMRT and VMAT which were 76.57% (±11.4), 67.69 %( ±19.20) and 80.69% (±7.06) (p<0.001). Only the mean
V95 of fIMRT was significantly less than Tan (p=0.01). Mean percentage of volume receiving ≥ 20 Gy (V20Gy) and
mean doses of the ipsilateral lung were 17.09% and 953.05 cGy, 16.60% and 879.20 cGy, 14.79% and 772.26 cGy,
15.32% and 984.34 cGy for Tan, fIMRT, iIMRT and VMAT. Only iIMRT had a significantly lower mean V20Gy and
the mean dose to ipsilateral lung in comparison with Tan. Significantly, high mean doses to the contralateral breast
(498.07 cGy, p<0.001) were observed in VMAT. Conclusion: The conventional tangential technique provides adequate
dose coverage but resulted in high dose-volumes. The iIMRT and fIMRT had significantly smaller high dose-volumes
and better conformity. VMAT demonstrated excellent dose homogeneity and conformity but an increased low-dose
volume outside the target should be of concern.
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Affiliation(s)
- Narudom Supakalin
- Division of Radiotherapy, Department of Radiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.
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Guo P, Pu T, Chen S, Qiu Y, Zhong X, Zheng H, Chen L, Bu H, Ye F. Breast cancers with EGFR and HER2 co-amplification favor distant metastasis and poor clinical outcome. Oncol Lett 2017; 14:6562-6570. [PMID: 29181099 PMCID: PMC5696709 DOI: 10.3892/ol.2017.7051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/28/2017] [Indexed: 02/05/2023] Open
Abstract
ErbB signaling serves essential roles in invasive ductal carcinoma (IDC). The aim of the present study was to assess gene amplification in ErbB family members in IDC with clinical implications. Quantitative polymerase chain reaction and fluorescence in situ hybridization were performed on formalin-fixed paraffin-embedded tumor samples for gene amplification detection. The clinical and histopathological characteristics, as well as the prognostic significance, were analyzed. Among the 119 IDC patients evaluated, epidermal growth factor receptor [EGFR; also known as human epidermal growth factor receptor (HER)1], HER2, HER3 and HER4 gene amplification was observed in 30 (25.2%), 44 (36.9%), 0 (0.0%) and 1 (0.8%) patients, respectively. EGFR amplification was associated with estrogen receptor status (P=0.028) and higher possibilities of recurrence (P=0.015) and distant metastasis (following initial surgery) (P=0.011). In survival analysis, EGFR amplification was also associated with disease-free survival (DFS) (P=0.001) and overall survival (OS) (P=0.003). HER2 amplification was associated with larger tumor size (P=0.006), later clinical stage (P=0.003) and distant metastasis (following initial surgery) (P=0.006). In survival analysis, HER2 amplification was also associated with DFS (P=0.011). Notably, the present study identified a group of patients in whom EGFR and HER2 were co-amplified. This group of patients appeared to have a higher possibility of metastasis (when diagnosed) (P=0.014) and distant metastasis (following initial surgery) (P<0.001). In survival analysis, these patients were noticed to be associated with DFS (P<0.001) and OS (P=0.002). With respect to treatment regimen, this was also true for the DFS association with chemotherapy (P<0.001), radiotherapy (P<0.001) and hormonal therapy (P=0.001). The present results suggest that EGFR and HER2 amplification favor distant metastasis following initial surgery and are significantly associated with poor clinical outcome in breast cancer patients.
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Affiliation(s)
- Peng Guo
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Tianjie Pu
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Pathology, State Key Laboratory of Biotherapy, National Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Shinan Chen
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yan Qiu
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Pathology, State Key Laboratory of Biotherapy, National Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiaorong Zhong
- Cancer Center, State Key Laboratory of Biotherapy, National Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Laboratory of Molecular Diagnosis of Cancer, State Key Laboratory of Biotherapy, National Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hong Zheng
- Cancer Center, State Key Laboratory of Biotherapy, National Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Laboratory of Molecular Diagnosis of Cancer, State Key Laboratory of Biotherapy, National Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Lina Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hong Bu
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Pathology, State Key Laboratory of Biotherapy, National Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Feng Ye
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Sikandar B, Qureshi MA, Naseem S, Khan S, Mirza T. Increased Tumour Infiltration of CD4+ and CD8+ T-Lymphocytes in Patients with Triple Negative Breast Cancer Suggests Susceptibility to Immune Therapy. Asian Pac J Cancer Prev 2017; 18:1827-1832. [PMID: 28749113 PMCID: PMC5648386 DOI: 10.22034/apjcp.2017.18.7.1827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: Patients with triple negative breast cancer (TNBC) have limited therapeutic options, largely because the complex tumour environment is not well-characterized. These patients are potential, but largely un-fathomed, candidates for immunotherapy. It is therefore highly relevant to characterize leukocyte complexity in TNBCs. Objective: To investigate leukocyte complexity in tumour environment of patients with TNBCs. Materials and methods: A total of 104 consecutive breast cancer patients undergoing mastectomy were recruited in the study after ethical approval. Clinico-pathological parameters were recorded and H and E staining was performed to investigate tumour morphology. Receptor status was investigated using antibodies against ER, PgR and Her-2, and patients were classified as having TNBC or non-TNBC tumours (including Luminal A, Luminal B and Her2 overexpressing tumours). Immune-cell infiltration was investigated using special stains and antibodies: α-CD3 (T-lymphocytes), α-CD20 (B-lymphocytes), α-CD4 (helper T-lymphocytes) and α-CD8 (cytotoxic T-lymphocytes). Immune cell densities were quantified as cell/mm2 using the CAP guidelines. Results: Of the 104 breast cancer patients investigated, a total of 27 (26%) had TNBC and 77(74%) non-TNBC. Patients with TNBC showed significantly increased tumour infiltration of lymphocytes (T and B-lymphocytes) compared to the patients with non-TNBC, while myelocytic infiltration was not significantly different in the two groups. Within the TNBC group, infiltration of T-lymphocytes (equal densities of CD4+ and CD8+ T-lymphocytes) was significantly higher compared to B-lymphocytes. Conclusion: Patients with TNBC show increased lymphocytic infiltration (more T-lymphocytes compared to B-lymphocytes). This suggests higher immunogenicity of TNBCs and may indicate a higher responsiveness of these cancers to immunotherapy.
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Affiliation(s)
- Bushra Sikandar
- Department of Pathology, Dow International Medical College, Dow Diagnostic Research and Reference Laboratory, Dow
University of Health Sciences Karachi, Pakistan.
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Kim S, Park HS, Kim JY, Ryu J, Park S, Kim SI. Comparisons of Oncologic Outcomes between Triple-Negative Breast Cancer (TNBC) and Non-TNBC among Patients Treated with Breast-Conserving Therapy. Yonsei Med J 2016; 57:1192-8. [PMID: 27401651 PMCID: PMC4960386 DOI: 10.3349/ymj.2016.57.5.1192] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The optimum local surgical strategy regarding breast-conserving therapy (BCT) for triple-negative breast cancer (TNBC) is controversial. To investigate whether BCT is appropriate for patients with TNBC, we evaluated the clinical outcomes of BCT in women with TNBC compared to those of women without TNBC, using a large, single-center cohort. MATERIALS AND METHODS We performed a retrospective analysis of 1533 women (TNBC n=321; non-TNBC n=1212) who underwent BCT for primary breast cancer between 2000 and 2010. Clinicopathological characteristics, locoregional recurrence-free survival (LRFS), and overall survival (OS) were analyzed. RESULTS Tumors from the TNBC group had a higher T stage (T2 37.4% vs. 21.0%, p<0.001), a lower N stage (N0 86.9% vs. 75.5%, p<0.001), and a higher histologic grade (Grade III 66.8% vs. 15.4%, p<0.001) than the non-TNBC group. There were no differences in 5-year LRFS rates between the TNBC and non-TNBC groups (98.7% vs. 97.8%, p=0.63). The non-TNBC group showed a slightly better 5-year OS than the TNBC group; however, the difference was not significant (96.2% vs. 97.3%, p=0.72). In multivariate analyses, TNBC was not associated with poor clinical outcomes in terms of LRFS and OS [hazard ratio (HR) for LRFS=0.37, 95% confidence interval (CI): 0.10-1.31; HR for OS=1.03, 95% CI: 0.31-3.39]. CONCLUSION TNBC patients who underwent BCT showed non-inferior locoregional recurrence compared to non-TNBC patients with BCT. Thus, BCT is an acceptable surgical approach in patients with TNBC.
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Affiliation(s)
- Sanghwa Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jegyu Ryu
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seho Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
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Rashid MU, Muhammad N, Bajwa S, Faisal S, Tahseen M, Bermejo JL, Amin A, Loya A, Hamann U. High prevalence and predominance of BRCA1 germline mutations in Pakistani triple-negative breast cancer patients. BMC Cancer 2016; 16:673. [PMID: 27553291 PMCID: PMC4995655 DOI: 10.1186/s12885-016-2698-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/09/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Women harboring BRCA1/2 germline mutations have high lifetime risk of developing breast/ovarian cancer. The recommendation to pursue BRCA1/2 testing is based on patient's family history of breast/ovarian cancer, age of disease-onset and/or pathologic parameters of breast tumors. Here, we investigated if diagnosis of triple-negative breast cancer (TNBC) independently increases risk of carrying a BRCA1/2 mutation in Pakistan. METHODS Five hundred and twenty-three breast cancer patients including 237 diagnosed ≤ 30 years of age and 286 with a family history of breast/ovarian cancer were screened for BRCA1/2 small-range mutations and large genomic rearrangements. Immunohistochemical analyses were performed at one center. Univariate and multiple logistic regression models were used to investigate possible differences in prevalence of BRCA1/2 mutations according to patient and tumor characteristics. RESULTS Thirty-seven percent of patients presented with TNBC. The prevalence of BRCA1 mutations was higher in patients with TNBC than non-TNBC (37 % vs. 10 %, P < 0.0001). 1 % of TNBC patients were observed to have BRCA2 mutations. Subgroup analyses revealed a larger proportion of BRCA1 mutations in TNBC than non-TNBC among patients 1) diagnosed at early-age with no family history of breast/ovarian cancer (14 % vs. 5 %, P = 0.03), 2) diagnosed at early-age irrespective of family history (28 % vs. 11 %, P = 0.0003), 3) had a family history of breast cancer (49 % vs. 12 %, P < 0.0001), and 4) those with family history of breast and ovarian cancer (81 % vs. 28 %, P = 0.0005). TNBC patients harboring BRCA1 mutations were diagnosed at a later age than non-carriers (median age at diagnosis: 30 years (range 22-53) vs. 28 years (range 18-67), P = 0.002). The association between TNBC status and presence of BRCA1 mutations was independent of the simultaneous consideration of family phenotype, tumor histology and grade in a multiple logistic regression model (Ratio of the probability of carrying BRCA1/2 mutations for TNBC vs. non-TNBC 4.23; 95 % CI 2.50-7.14; P < 0.0001). CONCLUSION Genetic BRCA1 testing should be considered for Pakistani women diagnosed with TNBC.
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Affiliation(s)
- Muhammad Usman Rashid
- Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), Lahore, Pakistan.,German Cancer Research Center (DKFZ), Molecular Genetics of Breast Cancer, Heidelberg, Germany
| | - Noor Muhammad
- Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), Lahore, Pakistan
| | - Seerat Bajwa
- Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), Lahore, Pakistan
| | - Saima Faisal
- Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), Lahore, Pakistan
| | - Muhammad Tahseen
- Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), Lahore, Pakistan
| | - Justo Lorenzo Bermejo
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Asim Amin
- Levine Cancer Institute (LCI), Charlotte, USA
| | - Asif Loya
- Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), Lahore, Pakistan
| | - Ute Hamann
- German Cancer Research Center (DKFZ), Molecular Genetics of Breast Cancer, Heidelberg, Germany.
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Park VY, Kim EK, Kim MJ, Yoon JH, Moon HJ. Breast parenchymal signal enhancement ratio at preoperative magnetic resonance imaging: association with early recurrence in triple-negative breast cancer patients. Acta Radiol 2016; 57:802-8. [PMID: 26516288 DOI: 10.1177/0284185115609803] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 09/02/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The signal enhancement ratio (SER) of surrounding non-tumor parenchyma at breast magnetic resonance imaging (MRI) can be helpful in breast cancer patients, but has not been investigated in patients with triple negative breast cancer (TNBC). PURPOSE To investigate the association between background parenchymal SER around the tumor on preoperative dynamic contrast-enhanced MRI with recurrence-free survival in patients with TNBC. MATERIAL AND METHODS Between April 2012 and May 2013, 71 TNBC patients who underwent preoperative MRI were included. SER values were calculated from regions of interest placed in the breast parenchyma around the tumor. Cox proportional hazards models were used to determine associations between MRI variables, clinical-pathologic variables, and recurrence-free survival. RESULTS Recurrence occurred in 8.5% (6/71) of patients. At univariate analysis, a higher SER around the tumor, larger tumor size, lymphovascular invasion, lymph node metastasis, receipt of neoadjuvant chemotherapy, receipt of total mastectomy, and not receiving adjuvant chemotherapy were associated with worse recurrence-free survival. At multivariate analysis of preoperative variables, a higher SER around the tumor was independently associated with worse recurrence-free survival (hazard ratio [HR] = 7.072, P = 0.003 for SER1; HR = 6.268, P = 0.006 for SER2; HR = 3.004, P = 0.039 for SER3). CONCLUSION Higher SER around the tumor at preoperative dynamic contrast-enhanced MRI is an independent predictor for recurrence in TNBC patients.
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Affiliation(s)
- Vivian Youngjean Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Payandeh M, Sadeghi M, Sadeghi E, Aeinfar M. Clinicopathology Figures and Long-term Effects of Tamoxifen Plus Radiation on Survival of Women with Invasive Ductal Carcinoma and Triple Negative Breast Cancer. Asian Pac J Cancer Prev 2016; 16:4863-7. [PMID: 26163605 DOI: 10.7314/apjcp.2015.16.12.4863] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Triple negative breast cancer (TNBC), characterized as estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 Her2 negative and accounting for 10-17% of all breast carcinomas, is only partially responsive to chemotherapy and suffers from a lack of clinically established targeted therapies. The aim of the current study was to evaluate the patterns of treatment and clinicopathology figures in Kurdish patients with triple-negative breast cancer, and to compare these to other reports. MATERIALS AND METHODS Between 2001 and 2014, 950 breast cancer patients were referred to our clinic. There were 74 female patients with TNBC, including 70 patients was invasive ductal carcinoma entered into our study. ER and PR positivity was defined as positive immunohistochemical staining in more than 10% of tumor cells. Immunohistochemistry assay with anti-HER2 antibodies was used to identify HER negative (0 and 1+) or positive (2+ and 3+). HER2 gene amplification was determined by fluorescent in situ hybridization (FISH). Overall survival (OS) was plotted with GraphPad Prism 5 Software using Kaplan-Meier and log-rank tests for comparison of results. RESULTS The mean age in the first diagnosis for 70 patients with triple TNBC and invasive ductal carcinoma was 49.6 years that range of age was 27-82 years. All of the patients were female. Of 70 patients, 23 patients had metastasis. Thirty-two patients (45.7%) were treated with tamoxifen and 39 (55.7%) with radiotherapy. Three-year, 5-year and 10-year OS rates for all patients were 82%, 72% and 64%, respectively. CONCLUSIONS The OS in our West Iran TNBC patients is less than reported elsewhere. However, treatment with combination of tamoxifen plus radiation increases the OS and reduces the mortality rate.
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Affiliation(s)
- Mehrdad Payandeh
- Department of Hematology and Medical Oncology, Kermanshah University of Medical Sciences, Kermanshah, Iran E-mail :
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Sun W, Li C, Liu M, Liu W, Yang C, Cai LI. Prognostic analysis of triple-negative breast cancer patients treated with adjuvant chemotherapy of fluorouracil, epirubicin and cyclophosphamide. Oncol Lett 2016; 11:2320-2326. [PMID: 26998170 DOI: 10.3892/ol.2016.4176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 01/15/2016] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to investigate the association between the clinicopathological and demographic factors, and the survival time of patients with triple-negative breast cancer (TNBC) in China. The patients had received adjuvant chemotherapy consisting of 5-fluorouracil, epirubicin and cyclophosphamide (FEC; 500 mg/m2 cyclophosphamide, day 1; 75 mg/m2 epirubicin, day 1; 500 mg/m2 5-fluorouracil, days 1 and 8; every 3 weeks, for at least 4 cycles). The clinicopathological and demographic factors affecting the outcome of the patients with TNBC that received adjuvant FEC chemotherapy were evaluated. Within these variables, the overall survival (OS) and disease-free survival (DFS) times were analyzed using the log-rank test, which was constructed using the multivariate Cox proportional hazards regression model and Kaplan-Meier analysis. Additionally, Spearman's χ2 test was used to analyze categorical variables. In the univariate statistical analysis, the significant risk factors for TNBC patient survival were the stage of disease and lymph node status, which were associated with the OS and DFS, and the total number of pregnancies, which was associated with the DFS. In the multivariate Cox proportional hazard model, lymph node status was an independent prognostic indicator of OS [P<0.001; hazard ratio (HR), 1.996; 95% confidence interval (CI), 1.465-2.720] and DFS (P<0.001; HR, 1.824; 95% CI, 1.315-2.531). By the Kaplan-Meier method, the stage of disease and lymph node status demonstrated a significant effect on OS and DFS. Patients with the lymph node status N3 and stage III disease possessed a poor prognosis and survival. An association between lymph node status and the tumor recurrence and mortality rate was identified. The area under the curves of the lymph node status for TNBC recurrence and mortality were 0.676 (P=0.002) and 0.685 (P=0.001), respectively. Additionally, the number of pregnancies was associated with tumor size, lymph node status and stages of disease. Lymph node status is an independent prognostic indicator of OS and DFS to TNBC patients with FEC adjuvant chemotherapy.
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Affiliation(s)
- Weiling Sun
- The Department of Endoscopy, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150040, P.R. China
| | - Chunhong Li
- The Fourth Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150040, P.R. China
| | - Meiyan Liu
- The Fourth Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150040, P.R. China
| | - Wei Liu
- The Fourth Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150040, P.R. China
| | - Chunyu Yang
- The Fourth Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150040, P.R. China
| | - L I Cai
- The Fourth Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150040, P.R. China
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