Suspected Accidental Infiltration of Rocuronium During General Anesthesia Induction: A Case Report

There are few reports on rocuronium infiltration under general anesthesia. We report a case of suspected accidental rocuronium infiltration during anesthesia induction. A 25-year-old woman with autism spectrum disorder, intellectual disability, and epilepsy was scheduled for the extraction of 4 impacted third molars under general anesthesia. After induction with sevoflurane, an intravenous (IV) line was established in the left cephalic vein. Rocuronium was administered; however, subcutaneous swelling at the IV site was observed immediately. Spontaneous ventilations were maintained until additional rocuronium was administered via a new IV line. After heat pack application, the swelling disappeared 60 minutes after infiltration, and no tissue damage was observed. A strategy was developed to continue neuromuscular monitoring until recovery occurred. Acceleromyography was used, and the train-of-4 ratios at 99, 130, and 140 minutes after infiltration were 0.79, 0.91, and 1.0, respectively. Sugammadex was administered to prevent neuromuscular blockade recurrence. The patient was extubated once adequate return of muscle function and consciousness were observed. No neuromuscular block prolongation or recurrence were observed postoperatively. When rocuronium infiltration is suspected, it is important to eliminate swelling at the infiltration site and determine a management strategy based on neuromuscular monitoring.

Risk factors for postoperative nausea and vomiting in patients of orthognathic surgery according to the initial onset time: a cross-sectional study

Background

A high incidence (40-73%) of postoperative nausea and vomiting (PONV) has been reported following orthognathic surgery, and various risk factors have been associated with it. Identifying PONV risk factors based on initial onset time will help establish preventive measures. This study aimed to identify factors that are significantly related to PONV based on the initial onset time after orthognathic surgery.

Methods

This study included 590 patients who underwent orthognathic surgery. Multivariate logistic regression analysis was performed to identify the risk factors that are significantly related to PONV. The objective variables were classified into three categories: no PONV, early PONV (initial onset time: 0-2 h after anesthesia), and late PONV (initial onset time: 2-24 h after anesthesia). The explanatory variables included relevant risk factors for PONV, as considered in previous studies.

Results

Total intravenous anesthesia with propofol was a significant depressant factor for early PONV (adjusted odds ratio [aOR] = 0.340, 95% confidence interval [CI] = 0.209-0.555) and late PONV (aOR = 0.535, 95% CI = 0.352-0.814). The administration of a combination of intraoperative antiemetics (vs. no administration) significantly reduced the risk of early PONV (aOR = 0.464, 95% CI = 0.230-0.961). Female sex and young age were significant risk factors for late PONV (aOR = 1.492, 95% CI = 1.170-1.925 and unit aOR = 1.033, 95% CI = 1.010-1.057, respectively).

Conclusion

We identified factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Total intravenous anesthesia with propofol significantly reduced the risk of PONV not only in the early period (0-2 h after anesthesia) but also in the late period (2-24 h after anesthesia).

Anesthetic management of a pediatric patient with Dravet syndrome: A case report

INTRODUCTION

Dravet syndrome (DS) is a rare and severe myoclonic epilepsy, with onset commonly occurring in infancy. Seizures are triggered by various causes, including fever, bathing, and light stimulus. DS is refractory to drug treatment. Moreover, status epilepticus (SE) can cause serious encephalopathy and epilepsy-related deaths. There are very few reports of general anesthesia in DS patients. Herein, we report our experience with the anesthetic management of a pediatric patient with DS.

PATIENT CONCERNS AND DIAGNOSES

A 5-year-old boy (height, 112 cm; weight, 19 kg) was diagnosed with DS through SCN1A genetic testing, which revealed a de novo novel missense mutation. His medical history included drug-resistant epilepsy, developmental delay, and hypotonia. His seizures tended to be triggered daily by a rise in body temperature (BT), bathing, and light stimulus. He could not receive adequate dental treatment due to DS, although he had previously undergone dental treatment under restraint at the pediatric dentistry department of our hospital.

INTERVENTIONS AND OUTCOMES

The patient was scheduled for intensive dental treatment under general anesthesia due to noncooperation, and DS-related limitations. By considering the risk posed by elevated BT, seizure-inducing drugs were avoided, and general anesthesia was completed as planned, uneventfully. Although fluctuation of BT occurred during the procedure, it was finally controlled at the end of anesthesia at about the same level as at anesthesia induction. However, small seizures and a single generalized convulsion were observed accompanied by fever on postoperative day 1. The patient was discharged from the hospital without major problems on postoperative day 3, because of detailed planning and close preoperative cooperation with the attending pediatrician.

CONCLUSION

It is essential to pay attention to managing BT and to avoid drugs that induce seizures during anesthesia for patients with DS. Cautious preoperative planning for anesthesia based on evaluation of the patient and rapid postoperative response in collaboration with the attending pediatrician is necessary in case an epileptic seizure occurs.

General anesthesia with a transcutaneous pacemaker for a Noonan syndrome patient with advanced atrioventricular block discovered in the remote period after open-heart surgery: a case report

We provided general anesthesia management to a patient with advanced atrioventricular block, which was discovered in the remote period after open-heart surgery. A 21-year-old man with Noonan syndrome was scheduled to undergo excision of a median intramandibular tumor. At 2 months of age, the patient underwent endocardial repair for congenital heart disease. During our preoperative examination, an atrioventricular block was detected, which had not been previously noted. Emergency drugs were administered, and a transcutaneous pacemaker was placed. During anesthesia induction, mask ventilation was easy, and intubation was performed smoothly using a video laryngoscope. The transcutaneous pacemaker was activated in demand mode at a pacing rate of 50 cycles/min approximately throughout the anesthesia time, and the hemodynamic status remained stable. The effect of intraoperatively administered atropine was brief, lasting only a few seconds. Although body movements due to thoracoabdominal muscle spasm were observed during pacemaker activation, they did not interfere with surgery. In postoperative patients with congenital heart disease, an atrioventricular block may be identified in the remote period, and preoperative evaluation should be based on this possibility. In addition, during anesthesia management, it is important to prepare multiple measures to maintain hemodynamic status.

Predictors of hypotension during anesthesia induction in patients with hypertension on medication: a retrospective observational study

Background

Hypotension during anesthesia induction is a common event, and occurs more frequently in patients with hypertension than in healthy individuals. Intraoperative hypotension in non-cardiac surgery is reportedly associated with various postoperative complications. However, the predictors of hypotension during anesthesia induction in patients with hypertension have not yet been ascertained. Therefore, we aimed to determine the predictors of hypotension during anesthesia induction in patients with hypertension on medication focusing on the half-life of the medication used.

Methods

In this retrospective observational study, we enrolled patients with hypertension on medication who underwent general anesthesia for oral and maxillofacial surgery between January 1, 2013, and December 31, 2019. Multivariable logistic regression analysis was conducted to test for associations between clinical factors and hypotension during anesthesia induction in patients with hypertension on medication.

Results

A total of 395 patients were included in this study. The risk factors for hypotension during anesthesia induction in patients with hypertension on medication were pre-induction mean arterial blood pressure (adjusted unit odds ratio, 0.96 [95% confidence interval, 0.94 to 0.98]), female sex (adjusted odds ratio [aOR], 1.63 [1.03 to 2.57]), regular use of angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors (ACE-Is) with a long half-life (vs. no regular use of ARBs/ACE-Is aOR, 4.02 [1.77 to 9.12]; vs. regular use of ARBs/ACE-Is with a short-to-middle half-life aOR, 3.17 [1.46 to 6.85]), and regular use of beta blockers (aOR, 2.45 [1.19 to 5.04]). Regular use of calcium channel blockers (aOR, 0.44 [0.25 to 0.77]) was a suppressive factor for hypotension during anesthesia induction in patients with hypertension.

Conclusions

In patients with hypertension on medication, regular use of ARBs/ACE-Is with a long half-life, regular use of beta blockers, low pre-induction mean arterial blood pressure, and female sex were risk factors for hypotension during anesthesia induction. Notably, regular use of ARBs/ACE-Is with a long half-life was a high-risk factor for hypotension during anesthesia induction in patients with hypertension on medication even after a 24-h preoperative withdrawal period.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-022-01899-9.

Cross-sectional Study of PONV Risk Factors for Oral Surgery After Intubated General Anesthesia With Total Intravenous Anesthesia

OBJECTIVE

The incidence of postoperative nausea and vomiting (PONV) after general anesthesia with total intravenous anesthesia (TIVA) was reported to be significantly lower than with volatile inhalational agents (13.3% vs 25%). However, no investigation of PONV risk factors associated with TIVA has ever been reported. This cross-sectional retrospective study aimed to investigate whether known risk factors influenced PONV in intubated general anesthetics utilizing TIVA for dental or oral and maxillofacial surgery.

METHODS

Subjects were 761 patients who underwent dental or oral and maxillofacial surgery under TIVA with propofol, fentanyl, and remifentanil. Univariate and multivariable logistic regression analyses were performed using PONV (within 24 hours) as the dependent variable and previously reported risk factors as independent variables.

RESULTS

Age (odds ratio [OR]: 1.020 per year decrease; 95% confidence interval [CI]: 1.0002-1.0418; P = .047) and female sex (OR: 2.73; 95% CI: 1.60-4.84; P < .001) were positively associated with PONV. Sagittal split ramus osteotomy (SSRO) (OR: 2.28; 95% CI: 1.21-4.33; P = .011) and bimaxillary osteotomy (OR: 5.69; 95% CI: 2.09-15.99; P < .001) were more likely to be associated with PONV than operations that were neither bimaxillary osteotomy nor SSRO. Late PONV (2-24 hours) had an ∼2.7 times higher incidence than early PONV (0-2 hours).

CONCLUSION

These findings suggest further PONV countermeasures, aside from TIVA with propofol and prophylactic antiemetics for orthognathic surgeries especially bimaxillary osteotomy, are needed.

Prolonged Washout Period for Avoiding Azilsartan-Induced Refractory Hypotension During General Anesthesia for a Patient With Renal Impairment

Angiotensin receptor blockers (ARBs) are widely used to treat hypertension, but severe refractory hypotension during general anesthesia is a well-known complication associated with the continuation of ARBs during the perioperative period. It has therefore been recommended that ARBs be withheld for 24 hours before induction of general anesthesia. However, impaired renal function affects the pharmacokinetics of each ARB differently. The half-life of azilsartan is prolonged in accordance with the degree of renal impairment. Herein, we describe a patient with chronic kidney disease grade 3B who experienced severe refractory hypotension after induction of general anesthesia requiring administration of dopamine following inadequate responses to ephedrine and phenylephrine despite a 24-hour azilsartan washout period. When the same patient underwent general anesthesia for a subsequent surgery, azilsartan was withheld for 48 hours before induction, resulting in mild intraoperative hypotension that responded adequately to phenylephrine. Severe refractory hypotension during general anesthesia cannot always be avoided by holding azilsartan for 24 hours in patients with significant renal impairment. Therefore, a longer washout period may be preferable for patients regularly taking azilsartan who also have concurrent substantial renal impairment.

Anesthetic Management of a Rett Syndrome Patient at High Risk for Respiratory Complications

Rett syndrome (RTT) is a rare genetic disorder that can present challenges in airway management during general anesthesia. This is a case report involving a 23-year-old woman with RTT who received an intubated general anesthetic 3 times for dental treatment. The patient also had severe scoliosis, was bedridden, and had dysphagia. These contributing factors likely led to the development of postoperative respiratory complications including pneumonia after the first case. As a result, several changes were incorporated into the 2 subsequent anesthetic plans in efforts to reduce the risk of such complications. Despite these measures, the patient was suspected of having bronchitis postoperatively after the second anesthetic, although the third occurred uneventfully. Anesthetic management alterations included use of desflurane for anesthetic maintenance and postoperatively delaying oral intake and instituting active postural changes.

Methemoglobinemia caused by a low dose of prilocaine during general anesthesia

Methemoglobinemia is a blood disorder in which an abnormal amount of methemoglobin is produced, and prilocaine is one of the drugs that can cause this disorder. The maximum recommended dose of prilocaine is 8 mg/kg. We report a case of methemoglobinemia caused by the administration of 4.2 mg/kg of prilocaine without other methemoglobinemia-inducing drugs during general anesthesia. A 17-year-old girl with hyperthyroidism and anemia was scheduled to undergo maxillary sinus floor elevation and tooth extraction. The patient's peripheral oxygen saturation (SpO₂) decreased from 100% at arrival to 95% after receiving prilocaine with felypressin following induction of general anesthesia. However, the fraction of inspired oxygen was 0.6. Blood gas analysis showed that the methemoglobin level was 3.8% (normal level, 1%–2%), fractional oxygen saturation was 93.9%, partial pressure of oxygen was 327 mmHg, and arterial oxygen saturation was 97.6%. After administration of 1 mg/kg of methylene blue, her SpO₂ improved gradually to 99%, and the methemoglobin value decreased to 1.2%. When using prilocaine as a local anesthetic, it is important to be aware that methemoglobinemia may occur even at doses much lower than the maximum recommended dose.

A Case of Methemoglobinemia Thought to Have Been Caused by the Combined Use of Propitocaine and Nitroglycerin During General Anesthesia

This is a case report of methemoglobinemia presumably caused by the combined use of prilocaine (propitocaine) and nitroglycerin under general anesthesia. Methemoglobinemia is reportedly caused by the administration of prilocaine at a dose of ≥8 mg/kg. Moreover, ≥3 μg/kg/min of nitroglycerin can also trigger methemoglobinemia. In this patient, methemoglobinemia occurred despite neither drug having been administered at the aforementioned doses. Even if individual doses of drugs predisposed to causing methemoglobinemia are low, combined use may increase the risk of methemoglobinemia.

Refractory Hypotension During General Anesthesia Despite Withholding Telmisartan

Angiotensin receptor blockers (ARBs) are commonly used to treat hypertension. However, similar to angiotensin-converting enzyme inhibitors, ARBs can also cause refractory hypotension during general anesthesia. Therefore, it has been recommended that ARBs be withheld for 24 hours prior to the induction of anesthesia. This is a case report of refractory hypotension requiring the administration of potent vasopressors after the induction of general anesthesia despite withholding telmisartan for 24 hours. In the same patient undergoing a subsequent general anesthetic, telmisartan was withheld for 5 days before induction, leading to mild intraoperative hypotension that responded adequately to phenylephrine. The primary cause of refractory hypotension during the first general anesthetic was suspected to be an insufficient telmisartan washout period. Telmisartan's half-life of 24 hours is notably the longest of all ARBs in current use. This case report demonstrates that refractory hypotension during general anesthesia cannot always be avoided by withholding telmisartan for 24 hours before the induction of anesthesia. Therefore, a washout period greater than 24 hours is preferable for patients taking telmisartan.

Development of Immortalized Human Tumor Endothelial Cells from Renal Cancer

Tumor angiogenesis research and antiangiogenic drug development make use of cultured endothelial cells (ECs) including the human microvascular ECs among others. However, it has been reported that tumor ECs (TECs) are different from normal ECs (NECs). To functionally validate antiangiogenic drugs, cultured TECs are indispensable tools, but are not commercially available. Primary human TECs are available only in small quantities from surgical specimens and have a short life span in vitro due to their cellular senescence. We established immortalized human TECs (h-imTECs) and their normal counterparts (h-imNECs) by infection with lentivirus producing simian virus 40 large T antigen and human telomerase reverse transcriptase to overcome the replication barriers. These ECs exhibited an extended life span and retained their characteristic endothelial morphology, expression of endothelial marker, and ability of tube formation. Furthermore, h-imTECs showed their specific characteristics as TECs, such as increased proliferation and upregulation of TEC markers. Treatment with bevacizumab, an antiangiogenic drug, dramatically decreased h-imTEC survival, whereas the same treatment failed to alter immortalized NEC survival. Hence, these h-imTECs could be a valuable tool for drug screening to develop novel therapeutic agents specific to TECs or functional biological assays in tumor angiogenesis research.

Abstract OT2-01-05: A randomized controlled trial comparing post-operative intensive follow-up with standard follow-up in high-risk breast cancer patients (JCOG1204: INSPIRE)

Background: The standard follow-up after surgery for breast cancer includes periodic interviews, clinical examinations, and mammography, but many institutions are conducting intensive follow-up including periodic computed tomography(CT), magnetic resonance imaging(MRI), and bone scintigraphy in the world, despite the lack of evidence to support this approach. While intensive follow-up may contribute to prolonged survival through earlier diagnosis and treatment of relapse, it has the disadvantages of high effort and costs placed on patients(pts) and healthcare workers, radiation exposure for imaging examinations, and overtreatment owing to false-positive results. Although past two randomized trials could not show significant difference in overall survival (OS), as imaging methods have remarkably improved, leading to the earlier detection of relapse, and medical therapies have remarkably improved in recent years, randomized controlled trials are needed to confirm whether intensive follow-up can really prolong survival sufficiently to offset these disadvantages in high-risk breast cancer pts.

Trial design: This study is a multi-institutional two-arm open label randomized controlled phase III trial being conducted with the participation of 42 hospitals belonging to the Breast Cancer Study Group of Japan Clinical Oncology Group. Eligible pts are randomized either to the intensive follow-up group or to the standard follow-up group; the former will undergo physical examination, bone scintigraphy, chest and abdominal CT, brain MRI/CT and frequent tumor markers, whereas the latter will undergo physical examination at the same frequency and tumor markers will be evaluated once a year. Mammography once a year is planned for both groups. This trial has been registered at the UMIN Clinical Trials Registry as UMIN000012429.

Eligibility criteria: High-risk breast cancer pts, who are expected to have recurrence rates of over 30% within 5 years after surgery. The main inclusion criteria are as follows: four or more axillary nodal metastases in the estrogen receptor (ER) positive pts without neoadjuvant chemotherapy(NC)., axillary node metastases in ER-negative pts without NC, axillary nodal metastases in ER-positive pts with NC, histologically proven residual invasive cancer in the breast or axilla in ER-negative with NC.

Specific Aims: The primary endpoint is OS, and secondary endpoints are disease-free survival, relapse-free survival, distant metastasis–free survival, OS in intrinsic subtypes, actual number of implemented examinations, compliance with pre-specified examinations, and adverse events.

Statistical methods: The primary endpoint will require a total of 538 events to be assessed in order to obtain a statistical power of 80% with a one-sided significance level of 0.05. Thus, the planned sample size to compare the two survival curves is set at 1500 pts, assuming an accrual time of 6 years and a follow-up time of 7 years according to the Schoenfeld and Richter's method.

Present accrual and target accrual: The trial was activated in November 2013. 773 pts have been enrolled by the end of June 2018.

Contact: Principal investigator Takashi Hojo MD tahojo@east.ncc.go.jp

Citation Format: Hojo T, Masuda N, Shibata T, Mizutani T, Shien T, Kinoshita T, Iwatani T, Kanbayashi C, Kitagawa D, Tsuneizumi M, Iwata H. A randomized controlled trial comparing post-operative intensive follow-up with standard follow-up in high-risk breast cancer patients (JCOG1204: INSPIRE) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-01-05.

Conscious sedation with midazolam intravenously for a patient with Parkinson's disease and unpredictable chorea-like dyskinesia

Oral surgery can be difficult in patients with chorea-like dyskinesia, which is common in those on long-term levodopa medication for Parkinson's disease, and we know of no conclusive evidence to indicate whether conscious sedation with midazolam is effective in such cases. We report a patient in whom levodopa-induced chorea-like dyskinesia disappeared when midazolam was given intravenously for conscious sedation.

ROS enhance angiogenic properties via regulation of NRF2 in tumor endothelial cells

Reactive oxygen species (ROS) are unstable molecules that activate oxidative stress. Because of the insufficient blood flow in tumors, the tumor microenvironment is often exposed to hypoxic condition and nutrient deprivation, which induces ROS accumulation. We isolated tumor endothelial cells (TECs) and found that they have various abnormalities, although the underlying mechanisms are not fully understood. Here we showed that ROS were accumulated in tumor blood vessels and ROS enhanced TEC migration with upregulation of several angiogenesis related gene expressions. It was also demonstrated that these genes were upregulated by regulation of Nuclear factor erythroid 2-related factor 2 (NRF2). Among these genes, we focused on Biglycan, a small leucine-rich proteoglycan. Inhibition of Toll-like receptors 2 and 4, known BIGLYCAN (BGN) receptors, cancelled the TEC motility stimulated by ROS. ROS inhibited NRF2 expression in TECs but not in NECs, and NRF2 inhibited phosphorylation of SMAD2/3, which activates transcription of BGN. These results indicated that ROS-induced BGN caused the pro-angiogenic phenotype in TECs via NRF2 dysregulation.

Abstract P3-13-17: A multi-center prospective study of radiofrequency ablation therapy for small breast carcinomas

Background: As the management of breast carcinoma evolves toward less invasive treatments, the next step is the possibility of removing the primary tumor without surgery. The most promising noninvasive ablation technique is radiofrequency ablation (RFA), which can effectively kill tumor cells with a low complication rate. Our preliminary studies of RFA followed by standard surgical resection have indicated that this technique is effective for surgical ablation of small (≤ 2cm) breast tumors without extensive intraductal components (EIC).

Methods: To determine if RFA is oncologically and cosmetically appropriate for the local treatment of primary breast carcinoma, this multi-center prospective study used RFA as the sole local treatment of breast tumors ≤ 1.5cm in size on ultrasound and MRI. Exclusion criteria include receiving of preoperative chemotherapy, or the presence of invasive lobular carcinoma or invasive ductal carcinoma with suspicious EIC. After confirmation that the standard baseline core biopsy for diagnosis and measurement of tumors markers (ER, PgR, HER-2/neu expression and the presence of the Ki-67 proliferative marker) have been obtained, consent will be obtained and the patient scheduled RFA. All patients received adjuvant radiation therapy. The use and choice of systemic therapy will be based on the information from the baseline core biopsy. The first primary endpoints of this study is successful tumor ablation, as evidenced by negative findings on vacuum-assisted or core biopsies and imaging studies after RFA. The second primary endpoints is the incidence of procedure related adverse events. Forty patients with small tumors that are clearly identifiable and measurable by ultrasound and MRI were enrolled. The response to ablation was evaluated with both vacuum-assisted or core biopsies and imaging studies every 3 months during the first year. The long-term outcomes were assessed using quality of life measurement scales and imaging studies every 6 months thereafter through year 5.

Results: Of the 58 patients who participated in this study, 55 completed the protocol. In 48 of the 55 (87%) treated patients, successful tumor ablation, as determined by negative findings on vacuum-assisted or core biopsies and imaging studies, was confirmed. The remaining 7 patients with biopsies positive for residual tumor underwent surgical resection. There were no local or distant recurrences in treated 55 patients with a median follow up of 47 (range 36-73) months.

Conclusions: RFA can be safely used alone in patients with small breast tumors, provided that local tumor control must be regularly assessed by image-guided vacuum-assisted or core biopsies after ablation. RFA has several potential advantages over lumpectomy for the treatment of early stage breast cancer.

Citation Format: Kinoshita T, Ohtani S, Doihara H, Yamamoto N, Takahashi M, Fujisawa T, Aogi K, Hojo T, Asaga S, Yoshida M, Tsuda H. A multi-center prospective study of radiofrequency ablation therapy for small breast carcinomas [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-13-17.

Upgrading of anaerobic digestion of waste activated sludge by a hyper-thermophilic–mesophilic temperature-phased process with a recycle system

A hyper-thermophilic–mesophilic temperature-phased anaerobic digestion with a recycle system effectively upgraded the mesophilic digestion of waste activated sludge.

Redox chemistry of nickel(II) complexes supported by a series of noninnocent β-diketiminate ligands

Nickel complexes of a series of β-diketiminate ligands ((R)L(-), deprotonated form of 2-substituted N-[3-(phenylamino)allylidene]aniline derivatives (R)LH, R = Me, H, Br, CN, and NO2) have been synthesized and structurally characterized. One-electron oxidation of the neutral complexes [Ni(II)((R)L(-))2] by AgSbF6 or [Ru(III)(bpy)3](PF6)3 (bpy = 2,2'-bipyridine) gave the corresponding metastable cationic complexes, which exhibit an EPR spectrum due to a doublet species (S = 1/2) and a characteristic absorption band in near IR region ascribable to a ligand-to-ligand intervalence charge-transfer (LLIVCT) transition. DFT calculations have indicated that the divalent oxidation state of nickel ion (Ni(II)) is retained, whereas one of the β-diketiminate ligands is oxidized to give formally a mixed-valence complex, [Ni(II)((R)L(-))((R)L(•))](+). Thus, the doublet spin state of the oxidized cationic complex can be explained by taking account of the antiferromagnetic interaction between the high-spin nickel(II) ion (S = 1) and the organic radical (S = 1/2) of supporting ligand. A single-crystal structure of one of the cationic complexes (R = H) has been successfully determined to show that both ligands in the cationic complex are structurally equivalent. On the basis of theoretical analysis of the LLIVCT band and DFT calculations as well as the crystal structure, the mixed-valence complexes have been assigned to Robin-Day class III species, where the radical spin is equally delocalized between the two ligands to give the cationic complex, which is best described as [Ni(II)((R)L(0.5•-))2](+). One-electron reduction of the neutral complexes with decamethylcobaltocene gave the anionic complexes when the ligand has the electron-withdrawing substituent (R = CN, NO2, Br). The generated anionic complexes exhibited EPR spectra due to a doublet species (S = 1/2) but showed no LLIVCT band in the near-IR region. Thus, the reduced complexes are best described as the d(9) nickel(I) complexes supported by two anionic β-diketiminate ligands, [Ni(I)((R)L(-))2](-). This conclusion was also supported by DFT calculations. Substituent effects on the electronic structures of the three oxidation states (neutral, cationic, and anionic) of the complexes are systematically evaluated on the basis of DFT calculations.

Abstract P3-02-06: Survival impact of early detection of recurrence after surgery in early breast cancer patients

Background and Object: Annual mammography and physical examination as the follow-up tests after surgery were recommended to early breast cancer patients based on the two randomized clinical trials (GIVIO and Rosselli Del Turco) which were reported in 1990s. Whereas, radiological imaging and blood test (serum tumor marker) for early detection of recurrence are not recommended due to the lack of evidence from clinical trial. However, the imaging techniques (helical CT, bone scan, PET/CT. MRI et al) to detect minute lesions and therapeutic options for metastatic breast cancer have been remarkably advanced since then. In fact, routine radiological examinations after surgery were performed in several Japanese hospitals for aiming early detection of recurrence as the clinical practice.

We here evaluate the possible benefit of early detection of recurrence by radiological and laboratory examinations during post-operative follow-up period.

Methods: Clinical information of breast cancer patients who were diagnosed as recurrence after surgery during 2005–2006 was collected from 30 hospitals in Japan. Clinical and pathological characteristics such as molecular subtype of breast cancer, survival time from initial therapy or 1st recurrence, detection methods and symptomatic information when they diagnosed as metastasis were analyzed retrospectively.

Results: As the routine examination of post-operative follow-up, serum tumor maker, chest x-ray/CT, abdominal US/CT and bone scan were done in 95%, 57%, 38%, 24% of 30 hospitals, respectively. Of the 698 patients individually evaluated in this analysis, 248 had loco-regional recurrences and 450 had distant metastases. The first distant metastatic site were 35% in bone, 30% in lung, 17% in liver and 11% in lymph node, respectively. All individual patients are divided into symptomatic (45.7%) or asymptomatic groups (54.3%) at the detection of metastases. Asymptomatic metastases were detected by serum tumor marker (26%), bone scan (18%), chest x-ray (17%), chest CT (17%), abdominal US (11%) and abdominal CT (5%), respectively. The median disease-free interval (DFI) was 3.0 years in both groups, but the median survival time after the diagnosis of recurrence to death were 3.7 years in asymptomatic patients and 3.0 years in symptomatic patients, respectively. In addition, asymptomatic group had significantly superior overall survival (from primary surgery to death) than symptomatic group with oligo-metastases such as limited organ disease (P &lt; 0.001).

Conclusions: Our data may support the hypothesis that early detection of breast cancer recurrences has beneficial impact on survival. Randomized clinical trial would be warranted to prove this hypothesis, and we are currently planning this.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-06.

P2-12-21: Impact of Recent Parity on Histopathological Tumor Features and Outcome of Young Women with Breast Cancer

Background

Younger age has been associated with worse outcome in breast cancer patients (pts) and recent parity has been epidemiologically identified as worse prognostic factor among women with breast cancer. The objective of this study was to explore potential factors associated with worse prognosis in young breast cancer pts, and to demonstrate the impact of parity on the histopathological tumor feature and patient outcome.

Materials and Methods: We retrospectively analyzed 634 early breast cancer pts younger than 45 years old who underwent surgery between 2000 and 2009. For statistical analysis, Pearson's and Fisher's exact test were used. Survival analysis was performed only for pts diagnosed before 2006 in order to obtain a minimum follow up 5 years.

Results: 108 women were diagnosed within 5 years since last parity (Group A), 216 were diagnosed &gt; 5 years since last parity (Group B) and 310 were nulliparous (Group C). Median age at diagnosis was 37 (range 26–44), 41 (range 32–44), and 38.5 (range 22–44) and family history (FH) of breast and/or ***ovarian cancer within second degree was found in 23, 22, and 23% of the pts in Groups A, B, and C, respectively. In Groups A, B and C, clinical stage was III in 22, 10 and 12% (p= .025), ER was positive in 65, 69 and 70% (p= .650), PgR was positive in 64, 75 and 74% (p= .057), and HER2 was positive in 25, 14 and 14% (p=.017), respectively. Tumors in Group A had higher histological grade (grade 3: 60/44/47%, p=.019), higher nuclear grade (grade 3: 61/47/48%, p=.036) and more lymph vessel invasion (61/52/45%, p=.015) compared to those in Groups B and C, respectively. Median follow up time was 85.1 months (range 1.8−137.1 months) during which there were 61 deaths. In univariate analysis, age and FH were not correlated with overall survival (OS). OS in Group A was significantly lower than in Group B (hazard ratio (HR) 3.51, 95% confidential interval (CI) 1.80−6.84, p&lt;.001) and in Group C (HR 2.42, 95%CI 1.36−4.29, p=.002), while OS did not differ significantly between Groups B and C. In the pts without FH, the HR of cancer death was more pronounced in Group A than in Group B (HR 4.25, 95%CI 1.97−9.14, p&lt;.001) or Group C (HR 2.67, 95%CI 1.43−5.01, p=.002), while there was no significant difference among the groups in pts with FH. In multivariate analysis among the pts without FH, lymph vessel invasion (HR 4.51, 95%CI 1.89−10.76, p=.001), Group A women (HR 2.28, 95%CI 1.25−4.17, p=.007), histological grade 3 (HR 2.72, 95%CI 1.28−5.77, p=.009), PgR negativity (HR 2.23, 95%CI 1.19−4.18, p=.013) and clinical stage II and III (HR 2.92, 95%CI 1.04−8.21, p=.04) were significantly associated with poor prognosis, adjusting for age.

Conclusion: Recent parity was associated with worse histopathological features in breast cancer of women younger than 45. It was also associated with worse outcome, especially among pts without FH. Recent parity seems to be a confounding factor for the worse outcome in young breast cancer patients, which justifies further studies to elucidate underlying biology.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-12-21.

Risk of breast cancer among Japanese women with a positive family history

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Background: Most breast cancer cases are sporadic, rather than associated with inherited gene mutations, such as BRCA1 and BRCA2. However, women with a family history of breast cancer are at increased risk of developing breast cancer compared to those women without any family history, even if they lack these gene mutations.

Methods: We analyzed 10892 patients including bilateral breast cancer cases (total of 11398 breast cancers) who underwent surgery at our hospital between 1962 and 2009. We excluded 295 cases whose family history data were not available. Clinical and pathological differences between following patient groups were tested; 9528 patients or 9955 cancers (88%) with negative family history (FH-), 896 patients or 951 cancers (8%) who had at least one first-degree relative with breast cancer (1FH+), 468 patients or 492 cancers (4%) who had second-degree relative with breast cancer (2FH+), and 1364 patients or 1443 cancers (12%) with family history regardless of first- or second-degree relative (FH+). Significance was established at a p-value of < 0.05.

Results: Among the family members, sisters were more likely to have treated for breast cancer (38% in FH+ group), followed by mothers (27%), aunts (26%), grandmothers (7%), and daughters (2%). The incidence of developing contralateral breast cancer was significantly higher in 1FH+ group, compared to patients in FH- and 2FH+ groups. No other factors showed any significant difference, including the incidence of cancer in other organs, pathological characteristics, and age of onset, although BRCA1 and BRCA2 mutation may be associated with increased risk of developing breast cancer at younger age. Outcome studies with available data did not show any significant difference in overall survival between FH+ and FH- patients.

Conclusions: A Japanese woman with a positive family history has a higher risk of developing breast cancer than women without any close relatives with breast cancer, similar to the results reported in Western countries where prevalence of breast cancer is higher. Regular checkup of contralateral breast is important for those patients whose first-degree relatives have also been diagnosed with breast cancer.

Study of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer

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Background: Despite the increasing use of both sentinel lymph node biopsy (SLNB) and preoperative chemotherapy (PST) in patients with operable breast cancer, there is still limited information on the feasibility and accuracy of SLNB following PST. In this study, the feasibility and accuracy of SLNB for breast cancer patients with clinically negative lymph nodes after PST were investigated. In addition, conditions that may affect SLN biopsy detection and false-negative rates with respect to clinical tumor response and clinical tumor/nodal status before PST were analyzed.

Methods: Between 2003 and 2008, 200 patients with stage II and III breast cancer previously treated with PST were enrolled in this study. The eligible criteria for PST were (a) primary tumor > 3cm or (b) positive axillary lymph node status on initial examination. FNA biopsy was performed for clinically or ultrasonographically suspicious axillary lymph nodes. The patients then underwent SLNB, which involved a combination of intradermal injection over the tumor of radiocolloid and subareolar injection of blue dye. This was followed by Level I/II axillary lymph node dissection (ALND).

Results: The median patient age was 49 years, and the median primary tumor size was 4.9 cm. The overall SLN identification rate was 94.5% (189 of 200). In 178/189 patients (94%) the SLN accurately predicted the axillary status. Eleven patients had a false-negative SLN biopsies, yielding a false-negative rate of 12.9%. There were no significant differences in the SLN identification rate according to tumor classifications before PST, the clinical nodal status before PST, the clinical tumor response after PST, or pathological response of the tumor after PST, although the SLN identification rate tended to be lower in patients with a T4 primary tumor.

Conclusions: Our data and some reports suggested that SLNB was feasible method for axillary staging in breast cancer patients who received PST even in patients who initially with lymph node positive disease. However, false-negative rate of SLNB in patients with clinical and pathological complete tumor response tended to be higher than other group.

Locoregional recurrence risk factor and indications for postmastectomy radiotherapy in Japanese patients with tumors 5 cm or larger

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Background: Locoregional recurrence (LRR) after mastectomy reduces the patient’s quality of life and survival. There is a consensus that postmastectomy radiotherapy (PMRT) helps achieve locoregional control and reduces LRR. However, in patients with large tumors, the question of which variables affect the likelihood of LRR and the role of PMRT has been the subject of substantial controversy. This study investigated what are risk factors for LRR and the efficacy of PMRT in this Japanese patient population.

Methods: This study examined 589 cases of invasive breast carcinoma with tumors 5 cm or larger from 1998 to 2008. We divided the study population into 3 groups: patients with negative nodes, 1-3 positive nodes, and ≥4 positive nodes. The relationship between various clinicopathological variables and LRR was examined and the relationship between LRR and PMRT was estimated.

Results: During the median follow-up was 44.2 months, 38 (6.5%) patients experienced LRR. In the multivariate analysis, independent predictors of LRR include pectoral invasion in patients with 1-3 positive nodes, and severity lymphatic invasion, estrogen receptor-negative status, and nodal ratio of positive/excised nodes ≥ 0.50 in patients with ≥4 positive nodes. In patients without positive nodes, none of the examined variables were significantly associated with LRR. PMRT did not improve the outcome of the patients at highest risk who had these variables.

Conclusions: The efficacy of PMRT in patients with large tumors was not shown. In the context of systemic therapy and adequate lymph node dissection, PMRT by itself had a limited role in providing locoregional control. Due to the very low incidence of LRR observed, PMRT was not necessary for patients with large tumors without lymph node metastasis. The indication for PMRT in patients with metastatic nodes remains controversial.

Modified primary tumour/vessel tumour/nodal tumour classification for patients with invasive ductal carcinoma of the breast

Background:

We previously reported that the primary tumour/vessel tumour/nodal tumour (PVN) classification is significantly superior to the UICC pTNM classification and the Nottingham Prognostic Index for accurately predicting the outcome of patients with invasive ductal carcinoma of the breast in a manner that is independent of the nodal status and the hormone receptor status.

Methods:

The purpose of the present study was to compare the outcome predictive power of a modified PVN classification to that of the newly devised pathological UICC pTNM classification and the reclassified Nottingham Prognostic Index in a different group of patients with invasive ductal carcinoma (n=1042) using multivariate analyses by the Cox proportional hazard regression model.

Results:

The modified PVN classification clearly exhibited a superior significant power, compared with the other classifications, for the accurate prediction of tumour recurrence and tumour-related death among patients with invasive ductal carcinoma in a manner that was independent of the nodal status, the hormone receptor status, and adjuvant therapy status.

Conclusion:

The modified PVN classification is a useful classification system for predicting the outcome of invasive ductal carcinoma of the breast.

Abstract P1-12-07: Neo-Adjuvant Exemestane in Post Menopausal Estrogen and/or Progesterone Receptor Positive Breast Cancer: A Randomized Phase II Trial To Investigate Optimal Duration (4 Month Versus 6 Month) of Preoperative Endocrine Therapy (PTEX46 Trial)

Background: Since the 1990s, primary endocrine therapy has been considered the gold standard in the adjuvant and metastatic treatment settings for estrogen and/or progesterone receptor (ER and/or PgR) positive breast cancer. This therapy has also been shown to be effective as neo-adjuvant endocrine therapy in these indications. In recent years, the focus of clinical interest has shifted to the third-generation aromatase inhibitors from tamoxifen. The optimal treatment duration time and causal relationship between neo-adjuvant endocrine therapy and survival, however, are not clear. We therefore conducted the present study to investigate the potential benefits of neo-adjuvant exemestane (E) therapy with the goal of identifying the optimal treatment duration (4 months versus 6 months).

Methods: Conducted at three hospitals in Japan, this study was a multicenter, randomized phase II trial of pre-operative E treatment in postmenopausal women with untreated primary breast cancer. Fifty postmenopausal women with ER positive and/or PgR positive invasive breast cancer were randomly assigned to E (25 mg/day) for 4 months (4 mo) or E (25 mg/day) for 6 months (6 mo). All patient data were collected by UMIN and were analyzed by the National Cancer Center in Japan. Tumor regression (by clinical examination, ultrasound, and MRI), pathological response, shift towards breast-conserving surgery, and safety assessments were the main outcome measures.

Results: Of the 50 patients that enrolled, 28 patients had undergone surgery. The mean ages in the 4 mo and 6 mo treatment groups were 66.7 years and 66.8 years, respectively. No significant differences in the patient characteristics were found in the two groups. The response rates (partial or complete responses) by clinical examination in the 4 mo and 6 mo groups were 37.5% and 50%, respectively. Pathological responses (minimal response or better) were found in 13.3% and 41.7% of patients and a partial mastectomy was performed in 50.0% and 58.3% of patients after 4 mo and 6 mo, respectively.

Conclusion: To date, the results of this study demonstrate that treatment with E for 6 mo was more efficacious than treatment with E for 4 mo. Further work is in progress to obtain data from additional patients and to identify the optimal duration of neo-adjuvant E.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-12-07.

FcγR2A and 3A polymorphisms predict clinical outcome of trastuzumab in both neoadjuvant and metastatic settings in patients with HER2-positive breast cancer

BACKGROUND

Antibody-dependent-mediated cytotoxicity (ADCC) is one of the modes of action for trastuzumab. Recent data have suggested that fragment C γ receptor (FcγR) polymorphisms have an effect on ADCC. This prospective phase II trial aimed to evaluate whether these polymorphisms are associated with clinical efficacies in patients who received trastuzumab.

PATIENTS AND METHODS

Patients in a neoadjuvant (N) setting received Adriamycin and cyclophosphamide followed by weekly paclitaxel/trastuzumab. Patients in a metastatic (M) setting received single trastuzumab until progression. In total, 384 distinct single nucleotide polymorphisms of different FcγR, HER2, and fucosyltransferase loci were assessed.

RESULTS

Fifteen operable and 35 metastatic HER2-positive breast cancer patients were enrolled in each of the N and M settings, respectively. The FcγR2A-131 H/H genotype was significantly correlated with the pathologically documented response (pathological response) (P = 0.015) and the objective response (P = 0.043). The FcγR3A-158 V/V genotype was not correlated with the pathological response, but exhibited a tendency to be correlated with the objective response. Patients with the FcγR2A-131 H/H genotype had significantly longer progression-free survival in the M setting (P = 0.034).

CONCLUSION

The FcγR2A-131 H/H polymorphism predicted the pathological response to trastuzumab-based neoadjuvant chemotherapy in early-stage breast cancer, and the objective response to trastuzumab in metastatic breast cancer.

Expression of Tn and sialyl Tn antigens in synovial tissues in rheumatoid arthritis

OBJECTIVES

The carbohydrate chains represented by mucins (MUCs) are expressed by a variety of normal and malignant secretory epithelial cells and induce a variety of immunoreactions. Tn and sialyl Tn antigens are tumour-associated carbohydrate antigens which are borne on the core proteins of mucins. The purpose of this study is to investigate the existence of tumour-associated carbohydrate antigens in rheumatoid arthritis (RA).

METHODS

. We examined the expression of Tn and sialyl Tn antigens in synovial tissues from RA and osteoarthritis (OA) patients by immunohistochemistry. In addition, mucins from synovial fluid (SF) from RA patients are purified by gel filtration and density gradient ultracentrifugation and the existence of these antigens examined by dot and Western blotting.

RESULTS

We found that Tn and sialyl Tn antigens were strongly expressed in synovial cells and infiltrating mononuclear cells on the sublining layer and lymphoid follicles in synovial tissues in RA compared with those in osteoarthritis. Tn and sialyl Tn antigens were detected in purified mucins of SF from RA patients.

CONCLUSIONS

Tumour-like synovial hyperplasia cells expressed Tn and sialyl Tn antigens. This finding suggests that the mucins exhibiting with abnormal glycosylation may be in part responsible for synovial hyperplasia, leading to the joint destruction in the pathogenesis of RA.

Utility of Intraoperative Frozen-Section Examinations of Surgical Margins: With Special Reference to the Implication of Features of Margin-Exposed Tumor Components on Further Surgical Treatment

Purpose: The assessment of surgical margins is important in breast conserving surgery (BCS). In BCS, we usually resect additional specimens after the diagnosis of positive margin by intraoperative frozen-section examinations (IFE). However, we often experience the patients who received additional resections after positive results by IFE but no tumors were detected in the permanent sections. If we can predict the absence of residual tumor components from IFE, it may be possible to avoid additional mastectomy. In the present study, we tried to identify histological characteristics of margin-exposed tumor components on IFE as predictive factors for the residual tumor components in the additionally resected specimens. Methods: 1,835 cases underwent BCS between October 1999 and July 2008 at the National Cancer Center Hospital, Tokyo, Japan. By the review of the pathological database, we chose patients who had positive surgical margins determined by IFE and had undergone immediate additional resection. Two observers (MK, HT) reviewed the slides of frozen sections and confirmed the presence of tumor components. Results: 220 cases (12%) were eligible for this study. Within the specimens of additional resection, residual tumors existed in 114 cases (51.8%) and no tumors existed in 106 cases (48.2%). As characteristics of the primary tumors, invasive lobular carcinoma, pT3, EIC(+) and lymphatic invasion were significantly associated with the residual tumor components. As characteristics of margin-exposed tumor components on IFE, the number of positive margins, their maximum diameter and histological type were correlated with the residual tumors. The rate of detection of the residual tumors was significantly higher in the group with multiple positive margins (50/72, 69%) than in the group with a single positive margin (64/148, 43%) (p=0.0003). The residual tumors were detected in 36.5% (38/104), 60.8% (62/102), and 100% (14/14) of the groups with &lt;6 mm, ≥6 to &lt;20 mm, and ≥20 mm of the maximum diameter of the exposed tumor components, respectively (p=0.0005). Although there was no significant relationship in the rate between the group with exposed noninvasive components and that with exposed invasive components, the residual tumor components were detected more frequently in the group with exposed lobular carcinoma components (20/29, 69%) than in the group with exposed ductal carcinoma components (94/191, 49%) (p=0.047). By a multivariate analysis, the number of positive margins and the maximum diameter were independent risk factors of the residual tumors. Conclusion: The diagnosis of positive margins by IFE was useful for the prediction of residual tumors, and three histological properties of margin-exposed tumor components were correlated with the absence of residual tumor components. It may be possible to consider stratification of additional surgical therapy according to the characteristics of margin-exposed tumor components on IFE.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4118.

A phase II trial of image-guided radiofrequency ablation of small breast carcinomas: Results of a multicenter study in Japan

e11535

Background: Locally ablative therapy of early breast cancer represents the next frontier in the evolution of minimally invasive breast conservative therapy. We performed this Phase II trial to determine the efficacy and safety of Radiofrequency (RF) ablation of small localized invasive breast carcinomas as a multicenter study in Japan. Methods: Thirty-nine patients with core-biopsy proven invasive breast cancer, T<2 cm in diameter on ultrasound and MRI were enrolled in this trial. Under ultrasound guidance, the tumor and at least a 5mm margin of surrounding breast tissue were ablated with saline- cooled RF electrode followed by surgical resection. Pathologic and immunohistochemical stains were preformed to assess tumor viability. Results: Thirty-seven patients completed the treatment. The mean tumor size on ultrasound was 1.50 cm. The mean ablation time was 12 minutes using mean power of 80.0 watts. During ablation, the tumor became progressively echogenic that correspond with the region of sever electrocautery injury at pathologic examination. Of the 37 treated patients, H&E and NADPH viability staining was available for 27 patients and in 25 (92.5%), there was no evidence of viable cancer cells. H&E and or ssDNA staining were available for another 10 patients. In total, complete thermal injury to the target lesions was recognized in 33 of 37 treated patients (89.2%). No sever adverse effect on the skin and chest wall were noted. Conclusions: RF ablation is a promising minimally invasive treatment of small breast carcinomas, as it can achieve effective cell killing with a low complication rate. We are planning a multicenter observation study for RF ablation of small breast carcinomas.

No significant financial relationships to disclose.

A clinico-pathological analysis of breast cancer patients with a family history

Abstract #6090

Background: It has been said that the high incidence of breast cancer within family lines could be investigated efficiently from genetic and environmental aspects. There could be a strong enough relationship between various carcinogenic factors and these family members. In this study, we examined the clinical and pathological characteristics of breast cancer among patients with a family history.&#x2028; Patients and Methods: We put the definition of 'Positive for a family history (FH+)' for patients who had one or more members within three generations apart from the proband. Patients with family history of breast cancer were selected out of 10506 patients who were treated in our hospital between 1962 and 2007.&#x2028; Results: There were 1272 cases in FH+ and 9234 cases in 'Negative for a family history (FH-)' group. Distribution within the family line showed the highest percentage for sisters at 37%, aunts at 25% and a mother at 25%. The family history positive breast cancer patients were around 5% in 1960-1970 although the number increased up to 18% in 2007. There was similar increasing pattern in Europe and America. The survival rate had no significant difference between FH+ and FH- statistically, but the trend was toward a better prognosis in FH+ cases. There was no relationship between family history and body mass index (BMI). The outbreak of contralateral breast cancer of FH+ was significantly higher than FH-. FH+ patients had significantly higher prevalence of a mastopathy compare to FH- patients. As for the history of other cancer species, the FH+ breast cancer patients within first generation apart from the proband had significantly higher chances compared to FH- patients.Conclusion: The breast cancer patients with family history require more detail examinations especially for the development of contralateral breast cancer. Also carcinomatous examinations are important other than breast cancer to those patients who are in the first generation apart from the proband.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6090.

The response to neoadjuvant chemotherapy and prognosis of triple-negative breast cancer patients

Abstract #5121

Purpose: It is said that triple negative breast cancer (TNBC) has poor prognosis. However, many study shows TNBC has better response to chemotherapy. Since neoadjuvant chemotherapy plays an important role to TNBC, we compared clinical and pathological response rate and prognosis between TNBC and non-TNBC.&#x2028; Patients and methods: This analysis retrospectively collected 2563 breast cancer patients for StageI-III who underwent surgery between January 2000 and September 2004 (median: 3.9 years) at National Cancer Center, Tokyo, Japan. We defined TNBC as Estorpgen and progesterone receptor negative and HER2 score 0-2+ by immnohistological report. There were 91 TNBC patients (23.1%) out of 400 patients (15.6%) who underwent neoadjuvant chemotherapy. Clinical and pathological response rate and Four-year progression free survival were compared between TNBC and non-TNBC.&#x2028; Results: There were 91 TNBC patients (23.1%). TNBC patients compared with non-TNBC had tendency to achieve cCR (91% vs 78%; p=.058) although TNBC had higher rate for cPD (6.6% vs 1.7%; p &lt;.0001). Also TNBC tended to have higher pathological CR rate of which we classified pCR only for grade 3 cases, compared to non-TNBC (13.1% vs 7.2%; p= .042 ). Interestingly HER2 overexpression type also had higher rate for pCR. As for pPD rate, TNBC had similar rate compared to non-TNBC (5.5% v 4.3%). Four-year progression free- survival rate was higher for non-TNBC. However, TNBC had higher Four-year survival free rate only when pCR were achieved after neoadjuvant chemotherapy (99% vs 82%; p=.02).&#x2028; Conclusion: Patients with TNBC tend to have clinical and pathological response of either CR or PD. Although non-TNBC had better prognosis by four-year survival free rate, TNBC could have better prognosis if neoadjuvant chemotherapy resulted in pCR. There may be some way to predict the efficacy of neoadjuvant chemotherapy and prognosis by analyzing the shrink pattern.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5121.