scholarly journals Characteristics and outcome of breast cancer-related microangiopathic haemolytic anaemia: a multicentre study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Marion Alhenc-Gelas ◽  
Luc Cabel ◽  
Frederique Berger ◽  
Suzette Delaloge ◽  
Jean-Sebastien Frenel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Multicentre Study ◽  
Haemolytic Anaemia ◽  
Clinical Decision Making ◽  
Stage Iv ◽  
Early Death ◽  
Low Grade ◽  
Microangiopathic Haemolytic Anaemia ◽  
Small Series

Abstract Background Cancer-related microangiopathic haemolytic anaemia (MAHA) is a rare but life-threatening paraneoplastic syndrome. Only single cases or small series have been reported to date. We set up a retrospective multicentre study focusing on breast cancer-related MAHA. Methods Main inclusion criteria were known diagnosis of breast cancer, presence of schistocytes and either low haptoglobin or cytopenia and absence of any causes of MAHA other than breast cancer, including gemcitabine- or bevacizumab-based treatment. Patient characteristics, treatments and outcome were retrieved from digital medical records. Results Individual data from 54 patients with breast cancer-related MAHA were obtained from 7 centres. Twenty-three (44%) patients had a breast tumour with lobular features, and most primary tumours were low grade (grade I/II, N = 39, 75%). ER+/HER2−, HER2+ and triple-negative phenotypes accounted for N = 33 (69%), N = 7 (15%) and N = 8 (17%) cases, respectively. All patients had stage IV cancer at the time of MAHA diagnosis. Median overall survival (OS) was 28 days (range 0–1035; Q1:10, Q3:186). Independent prognostic factors for early death (≤ 28 days) were PS > 2 (OR = 7.0 [1.6; 31.8]), elevated bilirubin (OR = 6.9 [1.1; 42.6]), haemoglobin < 8.0 g/dL (OR = 3.7 [0.9; 16.7]) and prothrombin time < 50% (OR = 9.1 [1.2; 50.0]). A score to predict early death displayed a sensitivity of 86% (95% CI [0.67; 0.96]), a specificity of 73% (95% CI [0.52; 0.88]) and an area under the curve of 0.90 (95% CI [0.83; 0.97]). Conclusions Breast cancer-related MAHA appears to be a new feature of invasive lobular breast carcinoma. Prognostic factors and scores may guide clinical decision-making in this serious but not always fatal condition.

Treatment Outcomes and Prognostic Factors in Male Patients With Stage IV Breast Cancer: A Population-based Study

2018 ◽  
Vol 18 (1) ◽  
pp. e97-e105 ◽  
Author(s):  
Wei Chen ◽  
Ying Huang ◽  
Gary D. Lewis ◽  
Sean S. Szeja ◽  
Sandra S. Hatch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Treatment Outcomes ◽  
Stage Iv ◽  
Population Based ◽  
Population Based Study ◽  
Stage Iv Breast Cancer ◽  
Male Patients

scholarly journals Incidence and Survival Among Young Women With Stage I–III Breast Cancer: SEER 2000–2015

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Alexandra Thomas ◽  
Anthony Rhoads ◽  
Elizabeth Pinkerton ◽  
Mary C Schroeder ◽  
Kristin M Conway ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Survival Data ◽  
De Novo ◽  
Stage Iv ◽  
Premenopausal Women ◽  
The United States ◽  
Stage I ◽  
Low Grade ◽  
High Grade ◽  
Stage Iv Breast Cancer

Abstract Background Although recent findings suggest that de novo stage IV breast cancer is increasing in premenopausal women in the United States, contemporary incidence and survival data are lacking for stage I–III cancer. Methods Women aged 20–29 (n = 3826), 30–39 (n = 34 585), and 40–49 (n = 126 552) years who were diagnosed with stage I–III breast cancer from 2000 to 2015 were identified from the Surveillance, Epidemiology, and End Results 18 registries database. Age-adjusted, average annual percentage changes in incidence and 5- and 10-year Kaplan-Meier survival curves were estimated by race and ethnicity, stage, and hormone receptor (HR) status and grade (low to well and moderately differentiated; high to poorly and undifferentiated) for each age decade. Results The average annual percentage change in incidence was positive for each age decade and was highest among women aged 20–29 years. Increased incidence was driven largely by HR+ cancer, particularly HR+ low-grade cancer in women aged 20–29 and 40–49 years. By 2015, incidence of HR+ low- and high-grade cancer each independently exceeded incidence of HR− cancer in each age decade. Survival for HR+ low- and high-grade cancer decreased with decreasing age; survival for HR− cancer was similar across age decades. Among all women aged 20–29 years, 10-year survival for HR+ high-grade cancer was lower than that for HR+ low-grade or HR− cancer. Among women aged 20–29 years with stage I cancer, 10-year survival was lowest for HR+ high-grade cancer. Conclusions HR+ breast cancer is increasing in incidence among premenopausal women, and HR+ high-grade cancer was associated with reduced survival among women aged 20–29 years. Our findings can help guide further evaluation of preventive, diagnostic, and therapeutic strategies for breast cancer among premenopausal women.

Prognostic Model for Relapse After High-Dose Chemotherapy With Autologous Stem-Cell Transplantation for Stage IV Oligometastatic Breast Cancer

2002 ◽  
Vol 20 (3) ◽  
pp. 707-718 ◽  
Author(s):  
Yago Nieto ◽  
Samia Nawaz ◽  
Roy B. Jones ◽  
Elizabeth J. Shpall ◽  
Pablo J. Cagnoni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Metastatic Breast ◽  
Local Therapy ◽  
Stage Iv ◽  
High Dose Chemotherapy ◽  
Long Term Results ◽  
High Dose ◽  
Nodal Ratio ◽  
Her 2

PURPOSE: To study prognostic factors after high-dose chemotherapy (HDC) for patients with stage IV oligometastatic breast cancer. PATIENTS AND METHODS: Sixty patients with minimal metastatic disease amenable to local therapy enrolled onto a prospective HDC trial were analyzed for potential prognostic factors. Tumor blocks were retrospectively collected from referring institutions. RESULTS: Median follow-up was 62 months (range, 4 to 120 months). Median relapse-free survival (RFS) and overall survival (OS) times were 52 and 80 months, respectively. Five-year RFS and OS rates were 52% (95% confidence interval [CI], 39% to 64%) and 62% (95% CI, 49% to 74%), respectively. HER-2 expression, number of tumor sites, primary axillary nodal ratio (number of positive nodes divided by number of sampled nodes), number of positive axillary nodes, and delivery or omission of radiotherapy to metastases correlated with RFS. HER-2 overexpression and more than one site were independent adverse risk factors for RFS. HER-2 and the axillary nodal ratio were independent predictors of OS. The following prognostic categories for RFS were established (RFS rate, median RFS): good risk, no factors (77%, 80 months); intermediate risk, one factor (41%, 28 months); and poor risk, both factors (10%, 10 months). CONCLUSION: Long-term results in patients with oligometastatic breast cancer are encouraging but need validation in prospective randomized studies. HER-2 expression, number of sites, and primary nodal ratio are independent outcome predictors. Confirmation of these observations in this selected population would imply the need for reevaluation of the current tenet that early detection of metastatic breast cancer recurrence is of no benefit.

scholarly journals Liver Resections of Isolated Liver Metastasis in Breast Cancer: Results and Possible Prognostic Factors

HPB Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Malte Weinrich ◽  
Christel Weiß ◽  
Jochen Schuld ◽  
Bettina M. Rau
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Liver Metastasis ◽  
Primary Tumour ◽  
Complete Resection ◽  
R0 Resection ◽  
Time Interval ◽  
Low Grade ◽  
Primary Surgery ◽  
Breast Cancer Liver Metastasis

Background. Breast cancer liver metastasis is a hematogenous spread of the primary tumour. It can, however, be the expression of an isolated recurrence. Surgical resection is often possible but controversial. Methods. We report on 29 female patients treated operatively due to isolated breast cancer liver metastasis over a period of six years. Prior to surgery all metastases appeared resectable. Liver metastasis had been diagnosed 55 (median, range 1–177) months after primary surgery. Results. Complete resection of the metastases was performed in 21 cases. The intraoperative staging did not confirm the preoperative radiological findings in 14 cases, which did not generally lead to inoperability. One-year survival rate was 86% in resected patients and 37.5% in nonresected patients. Significant prognostic factors were R0 resection, low T- and N-stages as well as a low-grade histopathology of the primary tumour, lower number of liver metastases, and a longer time interval between primary surgery and the occurrence of liver metastasis. Conclusions. Complete resection of metastases was possible in three-quarters of the patients. Some of the studied factors showed a prognostic value and therefore might influence indication for resection in the future.

Prognostic factors for stage IV hormone receptor-positive primary metastatic breast cancer

Breast Cancer ◽  
2011 ◽  
Vol 20 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Akiko Kawano ◽  
Chikako Shimizu ◽  
Kenji Hashimoto ◽  
Takayuki Kinoshita ◽  
Hitoshi Tsuda ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Metastatic Breast Cancer ◽  
Hormone Receptor ◽  
Metastatic Breast ◽  
Stage Iv ◽  
Hormone Receptor Positive

Prognostic factors in patients with isolated recurrences of breast cancer (stage IV-NED)

1999 ◽  
Vol 53 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Oscar Juan ◽  
Ana Lluch ◽  
Laura de Paz ◽  
Felipe Prósper ◽  
Pilar Azagra ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Stage Iv ◽  
Cancer Stage

scholarly journals The effect of tumor subtype on survival and the graded prognostic assessment (GPA) for patients with breast cancer and brain metastases.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 238-238 ◽  
Author(s):  
P. W. Sperduto ◽  
N. Kased ◽  
D. Roberge ◽  
R. Shanley ◽  
S. T. Chao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Brain Metastases ◽  
Predictive Power ◽  
Clinical Decision Making ◽  
Cox Regression ◽  
Rank Statistic ◽  
Tumor Subtype ◽  
Prognostic Assessment ◽  
Graded Prognostic Assessment

238 Background: The Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) was published to clarify prognosis for patients with brain metastases. This study refines the existing Breast GPA by analyzing a larger cohort and tumor subtype. Methods: A multi-institutional retrospective database of 400 breast cancer patients treated for newly-diagnosed brain metastases was generated. Prognostic factors significant for survival were analyzed by multivariate Cox regression (MCR) and recursive partitioning analysis (RPA). Factors were weighted by magnitude of their regression coefficients to define the GPA index. A GPA score of 4.0 represents the best prognosis, 0.0, the worst. Results: Significant prognostic factors by MCR and RPA were Karnofsky Performance Status (KPS), HER2, ER/PR status, and the interaction between ER/PR and HER2. RPA showed age was significant for patients with KPS 60-80. The median survival time (MST) overall was 13.8 months, and for GPA scores of 0-1.0, 1.5-2.0, 2.5-3.0 and 3.5-4.0 was 3.4 (n=23), 7.7 (n=104), 15.1 (n=140) and 25.3 (n=133) months, respectively (p < 0.0001). See table. Among HER2-negative patients, being ER/PR-positive improved MST from 6.4 to 9.7 months whereas in HER2-positive patients, being ER/PR-positive improved MST from 17.9 to 20.7 months. The log-rank statistic (predictive power) was 110 for the Breast-GPA versus 55 for tumor subtype. Conclusions: The Breast-GPA documents wide variation in prognosis and shows clear separation between subgroups of patients with breast cancer and brain metastases. This tool will aid clinical decision-making and stratification of clinical trials. These data confirm the effect of tumor subtype on survival and show the Breast-GPA offers significantly more predictive power than the tumor subtype alone. [Table: see text]

Locoregional lymphatic recurrence following axillary dissection for breast cancer.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 19-19
Author(s):  
S. M. L. Lim ◽  
F. L. Lam ◽  
S. J. N. Remulla
Keyword(s):  
Breast Cancer ◽  
Axillary Dissection ◽  
Breast Surgery ◽  
Bilateral Breast Cancer ◽  
Breast Cancer Surgery ◽  
Low Grade ◽  
Axillary Lymph ◽  
Tumour Grade ◽  
Primary Surgery ◽  
Small Series

19 Background: The risk of locoregional recurrence is of concern for women following breast cancer surgery. We report a single surgeon’s experience of locoregional lymphatic recurrence following axillary dissection (AD) in women with breast cancer. Methods: The aim of this study is to identify risk factors for locoregional lymphatic recurrence in women who have undergone breast surgery and AD for T1, T2 tumours. 14 women were identified over 10 years with documented recurrence in the regional lymphatic basin; ipsilateral, contralateral, supraclavicular and internal mammary lymph nodes. One patient presented with bilateral breast cancer. Patient characteristics as well as the tumour grade, ER, PR, HER2 reactivity and presence of lymphovascular invasion (LVI) were analysed. Results: Between 1996 and 2006, 756 women underwent primary surgery for breast cancer in our practice. We identified 14 women who relapsed with locoregional lymphatic recurrence and underwent further surgical management after a median follow-up of 4.5 years. 13/14 had undergone primary breast surgery at our centre, of which 73% underwent total mastectomy and AD. The median age was 48 years, 14% were nulliparous, and 50% were premenopausal. The mean tumour size was 2.48 cm and 7% had a contralateral cancer. The median axillary lymph node (LN) yield was 11.5 of which 57% (8/14) were node negative at primary surgery. In those 8 patients with negative AD, 50% recurred in the ipsilateral axillary LNs, 37.5% recurred in the ipsilateral supraclavicular LNs in the absence of axillary relapse, and 12.5% recurred in the contralateral axillary LNs in the absence of ipsilateral axillary relapse. Of the primary tumour characteristics, 13% were low grade, 43% had LVI, 57% were ER+, 64% PR+, 43% HER2+, and 14% triple negative. None of the patients had distant metastases at the time of relapse in the locoregional lymphatic basin. Conclusions: An axillary dissection did not prevent locoregional lymphatic recurrence in 14 women in our small series. On retrospective analysis, there was no dominant risk factor which could help to identify this group at high risk of relapse, although at least 50% who relapsed locoregionally were less than 50 years, premenopausal with a high tumour grade.

Patient experience and attitudes toward addressing the cost of breast cancer care.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6551-6551 ◽  
Author(s):  
Blair Billings Irwin ◽  
Yousuf Zafar ◽  
Ivy Altomare ◽  
Gretchen Genevieve Kimmick ◽  
P. Kelly Marcom ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Financial Distress ◽  
Cancer Care ◽  
Clinical Decision Making ◽  
Stage Iv ◽  
Insurance Companies ◽  
Disease Stage ◽  
High Quality ◽  
Societal Costs

6551 Background: The American Society of Clinical Oncology has suggested that patient-physician discussion of costs is a component of high quality care. Little data exists on patients’ experience confronting costs or attitudes on how cost should be addressed. Methods: We distributed a self-administered anonymous paper survey to consecutive patients with breast cancer presenting for a routine visit within 5 years of diagnosis at an academic center. Survey questions addressed financial distress, experience and preferences concerning discussions of cost, and views on cost control. Results are primarily descriptive, with comparison among patients on the basis of disease stage using Fisher’s exact test. All p-values are 2-sided. Results: We surveyed 134 patients (response rate 86%). Median age was 61. 72% stage I-III disease, and 28% (n=36) had stage IV disease. 44% (n=57) reported at least a moderate level of financial distress. Only 14% (n=18) reported ever discussing costs with their doctor, though 94% (n=121) felt doctors should talk to patients about costs. 53% (n=69) felt doctors should discuss direct costs with patients but only 38% (n=49) felt doctors should consider costs to society or insurance companies in their decision-making. Patients with metastatic disease were significantly less likely than those with earlier stage disease to want doctors to consider societal costs (33% (n=24) vs 6% (n=2), p<0.01). 88% (n=114) reported concern over costs of cancer care, but there was no consensus on how to control costs. Only 3% (n=4) favored greater cost sharing and 9% (n=11) supported greater means testing. A minority (33%, n=43) supported reducing drug costs through government price controls (33% n=43). The majority endorsed generic substitution (59%, n=75) and preferential selection of drugs which prolong survival 53% (n=69). Conclusions: Although many patients with breast cancer want to discuss costs of care with their doctors, there is little consensus on the ideal content of these discussions. Few patients support consideration of societal costs in clinical decision-making. Further research is needed to evaluate the potential for patient-physician discussions of cost to contribute to affordable high quality cancer care.

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