Detection of Isolated Tumor Cells in Bone Marrow Is an Independent Prognostic Factor in Breast Cancer

2003 ◽  
Vol 21 (18) ◽  
pp. 3469-3478 ◽  
Author(s):  
G. Wiedswang ◽  
E. Borgen ◽  
R. Kåresen ◽  
G. Kvalheim ◽  
J.M. Nesland ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Prognostic Factor ◽  
Tumor Cells ◽  
Vascular Invasion ◽  
Independent Prognostic Factor ◽  
Histologic Grade ◽  
Separate Analysis ◽  
Node Negative ◽  
Node Positive

Purpose: This study was performed to disclose the clinical impact of isolated tumor cell (ITC) detection in bone marrow (BM) in breast cancer. Patients and Methods: BM aspirates were collected from 817 patients at primary surgery. Tumor cells in BM were detected by immunocytochemistry using anticytokeratin antibodies (AE1/AE3). Analyses of the primary tumor included histologic grading, vascular invasion, and immunohistochemical detection of c-erbB-2, cathepsin D, p53, and estrogen receptor (ER)/progesterone receptor (PgR) expression. These analyses were compared with clinical outcome. The median follow-up was 49 months. Results: ITC were detected in 13.2% of the patients. The detection rate rose with increasing tumor size (P = .011) and lymph node involvement (P < .001). Systemic relapse and death from breast cancer occurred in 31.7% and 26.9% of the BM-positive patients versus 13.7% and 10.9% of BM-negative patients, respectively (P < .001). Analyzing node-positive and node-negative patients separately, ITC positivity was associated with poor prognosis in the node-positive group and in node-negative patients not receiving adjuvant therapy (T1N0). In multivariate analysis, ITC in BM was an independent prognostic factor together with node, tumor, and ER/PgR status, histologic grade, and vascular invasion. In separate analysis of the T1N0 patients, histologic grade was independently associated with both distant disease-free survival (DDFS) and breast cancer–specific survival (BCSS), ITC detection was associated with BCSS, and vascular invasion was associated with DDFS. Conclusion: ITC in BM is an independent predictor of DDFS and BCSS. An unfavorable prognosis was observed for node-positive patients and for node-negative patients not receiving systemic therapy. A combination of several independent prognostic factors can classify subgroups of patients into excellent and high-risk prognosis groups.

scholarly journals Vascular Invasion as an Independent Prognostic Factor in Lymph Node Negative Invasive Breast Cancer

2012 ◽  
Vol 13 (11) ◽  
pp. 5767-5772 ◽  
Author(s):  
Abbas Rezaianzadeh ◽  
Abdolrasoul Talei ◽  
Abdereza Rajaeefard ◽  
Jafar Hasanzadeh ◽  
Hamidreza Tabatabai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Invasive Breast Cancer ◽  
Vascular Invasion ◽  
Independent Prognostic Factor ◽  
Node Negative

FOXP3 Expression and Overall Survival in Breast Cancer

2009 ◽  
Vol 27 (11) ◽  
pp. 1746-1752 ◽  
Author(s):  
Andrea Merlo ◽  
Patrizia Casalini ◽  
Maria Luisa Carcangiu ◽  
Chiara Malventano ◽  
Tiziana Triulzi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Prognostic Factor ◽  
Breast Carcinoma ◽  
Survival Probability ◽  
Expression Patterns ◽  
Foxp3 Expression ◽  
Independent Prognostic Factor ◽  
Free Survival ◽  
Node Positive

Purpose The transcription factor forkhead box P3 (FOXP3) up- or downregulates a large number of genes and has been recently reported to be expressed in tumor cells. We investigated the prognostic importance of FOXP3 expression in patients with breast cancer. Patients and Methods The expression patterns of FOXP3 were characterized by immunohistochemistry in primary breast carcinoma specimens from patients of the Milan 3 and 1 trials. Kaplan-Meier analysis and Cox proportional hazards regression modeling were used to assess the overall survival, distant metastasis-free survival, and local relapse cumulative incidence, according to the presence or absence of FOXP3 expression. Results FOXP3 expression in tumors was associated with worse overall survival probability and the risk increased with increasing FOXP3 immunostaining intensity. FOXP3 was also a strong prognostic factor for distant metastases-free survival but not for local recurrence risk. In multivariate analysis FOXP3 resulted an independent prognostic factor and the hazard ratio of FOXP3 expression and of lymph node positivity were similar. In the Milan 3 trial, the probability of 10-year survival in node-negative subgroup was 100% for FOXP3-negative and 82% for FOXP3-positive patients; in node-positive subgroup 82% for FOXP3-negative and 41% for FOXP3-positive patients. Even in the Milan 1 trial the lack of FOXP3 expression in node-positive subgroup was related to a significantly better prognosis than in FOXP3-positive patients (10-year survival probability, 89% v 59%). Conclusion The data identify FOXP3 expression as a new independent prognostic factor in breast carcinoma, which might help to improve the selection of patients for appropriate therapy.

Does triple-negative breast cancer (TNBC) have distinct clinicopathologic characteristics and prognostic significance?

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21088-21088
Author(s):  
J. Rhee ◽  
S. Oh ◽  
D. Oh ◽  
S. Im ◽  
S. Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Significance ◽  
Histologic Grade ◽  
University Hospital ◽  
Her2 Status ◽  
Positive Staining ◽  
Clinicopathologic Characteristics ◽  
Node Negative ◽  
Node Positive

21088 Background: Studies have suggested that TNBC, defined by estrogen receptor-negative, progesterone receptor-negative, and HER2-negative, may represent the subset of breast cancer(BC) with different biologic behavior. Here we investigated the clinicopathologic characteristics of TNBC and its prognostic significance in Korean BC patients. Methods: Patients diagnosed as invasive BC and underwent curative surgery at Seoul National University Hospital between Jan. 2000 and Jun. 2003, were reviewed, retrospectively. We excluded the patients whose immunohistochemistry for hormone receptor nor HER2 status had not been evaluated, and who had been treated with adjuvant trastuzumab or neoadjuvant chemotherapy (CT). Clinicopathologic variables (age, T and N stage, endovascular or lymphatic tumor emboli, nuclear and histologic grade, p53, bcl2, Ki67) and 3 year relapse free survival (3YRFS) rate of TNBC were compared with those of non- TNBC. Results: 1,136 patients were eligible for analysis. The median follow-up was 48.7 months. 341 patients underwent breast conserving surgery followed by adjuvant radiotherapy. 249 patients were TNBC and 62.1% of those were node negative. 86.4% of node negative TNBC, 88.3% of node positive TNBC, 53.9% of node negative non-TNBC, and 90.2% of node positive non-TNBC received adjuvant CT. Compared with non-TNBC, TNBC was correlated with younger age (age<35,14.1% vs. 8.2%, p=0.013), higher nuclear and histologic grade(62.2% vs. 23.6%, p=0.001;60.2% vs. 24.6%, p=0.001, respectively); positive staining for p53 (p=0.001) and higher positivity for Ki67 (p=0.001), suggesting the biologic aggressiveness of TNBC. During the follow-up periods, 17.3% of TNBC were relapsed. In particular, 3YRFS in node negative TNBC and non-TNBC were 86% and 96%, respectively (p<0.001). But, in node positive BC, 3YRFS was not different between TNBC and non-TNBC (80.6% vs. 83%, p=0.99). Conclusions: We confirm that TNBC shows more aggressive clinicopathologic characteristics and in particular, higher relapse in node negative BC. Thus, triple-negativity(TN) may be integrated into risk factor analysis in node negative BC. Final results of more detailed molecular analysis for TNBC would be available in the meeting. No significant financial relationships to disclose.

Risk Factors for Locoregional Recurrence Among Breast Cancer Patients: Results From International Breast Cancer Study Group Trials I Through VII

2003 ◽  
Vol 21 (7) ◽  
pp. 1205-1213 ◽  
Author(s):  
A. Wallgren ◽  
M. Bonetti ◽  
R.D. Gelber ◽  
A. Goldhirsch ◽  
M. Castiglione-Gertsch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Risk Groups ◽  
Study Group ◽  
Node Negative ◽  
Node Positive ◽  
Cancer Study Group ◽  
Breast Cancer Study ◽  
Node Positive Disease

Purpose: To explore prognostic factors for locoregional failures (LRF) among women treated for invasive breast cancer within clinical trials of adjuvant therapies. Patients and Methods: The study population consisted of 5,352 women who were treated with a modified radical mastectomy and enrolled in one of seven International Breast Cancer Study Group randomized trials. A total of 1,275 women with node-negative disease received either no adjuvant therapy or a single cycle of perioperative chemotherapy, and 4,077 women with node-positive disease received adjuvant chemotherapy of at least 3 months’ duration and/or tamoxifen. Median follow-up is 12 to 15.5 years. Results: In women with node-negative disease, factors associated with increased risk of LRF were vascular invasion (VI) and tumor size greater than 2 cm for premenopausal and VI for postmenopausal patients. Of the 1,275 patients, 345 (27%) met criteria for the highest risk groups, and the 10-year cumulative incidences of LRF with or without distant metastases were 16% for premenopausal and 19% for postmenopausal women. For the node-positive cohort, number of nodes and tumor grade were factors for both menopausal groups, with additional prediction provided by VI for premenopausal and tumor size for postmenopausal patients. Of the 4,077 patients, 815 (20%) met criteria for the highest risk groups, and 10-year cumulative incidences were 35% for premenopausal and 34% for postmenopausal women. Conclusion: LRFs are a significant problem after mastectomy alone even for some patients with node-negative breast cancer, as well as after mastectomy and adjuvant treatment for some subgroups of patients with node-positive disease. In addition to number of positive lymph nodes, predictors of LRF include tumor-related factors, such as vascular invasion, higher grade, and larger size.

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