Invasive Lobular Carcinoma Classic Type: Response to Primary Chemotherapy and Survival Outcomes

2005 ◽  
Vol 23 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Massimo Cristofanilli ◽  
Ana Gonzalez-Angulo ◽  
Nour Sneige ◽  
Shu-Wan Kau ◽  
Kristine Broglio ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Invasive Lobular Carcinoma ◽  
Lobular Carcinoma ◽  
Nuclear Grade ◽  
Primary Chemotherapy ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Long Term Outcome ◽  
The Impact

Purpose To investigate the impact of histologic type invasive lobular carcinoma (ILC) versus invasive ductal carcinoma (IDC) on response to primary chemotherapy (PC) and long-term outcome. Patients and Methods The study included 1,034 patients with stage II and III breast cancer who participated in six clinical trials of PC at our institution between 1985 and 2002. One hundred twenty-two patients (12%) had ILC and 912 (88%) had IDC. All patients received anthracycline-based PC, and 346 patients (33.5%) also received a taxane as part of PC. Pathologic complete response (pCR) was defined as no evidence of invasive disease in the breast and axillary lymph nodes. Results The median patient age was 48 years (range, 18 to 79 years). Patients with ILC tended to be older (median age, 53 years v 47 years for patients with IDC) and have more hormone-receptor–positive tumors (92% v 62%; P < .001), lower nuclear grade (nuclear grade 3, 16% v 56%; P < .001), and higher stage at diagnosis (10% v 0% with stage IIIB or IIIC disease; P < .001). Patients with ILC were less likely to have a pCR (3% v 15%; P < .001) and had a larger number of involved axillary lymph nodes (41% v 26% had > 3 involved nodes; P = .001). At a median follow-up time of 70 months, ILC patients tended to have longer recurrence-free survival (P = .004) and overall survival (P = .001). Conclusion ILC is characterized by lower rates of pathologic response to PC but better long-term outcomes compared to IDC. pCR might not be a prognostic indicator for this group of patients.

Outcome After Pathologic Complete Eradication of Cytologically Proven Breast Cancer Axillary Node Metastases Following Primary Chemotherapy

2005 ◽  
Vol 23 (36) ◽  
pp. 9304-9311 ◽  
Author(s):  
Bryan T. Hennessy ◽  
Gabriel N. Hortobagyi ◽  
Roman Rouzier ◽  
Henry Kuerer ◽  
Nour Sneige ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Surrogate Marker ◽  
Axillary Node ◽  
Primary Chemotherapy ◽  
Axillary Lymph ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Metastatic Cells ◽  
Kaplan Meier

Purpose Pathologic complete remission (pCR) of primary breast tumors after primary chemotherapy (PCT) is associated with higher relapse-free survival (RFS) and overall survival (OS) rates. The purpose of this study was to determine long-term outcome in patients achieving pCR of cytologically proven axillary lymph node (ALN) metastases. Methods Patients with cytologically documented ALN metastases were treated in five prospective PCT trials. After surgery, patients were subdivided into those with and without residual ALN carcinoma. Survival was calculated by the Kaplan-Meier method. Results Of 925 patients treated, 403 patients had cytologically confirmed ALN metastases. Eighty-nine patients (22%) achieved ALN pCR after PCT. Compared with the group without ALN pCR, 5-year OS and RFS were improved in patients achieving ALN pCR (93% [95% CI, 87.5 to 98.5] and 87% [95% CI, 79.7 to 94.3] v 72% [95% CI, 66.5 to 77.5] and 60% [95% CI, 54.1 to 65.9], respectively; P < .0001). Residual primary tumor did not affect outcome of those with ALN pCR. Combination anthracycline/taxane-based PCT resulted in significantly more ALN pCRs, although outcome after ALN pCR was not improved by taxanes. We constructed a nomogram demonstrating that patients who do not benefit from neoadjuvant anthracyclines are unlikely to benefit from subsequent taxanes. Conclusion ALN pCR is associated with an excellent prognosis, even with a residual primary tumor, pointing to biologic differences between primary and metastatic cells. ALN pCR represents an early surrogate marker of long-term outcome. Response to initial PCT has important potential as a guide to subsequent therapy.

Chemotherapy with or without oophorectomy in high-risk premenopausal patients with operable breast cancer.

1985 ◽  
Vol 3 (8) ◽  
pp. 1059-1067 ◽  
Author(s):  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Lymph Nodes ◽  
Disease Free Survival ◽  
Operable Breast Cancer ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Cytotoxic Treatment ◽  
Premenopausal Patients ◽  
The Impact

A prospective randomized trial to assess the impact of adding oophorectomy to adjuvant chemotherapy has been conducted in premenopausal patients with operable breast cancer and with metastases in four or more axillary lymph nodes. Following at least total mastectomy and axillary clearance, 327 evaluable patients were randomized to adjuvant oophorectomy followed by chemotherapy with cyclophosphamide (C), methotrexate (M), 5-fluorouracil (F), and prednisone (p) or to CMFp alone. At 48 months of median follow-up, no statistically significant differences between regimens in terms of disease-free survival or overall survival were demonstrated, even for patients with steroid hormone receptor-containing tumors. A high incidence of amenorrhea (89%) due to ovarian function suppression was observed for the group receiving CMFp alone. Supplementation of the adjuvant therapy regimen by surgical oophorectomy is rendered superfluous by this effect of cytotoxic treatment. The addition of oophorectomy to combination chemotherapy with CMFp cannot be recommended as adjuvant treatment for high-risk (four or more axillary lymph nodes involved) premenopausal patients with operable breast cancer.

scholarly journals Prognostic Factors on the Positivity for Metastases of the Axillary Lymph Nodes from Primary Breast Cancer

PRILOZI ◽  
2017 ◽  
Vol 38 (1) ◽  
pp. 81-90
Author(s):  
Borislav Kondov ◽  
Goran Kondov ◽  
Zoran Spirovski ◽  
Zvonko Milenkovikj ◽  
Risto Colanceski ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Regression Analysis ◽  
Lymph Nodes ◽  
Primary Breast Cancer ◽  
Lymphovascular Invasion ◽  
Treated Patient ◽  
Univariate Analysis ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
The Impact

Abstract Aim: The aim of the study was to identify the impact of T stage, the presence of estrogen, progesterone, HER2neu receptors and the values of the Ki67 on the positivity for metastases of the axillary lymph nodes, from primary breast cancer. Material and methods: 290 surgically treated patients for breast cancer were included in the study. All cases have been analyzed by standard histological analysis including microscopic analysis on standard H&E staining. For determining the molecular receptors - HER2neu, ER, PR, p53 and Ki67, immunostaining by PT LINK immunoperoxidase has been done. Results: Patients age was ranged between 18-90 years, average of 57.6+11.9. The mean size of the primary tumor in the surgically treated patient was 30.27 + 18.3 mm. On dissection from the axillary pits 8 to 39 lymph nodes were taken out, an average of 13.81+5.56. Metastases have been found in 1 to 23 lymph nodes, an average 3.14+4.71. In 59% of the patients there have been found metastases in the axillary lymph nodes. The univariate regression analysis showed that the location, size of tumor, differentiation of the tumor, stage, the value of the Ki67 and presence of lymphovascular invasion influence on the positivity of the axillary lymph nodes. The presence of the estrogen receptors, progesterone receptors and HER2neu receptors showed that they do not have influence on the positivity for metastatic deposits in axillary lymph nodes. The multivariate model and the logistic regression analysis as independent significant factors or predictors of positivity of the axillary lymph nodes are influenced by the tumor size and the positive lymphovascular invasion. Conclusion: Our study showed that the involving of the axillary lymph nodes is mainly influenced by the size of the tumor and the presence of lymphovascular invasion in the tumor. Ki67 determined proliferative index in the univariate analysis points the important influence of positivity in the axillary lymph nodes, but not in the multivariate regressive analysis.

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