Clinical outcomes in very early breast cancer (≤ 1cm): A national population based analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12034-e12034
Author(s):  
Mahvish Muzaffar ◽  
Abdul Rafeh Naqash ◽  
Nasreen A. Vohra ◽  
Darla K. Liles ◽  
Jan H. Wong
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Early Breast Cancer ◽  
Older Age ◽  
National Database ◽  
Disease Specific Survival ◽  
Excellent Outcome ◽  
Significant Difference ◽  
Er Positive ◽  
Disease Specific

e12034 Background: The utilization of screening mammogram has resulted in increased diagnosis of very small breast cancers including T1a (≤5 mm), T1b ( > 0.5 but ≤1 cm). These small tumors have excellent prognosis with cancer-specific survival rates as high as 90% to 95%.This study evaluates outcomes in very early breast cancer in a national database. Methods: Patients with stage I breast cancer, tumor ≤ 1cm (T1aN0, T1bN0) diagnosed between 2006 and 2011 were selected from the SEER database. We excluded patients with missing biomarker information. Treatment outcome and prognostic factors for disease-specific survival (DSS) and overall survival (OS) were evaluated. Results: We identified 70,543 cases and included 54,796 patients with stageT1aN0M0 and T1bN0M0 in the final analysis.The mean age was 62.09 yrs(CI 95% 62.2-61.99),84% are white,7% black and 7% Other.89% were ER positive,11% ER negative and 3% had Her 2 positive tumors.71% of patients had T1b. ≤ 1cm breast cancer cases increased from 15% in 2006 to 18% in 2011.The 5-year disease specific survival (DSS) and overall survival (OS) for patients with stage T1aN0T1b N0 was 98.7% and 93.7%, respectively. Estrogen receptor(ER) positive tumors were associated with improved 5-yr DSS 99% vs 96% in ER negative (p < 0.0001) and OS in ER positive 94% vs 92%( p < 0.0001).Among white patients 5-yr DSS was 98.8% and OS was 93.7% while 5yr-DSS was 94%,OS 91.5% among black vs 5-yr DSS 99% and OS 96.3% in others( Asian or Pacific Islanders,AI), (p < 0.0001).Tumor subtype was not associated with significant difference in outcome but T1a tumor was associated with OS 94.5% vs 93.4% with T1b tumors(p < 0.0001) On cox model analysis factors which correlated with prolonged DSS and OS are race (p < 0.0001),older age (p < 0.0001), ER positivity (p < 0.0001) and tumor less than 5mm (p = 0.0006). Conclusions: Very early breast cancer is associated with excellent outcome but has some heterogeneity. Nonwhite/Non Black race was associated with better survival compared to white and black patients.ER positive tumors, older age were also associated with better outcome. This data while reassuring also brings into question of overtreatment of this disease subset.

Survival in Early Breast Cancer Patients Is Favorably Influenced by a Natural Humoral Immune Response to Polymorphic Epithelial Mucin

2000 ◽  
Vol 18 (3) ◽  
pp. 574-574 ◽  
Author(s):  
S. von Mensdorff-Pouilly ◽  
A.A. Verstraeten ◽  
P. Kenemans ◽  
F.G. M. Snijdewint ◽  
A. Kok ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Early Breast Cancer ◽  
Humoral Response ◽  
Disease Specific Survival ◽  
Breast Cancer Patients ◽  
Antibody Levels ◽  
Pretreatment Serum ◽  
Test Result ◽  
Disease Specific

PURPOSE: Polymorphic epithelial mucin (PEM or MUC1) is being studied as a vaccine substrate for the immunotherapy of patients with adenocarcinoma. The present study analyzes the incidence of naturally occurring MUC1 antibodies in early breast cancer patients and relates the presence of these antibodies in pretreatment serum to outcome of disease.MATERIALS AND METHODS: We measured immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to MUC1 with an enzyme-linked immunoassay (PEM.CIg), which uses a MUC1 triple-tandem repeat peptide conjugated to bovine serum albumin, in pretreatment serum samples obtained from 154 breast cancer patients (52 with stage I disease and 102 with stage II) and 302 controls. The median disease-specific survival time of breast cancer patients was 74 months (range, 15 to 118 months). A positive test result was defined as MUC1 IgG or IgM antibody levels equal to or greater than the corresponding rounded-up median results obtained in the total breast cancer population.RESULTS: A positive test result for both MUC1 IgG and IgM antibodies in pretreatment serum was associated with a significant benefit in disease-specific survival in stage I and II (P = .0116) breast cancer patients. Positive IgG and IgM MUC1 antibody levels had significant additional prognostic value to stage (P = .0437) in multivariate analysis. Disease-free survival probability did not differ significantly. However, stage II patients who tested positive for MUC1 IgG and IgM antibody and who relapsed had predominantly local recurrences or contralateral disease, as opposed to recurrences at distant sites in the patients with a negative humoral response (P = .026).CONCLUSION: Early breast cancer patients with a natural humoral response to MUC1 have a higher probability of freedom from distant failure and a better disease-specific survival. MUC1 antibodies may control hematogenic tumor dissemination and outgrowth by aiding the destruction of circulating or seeded MUC1-expressing tumor cells. Vaccination of breast cancer patients with MUC1-derived (glyco)peptides in an adjuvant setting may favorably influence the outcome of disease.

scholarly journals Alcohol Consumption Before and After Breast Cancer Diagnosis: Associations With Survival From Breast Cancer, Cardiovascular Disease, and Other Causes

2013 ◽  
Vol 31 (16) ◽  
pp. 1939-1946 ◽  
Author(s):  
Polly A. Newcomb ◽  
Ellen Kampman ◽  
Amy Trentham-Dietz ◽  
Kathleen M. Egan ◽  
Linda J. Titus ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Alcohol Consumption ◽  
Alcohol Intake ◽  
Cancer Survival ◽  
Breast Cancer Diagnosis ◽  
Breast Cancer Survival ◽  
Disease Specific Survival ◽  
Increased Risk ◽  
Disease Specific

Purpose Alcohol intake is associated with increased risk of breast cancer. In contrast, the relation between alcohol consumption and breast cancer survival is less clear. Patients and Methods We assessed pre- and postdiagnostic alcohol intake in a cohort of 22,890 women with incident invasive breast cancer who were residents of Wisconsin, Massachusetts, or New Hampshire and diagnosed from 198 to 200 at ages 20 to 79 years. All women reported on prediagnostic intake; a subsample of 4,881 reported on postdiagnostic intake. Results During a median follow-up of 11.3 years from diagnosis, 7,780 deaths occurred, including 3,484 resulting from breast cancer. Hazard ratios (HR) and 95% CIs were estimated. Based on a quadratic analysis, moderate alcohol consumption before diagnosis was modestly associated with disease-specific survival (compared with nondrinkers, HR = 0.93 [95% CI, 0.85 to 1.02], 0.85 [95% CI, 0.75 to 0.95], 0.88 [95% CI, 0.75 to 1.02], and 0.89 [95% CI, 0.77 to 1.04] for two or more, three to six, seven to nine, and ≥ 10 drinks/wk, respectively). Alcohol consumption after diagnosis was not associated with disease-specific survival (compared with nondrinkers, HR = 0.88 [95% CI, 0.61 to 1.27], 0.80 [95% CI, 0.49 to 1.32], 1.01 [95% CI, 0.55 to 1.87], and 0.83 [95% CI, 0.45 to 1.54] for two or more, three to six, seven to nine, and ≥ 10 drinks/wk, respectively). Results did not vary by beverage type. Women consuming moderate levels of alcohol, either before or after diagnosis, experienced better cardiovascular and overall survival than nondrinkers. Conclusion Overall alcohol consumption before diagnosis was not associated with disease-specific survival, but we found a suggestion favoring moderate consumption. There was no evidence for an association with postdiagnosis alcohol intake and breast cancer survival. This study, however, does provide support for a benefit of limited alcohol intake for cardiovascular and overall survival in women with breast cancer.

scholarly journals Trastuzumab as An Adjuvant Therapy for Early Breast Cancer

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 70s-70s
Author(s):  
S.W. Lee ◽  
H.F. Kamaruzaman ◽  
J. Sabirin
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Early Breast Cancer ◽  
Cochrane Review ◽  
Control Group ◽  
Duration Of Treatment ◽  
Adjuvant Trastuzumab ◽  
Common Cancer ◽  
Significant Difference

Background: In Malaysia, breast cancer is the most common cancer in females and also the first most common cancer among population regardless of gender. Trastuzumab is used for the treatment of early-stage breast cancer that is HER2 positive. Although this treatment has been routinely used, there are still controversial on the duration of the addition of trastuzumab to the chemotherapy regimen. Aim: To assess the safety and effectiveness of trastuzumab as an adjuvant in early breast cancer patients through a systematic review. Methods: Electronic databases were searched through the Ovid interface. The titles and abstracts were screened against the inclusion and exclusion criteria and then evaluated the selected full-text articles. Results: There was high level of evidence to suggest that the risk of congestive heart failure (CHF) was significantly higher in patients treated with trastuzumab compared with nontrastuzumab control group (RR 5.11; 90% CI: 3.00-8.72, P < 0.00001) in one Cochrane review, (RR 3.19; 95% CI: 2.03-5.02, P < 0.00001) in one systematic review and meta-analysis. Evidence also suggested that the risk was significantly higher with longer duration of treatment (> 6 months) RR 5.39; 90% CI: 3.56-8.17, P < 0.00001. The overall survival (OS) significantly favored trastuzumab-containing regimen over nontrastuzumab control group, (HR 0.66; 95% CI: 0.55-0.77, P < 0.00001). In terms of duration, subgroup analysis reported that the overall survival (OS) significantly favored trastuzumab-containing regimen over nontrastuzumab control group trials where trastuzumab was given longer (> 6 months), HR 0.67; 95% CI: 0.57-0.80, P < 0.00001. In the trials that gave trastuzumab and chemotherapy concurrently, HR significantly favored trastuzumab-containing regimens (HR 0.64; 95% CI: 0.57-0.80, P < 0.00001). The evidence from Cochrane systematic review suggests that disease-free survival (DFS) favored trastuzumab-containing regimen over the nontrastuzumab control group (HR 0.60; 95% CI: 0.50-0.71, P < 0.00001). In terms of duration of treatment, there was no significant difference in DFS when trastuzumab was used for less than six months or more than six months. The DFS significantly favored trastuzumab-containing regimen over nontrastuzumab control group when used either concurrently or sequentially. Limited evidence to suggest that two years duration of adjuvant trastuzumab was not more effective that one year of treatment. However, six months treatment with trastuzumab failed to show that it was noninferior to twelve months of trastuzumab. There was limited retrievable evidence to suggest that there is no significant difference in OS and DFS between the twelve months regimen and 9-week regimen for trastuzumab. Conclusion: Despite the higher rates of cardiac events, twelve months of adjuvant trastuzumab was suggested as the standard of care. However, other issues including cost and cost-effectiveness should be considered.

Long-Term Survival After Cisplatin-Based Induction Chemotherapy and Radiotherapy for Nasopharyngeal Carcinoma: A Pooled Data Analysis of Two Phase III Trials

2005 ◽  
Vol 23 (6) ◽  
pp. 1118-1124 ◽  
Author(s):  
Daniel T.T. Chua ◽  
Jun Ma ◽  
Jonathan S.T. Sham ◽  
Hai-Qiang Mai ◽  
Damon T.K. Choy ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Nasopharyngeal Carcinoma ◽  
Induction Chemotherapy ◽  
Phase Iii ◽  
Disease Specific Survival ◽  
Two Phase ◽  
Significant Difference ◽  
Disease Specific

Purpose To evaluate the long-term outcome in patients with nasopharyngeal carcinoma (NPC) treated with induction chemotherapy and radiotherapy (CRT) versus radiotherapy alone (RT). Patients and Methods The data from two phase III studies comparing CRT with RT in NPC were updated and pooled together for analysis. A total of 784 patients were included for analysis, with an equal number of patients in both arms. Induction chemotherapy consisted of two to three cycles of cisplatin, bleomycin, and fluorouracil, or cisplatin and epirubicin. RT was given to the nasopharynx and neck using megavoltage radiation (median dose, 70 Gy). The median follow-up time for surviving patients was 67 months. Analysis was based on intention to treat. Results The addition of induction chemotherapy to RT was associated with a decrease in relapse by 14.3% and cancer-related deaths by 12.9% at 5 years. The 5-year relapse-free survival rate was 50.9% and 42.7% in the CRT and RT arm, respectively (P = .014), and the 5-year disease-specific survival rate was 63.5% and 58.1% in the CRT and RT arm, respectively (P = .029). The 5-year overall survival rate was 61.9% and 58.1% in CRT and RT arm, respectively (P = .092). The incidence of locoregional failure and distant metastases was reduced by 18.3% and 13.3% at 5 years, respectively, with induction chemotherapy. There was no significant difference in the treatment failure patterns between the two arms. Conclusion The addition of cisplatin-based induction chemotherapy to RT was associated with a modest but significant decrease in relapse and improvement in disease-specific survival in advanced-stage NPC. However, there was no improvement in overall survival.

Tubular carcinomas of the breast: A comparison of features and survival outcomes versus low grade ductal and lobular carcinomas in the SEER database.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11596-e11596
Author(s):  
Andrew Michael Romano ◽  
Mark E Smolkin ◽  
Patrick Michael Dillon
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
Age At Diagnosis ◽  
Low Grade ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Significant Difference ◽  
Er Positive ◽  
Stage 1

e11596 Background: Tubular carcinoma of the breast (TC) is a rare histologic subtype of breast cancer considered to have a favorable prognosis relative to other histologies. TC is by definition low grade. TC is described to have clinical behavior similar to low grade ductal and lobular breast cancers, but due to its infrequent presentation, long-term follow-up studies of TC are lacking. Methods: The Surveillance, Epidemiology and End Results database was queried to include the years 1988-2009, selecting for patients with either grade 1 TC or grade 1 ductal and lobular breast cancer (G1BC). Data collected included age at diagnosis, race, stage, receptor status, overall survival, and surgery type. Two Cox proportional hazard models were assessed for differences between TC and G1BC, adjusting for age at diagnosis. Results: In SEER 18, 115,945 cases of TC+G1BC breast cancer are found, with 6.1% classified as TC. Of TC cases, 91% are stage 1, while 71% of GIBC are stage 1. Presenting stage 3 or 4 disease occurred in only 4.7% of G1BC versus 0.68% of TC cases. Due to the rarity of advanced disease, we analyzed early stage disease. For early Stage (1-2) breast cancer, mean age was 61.5 years for TC and 63.5 years for G1BC. The TC cases were 92% white, 4% black, 97% Estrogen Receptor (ER) positive, 82% Progesterone Receptor (PR) positive. Of G1BC cases, 88% were white, 5% black, 96% ER positive, 84% PR positive. Treatment differed with 76% of TC patients receiving lumpectomy versus G1BC where 65% received lumpectomy (p<0.001). There was no significant difference in overall survival between Stage I TC and G1BC (p=0.98), or between Stage II TC and G1BC (p=0.075), with the survival estimate higher for TC. Conclusions: In this large-scale analysis, TC was limited to early stage disease and there was no difference in overall survival between patients with early stage TC and early stage GIBC. There were similar receptor statuses and baseline characteristics, but more conservative surgical treatment in TC. Because no survival difference exists for early stage disease, the finding of tubular histology to guide treatment decisions may not be warranted.

External Beam Radiotherapy for Medullary Thyroid Cancer Following Total or Near-Total Thyroidectomy

2020 ◽  
pp. 019459982094769
Author(s):  
Michael Jin ◽  
Uchechukwu C. Megwalu ◽  
Julia E. Noel
Keyword(s):  
Overall Survival ◽  
Advanced Disease ◽  
External Beam Radiotherapy ◽  
National Database ◽  
External Beam ◽  
Disease Specific Survival ◽  
Lymph Node Yield ◽  
Medullary Thyroid ◽  
The Impact ◽  
Disease Specific

Objectives Medullary thyroid carcinoma (MTC) often presents with advanced disease and takes an aggressive course as compared with more well-differentiated thyroid cancers. The role of adjuvant therapy, specifically external beam radiotherapy (EBRT), remains disputed. This study investigated the impact of EBRT on survival in MTC. Study Design Cross-sectional analysis of a national database. Setting Patients with MTC were identified from the SEER program (Surveillance, Epidemiology, and End Results). Methods Collected variables included age, sex, race, T and N stages, lymph node yield, and use of EBRT. Propensity score matching was performed to determine the association of EBRT with overall and disease-specific survival. Results A total of 2046 patients with locoregional MTC were identified. Of these, 152 received EBRT. Patients receiving EBRT were older and had more advanced disease. EBRT was not associated with differences in overall survival (hazard ratio, 1.12; 95% CI, 0.76-1.65) or disease-specific survival (1.66; 0.93-2.95), as well as in subset analysis of age and disease extent. Long-term overall survival was similar, with 77.3% (95% CI, 70.1%-85.3%) and 58.3% (48.2%-70.5%) of patients without EBRT alive at 5 and 10 years, respectively (vs 70.7% [63.2%-79.1%] and 52.3% [43.3%-63.2%] of patients with EBRT). There were no differences in 5- and 10-year disease-specific survival. Conclusion EBRT was not associated with improved overall or disease-specific survival in patients with MTC. Decisions regarding EBRT must be made with consideration of morbidity relative to benefit for individual patients.

scholarly journals Survivorship and prognostic factors for pleomorphic liposarcoma: a population-based study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lu Wan ◽  
Chao Tu ◽  
Lin Qi ◽  
Zhihong Li
Keyword(s):  
Overall Survival ◽  
Tumor Size ◽  
Older Age ◽  
Disease Specific Survival ◽  
Poor Overall Survival ◽  
Poor Prognostic Factor ◽  
Entire Series ◽  
Pleomorphic Liposarcoma ◽  
Regional Stage ◽  
Disease Specific

Abstract Background Pleomorphic liposarcoma is the least common but most aggressive subtype of liposarcoma. Very few studies have presented data on pleomorphic liposarcoma specifically, often including a limited number of cases and short-term follow-up. As a result, the survivorship and prognostic characteristics of this tumor remain incompletely identified. Study design and setting Cross-sectional analysis of the Surveillance Epidemiology and End Results database (1996–2015). Results Overall survival for the entire series was 54% (95% confidence interval [CI], 49–58%) and 40% (95% CI, 35–45%) at 5 and 10 years, respectively. Disease-specific survival for the entire series was 60% (95% CI, 56–65%) and 53% (95% CI, 48–58%) at 5 and 10 years, respectively. Patients who survived 10 years or more were more likely to die of events unrelated to pleomorphic liposarcoma. Univariate and multivariate analysis demonstrated that not receiving cancer-directed surgery was an independent poor prognostic factor. Older age (≥ 65 years old) was associated with worse overall survival but not disease-specific survival. Tumor stage and radiotherapy showed different impact on survival depending on tumor size. In comparison to localized staged tumors, regional stage only predicts poor survival in patients with tumor size less than 5 cm, while distant stage is an independent worse prognosis factor. Radiotherapy only benefits patients with tumor size larger than 10 cm. These results were confirmed in competing risk analysis. Conclusion Survival rates of patients with pleomorphic liposarcoma has not changed over the past 20 years. Patients with distant stage have poor prognosis; regional stage indicates worse survival in patients with tumor size less than 5 cm. Receiving surgery could prolong the survival, while radiotherapy only benefits patients with large tumor size (> 10 cm). Older age is associated with poor overall survival but not disease-specific survival. Routine patient surveillance following initial diagnosis should at least be 10 years for pleomorphic liposarcoma.

scholarly journals Clinicopathologic Analysis of Lateral Margin Measured by Whole-Mount Section in T3 Rectal Cancer

2020 ◽  
Vol 36 (3) ◽  
pp. 172-177 ◽  
Author(s):  
Soomin Nam ◽  
Youngki Hong ◽  
Yoon Jung Choi ◽  
Jung Gu Kang
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Local Recurrence ◽  
Standard Technique ◽  
Disease Specific Survival ◽  
Significant Difference ◽  
Whole Mount ◽  
T3 Rectal Cancer ◽  
Lateral Margins ◽  
Disease Specific

Purpose: Total mesorectal excision is a standard technique for rectal cancer. The whole-mount section can encompass the entire specimen, so it is a more appropriate for measuring circumferential margin than conventional section. We analyzed the clinical characteristics and prognosis based on lateral margins (LMs) measured by whole-mount sections.Methods: Medical records of patients who were operated on for T3 rectal cancer from 2005 to 2015 were reviewed retrospectively. A total of 154 patients were included. The slides of the whole-mount sections were re-reviewed by a single pathologist.Results: We divided the groups according to the length of the LM (1 mm, 1.5 mm, and 2 mm). There was significantly frequent lymphovascular invasion and N state was higher when LM was short in all groups. There were more micrometastasis in group LM ≤1 mm (53.3% ≤1 mm vs. 26.6% >1 mm, P=0.039), but not in other groups. When looking at local recurrence alone, there was no significant difference between groups, but the 5-year local recurrence-free survival was significantly worse when LM ≤2 mm (P=0.050). In each analysis based on 1 mm and 1.5 mm, overall survival was worse when LM was short. In all groups, disease-specific survival was worse when LM was short.Conclusion: As previously known, securing a margin less than 1 mm negatively affects the prognosis. When LM was divided by 1.5 mm, there was a significant difference in overall survival. There was a significant difference in disease-specific survival when divided by 2 mm in T3 rectal cancer. However, further studies with more patients are necessary to secure the result.

Longer Time Intervals from Diagnosis to Surgical Treatment in Breast Cancer: Associated Factors and Survival Impact

2018 ◽  
Vol 84 (1) ◽  
pp. 63-70 ◽  
Author(s):  
Margaret Mariella ◽  
Charles W. Kimbrough ◽  
Kelly M. Mcmasters ◽  
Nicolas Ajkay
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Time Interval ◽  
Recurrence Free Survival ◽  
Disease Specific Survival ◽  
Free Survival ◽  
Factors Associated ◽  
The Impact ◽  
Disease Specific

Time interval (TI) from breast cancer diagnosis to definitive surgery is increasing, but the impact on outcomes is not well understood. TI longer than 30 days is associated with a greater chance of delay of chemotherapy, which may impact survival. We sought to identify factors associated with longer TI and the influence on outcome measures. Methods: We examined TI for stage 0-III breast cancer patients treated between 2006 and 2015 at a university-based cancer center. Univariate and multivariate analyses were used to study factors associated with TI <30, 30 to 60, and >60 days. Kaplan–Meier plots were used to examine the effect of different TI on overall survival, disease-specific survival, and recurrence-free survival. Results: 1589 patients were included with a median follow-up of 47 months. Median TI was 32 days. Median TI increased in patients from 2011 to 2015 compared with those from 2006 to 2010 (35 vs 30 days, P < 0.001). On multivariate analysis, mastectomy (with or without reconstruction), MRI use, and increasing age were independent predictors of TI >30 days. There were no significant differences in overall survival, disease-specific survival, or recurrence-free survival. There was no association between TI >30 days and a subsequent delay >60 days to adjuvant chemotherapy (OR 1.04, 95% CI 0.72–1.52). Conclusions: TI has increased in the last five years. Patient characteristics, tumor biology, and stage do not influence TI, whereas age, mastectomy, and MRI use were all associated with longer TI. Longer TI does not appear to significantly delay adjuvant chemotherapy or influence short-term outcomes.

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