scholarly journals Level of education, background and clinical stage as prognostic factors according RMST function in patients with early and locally advanced breast cancer: a single institution experience from Romania

2021 ◽  
Author(s):  
Irina Niță ◽  
Cornelia Nițipir ◽  
Ștefania Andreea Toma ◽  
Alexandra Maria Limbău ◽  
Edvina Pirvu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Advanced Breast Cancer ◽  
Tumor Size ◽  
Locally Advanced Breast Cancer ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Lymph Node Status ◽  
Level Of Education

Background and aims. Our aim is to examine the relationship between the level of education, background, tumor size and lymph node status on the treatment outcome in a group of patients with early and locally advanced breast cancer (BC) by using the restricted mean survival time (RMST), which summarizes treatment effects in terms of event-free time over a fixed period of time. Methods. We evaluated the prognostic values in 143 patients treated for early BC at Elias University Emergency Hospital, Bucharest, Romania and followed up for a maximum of 36 months. The protocol was amended to include the levels of education (gymnasium, high school, or university), the background (urban or rural) and the clinical stage (primary tumor (T) and regional nodes (N)). The methodology consisted in using a Kaplan–Meier analysis and RMST for the entire sample and Cox regression, for the variables with statistical influence. The principal endpoints of the study were overall survival (OS) and progression free survival (PFS). Results. The level of education had impact both on RMST OS (35.30 vs. 26.70) and death HR (hazard ratio) in the group of patients with general school level, compared with those with graduated university. In this study, the urban or rural background did not impact the outcome, probably because in this study we included predominantly patients from urban areas (83%). Although clinical tumor size measurements did not impact the outcome, the clinical staged lymph node influenced both OS (p=0.0500) and PFS (p=0.0006) for the patients with palpable or imaging proof of lymph node involvement of station 2 or 3. Conclusions. RMST provides an intuitive and explicit way to express the effect of those risk factors on OS and PFS in a cohort of early breast cancer patients. Low level of education and high-grade clinical lymph node status negatively influences the outcome of this cohort of BC patients.

scholarly journals Clinical efficacy of neoadjuvant FAC chemotherapy in locally advanced breast cancer patients

2003 ◽  
Vol 11 (3) ◽  
pp. 148-148
Author(s):  
Zdravko Zdrale ◽  
Snezana Susnjar ◽  
Ljiljana Stamatovic ◽  
Miodrag Matijasevic ◽  
Zora Neskovic-Konstantinovic
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Surgical Treatment ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Advanced Breast ◽  
Lymph Node Status ◽  
Axillary Lymph ◽  
Fac Chemotherapy

Background: FAC chemotherapy (CT) regimen is a well-established standard in the neo-adjuvant or primary chemotherapy for locally advanced breast cancer (LABC) treatment. Its main goal is to achieve locoregional tumor shrinkage allowing for the radical surgical treatment with curative intent. Concerning that prognosis of these patients depends on the response to initial neo-adjuvant therapy, we have analyzed clinical response to standard FAC CT in a group of routinely treated unrespectable LABC patients. Methods: During the three-year period, 50 pre- and postmenopausal patients without any cardiac risk factors, aged from 38-61 years, were treated with 3 to 4 cycles of neo-adjuvant FAC CT (500-50-500 mg/m 2 /21d). The initial diagnosis of LABC was based on tumor, nodal and/or skin characteristics: in 25 patients tumor was classified as T3-T4, N2 category was registered in 28 patients while skin lymphagiosis was found in 22 patients. Pathological diagnosis was confirmed either by skin, tumor and/or lymph node biopsy, or by tumorectomy (in 45 and 5 patients, respectively). Steroid receptor status was determined by biochemical DCC method in 35, or by immunohistochemistry in 7 patients. Results: Axillary lymph node status was evaluable in 47/50, and T status in 48/50 patients. Objective nodal response was achieved in 41/47 patients (12 CR and 29 PR, respectively), inflammatory skin features responded in 17/22 patients (2CR and 15PR, respectively). Overall objective response was achieved in 41/48 (82%) patients (9 CR, 32 PR), while 5 patients were classified as SD, and 2 consecutive patients as PD, with 2 non-evaluable patients. As far as toxicity was concerned, no acute cardiac damage was noted, emesis was successfully prevented with standard anti-emetics, and grade 3 to 4 alopecia developed in most of patients. Hematological tolerance was also good. Conclusion: Our results confirmed the high response rate to standard neoadjuvant FAC CT in unresectable LABC patients, in whom downstaging was achieved in majority, allowing for radical surgical treatment.

scholarly journals Identification of the sentinel lymph node using hemosiderin in locally advanced breast cancer

2017 ◽  
Vol 44 (6) ◽  
pp. 612-618
Author(s):  
PAULO HENRIQUE WALTER DE AGUIAR ◽  
RANNIERE GURGEL FURTADO DE AQUINO ◽  
MAYARA MAIA ALVES ◽  
JULIO MARCUS SOUSA CORREIA ◽  
AYANE LAYNE DE SOUSA OLIVEIRA ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Sentinel Lymph Nodes ◽  
Advanced Breast ◽  
Identification Rate

ABSTRACT Objective: to verify the agreement rate in the identification of sentinel lymph node using an autologous marker rich in hemosiderin and 99 Technetium (Tc99) in patients with locally advanced breast cancer. Methods: clinical trial phase 1, prospective, non-randomized, of 18 patients with breast cancer and clinically negative axilla stages T2=4cm, T3 and T4. Patients were submitted to sub-areolar injection of hemosiderin 48 hours prior to sentinel biopsy surgery, and the identification rate was compared at intraoperative period to the gold standard marker Tc99. Agreement between methods was determined by Kappa index. Results: identification rate of sentinel lymph node was 88.9%, with a medium of two sentinel lymph nodes per patients. The study identified sentinel lymph nodes stained by hemosiderin in 83.3% patients (n=15), and, compared to Tc99 identification, the agreement rate was 94.4%. Conclusion: autologous marker rich in hemosiderin was effective to identify sentinel lymph nodes in locally advanced breast cancer patients.

MRI tumor volume for predicting response to neoadjuvant chemotherapy in locally advanced breast cancer: Findings from ACRIN 6657/CALGB 150007

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 529-529
Author(s):  
N. Hylton ◽  
J. Blume ◽  
C. Gatsonis ◽  
R. Gomez ◽  
W. Bernreuter ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Breast Cancer ◽  
Tumor Size ◽  
Tumor Volume ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Pathologic Response ◽  
Advanced Breast ◽  
Tumor Diameter

529 Background: American College of Radiology Imaging Network (ACRIN) trial 6657, the imaging component of the I-SPY trial (CALGB 150007/150012), is testing MRI for predicting response to treatment and stratifying risk-of-recurrence in patients with locally-advanced breast cancer. We report preliminary results evaluating MRI for prediction of pathologic response. Methods: Women with ≥3 cm invasive breast cancer receiving neoadjuvant chemotherapy (NACT) with anthracycline-cyclophosphamide (AC) followed by a taxane (T) were enrolled from May 2002 to March 2006. MRI was performed prior to NACT (t1), after 1 cycle AC (t2), between AC and T (t3), and following T prior to surgery (t4). MRI tumor size assessments included longest diameter (MRLD) and tumor volume (MRVol). Clinical size (clinsize) and mammographic longest diameter (MGLD) were also recorded. Linear dimension was measured by the radiologist for MGLD and MRLD; MRVol was calculated by computer using signal enhancement ratio (SER) thresholds. Change in clinical and MRI variables at t2 were compared for ability to predict pathologic complete response (pCR). Results: 237 patients were enrolled at 9 institutions. 216 patients with complete imaging were analyzed. Of tumor size measurements at t4, MRVol showed the strongest correlation with pathsize among clinsize (r = 0.44), MGLD (ns), MRLD (r = 0.28) and MRVol (r = 0.61). Early change in MRVol measured at t2 was the only variable predictive of pCR among clinsize (p = 0.14, 0.15), MRLD (p = 0.40, 0.07), MRVol (p = 0.02, 0.01) and peak SER (p = 0.53, 0.72) in univariate and multivariate logistic regression, respectively. Conclusions: Tumor response measured volumetrically by MRI is a stronger and earlier predictor of pathologic response after NACT than clinical exam or tumor diameter. This work is funded by NIH/ACRIN U01 CA79778; CALGB CA31946, CA33601; NCI SPORE CA58207. [Table: see text]

Predicting Pathologic Responsive to Neoadjuvant Chemotherapy in Patients with Locally Advanced Breast Cancer by Radiomics of Multiparametric MR

2020 ◽  
Author(s):  
nannan Lu ◽  
jie Dong ◽  
xin Fang ◽  
lufang Wang ◽  
wei Jia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Regression Analysis ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Breast Cancer ◽  
Tumor Size ◽  
Locally Advanced Breast Cancer ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Adc Values

Abstract Background:Neoadjuvant chemotherapy for breast cancer was short of recognized treatment scheme and prediction factor. Diffusion weighted magnetic imaging can predict treatment response in patients with locally advanced breast cancer undergoing neoadjuvant chemotherapy. Methods:Fifty patients of breast cancer (mean age, 48.7 years) with stage II-III who underwent neoadjuvant chemotherapy and preoperative MRI were retrospectively evaluated between 2016 and 2020. Association between preoperative breast MRI findings or clinicopathological features and effect of neoadjuvant chemotherapy were studied. Risk factors were identified by multivariate logistic regression analysis. Results:Multivariate logistics regression analysis showed that clinical stage (OR, 0.104; 95% CI: 0.021, 0.516; p=0.006) at baseline and standard apparent diffusion coefficient (ADC) change (OR, 9.865; 95% CI: 1.024, 95.021; p=0.048) were predictive factors of neoadjuvant chemotherapy. The percentage of standard ADC value increasing in pCR group was larger than that in non-pCR group at first time point (p<0.05). The AUC of ROC curve was 0.828 (95% CI: 0.681, 0.975; p<0.05). In pCR group, change of standard ADC values was greater compared with that in tumor size at first follow-up (p<0.05). It was correlation between change of standard ADC values and tumor diameter at first follow-up (r, 0.438; p<0.05). Triple-negative patients in pCR group had higher change of standard ADC values than that in non-pCR groupat first follow-up (p>0.05).Conclusion:Standard ADC values change, clinical stage at baseline were closely related to the effect of neoadjuvant chemotherapy. The change of standard ADC values advanced reduction of tumor size at first follow-up and can predict effect of neoadjuvant chemotherapy in the early stage.

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