scholarly journals Assessment of Some Hematological parameters in Iraqi Women with Different Breast Cancer Stages

2020 ◽  
Vol 29 (2) ◽  
pp. 99-106
Author(s):  
Zahra M. Ali ◽  
Shatha H. Ali ◽  
Forat Y. Mohsen
Keyword(s):  
Breast Cancer ◽  
Iron Homeostasis ◽  
Hematological Parameters ◽  
Stage I ◽  
Disease Group ◽  
Hematological Markers ◽  
Group 3 ◽  
Group 2 ◽  
Blood Leukocyte ◽  
Wbc Count

Breast cancer (BC) is the most commonly diagnosed cancer in women. The metabolism of iron is closely regulated by hepcidin which exerts its action by interacting with a ferroportin.  The aim of the present study was to assess the alterations in the levels of some serum biomarkers that have a role in iron homeostasis (hepcidin and ferroportin) in addition to hematological parameters (hemoglobin, leukocyte and platelets count) in different stages of BC. This study included 66 women with BC. The patients were categorized as follows : group 1 includes :22 patients with stage I disease ,group 2 includes: 22 patients with stage II disease ,and group 3 include: 22 patients with stage III disease .Group 4 includes :22 apparently healthy women as control. Data analysis revealed a significant elevation of serum hepcidin levels of patients groups 1, 2, and 3 (437.2±26.4, 501.4±31.8 and 558.5±21.3 pg/ml respectively) ,vs  (179.4±19.8 pg/ml) of control, with  steady elevations from stage I to III . Furthermore, serum ferroportin levels were significantly lowered in groups 1 and 3 compared to control  (0.589±0.107  and 0.733±0.1 vs 1.37±0.28 ng/ml respectively).While  blood hemoglobin level of group 3 were lower (11.96±0.18 vs  12.7±0.13g/dl ) compared with controls . Blood leukocyte count of patients (all groups) (7.39±0.28 ,8.93±0.48,9.86±0.52 (^103/µl) respectively) were markedly increased compared to controls (6.06±0.23), while mean platelet count for patients in group 2&3 were significantly increased compared to controls  (313.9±19.3,309.2±25.3 vs 233.3±9.1 respectively). In conclusion, hepcidin, ferroportin and hematological markers including hemoglobin, WBC count and platelets count are altered in women with BC compared to healthy control. The changes occur mostly in accordance with disease stages.

Retrospective analysis of the role of CA 15-3 as a biomarker for breast cancer relapse.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e23051-e23051 ◽  
Author(s):  
Marwan Elahi Shaikh ◽  
Samantha Hall ◽  
Sijin Wen ◽  
Hui Liu ◽  
Abdul Miah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastases ◽  
Retrospective Analysis ◽  
Bone Pain ◽  
Stage I ◽  
Group 3 ◽  
Group 2 ◽  
Patient’S History ◽  
Relapse Group ◽  
Group 1

e23051 Background: The latest ASCO guidelines regarding tumor markers in breast cancer do not recommend routine monitoring of serum CA 15-3 (CA) levels alone as a marker for relapse. They do, however, acknowledge their use in conjunction with a patient’s history, physical exam, and diagnostic imaging. The study objective is to evaluate CA as a marker for relapse and determine its continued use in our patient population. Methods: We performed a retrospective analysis on female stage I-III breast cancer patients with an elevated CA marker treated in our cancer center between 2009-2014. Patients with metachronous or synchronous malignancies were excluded. Patients were categorized into three groups: Group 1 (elevated CA at relapse), Group 2 (normal CA at relapse, with elevation post-relapse), Group 3 (elevated CA without relapse). Categorical variables were collected to fulfill our objectives and the Fisher’s exact test was used to assess the correlation between them. The incidence rate and its 95% confidence interval were estimated based on the binomial distribution. Results: Out of 340 initially screened patients, 92 met our inclusion criteria: Group 1 (n = 25), Group 2 (n = 23), Group 3 (n = 44). The PPV for an elevated CA as a marker for relapse was 36% (95% CI: 26-48%). On routine surveillance, patients with elevated CA levels were more likely to have relapse if they presented with nausea (p = 0.02), myalgia (p = 0.003), or axial bone pain (p = 0.04). At relapse, an elevated CA was associated with fatigue (p = 0.02), myalgia (p = 0.01), liver metastases (p = 0.01), axial bone metastases (p = 0.005), and peripheral bone metastases (p = 0.0002). In patients with an elevated CA, a BMI < 25 had a higher incidence of relapse in comparison to those with a BMI ≥ 25 (p = 0.01). Conclusions: Our study suggests that a patient’s history, physical, and symptom-dictated imaging should be the main way to screen for relapse in stage I-III breast cancer. Based on the higher incidence of relapse in patients with both an elevated CA and symptoms of nausea, myalgia, or axial bone pain, we conclude that serum CA levels may be used as an adjunctive test in symptomatic patients. Our data also suggests that elevated CA levels may be less useful in detecting relapse in patients with BMI ≥ 25.

scholarly journals Comparison of Rare Types of Breast Cancer

2021 ◽  
pp. 9-17
Author(s):  
Osman Erdogan ◽  
Alper Parlakgumus ◽  
Ugur Topal ◽  
Kemal Yener ◽  
Umit Turan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Radical Mastectomy ◽  
Treatment Modalities ◽  
Breast Carcinomas ◽  
Term Survival ◽  
Prognostic Features ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aims: Mucinous, medullary, and papillary carcinomas are rarely encountered types of breast cancer. This study aims to contribute to the literature by comparing the clinical and prognostic features and treatment alternatives of rare breast carcinomas. Study Design: Thirty-four patients with rare breast cancer out of a total of 1368 patients who underwent surgery for breast cancer in our clinic between January 2011 and December 2020 were included in the study. Methodology: The patients were assigned into three groups, i.e., medullary carcinoma group (Group 1), mucinous carcinoma group (Group 2) and papillary carcinoma group (Group 3). Demographic and clinical features, treatment modalities used, surgical approaches, pathological features of tumors and survival were compared between the groups. Results: Thirty-four patients were included in the study. The mean age of the patients in Group 3 was higher, though it was not statistically significant. Modified radical mastectomy was more frequently performed in all the groups. The number of the lymph nodes removed through axillary dissections and the number of the positive lymph nodes were similar in all the groups. The tumors in all the groups were also of comparable sizes (30 mm in Group 1, 42.5 mm in Group 2 and 30 mm in Group 3; p:0.464). Estrogen receptors were negative in a significantly higher rate of Group 1(66.7% of Group 1, p<0,001). A significantly higher rate of Group 1 received postoperative chemotherapy (93,3% of Group 1,p:0.001), but the rate of the patients receiving hormonotherapy in this group was significantly lower (26.7% of Group, p<0,001). The patients with medullary cancer had significantly longer survival than those with mucinous cancer and those with papillary cancer (76.2 in Group 1, 54.5 in Group 2 and 58.4 in Group 3; p:0.005). Conclusion: While rare subtypes of breast carcinoma did not affect opting for surgical treatment, selection of oncological therapy was affected depending on the hormone receptor status of these tumors. The long-term survival differed between rare breast tumors. In view of the unique clinical pictures of the tumors, the patients should be evaluated individually, and the evaluation should be associated with theevidence-based principles available for more common breast carcinomas.

Delayed internal capsule infarctions following radiofrequency pallidotomy

1997 ◽  
Vol 87 (6) ◽  
pp. 955-960 ◽  
Author(s):  
Jae Y. Lim ◽  
Antonio A. F. de Salles ◽  
Jeff Bronstein ◽  
Donna L. Masterman ◽  
Jeffrey L. Saver
Keyword(s):  
Vascular Disease ◽  
Disease Risk ◽  
Internal Capsule ◽  
High Risk Group ◽  
Disease Group ◽  
Content Type ◽  
Posterior Limb ◽  
Group 3 ◽  
Group 2 ◽  
Capsular Infarction

✓ The authors report on a series of patients with idiopathic Parkinson's disease (IPD) who underwent stereotactic radiofrequency (RF) pallidotomies, three of whom suffered delayed postoperative strokes. These three belonged to a group consisting of 42 patients with medically intractable IPD in whom 50 pallidotomies were performed. All three patients had significant previous vascular disease and were in a high-risk group for cerebral infarction. A postoperative magnetic resonance (MR) image was obtained immediately after the pallidotomy was performed to document the placement of the RF lesion and to rule out any hematoma. The delayed strokes occurred on postoperative Days 10, 51, and 117 in patients with previous vascular disease (Group 1, 11 patients). No strokes occurred in the group with the vascular disease risk factor (Group 2, 11 patients) or in the group with no risk factors for vascular disease (Group 3, 20 patients). This observation is statistically significant (p < 0.05). The T2-weighted MR images showed the lesions as high-intensity signals extending to the posterior limb of the internal capsule ipsilateral to the pallidotomy site. The poststroke T1-weighted images obtained in two patients showed persistent contrast enhancement of the RF lesion and no enhancement around the stroke lesion. Clinically and radiographically, these discrete new lesions represent delayed infarctions, suggesting that RF lesioning can induce delayed injury in adjacent tissue. Patients with previously identified vasculopathy may be at risk for delayed capsular infarction following RF pallidotomy.

Hodgkin Lymphoma: 20 Years Experience From a Single Brazilian Institution

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3153-3153
Author(s):  
Camila C.G. Linardi ◽  
Luis Fernando Pracchia ◽  
Rodrigo Dolphini Velasques ◽  
Claudia Bitti Barroso ◽  
Valeria Buccheri
Keyword(s):  
Prognostic Factors ◽  
Hodgkin Lymphoma ◽  
Developed Countries ◽  
Stage I ◽  
Advanced Stage ◽  
Bulky Disease ◽  
Free Survival ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Abstract 3153 Hodgkin Lymphoma (HL) is characterized by high cure rates. Approximately 90% early stage and 60–70% advanced stage patients have long term disease free survival. In Brazil it is observed that about 60% of patients present with advanced stage, while in developed countries about 40% belong to this group. The aim of this retrospective study was to analyze data of patients with HL from the Oncohematology Unit of University of São Paulo- Medical School and evaluate the event free survival (EFS) and the overall survival (OS) according to clinical stage. We included all consecutive patients diagnosed with HL between January 1991 and June 2010. The collection of data from medical records was done and the following variables at diagnosis were evaluated: age and sex, staging according to Cotswolds modified Ann-Arbor criteria (CS), histological subtype, presence of B symptoms and bulky disease, International Prognostic Index (IPI) according to International Prognostic Factors Project on Advanced Hodgkin's Disease, laboratorial data, and the protocol used in first line therapy. The complete remission (CR) rate, EFS and OS were analyzed in all patients. The survival analysis was estimated by the Kaplan-Meier method and the survival curves were compared by the log-rank test. Differences in CR rates among staging groups were compared using the chi squared test. Overall, 564 HL patients were identified; thirteen did not have adequate information about clinical staging and were excluded from the analysis. The median age, at diagnosis, of the remaining 551 patients was 28 (12–83) and 54.3% were male. Histological subtypes lymphocyte rich classical HL, nodular sclerosis, mixed cellularity and lymphocyte depletion were found in 3.6%, 51.4%, 24.2% and 5.6% cases, respectively, and 11.8% patients were diagnosed as HL classic not classifiable otherwise. Nodular lymphocyte predominance was observed in 3.3% cases. Stage I, II, III and IV were found in 42 (7.6%), 208 (37.7%), 145 (26.3%) e 156 (28.3%) patients, respectively. B symptoms and bulky disease were present in 65.5%and 58.8% patients, respectively. After staging the patients were divided in three groups: group 1 -CS I/II, without B symptoms nor bulky disease= 62 (11.25%) patients, group 2 -CS I/ II, with B symptoms and/or bulky disease=188 (34.12%) patients and group 3- CS III/ IV= 301 (54.62%) patients. IPI high risk score was recognized in 63.9% patients of group 3. Only 1.5% of patients were treated with exclusive radiotherapy. Of the patients that were treated with chemotherapy, 4.9% were treated with MOPP, 23.1% with MOPPABV, 70.5% with ABVD and 1.5% with other types of chemotherapy. The median follow-up of the entire cohort was 59.6 months (0–258.8 months) and 88.3% (CI 95%: 85.2%-91.1%) were in CR at the end of treatment (CS I: 100%, CS II: 90.6% CS III: 84.6% and CS IV: 85.3%; p=0.03) (group 1: 98.2%, group 2: 90.2% and group 3: 84.9%; p=0.012). The 5-year EFS rate was 69.2% (CS I: 84.8%; CS II: 77.8%; CS III: 64.5%, CS IV: 56%; p=0.0008) (group 1: 88%, group 2: 76% and group 3: 60.3%; p=0.0002) (Figures 1 and 2). The 5-year OS rate was 86.44% (CS I: 90.3%, CS II: 94.6%, CS III: 87.6%, CS IV: 71.4%; p<0.0001) (group 1: 98.3%, group 2: 92.6% and group 3: 79, 6%; p=0.0003).Figure 1Figure 1. Figure 2Figure 2. We found that there were more advanced stage patients (stage III/IV) in comparison to developed countries, however, patients classified as stage I/II without poor prognostic factors, like B symptoms and/or bulky disease, showed high rates of CR, EFS and OS. These data suggest that there is a need to enhance early diagnosis in Brazilian patients, in order to detect less advanced stage patients due to late diagnosis. Disclosures: No relevant conflicts of interest to declare.

Reassignment of HER2 status for subgroups of breast cancer according to the 2018 updated American Society of Clinical Oncology and College of American Pathologists guidelines: The impact of combined immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) reflex testing in a large national reference laboratory.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3144-3144
Author(s):  
Katherine Geiersbach ◽  
Reid G. Meyer ◽  
Sara M. Kloft-Nelson ◽  
Darlene L. Knutson ◽  
Ryan A. Knudson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Her2 Status ◽  
Reference Laboratory ◽  
National Reference Laboratory ◽  
National Reference ◽  
Group 4 ◽  
Reflex Testing ◽  
Group 3 ◽  
Group 2 ◽  
The Impact

3144 Background: Updated ASCO/CAP Guidelines for HER2 testing in breast cancer have been most impactful on the resolution of certain challenging groups of FISH results. We review the change in assignment of HER2 status in a large series of breast cancers referred to a large national reference laboratory for FISH testing since the introduction of the 2018 updated guidelines. Methods: Patient samples submitted to the Mayo Clinic Cytogenetics Laboratory (N = 2208) were analyzed by FISH. Samples with Group 2, Group 3, or Group 4 FISH results were reflexed to immunohistochemistry (IHC) in our central laboratory; FISH slides for those cases with equivocal 2+ IHC results were re-scored in the regions of invasive cancer showing more intense membranous staining. A subset of 202 samples with Group 4 FISH results were also reflexed to the previously employed reflex FISH assay (HER2/D17S122), and these were also re-analyzed according to the new reflex IHC/FISH process. Results: 382 of 2208 breast cancer samples tested (17.3%) had FISH results categorized as Group 2 (N = 17, 0.8%), Group 3 (N = 34, 1.5%), or Group 4 (N = 331, 15%) and required reflex IHC testing, and of those, 75% were 2+ equivocal and required targeted re-analysis of the FISH slide according to the 2018 updated guidelines. Re-analysis of the FISH slide resulted in switching between Groups 1-5 in 19.4% of cases, but HER2 status was changed by FISH re-scoring in only 7.7% of cases re-scored (1.0% of all samples), generally due to only minor shifts in HER2 copy number and HER2/control ratios between the initial and IHC-guided reflex FISH scores. In the subset of 202 cases tested by both reflex methods, the previously employed HER2/D17S122 reflex probe set was positive in 123 cases (60.9%), whereas reflex IHC/FISH was positive in only 10 cases (7.9%). Including positive reflex IHC (0.4%) and positive reflex FISH results (2.1%), the overall assignment of positive HER2 status on our series of 2208 cases was 11.5%. Conclusions: Overall rates of HER2 positive FISH results have declined under the most recent ASCO/CAP guideline update as a consequence of new recommendations for reflex testing for Groups 2-4. This change is largely due to reassignment of Group 2 and Group 4 results as negative in the absence of positive IHC.

scholarly journals Roles of neutrophil/lymphocyte ratio in prognosis and in differentiation of potential beneficiaries in HER2-positive breast cancer with trastuzumab therapy

2019 ◽  
Author(s):  
Nianhua Ding ◽  
Juan Huang ◽  
Ningsha Li ◽  
Jiaqi Yuan ◽  
Shouman Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Her2 Positive ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Trastuzumab Treatment ◽  
Her2 Positive Breast Cancer ◽  
Group 3 ◽  
Group 2 ◽  
Group 1 ◽  
Positive Breast Cancer

Abstract Purpose: The relationship of neutrophil/lymphocyte ratio (NLR) with prognosis of HER2-positive breast cancer (BC) are not well studied. We aimed to assess the prognostic role of NLR in HER2-positive BC patients treated with or without trastuzumab.Methods: The clinical data of 843 HER2-positive BC patients from July 2013 to July 2018 were collected. The difference among variables was calculated by chi-square test. The associations between clinicopathological factors, NLR and disease-free survival (DFS) were analyzed by univariate and multivariate analyses.Results : Patients were divided into three groups. In group 1 containing 255 patients without trastuzumab treatment, pretreatment NLR showed no predictive value. Patients with trastuzumab treatment were divided into two groups on equal, according to pretreatment NLR values, low NLR (group 2) and high NLR (group 3). Patients in group 2 showed significantly higher 3-year DFS rate than patients in group 1 and group 3 (95.3% vs. 91.6% vs. 90.5%, respectively, P = 0.011); patients in the group 1 and group 3 had similar 3-year DFS outcome. Multivariate analysis showed high pretreatment NLR was significantly associated with shorter DFS (HR = 2.917, 95% CI=1.055-8.062, P = 0.039) in HER2-positive BC patients treated with trastuzumab. Conclusion : Among HER2-positive trastuzumab-treated BC patients, low pretreatment NLR value was associated with better DFS, and it might help to differentiate potential beneficiaries of trastuzumab treatment.

scholarly journals Evaluation of protective effect of myricetin, a bioflavonoid in dimethyl benzanthracene-induced breast cancer in female Wistar rats

2014 ◽  
Vol 03 (02) ◽  
pp. 107-111 ◽  
Author(s):  
J. K. Jayakumar ◽  
P. Nirmala ◽  
B.A. Praveen Kumar ◽  
Ashok P. Kumar
Keyword(s):  
Breast Cancer ◽  
Wistar Rats ◽  
Statistical Significance ◽  
Treated Animal ◽  
Group 4 ◽  
Female Wistar Rats ◽  
Group 3 ◽  
Group 2 ◽  
And Control

Abstract Background: Breast cancer is one of the most common cancers worldwide. Alarmingly, the incidence of breast cancer is rising rapidly in India. Aim: The present research was focused to assess the role of myricetin; a bioflavonoid in 7,12-dimethylbenzanthracene (DMBA)-induced breast cancer in female Wistar rats. Materials and Methods: A total of 36 female Wistar rats (total 6 groups, n = 6 per group) 6 - 8 weeks old, weighing 150 gm were used in the study. DMBA was given at the dose of 7.5 mg/kg subcutaneously in the mammary region once a week for 4 consecutive weeks in group 2. Vincristine was given in the dose of 500 μg/kg intraperitonially every week for 4 consecutive weeks in group 3. Myricetin was given orally in a dose of 50, 100, and 200 mg/kg in group 4, 5, and 6 respectively. The statistical significance of the data was determined using one way analysis of variance and Duncan’s multiple range test. Results: The result showed that myricetin increased the antioxidant levels in plasma, erythrocyte lysate, and breast tissue and was effective in preventing the oxidative damage induced by the carcinogen DMBA. Myricetin 50, 100, and 200 mg/kg/oral for 120 days treated animal resulted comparable results to that of standard vincristine and control groups. Conclusions: Myricetin was found to be either equieffective or more effective than vincristine in all the parameters studied. Myricetin proved the capacity of flavonols to act as antioxidant in cells represents a potential treatment in the field of oncology.

Activation of the PI3K/AKT signal transduction pathway is inversely associated with estrogen receptor levels and correlates with survival in hormone receptor-positive Her2/neu-negative breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10588-10588
Author(s):  
A. M. Gonzalez-Angulo ◽  
B. T. Hennessy ◽  
F. Meric-Bernstam ◽  
Y. Lu ◽  
W. F. Symmans ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hormone Receptor ◽  
Pik3ca Mutation ◽  
Significant Proportion ◽  
Stage I ◽  
Akt Pathway ◽  
Breast Cancers ◽  
Hormone Receptor Positive ◽  
Group 2 ◽  
Group 1

10588 Background: Hormone receptor-positive is the most common subtype of breast cancer. Despite the successes of antihormone therapy alone or combined with chemotherapy, a significant proportion of patients (30–40%) will have primary or acquired resistance to this treatment. There is a need to identify molecular markers to distinguish patients unlikely to benefit from therapy as well as novel targeted therapeutics that increase the response rate. Methods: We used a novel functional proteomics technology, reverse phase protein array (RPPA), to quantify expression and activation of 42 steroid and kinase signaling proteins in 64 hormone receptor-positive-Her2/neu-negative breast cancers from patients with stage I to III tumors managed with non-steroidal aromatase inhibitors ± chemotherapy. Unsupervised clustering analysis was used to molecularly group the tumors. Recurrence-free survival (RFS) was estimated with the Kaplan Meier product limit method and comparison was made using the Log-rank test. Correlation coefficients were used to look at the relationships between two variables. Results: Median age was 57 years (23–79). Sixteen patients (25%) had stage I tumors, 32 (50%) had stage II tumors and 16 (25%) had stage III tumors. There were two well-defined and distinct clusters of tumors: Group 1: ER high (n=25) and Group 2: PI3K/AKT activated (n=39). 3-year RFS estimates were 100% for group 1 and 59% for group 2 (p=0.04). There were thus clear inverse correlations between markers of activation of PI3K pathway and expression of ER (R for pAKT vs ER = -0.26, p=0.03). PIK3CA mutation was detected in 12/58 (21%) of hormone receptor-positive breast cancers and these tumors were found to have a proteomic signature distinct from PTEN loss with the former signature associated with a trend to improved RFS (p=0.06). Conclusion: Activation of the PI3K/AKT pathway in hormone receptor- positive-Her2/neu-negative breast cancer is inversely correlated with ER levels and associated with adverse outcome. At least in some cases, PI3K/AKT pathway activation, may be under the control of genomic aberrations. A validation set of 100 tumors treated with tamoxifen is on- going. No significant financial relationships to disclose.

Socioeconomic status as an independent prognostic factor in node negative, stage I-II breast cancer patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21129-21129
Author(s):  
I. Zeichner-Gancz ◽  
D. E. Munoz-Gonzalez ◽  
V. M. Pérez Sánchez ◽  
C. Castillero ◽  
M. Ramirez-Ugalde
Keyword(s):  
Breast Cancer ◽  
Socioeconomic Status ◽  
Statistical Significance ◽  
Stage I ◽  
High Status ◽  
Node Negative ◽  
Her 2 ◽  
Group 2 ◽  
Clinical Records ◽  
Group 1

21129 Background: Many prognostic factors for breast cancer are known, of those, clinical , histological, genetical and the socioeconomic status are considered important for the outcome of these patients. The objective of our study vas to evaluate the Socioeconomic status as an independent factor for survival Methods: Clinical records of node negative clinical stage I- II patients treated at the institution from 1980 to 1996 were reviewed . We included those initially treated with surgery, available paraphine blocks, follow up of at five years (the ones that had no recurrence). They were divided in two groups: 1: Lower socioeconomic status, economically deprived and 2: medium low to high status. The slides were reviewed s and the blocks were processed for immuno-histochemistry: steroid receptors, Her-2, p 53 and CD 34. The analysis was performed with X2, , t test and log rank for difference in survival Results: A total of 81 patients were studied, 35 in group 1, and 46 in group 2. Mean age for groups 1 and 2 was of 52 (28–74) and 52.9 (28–83) years respectively (p=0.39). Were stage I in group 1 8, II-28. In Group 2 were stage I, 12, II-34 (p=0.87). Patients in both groups were treated with surgery alone, with radiotherapy, chemotherapy and/or hormone therapy, without statistical significance for treatment.Vascular or lymphatic permeation was observed in 20 and 22 patients from groups 1 and 2 respectively (p=0.40). Mean SBR was of 7.2 and 7.1 respectively for groups 1 and 2 (p=0.54) Estrogen receptor was present in 10 and 11 patients (p=0.63) and progesterone receptor in 8 and 6 (p0.25) for each group. Her-2 was over expressed in 12 and 17 patients from group 1 and 2, p53 in 6 and 14 respectively (p=0.17)and CD34 in 7 and 6 for both groups respectively ( p=0.40). Median survival was of 225 months for group 1 and not reached at 243 months for group 2, with 90.22% alive, p= 0.005 Conclusions: According to our results, in this group of well studied patients, the only significant factor observed that had an impact over survival was the socioeconomic status. None of the clinical, histological or genetical variables showed significance. We think that prospective studies with special emphasis on the socioeconomic status have to be carried out in order to try to explain the differences that we observed. No significant financial relationships to disclose.

Increased intensification and total dose of cyclophosphamide in a doxorubicin-cyclophosphamide regimen for the treatment of primary breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-22.

1997 ◽  
Vol 15 (5) ◽  
pp. 1858-1869 ◽  
Author(s):  
B Fisher ◽  
S Anderson ◽  
D L Wickerham ◽  
A DeCillis ◽  
N Dimitrov ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Total Dose ◽  
Primary Breast Cancer ◽  
National Surgical Adjuvant Breast ◽  
Significant Difference ◽  
Bowel Project ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

PURPOSE The National Surgical Adjuvant Breast and Bowel Project (NSABP) initiated a randomized trial (B-22) to determine if intensifying but maintaining the total dose of cyclophosphamide (Cytoxan, Bristol-Myers Squibb Oncology, Princeton, NJ) in a doxorubicin (Adriamycin, Pharmacia, Kalamazoo, MI)-cyclophosphamide combination (AC), or if intensifying and increasing the total dose of cyclophosphamide improves the outcome of women with primary breast cancer and positive axillary nodes. PATIENTS AND METHODS Patients (N = 2,305) were randomized to receive either four courses of standard AC therapy (group 1); intensified therapy, in which the same total dose of cyclophosphamide was administered in two courses (group 2); or intensified and increased therapy, in which the total dose of cyclophosphamide was doubled (group 3). The dose and intensity of doxorubicin were similar in all groups. Disease-free survival (DFS) and overall survival were determined using life-table estimates. RESULTS There was no significant difference in DFS (P = .30) or overall survival (P = .95) among the groups through 5 years. At 5 years, the DFS of women in group 1 was similar to that of women in group 2 (62% v 60%, respectively; P = .43) and to that of women in group 3 (62% v 64%, respectively; P = .59). The 5-year survival of women in group 1 was similar to that of women in group 2 (78% v 77%, respectively; P = .86) and to that of women in group 3 (78% v 77%, respectively; P = .82). Grade 4 toxicity increased in groups 2 and 3. Failure to note a difference in outcome among the groups was unrelated to either differences in amount and intensity of cyclophosphamide or to dose delays and intervals between courses of therapy. CONCLUSION Intensifying or intensifying and increasing the total dose of cyclophosphamide failed to significantly improve either DFS or overall survival in any group. It was concluded that, outside of a clinical trial, dose-intensification of cyclophosphamide in an AC combination represents inappropriate therapy for women with primary breast cancer.

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