Oral Vinorelbine or Capecitabine Combined With Trastuzumab as Adjuvant Treatment for Patients With Lymph Node Negative, HER-2 Positive and Small Tumor Size Breast Cancer (ORCHID)

Background: Carcinoma of the breast is one of the most common cancer in women and it is the second cause of cancer deaths only to lung cancer. Recent attention has been directed singularly at molecular classifications of breast cancer. Molecular subtypes have different prognostic and therapeutic implications. Objective: The aim of this study was to assess the ER, PR, and HER-2/neu reactivity pattern in breast carcinomas and to correlate this reactivity pattern with stage tumor size and lymph node metastasis. Methodology: This is a prospective analytical observational study was conducted in the North East Cancer Hospital and Department of Pathology of North East Medical College, Sylhet, Bangladesh during a 42 months period from July 2015 to December 2018. Result: Among 67 Cases of primary invasive breast carcinoma only one case was male and 66 were female. In aspect of tumor size most of the patient presented with 2 to 5cm tumor, 47(70.2%) cases and (80.6%) presented with more than 2cm tumor size. In our study 38(56.7%) cases of breast cancer found ER positive, 38.8%(26 cases) PR positive and 22.4% (15 cases) HER2/neu positive, most common presentation of the disease was at stage llB(29 cases,45%), lymph node positivity 46(68.7%) cases and lymph node negative 21(31.3%) cases, 5(7.5%)cases. In aspect of molecular subtyping we found luminl A 29 (43.3%) cases Luminal B 11.9% (8 cases) basal like 22(32.8%) cases and HER-2/neu over expressed 8(11.9%) cases. Conclusion: Cancer screening and early detection program can improve our scenario. Journal of Current and Advance Medical Research 2020;7(1): 30-35

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Clinical significance of HER-2/neu oncogene amplification in primary breast cancer. The South Australian Breast Cancer Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.1993.11.10.1936 ◽

1993 ◽

Vol 11 (10) ◽

pp. 1936-1942 ◽

Cited By ~ 325

Author(s):

R Seshadri ◽

F A Firgaira ◽

D J Horsfall ◽

K McCaul ◽

V Setlur ◽

...

Keyword(s):

Breast Cancer ◽

Multivariate Analysis ◽

Tumor Size ◽

Copy Number ◽

Node Negative ◽

Node Positive ◽

Oncogene Amplification ◽

Her 2 ◽

Neu Oncogene

PURPOSE To determine prospectively the prognostic significance of HER-2/neu oncogene amplification in the primary tumors of breast cancer patients. METHODS HER-2/neu amplification in tumor DNA was determined by the slot-blot technique in 1,056 patients with breast cancer (stage I to III) diagnosed between 1987 and 1990. Parameters such as estrogen receptor (ER) and progesterone receptor (PgR) levels, tumor size, axillary nodal involvement, tumor grade, and time to relapse were prospectively obtained. RESULTS HER-2/neu oncogene amplification, > or = 2, > or = 3, and > or = 5 copy number, was detected in 21%, 11%, and 7% of patients, respectively. In a test set of 529 patients, Cox multivariate analysis showed HER-2/neu copy number > or = 3 or > or = 5 was associated with shorter disease-free survival (DFS) duration. HER-2/neu copy number > or = 3 correlated significantly with pathologic stage of disease, number of axillary nodes with tumor, histologic type, and absence of ER and PgR. For all patients, after a median follow-up duration of 39 months, Kaplan-Meier univariate analysis indicated that tumor oncogene copy number > or = 3 correlated with shorter DFS in both node-negative and node-positive patients. In Cox multivariate analysis, HER-2/neu copy number > or = 3 was associated with shorter DFS, independent of nodal status, ER level, and tumor size. CONCLUSION Although the follow-up duration of this study is relatively short, we conclude that HER-2/neu amplification is an independent predictor of shorter DFS in both node-negative and node-positive patients.

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Number of lymph nodes removed in sentinel lymph node-negative breast cancer patients is significantly related to patient age and tumor size

Cancer ◽

10.1002/cncr.24964 ◽

2010 ◽

Vol 116 (8) ◽

pp. 1987-1991 ◽

Cited By ~ 20

Author(s):

Elisa Rush Port ◽

Sujata Patil ◽

Michelle Stempel ◽

Monica Morrow ◽

Hiram S. Cody

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Nodes ◽

Cancer Patients ◽

Tumor Size ◽

Breast Cancer Patients ◽

Patient Age ◽

Node Negative ◽

Node Negative Breast Cancer

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Recurrence Score across the age spectrum: Is there an age discrimination?

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.27 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 27-27

Author(s):

Franz Omar Smith ◽

Marie Catherine Lee ◽

Geza Acs ◽

William J. Fulp ◽

Ji-Hyun Lee ◽

...

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Lymph Node ◽

Treatment Planning ◽

Tumor Size ◽

Predictive Power ◽

Early Stage ◽

Recurrence Score ◽

Positive Lymph Node ◽

Node Negative

27 Background: Treatment planning for early-stage estrogen receptor (ER) positive, lymph node negative breast cancer was based on prognostic factors with limited predictive power such as age. The Recurrence Score (RS) from the Oncotype DX assay (ODX) provides predictive power transcending age but is rarely applied to the elderly or young patients (pts). We examined our experience with RS along the age continuum. Methods: Retrospective review was conducted of prospectively gathered breast cancer pts having a RS obtained as part of their cancer care. Eligibility for performance of the ODX was based on NCCN guidelines or physician discretion. Comparisons on RS were made by age groups (young: <45yrs; middle: >45yrs -<70yrs: elderly: >70yrs) using general linear regression model and the exact Wilcoxon Rank Sum Test. Results: 677pts had 681 tumors with RS available (89 young, 476 middle and 112 elderly pts). Median RS for the study pts was 17 (range 0-85) and 16, 17, and 15 for the young, middle, and elderly respectively. Median age was 58yrs (range: 27-95); young, middle, and elderly was 42, 58, and 74yrs respectively. Age as a continuous or categorical variable was not predictive of RS (p value = 0.38, 0.58 respectively). No significant differences were seen between age cohorts for histology, mitotic rate, lymphovascular invasion (LVI), grade, nodal status, stage, or strength of ER positivity. Mastectomy rates were higher in the young (57.5%), compared to the middle (42.5%) and elderly (39.6%) (p=0.02). Median invasive tumor size was 1.6, 1.5, and 1.5cm for young, middle, and elderly. Larger tumor size, as a continuous variable, equaled higher RS (p=0.046). Other significant factors predicting higher RS were increased mitosis (p<0.001), LVI (p=0.013), high grade (p<0.001), and weak (<10%) ER positivity (p<0.001). Nodal status, stage, and histology did not affect RS. Conclusions: Age has limited predictive power for treatment planning for breast cancer. Age alone should not preclude recommendations for performance of ODX in estrogen receptor positive lymph node negative early stage breast cancer as the RS distribution across the spectrum of age is well matched.

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Comparison of ER, PR, Ki67 and HER-2/neu Reactivity Pattern with Patients’ Age, Histologic Grade, Tumor Size and Lymph Node Status in Invasive Ductal Breast Cancer

International Journal of Cancer Management ◽

10.5812/ijcm.98325 ◽

2020 ◽

Vol 13 (6) ◽

Author(s):

Mahsa Ahadi ◽

Motahareh Heibatollahi ◽

Sara Zahedifard

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Tumor Size ◽

Histological Grade ◽

Lymph Node Involvement ◽

Lymph Node Status ◽

Invasive Ductal Breast Cancer ◽

Ductal Breast Cancer ◽

Node Involvement ◽

Her 2

Background: Breast cancer is the most prevalent neoplasm diagnosed in Iranian women. Objectives: The current study was performed to measure the hormone receptor status and its possible connection with the patient’s age, tumor size, histological grade, and lymph node status and involvement in patients with invasive ductal breast cancer (IDBC) Methods: A total of 103 women with IDBC recently diagnosed at the Department of Pathology of Shohada-E-Tajrish Hospital were entered into this study. The mean age of the patients was 48.4 years, and 59.2% of cases were 50 years old or less. Results: Most lesions (78.6%) were more than 2 cm at their greatest dimension. Grade-II lesions were observed in a large number of patients and 59.8% of cases had lymph node involvement. Positive ER, PR, and HER-2/neu were detected in 59%, 57%, and 29% of patients, respectively. A significant correlation was found between patients’ age and histologic score, tumor dimension and both histologic score and nuclear grade, and, finally, between lymph node involvement and nuclear grade. Conclusions: According to previous studies, the evaluation of hormone receptor status in patients with breast cancer is strongly recommended. Here, by studying its possible connection with the patient’s age, tumor size, histological grade, and lymph node metastasis, we detected some biomarkers, which could be used as prognostic indices in these patients. These biomarkers could help us in the clinical management of patients with IDBC by providing the best therapeutic options.

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The risk of breast cancer recurrence in the sentinel lymph node era

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10600 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10600-10600

Author(s):

L. P. Gold ◽

Z. Cheng ◽

L. Tafra ◽

K. Sawyer ◽

K. Verbanac ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Adjuvant Therapy ◽

Tumor Size ◽

Cancer Recurrence ◽

Breast Cancer Recurrence ◽

Prognostic Models ◽

Node Negative ◽

Significant Difference

10600 Background: Sentinel lymph node biopsy (SLNB), the preferred method of axillary staging in early breast cancer, is more sensitive and accurate compared to axillary node dissection. However, this data has not been incorporated into current prognostic models estimating the risk of breast cancer recurrence. We hypothesize that prognostic models based on data in the pre-SLN era underestimate survival and exaggerate benefits resulting from adjuvant therapy. In order to evaluate this hypothesis, we examined the disease free survival (DFS) and overall survival (OS) in an IRB approved, prospective, multicenter study of SLNB. Methods: From 1996–2005, 564 patients who had invasive disease in whom a SLN was found were examined from two experienced sites . Data was analyzed with regards to SLN status, tumor size, grade, lymphovascular invasion (LVI), age, estrogen receptor (ER) status and use of chemotherapy with respect to DFS and OS. Results: Median age was 57 years, tumor size was 1.5 (range 0.08–10.5) cm and follow-up was 46.2 (range 1–104.5) months. The SLN was positive in 31.2% of patients. The Kaplan-Meier (K-M) 5 year estimate of OS was 94.5(±1)% and DFS 88(±2)%. Tumor grade and size, LVI, ER- and +SLN significantly correlated with poorer DFS and OS by univariate analysis. By multivariate analysis, however, SLN status was the only statistically significant predictor for DFS (p = 0.004; HR = 3.4; CI = 1.5 - 8.0) and OS (p = 0.0051; HR = 7.3; CI = 1.8–29.4). SLN negative patients showed K-M 5 year DFS and OS estimates of 94(±)% and 97.4(±1)% respectively. There was no significant difference in DFS for SLN- patients treated with or without chemotherapy (p = 0.3). Conclusions: SLN status was the only significant predictor of DFS and OS. In node negative patients, we observed a higher DFS and OS than current statistical models based on historical data would have predicted. In this new era of SLNB, the magnitude of benefit from adjuvant therapy in sentinel node negative patients should be re-evaluated. No significant financial relationships to disclose.

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Nomogram to predict sentinel lymph node involvement in patients with clinically node-negative breast cancer receiving neoadjuvant chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.150 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 150-150 ◽

Cited By ~ 2

Author(s):

Lisa R. Allen ◽

Pranjali V. Gadgil ◽

Roland Bassett ◽

Kelly Hunt ◽

Elizabeth Ann Mittendorf ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Tumor Size ◽

Multidisciplinary Treatment ◽

Tumor Location ◽

Lymph Node Involvement ◽

Breast Cancer Patients ◽

Node Negative ◽

Node Involvement

150 Background: Sentinel lymph node biopsy (SLNB) has been shown to be an accurate predictor of axillary lymph node involvement in breast cancer patients treated with neoadjuvant chemotherapy (NAC). A predictive model of SLN positivity in clinically node negative patients who completed NAC can assist in preoperative multidisciplinary treatment decision making, such as planning for postmastectomy radiation therapy and breast reconstruction. Methods: We reviewed our prospective database to identifyclinically node negative patients with invasive breast cancer who underwent NAC and SLNB from 1998-2011. Clincopathologic factors including age, tumor location, histology, nuclear grade, tumor size, decrease in tumor size with therapy, multifocality, nodal appearance on preoperative ultrasound, hormone receptor status, and lymphovascular invasion (LVI) were analyzed. A nomogram to predict SLN metastasis was developed using multivariate logistic regression analysis. Results: A total of 836 patients were treated with NAC followed by SLNB. Of these, 160 patients (19.1%) had a positive SLN. All factors were significant predictors of SLN positivity on univariate analysis except tumor location and nodal appearance on preoperative ultrasound. Multivariate analysis showed that young age, invasive lobular histology, tumor size, multifocality, and LVI were independent positive predictors of SLN positivity whereas high grade, response to chemotherapy, and triple negative hormone receptor status were negative predictors. Favorable histologies were strongly associated with a lower rate of SLN positivity but were excluded from the nomogram due to small numbers of patients (N=14). Discrimination of the nomogram to correctly predict SLN positivity was measured using the area under the receiver operating characteristic curve (AUC). The unadjusted AUC was 75.9, while the internally validated 2000 bootstrap sample-adjusted AUC was 74.2. Conclusions: Neoadjuvant chemotherapy is known to decrease the incidence of positive nodes in breast cancer patients. Use of our nomogram preoperatively can assist in decisions regarding multidisciplinary treatment planning.

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