Determination of Significant Pretreatment Factors that Predict Survival in Indonesian Subjects with Breast Cancer

BACKGROUND: The determination of the pre-treatment’s survival predictive factors is very important as a basis for clinicians to educate and determine appropriate management for patients. AIM: This study aimed to determine the pre-treatment risk factors that predict survival in Indonesian subjects with breast cancer. METHODS: This was a cohort retrospective study conducted on breast cancer subjects visiting Sanglah General Hospital from 2016 to 2020. Data were collected from Indonesian Cancer Registry medical records such as age, tumor size, lymph nodes, metastasis, Karnofsky score, serum CA15-3 level, hormonal receptor status (ER/PR), HER2, Ki-67, LVI, tumor-infiltrating lymphocytes, cell type, histological grade, and survival status until December 2020. Data were tabulated and analyzed statistically using SPSS 25.0. RESULTS: The median survival of breast cancer in this study was 47 months (SD 4.851). Majority of breast cancer subjects with mortality outcome were those who had Karnofsky score less than 70, tumor size ≥5 cm with infiltration, presence of contralateral lymph node, with metastasis, serum CA15-3 level >25 IU/mL, negative hormonal receptor, negative HER2 receptor, Ki67 higher than 14, negative lymphovascular invasion, negative tumor-infiltrating lymphocytes, and histological Grade 3. Age and pathological type were not significantly differed the breast cancer outcome. CONCLUSION: There were significant effects of tumor size, KGB status, metastasis, serum CA15-3 levels, hormone receptor, HER2 receptor, Karnofsky score, lymphovascular invasion, tumor-infiltrating lymphocytes, and histological grade on breast cancer subjects’ survival.

Comparative study of Hormonal Receptor Status Discrepancy - Brain Breast Cancer Metastasectomy vs Other Localities.

Purpose: Hormonal receptor (HR) status is one of the key factors when determining the treatment of breast cancer. Even though HR conversion is one of the most researched topics recently, most of the previous studies include only the results of biopsies instead of samples obtained by metastasectomy. Aim: The aim of this study is to compare the occurrence of HR status conversion in brain breast cancer metastatic tissue to other localities. Methods: A total of 50 patients after breast cancer metastasectomy of brain, lung or liver were included in the study. The clinical characteristics were recorded. Results: HR conversion was observed in a total of 30 cases (60.0%), while HER2 (human epidermal growth factor receptor 2) discrepancy occurred only in one case (2.0%). Endocrine therapy significantly contributed to the decrease progesterone and estrogen receptor expression in metastatic tissue compared to the primary tumor (p = 0.009, p = 0.023; respectively). Triple negativity was more common in the brain metastases (p = 0.039). Liver metastases occurred in significantly younger patients (p = 0.034), however brain metastases had the poorest OS (p = 0.007). Conclusion: HR conversion occurs in more than 50% of cases of breast cancer metastatic disease, while HER2 discrepancy is rare. Hormonal therapy significantly contributes to the decrease of HR positivity in metastases. Triple negativity is more common in the brain metastases than in other localities. Brain metastases of breast cancer are associated with the poorest prognosis.

Hormone Receptor Expression Variations in Normal Breast Tissue: Preliminary Results of a Prospective Observational Study

Normal breast tissue undergoes great variations during a woman’s life as a consequence of the different hormonal stimulation. The purpose of the present study was to examine the hormonal receptor expression variations according to age, menstrual cycle, menopausal state and body mass index. To this purpose, 49 tissue samples of normal breast tissue, obtained during surgery performed for benign and malignant conditions, were immunostained with Estrogen (ER), Progesterone (PR) and Androgen receptors (AR). In addition, Ki67 and Gross Cystic Disease Fluid Protein were studied. The data obtained revealed a great variability of hormone receptor expression. ER and AR generally increased in older and post-menopausal women, while young women presented a higher proliferative rate, evaluated with Ki67. PR increase was observed in women with BMI higher than 25. The different hormonal receptor expression could favor the development of breast cancer.

Primary Systemic Therapy for HER2/Neu-Positive Operable Breast Cancer Increases the Number of Breast-Conserving Surgery and Disease-Free Survival: Retrospective Cohort Analysis at Single Institution

Objective The aim of this study was to evaluate the efficacy and cardiotoxicity profile, and to reduce the extend of breast cancer surgery in primary systemic therapy (PST) HER2/neu–positive operable breast cancer patients. Materials and Methods A total of 152 patients diagnosed from 2010 to 2015 were included in the study. The PST consisted of a sequential regimen of taxanes and anthracyclines plus trastuzumab. The clinical and pathological responses and the type of breast cancer surgery were evaluated and correlated with clinical and biological factors. The cardiotoxicity profile and long-term benefits were analyzed. Results The median patient age was 47 (37–67) years, with T2 and T3 67 (44.1%) and 85 (55.9%), respectively. Axillary lymph node breast cancer at diagnosis N0 was 104 (68.4%) and N1 and N2 were 28.9% and 2.6%, respectively. A total of 95.7% of patients had nonspecific type of breast cancer, 67% of tumors were hormonal receptor–negative, 75.5% were grade III, 100% Ki67 > 20%, and 90% of tumors were confirmed to be HER2/neu–positive through immunohistochemistry. Following PST, pathological complete response (pCR) rate was achieved in 44.7% evaluable patients. The pCR rate was higher in HR-negative (93.1% vs. 6.9%) cancer and in grade III (86.2%) than in grade I and II (13.8%) cancer; only 75.5% of complete response (CR) on ultrasound and magnetic resonance imaging were also CR on pathology results. Breast conserving surgery was performed in 41.4%. Regarding type of chemotherapy, there were no significant differences between chemotherapy with anthracycline backbone or taxanes to achieved pathological complete response. Despite that, we were unable to demonstrate an association between pCR and better DFS with p = 0.096; HR 5.7 95.0% CI (0.73–45.52). Patients who are hormonal receptor positive tend to have lower disease-free survival (DFS) than those who are hormonal receptor negative; HR = 6.34, 95.0% CI (1.54–26.00) and p = 0.010. Five years DFS was higher for those who achieved pCR compare with those who did not. Even in this research we failed to show it is statistically significant. Conclusion A sequential regimen of taxanes and anthracyclines plus trastuzumab was effective with high pCR rates and increases the possibility to do breast conservation surgery and had tolerable cardiotoxicity profile.

Presentation and Survival by Hormonal Receptor Status in Metaplastic Breast Cancer: A Propensity Score-matched Analysis

Background: Studies reported the hormonal receptor (HR) status was not associated with survival in metaplastic breast cancer (MBC). In addition, MBC patients cannot benefit from chemotherapy (CT). The present study aimed to evaluate the efficacy of CT on MBC patients with high risk (T1-4N2-3M0 and T4N0-1M0) by propensity-score matching (PSM). Methods: A retrospective study was performed to analyze MBC from the SEER database. Breast cancer-specific survival (BCSS) rates were analyzed using the Kaplan–Meier curve and differences assessed by log-rank tests. Cox proportional hazard models were used to assess BCSS. PSM was used to make 1:1 case-control matching.Results: We identified 3116 patients. The median follow-up time was 44 months (range, 1–321 months). 23.0% of patients were HR-positive. About 62.5% of patients received CT, which seem not to relate to HR status. Recurrence risk had a significant difference between HR-negative and HR-positive groups. In the multivariable Cox proportional hazards regression model, HR status was not associated with a better BCSS. CT had no benefit for MBC. Multivariate analyses after PSM (n=1274) confirmed that both CT and HR status were not associated with prognosis. The Kaplan–Meier curve before PSM showed that HR-negative MBC with intermediate-risk benefited from CT. For HR-positive MBC, patients with intermediate and high risk benefited from CT. However, CT could only benefit for HR-positive MBC with high risk after PSM.Conclusion: PSM analysis showed that CT could only benefit for HR-positive MBC with high risk.