bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of the prognostic factors of triple-negative breast cancer and the clinical efficacy of postoperative radiotherapy in early cases.
Authors: Cheng XT , Zhang Y , Zuo XX , Yang J , Dong ML , Liu K , Mi Y , Shi Yg
Published: May 2020

e12502

Background: To explore the prognostic value of pretherapeutic peripheral blood parameters and breast imaging-reporting and data system (BI-RADS) classification of triple-negative breast cancer (TNBC) and the effect of postoperative radiotherapy in early cases. Methods: A total of 278 TNBC patients’ medical records between January 2013 and December 2018 were retrospectively collected, including white blood cells, neutrophils, lymphocytes, platelets, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), serum tumor markers, BI-RADS classification, TNM staging and therapeutic methods. We used the log-rank test and Kaplan-Meier curves to assess the progression-free survival (PFS) of enrolled patients. Multivariate prognostic analysis was performed by the Cox regression model. Results: The median PFS of all 278 patients was 20 months (4-72 months) at the end of follow-up. Operable patients who obtained adjuvant chemotherapy had a better median PFS (20 vs 18.5 months, P= 0.018, HR = 5.943, 95% CI: 1.36-25.92) than those without. Lymph node metastasis (52%) and chest well relapse (28%) were the critical failure forms followed by other metastases (12% lungs, 9.3% bones, 4% liver and 2.7% brain) with p value less than 0.001. Multivariate analysis indicated that platelet counts > 113.5×109/L (p = 0.024), PLR ≤ 111.7 (p = 0.036) and CA15-3 ≤ 8.4 U/mL (p = 0.003) were significantly associated with the favourable prognosis of PFS in TNBC patients. Furthermore, BI-RADS of grade 2-4 had a better median PFS compared with grade of 5-6(20 vs 17.5 months, p = 0.008, HR = 2.154, 95% CI: 1.219-3.805). In subgroup analysis, forty-three early cases with pN1 stage earned additional benefits from postoperative radiotherapy in terms of low risk of distant metastasis and recurrence (p = 0.014). Residual tumor after surgery was another important factor of poor prognosis (p = 0.029). Conclusions: Adjuvant chemotherapy improved median PFS for operable TNBC patients and pretherapeutic platelets, PLR, CA15-3 and BI-RADS were the independent prognostic factors of survival. Lymph node metastasis and chest well relapse were the main patterns of treatment failure. Radiotherapy could reduce the risk of disease progression for postoperative patients with N1 stage.
Baseline skeletal muscle density and adverse outcomes during chemotherapy for early breast cancer.
Authors: Aleixo Gabriel , Deal Allison Mary , Nyrop Kirsten A. , Muss Hyman B. , Williams Grant Richard , Damone Emily , Yu Hyeon , Shachar Shlomit S.
Published: May 2020

e12506

Background: Skeletal Muscle Density (SMD) is the amount of fat infiltration in the muscle, Low SMD (myosteatosis), is associated with chemotherapy toxicity in women with breast cancer (BC); however, cut points are not consistent across studies. We investigated the association of alternative cut-points for low SMD at BC diagnosis and adverse outcomes during chemotherapy in women with early BC. Methods: This is a retrospective chart review. Axial CT images were evaluated at the L3 level to calculate average SMD in Hounsfield Units (HU). Three cut points (Table) classified patients as low versus normal SMD. T-test was used to calculate the relative risk (RR) for adverse events. Results: In 340 patients, the mean age was 51. Table shows RR for three adverse events (dose reduction, early treatment discontinuation, hospitalization) for each of the three cut points. Conclusions: All three cut-points described in the literature are reliable for stratification of patients with EBC for myosteatosis and associated chemotherapy-related adverse events. [Table: see text]
Recurrence risk stratification by Dutch clinical risk criteria for early-stage luminal breast cancer patients in Taiwan: A population-based analysis.
Authors: Lei Lei , Chan Han-Ching , Jia Wang Xiao , Lu Tzu-Pin , Cheng Skye Hung-Chun
Published: May 2020

e12509

Background: Dutch clinical risk criteria (low-risk definition: age > 35 years and (grade 1 with tumor ≤3cm, grade 2 with tumor ≤2cm, or grade 3 with tumor ≤1cm) have been used to stratify the benefit of MammaPrint and Oncotype DX for the decision-making regarding adjuvant chemotherapy for early-stage luminal breast cancer. We propose that the criteria could help to identify low-risk patients who could barely benefit from multi-gene testing. Methods: Breast cancer patients from Taiwan Cancer Database initially treated with primary surgeries between 2008 and 2012 who met the following criteria: (1) pathologic node-negative, (2) hormone receptor-positive, (3) HER2-negative, (4) undergone hormonal therapy, and (5) a minimum follow-up time of 5-year if free from any event, were enrolled in this study. Out of the total 2679 eligible patients, 1074 (40.1%) patients received adjuvant chemotherapy in addition to endocrine therapy. The study endpoints included breast cancer-specific survival (BCSS) and overall survival (OS). Kaplan-Meier statistics estimated the difference between clinical outcomes in low- and high-risk groups. Results: The median follow-up time of BSCC and OS was 5.9 years (range, 0-7 years) and 5.8 years (range, 0-7 years), respectively. There were statistical significances of 5-year BCSS (n = 2679) and 5-year OS (n = 2636) between low-risk and high-risk groups (in both endpoints, P < 0.0001). According to the Dutch criteria, low-risk patients with and without adjuvant chemotherapy had a 5-year BCSS of 99.0% vs. 99.2% and a 5-year OS of 98.4% vs. 97.4%, respectively. High-risk patients with and without adjuvant chemotherapy had a 5-year BCSS of 97.7% vs. 98.1% and a 5-year OS of 96.4% vs. 95.3%, respectively. Conclusions: The benefit of chemotherapy in low-risk patients classified by Dutch criteria might be very small since the breast cancer mortality was less than 1% with a minimum of 5-year follow-up. Dutch criteria cannot identify high-risk patients who would benefit from chemotherapy. We assumed that multi-gene testing in low-risk patients would not be cost-effective.
Development of cardiac events in postmenopausal breast cancer patients treated with Aromatase inhibitor (AI) and Selective estrogen receptor modulator (SERM).
Authors: Parajuli Priyanka , Regmi Manjari Rani , Maini Ruby , Lara Garcia Odalys Estefania , Tandan Nitin , Mirihagalle Noupama , Cheema Asad , Abedrabo Sabree , Niaz Zurain , Koester Cameron , Sahib Hamsa , Bhandari Bishal , Johnson Alexander , Ibrahim Abdisamad M. , Delfino Kristin , Robinson Kathy , Desai Meghna R. , Kulkarni Abhishek
Published: May 2020

e12529

Background: Breast cancer is the most common cancer diagnosed in women. Cardiovascular diseases (CVD), alternatively, is the leading cause of mortality in women worldwide. Adjuvant endocrine therapy including AI and SERM is offered to almost 75% of patients with estrogen receptor–positive (ER+) disease and potentially raises concerns for negative effects in cardiovascular health. Our study aims to evaluate cardiac events including acute coronary syndrome (ACS) and heart failure requiring hospitalization (HF) in post-menopausal patients treated with AI and SERM. Methods: An institutional database of 478 patients with histologically confirmed hormone receptor positive breast cancer diagnosed between 01/01/2014 to 12/31/2017 was reviewed after IRB approval. Development of ACS and heart failure requiring hospitalization upon initiating AI or SERM was considered an adverse cardiac event. Statistical analysis was performed with SAS v9.4. software. Chi Square (or Fisher’s Exact test) was used to test associations between various medication and cardiac events. Student’s T-test (or non-parametric equivalent when violations occurred) was used to assess if there was a difference in delta between those on and those not on medication categories. All significance was assumed at the p < 0.05 level. Results: Of 478 patients who met the inclusion criteria, 336 (70%) patients were postmenopausal. Of the 336 patients, 55% (n = 185) and 22% (n = 77) were offered therapy with AI and SERM, respectively. 6.49 % (n = 12) developed cardiac event with AI compared to 7.10 % (n = 13) who were not on AI therapy, (p = 0.814). Similarly, 6.49 % (n = 5) developed cardiac event with SERM compared to 6.87 % (n = 20) who were not on SERM therapy, (p = 0.9064). Moreover, an interesting finding in patients treated with SERM therapy compared to those not on SERM therapy was the delta of left ventricular ejection fraction (LVEF). Median LVEF of 3.5% (0 to 21%) was noted in patients treated with SERM compared to a median LVEF of 5% (0 to 55%) in patients who were not treated with SERM, p = 0.048. Conclusions: Our findings revealed AI and SERM therapy did not increase adverse cardiac events in our patient cohort. Cardiac safety of the patients is less likely to be compromised with AI and SERM therapy and therefore, should be initiated early in the course of treatment for better patient outcome. Furthermore, since SERM therapy can possibly have an effect in the LVEF of patients, a frequent evaluation LVEF is warranted to prevent any unwarranted complications.
Neoadjuvant chemotherapy versus adjuvant chemotherapy in breast cancer patients: Analysis of breast conserving rate and de-escalation of axillary surgery in 5,141 Korean women.
Authors: Lee Young Joo , Kim Jisun , Gwark Sung-chan
Published: May 2020

e12531

Background: Neoadjuvant chemotherapy (NCT) in breast cancer has several advantages such as more breast conservation surgery (BCS) rate and de-escalation of extent of axillary surgery. Actual practice change in this area compared with adjuvant chemotherapy (ACT) is not well established. Methods: We retrospectively analyzed 5,141 women diagnosed with breast cancer from 2009 to 2013, treated with chemotherapy before or after definite surgery. BCS rate and axillary surgery categories (sentinel lymph node biopsy (SNB), axillary lymphnode dissection (ALND) or SNB followed by ALND) are compared between two groups. Results: Among 5,141 patients, 3930 (76.4%) women had ACT and 1211 (23.6%) had NCT. Median age at diagnosis was 48 (range 22-83). BCR rate was lower in T2 (57.1% vs 64.1%), T3 (12.6% vs 20.9%) group between ACT vs NCT ( p=0.03, 0.001), no difference was shown in T1 and T4 tumors. SNB try (SNB only or SNB followed by ALND) rate was still higher in ACT group with cN0 (98.4% vs 95.4%), cN1 (89.3% vs 73.5%), cN2 (77.9% vs 62.1%) tumors ( p=0.001, <0.001, 0.003, respectively). SNB only rate which means that patients spared ALND, was lower in ACT group with all cN stage (cN1; 17.5% vs 29.2%, cN2; 3.2% vs 5.9%, cN3; 5.1% vs 20.5%, all p=0.000) except cN0 (95.6% vs 81.4%, p<0.001). Axillary surgery rate analyzed with pathologic N stage showed more ALNDs attempted even after achieving pathologic complete nodal response or minimal residual N disease (ypN0: 4.4% vs 27.2%, ypN0(i) & ypN1mi; 26.2% vs 57.6%, p<0.001, =0.001 respectively). In contrast however, average of total axillary nodes retrieved by cN stage were statistically lower in NCT group in clinically positive tumors (N1; 15.3 vs 12.7, N2; 19.1 vs 14.6, N3; 25.1 vs 15.6, all p<0.001). Conclusions: NCT had shown advantage to perform more BCS than ACT in T2, T3 tumors. SNB attempts in NCT was comparable to ACT. Still, patients with NCT received more aggressive axillary surgery than ACT shown by axillary surgery category irrespective of negative SNB results.
Omitting chemotherapy in more patients with early breast cancer in the post-TAILORx era.
Authors: Markopoulos Christos , Sariyanni Zoi Andromahi , Ziogas Dimitrios C. , Antonopoulou Zoh , Tsoulos Nikolaos
Published: May 2020

e12534

Background: The purpose of this analysis is to evaluate how many patients previously treated according to OncotypeDX Recurrence Score (RS) could have been spared of Chemotherapy if the TAILORx RS data had been taken into account in the clinical treatment decisions. Methods: A series of 182 patients, 34-74 years of age with early breast cancer, treated in our Breast Unit during the last 10 years, for whom treatment decisions were based on OncotypeDX RS. The Recurrence Scores of all these patients were obtained and the actual treatment decisions that were made based on the pre-TAILORx cut-offs of RS 18 and 31 were recorded. These decisions were then re-evaluated based on the after TAILORx cut-off scores, by taking also into consideration the patients’ age. Descriptive statistics were used as well as logistic regression models to estimate the potential change in treatment decisions based on the new Oncotype Dx cut-offs. Results: In the cohort of patients we analyzed that underwent Oncotype Dx testing, 34.1% (62/182) received Chemotherapy, based on the initial pre-TAILORX cut-offs of the RS. When utilizing the new cut-offs (after TAILORx results) in combination with age, we have estimated that, for the patients > 50 years of age, a 12.7% was potentially over-treated and for those ≤50 years old, 9.1% was potentially over-treated since they have received chemotherapy with a RS below 16; additionally, 30.8% of the patients of that age that have RS between 16 and 20 have received chemotherapy even though the average chemotherapy benefit for this group is 1.6% and can go up to 6.7% if they have a high clinical risk as it was defined by the investigators of the TAILORx trial. Finally, 84,6% of patients ≤50 years old with RS between 21-25 received chemotherapy with a 6.5% potential benefit demonstrated in the TAILORx trial. Conclusions: Our analysis suggests that, by using the cut-offs of TAILORx trial, adjuvant chemotherapy could had been omitted in at least a further 11.5% of patients with early breast cancer, reassuring their quality of life without declining their prognosis.
Practice-changing use of the 21-gene oncotype DX breast recurrence score test in Latin American hospitals.
Authors: Gomez Henry Leonidas , Bargallo-Rocha Juan Enrique , Billinghurst Roberto Jorge , Núñez de Pierro Aníbal Roberto , Coló Federico Andrés , Benitez Gil Lisandro Luis , Allemand Carola , McLean Ignacio Leonardo , Lema-Medina Mauricio , Herazo-Maya Fernando , Terrier Francisco Jose , Gerson Cwilich Raquel , León Rivera Mauricio , Falcon Silvia Gabriela , Castaño Roberto Eduardo , Oliveira Sergio Cordeiro , Jakubowski Debbie M , Chao Calvin Y.
Published: May 2020

e12539

Background: The 21-gene test is clinically validated to predict chemotherapy (CT) benefit in node-negative (N0) and node-positive (up to 3 axillary nodes, N+) HR+, HER2− early-stage breast cancer (ESBC). TAILORx showed no CT benefit overall in N0 patients with RS 0-25, but younger patients with RS 16-25 might have some. Clinical guidelines worldwide incorporate the 21-gene test; still, the impact of the test on treatment decisions is unclear in Latin America, where patients often present younger and with more advanced disease. We present a physician survey of the impact of Recurrence Score results on treatment decisions in clinical practice in Latin America. Methods: This multicenter, non-therapeutic, prospective survey enrolled consecutive patients who had 21-gene testing during routine care at 14 community and academic sites in Argentina, Colombia, Mexico, and Peru. Tests were paid for by patients. The physician survey captured patient and tumor characteristics and treatment decisions by physicians pre- and post-assay result. The survey included patients treated before and after TAILORx results reported in 6/2018. Overall net percent change in CT recommendation and 95% Clopper Pearson confidence intervals (CI) were estimated. The proportion with a change between pre-assay treatment recommendation and actual treatment received was calculated overall and by Recurrence Score groups per TAILORx. Results: Between 3/2015 and 12/2019, the survey was completed for 647 patients. 20% had N+ ESBC. Mean patient age was 54 y (24-85 y); 55% were postmenopausal. 17%/63%/20% had grade 1/2/3 tumors; 70%/30% had tumors ≤2/ > 2 cm in size. Recurrence Score results were: 20% RS 0-10, 56% RS 11-25, and 24% RS 26-100. Overall, CT recommendations fell from 325 patients pre-assay to 199 patients post-assay, a 39% decrease (95% CI 33.4 to 44.3) (36% decrease in N0; 46% decrease in N+). The direction of change was consistent with Recurrence Score results. Among N0 patients, the decrease in CT recommendations was 28% (95% CI 18.9 to 39.5) before TAILORx reported and 36% (95% CI 28.4 to 43.7) after. Conclusions: This large survey of 21-gene test practice patterns was the first conducted in Latin America and showed the relevance of 21-gene testing in low- and medium-resource countries to minimize CT over- and underuse in ESBC. Our results showed substantial reductions in CT use overall. After TAILORx, CT use was further reduced, indicating the practice-changing potential of that study.
Assessment of the sexual health of breast cancer survivors and their interest in discussing their difficulties with their doctors during follow-up.
Authors: Camejo Natalia , Castillo Cecilia , Hernandez Ana laura , Artagaveytia Nora , Amarillo Dahiana , Delgado Lucia Beatriz
Published: May 2020

e12542

Background: Sexual dysfunction from breast cancer and its various therapies is present in up to 60% of the breast cancer patients. Sexuality remains a neglected issue; doctors often ignore it, claiming they lack the time, knowledge or expertise required to address it. Objectives: To evaluate the sexuality of breast cancer survivors, inquire about the degree of interest in receiving help to resolve sexual dysfunctions related to the diagnosis and treatment of the disease and the level of satisfaction with the care received. Methods: One hundred twenty eigth patients with early breast cancer treated at the Mastology Unit of the Hospital de Clínicas were enrrolled. The study was approved by the hospital’s Ethics Committee. The selected questionnaire is the one used at the University of Chicago Medical Oncology Clinic. Results: Most patients were over 50 years old (96 patients) and had a sexual partner (87 patients), 98 patients (76.5%) had been sexually active within the last 12 months and 85 (86.7%) reported having sexual problems. Moreover, most patients (67/128, 68.3%) responded that sexuality was important in their lives; 85 (86.6%) were interested in receiving support to treat their sexual difficulties, and 72 (73.4%) saw the feasibility of addressing them with a doctor. However, only 29 (29.6%) had sought medical help for that purpose, and most were unhappy with the care received. Seventy-nine patients (80.6%) would be willing to participate in a program aimed at confronting their sexual problems. Conclusions: Our results reveal the need to address the sexual problems of patients diagnosed and treated for breast cancer as part of their medical care. Future studies should focus on developing and evaluating the success of specific interventions in the management of these patients’ sexual dysfunction and - even more importantly - designing strategies for its prevention.
Prognosis, biological characteristics and importance of treatment's delay of breast cancer diagnosed during pregnancy.
Authors: Munoz-Montano Wendy , Alvarado Alberto , Cabrera Paula , Lara Fernando , Fany Porras-Reyes , Perez-Sanchez Victor , Mohar Alejandro , Arrieta Oscar , Vazquez Rafael , Bargallo-Rocha Juan Enrique
Published: May 2020

e12545

Background: Breast cancer in pregnancy is that diagnosed during pregnancy or in the first year after birth (1), is the most frequent malignant neoplasms during pregnancy, (2,3); however, only 0.2% to 2.9% of all breast cancers occur during pregnancy(4), the incidence of breast cancer during pregnancy (BCDP) has increased the last few decades probably because of the delayed childbearing and the rise of maternal age (5,6). Because of the rarity of cases and the impracticability of conducting randomized controlled studies in this setting, several studies are retrospective, whilst some studies suggest outcomes for women are similar to non-pregnant patients with breast cancer(8–11), others (12–17) have demonstrated that pregnancy in itself is an adverse prognostic factor for survival. To contribute with the existing literature, we aimed to perform a cohort to analyze if there is a difference prognosis of patients with BCDP who started treatment during pregnancy or waited for delivery. Methods: We analyzed the baseline characteristics distribution in the BCP using the chi-square test and the Fisher’s exact test for categorical variables. We considered a statistically significant association when p value was < 0.05. DFS and OS analyses were conducted using the Kaplan–Meier method, and the log-rank test was used to determine if there were any differences in the survival curves by the variables of interest. We performed the statistical analysis using the SPSS 25.0 software for Windows (SPSS Inc., Chicago, IL, USA). Results: Among 8037 breast cancer patients enrolled in the database at Instituto Nacional de Cancerología, Mexico (INCan), within the social security program named “Seguro Popular”, between January 2007 and June 2018, we identified and included 61 women, median maternal age at diagnosis in our BCP group was 35 years (range 21-47), triple negative and her2 comprised 50.8% and 49.2% of BCP is comprised by luminal tumors. Conclusions: We strongly believe that the treatment of breast cancer during pregnancy should be started as soon as possible, since we have seen that its delay in childbirth translates into worse disease-free and overall survival. [Table: see text][Table: see text]
Single center retrospective study on cardiac safety of anti-HER2 agents and anthracyclines.
Authors: Lara Garcia Odalys Estefania , Maini Ruby , Parajuli Priyanka , Regmi Manjari Rani , Koester Cameron , Tandan Nitin , Cheema Asad , Niaz Zurain , Abedrabo Sabree , Sahib Hamsa , Mirihagalle Noupama , Ibrahim Abdisamad M. , Johnson Alexander , Bhandari Bishal , Delfino Kristin , Robinson Kathy , Desai Meghna R. , Kulkarni Abhishek
Published: May 2020

e12548

Background: Chemotherapy-induced cardiotoxicity has been associated with certain breast cancer therapy regimens, such as anthracyclines. With the development of newer therapies, just as the anti HER2 agents,another association with cardiotoxicity has been recognized in these drug groups. We report the cardiac safety of anti-HER2 agents and anthracyclines. Methods: A retrospective chart review was conducted of patients diagnosed with breast cancer between January 1st 2014 and December 31st 2017, treated with chemotherapy were identified from a large cancer center database. Heart failure, ACS, and other comorbidities were identified using billing codes. Primary outcome was cardiac event,defined by New York Heart Association class II, III or IV heart failure, ACS and heart failure hospitalization. Fisher's exact test was used to test associations between medication categories and cardiac events. Results: A total of 478 patients were included in our study.Our results indicated a significant association of anti HER2 agents with new heart failure with 12.24% (6/49) of patients, compared to 4.04% (12/297) in the control group (p = 0.0288). For the compound of all cardiac events, patients on the anti HER2 arm did not have a significant association, representing 12.50%(6/48) (p = 0.117).Regarding anthracyclines, results demonstrated a significant association of cardiac events, with an incidence of 17.46%(11/63) compared to 4.59%(14/305) in the control group (p = 0.001). We also found that specifically for new onset heart failure, the anthracycline group had a proportion of 13.64%(9/66), in comparison to the control group which had an incidence of 3.21%(9/280) (p = 0.0023). Conclusions: These findings are comparable to rates reported in studies evaluating cardiac safety of anthracyclines and anti-HER2 agents,calling attention to the importance of novel techniques and treatments for the management of chemotherapy-induced cardiotoxicity.
Relationship of the breast ductal carcinoma in situ (DCIS) immune microenvironment with clinicopathological features: An institutional experience.
Authors: Eisenbud Lauren , Lama Tamang Tsering G. , Cheng Caleb , Ifegwu Ibe , Tang Tianyi , Lin Erin , Lane Karen , Ziogas Argyrios , Mehta Rita S. , Parajuli Ritesh
Published: May 2020

e12565

Background: DCIS is usually treated with resection followed by 5 years of adjuvant endocrine therapy for hormone receptor (HR) + DCIS. Endocrine therapy is not used in HR- DCIS. Although DCIS is considered a precursor lesion to invasive breast cancer, the different molecular subtypes confer variable clinical outcomes. The host immune response plays a key role in breast cancer progression and response to therapy. However, relative to invasive breast cancer, the immune milieu of DCIS is less understood. This retrospective study compares the clinical outcomes and tumor microenvironment of HR+ and HR- DCIS in order to identify clinical and immunological features in HR- DCIS that may predict an increased risk of recurrence or progression to invasive breast cancer. Methods: A single institution retrospective chart review was performed to identify patients diagnosed with DCIS between 2012 and 2017. A clinico-pathologic data set, as well as the PD-L1 expression of the DCIS and TILs were collected and correlated with various outcomes. Results: Our cohort consisted of 20 cases of HR- DCIS and 50 cases of HR+ DCIS. Overall, 56% were Caucasian, 20% Asian, 18% Hispanic, and 6% African American. Of the HR- patients, 70% were Caucasian, 15% Hispanic, and 15% Asian. Of the 17 HR- patients with available HER2 data, 76% had HER2+, and 24% triple negative (TN) DCIS. 18% of the HR+ patients and 38% of the HR- patients were PD-L1+. 25% of the HR-/HER2+ patients, and 75% of the TN patients were PD-L1+. 6% of the HR+ patients developed recurrent disease, 2 with DCIS and 1 with invasive ductal carcinoma. 20% of the HR- patients had recurrent disease, all of whom were HER2+. Of the HR- patients that recurred, 2 recurred with metastatic disease, 1 with ipsilateral invasive ductal carcinoma, and 1 with DCIS. All 7 patients that recurred had original DCIS pathology showing a high nuclear grade. Our future results at the time of the meeting will expand on this cohort. Conclusions: This retrospective analysis showed that HR- DCIS conferred higher rates of local and distant recurrence. Therefore, there is a need for treatments to reduce the recurrence rates of HR- DCIS. There are ongoing clinical trials for the high risk, HR-/HER2+ DCIS subtype. TN DCIS is also an aggressive phenotype. Given the high rate of PD-L1 positivity we detected in TN DCIS, immune-based therapy may be useful in the adjuvant setting to reduce the risk of recurrence in this cohort of patients.
Immunological predictive and prognostic factors in patients with stage II-III triple negative breast cancer.
Authors: Gordeeva Olga , Kolyadina Irina Vladimirovna , Chertkova Antonina , Shoua Esma , Kadagidze Zaira , Slavina Elena , Zabotina Tatiana , Vishnevskaya Yana , Ganshina Inna , Zhukova Lyudmila , Meshcheryakov Andrey
Published: May 2020

e12581

Background: Triple negative breast cancer (TNBC) is the most aggressive subtype of breast cancer. Pathologic complete response (pCR) achievement during neoadjuvant chemotherapy (NACT) is very important for these pts as it correlates with long-term outcome. Predictive and prognostic factors for this group of pts are needed. Methods: Since 2014 we treated 98 pts with histologically confirmed stage II-III TNBC with following regimen of NACT: 6 cycles of Cisplatin 75mg/m2 day 1 and Paclitaxel 80mg/m2 days 1, 8, 15, every 4 weeks according to local protocol. After NACT pts proceeded to radical breast surgery with assessing of pathological response. Before the treatment we assessed TILs in biopsy samples of all patients. We also conducted subpopulation analysis of lymphocytes in peripheral blood before treatment. We analyzed CD8+, CD25+, NK and NKT cells as they were reported to be significant earlier. We compared results with median value in reference group (mRG) of healthy women. Results: Among all 98 pts 86 (87%) were operated, pCR was achieved in 60,5% of operated pts. pCR strongly correlated with TILs level: 38,5% for pts with TILs < 5% and 69,8% for pts with TILs > 5% (p = 0,05). We also found that NKT population was associated with pCR: 77,8% vs 45,8% among patients with NKT above mRG and up to mRG, respectively (p = 0,01). It correlated also with tpCR: 22,2% vs 70,6% (p = 0,01). When both CD25+ and NKT population were above mRG pCR rate achieved in 85,7% pts vs 50,0% pts if it was up to mRG (p = 0,049). NK, CD8+ and CD25+ did not show any correlation with pCR. Survival results are presented in table below. NK, NKT and TILs did not show any correlation with survival. Interestingly, CD8+ were also associated with lower incidence of visceral metastases: 42,1% in pts with normal CD8+ and 15,7% in pts with CD8+ above normal (p = 0,19). Conclusions: Not only TILs, but also NKT and CD25+/NKT population in the peripheral blood could be possible predictive factors for patients with stage II-III TNBC receiving NACT. CD8+, CD25+ and NKT populations could be further studied as prognostic markers for this group of patients. [Table: see text]
Presence of human papillomavirus DNA in breast cancer patients: SERUM and tissue analysis.
Authors: Ravaioli Sara , Rocca Andrea , Pirini Francesca , De Matteis Serena , Fanini Francesca , Tumedei Maria Maddalena , Maltoni Roberta , Michela Palleschi , Martinelli Giovanni , Bravaccini Sara
Published: May 2020

e12582

Background: It has been demonstrated an increased risk of breast cancer (BC) incidence in patients with previous cervical dysplasia, suggesting a role of human papillomavirus (HPV) of cervical lesions in the development of BC. Although, the origin of HPV spreading to the mammary gland and its mechanism of dissemination is not clear. Methods: Seven serum samples from healthy donors and 58 from early BC patients collected pre-surgery were analyzed for the presence of HPV DNA. For 49/58 patients HPV DNA was analyzed also on the primary tumor tissue. 17 patients had luminal A BC (4 relapsed, 13 non relapsed), 16 had luminal B BC (5 relapsed, 11 non relapsed), 13 had triple-negative BC (6 relapsed, 7 non relapsed), 12 had HER2-positive BC (4 relapsed, 8 non relapsed). Circulating DNA was extracted from 500 μl of serum by Qiamp DNA Mini kit (Qiagen, Milan, Italy) and tumor DNA was extracted from at least four 10-micron sections by QIAamp DNA FFPE Tissue Kit (Qiagen, Milan, Italy). Circulating HPV DNA was amplified by a multiplex PCR with HPV E6 or E7 gene-specific primers and the sequence was assessed by a high-throughput MALDI-TOF mass spectrometry-based method. Results: HPV DNA was detected in only 5 serum of BC patients and in none of the healthy controls. 4/5 BC cases had high-risk HPV DNA (type 39,45,52,59) and 1 had type 73 low-risk HPV DNA. 4/5 HPV DNA-positive patients had previously low-grade cervical intraepithelial neoplasia (CIN I) detected by Pap smear. These 5 patients with circulating HPV DNA did not show HPV positivity in the BC tissue. 2 out of 49 cases were positive for universal HPV DNA sequence in tissue and only 1 case showed HPV type 51. No relation was found between HPV infection and tumor subtype or prognosis, neither for HPV DNA positivity between serum and tissue. Conclusions: Our data support the feasibility of HPV DNA detection by liquid biopsy in BC. The presence of circulating HPV could be due to a viral spread from other organs. More data are needed to establish the role of circulating HPV DNA and its potential association with HPV infection of the breast and/or of the cervix. [Table: see text]
Breast cancer in women aged 80 years and older: Clinical characteristics and treatment patterns according to biologic subtype.
Authors: Wong Stephanie M , Boileau Jean-Francois , Rana Mariam , Muanza Thierry , Margolese Richard G. , Monette Johanne , Bahoric Boris , Basik Mark
Published: May 2020

e12594

Background: Older age is associated with poorer breast cancer-specific survival (BCSS) outcomes, despite a higher prevalence of biologically favorable disease. We sought to evaluate differences in the clinical characteristics and management of older women according to biologic subtype of breast cancer. Methods: The Surveillance, Epidemiology, and End Results (SEER) treatment database was queried to identify all women aged 80 years or older with a first diagnosis of invasive breast cancer between 2010 and 2016. Patients were subgrouped according to biologic subtype and clinical and treatment-related variables were compared. Multivariable logistic regression was then performed to determine factors independently associated with receipt of breast-conserving surgery (BCS) and adjuvant radiation. Results: Overall, 27,375 women with a median age of 84 (range, 80-108 years) met inclusion criteria. The majority of older women were diagnosed with HR+HER2- breast cancer (78.9%), followed by HER2+ (11.0%) and triple-negative breast cancer (TNBC) (10.0%). In women with stage I-III disease, non-operative management was employed in 13.4% of HR+HER2- patients, compared to 16.7% of HER2+ patients and 11.0% of TNBC (p < 0.001). In those undergoing surgery, BCS was most common in HR+HER2- patients (80.9%), compared to HER2+ (68.9%) and TNBC (67.8%; p < 0.001). Axillary surgery was performed in 74.0% of early stage patients with HR+HER2- disease, compared to patients with HER2+ (77.8%) and TNBC (79.3%; p < 0.001). In adjusted analyses controlling for stage and clinical variables, women aged 80 years or older with HER2+ breast cancer and TNBC had a lower likelihood of BCS (ORHER2+ 0.72, 95% CI 0.65-0.80; ORTNBC 0.72, 95% CI 0.65-0.81), and an increased likelihood of adjuvant radiation (ORHER2+ 1.14, 95% CI 1.02-1.27; ORTNBC 1.40, 95% CI 1.25-1.57). Conclusions: One fifth of women with breast cancer over age 80 are diagnosed with HER2+ and triple-negative subtypes, which are associated with more aggressive local therapy. Further studies are warranted to determine if higher rates of adjuvant radiation optimize local control in older HER2+ and TNBC patients at increased risk for early locoregional recurrences.
Impact of preoperative magnetic resonance imaging (MRI) on conservative surgery (CSur) among curable breast cancer (BC) patients treated in a specialized center in Latin America.
Authors: Lima Julianne Maria da Silva , Cunha Thatyane , Dassie Thamyse , Melo Sandro , Mori Lincon , Martha Gustavo , Hanna Samir , Mano Max S. , Giannotti Daniela , Andrade Felipe
Published: May 2020

e12595

Background: Preoperative breast MRI can provide important clinical information on the surgical management of BC patients (pts). However, there is no evidence that it can produce a statistical impact on surgical outcomes in the early BC setting. This retrospective study sought to evaluate whether preoperative MRI was significantly correlated with CSur among early BC pts. Methods: Digital and physical records from 532 pts treated in a specialized BC center in Brazil from 2005 to 2018 were analyzed. The institutional database registered pathological, radiological and clinical information. The categorical variables CSur and MRI were analyzed by Chi-squared coefficient of correlation, whereas significant correlations were included in a multivariate logistic regression model. All statistical analysis were performed in STATA version 15.1C. Results: The present analysis included 532 pts. The diagnosis was suspected through suspicious self-exam in 380 pts (71%), while 129 pts (24%) had altered mammary screening tests. Clinical T and N stages were: T0-1=154pts (29%); T2=179 pts (33%); T3=135 pts (25%); T4=49 pts (9%); N0=267 pts (50%); N1=172 pts (32%); N2=80 pts (15%). Neoadjuvant treatment was performed in 223 pts (42%). MRI was indicated in 248 pts (46%). CSur was performed in 149 pts (28%). Margins were positive in 15 cases. This study found a statistically significant correlation between CSur and MRI ( X2 = 8.07; p=0.018). Although, when controlled for neoadjuvant treatment, T, N, and age, the independent variable MRI was not a statistical predictor of CSur (R=0.008; t=0.25; p=0.8; 95%CI -0.57 – 0.74). Advanced T and neoadjuvant treatment were inversely correlated with CSur in the multivariate analysis (R= -0.11; t= -7.8; p<0.001 and R= -0.11; t= -2.88; p=0.004, respectively). One multivariate analysis to evaluate predictors of T stages showed that suspicious self-exam and N stage had a significant linear relationship with T stages when controlled for age (R=0.70; t=7.9; p<0.001; and R=0.76; t=15; p<0.001, respectively). Conclusions: Preoperative MRI can have impact on the conservative surgical management of curable BC patients and the present analysis showed a positive correlation. In the logistic regression model, MRI was not identified as a predictor of CSur, however the proportion of locally advanced BC may have influenced the results. Further studies must be strengthened for identifying in which subgroup of patients MRI may be a predictor of surgical outcomes.
Association between obesity and the clinical stage of newly diagnosed breast cancer: Experience with 2212 patients.
Authors: Alshamsan Bader I , Suleman Kausar , Agha Naela , Abdelgawad Marwa Ismail , Alzahrani Mashari J , Al-Tweigeri Taher , Ajarim Dahish Saed , Elhassan Tusneem , Alsayed Adher
Published: May 2020

e12602

Background: Excess weight is currently recognized as a risk factor for several cancer types, including breast cancer. The primary goal of this study was to evaluate the impact of overweight and obesity in newly diagnosed breast cancer patients at the time of presentation. Methods: A retrospective analysis of breast cancer from a prospective database of all newly diagnosed non-metastatic breast cancer patients seen at King Faisal Specialist Hospital and Research Center between 2002 and 2014 was performed. The clinical stages were divided into early stage breast cancer and locally advanced breast cancer. The body mass index (BMI) groups were underweight, normal, overweight, and obese based on the World Health Organization classifications of BMI. The patient characteristics are presented as medians with interquartile ranges (IQRs) and frequencies for continuous and categorical variables, respectively. The association between BMI groups and clinical stage at presentation was evaluated using the logistic regression model. Survival probabilities were calculated using the Kaplan-Meier estimator. Results: In total, 2212 patients were eligible for the study. The median age at diagnosis was 45 (IQR = 39-52) years; 62% patients were pre-menopausal, and 31% were post-menopausal. The median BMI was 30 (IQR = 26-34) kg/m2. In this population, 53% patients were obese; 31%, overweight; and 14.7%, in the normal range at diagnosis. Regression analysis revealed a significant association between clinical stage and BMI at the time of presentation (p = 0.006). Obese patients showed a 40% higher chance of having locally advanced presentation than the normal BMI group (OR = 1.41, 95% confidence interval = 1.06-1.86, p = 0.02). However, overweight had no significant association with clinical stage (OR = 1.03, 95% confidence interval = 0.76-1.8). The median follow-up duration was 39 (IQR = 22-66.6) months. Overall survival showed no significant association with different BMI groups and breast cancer subtypes. Conclusions: The prevalence of overweight and obesity was found to be high (85%) in newly diagnosed breast cancer patients in Saudi Arabia. Obesity is associated with a more advanced clinical stage at the time of diagnosis of breast cancer and may be a contributing factor for more locally advanced presentations in the region.
Advantages of intraoperative digital specimen radiography (IDSR) in breast surgery.
Authors: Zhukova Lyudmila , Maksimov Nikita , Kvetenadze Gurami , Shivilov Evgeniy , Arslanov Khalil , Smirnov Anton
Published: May 2020

e12613

Background: Breast cancer is in first place among malignant diseases in women in Russia. We can provide, in most cases, breast-conserving surgery (BCS), due to progress in early diagnosis. Evaluation of positive margins is still one of the most important objectives in breast-conserving surgery. Objectives: To assess the benefits of IDSR in BCS of patients with “carcinoma in situ”. Methods: The results of treatment of 55 patients with breast cancer “carcinoma in situ” in our clinic were evaluated in two comparable groups. Group A included 28 patients, who were operated on from January 2019 to June 2019 and had breast-conserving surgery without IDSR. Group B included 27 patients, who were operated on from June 2019 to January 2020 and had breast-conserving surgery with the evaluation of margins by IDSR. Results: In a planned histological examination positive margins were detected in group A in 4 cases (14%) and required reoperation. In group B all margins were clear. After IDSR, 6 (22%) patients out of 27 in this group showed microcalcifications in the resection margins or at a distance of less than 1 mm and required intraoperative additional excision to obtain clean margins. Conclusions: IDSR reduces the frequency of reoperation due to increased detection of positive margins, allows to correct scope and duration of surgery because of impact on the time of the surgical decision-making process.
Are there inequities in reconstruction after mastectomy in breast cancer patients related to race or insurance status?
Authors: Chuba Paul J. , Vlachaki Maria T. , Koerner Sean , Stefani William , Falk Jeffrey
Published: May 2020

e12615

Background: Patients with invasive or in-situ breast cancers may increasingly be offered bilateral mastectomy with reconstruction with a view towards achieving symmetry and risk reduction. We investigated whether this treatment option was offered equally based on race and insurance status. Methods: Rates of mastectomy and reconstruction were studied among 4703 patients diagnosed or treated at Ascension St John Hospital, Ascension Macomb Oakland Hospital, and Ascension Providence Hospital between 2005 and 2015. Data collected included demographics, tumor characteristics, insurance (primary payer), first course of surgical treatment, vital status, and cause of death. Cases coded as contralateral mastectomy and reconstruction were considered as representative of “bilateral mastectomy” and reconstruction. Results: Insurance status could be definitively categorized as HMO/PPO, fee for service (FFS), Medicare, or Medicaid in 2375 breast cancer patients. Medicaid HMO was categorized as Medicaid and Medicare with or without supplemental insurance was categorized as Medicare. For simplicity, cases coded as uninsured, other, and NOS were not analyzed further. A total of 406 of 2375 (17.0%) were coded as contralateral mastectomy with reconstruction. Smaller numbers of Medicare cases had contralateral mastectomy and reconstruction (7.3%) compared to 23.3% for HMO/PPO, 26.3% for FFS, and 16% for Medicaid, presumably related to older age. Within each insurance category, similar proportions of Caucasian and African American women were treated with contralateral mastectomy (Table) compared to all patients (Table). Conclusions: Patients having Medicaid insurance had lower rates of contralateral mastectomy and reconstruction compared to HMO/PPO and FFS cases. African American race did not appear to be associated with lower rates of this surgery within the Ascension St John, Ascension Macomb Oakland, and Ascension Providence hospitals. [Table: see text]
Prognostic and predictive value of neutrophil/lymphocyte ratio in patients with triple-negative and HER2-positive breast cancer undergoing neoadjuvant systemic therapy.
Authors: Jagiello-Gruszfeld Agnieszka I. , Jodkiewicz Magdalena , Kowalska Maria , Michalski Wojciech , Olszewski Wojciech P , Niwinska Anna , Gorniak Anna , Pogoda Katarzyna , Dubianski Roman , Gorska Katarzyna , Glinka Ewa , Pienkowski Tadeusz , Nowecki Zbigniew
Published: May 2020

e12620

Background: Preoperative neutrophil-lymphocyte ratio (NLR) have been suggested to be correlated with the prognosis of patients with breast cancer (BC). However, the results still remain controversial. The goal of our study was to evaluate the predictive and prognostic value of NLR in early stage triple negative and HER2-pos breast cancer patients undergoing NAC. Methods: 96 female patients (pts) with histologically proven breast cancer (51 TNBC, and 45 HER2 pos) were analysed in this retrospective analysis. The NLR before the initiation of NAC was documented. Histopathological response in surgically removed specimens was evaluated using the Residual Cancer Burden (RCB) Calculator (by MD Anderson Cancer Center). The pCR was defined as no invasive tumor in primary tumor bed and lymph nodes. The NLR variable was analyzed as both continuous and categorical. The impact on pCR and RCB was tested using Mann-Whitney, Kruskal-Willis or the Chi-2 test, respectively. Results: Only 4 categories of NAC were used: in TNBC 4 x ACdd followed by 12 x PCL (38 pts) or 4 x ACdd followed by 12 x PCL+ carboplatin AUC 1.0-2 (13 pts), in HER2-pos 39 pts received 6 x TCH (docetaxel + tratuzumab + carboplatin AUC 6) and 6 pts 4 x ACdd followed by 12 x PCL iv + 4 x trastuzumab. In 27 pts (53%) with TNBC and 24 pts (53%) with HER2-pos breast cancer pCR was obtained after NAC. RCB distribution was: 0-53.1%, 1-22%, 2-17.6%, 3-7.3%. No association with NLR and pCR could be observed (p > 0.26). No association with NLR and RCB could be observed (p > 0.18). Conclusions: In our retrospective analysis we could not demonstrate predictive or prognostic value of NLR in the cohort of early stage triple negative and HER2-positive breast cancer patients treated with NAC. Further studies are planned in a group of patients with Luminal B, HER2 – negative breast cancer, who received NAC.