bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of Oncotype Dx test in patients with T1bN0, grade 1, hormone receptor-positive, HER2-negative breast cancer.
Authors: Gudena Vinay K. , Causey Lindsey , Stuart Dawn , Martini Keisha 
Published: May 2019

e12043 Background: NCCN (National comprehensive cancer network) recommends to consider Oncotype DX testing for patients diagnosed with T1bN0 stage 1A breast cancers that are hormone receptor positive and HER-2 negative. This study is a retrospective review of these patients diagnosed at Cone Health Cancer Center between 2012 and 2018 who had Oncotype DX testing. Methods: Patients with T1b hormone receptor positive and HER-2 negative breast cancers, who had Oncotype DX testing performed were queried from tumor registry from 2012 to 2018. Registry provided data on the patients ER/PR and Her 2 neu as well as whether they received chemotherapy. Patient charts were reviewed for grade, Ki 67 and their Oncotype Dx scores. Results: A total of 104 patients with T1b N0 (stage IA ) invasive breast cancers that were ER and PR positive and HER-2 negative between 2012 and 2018 had Oncotype DX test performed. Grade 1 tumors comprised 75 patients. Among these, four patients received adjuvant chemotherapy who had Oncotype scores of 22, 27, 29 and 38. Among patients with Ki 67 ≤ 10% and grade 1, only one patient out of 104 required chemotherapy. Conclusions: This retrospective analysis suggests that 97% of patients with T1b, grade 1, ER/PR positive, HER-2 negative breast cancers had Oncotype scores of less than 25. Hence Oncotype testing may be safely omitted for this group. Grade along with Ki 67 can identify a subset of T1bN0 ER/PR positive and Her 2 negative patients who do not need Oncotype testing.[Table: see text]
Survival outcomes by hormone receptor expression in early-stage HER2-positive breast cancer.
Authors: Sardesai Sagar D. , Kassem Mahmoud , Morgan Evan , Palettas Marilly , Stephens Julie , Williams Nicole Olivia , Stover Daniel G. , Van Deusen Jeffery , Wesolowski Robert , Lustberg Maryam B. , Ramaswamy Bhuvaneswari 
Published: May 2019

e12050 Background: The clinical heterogeneity seen in HER 2 positive breast cancer (BC), mostly related to hormone receptor (HR) expression has been suggested to underlie the variability of response not only to endocrine treatments, but also to anti-HER-2 therapies. Herein, we describe our single institution experience with clinical outcomes by HR expression in early HER 2 positive BC. Methods: An IRB-approved single-institution retrospective analysis was performed for 400 consecutive patients with non-metastatic HER 2 + BC treated at the Ohio State University Comprehensive Cancer Center from 2005-2015. Medical records were reviewed for clinic-pathologic, treatment, and survival information. Disease Free Survival (DFS) was defined as time from diagnosis to first recurrence (loco-regional or distant recurrence) including second primary BC or death. Overall survival (OS) was defined as time from diagnosis to death or last known follow up. OS and DFS estimates were generated using Kaplan Meier methods and compared using Log-rank tests. Cox proportional hazard models were used to calculate univariate and multivariate hazard ratios for OS and DFS. Results: a total of 180/400(45%) patients were diagnosed with HR positive disease. The mean age was 54.1y and patients were predominately white (267, 84%), post-menopausal (190, 60%) and presented with invasive ductal cancer (293, 92%). HR negative disease was significantly associated with high tumor grade (72% vs. 52%, p <0.0001) and lower BMI (27.6 vs 30.1, p 0.0218) compared to HR + tumors. The frequency of CNS metastases was not significantly different between both groups (8 (4%) in HR + vs. 8(6%) in HR –, p 0.9909). 173(96%) of HR + patients received anti-estrogen therapy with median duration of therapy of 40.9 months and 22(13%) received adjuvant ovarian suppression. There was no significant difference between the DFS and OS by hormone receptor expression (P= 0.7459 and 0.6518 respectively). However, higher number of HR negative patients undergoing neoadjuvant therapy achieved a complete pathologic response (pCR, 64% vs 44%, p 0.0092). pCR was prognostic for both DFS(p 0.0002) and OS (p 0.0008) in HR negative subgroup and not in HR + subgroup. Conclusions: The triple positive phenotype represents a distinct clinical subtype of HER 2 positive breast cancer associated with low tumor grade and lower frequency of pCR. Consistent with other studies, pCR was not prognostic of long term survival in triple positive disease. Future trials investigating the ER/ HER 2 cross talk are needed for this patient population.
Are elderly breast cancer patients offered appropriate therapy i.e. surgery, chemotherapy, radiation, and endocrine therapy, in a rural population?
Authors: Johnson Alexander , Agbisit Christian , Delfino Kristin , Robinson Kathy , Desai Meghna R. 
Published: May 2019

e12053 Background: The NCI SEER data demonstrated that age adjusted incidence rate of geriatric breast cancer is 427.5 per 100,000. Mortality rates for breast cancer have improved over the last 20 years,but the risk of breast cancer death has decreased 3 fold more rapidly in younger vs. geriatric population. Comorbid illnesses are more prevalent in elderly & therapy offered is often less aggressive. The objective of this study was examine practice patterns in a rural geriatric breast cancer population. The patients were divided into groups with life expectancies (LE) > 10 years or not. Analysis was also performed in groups based on age ranges. Methods: An institutional database of 269 patients with histologically confirmed invasive or in-situ breast cancer with age 65 or older at the time of diagnosis was reviewed in an IRB approved fashion. Data was collected on age at diagnosis, LE, and the rates of chemotherapy, surgery, radiation therapy, multidisciplinary discussion, clinical trials, Adjuvant Online!, & endocrine therapy offered. LE data was divided into patients with greater than 10 years of life expectancy or not at the time of diagnosis. A separate analysis examined the rates of the above in age ranges of 65-70, 71-80, and 81 plus. Variations in significance were identified using Fishers Exact Test. Results: 44 patients (16.4%) had a LE at diagnosis of < 10 years. Surgery was offered in n=262 patients (97.4%). Radiation therapy was offered in n=170 patients (64.9%). Endocrine therapy was offered in n= 221 patients (83.1%). Chemotherapy was offered in n= 72 patients (27.2%). In the greater than or less than 10 year LE group, statistically significant variations were noted in the rates of radiation (p=0.0047) & chemotherapy (p=0.0067) treatments offered to patients based on their life expectancy. When patients were grouped by age range, statistically significant variations were noted in the rates of radiation treatment (p=0.0221), endocrine treatment (p=0.032), chemotherapy (p≤0.0001), & participation in clinical trials (p=0.0218). Conclusions: Our study identified statistically significant differences in the rates of radiation & chemotherapy offered to patients based on their life expectancy. Statistically significant differences in rates of radiation, endocrine therapy, chemotherapy, and participation in clinical trials were observed based on the age ranges of patients. No differences were noted in the rates of surgery offered, use of Adjuvant Online, and multidisciplinary discussion based on LE & age range.
Short versus long duration of adjuvant trastuzumab (T) in HER2+ breast cancer: A systematic review and meta-analysis of randomized controlled trials (RCTs).
Authors: Sipra Qurat Ul Ain Riaz , Riaz Irbaz Bin , Husnain Muhammad , Raina Ammad , Khan Ahsan , Akhtar Maheen , Wang Zhen , Murad M. Hassan , Leon-Ferre Roberto Antonio 
Published: May 2019

e12057 Background: Several RCTs have evaluated a shorter duration of T ( < 12 months) with hopes of similar efficacy, reduced cardiotoxicity, cost and burden of treatment. Of the 5 major studies, PERSPHONE showed that 6 months was non-inferior compared to 12 months. However, four additional studies of shorter duration failed to demonstrate non-inferiority. Therefore, we performed an updated systematic review and a meta-analysis to assess the optimal duration of adjuvant T. Methods: MEDLINE, EMBASE, Cochrane, Scopus and conference proceedings were searched to identify RCTs comparing one year of adjuvant T with a shorter duration in early-stage HER2+ breast cancer. The DerSimonian-Laird random-effects Meta-Analysis was performed using CMAv3 software to derive pooled Hazard Ratio (HR) estimates for overall survival (OS, Disease-Free Survival (DFS) and Odds Ratio(OR) estimates of cardiac toxicity. Q-test was used to assess between-study heterogeneity; I2 statistic was computed to express the percentage of the total observed variability due to study heterogeneity. The risk for bias was assessed using the Cochrane Collaboration’s tool. Results: We screened 1772 citations and identified 5 studies(n = 11,377) for analysis. 5691 patients were randomized to 12 months of adjuvant T while 5686 were randomized to a shorter duration (3 studies evaluated 6 vs 12 months, 2 studies evaluated 9 weeks vs 12 months). OS (HR, 1.16, 95% CI 1.03-1.31, P= 0.015,I2 0.00, p= 0.837) and DFS (HR, 1.14, 95% CI 1.02-1.26 , P = 0.016,I2 14.90, p= 0.319) were significantly worse in patients receiving shorter duration T as compared to 12 months. Cardiotoxicity was significantly higher in the 12 month group vs shorter duration (OR, 2.10, 95% CI 1.58-2.80, p = 0.000 ,I2 51.182, p= 0.085). Grade 3/4 cardiac events and cardiac events leading to discontinuation of therapy were significantly higher in patients receiving 12 months (HR 2.06, 95% CI 1.60-2.63, P = 0.000, I2 3.967, p= 0.384). There was no significant heterogeneity among studies. Risk of bias was low. Conclusions: Twelve months of adjuvant T is associated with significantly better DFS and OS compared to a shorter duration. As such, 12 months should remain the standard of care for most patients. There is an unmet need to identify lower risk groups which might do well with from shorter duration of HER2-directed therapy.
A prospective study to evaluate the accuracy of axillary staging using ultrasound and USG-guided fine needle aspiration cytology in early breast cancer patients in a high-volume center.
Authors: Singh Rashpal , Dhamija Ekta , Deo SVS , Mathur Sandeep , Thulkar Sanjay 
Published: May 2019

e12060 Background: In breast cancer, axillary lymph node involvement directly impacts the patient survival and prognosis.Sentinel lymph node biopsy (SLNB) is a procedure of choice for axillary staging in early breast cancer. Currently, management options for axilla management are ALND & SLNB in node positive & in node negative respectively. In developing nation like India,where resource constraints, logistics issues and over burden health institutes create difficulty in managing patients, our study address this issue by implementing USG and USG-FNAC in early breast cancer patients in developing nation. Methods: All early breast cancer patients were screend by ultrasound axilla to categorise the nodes as suspicious or non suspicious. Suspicious nodes underwent USG & FNAC using vascualr pedicle based nodal mapping for node targeted on USG-FNAC, if node found to be positive, patient underwent ALND & negative node patients underwent SLNB.All non-suspicious nodes patient underwent SLNB. Final histopathology was taken as gold standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value, accuacy and false negative rate calculated for USG & USG-FNAC. Results: Total 100 patients included in which 58 were non-suspicious and 42 suspicious nodes on USG. Among suspicious group, 24 were positive on USG-FNAC & 18 were negative.In non suspicious SLNB done in all. False negative rate of USG & USG-FNAC was 38% and 17% respectively. Conclusions: Our study indicates the feasibility of USG & USG-FNAC in a high volume centre with good accuracy of around 70- 80%.Overall, 24 % of total patients can be taken up for ALND without performing SLNB.This study can guide us to utilize ultrasound and ultrasound-guided FNAC as a routine evaluation tool in the pre operative assessment of axillary lymph nodes in early breast cancer. Our study showed good and acceptable result (75%) in isolating and retrieving the targeted node by just following the Vascular pedicle based node mapping of axilla to locate the suspicious node without using any tagging or marking of node from where FNAC was performed. This finding can act as a good practicing tool in a busy high volume, logistics issue and and resource constraint hospitals.[Table: see text]
Correlation between TopIIα and ki-67 expression in tumors of luminal, primary operable breast cancer without HER2/neu overexpression in postmenopausal women as a prognostic factor.
Authors: Ulianova Elena P. , Kit Oleg I. , Tokmakov Vasilij V. , Shatova Iuliana S. , Novikova Inna A. , Sagakyants Aleksandr B. , Nepomnyashchaya Evgeniya M. , Shulgina Oksana G. , Chernikova Elena N. , Bakulina Svetlana M. , Lysenko E. P. , Bondarenko Elena S. , Vladimirova Liubov Yu 
Published: May 2019

e12065 Background: Assessment of proliferative activity is important in terms of tumor prognosis. Topoisomerase IIα (TopIIα) and ki-67 are common markers of breast cancer (BC) cell proliferation. The purpose of the study was to assess the correlation between TopIIα and ki-67 expression as a prognostic factor in luminal, primary operable breast cancer without Her 2 neu overexpression in postmenopausal women. Methods: 60 postmenopausal patients with BC (invasive ductal carcinoma) were equally divided into 3 groups: I –luminal A BC, surgical treatment with subsequent radiotherapy and hormonal therapy; II – luminal B BC, surgical treatment with subsequent radiotherapy and hormonal therapy; III – luminal B BC, surgical treatment with subsequent radiotherapy, polychemotherapy and hormonal therapy. Mean age of patients: I – 76.16±3.14 years, II – 65.0±3.91, III – 74.0±2.54 years. Immunohistochemical study was performed with mouse monoclonal ki-67 (Thermo scientific) and TopIIα (Santa Cruz Biotechnology) antibodies using the Reveal Polyvalent HRP-DAB Detection System. Results were analyzed using the STATISTICA 10.0 program (StatSoftInc., USA). Results: The average expression levels of the ki-67 marker in the groups were: I - 12.3±1.4%, II - 15.1±3.1%, III - 37.0±7.1%; TopIIα expression – 3.5±1.6%, 16.0±5.9%, 21.7±6.4%, respectively. The statistically significant Spearman correlation between TopIIα and ki-67 was observed both as general in groups (r = 0.787 at p < 0.001) and in groups with luminal B subtype (groups II and III). Strong positive correlation between TopIIα and ki-67 was registered in groups II (r = 0.941 at p < 0.01) and III (r = 0.864 at p < 0.001) with luminal B subtype. Weak correlation was observed in group I with luminal A subtype (r = 0.477 at p≥0.05). Conclusions: The study revealed a correlative increase in the level of TopIIα with simultaneous overexpression of the ki-67 protein in the studied groups. This indicator can be considered predictive for breast cancer.
Impact of surgery type on survival in breast cancer patients.
Authors: Ngo Phuong Tuyet , Bhandari Shruti , Murray Drew , Mudra Sarah , Wu Xiaoyong , Lele Rachana Shirish , Srivastava Sudhir , Mandadi Mounika , Riley Elizabeth Carloss 
Published: May 2019

e12072 Background: Breast cancer is the most common malignancy affecting women, and treatment is multidisciplinary. Both patient and tumor related factors impact surgical decision making. Recently, rates of mastectomy, prophylactic mastectomy and reconstruction have increased. The impact of this on modern survival, the relationship to patient and tumor related factors is not well described. Methods: The National Cancer Database identified 1,042,057 patients who underwent surgery with lumpectomy or mastectomy with or without reconstruction for stages I-III breast cancer from 2004-2014. Variables collected included gender, race, age, stage, facility type, insurance status, and overall survival. Data was analyzed using univariable and multivariable logistic and Cox proportional hazards regression models. Results: Of all surgeries, 61.2% were lumpectomy (n = 638,088), 27.9% were mastectomy without reconstruction (n = 290,463) and 10.9% were mastectomy with reconstruction (n = 113,506). African American patients were more likely to get mastectomy without reconstruction than lumpectomy (OR 1.05; 95% CI 1.03-1.06, p < 0.001) but less likely to get reconstruction than lumpectomy (OR 0.73; 95% CI 0.71-0.75). Patients 50-65 years were less likely to get mastectomy either with and without reconstruction compared to lumpectomy (OR 0.45; 95% CI 0.44-0.46; OR 0.87; 95% CI 0.86-0.88, p < 0.001, respectively). Reconstruction was more likely in patients with private insurance compared to those with Medicare (OR 1.46; 95% CI 1.43-1.50, p < 0.001) and was less likely to occur at a community center compared to an academic facility (OR 0.48; 95% CI 0.47-0.49, p < 0.001). Mastectomy without reconstruction also had a higher likelihood of death when compared to lumpectomy patients (HR 1.28; 95% CI 1.26-1.29, p < 0.00). Conclusions: The majority of women in this large dataset had breast conserving surgery. Of those patients who underwent mastectomy, only a minority had reconstruction. Age > 50 years and treatment at a non-academic facility were associated with less reconstruction along with established risk factors for worse outcome including African American race and Medicaid/Uninsured. Despite adjusting for these risk factors, mastectomy without reconstruction was still associated with a lower survival. Further analysis including tumor biology is needed to better understand the impact of these findings.
The treatment option of progressive disease in breast cancer during neoadjuvant chemotherapy: A single-center experience.
Authors: Zheng Yurong , Ding Xiaowen , Zou Dehong , Zhang Fanrong , Qin Chengdong , Yang Hongjian , Mo Wenju , Ding Yu-Qin , Yu Yang 
Published: May 2019

e12082 Background: Patients’ responses to breast cancer neoadjuvant chemotherapy (NACT) differ because of heterogeneous tumor characteristics. Reports about NACT progression are sporadic. In this study, we aimed to evaluate the characteristics and treatment option of progressive disease in breast cancer after neoadjuvant chemotherapy in China. Methods: We enrolled 1187 patients who received NACT in our cancer center between January 1, 2007, and December 31, 2016. We analyzed the characteristics and treatments of patients with progressive disease (PD) or non-PD or pathological complete response (pCR). Results: In total, 45 (3.8%) patients had PD. PD patients were associated with a significantly worse disease–free survival (DFS) (hazard ratio (HR) = 3.77; 95% CI, 1.77 to 8.00; P = .001) and overall survival (OS) (HR = 3.85; 95% CI, 1.77 to 8.35; P = .001). For the PD patients, 28 (62.2%) patients received mastectomy immediately after PD, and 17 (37.8%) changed to chemotherapy. DFS and OS exhibited no significant differences between these two salvage therapies. After a change to second chemotherapy, 58.8% (10/17) patients had PD or SD. With the exception of tumor size, pretreatment T stage, and histology type, no other significant differences were noted between PD and pCR patients. Conclusions: Our results demonstrated that PD patients were associated with a significantly worse prognosis. Based on these results, we suggest to give the addition of trastuzumab to HER-2 positive patients instead of changing the chemotherapy regimen and proceeding to surgery instead of further chemotherapy once patients have PD during NACT. Given that some similar characteristics exist between PD and pCR patients, more studies to identify novel molecular markers to predict disease response to NACT should be performed.
The role of stromal tumor infiltrating lymphocytes (sTILs) as a predictive biomarker for carboplatin-based neoadjuvant chemotherapy (NACT) in triple-negative breast cancer (TNBC).
Authors: Walsh Elaine M. , O'Loughlin Mark , Shalaby Aliaa , Webber Mark , Kerin Michael J. , Glynn Sharon A. , Callagy Grace , Keane Maccon M. 
Published: May 2019

e12085 Background: High numbers of sTILs are predictive of pCR in TNBCs. This study examines the role of sTILs as a predictive biomarker for carboplatin (Cb) based NACT. Methods: sTILs were scored on 88 pre NACT TNBC biopsies as per the International TILs Working Group and were scored as continuous and categorical variables: 0-10%; 11-25%; 26-49%; ≥50%. OR was calculated using non-pCR as baseline parameter. Results: Patients with sTILs > 10% had increased pCR rates compared to those with sTILs ≤10%: pCR breast (B) (61% vs 31% p = 0.004); pCR breast/axilla (BA) (52% vs 29% p = 0.021). In those treated with Cb, there were no differences in pCR B between sTILs > 10% or ≤10% (67% vs 53%; p = 0.355) or pCR BA (60% vs 53%; p = 0.500). In those who did not receive Cb, sTILs > 10% had increased pCR B (57% vs 15%; p = 0.002) and pCR BA (46% vs 12%; p = 0.005) compared to sTILs ≤10%. Similar trends were seen with sTILs > 25% and ≥50%: differences were seen in patients who did not receive Cb, but not in those treated with Cb. In LPBCs, the addition of Cb did not significantly increase pCR rates: 67% vs 83% for Cb and non-Cb regimens (p = 0.583). In non-LPBC, pCR rates were increased with Cb: pCR B 59% vs 31% (p = 0.017), and pCR BA 56% vs 23% (p = 0.005) for Cb and non-Cb regimens. The association between sTILs and pCR was significant in multivariable models adjusting for grade and Cb. In patients who did not receive Cb (n = 54), increasing sTILs were associated with increased pCR B (OR 0.15 p = 0.004; OR 0.27 p = 0.039; OR 0.10 p = 0.05 for > 10%, > 25%, ≥50%) and pCR BA (OR 0.18 p = 0.019; OR 0.08 p = 0.029 for > 10%, ≥50%). In patients treated with Cb (n = 30), increasing sTILs were not associated with pCR B (OR 1.97 p = 0.581; OR 0.27 p = 0.334; OR 0.50 p = 0.719) or pCR BA (OR 2.93 p = 0.372; OR 0.79 p = 0.831; OR 0.40 p = 0.622 for > 10%, > 25%, ≥50%). Conclusions: sTILs are predictive of pCR: as sTILs increase, pCR rates increase. Tumors with high sTILs had high pCR rates to anthracycline-taxane (AT) NACT. The effect of increasing sTILs on pCR was most notable in patients who did not receive Cb based NACT, suggesting that tumors with high sTILs are inherently sensitive to AT based chemotherapy. Intensifying NACT with Cb could be used to increase pCR rates in patients with low sTILs. sTILs should be explored as a biomarker to intensify chemotherapy in those with low sTILs, and to de-escalate chemotherapy in tumors with high sTILs.