bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract P1-14-05: Predicting Brain Metastasis in Breast Cancer Patients: Who Is at Highest Risk?
Authors: Siripurapu V , Ruth K , Cristofanilli M , Egleston BL , Sigurdson ER , Freedman GM , Goldstein LJ , Bleicher RJ. 
Published: April 2011

Abstract
Background: The development of brain metastases (BrM) in women with breast cancer is associated with more advanced stage at presentation (Atahan 2008), although predicting who is at greatest risk remains difficult. This study aims to determine the characteristics of those at highest risk for BrM, and characterize treatment prior to their development. Methods: A prospective database containing 4,169 breast cancer patients (pts) was retrospectively reviewed for those developing BrM between 1997 and 2007. Demographic and prognostic variables were reviewed. Controls without BrM were matched for T stage, N stage and ER status, with 2 matched controls for 44 BrM pts.
Results: Forty-nine patients (1.2%) developed BrM, among whom 6 were evident at initial presentation. BrM pts overall were diagnosed at a median age of 57 y with pathologic stages I and II accounting for 33% of cases at initial presentation. Pts developed BrM at a median of 19.7 mos after diagnosis. T1/T2 tumors were present in 65% of overall cases. 21 (43%) were ER/PR negative. Among 24 sites of distant disease evident prior to BrM were 16 (66%) bone and 6 (25%) lung metastases. Univariate BrM predictors included evidence of prior non-brain metastases (p=0.0004), high nuclear grade (p=0.002), PR-negativity (p=0.005), and inflammatory breast cancer (IBC, p=0.04). Family history of breast cancer approached significance (p=0.053). On multivariable analysis for predictors, prior non-brain metastases (p=0.001), high nuclear grade (p=0.006), and IBC (p=0.01) remained significant predictors. Despite adjustment for T and N stage, univariate treatments associated with, but given prior to BrM development, were use of radiotherapy (p=0.002), chemotherapy (p=0.009), and mastectomy (vs lumpectomy, p=0.03; vs no operation, p=0.0016). The sole treatment associated on multivariable analysis was chemotherapy use (p=0.02). After BrM diagnosis, 94% had whole brain radiotherapy, 22% had chemotherapy, and 8% underwent neurosurgery. BrM pts’ median survival was 38.6 mos, while matched controls did not reach median survival in 100 mos of mean follow up. Median time from BrM diagnosis to death was 10.8 mos, with a 5 y survival of 25.6%. Conclusion: The development of BrM is associated with shorter survival in patients with breast cancer. Several clinico-pathologic factors may identify patients at greatest risk of developing BrM, even in the face of more aggressive primary therapy. Such risk factors should be considered when developing early diagnostic and therapeutic interventions for BrM, and when validating any such intervention prospectively.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-14-05.
Abstract P1-15-05: HER2 Positivity Correlates to Coexisting Invasion in Ductal Carcinoma In Situ of the Breast
Authors: Liao N , Zhang G , Liu Y , Li X , Yao M , Zu J , Xu F , Li L , Wu Y. 
Published: April 2011

Abstract
Background: Ductal carcinoma in situ (DCIS) of the breast with coexisting invasion is commonly seen and no consensus on any biomarkers capable of discriminating this subgroup is reached yet. We therefore carried out a retrospective study to investigate the receptor status and histological grade in Chinese DCIS patients aiming to identify if there is any independent predictor that could discriminate the subgroup of DCIS with coexisting invasion from pure DCIS patients.
Methods: A Consecutive Chinese DCIS patient cohort in a single institution was included for ER, PR and HER2 status and histological grade evaluation. Patients with invasion foci greater than 1cm in diameter were excluded. For HER2 (2+) cancers by IHC, fluorescence in situ hybridization was performed to examine HER2 gene amplification status. HER2 positive was defined as HER2 (3+) by IHC or HER2 gene amplified. Histological grading was performed only for DCIS component using Van Nuys classification system. Molecular subtypes were also profiled using the following criteria: ER and/or PR positive and HER2 negative as luminal A, ER or PR positive and HER2 positive as luminal B, ER and PR negative while HER2 positive as HER2-positive and ER, PR, HER2 negative as basal-like. Age, histological grade, ER, PR, and HER2 status were included in association analyses using appropriate statistical methods to test if any of these markers independently correlates to DCIS with invasion. Results: Our study included 183 patients in total. Among these patients, 140 had pure DCIS and 43 had DCIS with invasion. Luminal A subtype accounted for 49.7% of all cases, HER2-positive subtype for 27.9% and only 10.4% and 12.0% were luminal B and basal-like subtypes, respectively. Univariate analyses showed that histological grade 2, grade 3 and HER2 positive status were associated with DCIS with invasion, odds ratios 5.1(95%CI 1.3-19, P=0.017), 5.2 (95%CI 1.5-18, P=0.01) and 3.34 (95%CI 1.6 −6.8, P=0.001), respectively. Nonetheless, after adjusting for other markers, only HER2 positivity independently correlates to DCIS with invasion, odds ratio 3.8 (95%CI 1.4 to 10, P=0.008). Consistently, luminal B and HER2-positive subtypes were also correlated to DCIS with invasion and the odds ratio was 3.0 (95%CI 1.0-8.7, P=0.045) and 3.0 (95%CI 1.4-6.6, P=0.005), respectively when compared to luminal A subtype. Basal-like subtype was not correlated to DCIS with invasion, odds ratio 0.50(95%CI 0.11-2.4, P=0.384).
Conclusions: Our study suggests that HER2 positivity rather than higher histological grade is the independent predictor for coexisting invasion. ER/PR status and age do not correlate to coexisting invasion. Molecular subtype classification for treatment guidance especially HER2 targeted therapy in DCIS deserves further exploration.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-15-05.
Abstract P1-15-06: Incidence of HER2 Positive Quantified by FISH in Ductal Breast Carcinoma In Situ
Authors: Calvo-Plaza I , Suarez-Gauthier A , Ugidos L , Lopez-Rios F , Perez-Rodriguez F , Garcia-Garcia E , Conde E , Angulo B , Hidalgo M , Estevez L. 
Published: April 2011

Abstract
Purpose: The Her2/neu gene is amplified and/or its protein is overexpressed in 15-25% of invasive breast cancer, but in Ductal Carcinoma In Situ (DCIS) this expression is highly increased (60-80%). We review our rate of DCIS with Her2 amplified in a prospective series of women with new diagnosis of DCIS. Methods: Patients with new diagnosis of DCIS by biopsy were studied. The status of Her2 was evaluated by fluorescence in situ hybridization (Vysis path vision HER-2 DNA probe kit) and was considered amplified if the ratio HER2/CEP17 was &gt;2.0. The status of estrogen and progesterone receptors were analyzed by inmunohistochemistry (IHQ). Data evaluating architectural pattern and histological grade were also collected. Results: Data from 53 patients with DCIS were included (two patients with combined invasive ductal carcinoma detected at time of surgery and 51 cases of pure DCIS). HER2 was amplified in 20 patients (37%), with HER2/CEP17 ratios between 2.16 to 14.00. A total of 29 patients had grade III DCIS, and of those 18 (62%) had Her2 amplified. 17 patients (32%) were estrogen and progesterone receptors negative (10 with Her2 amplified). We have not observed any correlation about architectural pattern (comedo, cribriform, micropapillary, solid/necrotic) and amplification of Her2. Conclusion: In our series of DCIS patients the Her2 amplification was less commonly found compared to prior studies (37% vs &gt;60%). Most of DCIS were grade 3 (90%) and no relation was found among the architectural pattern and amplification of Her2.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-15-06.
Abstract P1-16-02: Retrospective Review of Male Breast Cancer Patients: Analysis of Tamoxifen-Related Side Effects
Authors: Pemmaraju N , Munsell M , Hortobagyi GN , Giordano S. 
Published: April 2011

Abstract
Background: Male breast cancer (MBC) is an uncommon malignancy with approximately 2000 American men diagnosed per year. It has been observed that the side effect profiles and tolerability with anti-hormonal treatments such as tamoxifen differ between women and men. There is a paucity of data specifically evaluating the side effect profiles of antihormonal treatments in MBC patients (pts).
Objective: To specifically study the side effects of tamoxifen in a cohort of MBC pts and to determine toxicities in this population. Methods: We retrospectively reviewed all MBC pts evaluated at our institution from 1999-2009. Out of a total of 126 MBC pts, 64 met the following inclusion criteria: stage I-III, treated with tamoxifen, and at least one follow-up visit after starting tamoxifen. A descriptive analysis of side effects was performed on these 64 pts.
Patient Characteristics and Results: Median follow-up time at our institution was 4.2 years (range 0.3-10.9). Median follow-up from the start of tamoxifen therapy was 4.0 years (range 0.3-19.4). The median age at diagnosis was 61 years (range 30-79). Breakdown by stage included: 29.7% Stage I, 54.7% stage II, and 15.6% stage III. Median initial tumor size was 2.0 cm (range 0.5-6.5). 100% were hormone-receptor positive and 7 tumors (11%) were HER2/neu-positive. Two pts had history of prior therapeutic radiation, and 11 pts (17%) had a prior or concomitant cancer diagnosis, including 6 pts with history of prostate cancer and 2 pts with history of renal cell carcinoma. Sixteen (25%) developed metastatic disease or recurrence. Thirty (47%) pts experienced at least one or more side effect while taking tamoxifen. There were a total of 101 documented side effects (more than one side effect in some pts). The most common toxicity was weight gain (14 out of 64 pts, 22%) and sexual dysfunction/loss of libido (14pts, 22%), followed by hot flashes (8pts, 13%), neurocognitive deficits (6 pts, 1%), thromboembolic events (4 pts, 1%) ocular events (3pts), mood alterations (2pts), depression (2 pts), GI disturbance(2 pts), insomnia (1) and leg cramps (1). Importantly, 13 out of the 64 (20.3%) pts discontinued tamoxifen due to toxicity: 1 for ocular, 2 for neurocognitive deficits, 4 for thromboembolic events, 2 for bone pain, 3 for loss of libido, and 1 for leg cramps.
Conclusions: To our knowledge, this is the largest retrospective study specifically examining tamoxifen-related side effects among MBC pts. Among MBC pts, there is a high rate of discontinuation of tamoxifen. Further prospective work regarding better understanding of male hormonal biology as well as novel anti-hormonal drug development may be warranted in this unique population.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-16-02.
Abstract P1-17-01: Differences in Survival among Women with Stage III Inflammatory and Non-Inflammatory Locally Advanced Breast Cancer Appear Early: A Large Population Based Study
Authors: Dawood S , Ueno NT , Valero V , Woodward W , Buchholz TA , Hortobagyi GN , Gonzalez-Angulo AM , Cristofanilli M. 
Published: April 2011

Abstract
Background
Significant improvements in the survival of women with breast cancer have been observed and are attributed to a multidisciplinary approach and the introduction of polychemotherapy regimens. The objective of this population based study was to determine if differences, if any, in survival exist among women with inflammatory (IBC) and non-IBC locally advanced breast cancer (LABC) diagnosed in this era.
Methods
The Surveillance, Epidemiology and End Results Registry was searched to identify women with stage IIIB and C breast cancer who were diagnosed between 2004 and 2007 who had undergone surgery and radiation therapy. Patients were categorized as either having IBC or non-IBC LABC according the AJCC 6th edition criteria. Breast cancer specific survival (BCS) was estimated using the Kaplan-Meier product limit method and compared across groups using the log rank statistic. Cox models were then fitted to compare the association between breast cancer type and BCS after adjusting for patient and tumor characteristics.
Results
Eight hundred and twenty eight (19.2%) women and 3476 (80.8%) women had stage IIIB/C IBC and non-IBC LABC respectively. Median follow up was 19 months. 2-year BCS was 90% (95% CI 88-91%) for the whole cohort and 84% (95% CI 80%-87%) and 91% (95% CI 90%-91%) among women with IBC and non-IBC LABC respectively. In the multivariable model compared to women with non-IBC LABC women with IBC had a 43% increased risk of death from breast cancer that was statistically significant (HR=1.43, 95% CI 1.10-1.86, p=0.008). Conclusion
In the era of multidisciplinary management and anthracycline and taxane based polychemotherapy regimens women with IBC continue to have inferior survival outcomes compared to women with non-IBC LABC with differences in survival appearing early.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-17-01.
Abstract P1-17-03: Comparison of Long Term Outcome of Locally Advanced and Inflammatory Breast Cancers Treated with Dose Dense Neoadjuvant Chemotherapy
Authors: Giacchetti S , Porcher R , Lehmann-Che J , Roquancourt A , Cuvier C , Hamy AS , Bertheau P , de Thé H , Marty M , Espié M. 
Published: April 2011

Abstract
Background: Inflammatory breast cancers (IBC) have a worse prognosis than locally advanced breast cancer (LABC) (KW Hance, JNCI 2005; 97:966-75). We report a series of LABC and IBC treated with dose dense anthracycline and cyclophosphamide and report the correlation between phenotypic features, pathological complete response (pCR) and disease free survival (DFS).
Materials and methods: Between 1990 and 2003, 196 patients (pts) with LABC (105 pts) and IBC (91 pts) treated at St Louis hospital received
6 cycles (c) of dose dense Cyclophophamid (1.2g/m2 d1)-Epirubicin (E) (75mg/m2d1) q2w (SIM regimen). 133 patients had frozen biopsy allowing p53 determination. Surgery was done after chemotherapy. pCR was defined as no residual invasive tumor in breast and lymph nodes.
Results: Median follow-up was 110 months. IBC were more often ER negative than LABC(52 % vs 34%), more often triple negative (33 % vs 22 %) and more often TP53 mutations .(60% vs 39 %).
pCR in breast and lymph nodes was identical in LABC (17 pts,16%) and in IBC (14 pts, 16 %).
Table I Pathological response and factors associated with pCR
Negative ER and presence of TP53 mutations were strong predictive factors of chemotherapy efficacy in LABC and less in IBCS. histologically grade 3 was not predictive in IBC.
Median disease free survival (DFS) was higher in LABC [103 months (m)] than in IBC (54 m), p=.031. Median Overall survival (OS) was not reached in LABC and was of 134 m in IBC (p = .015). A significant effect of ER status on DFS was found in LABC and IBC. When adjusting for ER, IBC still had a significantly shorter DFS (HR 1.64, 95%CI 1.12 to 2.39, P=.011). Similar results were found for OS. For TP 53, a significant interaction was found with LABC/IBC (p=0.017) with a risk for mutated patients in LABC (p=0.004) and a slight and nonsignificant increased risk in IBC patients (p=0.62).
Estimated disease free survival at 15 years
Conclusion: High risk patients treated with dose dense cyclophosphamide and anthracyclin have very long survival rate. Negativity of ER and p53 mutations are strong predictive factors of good outcome in LABC but less in IBC. This approach in ER-LABC should be prospectively studied..

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-17-03.
Abstract P2-02-06: Efficacy and Cost Benefit of Preoperative MRI in the Diagnostic Procedure for Operable Breast Cancer
Authors: Kojima Y , Yamauchi H , Tsunoda H , Kikuchi M , Honda S , Yoshida A , Yagata H , Tsugawa K , Nakamura S. 
Published: April 2011

Abstract
Purpose
The role of preoperative MRI for operable breast cancer is controversial. In this study, we evaluate the efficacy of preoperative MRI as a diagnostic tool to determine the most appropriate procedure (i.e; mastectomy or partial mastectomy) for operable breast cancer patients and cost saving benefit from selecting the most appropriate procedure.
Patients and Methods
From January 2006 to December 2007, we retrospectively studied 1149 patients. All of these patients were diagnosed with breast cancer and consequently underwent mammography (MMG), ultrasound (US) and MRI before surgery so as to determine the optimal procedure. We extracted all the cases which required changes in procedures due to the MRI findings, and compared the radiological data to the clinical and pathological outcomes. Furthermore, we studied the overall cost differences between using MRI and not using MRI. Results
In seventy seven cases, 6.7% of the total, operational changes were made because of preoperative MRI findings, which resulted in better operational outcomes. The main reason for procedural changes was the MRI findings revealed more extensive lesions, which pathologically proven to be in situ lesions. In some cases, additional lesions were pointed out by the MRI, which led us to avoid undertreatment. Among 77 cases, 69 were pathologically proven to have accurate radiological diagnosis and appropriate procedural change with MRI. The positive predictive value of preoperative MRI for partial resection was 99.1% and that for total mastectomy was 97.1%. The calculated cost difference for appropriate procedural change with MRI compared with not using MRI was $4,340. From our data, in 69 cases among 1149 received this appropriate change, $260 per case would be saved, which assumed to be more than $130 million in a year.
Conclusion
Adding preoperative MRI in the diagnostic procedures for the accurate operation in breast cancer might be effective. Usage of MRI preoperatively also save the inappropriate cost in breast cancer operations.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-02-06.
Abstract P2-02-08: 3-Tesla MRI Is More Useful for the Evaluation of Intraductal Spreading Area of Breast Cancer: A Comparative Study with Conventional 1.5-Tesla MRI
Authors: Tanaka H , Kubo M , Kamitani T , Yamamoto H , Shirahane K , Tanaka M. 
Published: April 2011

Abstract
Background: High quality of space and temporal resolution is demanded from the diagnosis for intraductal spreading area of breast cancer. In our hospital, from April 2007, 3-Tesla (T) MRI was transduced and high resolution dynamic studies for bilateral mammary have been performed. We have reported the accuracy of 3-T MRI in the evaluation of intraductal spreading area of breast cancer at 31st SABCS. At this time, we demonstrate our follow-up data.
Methods: We assessed 256 patients with primary breast cancer who underwent the 3-T or 1.5-T breast MRI as pre-operative examination between April, 2007 and February, 2010. Concerning the diagnosis of intraductal spreading area of breast cancer, we weighed 3-T MRI against conventional 1.5-T MRI. Using 1.5-T or 3-T MRI (Achieva, Philips), we injected contrast medium (Magnepist) with 0.2ml/kg body weight in 1ml/sec and photographed five aspects before injection and after injection for every 90 seconds.
We obtained fat-sat T1-weighted magnetic resonance image (T1WI), multi-planar reconstruction (MPR) image and standard maximum intensity projection (MIP) image based on T1WI by coronal section, and furthermore slab MIP image with Aquerius net (Terarecon), and we evaluated the enhanced area.
Results: 138 cases were examed with 1.5-T MRI, and 118 cases with 3-T MRI. In 1.5-T group, 40 cases (30%) were underestimated, additional resection were required intraoperativelly with cancer-cells positive surgical margin in 18 cases (13%), and surgical margin was positive with carcinoma cells by final pathological findings in 12 cases.
In two patients we were forced to changes from breast-conserving surgery to mastectomy, and two cases underwent reoperation (mastectomy) with the diagnosis of widely positive surgical margin. In comparison with 1.5-T MRI group, 16 cases (14%) were underestimated in 3-T MRI group, intraoperative addition resection in eight cases (7%), and surgical margin positive by the final pathological findings in 13 cases, respectively.
Conclusions: The concern to enhance an artifact is known on 3-T MRI because it has high resolution. However, it may be more useful rather than1.5-T MRI because of its high resolution, to evaluate the intraductal spreading area of breast cancer and to determine the extent of surgical resection.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-02-08.
Abstract P2-02-10: Clinical Utility of MRI before Re-Lumpectomy in Breast Conserving Operation
Authors: Jeon C , Lee JS , Kim S 
Published: April 2011

Abstract
Background: It was necessary to know the resection margin status for breast conserving operations after diagnostic excisional biopsies. The purposes of this study were to assess the accuracy of breast MRI in detecting residual tumor extent around excisional biopsy or mammotome biopsy sites with unknown resection margin status and evaluate the impact of MRI on surgical treatment planning for breast conserving operation. Material and Methods: Preoperative breast MRI was performed in 47 breast cancer patients who underwent mammotome biopsy and excisional biopsy with unknown resection margin status. All subjects underwent breast MRI and ultrasonography for extent of residual tumor, and were evaluated by experienced two diagnostic radiologists, followed by immediate curative operation. We investigated the correlation between radiologic and pathologic finding and the radiologic decision's effect on further surgical treatment. Results: 28 patients(59.6%) were taken by excisional biopsy, 13 patients by mammotome biopsy(27.7%), and 6 patients(12.8%) by lumpectomy. Twenty-five patients (53.1%) underwent re-lumpectomy, while 19 patients (40.4%) mastectomy, and 3 patients(6.3%) only sentinel lymph node biopsy. Residual tumor was present in 33 patients (70.3%) and multifocal breast cancer was found in 12 patients (25.5%). In terms of the accuracy of MRI in detecting residual tumor, the sensitivity was 63.6%, specificity was 45.5% and the positive predictive value was 77.7%. In that of ultrasonographies, the sensitivity was 52.3%, specificity was 88.8%, and the positive predictive value was 91.6%. Pathologic finding of residual tumor showed that ductal carcinoma in situ was most common (57.1%) in not only radiologic-pathologic concordant cases, but also in radioloigc-pathologic discordant cases (58.3%). But 5 patients (10.6%) with invasive ductal carcinoma in residual tumor were not detected by MRI. Positive predictive value was not associated with residual tumor sizes. The MR findings of residual tumor changed the next procedure from re-lumpectomy to mastectomy (10 patients), additional biopsy of suspicious lesion in ipsilateral breast (2 patients), and second-look ultrasonography (4 patients). Discussion: Preoperative MRI was not critical effect on evaluating the margin status around excisional biopsy sites. An important clinical role of
MRI is to identify a subset of patients with extensive residual or multifocal breast cancer who would be better served by undergoing mastectomy rather than breast conserving operation.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-02-10.