Clinicopathologic Characteristics and Prognosis of Early Stage Triple Negative Breast Cancer: Comparison with Non-triple Negative Group

PURPOSE: Triple negative breast cancer (estrogen receptor-negative, progesterone receptor-negative, and HER2/neu negative) is associated with high risk of recurrence and poor prognosis. We investigated the characteristics and prognosis of triple negative early-stage breast cancer. METHODS: We reviewed the records of 821 early-stage breast cancer patients treated at our hospital from 1995 to 2005. We studied the differences between a triple negative group compared with a non-triple negative group. RESULTS: Of 821 early-stage breast cancer patients, 200 (24.4%) were classified as triple negative. Large tumors (>2 cm) in the triple negative group were significantly more than those in the non-triple negative group (P=0.042). Histologic and nuclear grade of the triple negative group were significantly higher than those of the non-triple negative group (P<0.001). The median follow-up time is 50 months (1~135). There have been 50 local recurrences, 98 distant metastases, and 65 deaths. There were high rates of local recurrence in the triple negative group but no difference in 5-year disease free survival rates (P=0.178). The 5-year overall survival rate showed 85% in the triple negative group but 92.8% in the non-triple negative group (P=0.008). The relative risk for overall survival was 1.93 times higher in the triple negative group. CONCLUSION: Triple negative breast cancer patients in early stages have poor pathologic findings and prognoses. Careful treatment and follow-up are important and further investigation is necessary for triple negative breast cancer.

Clinicopathologic factor and Lymphovascular Invasion in Breast cancer / 한국유방암학회지

PURPOSE: Clinicopathologic factors associated with prognosis in breast cancer patients have varied. Among clinicopathologic factors, lymphovascular invasion (LVI) has been suggested to be a significant prognostic indicator for breast cancer. LVI means that cancer cells were found invading the lymphatics in the breast parenchyma adjacent to or well beyond the margin of the invasive tumor, and this can be an indicator of an increased chance that cancer could spread, as is demonstrated by the positive lymph nodes. The objective of this study was to determine whether LVI are associated with other clinicopathologic factors in breast cancer. METHODS: The expression of HER-2, Ki-67, P53, estrogen receptor and progesterone receptor was determined immunohistochemically in 120 breast cancer patients, including 77 patients that demonstrated the absent of LVI and 43 patients with the present of LVI. RESULTS: LVI was noted in 43 patients (35.8%) of the 120 breast cancer patients. Of the 77 patients with absent of LVI, the number of stage III patients (13 patients, 16.9%) was lower than the number of stage I (25 patients, 32.5%) and stage II breast cancer patients (39 patients, 50.6%). Of the 43 patients with absent of LVI, 5 patients (11.6%), 13 patients (30.2%), and 25 patients (58.2%) were in stage I, II, and III, respectively. There was a significant correlation between LVI and the stage (P=0.000). The strong expression (+3) of HER-2 was seen in 17 (39.5%) of the 43 patients in whom LVI was seen and in 15 (19.5%) of the 77 patients in whom LVI was not seen. Overexpression of Ki-67 was noted in 42 (97.7%) of the 43 patients in whom LVI was seen and in 64 (83.1%) of the 77 in whom LVI was not seen. HER-2 and Ki-67 overexpression was significantly associated with LVI (p=0.027 and p=0.018, respectively). LVI did not correlate with the expression of P53, the estrogen receptor status and the progesterone receptor status. There was a strong association of LVI and the lymph node status (p=0.000). Finally, LVI was associated with tumor size (p=0.014) and with the nuclear grade (p=0.022). CONCLUSION: This study demonstrates the potential value of the lymph nodal status, tumor size, stage and nuclear grade for the assessment of lympho-vascular invasion; and the overexpressions of HER-2 and Ki-67 were strong indicators of LVI in invasive ductal carcinoma of the breast.

Correlation between Hormonal Receptor Status and Clinicopathologic Factors with Prognostic Assesment in Breast Cancer

PURPOSE: The stati of estrogen (ER) and progesterone receptors (PR) have been established as useful prognostic and predictive factors in the clinical management of women with breast cancer. This study was designed to correlate the presence of hormonal receptors with the established clinicopathological parameters, including age, tumor size, nodal status, stage, p53 and c-erbB-2 stati and to assess the prognostic significance of the hormonal receptors stati. METHODS: A retrospective study was conducted of all the breast cancer patients with known ER and PR stati between 1983 and 2002 at the Dongsan Medical center. The clinical features and pathological and immunohistochemistry reports were reviewed, and the ER and PR stati compared with the clinicopathological factors using independent sample T-tests, cross-tabulation, chi-square tests, and a one way ANNOVA. A survival analysis was performed using Kaplan-Meier method and log rank tests. RESULTS: Of 893 patients, 443 (49.6%) and 435 (48.5%) were ER-positive and PR-positive, respectively. The ratios of the patients with ER+PR+, ER+PR-, ER-PR+ and ER-ER- were 37.1, 12.5, 11.6 and 38.7%, respectively. The ER status was not related to the age, tumor size, nodal status, stage and c-erbB-2 status. The ER-negative patients had significantly more frequent overexpression p53 gene than the ER-positive patients (P=0.000). The PR status was not related to the age, nodal status, stage and c-erbB-2 status, but the average tumor size was larger in the PR-negative than the PR-positive patients (P=0.02). The PR-negative patients also had significantly more frequent overexpression p53 gene than the PR-positive patients (P= 0.000). The ER-positive or PR-positive patients had a better prognosis than the ER-negative and PR-negative patients (P=0.000). CONCLUSION: The hormonal receptors stati were not definitely related to the clinicopathological factors including the age, tumor size, lymph node status, stage, c-erbB-2 status, with the exception of p53 overexpression. A positive hormonal receptor status was a good prognostic factor.

The Clinicopathologic Factors Affecting the False Negativity of Fine Needle Aspiration Cytology (FNAC) in Breast Cancer

PURPOSE: The aim of this study was to understand the diagnostic false negative outcome of FNAC at the first clinic visit of patients in relation to various clinicopathological factors with the uni- and multivariate analysis. METHODS: From January 1993 to October 2001, the one hundred and twenty-one cases of primary palpable breast cancers which were diagnosed by FNAC were reviewed retrospectively. RESULTS: The ages of the patients varied from 24 to 84 (mean age was 51.3 years). Ten clinicopathological factors correlating with failure or success of FNAC were analyzed. In univariate analysis, statistical significances were observed in palpability (P<0.001), tumor size (P<0.001), histopathologic type (P<0.001), cellular distribution (P=0.002), TNM staging (P=0.042), mammographic findings (P<0.001). On the other hand, other factors such as age, ultrasound findings, extent of tumors, ER status, aspiratiors did not reveal any statistical significance. In multivariate analysis, palpability (P=0.002), histopathologic type (P=0.0457), mammographic findings (P=0.0161) were observed significantly. CONCLUSION: The most important factors for concerning diagnostic failure by FNAC seemed to be summarized into clinically palpability, histopathologic type, mammographic findings, inexperience and number of aspirator were also considered as a factor of diagnostic failure. In rare carcinomas such as lobular carcinoma and DCIS, high false negative rate was identified.

Prediction of Peritoneal Recurrence after a Curative Resection for Gastric Cancers Based on Clinicopathologic Factors

PURPOSE: This study was designed to investigate the clinicopathologic factors related to peritoneal recurrence and to predict peritoneal recurrence based on clinicopathologic factors. METHODS: A retrospective analysis of 383 patients with peritoneal recurrence, out of 4184 patients who had undergone curative gastric resection at SNUH from 1986 through 1996 was done. RESULTS: Of the patients with peritoneal recurrence, 275 (71.8%), 97 (25.3%), and 11 (2.9%) were early (0~24 months), intermediate (24~60), and late (more than 60) recurrence, respectively. In multivariate analysis, serosal invasion, lymph node metastasis, size of tumor, Borrmann type, perineural invasion and sex were independent prognostic factors for peritoneal recurrence. After classifying all patients into 16 groups on the basis of 4 factors, serosal invasion, lymph node metastasis, Borrmann type, and size, the number and proportion of a patients with peritoneal recurrence was obtained. There was 4.2% peritoneal recurrence in the most favorable group (n = 71), which had a Borrmann type 1 or 2 lesion less than 5 cm in maximal diameter with neither serosal invasion nor lymph node metastasis. There was a 25.4% peritoneal recurrence in the most unfavorable group (n = 331), which had a Borrmann type 3 or 4 lesion more than 5 cm with serosal invasion and lymph node metastasis. CONCLUSION: Our results suggest that patients with a Borrmann 3 or 4 lesion more than 5cm in maximal diameter, with serosal invasion and lymph node metastasis have thehighest risk for peritoneal recurrence. These patients could be considered as candidates for a treatment modality such as intraperitoneal chemotherapy or hyperthermic chemotherapy.