Prognostic value of the 21-gene recurrence score in ER-positive, HER2-negative, node-positive breast cancer was similar in node-negative diseases: a single-center study of 800 patients / 医学前沿

Multi-gene assays have emerged as crucial tools for risk stratification in early-stage breast cancer. This study aimed to evaluate the prognostic significance of the 21-gene recurrence score (RS) in Chinese patients with pN0-1, estrogen receptor-positive (ER

Favorable results of patients with pT1a, b, c, lymph node-negative early breast cancer in the long interval

Background: The clinical characteristics of patients who had lymph node-negative early breast cancer were assessed. Patients and Methods: We assessed a total of 576 patients in the study, including 74 patients (12.8%) with T1a, 119 patients (20.7%) T1b, and 367 patients (63.7%) with T1c. Patients with T1 tumors were further classified into three groups according to hormone receptor (HR) and human epidermal growth factor-receptor 2 (HER2) status. Results: In patients with T1a, the disease-free survival (DFS) rate was 98.4% at 2 years (P = 0.001). In subgroup analysis of early breast cancers, 10-year-DFS rates of the patients in HR+/HER2–, HR–/HER2+, and HR–/HER2– subgroups were not significantly different (P = 0.917). Conclusion: The T1a group had a worse prognosis than T1b and T1c groups in second years (P = 0.001); however, there was not statistically important difference between HR+, HER2+ and triple negative subgroups (P = 0.917). Although there are differences in patients and tumor features, the prognosis of patients with T1a, b, c N0M0 breast cancer is excellent

Dual partial arc volumetric-modulated arc therapy: The game changer for accelerated hypofractionated whole-breast radiotherapy with simultaneous integrated tumor cavity boost in early breast cancer - A comparative dosimetric study with single partial arc volumetric-modulated arc therapy

Introduction: In a previous study, we demonstrated clinical and dosimetric feasibility of single partial arc volumetric modulated arc therapy (VMAT) for accelerated hypofractionated whole breast radiotherapy with simultaneous integrated boost (SIB) to lumpectomy cavity for early breast cancer. In this dosimetric study, we compared dual partial arcs versus single arc. Patients and Methods: Fifteen consecutive patients for treatment with hypofractionated accelerated radiotherapy with SIB using VMAT were planned with single partial arc in an earlier study, initial result of which is published elsewhere. The comparative dosimetric plan was created using two partial arcs. Skewness and kurtosis test, Paired Student's t-test, and Wilcoxon signed-rank test were applied for statistical analysis. P < 0.05 was considered statistically significant. Results: Most planning targets are better achieved with dual arc technique. Coverage of planning target volume (PTV) whole breast (PTVWB) and PTV lumpectomy cavity (PTVBOOST) was significantly improved with dual partial arc without significant difference in conformity index and homogeneity index. Dual arc improved dosimetric parameter significantly. Mean dose (Dmean) and maximum dose (Dmax) of whole breast PTV as well as Dmax of PTVBOOST; ipsilateral and contralateral lung Dmean, Dmax, 5 Gy volume (V5); contralateral lung Dmean, Dmax, V5; Heart V25 and V18; Dmean of 5 mm thickness skin; Dmean and Dmax of ribs; and Dmean and Dmax of contralateral breast were improved with dual arc. Conclusion: This is first of its kind study establishing the advantage of dual partial arcs in the current context. Dual partial arcs improved dosimetry over single partial arc. Significant dose reduction can be achieved for multiple crucial organs at risk

Amplification of Stem Genes: New Potential Metastatic Makers in Patients with an Early Form of Breast Cancer

Progress of hypofractionated radiotherapy after breast-conserving surgery / 中国肿瘤临床

Breast-conserving surgery plus adjuvant whole-breast irradiationmay reduce the risk of local tumors and improve living con-ditions of patients. Conventional whole-breast radiotherapy confers good tumor control and esthetic effects with lower toxicity. How-ever, treatment periods of 5-7 weeks are inconvenient for patients and may lead to the wastage of medical resources. Thus, increasing-ly more individuals tend to choose a short-term radiotherapy mode, such as hypofractionated radiotherapy or partial breast irradia-tion. Many published reports suggest that short-term radiotherapy is safe and effective, similar to conventional fractionation, with comparable tumor control and fewer side effects than noted with conventional fractionation. Therefore, in contrast to conventional whole-breast radiotherapy, short-time radiotherapy shows remarkable advantages in shortening the total treatment duration, reduc-ing medical costs, saving medical resources, and improving the quality of life of patients.

Clinical analysis of chemoradiation sequence for early breast cancer patients with conserving surgery / 中华放射医学与防护杂志

Objective To investigate the prognostic factors affecting early breast cancer patients with conserving surgery and discuss the influences of chemoradiation sequence on treatment efficacy.Methods We retrospectively analyzed 191 cases of early breast cancer after breast conservation surgery in the second hospital of Dalian medical university,from January 1,2006 to December 31,2015.According to the treatment order,they were divided into radiotherapy group,chemotherapy group and sandwich group.There were 32 patients in the radiotherapy group,107 patients in the chemotherapy group,and 52 patients in the sandwich group.The sandwich group was treated with chemotherapy-radiotherapy-chemotherapy.The factors were analyzed independently from the patients' age,menopausal status,pathology type,tumor size (T1,T2),axillary lymph node,molecular type of breast cancer,the interval between surgery and radiation,vascular tumor emboli.Regression model was used to find the risk factors of early stage breast cancer patients with conserving surgery.The 5-year LRR and 5-year OS was compared among radiotherapy-first group,chemotherapy-first group,the sandwich group in patients with high risk factors,and the factors associated with the prognosis of patients were analysed.Results The Multivariate Cox Regression model showed that tumor size,axillary lymph node,vascular tumor emboli,the interval between surgery and radiation were independent risk factors associated with 5-year OS.Among patients with T1 and T2 stage in radiotherapy-first group,chemotherapy-first group,sandwich group,there was no statistical difference in 5-year LRR or 5-year OS (P ＞ 0.05).Among patients with N0 stage in radiotherapy first group,chemotherapy first group,sandwich group,5-year LRR were not statistically different (P ＞ 0.05).For patients with N1 stage in chemotherapy-first group and the sandwich group 5-year LRR were with statistical difference(x2 =4.813,P =0.028).OS were without statistical difference (P ＞ 0.05).In patients with vascular tumor emboli in radiotherapy-first group,chemotherapy-first group,the sandwich group,5-year LRR were without statistical difference (5.3％,9.2％,vs.18.1％,P ＞ 0.05),OS were statistically different (61.5％,90.1％ vs.87.2％,x2 =6.282,P =0.043).For patients without vascular tumor emboli,there was no statistical difference in 5-year LRR (P ＞ 0.05).For patients started radiation within 6 months after surgery in radiotherapy-first group,chemotherapy-first group,the sandwich group,5-year LRR were without statistical difference (P ＞ 0.05).However,patients in chemotherapy-first group the time interval surgery and radiation ≤6 months vs.＞6 months 5-year LRR was 5.2％ and 14.1％ (x2 =4.886,P=0.027),5-year OS were 96.9％ and 85.7％ (x2 =5.758,P =0.038).Conclusions Clinical treatment is based on individualized options.For patients with negative axillary lymph nodes,but high risk factors for local recurrence,radiotherapy may be performed firstly.For high-risk patients with axillary lymph node metastasis or vascular tumor embolus,chemotherapy should be started early and radiotherapy may be followed,but not more than 6 months.

Quality of life assessment after modified radical mastectomy in early breast cancer

Background: Modified radical mastectomy performed for CA breast is a life modifying surgery for most women. It creates a profound impact on the quality of life enjoyed by the women. The magnitude of change in quality may pave the way for more conservative surgery in the future. Aim: To assess the quality of life in patients undergoing modified radical mastectomy for early breast cancer. Materials and methods: This was a prospective study consisting of 50 patients who underwent modified radical mastectomy in our institution from 2013-2015 for early breast cancer. Quality of life was assessed 6 months after surgery using a translated version of a customized questionnaire, which was based on the Royal College of surgeons’ questionnaire. Results: In our study, the most common age group was found to be between 51-60 years (24). Most patients (30) had poor quality of life with 19 patients having an average quality of life. 23 patients with poor quality of life were from the lower socioeconomic class. 47 patients (94%) did not have any restriction of daily activities. Most of the patients (49) had mild pain and discomfort. Among the patients experiencing mild pain 59% (29 patients) had poor quality of life. Severe psychological impairment was present in 30 of our study population and was associated with poor quality of life in 29 cases (97%). 34 patients in the study population were not satisfied with their body image and was associated with poor quality of life in 30 (88%) of the cases. 27 patients in the study group were not satisfied with their sexual life and it was associated with poor quality of life in 23 (85%) of the patients. Conclusion: From this study we have concluded that the quality of life is poor in majority of the patients undergoing modified radical mastectomy for early breast cancer with most of the patients S. Maniselvi, T. Babu Antony, Ponmuthu, Deepak David Chellappa. Quality of life assessment after modified radical mastectomy in early breast cancer. IAIM, 2017; 4(12): 52-58. Page 53 having psychological impairment, unsatisfied body image perception, unsatisfied sexual life and mild pain. In addition to these factors socioeconomic status of the patient also affects the quality of life in these patients

A Cost-Effectiveness Analysis of Adjuvant Trastuzumab Regimens in HER2-Positive Early Breast Cancer / 中国药学杂志

OBJECTIVE: To advocate Patient Assistant Program Projects (PAP Projects) decision-making, this study assesses the long-term cost-effectiveness of 1-year adjuvant trastuzumab therapy for women with human epidermal growth factor receptor 2 (HER2) positive early breast cancer. METHODS: A Markov model tracked yearly patients' transitions between five health states. The cycle length was 1 year and the sum was 45. From the perspective of the China health insurance system, the direct medical cost was estimated based on a survey of clinical expert panels. A discounting rate of 3% was used to discount direct medical cost and health outcomes. Utility and transition probabilities were retrieved from the HERA trial and literature. To estimate the direct medical cost, a survey of clinical expert panels was conducted. The cost of trastuzumab and HER2 test based on Roche. The key factor of the model was realized by one-way sensitivity analysis. The result of a probability sensitivity analysis conducted by Monte Carlo simulation was expressed as an incremental cost-effectiveness scatter plot. RESULTS: Without PAP Projects in Guangzhou, the adjuvant trastuzumab treatment prolonged 1.79 QALYs when the cost increased ¥53 301 and the Incremental cost-effectiveness ratio (CER) was ¥29 731/QALY, which is cost-effective based on Guangzhou's per capita GDP in 2015. With PAP Projects, the adjuvant trastuzumab treatment was totally cost-effectiveness. The sensitivity analysis demonstrated that the model was moderate. CONCLUSION: One year adjuvant trastuzumab treatment is a cost-effective therapy for patients with HER-2 positive breast cancer. With PAP Projects in Guangzhou, the adjuvant trastuzumab treatment is projected to be associated with improved QALYs and reduces direct medical costs, compared with the standard chemotherapy, represents a dominant treatment option among patients with HER2-Positive Early Breast Cancer. PAP Projects in Guangzhou should be persisted and spread in China.

Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients / 고신대학교의과대학학술지

OBJECTIVES: Breast conserving surgery (BCS) for early breast cancer is now an accepted treatment, but there are controversies about its comparability with mastectomy. Thus, we investigated the survival outcomes who underwent BCS and modified radical mastectomy (MRM). METHODS: In this retrospective review, we analyzed the survival outcomes of 618 patients with early breast cancer who underwent two different surgery from January 2002 to December 2009. Postoperative pathologic difference, disease free survival period, overall survival period, recurrence pattern, recurrent rate and site were compared. In addition, preoperative patients data are also collected. RESULTS: Disease free survival period of MRM and BCS was 108.46 months and 80.82 months, respectively (P < 0.01). However, there was no significant correlation between overall survival period and operative methods (P = 0.67). In addition, recurrence pattern (P = 0.21), recurrent rate (P = 0.36) and site (P = 0.45, P = 0.09) were not associated with operative method. CONCLUSIONS: In this study, we can suggest that early breast cancer patients could improve their disease free survival if they underwent MRM. So, when we operate high risk breast cancer patients, MRM could be considered for their disease free life. Further studies may be required to establish appropriate strategy of surgery for early breast cancer.

Impact of post‑operative radiation on coronary arteries in patients of early breast cancer: A pilot dosimetric study from a tertiary cancer care center from India.

BACKGROUND: The significant impact of postoperative radiotherapy (PORT) on cardiac morbidity in patients of early breast cancer (EBC) undergoing breast‑conserving surgery has been shown in different studies. The present study was conducted to assess the impact of surgery and the side of involvement on radiation dose to left anterior descending artery (LAD) and Left circumflex coronary artery (LCx). MATERIALS AND METHODS: Totally, 58 patients of EBC were randomly chosen for this dosimetric study and planned with tangential field technique without intensity modulation (IM). Heart, LAD, and LCx (n = 55) were contoured. Dose volume histograms were analyzed to determine the Dmax (maximum dose) and Dmean (mean dose) of LAD and LCx. Student’s t‑test was used for comparative analysis of the means. RESULTS: The mean Dmax of LAD for left (L) EBC was 3.17 Gray (Gy) while for right (R) EBC it was 0.86 Gy (P = 0.007; 95% C.I, 1.14–3.48). The mean Dmean of LAD for L‑EBC and R‑EBC were 1.97 Gy and 0.79 Gy, respectively (P = 0.029; 95% C.I, 0.77–1.60). The mean‑Dmax of LCx for patients with L‑EBC (2.9 Gy; range: 1.2–4.35 Gy) was statistically higher than that for R‑EBC (1.3 Gy; range: 0.7–3.2 Gy) (P = 0.045). The mean‑Dmean of LCx for L‑EBC (2.1 Gy; range: 0.6–3.6 Gy) was also significantly higher than that of L‑EBC (0.9 Gy; range: 0.7–2.1 Gy) (P = 0.03). There was no significant impact of the pattern of surgery on LAD dose, but significance was noted for LCx dose parameters (P = 0.04 and 0.08 for m‑Dmax and m‑Dmean of LCx). CONCLUSION: This pilot dosimetric study confirms the assumption that patients with left‑sided EBC are at higher risk of developing long‑term cardiac morbidity when treated with PORT due to increased dose to LAD.

Clinical efficacy comparison of breast-conserving surgery and modified radical mastectomy in treatment of early breast cancer / 局解手术学杂志

Objective To compare the effects of breast-conserving and modified radical mastectomy of early-stage breast cancer. Meth-ods 80 patients with early breast cancer were divided into two groups according to the different operation methods. The treatment group were given breast-conserving surgery while the control group were given modified radical mastectomy, and the clinical efficacy of two groups were observed. Results The operation time, intraoperatve blood soss, average drainage and the length of hospital stay of the breast-conserving group were significantly lower than those of the control group, and the excellent rate of breast shape in the breast-conserving group was signif-icantly higher with a statistically significant difference (P0. 05). Conclusion The effect of breast-conserving surgery in treatment of early breast cancer is satisfactory, so it is recommending for wide application.

Research progress in antitumor effects of zoledronic acid in early breast cancer / 中国肿瘤临床

Adjuvant treatment, which includes chemotherapy and endocrine therapy, for early breast cancer may impair bone den-sity, resulting in bone loss. The third generation bisphosphonate-zoledronic is an anti-resorptive agent that inhibits osteoclast-mediated bone resorption. This drug can be mainly used in the treatment of hypercalcemia caused by bone metastases of the cancer. The Zome-ta-Femara Adjuvant Synergy Trial revealed that immediate zoledronic acid and endocrine therapy not only prevents bone loss, but also reduces recurrence. The Austrian Breast and Colorectal Cancer Study Group-12 (ABCSG-12) also confirmed that zoledronic acid, when combined with endocrine therapy, could reduce the risk of cancer disease progression and death. Moreover, preclinical studies and clini-cal trials have demonstrated the synergistic antitumor effects of chemotherapy and zoledronic acid. Neo-adjuvant zoledronic acid to re-duce recurrence trials showed that the addition of zoledronic acid to adjuvant chemotherapy significantly reduced the risk of disease pro-gression and death in postmenopausal women more than five years postmenopause at the beginning of the study or over 60 years of age at the baseline. The ABCSG-12 subgroup analysis based on age (≤40 years or>40 years) also showed that zoledronic acid can signifi-cantly improve the prognosis in women who were over 40 years at the study entry. These results suggest that zoledronic acid administra-tion in patients with lowered estrogen levels (naturally or as a consequence of adjuvant treatment) easily exerts anti-tumor effects. How-ever, the optimal dose and duration of zoledronic acid requires further studies. More clinical trials should be performed to provide suffi-cient evidence to support the effectiveness of zoledronic acid in the treatment of early breast cancer.

Radioterapia externa parcial acelerada en pacientes con cáncer de seno en estado temprano / External Beam Partial Breast Irradiation for Early Breast Cancer

Objetivo: Demostrar la eficacia y efectividad de la radioterapia parcial acelerada en cáncer temprano de mama en pacientes tratadas con cirugía conservativa. Método: Se trataron cien mujeres con radioterapia externa parcial acelerada, con dosis en un rango de 35 a 38,5 Gy, en 10 fracciones en 5 días dos veces al día con un intervalo de 6 horas. Todas se trataron con 4 campos no cooplanares. El volumen tumoral clínico estuvo cubierto de forma homogénea con la isodosis del 100 %; así mismo el volumen de planeación del blanco, incluido en la isodosis del 95 %. Resultados: El seguimiento promedio fue de 54,3 meses. La tolerancia al tratamiento fue buena y ninguna mujer presentó toxicidad grado 2 o 3. Hasta el momento una paciente presentó recaída ganglionar, local y a distancia. Conclusión: El tratamiento fue bien tolerado, con toxicidad baja y con buenos resultados, en un tiempo corto, con posibles beneficios económicos especialmente en la población de países en vías de desarrollo...

Objective: In this study, our purpose was todemonstrate the feasibility and effectiveness ofexternal beam partial breast irradiation (PBI) inpatients with early-stage breast cancer treated withbreast-conserving surgery. Methods: 100 patientswere treated with PBI with doses ranging from 35to 38.5 Gy, in 10 fractions b.i.d. All patients weretreated with four non-coplanar fields. The clinicaltumor volume was well encompassed withinthe isodose line of 100 % as well as the planningtarget volume which was within the isodose lineof 95 %. Results: The median follow-up was of54.3 months. The treatment was well tolerated,with no more than grade I toxicity. So far, therehas been one patient with local and axillar recurrence.Conclusions: In our experience, thetreatment was well tolerated with low toxicityand with good results, in a shorter treatment time,with the economical benefits this has, especiallyfor populations in developing countries...

Influence of mastectomie avec dissection axillaire on life quality of patients with patients with breast cancer / 中国实用护理杂志

ObjectiveTo comprehend the similarities and differences of postoperative quality of life between mastectomie avec dissection axillaire and modified radical mastectomy among patients with breast cancer,and in order to supply references for establishing corresponding nursing measures. Methods160patients with early breast cancer were selected,40 patients accepted the mastectomie avec dissection axillaire (the conservative group)and 120 patients accepted modified radical mastectomy (the radical group).The quality of life of patients was surveyed with questionnaires. ResultsThe EORTC QLQ-C30 score of the conservative group was not significant than the radical group.The EORTC QLQ-BR 23 score showed that the conservative group had a better self-evaluation of their configuration. ConclusionsThe patients who accepted the mastectomie avec dissection axillaire will live a better life than those who accepted modified radical mastectomy.

Removal and diagnosis effect of staining with mixture of methylene blue and meglucamine diatrizoate for minute mammary lesion / 中国基层医药

Objective To discuss the effect of staining with the mixture of methylene blue and meglucamine diatrizoate on removal and diagnosis of minute mammary lesion(diameter≤ 1. 0cm). Methods 212 cases of mammary lesion were removed and diagnosed by the method of B-ultrosound and staining with the mixture of methylene blue and meglucamine diatrizoate. Results All of cases were removed and diagnosed successfully, including 7cases of early invasive ductus cancer and 1 case of ductal carcinoma in situ. Conclusion The method of staining with the mixture of methylene blue and meglucamine diatrizoate could significantly improve the accuracy of removal of minute mammary lesion and the percentage of diagnois of early breast cancer, and have high safety.

Long-term Results of Breast-conserving Surgery and Radiation Therapy in Early Breast Cancer / 대한방사선종양학회지

PURPOSE: To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. MATERIALS AND METHODS: One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10~16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13~179 months, with a median of 92.5 months. RESULTS: The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy (6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). CONCLUSION: Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks.

Result of Sentinel Lymph Node Biopsy Using Radioisotope in Clinically Lymph Node Negative Breast Cancer / 한국유방암학회지

PURPOSE: Sentinel lymph node biopsy (SLNB) has been developed to accurately assess the axillary lymph node status accurately without having to remove most of the axillary contents in node negative early breast cancer patients. The aims of this study were to evaluate the accuracy, the false negative rate and the advantage of additional axillary sampling for SLNB with using radioisotope. METHODS: Between December 2003 and June 2005, we carried out SLNB for 574 breast cancer patients who were diagnosed and had operation at Asan Medical Center. For detection of the sentinel lymph node (SLN), radioisotope was injected into the periareolar area on the operating day, breast scintigraphy was performed and finally the biopsy was done using a gamma-detection probe in the operating room. If the SLN turned out to be positive for metastatic malignancy according to the frozen section histology, then additional axillary lymph nodes (LN) dissection was performed. But, if it was free of metastasis, then only axillary node sampling (n< or =5) or no further treatment was done. RESULTS: The mean number of resected SLNs was 2.67+/-0.98 (1-7) and the mean number of total LN was 8.5+/-5.0 (1-38). The SLN was detected 82.8% of the time on lymphoscintigraphy and 98.4% of the time with the gamma probe. Axillary metastasis was founded in 118 cases (20.9%). The accuracy was 98.2%, and the false negative rate was 7.89%. For the SLN positive cases, there were 73/78 cases (93.6%) of 1st SLN metastasis, there were 75/78 cases (93.6%) of 1st and 2nd SLN metastasis, and 75/78 (93.6%) of 1st to 3rd SLN metastasis. The false negative rate of the alternative frozen section was 40% and that of the full frozen section was 24.1%. The difference was statistically significant. CONCLUSION: SLNB using (99m)Tc-antimony trisulfide colloid (0.5 mCi) showed a high detection rate and a low false negative rate. The false negative rate was decreased by using full section H&E staining and at least 3 SLNs showed the exact LN status. Even if the SLN was free of metastasis, additional sampling may decrease the false negative rate.

Effects of the Expression of Leptin and Leptin Receptor (OBR) on the Prognosis of Early-stage Breast Cancers / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Obesity-related leptin and leptin receptor (OBR) have a relation to the development of cancer and metastasis and also the low survival rate for breast cancer patients. Leptin has been associated with increased aromatase activity and it displays functional cross-talk with estrogen. This study was designed to determine the relationship between the expression of leptin and OBR in breast cancer tissue and the prognosis of early-stage breast cancer patients, and especially for the tamoxifen-treated patients. MATERIALS AND METHODS: Ninety-five patients with early-stage breast cancer and who had undergone surgical treatment at Kyung Hee University Hospital between January 1994 and June 2004 were analyzed. The surgical specimens underwent immunohistochemical analysis for leptin and OBR. The patients' survival and clinical characteristics were obtained from the medical records. RESULTS: Of the 95 patients, 79 (83%) and 32 (33.7%) showed the expression of leptin and OBR in breast cancer tissue, respectively. The expression of leptin and OBR in breast cancer tissue was not significantly related to the clinicopathological characteristics, including obesity, the expression of hormonal receptor, the HER-2/neu expression, menopause, stage and the nuclear grade. The expression of leptin and OBR was not significantly related to the overall disease-free survival (DFS). For the tamoxifen-treated postmenopausal obese patients, the DFS of the leptin-positive group was higher than that of the leptin-negative group (p=0.017). CONCLUSION: The expression of leptin and OBR in breast cancer tissue may be not a prognostic factor for disease-free survival of breast cancer patients. In the future, further studies are needed to determine whether leptin expression could be a predictive factor for tamoxifen therapy in the postmenopausal obese subgroup among the early breast cancer patients.

The Prognostic Value of the S-phase Fraction and Ki-67 Expression in Early Breast Cancer

PURPOSE: The aim of this study was to compare the S-phase fraction (SPF) and Ki-67 with other biologic factors, and to assess the prognostic value of Ki-67 and SPF in 108 breast cancer patients. MEHOODS: The SPF and Ki-67 level were determined in formalin-fixed, paraffin-embedded tissue specimens from 108 patients with early breast cancer who underwent surgery between January 1997 and December 2000 at the Wonkwang University Hospital. The clinicopathological characteristics of the early breast cancer such as the tumor size, node status, histological grade, hormone receptor, various tumor markers and cancer recurrence were compared with the SPF and Ki-67 values. RESULTS: The median SPF was 9.03% (range 0~43%). The SPF correlated with CD31 (P=0.020) and DNA diploidy (P=0.000). Ki-67 correlated with the histological grade (P= 0.010) and p53 (P=0.035). No correlation was found between the SPF and Ki-67. Eight cases recurred during the follow-up period. Strong expression of Ki-67, p53, DNA aneuploidy and a young age were correlated with recurrence (P=0.001, P=0.029, P=0.021 and P=0.002, respectively). However, the SPF was not related to recurrence. CONCLUSION: In early breast cancer, Ki-67 expression is correlated with the histological grade and p53 expression. In addition, strong Ki-67 expression is associated with a recurrence. Further studies regarding the prognostic significance of the proliferation markers, such as Ki-67 and SPF, will be needed to confirm these results.

Predicting the Status of the Nonsentinel Lymph Nodes in early Breast Cancer Patients with Positive Sentinel Lymph Nodes / 한국유방암학회지

PURPOSE: The need for completion axillary lymph node dissection, even in early breast cancer patients with a positive sentinel lymph node, has been questioned. The purpose of this study was to determine the factors that predict the presence of metastasis in non-sentinel lymph nodes (NSLNs) when the sentinel lymph node (SLN) was positive. METHODS: Between December 1998 and June 2004, the records of 104 early breast cancer patients with a positive SLN and who underwent completion axillary lymph node dissection were reviewed. The clinicopathological features in SLN-positive patients were evaluated as possible predictors of metastatic NSLN. RESULTS: Forty four (42.3%) of the 104 patients with positive SLN had metastatic NSLNs. In a univariate analysis, unicentric multifocality (P=0.016), lymphovascular invasion (P=0.006) and SLN metastasis larger than 2 mm (P= 0.003) were associated with positive NSLN findings. The number of SLNs removed was significantly associated as a negative predictor (P=0.043). A multivariate analysis revealed that SLN metastasis >2 mm (P=0.021) and lymphovascular invasion (P=0.040) were independent predictors of metastatic NSLN. CONCLUSION: The likelihood of metastatic NSLNs correlates with the size of the largest SLN metastasis and the presence of lymphovascular invasion of the primary tumor. Even though in early breast cancer with positive SLNs, incorporating these factors may help determining which patients would benefit from additional axillary lymph node dissection.