Clinico-pathologic factors associated with the occurrence of early and late metastatic spread in a cohort of breast cancer patients.

BACKGROUND AND OBJECTIVE: Distant metastatic spread in breast cancer patients is a complex phenomenon involving several prognostic factors. We focused our analysis on early metastatic breast cancer (EMBC) (occurring during the first 36 months) versus late metastatic breast cancer (LMBC) (occurring beyond 3 years) in order to ascertain their possible differential predictive factors. METHODS: diagnostic, surgical, and follow-up data were assessed for consecutive patients with breast cancer undergoing surgery between 1997 and 2019. We analysed the predictive factors for distant metastasis using both univariate and multivariate analysis. RESULTS: The median follow-up for this cohort of 2708 patients was 89 months. The median metastasis-free interval (FMI) for metastasis patients was 38 months (17 months for EMBC group and 76 months for LMBC group). Distant metastases developed in 12.9% (350/2708); 48% (168/350) of them as EMBC and 52% (182/350) as LMBC. Loco-regional recurrence and nodal extracapsular extension were the only common predictors for both. CONCLUSIONS: EMBC and LMBC appeared as two separate conditions, with a different outcome. In the EMBC group, tumour proliferation related factors were significant (histological grade, tumour size, body mass index), whereas for LMBC, other slow-acting factors seemed to be involved (screening program, tumour burden, bilateral tumour).

Comparative Long-term Study of a Large Series of Patients with Invasive Ductal Carcinoma and Invasive Lobular Carcinoma. Loco-Regional Recurrence, Metastasis, and Survival.

Our aim was to compare histologic and immunohistochemical features, surgical treatment and clinical course, including disease recurrence, distant metastases, and mortality between patients with invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC). We included 1,745 patients operated for 1,789 breast tumors, with 1,639 IDC (1,600 patients) and 145 patients with ILC and 150 breast tumors. The median follow-up was 76 months. ILC was significantly more likely to be associated with a favorable phenotype. Prevalence of contralateral breast cancer was slightly higher for ILC patients than for IDC patients (4.0% versus 3.2%; p = n.s). ILC was more likely multifocal, estrogen receptor positive, Human Epidermal Growth Factor Receptor-2 (HER2) negative, and with lower proliferative index compared to IDC. Considering conservative surgery, ILC patients required more frequently re-excision and/or mastectomy. Prevalence of stage IIB and III stages were significantly more frequent in ILC patients than in IDC patients (37.4% versus 25.3%, p = 0.006). Positive nodes were significantly more frequent in the ILC patients (44.6% versus 37.0%, p = 0.04). After adjustment for tumor size and nodal status, frequencies of recurrence/metastasis, disease-free and specific survival were similar among patients with IDC and patients with ILC. In conclusion, women with ILC do not have worse clinical outcomes than their counterparts with IDC. Management decisions should be based on individual patient and tumor biologic characteristics rather than on lobular versus ductal histology.

Breast Cancer Patients Undergoing Sentinel Node Biopsy: Additional Axillary Tumor Burden as a Function of the Total Number of Excised Sentinel Nodes-A Multicenter Study.

BACKGROUND: Recent studies have challenged the long-standing assumption that breast cancer prognosis is determined by lymph node regional status. We assessed locoregional relapse, distant metastases, and mortality alongside additional axillary disease in breast cancer patients undergoing sentinel node (SN) biopsy. PATIENTS AND METHODS: This prospective study assessed 1070 women with clinical T1-T2 invasive breast cancer with negative clinical/ultrasound axillae. RESULTS: A total of 25.1% of patients had positive SN biopsy findings, of whom 69.2% had only 1 involved SN. The rate of axillary recurrence was 0.7%, with no significant differences found between patients with positive or negative SN (0.6% vs. 1.1%). There were also no significant differences in the rate of distant metastases or breast cancer-specific mortality. If we had applied the Z0011 trial suggestions, residual axillary disease would have reached 16.2%: 13.5% in patients over 50% and 21.3% in patients under 50. The rate of residual axillary disease would have been 25.2% in patients with only 1 SN (20.2% in patients over 50% and 38.2% in patients under 50). In patients with 2 SN, residual disease would have ranged from 12.0% in patients over 50% to 19.0% in patients under 50. From 3 SN on, residual disease seems negligible. CONCLUSION: There were no significant differences in locoregional relapse, distant metastases, or mortality between patients with negative and positive SN. Patients with 3 or more SN have no additional axillary disease. In patients younger 50, one must be extremely cautious if the Z0011 suggestions are to be applied, especially if there is only 1 SN.

Comparison of Screened and Nonscreened Breast Cancer Patients in Relation to Age: A 2-Institution Study.

INTRODUCTION: Screening programs for breast cancer aim to allow early diagnosis, and thus reduce mortality. The aim of this study was to assess the effect of a population screening program in a sample of women aged between 50 and 69 years in terms of recurrence, metastasis, biological profiles, and survival, and to compare their results with those of women of a wider age range who did not participate on the screening program. PATIENTS AND METHODS: A prospective multicenter study in which 1821 patients with 1873 breast tumors who received surgery between 1999 and 2014 at MútuaTerrassa University Hospital and the Hospital of Terrassa in Barcelona were analyzed. A comparison was performed in the 50- to 69-year-old age group between those who participated on the screening program and those who did not. RESULTS: The mean age of patients was 58 years. The mean follow-up was 72 months, and median follow-up 59 months. The screened group showed significantly better results in all prognostic factors and in specific mortality than all nonscreened groups. The specific mortality rate in the screened patients was 2.4% (12/496), local recurrence 2.8% (14/496), and metastasis at 10 years 3.6% (18/496). In the nonscreened group, younger women presented a higher rate of metastasis (16.4% [81/493]) and a shorter disease-free period (77.1% [380/493]). The age group older than 70 years had the highest number of T4 tumors (7.5% [30/403]) and the highest proportion of radical surgery (50.4% [203/403]). CONCLUSION: Patients in the screening program presented improved survival. We speculate that extending breast cancer screening programs to women younger than 50 and older than 70 years could bring about mortality benefits.

Differential survival and recurrence patterns of patients operated for breast cancer according to the new immunohistochemical classification: analytical survey from 1997 to 2012.

Breast cancer can no longer be considered only one condition. It should be regarded rather as a heterogeneous group of diseases with different molecular outlines. The aim of this study is to establish a correlation between immunohistochemical tumor sub-typing and surgical treatment, local recurrence rates, distant metastases, and cancer-specific mortality at 5 and 10 years. At least, four tumor sub-types have been described, which were associated with variable risk factors, different natural clinical course, and different response to both local and systemic therapies. For Luminal A: ER + and/or PR + HER2- Ki67 <15 %; Luminal B: ER + and/or PR + HER2- Ki67 ≥ 15 %; Pure HER2: ER-PR-HER2+; Triple Negative: ER-PR-HER2-. One thousand four hundred seventy-seven patients operated for 1,511 invasive breast tumors were included. Disease-free survival, overall mortality, and breast cancer-specific mortality at 5 and 10 years were calculated. Distant metastases prevalence ranged from 8 to 28 % across sub-types, increasing stepwise from Luminal A, Luminal B, and pure HER2 through triple negative. Conversely, larger tumors with significant axillary burden were more likely to belong to HER2 or triple negative groups. Luminal A sub-type patients showed significantly lower mortality rates both overall and specific at 5 and 10 years, as compared to the rest. Luminal B patients showed lower mortality rates only when compared with triple negative patients. Simple classification of breast cancer patients based on immunohistochemistry and other risk factors is quite useful to establish groups with bad or even worse prognosis. Although results from immunohistochemical classification were not taken into account for surgical procedure decision-making, we found that pure HER2 and triple negative patients received nevertheless higher rates of radical treatment.