Accuracy validation of adjuvant! online in Taiwanese breast cancer patients--a 10-year analysis.

BACKGROUND: Adjuvant! Online ( http://www.adjuvantonline.com) is an Internet-based software program that allows clinicians to make predictions about the benefits of adjuvant therapy and 10-year survival probability for early-stage breast cancer patients. This model has been validated in Western countries such as the United States, United Kingdom, Canada, Germany, and Holland. The aim of our study was to investigate the performance and accuracy of Adjuvant! Online in a cohort of Taiwanese breast cancer patients. METHODS: Data on the prognostic factors and clinical outcomes of 559 breast cancer patients diagnosed at the National Cheng Kung University Hospital in Tainan between 1992 and 2001 were enrolled in the study. Comprehensive demographic, clinical outcome data, and adjuvant treatment data were entered into the Adjuvant! Online program. The outcome prediction at 10 years was compared with the observed and predicted outcomes using Adjuvant! Online. RESULTS: Comparison between low- and high-risk breast cancer patient subgroups showed significant differences in tumor grading, tumor size, and lymph node status (p < 0.0001). The mean 10-year predicted death probability in 559 patients was 19.44%, and the observed death probability was 15.56%. Comparison with the Adjuvant! Online-predicted breast cancer-specific survival (BCSS) showed significant differences in the whole cohort (p < 0.001). In the low-risk subgroup, the predicted and observed outcomes did not differ significantly (3.69% and 3.85%, respectively). In high-risk patients, Adjuvant! Online overestimated breast cancer-specific survival (p = 0.016); the predicted and observed outcomes were 21.99% and 17.46%, respectively. CONCLUSIONS: Adjuvant! Online accurately predicted 10-year outcomes and assisted in decision making about adjuvant treatment in low-risk breast cancer patients in our study, although the results were less accurate in the high-risk subgroup. Development of a prognostic program based on a national database should be considered, especially for high-risk breast cancer patients in Taiwan.

Survival Benefit of Tamoxifen in Estrogen Receptor-Negative and Progesterone Receptor-Positive Low Grade Breast Cancer Patients / 한국유방암학회지

PURPOSE: This study aimed to analyze the efficacy and prognostic significance of adjuvant tamoxifen in breast cancer patients with various hormone receptor statuses. METHODS: Typically, 1,260 female breast cancer patients were recruited in this study. The correlation between estrogen receptor (ER)/progesterone receptor (PR) phenotypes and clinical characteristics was investigated, and the survival rate was assessed after 5-year follow-up. RESULTS: The 5-year overall survival (85%) was better in women under the age of 50 years. Patients with ER+/PR+ tumors had a better 5-year survival rate (94%); those with ER-/PR- tumors experienced the worst outcome (74% survival rate); whereas single-positive cases were in between. In 97 out of 128 patients with ER-/PR+ tumors, tamoxifen was given as adjuvant hormonal therapy, and it increased the survival benefit in the lower grade group in terms of overall survival and disease-free survival (p=0.01 and p=0.03, respectively). CONCLUSION: For high-grade tumors with ER-/PR+, adjuvant tamoxifen therapy may have no survival benefit, whereas for the patients with low-grade ER-/PR+ tumors, adjuvant tamoxifen therapy is highly suggestive.

Clinicopathological features of triple-negative breast cancer in Taiwanese women.

BACKGROUND: The goal of this study was to identify prognostic factors that influence the survival outcome of Taiwanese women with triple-negative breast cancer (TNBC). METHODS: Of 709 patients with breast cancer diagnosed between January 2002 and December 2005, 152 patients (21.4 %) were diagnosed with TNBC. The overall survival and disease-free survival were estimated using the Kaplan-Meier method and compared between groups using the log-rank test. Univariate and multivariate analyses were used to identify the prognostic factors, and the prognostic significance of these factors in TNBC patients was reviewed. RESULTS: The median follow-up time was 70.5 months. Kaplan-Meier analysis showed significant difference between the tumor subgroups (TNBC vs. non-TNBC) in 5-year overall survival (p = 0.01) and 5-year disease-free survival (p < 0.0001). Univariate analysis showed that tumor subgroup (TNBC vs. non-TNBC) was a significant predictor of 5-year overall survival and disease-free survival. Tumor size, lymph node status, stage, grade, estrogen receptor status, progesterone receptor status, and HER2 status were also significant. In the multivariate analysis, only tumor size, lymph node status, and grade were significantly related to 5-year overall survival and disease-free survival. In TNBC patients, nodal status was significantly related to 5-year overall survival (HR = 7.47, p < 0.0001) and 5-year disease-free survival (HR = 3.913, p = 0.001). CONCLUSION: In TNBC, nodal status is a prognostic indicator of survival. The TNBC subgroup had a worse pattern of relapse compared to the non-TNBC, irrespective of nodal negative or nodal positive breast cancer patients. We suggest that this subgroup should receive aggressive treatment to prevent early recurrence or death. Further prospective clinical trials are warranted to identify a more efficient treatment regimen to improve the prognosis.

Acupuncture-Related Rapid Dermal Spread of Breast Cancer: A Rare Case / 한국유방암학회지

Many ethnic Chinese patients seek second or adjuvant alternative therapies after breast cancer is diagnosed. Chinese herbs and acupuncture are the most popular methods in East Asia. We present a case of acupuncture manipulation-related cutaneous spread that no literature reported before. Post-acupuncture cutaneous spread was noted in a 54-year-old woman with left neck lymph node recurrence after complete surgery, chemotherapy and radiotherapy treatment. The results of chest computed tomography and skin biopsy showed the metastatic breast cancer in the dermis. Six courses of paclitaxel and gemcitabine followed by trastuzumab were given as therapeutic chemotherapy. The neck mass and cutaneous lesions subsided after 2 courses of chemotherapy. Direct puncture of a metastatic lymph node might increase the incidence of tumor spread on the skin. Therefore, despite the efficacy of complementary and alternative medicine, its safety and possible side effects should be more emphasized.

Comparative Analysis of Logistic Regression, Support Vector Machine and Artificial Neural Network for the Differential Diagnosis of Benign and Malignant Solid Breast Tumors by the Use of Three-Dimensional Power Doppler Imaging

OBJECTIVE: Logistic regression analysis (LRA), Support Vector Machine (SVM) and a neural network (NN) are commonly used statistical models in computer-aided diagnostic (CAD) systems for breast ultrasonography (US). The aim of this study was to clarify the diagnostic ability of the use of these statistical models for future applications of CAD systems, such as three-dimensional (3D) power Doppler imaging, vascularity evaluation and the differentiation of a solid mass. MATERIALS AND METHODS: A database that contained 3D power Doppler imaging pairs of non-harmonic and tissue harmonic images for 97 benign and 86 malignant solid tumors was utilized. The virtual organ computer-aided analysis-imaging program was used to analyze the stored volumes of the 183 solid breast tumors. LRA, an SVM and NN were employed in comparative analyses for the characterization of benign and malignant solid breast masses from the database. RESULTS: The values of area under receiver operating characteristic (ROC) curve, referred to as Az values for the use of non-harmonic 3D power Doppler US with LRA, SVM and NN were 0.9341, 0.9185 and 0.9086, respectively. The Az values for the use of harmonic 3D power Doppler US with LRA, SVM and NN were 0.9286, 0.8979 and 0.9009, respectively. The Az values of six ROC curves for the use of LRA, SVM and NN for non-harmonic or harmonic 3D power Doppler imaging were similar. CONCLUSION: The diagnostic performances of these three models (LRA, SVM and NN) are not different as demonstrated by ROC curve analysis. Depending on user emphasis for the use of ROC curve findings, the use of LRA appears to provide better sensitivity as compared to the other statistical models.