Residual Risk of Breast Cancer Recurrence 5 Years After Adjuvant Therapy

Departments of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Journal of the National Cancer Institute (Impact Factor: 12.58). 09/2008; 100(16):1179-83. DOI: 10.1093/jnci/djn233
Source: PubMed


There is limited prognostic information to identify breast cancer patients who are at risk for late recurrences after adjuvant
or neoadjuvant systemic therapy (AST). We evaluated the residual risk of recurrence and prognostic factors of 2838 patients
with stage I–III breast cancer who were treated with AST between January 1, 1985, and November 1, 2001, and remained disease
free for 5 years. Residual recurrence-free survival was estimated from the landmark of 5 years after AST to date of first
recurrence or last follow-up using the Kaplan–Meier method. The log-rank test (two-sided) was used to compare groups. Residual
recurrence-free survival rates at 5 and 10 years were 89% and 80%, respectively, and 216 patients developed a recurrence event.
The 5-year residual risks of recurrence for patients with stage I, II, and III cancers were 7% (95% confidence interval [CI]
= 3% to 15%), 11% (95% CI = 9% to 13%), and 13% (95% CI = 10% to 17%), respectively (P = .02). In multivariable analysis, stage, grade, hormone receptor status, and endocrine therapy were associated with late
recurrences. Breast cancer patients have a substantial residual risk of recurrence, and selected tumor characteristics are
associated with late recurrences.

Download full-text


Available from: Banu Arun, Mar 17, 2014

Click to see the full-text of:

Article: Residual Risk of Breast Cancer Recurrence 5 Years After Adjuvant Therapy

142.59 KB

See full-text
  • Source
    • "MSCs in general have controversially been reported to support [26, 28–31] or to suppress [32] [33] [34] cancer cells. Thus, considering the fact that the risk of breast cancer recurrence is up to 13% after adjuvant therapy [35], investigating the effects of ADSCs on breast cancer prior to performing ADSC-enhanced fat grafting for reconstructive purposes after oncological surgery on a routine basis is of the utmost importance. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Conventional breast cancer extirpation involves resection of parts of or the whole gland, resulting in asymmetry and disfiguration. Given the unsatisfactory aesthetic outcomes, patients often desire postmastectomy reconstructive procedures. Autologous fat grafting has been proposed for reconstructive purposes for decades to restore form and anatomy after mastectomy. Fat has the inherent advantage of being autologous tissue and the most natural-appearing filler, but given its inconsistent engraftment and retention rates, it lacks reliability. Implementation of autologous fat grafts with cellular adjuncts, such as multipotent adipose-derived stem cells (ADSCs), has shown promising results. However, it is pertinent and critical to question whether these cells could promote any residual tumor cells to proliferate, differentiate, or metastasize or even induce de novo carcinogenesis. Thus far, preclinical and clinical study findings are discordant. A trend towards potential promotion of both breast cancer growth and invasion by ADSCs found in basic science studies was indeed not confirmed in clinical trials. Whether experimental findings eventually correlate with or will be predictive of clinical outcomes remains unclear. Herein, we aimed to concisely review current experimental findings on the interaction of mesenchymal stem cells and breast cancer, mainly focusing on ADSCs as a promising tool for regenerative medicine, and discuss the implications in clinical translation.
    Stem cell International 05/2015; 2015. DOI:10.1155/2015/120949 · 2.81 Impact Factor
  • Source
    • "This expected finding also serves as an internal control for the utility of SD as a marker of synchronized growth. In comparison to ER−, the ER+ population recurs later [1], and this was also the case in our study. An alternative explanation for the delayed relapse and prolonged dormant state of the slow growing ER+ tumors could be the requirement of an spontaneous enabling sub-clonal evolution in these cells [46], which would occur independently in individual cells over time. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A significant variation in the metastatic pattern among breast cancer patients exists. Clinical observations suggest that these differences are related to time to recurrence (TTR), thus suggesting a common systemic growth signal at the time of surgery. Our goal was to identify a marker for synchronized growth of micrometastases. To quantify the metastatic pattern at first relapse, 180 patients with metastatic breast cancer were studied. Standard deviation (SD) of lesions size and lesion number was calculated and served as a marker for variation. Patients with low SD (multiple/similar sized lesions) were assumed to have synchronized growth, whereas patients with high SD were assumed to have unsynchronized growth. Patients were grouped according to TTR; early (< 3 years-) or late (> 3 years- after surgery). In patients not receiving systemic adjuvant treatment, median SD was significantly lower in the early group (2.5 mm) compared with 6.4 mm in the late group (p = 0.005). In node negative patients, median SD was significantly lower in the early group (3.0 mm) when compared with the late group (5.7 mm, p = 0.02). An additional drop in SD was observed immediately after end of adjuvant endocrine therapy. Our results identify SD as a marker of synchronized metastatic growth in breast cancer. A metastatic phenotype characterized by multiple similar sized metastases, suggesting synchronized onset of growth of micrometastases was predominantly found in patients recurring early after surgery and was counteracted by adjuvant treatment. Systemic growth signals caused by surgery might be antagonized during the time window following surgery.
    Breast Cancer Research and Treatment 07/2014; 146(3). DOI:10.1007/s10549-014-3057-9 · 3.94 Impact Factor
  • Source
    • "Uncross-linked collagen Type I is unstable over a period of months, but when a crosslinking agent is added the altered mechanics result in decreased enzymatic and thermal degradability. A leading factor in breast-cancer-related death is the recurrence of a tumor following mastectomy [35, 36]. If an anticancer treatment could be incorporated into a tissue-engineered product, the recurrence of cancer might be reduced. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Research efforts investigating the potential of natural compounds in the fight against cancer are growing. Tannic acid (TA) belongs to the class of hydrolysable tannins and is found in numerous plants and foods. TA is a potent collagen cross-linking agent; the purpose of this study was to generate TA-cross-linked beads and assess the effects on breast cancer cell growth. Collagen beads were stable at body temperature following crosslinking. Exposure to collagen beads with higher levels of TA inhibited proliferation and induced apoptosis in normal and cancer cells. TA-induced apoptosis involved activation of caspase 3/7 and caspase 9 but not caspase 8. Breast cancer cells expressing the estrogen receptor were more susceptible to the effects of TA. Taken together the results suggest that TA has the potential to become an anti-ER(+) breast cancer treatment or preventative agent.
    11/2013; 2013:369609. DOI:10.1155/2013/369609
Show more