Triple negativity and young age as prognostic factors in lymph node-negative invasive ductal carcinoma of 1 cm or less.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
BMC Cancer (Impact Factor: 3.32). 10/2010; 10:557. DOI: 10.1186/1471-2407-10-557
Source: PubMed

ABSTRACT Whether a systemic adjuvant treatment is needed is an area of controversy in patients with node-negative early breast cancer with tumor size of ≤1 cm, including T1mic.
We performed a retrospective analysis of clinical and pathology data of all consecutive patients with node-negative T1mic, T1a, and T1b invasive ductal carcinoma who received surgery between Jan 2000 and Dec 2006. The recurrence free survival (RFS) and risk factors for recurrence were identified.
Out of 3889 patients diagnosed with breast cancer, 375 patients were enrolled (T1mic:120, T1a:93, T1b:162). Median age at diagnosis was 49. After a median follow up of 60.8 months, 12 patients developed recurrences (T1mic:4 (3.3%), T1a:2 (2.2%), T1b:6 (3.7%)), with a five-year cumulative RFS rate of 97.2%. Distant recurrence was identified in three patients. Age younger than 35 years (HR 4.91; 95% CI 1.014-23.763, p = 0.048) and triple negative disease (HR 4.93; 95% CI 1.312-18.519, p = 0.018) were significantly associated with a higher rate of recurrence. HER2 overexpression, Ki-67, and p53 status did not affect RFS.
Prognosis of node-negative breast cancer with T1mic, T1a and T1b is excellent, but patients under 35 years of age or with triple negative disease have a relatively high risk of recurrence.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Data regarding the clinical significance of HER2+ and TN status in patients with small node negative tumors is limited and conflicting. It remains unclear who among those with small lesions might benefit from more aggressive adjuvant therapy. Methods We identified all node negative breast cancer patients with tumor size ≤ 1 cm diagnosed between 1/1/1995 and 12/31/2008 through our institutional breast service database. Patients were classified according to their receptor status into three groups: 1) Hormone receptor (HR) + (ER or PR positive, HER2 negative); 2) HER2+ (IHC 3+ or FISH ≥2); and 3) TN (ER, PR, and HER2 negative). RFS was calculated using Kaplan-Meier methods. Results Among 656 patients with tumor ≤ 1 cm, 494 (75%) of the patients were HR+, 107 (16%) were HER2+, and 55 (9%) were TN. Median age was 59 years (range 27-92 years). Median follow-up was 3.5 years. The 5-year RFS rates were 98.2%, 97.1%, and 83.5% in patients with HR+, HER2+, and TN tumors, respectively (p<0.001). In multivariate analysis, TN status was associated with worse RFS (HR 6.70, 95% CI 3.02-14.86), while HER2+ was not (HR 1.64, 95% CI 0.73-3.69). Conclusion TN, but not HER2+ status, was associated with worse RFS in patients with T1abN0 tumors, and adjuvant chemotherapy may be considered in patients with TN breast cancer.
    Clinical Breast Cancer 10/2014; · 2.63 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Invasive micropapillary carcinoma (IMPC) of the breast is an uncommon, highly aggressive breast cancer that may occur in pure and mixed forms. Our aim in this study is to investigate the relationship between clinical, histopathologic, and immunohistochemical features of pure and mixed IMPC cases diagnosed and treated at our institution. One hundred and three IMPC cases diagnosed at our institution over a period of 19 years have been selected. Clinical, histopathologic features, as well as hormone status and c-erb-B2 overexpression of tumors were re-evaluated. Mann-Whitney U, chi-squared, Kaplan-Meier, and Fisher's exact tests were used for statistical analyses. Results were considered to be significant at p < 0.05. Twenty cases (19.4%) were pure, and 83 cases (80.6%) were mixed IMPC. The most common nonmicropapillary invasive carcinoma component in mixed cases was invasive ductal carcinoma (IDC; 78.3%). Progesterone receptor was significantly less positive in pure IMPC cases (p = 0.031). There was no statistically significant difference between the two groups, in terms of mean age of the patients (53.0 versus 52.8), mean tumor size (26.6 mm versus 27.7 mm), presence of high-grade tumor (p = 0.631), presence of sentinel lymph node (SN) metastasis (p = 1.000), axillary lymph node metastasis (p = 1.000), lymphatic invasion (p = 1.000) and blood vessel invasion (p = 0.475), c-erbB-2 overexpression of tumor cells (p = 0.616), distant metastasis (p = 0.549), or overall survival (p = 0.759). The local recurrence rate of the two groups was not statistically significant either (16.7% versus 4.3%). However, local recurrence was detected 12% more commonly (p = 0.100), and ~8 months earlier (p = 0.967) in pure IMPC cases, compared to mixed cases. In addition, presence of local recurrence was found to be statistically significantly associated with estrogen receptor (ER) status (p = 0.004), progesterone receptor (PR) status (p = 0.001), and c-erb-B2 overexpression (p = 0.016) in all patients. Overall survival rate was significantly associated with ER staining of the tumor (log-rank = 0.028). Our findings suggest that hormone receptor negativity may explain the more aggressive behavior of pure IMPC compared to mixed cases. Besides, longer survival period of patients with ER positivity, and the relationship of hormone status and c-erb-B2 overexpression and local recurrence further support favorable prognostic value of hormone receptors in invasive breast cancer.
    The Breast Journal 05/2013; · 1.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Patients with small node-negative breast tumors, who are younger, or have human epidermal growth factor receptor 2 (HER2)-positive or triple negative breast cancer (TNBC) subtypes, are at increased recurrence risk. Concurrently, systemic treatment recommendations have evolved. Less is known about how frequently cytotoxic chemotherapy is given to these patients. Mastectomy rates have also increased. This study reports recent incidence of T1a,bN0M0 breast cancer and the characteristics associated with chemotherapy delivery and surgery selected. Patients and Methods This retrospective cohort is comprised of invasive female breast cancers diagnosed with AJCC Stage T1a,bN0M0 during 2010-2012 from the Iowa Surveillance, Epidemiology and End Results (SEER) Cancer Registry. Chemotherapy use and surgery were identified by the registry. Univariate and multivariate analysis were performed to determine patient differences across subtype and factors associated with treatment. Results The study included 1,687 patients. This represented 27.6% of all AJCC Stage I(a-c)-III breast cancer in 2010-2012, up from 18% in 1990 (P<0.0001). Of 1,456 patients with known subtype, 8.8% and 6.4% had HER2-positive and TNBC disease, respectively. Chemotherapy was given to 7.5% of women with T1aN0M0 and 12.7% of T1bN0M0 tumors. Likelihood of systemic treatment was associated with breast cancer subtype, tumor differentiation and age in a multivariate model. Mastectomy rate was 31.8%. Conclusion Small, node-negative breast cancers continue to grow significantly as a percent of invasive breast cancer diagnoses. In 2010-2012, in Iowa, systemic chemotherapy correlated with risk factors associated with recurrence: age, subtype, and tumor differentiation. Relatively high rates of mastectomy were seen.
    Clinical Breast Cancer 08/2014; · 2.63 Impact Factor

Full-text (3 Sources)

Available from
May 22, 2014