[Show abstract][Hide abstract] ABSTRACT: There is a significant difference in the mean tumor size between very young breast cancer patients and their elder counterparts. A simple comparison may show obvious prognostic differences. We investigated the prognostic impact of age by reducing the influence of the tumor size, which is thought to be a confounding factor.
We investigated 1,880 consecutive pT1-4N0-3M0 breast cancer patients treated at less than 45 years of age between 1986 and 2002 and conducted a case-control study of breast cancer subjects less than 30 years of age. Each patient (Younger than 30) was matched with a corresponding control subject (Elder counterpart) based on an age 15 years above the patient's age, a similar tumor size and a status of being within 1 year after surgery. In addition, we assessed 47 patients with pregnancy-associated breast cancer (PABC). The levels of hormone receptors were measured using an enzyme immunoassay (EIA), and receptor-positive cases were divided into "weakly" and "strongly" positive groups based on the median value. Years from the last childbirth (YFLC) was categorized as "recent" and "past" at the time point of 8 years.
There were fewer past YFLC cases, more partial mastectomy cases, a higher rate of scirrhous carcinoma or solid-tubular carcinoma in the Younger than 30 group than in the Elder counterpart group. The rates of a PgR-negative status in the Younger than 30 and Elder counterpart groups were 45.1 and 29.9%, respectively, As for the relationship between the PgR-negative rate and YFLC, the rates of a PgR-negative status in the past YFLC, nulliparous, recent YFLC and PABC groups were 31.9, 37.7, 44.4 and 65.7%, respectively. On the other hand, the rates of strongly positive cases were 42.6, 30.2, 22.2 and 8.6%, respectively. The 10-year recurrence-free survival rates in the Younger than 30, Elder counterpart and PABC groups were 61.7, 65.6 and 54.1%, respectively. The differences between the groups were not significant. In a multivariate analysis, independent prognostic facers included the number of lymph node metastases (4-9, HR:3.388, 95% CI 1.363-8.425, p = 0.0086, over 10, HR: 6.714, 2.033-22.177, p = 0.0018), solid-tubular carcinoma (HR 3.348, 1.352-8.292, p = 0.0090), scirrhous carcinoma (HR 2.294, 1.013-5.197, p = 0.0465) and past YFLC (HR 0.422, 0.186-0.956, p = 0.0387). An age younger than 30 was not found to be an independent prognostic factor.
The prognosis of the very young women was the same as their elder counterparts with a matched tumor size, and age was not identified to be an independent prognostic factor according to the multivariate analysis. Recent childbirth probably influences the prognosis of patients younger than 30 years of age with breast cancer by lowering hormonal sensitivity.
[Show abstract][Hide abstract] ABSTRACT: We classified ipsilateral breast tumor recurrences (IBTRs) based on strict pathological rules. Ninety-six women who were surgically treated for IBTR were included. IBTRs were classified according to their origins and were distinguished based on strict pathological rules: relationship between the IBTR and the primary lumpectomy scar, surgical margin status of the primary cancer, and the presence of in situ lesions of IBTR. The prognosis of these subgroups were compared to that of new primary tumors (NP) in the narrow sense (NPn) that occurred far from the scar. Distant-disease free survival of IBTR that occurred close to the scar with in situ lesions and a negative surgical margin of the primary cancer (NP occurred close to the scar, NPcs) was similar to that of NPn. In contrast, IBTR that occurred close to the scar without in situ lesions (true recurrence (TR) that arose from residual invasive carcinoma foci, TRinv) had significantly poorer prognosis than NPn. IBTR that occurred close to the scar with in situ lesions and a positive surgical margin of the primary cancer (TR arising from a residual in situ lesion, TRis) had more late recurrences than NPcs. Precise pathological examinations indicated four distinct IBTR subtypes with different characteristics.
Pathology International 02/2015; 65(3). DOI:10.1111/pin.12253 · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Axillary dissection omission for sentinel lymph node-negative patients has been a practice at Cancer Institute Hospital, Japanese Foundation for Cancer Research since 2003. We examined the long-term results of omission of axillary dissection in sentinel lymph node-negative patients treated at our hospital, as well as their axillary lymph node recurrence characteristics and outcomes.
Our study included 2,578 patients with cTis or T1-T3N0M0 primary breast cancer for whom dissection was omitted because they were sentinel lymph node negative. The median observation period was 75 months.
In sentinel lymph node-negative patients for whom dissection was omitted, the rates of axillary lymph node recurrence, distant recurrence, and breast cancer mortality were 0.9, 2, and 1 %, respectively. Eighteen patients underwent additional dissection if axillary lymph node recurrence was observed at the first recurrence. Four triple-negative (TN) patients experienced distant recurrence after additional dissection. All four patients were administered anticancer agents after axillary lymph node recurrence and experienced recurrence within 1 year of additional dissection. The axillary lymph node recurrence rate was 0.8 % for luminal and 4.5 % for TN subtypes.
The long-term prognoses of patients for whom dissection was omitted owing to negative sentinel lymph node metastases were similar to those reported previously-low recurrence and mortality rates. The frequency of axillary lymph node recurrence and the post-recurrence outcome differed between luminal and TN cases, with recurrence being more frequent in patients with the TN subtype. TN patients also had poorer prognoses, even after receiving additional dissection and anticancer agents after recurrence.
Breast Cancer 11/2014; DOI:10.1007/s12282-014-0576-5 · 1.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose
To establish an optimal surveillance schedule after surgery for breast cancer, patients included in an institutional database were retrospectively investigated with respect to the first metastatic site and timing of recurrence.
Patients and methods
We investigated 11,676 pT1-4pN0-2M0 breast cancer patients treated from 1985 to 2009 and followed up until June 2014. Our surveillance protocol included physician visits and examinations with bone scans, liver echography, chest roentgenography and laboratory tests. We evaluated the liver, bones, lungs and pleura as surveillance covering sites (SCS) in addition to parameters such as time points exceeding 80 % with respect to the accumulated percentage of patients of recurrence and the number of surveillance per one recurrence (NSR), calculated by dividing the number of patients at risk of recurrence at the start of a particular time frame by the number of patients of recurrence at SCS within that period.
There were a total of 1,962 recurrent patients, including 601 patients with locoregional recurrence, nine patients with recurrence in the opposite breast, 1,349 patients with recurrence at distant sites and three unknown patients. The number of patients with the bones, lungs, liver and pleura as the first site of recurrence was 447, 324, 144 and 69, respectively, and 72.9 % of the distant metastatic lesions belonged to SCS. The five-year overall survival rate after recurrence among the patients with single recurrent site was longer than that observed among the patients with multiple sites of recurrence (43.3 vs 25.3 %; p
Breast Cancer 10/2014; DOI:10.1007/s12282-014-0571-x · 1.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
The TNM classification of the Unio Internationalis Contra Cancrum was revised for the seventh edition. The major change concerning breast cancer is a change in the stages for patients with T0 or T1N1miM0. In the present study, the seventh edition of the TNM classification was validated in breast cancer.
The stages of 416 breast cancer patients, treated at our hospital in 1996, were classified according to the TNM classification, sixth and seventh editions, and their prognoses were compared.
Case distribution using the sixth edition was stage 0, 56 cases (13.5 %); stage I, 158 cases (38.0 %); stage II, 130 [A, 102; B, 28] cases (31.2 [A, 24.5; B, 6.7] %); and stage III, 72 [A, 31; B, 8; C, 33] cases (17.3 [A, 7.5; B, 1.9; C, 7.9] %). According to the seventh edition, the stages for 20 patients, accounting for 19.6 % of IIA cases according to the sixth edition, decreased from IIA to IB. The 10-year overall survivals were stage 0, 91.1 %; stage I, 88.6 %; stage II, 80.8 %; and stage III, 63.9 % according to the sixth edition; and stage 0, 91.1 %; stage I, 88.8 %; stage II, 79.1 %; and stage III, 63.9 % according to the seventh edition. Although no significant differences were seen among the survival rates for stages 0 to II according to the sixth edition, there was a significant difference between stage I and II according to the seventh edition (p = 0.026).
The latest revision of the TNM classification is appropriate for breast cancer from the perspective of prognosis.
Breast Cancer 02/2013; 21(6). DOI:10.1007/s12282-013-0453-7 · 1.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The indication for postmastectomy radiotherapy (PMRT) in breast cancer patients with one to three positive lymph nodes has been in discussion. The purpose of this study was to identify patient groups for whom PMRT may be indicated, focusing on varied locoregional recurrence rates depending on lymphatic invasion (ly) status.
Retrospective analysis of 1,994 node-positive patients who had undergone mastectomy without postoperative radiotherapy between January 1990 and December 2000 at our hospital was performed. Patient groups for whom PMRT should be indicated were assessed using statistical tests based on the relationship between locoregional recurrence rate and ly status.
Multivariate analysis showed that the ly status affected the locoregional recurrence rate to as great a degree as the number of positive lymph nodes (p < 0.001). Especially for patients with one to three positive nodes, extensive ly was a more significant factor than stage T3 in the TNM staging system for locoregional recurrence (p < 0.001 vs. p = 0.295).
Among postmastectomy patients with one to three positive lymph nodes, patients with extensive ly seem to require local therapy regimens similar to those used for patients with four or more positive nodes and also seem to require consideration of the use of PMRT.
International journal of radiation oncology, biology, physics 12/2011; 83(3):845-52. DOI:10.1016/j.ijrobp.2011.08.029 · 4.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We reported that breast cancers achieving pathological complete response (pCR) or progressive disease (PD) to neoadjuvant chemotherapy (NAC), which are considered exact opposites on the chemosensitivity spectrum, have certain clinicopathological features in common. To determine the highly sensitive and highly resistant subsets to cytotoxic chemotherapy, we evaluated predictive factors for pCR and PD to NAC, and assessed the similarities in these factors.
Subjects comprised 300 women with 304 stage II or III breast cancers treated with chemotherapy that was anthracycline-based, taxane, or both, followed by surgery between 2007 and 2008. We retrospectively evaluated pre-NAC clinicopathological features including chemotherapy regimen, clinical T stage, nuclear grade (NG), hormone receptor (HR) status, and human epidermal growth factor receptor-2 (HER2) status in pCR and PD, using univariate chi(2) testing and multivariate logistic regression analyses.
Of 304 tumors, 30 (10%) achieved pCR and 22 (7%) showed PD to NAC. Multivariate analysis demonstrated that anthracycline plus taxane chemotherapy (P = 0.006), NG3 (P = 0.006), HR-negativity (P = 0.013), and HER2-positivity (P = 0.010) were significant predictors of pCR, and T3-4 (P = 0.002) and NG3 (P = 0.010) were significant predictors of PD.
High-grade breast cancers include both highly sensitive and highly resistant subsets to cytotoxic chemotherapy. Three factors can help discriminate between these subsets. HR-negative and HER2-positive can be predictive of high chemosensitivity. Advanced primary tumor stage can be predictive of high chemoresistance.
Journal of Cancer Research and Clinical Oncology 02/2010; 136(9):1431-8. DOI:10.1007/s00432-010-0798-7 · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The impact of sentinel lymph node biopsy on breast cancer mimicking ductal carcinoma in situ (DCIS) is a matter of debate.
We studied the rate of occurrence of sentinel lymph node metastasis in 255 breast cancer patients with pure DCIS showing no invasive components on routine pathological examination. We compared this to the rate of occurrence in 177 patients with predominant intraductal-component (IDC) breast cancers containing invasive foci equal to or less than 0.5 cm in size.
Most of the clinical and pathological baseline characteristics were the same between the two groups. However, peritumoral lymphatic permeation occurred less often in the pure DCIS group than in the IDC-predominant invasive-lesion group (1.2% vs. 6.8%, p = 0.002). One patient (0.39%) with pure DCIS had two sentinel lymph nodes positive for metastasis. This rate was significantly lower than that in patients with IDC-predominant invasive lesions (6.2%; p < 0.001).
Because the rate of sentinel lymph node metastasis in pure DCIS is very low, sentinel lymph node biopsy can safely be omitted.
World Journal of Surgical Oncology 01/2010; 8(1):6. DOI:10.1186/1477-7819-8-6 · 1.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To clarify clinicopathological similarities and differences between breast carcinomas that achieve pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) and those showing progressive disease (PD) during NAC, we compared pre-NAC clinicopathological characteristics between these tumors.
Subjects comprised 32 patients (6%) achieved pCR and 33 patients (7%) showed PD of 494 patients (498 breasts) with stage II or III breast carcinoma who underwent anthracycline-based or taxane chemotherapy or both, followed by surgery, between 2000 and 2006. We compared patient characteristics before NAC, and histomorphology, immunohistochemistry, and molecular subtypes of tumors using pre-NAC biopsy samples. Immunohistochemistry included estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor-2 (HER2), epidermal growth factor receptor (EGFR), cytokeratin 5/6 (CK5/6). Molecular subtypes were defined by ER, PgR, HER2, EGFR, and CK5/6. We compared these factors between pCR and PD using univariate chi (2) testing and multivariate logistic regression analyses.
No significant differences between groups were seen regarding NAC regimens. Solid-tubular carcinoma (53% of pCR, 61% of PD), histological grade 3 (78% of pCR, 79% of PD), ER-status (91% of pCR, 82% of PD), and basal-like subtype (44% of pCR, 58% of PD) were often observed in both groups. In multivariate analyses, lower clinical N stage at diagnosis (P = 0.004) and HER2/ER-PgR- subtype (P = 0.020) were significantly associated with pCR.
Breast carcinomas achieving pCR or showing PD with NAC have common peculiar characteristics such as solid-tubular carcinoma, high grade, hormone receptor negativity, and basal-like subtype. Conversely, discriminative factors include clinical N stage at diagnosis and HER2/ER-PgR- subtype.
Journal of Cancer Research and Clinical Oncology 09/2009; 136(2):233-41. DOI:10.1007/s00432-009-0654-9 · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Herein is reported a rare case of carcinoma arising from papilloma of the breast. A 63-year-old postmenopausal woman noticed a nodule approximately 1 cm in diameter in her left breast. Ultrasonography indicated a mass with a solid pattern within an intracystic tumor measuring 1.5 x 1.5 x 1.4 cm in diameter located near the left nipple. On total image analysis malignancy could not be denied, therefore lumpectomy with resection of the surrounding tissue was performed. Histologically the tumor consisted of cancerous and papilloma components. The cancer cells had high-grade nuclear atypia, were irregular, and contained abundant eosinophilic cytoplasm with a thin vascular stalk. In contrast, the tumor cells had no atypia, and had a thick stroma in the papilloma components. Both lesions could be distinguished clearly from each other. In addition, a transition from papillary to cancerous elements in some areas was seen. An additional partial mastectomy was performed after the lumpectomy but no carcinoma foci were noted in the excised tissue. Possible occurrence of cancerous change in solitary intraductal papilloma of the breast was suspected.
Pathology International 04/2009; 59(3):185-7. DOI:10.1111/j.1440-1827.2009.02348.x · 1.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sentinel lymph node biopsy (SNB) has been a standard technique in early breast cancer. However, it is not clear that the SNB procedure can be applied to second breast cancer or recurrence occurring in the previously treated breast. The purpose of this study was to clarify the feasibility of the SNB procedure in breast cancer occurring in the previously treated breast, and to investigate the factors related to altered lymphatic flow.
Between April 2004 and December 2006, 1490 patients underwent the breast SNB procedure. Among them, 31 patients had a history of previous treatments in the same breast. Recent excision biopsy cases were not included in this group. All patients had previous breast-conserving surgery in the same breast. Sixteen patients had axillary dissection, 3 had SNB, and 12 had no axillary treatment. Ten patients had received radiation therapy to the breast and axilla. Visualization of axillary nodes, internal mammary nodes and contralateral axillary nodes was evaluated and compared with pathological results.
Axillary nodes were visualized in 23 patients, internal mammary nodes in 7 patients, and contralateral axillary nodes in 7 patients. The patients with previous axillary dissection exhibited altered lymph node distribution, but did not show involvement of contralateral axillary nodes. Visualization of contralateral axillary nodes occurred in 7 of the 10 patients with previous irradiation to breast irrespective of axillary dissection. Twenty-eight patients underwent SNB, 4 of whom showed cancer-positive nodes. Three patients were cancer-positive in non-ipsilateral axillary nodes (one patient showed positive opposite axillary node and two patients showed positive internal mammary nodes).
Previous axillary dissection or irradiation to the breast greatly influences lymphatic flow. Irradiation to the breast may be a strong factor for the visualization of contralateral axillary nodes. Despite the frequent alteration of lymphatic flow, SNB seems to be feasible in secondary or recurrent breast cancer patients.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 05/2008; 34(4):365-8. DOI:10.1016/j.ejso.2007.04.007 · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The impact of skin invasion in node negative breast cancer is uncertain.
We determined the prognosis in 97 node negative breast cancer patients (case group) who had tumors with skin invasion. Then we compared these patients with 4500 node negative invasive breast cancer patients treated surgically in the same period.
Patients with skin invasion tended to be older, had more invasive lobular carcinoma and larger tumor size, and were less likely to have breast conserving surgery than those in the control group. The 5-year disease-free survival rate in the case group was 94.0%. There was no significant difference in the 10-year disease-specific overall survival rates in terms of skin invasion in node negative patients (90.7% in the case group, 92.9% in the control group; p = 0.2032).
Results suggest that skin invasion has no impact on survival in node negative invasive breast cancer patients. The adjuvant regimens which the individual institute applies for node negative breast cancer should be used regardless of skin invasion.
World Journal of Surgical Oncology 02/2008; 6:10. DOI:10.1186/1477-7819-6-10 · 1.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the relationship between the tumor size of breast cancer by palpation and the sensitivity of mammography (MMG) and ultrasonography (US), and which modality can detect nonpalpable breast cancer in women aged 30 to 39 years.
We retrospectively evaluated the tumor size by palpation, breast density, and the sensitivity of MMG and US in 165 patients aged 30 to 39 years. Palpation, US, and MMG were performed with prior knowledge of the results of other modalities. The tumor size on palpation were classified into Tnp; nonpalpable, T1p; 2 cm or less, T2p; more than 2 cm, but not more than 5 cm, and T3p; more than 5 cm.
Of 165 patients, 147 patients (89%) showed mammographically dense breasts. Of 165 cancers, 14 (8%) were Tnp, 40 (24%) were T1p, 82 (50%) were T2p, and 29 (18%) were T3p. The sensitivity of MMG was 57% (8 of 14) for Tnp, 78% (31 of 40) for T1p, 90% (74 of 82) for T2p, and 97% (28 of 29) for T3p. The sensitivity of US was 43% (6 of 14) for Tnp and 100% for palpable cancers. Of 14 nonpalpable cancers, 4 (29%), 4 (29%), and 2 (14%) could be detected by only MMG, bloody nipple discharge, and US.
The sensitivity of MMG depends on the tumor size on palpation in this age range. MMG fails to detect relatively large palpable cancers. On the other hand, US can detect all palpable cancers. However, the sensitivity of US declines for nonpalpable cancers. For the detection of nonpalpable cancers, MMG, US, and nipple discharge are complementary modalities.
Breast Cancer 02/2007; 14(3):255-9. DOI:10.2325/jbcs.14.255 · 1.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To confirm which modality, ultrasonography (US) or mammography (MMG), is useful to detect breast cancer in women aged 30 to 39 years, and to compare the sensitivity and findings of these two modalities for invasive carcinoma and ductal carcinoma in situ (DCIS) in the diagnostic setting.
We retrospectively evaluated the sensitivity and findings of these two modalities in 165 patients aged 30 to 39 years, who underwent surgery at the Cancer Institute Hospital between 2001 and 2003. US or MMG were performed after obtaining information on the other modalities previously used and physical examination. The abnormal findings of US were defined as mass lesions and focal hypoechoic areas due to breast cancer. The abnormal findings of MMG were defined as category 3 to 5 (Japanese Mammography Guidelines) masses, calcifications, and other findings due to cancer.
Of 165 patients, 147 patients (89%) mammographically showed dense breasts. Histologically, 146 (88%) were invasive carcinomas and 19 (12%) were DCIS. In all carcinomas, the sensitivity of US (95%) was higher than that of MMG (85%). The sensitivity of US for invasive carcinoma (99%) was higher than that of MMG (85%). On the other hand, the sensitivity of MMG for DCIS (89%) was much higher than that of US (68%).
US is more sensitive to detect breast cancers than MMG in this age range, especially for invasive carcinoma. On the other hand, MMG is useful for detecting DCIS, especially when it manifests with microcalcifications.
Breast Cancer 02/2007; 14(2):229-33. DOI:10.2325/jbcs.891 · 1.59 Impact Factor