[Show abstract][Hide abstract] ABSTRACT: Purpose
The prognosis of breast cancer has been consistently improving. We analyzed our cohort of breast cancer patients with a long-term follow up at a single center over time.
Materials and Methods
A total of 1889 patients with known cancer stages were recruited and analyzed between January 1991 and December 2005. Patients were classified according to the time periods (1991-1995; 1996-2000; 2001-2005). To determine intrinsic subtypes, 858 patients whose human epidermal growth receptor-2 status and Ki67 were reported between April 2004 and December 2008 were also analyzed.
At a median follow up of 9.1 years, the 10-year overall survival (OS) rate was 80.5% for the entire cohort. On multivariate analysis for OS and recurrence-free survival (RFS), the time period was demonstrated to be a significant factor independent of conventional prognostic markers. In the survival analysis performed for each stage (I to III), OS and RFS significantly improved according to the time periods. Adoption of new agents in adjuvant chemotherapy and endocrine therapy was increased according to the elapsed time. In the patients with known subtypes, OS and RFS significantly differed among the subtypes, and the triple-negative subtype showed the worst outcome in stages II and III.
In the Korean breast cancer cohort with a long-term follow up, our data show an improved prognosis over the past decades, and harbor the contribution of advances in adjuvant treatment. Moreover, we provided new insight regarding comparison of the prognostic impact between the tumor burden and subtypes.
Full-text · Article · Sep 2014 · Yonsei Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Purpose: The purpose of this study was to identify biopsychosocial predictors of the quality of life in breast cancer patients. Disease factors (disease stage, type of surgery, type of treatment, family history), personal factors (age, education level, income), and psychosocial factors (psychological symptoms, optimism, self-esteem, husband's support, cancer coping) were included in biopsychosocial predictors. Methods: A total of 128 breast cancer patients were recruited. Subjects were assessed by the Optimism Scale, the Selfesteem Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Breast Cancer Module (EORTC QLQ-BR23), the Symptom Checklist- 90-Revision (SCL-90-R), and the Korean Cancer Coping Questionnaire (KCCQ). Results: Disease factors and personal factors were not different between the high and low quality of life group. But the psychosocial factors were significantly different. Somatization, anxiety, depression, interpersonal sensitivity, hostility, and phobic anxiety showed significantly lower scores in the high quality of life group than the low group. Optimism, self-esteem and husband's support showed significantly higher score in the high quality of life group than the low group. In a stepwise multiple regression analysis, not disease factors and personal factors but the psychosocial factors significantly predicted the quality of life in breast cancer patients. Especially, somatization and depression significantly predicted the quality of life. Conclusion: Among psychosocial factors, somatization and depression were the most significant predictors of the quality of life in breast cancer patients. These results supported psychosocial intervention should be needed to breast cancer patients, in order to improve the quality of life.
Preview · Article · Jun 2010 · Journal of Breast Cancer
[Show abstract][Hide abstract] ABSTRACT: Purpose: To assess the appropriateness of radiotherapy volume for patients receiving breast-conserving treatment (BGT) through analysis of recurrence pattern and factors affecting recurrence. Methods: From 1991 to 1996, 362 patients who received BCT were retrospectively evaluated. The radiation volume was the involved breast alone in the patents with less than 4 positive axillary lymph nodes (LNs), and breast and supraclavicular fossa in patients with 4 or more positive axillary LNs. The median follow-up period was 123 months (range, 3-169 months). Results: Ten-year overall, disease-free, local recurrence-free, and regional recurrence-free survival rates were 86.2%, 82.2%, 95.9%, and 95.2%, respectively. Among 310 patients receiving radiotherapy on the breast alone, 15 (4.8%) had regional recurrence. In particular, patients with inner quadrant lesions had high regional recurrence rates (11/98, 11.2%) (p<0.001). Conclusion: These low local recurrence rates may reveal that the current radiotherapy technique was successful. However, in cases of inner quadrant lesions, there were a considerable number of regional recurrences, even in NO cases. This may suggest a potential role for irradiation on regional LNs in this group.
Preview · Article · Dec 2009 · Journal of Breast Cancer
[Show abstract][Hide abstract] ABSTRACT: In 2002, breast became the most common cancer site in Korean women. Using national breast cancer incidence data during 1993-2002, crude, age-standardized, and age-specific rates for incidence and mortality were calculated. Survival was examined for cases diagnosed during 1993-2002 and followed up to 2004. Observed survival was calculated using the life table method and relative survival using the Ederer II method. Age-standardized incidence rates in female increased from 14.5 in 1993 to 26.2 per 100,000 in 2002. Age-specific incidences showed peaks in women in their forties. Mortality rates increased from 3.7 in 1993 to 4.6 per 100,000 in 2002 and showed peaks in women in their fifties. Five-year relative survival for female breast cancer diagnosed during 1993-2002 was 82.2%. When we examined the secular trends using cases diagnosed 1993-1999 for complete 5-yr followup, the 5-yr relative survival increased from 75.2% in 1993 to 83.5% in 1999. The data from this study will provide valuable information to plan and evaluate actions against breast cancer including national breast cancer screening.
Full-text · Article · Oct 2007 · Journal of Korean Medical Science
[Show abstract][Hide abstract] ABSTRACT: Sentinellymph node (SLN) biopsy is considered a highly accurate and very economic method of assessing the axillary nodal status in breast cancer patients. Recently immunohistochemical (IHC) staining and reverse transcriptase polymerase chain reaction (RT-PCR) are commonly used to evaluate micrometastasis in the sentinel lymph node. However, most of the RT-PCR studies have been performed using fresh tissue. This study was conducted to assess micrometastasis in clinically node-negative breast cancer by using RT-PCR technique on the paraffin embedded sentinel lymph nodes.
Preview · Article · Jan 2005 · Journal of Breast Cancer
[Show abstract][Hide abstract] ABSTRACT: The need for completion axillary lymph node dissection, even in early breast cancer patients with a positive sentinel lymph node, has been questioned. The purpose of this study was to determine the factors that predict the presence of metastasis in non-sentinel lymph nodes (NSLNs) when the sentinel lymph node (SLN) was positive.
[Show abstract][Hide abstract] ABSTRACT: Sentinel lymph node (SLN) biopsy has become a new standard procedure in the treatment of patients with early breast cancer. Furthermore, many institutions have begun offering the sentinel lymph node biopsy without simultaneous axillary dissection as a possible standard procedure when the SLN was free from tumors. For appropriate intraoperative decision making on the presence of cancer cells in axillary lymph nodes, a fast and accurate method to assess the SLN is required. The authors performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (IHC) staining of the SLN removed during the operations of breast cancer patients.
[Show abstract][Hide abstract] ABSTRACT: Although an axillary lymph node dissection (ALND) has been considered as an ultimate procedure for axilla in the breast carcinoma, complications after ALND and conceptual revolution for the role of axillary nodes have made it necessary to look for an alternative. Recent studies of sentinel lymphadenectomy (SLND) have shown that SLND accurately predict axillary nodal status. However, for a satisfying outcome in SLND, a learning period would be required, as other surgical procedures do. In this study, the necessity of the learning period for SLND were examined.
[Show abstract][Hide abstract] ABSTRACT: Over-expression of the human epidermal growth factor receptor-2 (HER2/neu) has been observed in many cancers, and is associated with a poor prognosis. Recent adjuvant treatment with anti-HER2 monoclonal antibodies in breast cancer has increased the demand for an evaluation of the HER2/neu status in breast cancer. The aim of this study was to investigate the HER2/neu status in breast cancer by a real-time quantitative polymerase chain reaction (PCR) method using LightCycler (Roche Diagnostics, Mannheim, Germany). DNA samples from the fresh tumor tissues of 27 patients with breast cancer were analyzed in parallel using immunohistochemistry (IHC) and the other prognostic parameters including estrogen receptor, progesterone receptor, cytokeratin, and DNA ploidy. Ten (37%) out of 27 cases tested were positive for HER2/neu, while 16 (73%) out of 22 tested positive through an IHC study. The correlation between the DNA aneuploidy and the positive results for HER2/neu were only observed using the real-time PCR method (p < 0.05). There was no significant correlation between the HER2/neu status and the S-phase fractions of the DNA ploidy or other parameters. This study demonstrated that there is marked discordance in the results for the HER2/neu status according to the various methods used. Real-time quantitative PCR for HER2/neu appears to be clinically useful due to its simplicity and ability to produce rapid results.
Preview · Article · Jun 2002 · Yonsei Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Cyclin/cdc complexes are known to function in cell-cycle regulation. Cyclin D1/cdk4 and -6 complexes, which functions as a G1-S checkpoint and cyclin B1/cdc2 complexes, a G2-M checkpoint are essential for DNA synthesis and mitosis, respectively. Thus, dysregulated overexpression of cyclins appears to be involved in uncontrollable cell proliferation and early tumor development. We investigated the expression and proliferative index of cyclin D1 (PIcyclin D1), cyclin B1 (PIcyclin B1) and Ki-67 (PIKi-67) using immunohistochemical staining on 15 cases of ductal hyperplasia (DH), 26 cases of atypical ductal hyperplasia (ADH) and 43 cases of ductal carcinoma in situ (DCIS) of the breast in order to evaluate whether these cyclins are associated with abnormal cell proliferation and play a role in tumor development from ADH to carcinoma. Furthermore, we investigated whether the expression and proliferative index of the cyclins and Ki-67 are correlated with the histologic grade according to the Van Nuys classification and with the histologic subtype according to traditional classification. Finally, we estimated the correlation coefficient among PIcyclin D1, PIcyclin B1, PIKi-67 and estrogen receptor in ADH and DCIS. The expression of cyclin D1 was detected in 39.5% of DCIS and 7.7% of ADH cases. In the DH cases, expression of cyclin D1 was not found. Expression of cyclin B1 was also detected in 69.7% of DCIS, 50.0% of ADH and 93.3% of the DH cases. The PIcyclin D1 was significantly different among these three groups. Moreover, the PIcyclin D1 and PIKi-67 were differed significantly between the low grade DCIS and ADH cases. However, PIcyclin B1 only appeared to be significantly different between the total DCIS and ADH. Results of the correlation coefficient among PIcyclin D1, PIcyclin B1 and PIKi-67 were positively correlated with each other. No significant correlation was found between the expression of ER and cyclin D1 in ADH and DCIS. In summary, our results support the hypothesis that a cyclin D1 and cyclin B1 protein aberration, along with Ki-67, may act as a relatively early event in the tumor development from ADH to carcinoma.
Preview · Article · Jul 2000 · Yonsei Medical Journal
[Show abstract][Hide abstract] ABSTRACT: The initial presentation of breast malignancy as noninvasive carcinoma in an area of sclerosing adenosis is unusual. Especially, lobular carcinoma in situ in sclerosing adenosis sometimes can be a potential source of confusion with invasive lobular carcinoma. We report a case of lobular carcinoma in situ presenting in adenosis exhibiting patterns akin to invasive lobular carcinoma, thus leading to potential misdiagnosis. Overall architecture of the lesion as seen at lower power and immunohistochemistry can be useful to distinguish between sclerosing adenosis with lobular carcinoma in situ and infiltrating lobular carcinoma.
Preview · Article · May 2000 · Yonsei Medical Journal
[Show abstract][Hide abstract] ABSTRACT: The natural history of the patients of ductal carcinoma in situ(DCIS) with microinvasion is poorly defined, and the clinical management of these patients with particular reference to management of the axilla, has been controversial. Previous studies of this lesion have used and/or arbitrary criteria for the evaluation of microinvasion.
[Show abstract][Hide abstract] ABSTRACT: In breast cancer, the single most important prognostic indicator is the axillary nodal status of the metastasis. The sentinel lymph nodes are the lymph nodes of the primary tumor that is drained first, which can predict the presence of the tumor metastasis with high accuracy. This study was designed to find out how accurately the sentinel node biopsy using radioactive material can predict axillary nodal status.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only. Data were obtained at preoperatively, three days after operation, at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint, upper extremity circumferential measurements, as well as 10 elements of shoulder function. Postoperatively, both groups showed an increased range of motion of the shoulder joint and improved functional activities, but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment. This study also showed that an early rehabilitation program did not increase postoperative complications. We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion, and significantly better in a rehabilitation group.
Preview · Article · Mar 1999 · Yonsei Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Oncogene c-erbB2 produces a transmembrane protein similar in structure to the surface growth factor receptor, and this protein belongs to the tyrosine kinase family. Overexpression of c-erbB2 is known to lower the survival rate of breast cancer patients. c-erbB2 protein is an imp011ant antigen for tumor specific cytotoxic T lymphocytes induction that is dependent on its presentation as stably complexed with HLA-A2. In 1997, Nistico P reported low frequency of c-erbB2 proto-oncogene overexpression in HLA-A2 positive breast cancer patients. And then in this study, correlation of HLA-A2 and the c-erbB2 expression was investigated in breast cancer patients.
[Show abstract][Hide abstract] ABSTRACT: In Korea, the incidence of breast cancer is relatively lower than in western country, but it is in increasing slope. However the mammographic patterns of Korean breast cancer patients are not well known.
[Show abstract][Hide abstract] ABSTRACT: Breast cancer is the third leading cause of cancer related deaths in Korean women. Members of the erbB receptor family, the EGF receptor and c-erbB2, c-erbB3 and c-erbB4, are commonly over-expressed in human breast cancer and there is a high correlation with an aggressive breast cancer phenotype and poor patient prognosis. Since the over-expression of the EGF receptor and c-erbB2 suggested that signalling of erbB receptors may contribute to the development and progression of breast cancer, we investigated the correlation of clinicopathological factors and the immunohistochemical expression of c-erbB2, c-erhB3 and c-erbB4. To determine the c-erbB immunoreactivity, we used Rabbit anti-human c-erbB2 oncoprotein (DAKO, Denmark), mouse monoclonal c-erbB3(RTJ.2 Santa Cruz) and rabbit polyclonal antibody c-erbB4(Santa Cruz) directed against each c-erbB protein by immunohistochemistry from paraffin-embedded tissue in a series of 190 women with breast cancer. About 25.8%(49 out of 190 patients) of breast cancers overexpressed c-erbB2, and 40.0%(76 out of 190 patients) and 18.9%(36 out of 190 patients) overexpressed c-erbB3 and c-erbB4, respectively. Poor histologic grade showed tendency of positive correlation of the positivity of c-erbB2 and 3 but without statistical significance and no correlation with c-erbB4. We observed positive correlations among c-erbB2, c-erhB3 and c-erbB4 expression.(p<0.05) Estrogen receptors (ER) showed inverse correlations with c-erbB2(p=0.001), c-erbB3(p=0.043) and c-erbB4(p=0.197) and progesterone receptors also showed inverse correlation with c-erbB2(p=0.018). Tumor size (p>0.05) and lymph node status(p>0.05) were not related with c-erbB family expression. The expressions of c-erbB2, c-erbB3 and c-erbB4 showed no survival benefit or no disease free benefit compared to c-erbB family negativity in univariate analysis (Kaplan-Meier life table analysis). Our results suggest that c-erbB2, c-erbB3 and c-erbB4 may regulate the growth of breast cancer by the interactions of these family of growth factor receptor that are dependent of hormonal control.
[Show abstract][Hide abstract] ABSTRACT: c-erbB2 encodes 185 kDa oncoprotein with tyrosine kinase activity and has homology to the epidermal growth factor receptor. c-erbB2 proto-oncogene is found to be overexpressed in approximately 20 to 30% of primary breast cancer and has been associated with poor prognosis and lower response to conventional chemotherapy.