19 research outputs found
Tumor-Nipple Distance of ≥ 1 cm Predicts Negative Nipple Pathology After Neoadjuvant Chemotherapy.
ASO Author Reflections: Low-Volume Sentinel Node Disease After Neoadjuvant Chemotherapy is Still an Indication for Axillary Dissection
ASO Author Reflections: Locoregional Recurrence Rates are Low with the Selective Use of PMRT in Patients with T1-2 Tumors and One to Three Positive Lymph Nodes
The changing utilization of neoadjuvant chemotherapy among different racial groups and its effect on mastectomy rates.
Effect of adjuvant trastuzumab on locoregional recurrence in human epidermal growth factor receptor 2-positive breast cancer treated with post-mastectomy radiation therapy.
Alterations of the 70 kDa heat shock protein (HSP70) and sequestosome-1 (p62) in women with breast cancer
Peripheral blood mononuclear cells (PBMCs) respond to altered
physiological conditions to alleviate the threat. Production of the 70
kDa heat shock protein (HSP70) is up-regulated to protect proteins from
degradation. Sequestosome-1 (p62) binds to altered proteins and the
p62-protein complex is degraded by autophagy. P62 is also a regulator of
intracellular kinase activity and cell differentiation. We hypothesized
that the PBMC response to a malignant breast mass involves elevated
production of HSP70 and a decrease in intracellular p62. In this study
46 women had their breast mass excised. PBMCs were isolated and
intracellular levels of HSP70 and p62 were quantitated by ELISA.
Differences between women with a benign or malignant breast mass were
determined. A breast malignancy was diagnosed in 38 women (82.6%) while
8 had a benign lesion. Mean intracellular HSP70 levels were 79.3 ng/ml
in PBMCs from women with a malignant lesion as opposed to 44.2 ng/ml in
controls (p = 0.04). The mean PBMC p62 level was 2.3 ng/ml in women with
a benign breast lesion as opposed to 0.6 ng/ml in those with breast
cancer (p < 0.001). Mean p62 levels were lowest in women with invasive
carcinoma and a positive lymph node biopsy when compared to those with
in-situ carcinoma or absence of lymphadenopathy, respectively.
Intracellular HSP70 and p62 levels in PBMCs differ between women with a
malignant or benign breast lesion. These measurements may be of value in
the preoperative triage of women with a breast mass
Tumor-Nipple Distance of ≥ 1 cm Predicts Negative Nipple Pathology After Neoadjuvant Chemotherapy.
BACKGROUND: As neoadjuvant chemotherapy (NAC) for breast cancer has become more widely used, so has nipple-sparing mastectomy. A common criterion for eligibility is a 1 cm tumor-to-nipple distance (TND), but its suitability after NAC is unclear. In this study, we examined factors predictive of negative nipple pathologic status (NS-) in women undergoing total mastectomy after NAC. METHODS: Women with invasive breast cancer treated with NAC and total mastectomy from August 2014 to April 2018 at our institution were retrospectively identified. Following review of pre- and post-NAC magnetic resonance imaging (MRI) and mammograms, the association of clinicopathologic and imaging variables with NS- was examined and the accuracy of 1 cm TND on imaging for predicting NS- was determined. RESULTS: Among 175 women undergoing 179 mastectomies, 74% of tumors were cT1-T2 and 67% were cN+ on pre-NAC staging; 10% (18/179) had invasive or in situ carcinoma in the nipple on final pathology. On multivariable analysis, after adjusting for age, grade, and tumor stage, three factors, namely number of positive nodes, pre-NAC nipple-areolar complex retraction, and decreasing TND, were significant predictors of nipple involvement (p < 0.05). The likelihood of NS- was higher with increasing TND on pre- and post-NAC imaging (p < 0.05). TND ≥ 1 cm predicted NS- in 97% and 95% of breasts on pre- and post-NAC imaging, respectively. CONCLUSIONS: Increasing TND was associated with a higher likelihood of NS-. A TND ≥ 1 cm on pre- or post-NAC imaging is highly predictive of NS- and could be used to determine eligibility for nipple-sparing mastectomy after NAC
The Effect of Adjuvant Trastuzumab on Locoregional Recurrence of Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Treated with Mastectomy.
BACKGROUND: Human epidermal growth factor receptor 2 (HER2) overexpression was associated with locoregional recurrence (LRR) in the preadjuvant trastuzumab era. This study aimed to examine the effect of trastuzumab on LRR in mastectomy patients and whether it varied with postmastectomy radiation (PMRT).
METHODS: From the authors\u27 institutional database, 501 women with stages I-III HER2-positive breast cancer who underwent mastectomy from 1998 to 2007 were identified. A landmark analysis was performed to compare two cohorts: 170 women who received trastuzumab and 281 who did not. Kaplan-Meier methods were used to estimate locoregional recurrence-free survival (LRRFS). A propensity score analysis was used to balance the treatment groups with respect to multiple covariates. Analogous methods were used to study the effect of PMRT.
RESULTS: The women in the trastuzumab group were more likely to be node positive and to receive systemic therapy or PMRT (p \u3c 0.01). The 5-year LRRFS was 98 % in the trastuzumab troup versus 94 % in the no trastuzumab group [hazard ratio (HR) 0.31; 95 % confidence interval (CI) 0.09-1.09; p = 0.07]. After adjustment for multiple covariates, including receipt of chemotherapy and PMRT, trastuzumab decreased LRR rates (HR 0.21; 95 % CI 0.04-0.94; p = 0.04). Among the women who received PMRT, trastuzumab reduced the 5-year LRR rate (0 vs 5 %; p = 0.06). Among those who did not receive PMRT, trastuzumab did not significantly decrease LRR (3 vs 6 %; p = 0.26).
CONCLUSION: High rates of locoregional control (5-year rate, 98 %) were observed among patients who received trastuzumab and mastectomy ± PMRT. Trastuzumab decreased LRR in HER2-positive women who received mastectomy and PMRT, suggesting that the largest benefit is seen in a higher-risk subset of patients