- Email: [email protected]
New trends for surgical treatment of locally advanced breast cancer
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Abstracts / The Breast 20 (2011) S12–S55
doxorubicin and fluorouracil and then surgery (15 patients with BCT, 11 patients with skin sparing mastectomy and latesmus dorsi reconstruction, 30 patients underwent MRM) followed by radiotherapy were examined between the years January 2007- January 2009 retrospectively. Before neoadjuvant chemotherapy, ten patients (18%) were Stage IIB, 32 patients (57%) Stage IIIA, 9 patients (16%) Stage IIIB and 5 patients stage IIIC (9%). Result: Clinical down staging was obtained in 49 (87.5%) of patients. five (9%) patients had complete clinical response, 44 (78.5%) patients with partial response, six patients (10.7%) had stable disease and 1 (1.8%) patient with progressive disease. The primary tumor could not be palpated after chemotherapy in 7 (12.5%) of 56 patients presenting with palpable mass, therefore wire localization was performed for BCS. Median follow-up was 41.5 months (ranging 20 to 50 months). Local recurrence was detected in 9 (16%) patients. Distant metastasis developed in 11 (19.5%) patients. Eight of the patients died of distant metastases and three of them are alive at 42 months. Discussion: Negative margin is more important factor in terms of local recurrence. Histological grade, menopausal and hormonal status are important factors in term of distant metastasis. BCS can be performed safely by achieving free surgical margin in patients who have small sized tumor.
PO59 FEATURES OF RECURRENCE OF TRIPLE METASTATIC BREAST CANCER (NMBC) INSTITUTION STUDY
NEGATIVE PATIENTS:
(TN) NONA SINGLE
Ashley Alarcon-Rozas, Rosario Cueva, Jose Galarreta, Jesus Torres, Jose Ramirez, Elmer Gonzales Hospital Almenara, Lima, Peru Background: The TN is a subtype of breast cancer (BC) negative for ER, PR and Her2/neu and is the most agressive subtype. Previous studies suggested that DFS of women with TN-BC is shorter than any other subtype and they demonstrated racial differences. TN-BC is more agressive in non caucasian population. Objectives: In this retrospective study our goal is to determine the incidence of TN in non metastatic BC, the recurrence rate (RR) and the patterns of recurrence by anatomic region and the DFS. Material and Methods: We reviewed 1042 medical records of BC patients diagnosed between Jan/2000 to Dec/2005 at the Almenara Hospital in Lima Peru. 215 patients were identified as TN NMBC. We collected the clinical data including age, menopausal status, staging, hormone receptor status as well as Her2/neu status and analized by statistic software SPSS v. 17.0. Results: The incidence of TN NMBC were 20.6% (215); of them 18.6% (40) patients had recurrences. The median age in patients with recurrent disease were 52.5 years (31-93years); the median DFS were 27 months with a median follow-up of 64 months. According to initial staging the recurrences were 7.5% (3); 32.5% (13); and 60% (24) respectively for patients with stages I, II and III. Almost one third (35%) of patients with recurrences were lymphatic node negative at diagnosis after mastectomy. The most frequent involved organs were visceral (lung¼12, liver¼3) 37.5% (15); bone 25% (10); skin 20% (8); CNS 12.5% (5) and contralateral breast 5% (2). There were four nuliparus women two of them had skin recurrence and the others two had bone metastasis. Additionally we found five patients with history of first degree familiar BC four of them were stage two with lymh node negative at diagnosis. Summary: TN NMBC constitutes 20.6% of all BC in our institution; the majority of relapses were stage III (60%). The median DFS for recurrence were 27 months and the most frequent sites involved were visceral (37%) and bone (25%). It is important to know that 12.5% of recurrences were to CNS and one third of the patients were lymph node negatives. We found 20.6% of incidence of TN-BC which is close to the incidence of African American population (25%) and in contrast to Caucasian population (7%-9%) and the Asian population (7%-10%). This is to our knowledge the first study of patterns of recurrence in TN NMBC in a Latino population
PO60 FINAL RESULTS OF A PILOT STUDY OF PATHOLOGICAL COMPLETE RESPONSE (PCR) IN LABC PATIENTS TREATED WITH AC X 4 DOSE DENSE FOLLOWED BY WEEKLY PACLITAXEL X 12 WITH CAPECITABINE Ashley Alarcon-Rozas 1, Cesar De Las Casas 2, Jose Galvez 5, Romulo Cardenas 3, Diego Venegas 4, Claudia Lozada 1 1 Clinica Angloamericana, Lima, Peru 2 VA Hospital, San Antonio TX, USA 3 Hospital Militar, Lima, Peru 4 Hospital Cayetano Heredia, Lima, Peru 5 Clinica San Felipe, Lima, Peru Background: This is a multicentric study looking to achieve a pCR after preoperative chemotherapy that correlates with better OS in patients with LABC. The correlation of Hormonal Receptors and Her2 with response to this treatment is a secondary objective. Patients and Methods: Between May/2007 and January/2010 we collected 65 patients 60 of then were valuables. Patients had tumors between 2.5 and 20cm. All of them with biopsy and IHC before systemic treatment. They have received doxorrubicin 60mg/m2 and cyclophosphamide 600mg/m2 every 2 weeks times 4 with G-CSF support, then weekly paclitaxel 80mg/m2 times 12 concurrent with capecitabine 700mg/m2 2 weeks on 1 week off followed by surgery. After surgery we use Miller and Payne method to evaluate responses. pCR is defined as no evidence of malignant cells in the nodes and in the primary tumor. Results: We analized 60 patients. 5 pts. died, 4 of them due to progressive disease and 1 due to cirrosis. The median age were 56 years, 33.3% were premenopausal; 84% had tumors bigger than 5cm and 20% bigger than 10cm. The ORR were 85%, pCR were 29.7% (14/48), of them 35% (5) were triple negatives, 21.4% (3) were Her2 positive and 42% (6) were hormonal receptors positives. Patients who do not achieve more than 50% of response after anthracyclinesas and after taxanes with capecitabine were 17% and of them 85% were HR positive Her2 negative with similar profiles in 12 patients who had progressive disease. Almost 50% of all triple negative pts. achieve pCR, 33% of Her2 postive HR negatives had pCR (we do not use trastuzumab) and finally 15% of HR positives had pCR. Conclusion: To our knowledge this is the first study with anthracyclines, paclitaxel and capecitabine given concurrently in neoadjuvant setting. The pCR almost 30% is high considering that more than 80% of patients had huge tumors and in contrast with other studies this combinations works in HR positive tumors with low histological grades grades achieving 15% of pCR, probably the higest response in these subtype tumors. We need more studies to confirm this response rate in HR positives pts.
PO61 NEW TRENDS FOR SURGICAL TREATMENT OF LOCALLY ADVANCED BREAST CANCER Angelo Gustavo Zucca Matthes 1, Rene Aloisio da Costa Vieira 1, Ligia Maria Kerr 1, Raphael Luis Haikel 1, Gilberto Uemura 2 1 Hospital de Cancer de Barretos, Barretos, SP, Brazil 2 Faculdade de Medicina de Botucatu - UNESP, Botucatu, SP, Brazil Introduction: The locally advanced breast cancer is still common in developing countries. The neoadjuvant chemotherapy (NC) allows converting large tumor into operable one. Oncoplastic surgery (OS) adds new techniques to breast conservative treatment (BCT). The association between NC and OS provides the resection of large amount of breast tissue, including skin, with satisfactory aesthetic results. Objective: Evaluate the possibilities to indicate oncoplastic techniques to determine BCT after NC for large breast tumors. Material and Methods: A prospective clinical trial (www.clinicaltrials.gov, NCT00820690) study with women breast cancer patients, clinical stage III, submitted to NC, based on four cycles of doxorubicin 60mg/m2 + cyclophosphamide 600 mg/m2 and 4 cycles of paclitaxel 175mg/m2. Preoperative tattoo was realized for all patients to determine the clinical
Abstracts / The Breast 20 (2011) S12–S55
dimensions of the tumor. Tumor size was controlled by physical and radiological exams. The oncoplastic surgeries were offered in accordance to clinical-imaging previous to NC, final response to chemotherapy, tumor localization, tumor size, breast size, oncologic security, patient comorbidities and experience of the surgeon. The skin-sparing mastectomy with immediate breast reconstruction was also considered an oncoplastic technique. The surgical planning has involved the whole area previously marked by the tattoo regardless of tumor response. A detailed analysis of the pathological specimen was provided to confirm the oncologic safety of the treatment. All patients were followed by radiotherapy after surgery. Results: 50 patients were enrolled. PE tumor median measurement was 6.5 cm (3.0 to 14.0 cm) and pathologic median tumor was 4.0 cm (0 to 14.5cm). Pathologic response was rated as stable disease, progressive disease, partial response and complete response in 18%, 10%, 68% and 4% of the cases, respectively. Pathologic responses were diverse and included tumor micro-fragmentation and macro-fragmentation. PE tumor size before chemotherapy correlated best with MRI (ricc 0.588, p < 0.001), as well as pathologic tumor size measured after chemotherapy correlated best with MRI (ricc 0.738, p <0.001). Skin involvement was presented in 36% (18) of pathologic specimen regardless previous clinical exam noticed. The surgical approach allowed BCT in 34% (17) of patients. Conclusion: Oncoplastic techniques increase the rates of BCT for selected patients in spite of large locally advanced tumors. The surgical planning, mainly using MRI, is fundamental to this approach. This study recommends the full resection of the tumoral area previous to NC, including marked skin, regardless the response to neoadjuvant treatment. The follow-up of these patients will be important for additional information in the future.
PO62 BREAST CANCER: IS THERE ANY DIFFERENCE IN YOUNGER WOMEN? Miguel Abreu 1, Marcos Pantarotto 1, Ana Castro 1, Eduarda Matos 2, Rosário Couto 1, Noémia Afonso 1, Helena Rodrigues 1 1 Portuguese Institute of Oncology of Porto, Porto, Portugal 2 Biomedical Sciences Institute Of Abel Salazar of University of Porto, Porto, Portugal Background: Breast cancer is the most frequently diagnosed malignancy in women. Although the risk increases with age, it is estimated that approximately 5-7% of the cases occur in women under the age of 40. In this group, breast cancer tends to exhibit more aggressive features and is associated with higher rates of recurrence and mortality. Material and Methods: Review of clinical files of 916 female patients diagnosed with breast cancer admitted to the IPO- Porto in 2005 and identification of two groups according to age at diagnosis - not more than 40 years versus more than 40 years. Evaluation of demographic, tumor- related variables, treatment and survival were done. Univariate analysis, using the method of chi-square test, was used to identify statistically significant differences between the two groups. The differences with statistical significance were evaluated using a multivariate analysis. Survival curves were calculated for the two groups by the Kaplan-Meier method and compared using the log-rank test. Statistical significance was set at p<0.05. Results: Of the treated patients, 53 (13,8%) were younger than 40 years. Compared to the group of patients aged over 40 years, the younger patients had with statistically significant difference: more advanced stage at diagnosis (II/III), p¼0,017, tumors with a higher degree of differentiation (G2/G3), p¼0,012, negative hormone receptors, p¼0,007, and lymph node invasion advanced at diagnosis (N3), p¼0,03. The surgery performed more frequently in younger women was modified radical mastectomy. In multivariate analysis the only factor of poor prognosis with statistical difference between the two groups was the expression of hormone receptors (p¼0,04). There was no difference between the survivals at five years of the two groups. Conclusions: It is confirmed in clinical practice a higher association of classical factors of poor prognosis in patients diagnosed with breast cancer at younger age, particularly the absence of expression of hormone receptors. The individualized adjuvant therapy, adjusted to prognostic factors,
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allows survival at 5 years overlapping with that of patients of older age. A longer follow-up of these patients will assess differences in recurrence and late survival.
PO63 ETHNIC DIFFERENCES IN SURVIVAL OF BREAST CANCER PATIENTS IN KAZAKHSTAN Nikolay Malyshev 1, Andrey Panibratez 2, Vladimir Kulishov 2, Indira Omarova 2, Valentina Sirota 1 1 Karaganda State Medical University, Karaganda, Kazakhstan, 2 Karaganda Regional Cancer Center, Karaganda, Kazakhstan Aim: To discover impact of ethnicity on survival of breast cancer patients. Materials and methods: 114 patients of Kazakh nation and 199 patients of Russian nation were included in the research. Immunohistochemical phenotype of breast cancer was identified according to national and international recommendations. All patients were treated in Karaganda Regional Cancer Center (Kazakhstan) in 2006. Stage distribution was similar in all groups. Duration of follow-up was 3 years. All differences were approved as statistically significant, when p-value was less than 0.05. The data were processed in statistical application - Statistica 6.0. Results: Mean disease-free survival was distributed in Kazakh and Russian patients according to molecular phenotypes: basal-like - 26.1 and 29.4 months, respectively; Her2/neu positive - 22.7 and 26.3 months; Luminal A - 31.8 and 31.7 months; Luminal B - 32.4 and 27.4 months. Mean overall survival was distributed in Kazakh and Russian patients also according to molecular phenotypes: basal-like - 29.1 and 32.1 months, respectively; Her2/neu positive - 27.0 and 30.5 months; Luminal A - 34.6 and 34.1 months; Luminal B - 34.4 and 32.7 months. Mean disease-free survival time of Kazakh breast cancer patients with basal-like and Her2/neu positive phenotypes was lower than the same parameters of Russian patients (p<0.05). Mean DFS time in patients with Luminal A phenotype was almost identical. Mean DFS time in patients with Luminal B was different, but it was statistically insignificant (p>0.05). Mean overall survival time was lower in Kazakh patients with basal-like and Her2/neu positive phenotypes, but it was only tendency, which did not achieve the border of statistical significance. Levels of mean OS time were almost the same in patients with Luminal A and Luminal B phenotypes in both ethnic groups. Conclusion: Ethnic groups had statistically significant impact on diseasefree survival and potentially might influence on overall survival. Still immunohistochemical phenotypes of breast cancer have stronger and more powerful weight in terms of survival and efficacy of treatment.
PO64 SURGICAL OPTIONS IN THE MANAGEMENT OF PATIENTS WITH LOCALLY ADVANCED BREAST CANCER IN A RESOURCE CONSTRAINED SETTING: THE LAGOS UNIVERSITY TEACHING HOSPITAL (LUTH) EXPERIENCE Abdul Razzaq Lawal, Charles Anunobi, Andrew Ugburo, Adedapo Osinowo, Muhammad Habeebu, Adedoyin Adesanya, Oluwole Atoyebi, Adekunbiola Banjo College of Medicine of the University of Lagos, Lagos, Nigeria Introduction: Breast cancer management in developing countries is complicated by late presentation and limited resources hampering achieving international standards regarding surgical interventions. In Nigeria, most patients presenting to tertiary care have locally advanced breast cancer (labc). The optimal surgical management of labc involves neo-adjuvant chemotherapy and breast conserving surgery or mastectomy and breast reconstruction. The study audited our present practice (what surgical interventions are our breast cancer patients receiving?) and provides a basis for comparison with accepted standards. Patients and methods: This was a retrospective case record review. All (including theatre, clinic, pathology and ward) records were reviewed. The
Abstracts / The Breast 20 (2011) S12–S55
doxorubicin and fluorouracil and then surgery (15 patients with BCT, 11 patients with skin sparing mastectomy and latesmus dorsi reconstruction, 30 patients underwent MRM) followed by radiotherapy were examined between the years January 2007- January 2009 retrospectively. Before neoadjuvant chemotherapy, ten patients (18%) were Stage IIB, 32 patients (57%) Stage IIIA, 9 patients (16%) Stage IIIB and 5 patients stage IIIC (9%). Result: Clinical down staging was obtained in 49 (87.5%) of patients. five (9%) patients had complete clinical response, 44 (78.5%) patients with partial response, six patients (10.7%) had stable disease and 1 (1.8%) patient with progressive disease. The primary tumor could not be palpated after chemotherapy in 7 (12.5%) of 56 patients presenting with palpable mass, therefore wire localization was performed for BCS. Median follow-up was 41.5 months (ranging 20 to 50 months). Local recurrence was detected in 9 (16%) patients. Distant metastasis developed in 11 (19.5%) patients. Eight of the patients died of distant metastases and three of them are alive at 42 months. Discussion: Negative margin is more important factor in terms of local recurrence. Histological grade, menopausal and hormonal status are important factors in term of distant metastasis. BCS can be performed safely by achieving free surgical margin in patients who have small sized tumor.
PO59 FEATURES OF RECURRENCE OF TRIPLE METASTATIC BREAST CANCER (NMBC) INSTITUTION STUDY
NEGATIVE PATIENTS:
(TN) NONA SINGLE
Ashley Alarcon-Rozas, Rosario Cueva, Jose Galarreta, Jesus Torres, Jose Ramirez, Elmer Gonzales Hospital Almenara, Lima, Peru Background: The TN is a subtype of breast cancer (BC) negative for ER, PR and Her2/neu and is the most agressive subtype. Previous studies suggested that DFS of women with TN-BC is shorter than any other subtype and they demonstrated racial differences. TN-BC is more agressive in non caucasian population. Objectives: In this retrospective study our goal is to determine the incidence of TN in non metastatic BC, the recurrence rate (RR) and the patterns of recurrence by anatomic region and the DFS. Material and Methods: We reviewed 1042 medical records of BC patients diagnosed between Jan/2000 to Dec/2005 at the Almenara Hospital in Lima Peru. 215 patients were identified as TN NMBC. We collected the clinical data including age, menopausal status, staging, hormone receptor status as well as Her2/neu status and analized by statistic software SPSS v. 17.0. Results: The incidence of TN NMBC were 20.6% (215); of them 18.6% (40) patients had recurrences. The median age in patients with recurrent disease were 52.5 years (31-93years); the median DFS were 27 months with a median follow-up of 64 months. According to initial staging the recurrences were 7.5% (3); 32.5% (13); and 60% (24) respectively for patients with stages I, II and III. Almost one third (35%) of patients with recurrences were lymphatic node negative at diagnosis after mastectomy. The most frequent involved organs were visceral (lung¼12, liver¼3) 37.5% (15); bone 25% (10); skin 20% (8); CNS 12.5% (5) and contralateral breast 5% (2). There were four nuliparus women two of them had skin recurrence and the others two had bone metastasis. Additionally we found five patients with history of first degree familiar BC four of them were stage two with lymh node negative at diagnosis. Summary: TN NMBC constitutes 20.6% of all BC in our institution; the majority of relapses were stage III (60%). The median DFS for recurrence were 27 months and the most frequent sites involved were visceral (37%) and bone (25%). It is important to know that 12.5% of recurrences were to CNS and one third of the patients were lymph node negatives. We found 20.6% of incidence of TN-BC which is close to the incidence of African American population (25%) and in contrast to Caucasian population (7%-9%) and the Asian population (7%-10%). This is to our knowledge the first study of patterns of recurrence in TN NMBC in a Latino population
PO60 FINAL RESULTS OF A PILOT STUDY OF PATHOLOGICAL COMPLETE RESPONSE (PCR) IN LABC PATIENTS TREATED WITH AC X 4 DOSE DENSE FOLLOWED BY WEEKLY PACLITAXEL X 12 WITH CAPECITABINE Ashley Alarcon-Rozas 1, Cesar De Las Casas 2, Jose Galvez 5, Romulo Cardenas 3, Diego Venegas 4, Claudia Lozada 1 1 Clinica Angloamericana, Lima, Peru 2 VA Hospital, San Antonio TX, USA 3 Hospital Militar, Lima, Peru 4 Hospital Cayetano Heredia, Lima, Peru 5 Clinica San Felipe, Lima, Peru Background: This is a multicentric study looking to achieve a pCR after preoperative chemotherapy that correlates with better OS in patients with LABC. The correlation of Hormonal Receptors and Her2 with response to this treatment is a secondary objective. Patients and Methods: Between May/2007 and January/2010 we collected 65 patients 60 of then were valuables. Patients had tumors between 2.5 and 20cm. All of them with biopsy and IHC before systemic treatment. They have received doxorrubicin 60mg/m2 and cyclophosphamide 600mg/m2 every 2 weeks times 4 with G-CSF support, then weekly paclitaxel 80mg/m2 times 12 concurrent with capecitabine 700mg/m2 2 weeks on 1 week off followed by surgery. After surgery we use Miller and Payne method to evaluate responses. pCR is defined as no evidence of malignant cells in the nodes and in the primary tumor. Results: We analized 60 patients. 5 pts. died, 4 of them due to progressive disease and 1 due to cirrosis. The median age were 56 years, 33.3% were premenopausal; 84% had tumors bigger than 5cm and 20% bigger than 10cm. The ORR were 85%, pCR were 29.7% (14/48), of them 35% (5) were triple negatives, 21.4% (3) were Her2 positive and 42% (6) were hormonal receptors positives. Patients who do not achieve more than 50% of response after anthracyclinesas and after taxanes with capecitabine were 17% and of them 85% were HR positive Her2 negative with similar profiles in 12 patients who had progressive disease. Almost 50% of all triple negative pts. achieve pCR, 33% of Her2 postive HR negatives had pCR (we do not use trastuzumab) and finally 15% of HR positives had pCR. Conclusion: To our knowledge this is the first study with anthracyclines, paclitaxel and capecitabine given concurrently in neoadjuvant setting. The pCR almost 30% is high considering that more than 80% of patients had huge tumors and in contrast with other studies this combinations works in HR positive tumors with low histological grades grades achieving 15% of pCR, probably the higest response in these subtype tumors. We need more studies to confirm this response rate in HR positives pts.
PO61 NEW TRENDS FOR SURGICAL TREATMENT OF LOCALLY ADVANCED BREAST CANCER Angelo Gustavo Zucca Matthes 1, Rene Aloisio da Costa Vieira 1, Ligia Maria Kerr 1, Raphael Luis Haikel 1, Gilberto Uemura 2 1 Hospital de Cancer de Barretos, Barretos, SP, Brazil 2 Faculdade de Medicina de Botucatu - UNESP, Botucatu, SP, Brazil Introduction: The locally advanced breast cancer is still common in developing countries. The neoadjuvant chemotherapy (NC) allows converting large tumor into operable one. Oncoplastic surgery (OS) adds new techniques to breast conservative treatment (BCT). The association between NC and OS provides the resection of large amount of breast tissue, including skin, with satisfactory aesthetic results. Objective: Evaluate the possibilities to indicate oncoplastic techniques to determine BCT after NC for large breast tumors. Material and Methods: A prospective clinical trial (www.clinicaltrials.gov, NCT00820690) study with women breast cancer patients, clinical stage III, submitted to NC, based on four cycles of doxorubicin 60mg/m2 + cyclophosphamide 600 mg/m2 and 4 cycles of paclitaxel 175mg/m2. Preoperative tattoo was realized for all patients to determine the clinical
Abstracts / The Breast 20 (2011) S12–S55
dimensions of the tumor. Tumor size was controlled by physical and radiological exams. The oncoplastic surgeries were offered in accordance to clinical-imaging previous to NC, final response to chemotherapy, tumor localization, tumor size, breast size, oncologic security, patient comorbidities and experience of the surgeon. The skin-sparing mastectomy with immediate breast reconstruction was also considered an oncoplastic technique. The surgical planning has involved the whole area previously marked by the tattoo regardless of tumor response. A detailed analysis of the pathological specimen was provided to confirm the oncologic safety of the treatment. All patients were followed by radiotherapy after surgery. Results: 50 patients were enrolled. PE tumor median measurement was 6.5 cm (3.0 to 14.0 cm) and pathologic median tumor was 4.0 cm (0 to 14.5cm). Pathologic response was rated as stable disease, progressive disease, partial response and complete response in 18%, 10%, 68% and 4% of the cases, respectively. Pathologic responses were diverse and included tumor micro-fragmentation and macro-fragmentation. PE tumor size before chemotherapy correlated best with MRI (ricc 0.588, p < 0.001), as well as pathologic tumor size measured after chemotherapy correlated best with MRI (ricc 0.738, p <0.001). Skin involvement was presented in 36% (18) of pathologic specimen regardless previous clinical exam noticed. The surgical approach allowed BCT in 34% (17) of patients. Conclusion: Oncoplastic techniques increase the rates of BCT for selected patients in spite of large locally advanced tumors. The surgical planning, mainly using MRI, is fundamental to this approach. This study recommends the full resection of the tumoral area previous to NC, including marked skin, regardless the response to neoadjuvant treatment. The follow-up of these patients will be important for additional information in the future.
PO62 BREAST CANCER: IS THERE ANY DIFFERENCE IN YOUNGER WOMEN? Miguel Abreu 1, Marcos Pantarotto 1, Ana Castro 1, Eduarda Matos 2, Rosário Couto 1, Noémia Afonso 1, Helena Rodrigues 1 1 Portuguese Institute of Oncology of Porto, Porto, Portugal 2 Biomedical Sciences Institute Of Abel Salazar of University of Porto, Porto, Portugal Background: Breast cancer is the most frequently diagnosed malignancy in women. Although the risk increases with age, it is estimated that approximately 5-7% of the cases occur in women under the age of 40. In this group, breast cancer tends to exhibit more aggressive features and is associated with higher rates of recurrence and mortality. Material and Methods: Review of clinical files of 916 female patients diagnosed with breast cancer admitted to the IPO- Porto in 2005 and identification of two groups according to age at diagnosis - not more than 40 years versus more than 40 years. Evaluation of demographic, tumor- related variables, treatment and survival were done. Univariate analysis, using the method of chi-square test, was used to identify statistically significant differences between the two groups. The differences with statistical significance were evaluated using a multivariate analysis. Survival curves were calculated for the two groups by the Kaplan-Meier method and compared using the log-rank test. Statistical significance was set at p<0.05. Results: Of the treated patients, 53 (13,8%) were younger than 40 years. Compared to the group of patients aged over 40 years, the younger patients had with statistically significant difference: more advanced stage at diagnosis (II/III), p¼0,017, tumors with a higher degree of differentiation (G2/G3), p¼0,012, negative hormone receptors, p¼0,007, and lymph node invasion advanced at diagnosis (N3), p¼0,03. The surgery performed more frequently in younger women was modified radical mastectomy. In multivariate analysis the only factor of poor prognosis with statistical difference between the two groups was the expression of hormone receptors (p¼0,04). There was no difference between the survivals at five years of the two groups. Conclusions: It is confirmed in clinical practice a higher association of classical factors of poor prognosis in patients diagnosed with breast cancer at younger age, particularly the absence of expression of hormone receptors. The individualized adjuvant therapy, adjusted to prognostic factors,
S33
allows survival at 5 years overlapping with that of patients of older age. A longer follow-up of these patients will assess differences in recurrence and late survival.
PO63 ETHNIC DIFFERENCES IN SURVIVAL OF BREAST CANCER PATIENTS IN KAZAKHSTAN Nikolay Malyshev 1, Andrey Panibratez 2, Vladimir Kulishov 2, Indira Omarova 2, Valentina Sirota 1 1 Karaganda State Medical University, Karaganda, Kazakhstan, 2 Karaganda Regional Cancer Center, Karaganda, Kazakhstan Aim: To discover impact of ethnicity on survival of breast cancer patients. Materials and methods: 114 patients of Kazakh nation and 199 patients of Russian nation were included in the research. Immunohistochemical phenotype of breast cancer was identified according to national and international recommendations. All patients were treated in Karaganda Regional Cancer Center (Kazakhstan) in 2006. Stage distribution was similar in all groups. Duration of follow-up was 3 years. All differences were approved as statistically significant, when p-value was less than 0.05. The data were processed in statistical application - Statistica 6.0. Results: Mean disease-free survival was distributed in Kazakh and Russian patients according to molecular phenotypes: basal-like - 26.1 and 29.4 months, respectively; Her2/neu positive - 22.7 and 26.3 months; Luminal A - 31.8 and 31.7 months; Luminal B - 32.4 and 27.4 months. Mean overall survival was distributed in Kazakh and Russian patients also according to molecular phenotypes: basal-like - 29.1 and 32.1 months, respectively; Her2/neu positive - 27.0 and 30.5 months; Luminal A - 34.6 and 34.1 months; Luminal B - 34.4 and 32.7 months. Mean disease-free survival time of Kazakh breast cancer patients with basal-like and Her2/neu positive phenotypes was lower than the same parameters of Russian patients (p<0.05). Mean DFS time in patients with Luminal A phenotype was almost identical. Mean DFS time in patients with Luminal B was different, but it was statistically insignificant (p>0.05). Mean overall survival time was lower in Kazakh patients with basal-like and Her2/neu positive phenotypes, but it was only tendency, which did not achieve the border of statistical significance. Levels of mean OS time were almost the same in patients with Luminal A and Luminal B phenotypes in both ethnic groups. Conclusion: Ethnic groups had statistically significant impact on diseasefree survival and potentially might influence on overall survival. Still immunohistochemical phenotypes of breast cancer have stronger and more powerful weight in terms of survival and efficacy of treatment.
PO64 SURGICAL OPTIONS IN THE MANAGEMENT OF PATIENTS WITH LOCALLY ADVANCED BREAST CANCER IN A RESOURCE CONSTRAINED SETTING: THE LAGOS UNIVERSITY TEACHING HOSPITAL (LUTH) EXPERIENCE Abdul Razzaq Lawal, Charles Anunobi, Andrew Ugburo, Adedapo Osinowo, Muhammad Habeebu, Adedoyin Adesanya, Oluwole Atoyebi, Adekunbiola Banjo College of Medicine of the University of Lagos, Lagos, Nigeria Introduction: Breast cancer management in developing countries is complicated by late presentation and limited resources hampering achieving international standards regarding surgical interventions. In Nigeria, most patients presenting to tertiary care have locally advanced breast cancer (labc). The optimal surgical management of labc involves neo-adjuvant chemotherapy and breast conserving surgery or mastectomy and breast reconstruction. The study audited our present practice (what surgical interventions are our breast cancer patients receiving?) and provides a basis for comparison with accepted standards. Patients and methods: This was a retrospective case record review. All (including theatre, clinic, pathology and ward) records were reviewed. The