- Email: [email protected]
P259 Outcome of elderly women with breast cancer
14th St.Gallen International Breast Cancer Conference / The Breast 24S1 (2015) S87–S150
Methods: Records review identified 1,240 women diagnosed with breast cancer from 1998–2007. Women diagnosed with ILC (n = 43) and IDC (n = 1,197) were compared in means of tumor detection, operative procedures, tumor characteristics, systemic treatment and survival. Results: Overall, median age at diagnosis was 48 (23–87). Most of the patients presented with palpable mass. Only half the patients underwent mammography at the time of diagnosis. The ILC group had higher rates of BIRADS 4, compared with the IDC group (34.8% vs. 26.5%). Mastectomy rate was higher in the ILC group (90.7% vs. 81.7%). Median tumor size was 2.8 cm in both groups with almost half of them had axillary lymph node involvement. No differences in pathological staging, tumor grade and lymphovascular invasion between the two groups. Positive estrogen (65.1% vs. 49.1%) and/or progesterone receptors (62.8% vs. 41.2%, p = 0.01) were higher in the ILC group. There were no differences in adjuvant chemotherapy (86.0% vs. 79.3%), hormonal therapy (67.4% vs. 63.5%) and radiotherapy (48.8% vs. 42.1%) between the two groups. At a median follow-up of 85 months, there were no differences in 5-year disease-free survival (60.5% vs. 65.7%), distant disease-free survival (62.8% vs. 69.2%) and overall survival (72.1% vs. 73.5%) between the two groups. Pathological staging (stage 3; HR 1.83, 95% CI 1.11– 3.02, p = 0.02) and nodal involvement (HR 1.98, 95% CI 1.45–2.70, p < 0.001) were predictive factors for disease recurrence and death. Conclusion: Although difficult in tumor detection, women with ILC have comparable clinical and tumor characteristics with IDC, resulting in equivalent survival outcomes. Pathological staging and nodal status are predictive factors for survival. Disclosure of Interest: No significant relationships. P258 Prognostic value of tumor biology and adjuvant systemic therapy in breast cancer stage I I.V. Kolyadina1 *, I.V. Poddubnaya2 , G.A. Frank2 , A.I. Karseladze3 , D.V. Komov3 . 1 Surgical Oncology, Russian Medical Academy of Postgraduate Education, Russian Cancer Research Center, Moscow, Russian Federation, 2 Oncology Chair, Russan Medical Academy of Postgraduate Education, Moscow, Russian Federation, 3 Pathology, Russian Cancer Research Center, Moscow, Russian Federation Goals: to study the prognostic value of clinical and morphological factors for the risk of recurrences in breast cancer stage I. Methods: In study included 1341 women with breast cancer stage I (T1a-b-cN0M0), treated in the RCRC and RMAPE 1985– 2012. We analyzed the clinical factors (age, local and adjuvant systemic treatment) and morphological factors (status of estrogen and progesterone receptors, HER2 and KI67, biological subtype, presence of lymph vascular invasion and intraductal component and the tumor size T1a-b-c). We assessed the risk of recurrence (median follow up – 96 months), the rate of relapse and diseasefree survival in different subgroups using univariate and multivariate COX-regression analysis. Results: In univariate COX-regression analysis we found the prognostic value for the risk of recurrences of such morphological factors: grade of tumor (p = 0.034), histological type (p = 0.025), tumor size T1a-b-c (p = 0.004), presence of lymph vascular invasion (p = 0.03) and biological subtype of breast cancer (p = 0.002). The most favorable is the luminal A subtype with minimal rate of distant relapses (1.6%), the maximum time to progression (median 48 months) and the best rate of the 5- and 10-year disease-free survival (97.2% and 93.8%, respectively). The most important clinical factors were age (p = 0.001), the volume of surgery (p = 0.032), and adjuvant systemic therapy (chemotherapy, endocrine therapy or both therapies) in accordance with the biological subtype, p < 0.0001. In multivariate regression analysis, only two factors were significant for predicting the risk of recurrence of breast cancer stage I:
S115
biological subtype and adjuvant systemic therapy. Compared with luminal A subtype the risk of relapse is significant higher in luminal B subtypes (HER2-negative: HR 1.393; HER2-positive: HR 1.321), in triple negative subtype – HR 2.297 and, especially, in hormone negative HER2-positive subtype – HR 6.001, p = 0.04. Adjuvant systemic therapy reduce the risk of recurrence until 74% in breast cancer stage I (HR = 0.276, p < 0.0001). Conclusion: The tumor biology and adjuvant systemic therapy determines prognosis in breast cancer stage I. Disclosure of Interest: No significant relationships. P259 Outcome of elderly women with breast cancer N. Kobayashi *, K. Ushimado, M. Hikichi, T. Utsumi. Breast Surgery, Fujita Health University, Toyoake Aichi, Japan Goals: Women in Japan have the longest life expectancy in the world at 86.6 years old. We retrospectively reviewed the clinical and pathologic data including intrinsic subtypes and outcome of the breast cancer patients diagnosed at age 70 and older. Methods: From January 2000 to June 2014, 313 patients with breast cancer (≥70 years) who were treated at our hospital were included. The median age of the patients was 76 years, with a range of 70 to 92 years old. Ki-67 labeling index (LI) was categorized as low (<20%) and high (≥20%) in invasive cancer breast (IBC). Tumors were classified as luminal A (ER+ and PR+, and HER2− and Ki67 low), luminal B (ER+ and/or PR+, and HER2+ or Ki67 high), HER2 disease (ER−, PR−, HER2+), or triple negative (TN) (ER−, PR−, HER2−). Disease-free survival (DFS) and overall survival (OS) curves were generated using the method of Kaplan and Meier. Survival comparisons were made with the log-rank test. The level of significance was taken to be 0.05. SPSS 18.0 software package was used for statistical analysis. Results: The median tumor size was 2.1 cm. The 313 cases of breast cancer had the following distribution by stage: stage 0, 16 (5.1%); stage I, 126 (40.3%); stage IIA, 95 (30.3%); stage IIB, 39 (12.5%); stage IIIA, 6 (1.9%); stage IIIB, 21 (6.7%); stage IIIC, 3 (1.0%); stage IV, 7 (2.2%). The Number of patients with IBC (n = 293) in each subtype was as follows; luminal A 144 patients (49.2%), luminal B 77 patients (26.3%), HER2 disease 19 patients (6.5%), and triple negative 53 patients (18.0%). Of the 293 patients, 280 patients (95.5%) underwent surgery. The 90-days mortality was 0%. Patients with node negative (n = 207; 70.6%) had better prognosis than those with node positive (n = 86; 29.4%) [5-year DFS: 92.4% (node negative) vs. 76.7% (node positive), p = 0.002, 5-year OS: 89.2% vs. 77.4%, p = 0.002]. Eightyseven percent of the patients with IBC were treated with anti-cancer drug [chemotherapy (n = 45), endocrine therapy (n = 217) and antiHER2 therapy (n = 15)]. The patients who were treated with anticancer drug had better prognosis than those who did not [5-year OS: 87.3% vs. 73.8, p = 0.002]. TN was a significant predictor of worse OS [5-year OS: luminal A: 90.5%, luminal B: 86.9%, HER2 disease: 100%, and TN: 77.8%, p = 0.002]. High Ki-67 LI was also a significant predictor of worse outcome. ER status and PgR status were not associated with clinical outcome. Conclusion: Nodal status, Ki-67, and TN were prognostic factors in elderly women with breast cancer. Disclosure of Interest: No significant relationships.
Methods: Records review identified 1,240 women diagnosed with breast cancer from 1998–2007. Women diagnosed with ILC (n = 43) and IDC (n = 1,197) were compared in means of tumor detection, operative procedures, tumor characteristics, systemic treatment and survival. Results: Overall, median age at diagnosis was 48 (23–87). Most of the patients presented with palpable mass. Only half the patients underwent mammography at the time of diagnosis. The ILC group had higher rates of BIRADS 4, compared with the IDC group (34.8% vs. 26.5%). Mastectomy rate was higher in the ILC group (90.7% vs. 81.7%). Median tumor size was 2.8 cm in both groups with almost half of them had axillary lymph node involvement. No differences in pathological staging, tumor grade and lymphovascular invasion between the two groups. Positive estrogen (65.1% vs. 49.1%) and/or progesterone receptors (62.8% vs. 41.2%, p = 0.01) were higher in the ILC group. There were no differences in adjuvant chemotherapy (86.0% vs. 79.3%), hormonal therapy (67.4% vs. 63.5%) and radiotherapy (48.8% vs. 42.1%) between the two groups. At a median follow-up of 85 months, there were no differences in 5-year disease-free survival (60.5% vs. 65.7%), distant disease-free survival (62.8% vs. 69.2%) and overall survival (72.1% vs. 73.5%) between the two groups. Pathological staging (stage 3; HR 1.83, 95% CI 1.11– 3.02, p = 0.02) and nodal involvement (HR 1.98, 95% CI 1.45–2.70, p < 0.001) were predictive factors for disease recurrence and death. Conclusion: Although difficult in tumor detection, women with ILC have comparable clinical and tumor characteristics with IDC, resulting in equivalent survival outcomes. Pathological staging and nodal status are predictive factors for survival. Disclosure of Interest: No significant relationships. P258 Prognostic value of tumor biology and adjuvant systemic therapy in breast cancer stage I I.V. Kolyadina1 *, I.V. Poddubnaya2 , G.A. Frank2 , A.I. Karseladze3 , D.V. Komov3 . 1 Surgical Oncology, Russian Medical Academy of Postgraduate Education, Russian Cancer Research Center, Moscow, Russian Federation, 2 Oncology Chair, Russan Medical Academy of Postgraduate Education, Moscow, Russian Federation, 3 Pathology, Russian Cancer Research Center, Moscow, Russian Federation Goals: to study the prognostic value of clinical and morphological factors for the risk of recurrences in breast cancer stage I. Methods: In study included 1341 women with breast cancer stage I (T1a-b-cN0M0), treated in the RCRC and RMAPE 1985– 2012. We analyzed the clinical factors (age, local and adjuvant systemic treatment) and morphological factors (status of estrogen and progesterone receptors, HER2 and KI67, biological subtype, presence of lymph vascular invasion and intraductal component and the tumor size T1a-b-c). We assessed the risk of recurrence (median follow up – 96 months), the rate of relapse and diseasefree survival in different subgroups using univariate and multivariate COX-regression analysis. Results: In univariate COX-regression analysis we found the prognostic value for the risk of recurrences of such morphological factors: grade of tumor (p = 0.034), histological type (p = 0.025), tumor size T1a-b-c (p = 0.004), presence of lymph vascular invasion (p = 0.03) and biological subtype of breast cancer (p = 0.002). The most favorable is the luminal A subtype with minimal rate of distant relapses (1.6%), the maximum time to progression (median 48 months) and the best rate of the 5- and 10-year disease-free survival (97.2% and 93.8%, respectively). The most important clinical factors were age (p = 0.001), the volume of surgery (p = 0.032), and adjuvant systemic therapy (chemotherapy, endocrine therapy or both therapies) in accordance with the biological subtype, p < 0.0001. In multivariate regression analysis, only two factors were significant for predicting the risk of recurrence of breast cancer stage I:
S115
biological subtype and adjuvant systemic therapy. Compared with luminal A subtype the risk of relapse is significant higher in luminal B subtypes (HER2-negative: HR 1.393; HER2-positive: HR 1.321), in triple negative subtype – HR 2.297 and, especially, in hormone negative HER2-positive subtype – HR 6.001, p = 0.04. Adjuvant systemic therapy reduce the risk of recurrence until 74% in breast cancer stage I (HR = 0.276, p < 0.0001). Conclusion: The tumor biology and adjuvant systemic therapy determines prognosis in breast cancer stage I. Disclosure of Interest: No significant relationships. P259 Outcome of elderly women with breast cancer N. Kobayashi *, K. Ushimado, M. Hikichi, T. Utsumi. Breast Surgery, Fujita Health University, Toyoake Aichi, Japan Goals: Women in Japan have the longest life expectancy in the world at 86.6 years old. We retrospectively reviewed the clinical and pathologic data including intrinsic subtypes and outcome of the breast cancer patients diagnosed at age 70 and older. Methods: From January 2000 to June 2014, 313 patients with breast cancer (≥70 years) who were treated at our hospital were included. The median age of the patients was 76 years, with a range of 70 to 92 years old. Ki-67 labeling index (LI) was categorized as low (<20%) and high (≥20%) in invasive cancer breast (IBC). Tumors were classified as luminal A (ER+ and PR+, and HER2− and Ki67 low), luminal B (ER+ and/or PR+, and HER2+ or Ki67 high), HER2 disease (ER−, PR−, HER2+), or triple negative (TN) (ER−, PR−, HER2−). Disease-free survival (DFS) and overall survival (OS) curves were generated using the method of Kaplan and Meier. Survival comparisons were made with the log-rank test. The level of significance was taken to be 0.05. SPSS 18.0 software package was used for statistical analysis. Results: The median tumor size was 2.1 cm. The 313 cases of breast cancer had the following distribution by stage: stage 0, 16 (5.1%); stage I, 126 (40.3%); stage IIA, 95 (30.3%); stage IIB, 39 (12.5%); stage IIIA, 6 (1.9%); stage IIIB, 21 (6.7%); stage IIIC, 3 (1.0%); stage IV, 7 (2.2%). The Number of patients with IBC (n = 293) in each subtype was as follows; luminal A 144 patients (49.2%), luminal B 77 patients (26.3%), HER2 disease 19 patients (6.5%), and triple negative 53 patients (18.0%). Of the 293 patients, 280 patients (95.5%) underwent surgery. The 90-days mortality was 0%. Patients with node negative (n = 207; 70.6%) had better prognosis than those with node positive (n = 86; 29.4%) [5-year DFS: 92.4% (node negative) vs. 76.7% (node positive), p = 0.002, 5-year OS: 89.2% vs. 77.4%, p = 0.002]. Eightyseven percent of the patients with IBC were treated with anti-cancer drug [chemotherapy (n = 45), endocrine therapy (n = 217) and antiHER2 therapy (n = 15)]. The patients who were treated with anticancer drug had better prognosis than those who did not [5-year OS: 87.3% vs. 73.8, p = 0.002]. TN was a significant predictor of worse OS [5-year OS: luminal A: 90.5%, luminal B: 86.9%, HER2 disease: 100%, and TN: 77.8%, p = 0.002]. High Ki-67 LI was also a significant predictor of worse outcome. ER status and PgR status were not associated with clinical outcome. Conclusion: Nodal status, Ki-67, and TN were prognostic factors in elderly women with breast cancer. Disclosure of Interest: No significant relationships.