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P310 Nomogram predicting clinical outcomes in breast cancer patients treated with neoadjuvant chemotherapy
S76
Poster Session II. Locally advanced and metastatic disease
P310
Nomogram predicting clinical outcomes in breast cancer patients treated with neoadjuvant chemotherapy
B. Keam1 , S.-A. Im1 , S. Park2 , B.-H. Nam2 , S.-W. Han1 , D.-Y. Oh1 , W. Han3 , T.-Y. Kim1 , I.A. Park4 , D.-Y. Noh3 . 1 Internal Medicine, Seoul National University Hospital, Seoul, 2 Cancer Biostatistics Branch, National Cancer Center, Goyang-si, 3 Surgery, 4 Pathology, Seoul National University Hospital, Seoul, Korea, Republic of Goals: Prognostic models or nomograms of early breast cancer could not be applied in neoadjuvant setting, because neoadjuvant chemotherapy (NAC) alters potential prognostic factor. The aim of this study was to combine clinical pathologic variables that are associated with pathologic complete response (pCR) and relapse-free survival (RFS) after NAC into prediction nomograms. Methods: A total of 370 stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. We developed the nomograms using logistic regression model for pCR and Cox proportional hazard regression model for RFS. Results: The nomogram for pCR based on initial tumor size, estrogen receptor (ER), human epidermal growth factor receptor 2, and Ki67 had good discrimination performance (AUROC = 0.830). Multivariate Cox model identified age less than 35, initial clinical stage, pathologic stage, ER, Ki67 as prognostic factors, and the nomogram for RFS was developed based on these covariates. The concordance index for the second nomogram was 0.781, and calibration was also good. Conclusion: We developed nomograms based on clinical and pathologic characteristics to predict the probability of pCR and RFS for patients receiving neoadjuvant docetaxel/doxorubicin chemotherapy. We suggest that these nomograms allow individualized outcome prediction, which could aid clinicians in decision making process. Disclosure of Interest: None Declared
P311
Tumor-infiltrating lymphocytes are an important pathological predictor for neoadjuvant chemotherapy in patients with breast cancer
R. Yamaguchi1 , M. Tanaka2 , A. Yano3 , M. Yamaguchi2 , H. Yano1 . 1 Pathology, Kurume University School of Medicine, 2 Surgery, 3 Clinical Research Center, Social Insurance Kurume Daiichi Hospital, Kurume, Japan Goals: We examined the pathological factors predictive for neoadjuvant chemotherapy (NAC) in patients with breast cancer. Methods: Subjects comprised 24 cases who achieved a pathologically complete or near complete response and 44 cases who did not respond to NAC (anthracycline-based regimen) from 2005–2010 at Social Insurance Kurume Daiichi Hospital. We investigated predictive pathological factors using histomorphology and immunohistochemistry by pre-NAC 68 needle biopsy samples. For histomorphology and biomarkers, each factor was divided into two categories and compared as follows: the degree of tumor-infiltrating lymphocytes, 0−1 (mild) vs 2−3 (moderate to marked); histological grade, 1 (low) vs 2−3 (high); estrogen receptor (ER) status, negative vs positive; HER2 status, negative vs positive; clinical T stage, T1−2 vs T3−4; clinical N stage, N0−1 vs N2−3; and triple negative (TN) (ER/progesterone/HER2) status, TN vs non-TN. Results: In univariate analysis, there was a higher degree of moderate to marked, but not mild, tumor-infiltrating lymphocytes in responders than in non-responders to NAC (P < 0.0001). A high histological grade (p < 0.0001) and a negative ER status (p < 0.0011) were significantly higher in responders than in non-responders to NAC. There were no significant differences in HER2 positivity (p = 0.315), clinical T stage (p = 0.2663), clinical N stage (p = 0.7555), and TN status (p = 0.4809) among the groups. Conclusion: Increased tumor-infiltrating lymphocytes, histological grade and ER negativity are important predictive pathological factors for NAC in patients with breast cancer. Disclosure of Interest: None Declared
Friday, 18 March 2011
Friday, 18 March 2011
Locally advanced and metastatic disease P314
Multimodality therapy in locally advanced breast cancer − prediction of outcome by clinical and pathological features
1 , B. Kaleta2 , B. Lange1 , E. Nowicka1 , J. Rogozinska-Szczepka ´ K. Trela1 , A. Smok-Ragankiewicz3 , B. Lukaszczyk-Wideł1 . 1 Department of Radiotherapy, 2 Department of Clinical Oncology, 3 Department of Pathology, Center of Oncology MSC Memorial Institute, Gliwice, Poland
Goals: The aim of the study was to evaluate the importance of clinical and pathological features in predicting the outcome of multimodality therapy for locally advanced breast cancer. Methods: We retrospectively reviewed the group of 317 breast cancer patients in Center of Oncology in Gliwice from 2000 to 2005. All patients were treaded by multimodality strategy consisting of induction CAF chemotherapy followed by surgery and radiotherapy. Patients with hormone positive tumors received hormonal therapy. Mean age was 49 y and 15% (48 pts) were below 40 y. Forty percent of tumors were in II and 60% in III clinical stage. The mean number of chemotherapy cycles was 5 (range 2−8). All patients were operated. Standard procedure was radical mastectomy in 73% of pts and in 27% breast conserving therapy was feasible. Surgical specimens were analyzed for histology, nodal status and receptor status. Complete clinical response was noted in 89 (32%) pts and complete pathological response was achieved in 76 (24%). Nodal metastases found in 43% of patients and 18% of pts had more than 3 metastatic nodes. Hormonal receptor status was assessed in 258 pts (81%) and 45% were positive. HER 2 /neu status was analyzed in 81pts and overexpression was noted in 14 (17%). Triple negative tumors diagnosed in 22 (7%) cases. Results: At a median follow-up of 68 months, the 5y OS and DFS was 82% and 78% respectively. Disease relapsed in 76 patients (24%). Local relapse was always connected with distant metastases. Sixty four patients died (20%) and all because of breast cancer. There was no statistical difference in survival (OS and DFS) according to the rate of pathological complete response, age and tumor size. OS and DFS were significantly influenced by the clinical stage (II vs. III, OS, p = 0.0019; DFS, p = 0.09), the number of pathologically involved nodes (OS, p = 0.001; DFS, p = 0.0058) and ER/PR receptor status (OS, p = 0.004; DFS, p = 0.004). Triple negative tumors did significantly worse: 5y DFS and OS were 50% and 55% respectively. Conclusion: Clinical stage at presentation, hormone receptor status and the number of pathologically involved nodes were identified as predictors of outcome in locally advanced breast cancer treated with multimodality therapy. Disclosure of Interest: None Declared
P315
Acceptance and adherence with oral endocrine therapy in women with metastatic breast cancer: ExaCampania group study
R. Addeo1 , P. Russo1 , L. Maiorino2 , A. Febraro3 , L. Leo4 , P. Incoronato5 , A. Pisano6 , M. Bianco7 , R. Mabilia8 , S. del Prete9 . 1 U.O. Oncologia, Asl Na2 Nord, Frattamaggiore, 2 U.O. Oncologia, San Gennaro Hospital, Napoli, 3 U.O. Oncologia, Fatebenefratelli Hospital, Benevento, 4 U.O. Oncologia, Aslce, Piedimonte Matese (CE), 5 U.O. Oncologia, Aslna2 Nord Giugliano I (NA), 6 U.O. Oncologia, Aslna2 Nord, Pozzuoli (NA), 7 U.O. Oncologia, Aslna3 Sud Gragnano, 8 U.O. Oncologia, Aslna2 Nord, Ischia, 9 U.O. Oncologia, Asla2 Nord, Frattamaggiore, Italy Goals: Oral agents for anticancer therapy provide an attractive approach for patient acceptance and use of oral treatments is increasing. Adherence (often referred to as compliance) can be defined as he extent to which a patient’s behavior coincides with medical advice. Patient Adherence is critical in evaluating the effectiveness of an oral therapy. We sought to measure acceptance and adherence among women with metastatic breast received an endocrine therapy with Examestane. Methods: Overall 285 patients with histologically proven Breast cancer treated with examestane were enrolled. The level of acceptance was evaluated using a questionnaire with ten questions administered every 3 months
Poster Session II. Locally advanced and metastatic disease
P310
Nomogram predicting clinical outcomes in breast cancer patients treated with neoadjuvant chemotherapy
B. Keam1 , S.-A. Im1 , S. Park2 , B.-H. Nam2 , S.-W. Han1 , D.-Y. Oh1 , W. Han3 , T.-Y. Kim1 , I.A. Park4 , D.-Y. Noh3 . 1 Internal Medicine, Seoul National University Hospital, Seoul, 2 Cancer Biostatistics Branch, National Cancer Center, Goyang-si, 3 Surgery, 4 Pathology, Seoul National University Hospital, Seoul, Korea, Republic of Goals: Prognostic models or nomograms of early breast cancer could not be applied in neoadjuvant setting, because neoadjuvant chemotherapy (NAC) alters potential prognostic factor. The aim of this study was to combine clinical pathologic variables that are associated with pathologic complete response (pCR) and relapse-free survival (RFS) after NAC into prediction nomograms. Methods: A total of 370 stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. We developed the nomograms using logistic regression model for pCR and Cox proportional hazard regression model for RFS. Results: The nomogram for pCR based on initial tumor size, estrogen receptor (ER), human epidermal growth factor receptor 2, and Ki67 had good discrimination performance (AUROC = 0.830). Multivariate Cox model identified age less than 35, initial clinical stage, pathologic stage, ER, Ki67 as prognostic factors, and the nomogram for RFS was developed based on these covariates. The concordance index for the second nomogram was 0.781, and calibration was also good. Conclusion: We developed nomograms based on clinical and pathologic characteristics to predict the probability of pCR and RFS for patients receiving neoadjuvant docetaxel/doxorubicin chemotherapy. We suggest that these nomograms allow individualized outcome prediction, which could aid clinicians in decision making process. Disclosure of Interest: None Declared
P311
Tumor-infiltrating lymphocytes are an important pathological predictor for neoadjuvant chemotherapy in patients with breast cancer
R. Yamaguchi1 , M. Tanaka2 , A. Yano3 , M. Yamaguchi2 , H. Yano1 . 1 Pathology, Kurume University School of Medicine, 2 Surgery, 3 Clinical Research Center, Social Insurance Kurume Daiichi Hospital, Kurume, Japan Goals: We examined the pathological factors predictive for neoadjuvant chemotherapy (NAC) in patients with breast cancer. Methods: Subjects comprised 24 cases who achieved a pathologically complete or near complete response and 44 cases who did not respond to NAC (anthracycline-based regimen) from 2005–2010 at Social Insurance Kurume Daiichi Hospital. We investigated predictive pathological factors using histomorphology and immunohistochemistry by pre-NAC 68 needle biopsy samples. For histomorphology and biomarkers, each factor was divided into two categories and compared as follows: the degree of tumor-infiltrating lymphocytes, 0−1 (mild) vs 2−3 (moderate to marked); histological grade, 1 (low) vs 2−3 (high); estrogen receptor (ER) status, negative vs positive; HER2 status, negative vs positive; clinical T stage, T1−2 vs T3−4; clinical N stage, N0−1 vs N2−3; and triple negative (TN) (ER/progesterone/HER2) status, TN vs non-TN. Results: In univariate analysis, there was a higher degree of moderate to marked, but not mild, tumor-infiltrating lymphocytes in responders than in non-responders to NAC (P < 0.0001). A high histological grade (p < 0.0001) and a negative ER status (p < 0.0011) were significantly higher in responders than in non-responders to NAC. There were no significant differences in HER2 positivity (p = 0.315), clinical T stage (p = 0.2663), clinical N stage (p = 0.7555), and TN status (p = 0.4809) among the groups. Conclusion: Increased tumor-infiltrating lymphocytes, histological grade and ER negativity are important predictive pathological factors for NAC in patients with breast cancer. Disclosure of Interest: None Declared
Friday, 18 March 2011
Friday, 18 March 2011
Locally advanced and metastatic disease P314
Multimodality therapy in locally advanced breast cancer − prediction of outcome by clinical and pathological features
1 , B. Kaleta2 , B. Lange1 , E. Nowicka1 , J. Rogozinska-Szczepka ´ K. Trela1 , A. Smok-Ragankiewicz3 , B. Lukaszczyk-Wideł1 . 1 Department of Radiotherapy, 2 Department of Clinical Oncology, 3 Department of Pathology, Center of Oncology MSC Memorial Institute, Gliwice, Poland
Goals: The aim of the study was to evaluate the importance of clinical and pathological features in predicting the outcome of multimodality therapy for locally advanced breast cancer. Methods: We retrospectively reviewed the group of 317 breast cancer patients in Center of Oncology in Gliwice from 2000 to 2005. All patients were treaded by multimodality strategy consisting of induction CAF chemotherapy followed by surgery and radiotherapy. Patients with hormone positive tumors received hormonal therapy. Mean age was 49 y and 15% (48 pts) were below 40 y. Forty percent of tumors were in II and 60% in III clinical stage. The mean number of chemotherapy cycles was 5 (range 2−8). All patients were operated. Standard procedure was radical mastectomy in 73% of pts and in 27% breast conserving therapy was feasible. Surgical specimens were analyzed for histology, nodal status and receptor status. Complete clinical response was noted in 89 (32%) pts and complete pathological response was achieved in 76 (24%). Nodal metastases found in 43% of patients and 18% of pts had more than 3 metastatic nodes. Hormonal receptor status was assessed in 258 pts (81%) and 45% were positive. HER 2 /neu status was analyzed in 81pts and overexpression was noted in 14 (17%). Triple negative tumors diagnosed in 22 (7%) cases. Results: At a median follow-up of 68 months, the 5y OS and DFS was 82% and 78% respectively. Disease relapsed in 76 patients (24%). Local relapse was always connected with distant metastases. Sixty four patients died (20%) and all because of breast cancer. There was no statistical difference in survival (OS and DFS) according to the rate of pathological complete response, age and tumor size. OS and DFS were significantly influenced by the clinical stage (II vs. III, OS, p = 0.0019; DFS, p = 0.09), the number of pathologically involved nodes (OS, p = 0.001; DFS, p = 0.0058) and ER/PR receptor status (OS, p = 0.004; DFS, p = 0.004). Triple negative tumors did significantly worse: 5y DFS and OS were 50% and 55% respectively. Conclusion: Clinical stage at presentation, hormone receptor status and the number of pathologically involved nodes were identified as predictors of outcome in locally advanced breast cancer treated with multimodality therapy. Disclosure of Interest: None Declared
P315
Acceptance and adherence with oral endocrine therapy in women with metastatic breast cancer: ExaCampania group study
R. Addeo1 , P. Russo1 , L. Maiorino2 , A. Febraro3 , L. Leo4 , P. Incoronato5 , A. Pisano6 , M. Bianco7 , R. Mabilia8 , S. del Prete9 . 1 U.O. Oncologia, Asl Na2 Nord, Frattamaggiore, 2 U.O. Oncologia, San Gennaro Hospital, Napoli, 3 U.O. Oncologia, Fatebenefratelli Hospital, Benevento, 4 U.O. Oncologia, Aslce, Piedimonte Matese (CE), 5 U.O. Oncologia, Aslna2 Nord Giugliano I (NA), 6 U.O. Oncologia, Aslna2 Nord, Pozzuoli (NA), 7 U.O. Oncologia, Aslna3 Sud Gragnano, 8 U.O. Oncologia, Aslna2 Nord, Ischia, 9 U.O. Oncologia, Asla2 Nord, Frattamaggiore, Italy Goals: Oral agents for anticancer therapy provide an attractive approach for patient acceptance and use of oral treatments is increasing. Adherence (often referred to as compliance) can be defined as he extent to which a patient’s behavior coincides with medical advice. Patient Adherence is critical in evaluating the effectiveness of an oral therapy. We sought to measure acceptance and adherence among women with metastatic breast received an endocrine therapy with Examestane. Methods: Overall 285 patients with histologically proven Breast cancer treated with examestane were enrolled. The level of acceptance was evaluated using a questionnaire with ten questions administered every 3 months