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Using nodal ratio to predict recurrence in patients with 4 or more positive lymph nodes early stage breast cancer
abstracts
301P
A novel PET parameter for cancer stem cell metabolism: Early prediction of chemosensitivity to neoadjuvant chemotherapy in locally advanced breast cancer
C. Kim1, H.J. Choi2 1 Nuclear Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea, 2Nuclear Medicine, Hanyang University Medical Center, Seoul, Republic of Korea Background: Early predicting the pathologic complete response (pCR) after neoadjuvant chemotherapy in patients with locally advanced breast cancer (LABC) is closely associated with clinical outcomes. However, conventional metabolic parameters using baseline 18F-FDG PET/CT have failed to accurately predict the pCR. Breast cancer stem cells (CSCs) are known for their established role in chemoresistance. We designed a new PET parameter for CSC metabolism (MTVcsc) from pretreatment 18F-FDG PET/ CT by using distinctive glucose metabolism between CSCs and differentiated cancer cells, and aimed to evaluate the prognostic value of the MTVcsc. Methods: A total of 71 patients with LABC who underwent initial 18F-FDG PET/CT before NAC were included in this study. The SUV values of single voxels within the primary tumor were clustered by performing k-means clustering using R version 3.5.3 and MTVcsc was derived by calculating the volume of the most glycolytic cluster. The predictive values of the MTVcsc, as well as clinicopathologic and conventional metabolic parameters (SUVmax, MTV, TLG) for pCR, were analyzed by multivariable logistic regression. Results: Seventeen patients were excluded from the final analysis due to small tumor size (< 64 voxels). The lower MTVcsc and non-luminal subtypes were significantly associated with achieving pCR following NAC (Table). The MTVcsc outperformed the conventional PET parameters in predicting pCR. Table Univariable and multivariable logistic regression model of clinicopathologic and metabolic parameters for predicting pathologic complete response. Conclusions: MTVcsc, a novel PET parameter for CSC metabolism, provides predictive value for pCR. By further stratifying LABC patients with a combination of MTVcsc and molecular subtype at initial staging workup, achieving pCR after NAC can be early predicted more accurately. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
v102 | Breast Cancer, Locally Advanced
302P
Using nodal ratio to predict recurrence in patients with 4 or more positive lymph nodes early stage breast cancer
B. Graja, M. Nesrine, A. Ghorbel, H. El Benna, Y. Berrazega, N. Daoud, S. Labidi, H. Boussen Medical Oncology, Abderrahmen Mami Hospital, Tunis, Tunisia Background: The purpose of this study was to evaluate the prognostic value of nodal ratio compared to the absolute number of positive lymph nodes in patients with 4 positives nodes early-stage breast cancer. Methods: Between 2010-2015, we identified 111 patients with early-stage pN2-N3 breast cancer. All patients were treated with curative intent and had at least 8 resected lymph nodes. We calculated nodal ratio (NR¼positive over excised lymph nodes) for each patient. Several prognostic factors were evaluated. The Cox proportional hazard model was used to evaluate the prognostic significance for relapse-free survival and overall survival. Results: Median age was 50 years old. Lymph node involvement was pN2 in 61.3% of cases and pN3 in 38.7% of cases. Median tumor size was 46 mm. Hormonal receptors were positive in 73.9% of cases. Her2 Neu was overexpressed in 32.4% of cases. Relapse rate was 34.2% (locoregional 36.2%, metastatic in 63.8%). After a median follow-up of 44 months, we did not observe any difference in terms of relapse rate (30% vs 40%, p ¼ 0.19), time to relapse (25 months, p ¼ 0.94), relapse-free survival and overall survival according to absolute number of involved lymph nodes (pN2 vs pN3 groups). NR 60% was significantly correlated with relapse rate (24% vs 53%, p ¼ 0.02). There was no impact of NR on time to relapse (24 vs 26 months p ¼ 0.81). In univariate analysis we observed a significant difference in 5-year relapse-free survival between patients with NR < 60% vs NR 60% (59% vs 49%, p ¼ 0.04). In multivariate analysis including: grade, hormonal receptors, HER2, Ki67, we observed that NR was as an independent prognostic factor for relapse-free survival. There was no impact on overall survival. Conclusions: NR 60% predicted relapse-free survival better than the absolute number of involved lymph nodes in pN2 and pN3 early-stage breast cancer. Legal entity responsible for the study: Abderrahmen Mami Hospital. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
303P
Re-sentinel node biopsy for local recurrence after breast-conserving surgery
Y. Matsubara1, T. Yamanaka1, T. Yamashita1, S. Okamoto1, S. Toda1, K. Kohagura1, Y. Sugawara1, A. Yamanaka1, N. Suganuma1, H. Nakayama2, T. Yoshida2, H. Iwasaki1, Y. Rino2, M. Masuda2 1 Breast And Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan, 2Surgery, Yokohama City University, Yokohama, Japan Background: The usefulness of re-sentinel node biopsy (re-SNB) is unclear in the management of patients with ipsilateral recurrent breast cancer. Methods: We retrospectively reviewed 52 patients with locally recurrent breast cancer who underwent re-SNB from July 2012 to March 2019. Both radioactive colloid and indocyanine green were used in all cases. Results: Forty-four patients were after SNB and 8 were after axillary lymph node dissection(ALND). SLNs were successfully visualized by lymphoscintigraphy in 94.2% (49/52) of cases (95.4% post-SNB vs. 87.5% post-ALND, Fisher’s exact test, p ¼ 0.401). Among post-SNB patients with successful mapping, 50% had SLNs only in ipsilateral
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz241.010/5576810 by guest on 09 October 2019
p ¼ 0,001) were associated with DFS but no pCR (p ¼ 0,051). On multivariate analysis, only delta TIL remainedstatistically significant (HR ¼ 1.9 [95% CI, 1.1–3.4], p ¼ 0.03). Conclusions: We showed in this retrospective series of 30 TNIBC that dose dense dose intense chemotherapy is efficient in this population. Delta TIL is a strong prognostic factor associated with DFS. We show that a positive Delta TILis, among others, a strong and independent predictor of DFS: in TNIBC contrary to the results obtained in TN non inflammatory breast cancers, an increase in TIL after chemotherapy is associated with a decrease in DFS.The exact impact of LVI must be further investigated. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology
301P
A novel PET parameter for cancer stem cell metabolism: Early prediction of chemosensitivity to neoadjuvant chemotherapy in locally advanced breast cancer
C. Kim1, H.J. Choi2 1 Nuclear Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea, 2Nuclear Medicine, Hanyang University Medical Center, Seoul, Republic of Korea Background: Early predicting the pathologic complete response (pCR) after neoadjuvant chemotherapy in patients with locally advanced breast cancer (LABC) is closely associated with clinical outcomes. However, conventional metabolic parameters using baseline 18F-FDG PET/CT have failed to accurately predict the pCR. Breast cancer stem cells (CSCs) are known for their established role in chemoresistance. We designed a new PET parameter for CSC metabolism (MTVcsc) from pretreatment 18F-FDG PET/ CT by using distinctive glucose metabolism between CSCs and differentiated cancer cells, and aimed to evaluate the prognostic value of the MTVcsc. Methods: A total of 71 patients with LABC who underwent initial 18F-FDG PET/CT before NAC were included in this study. The SUV values of single voxels within the primary tumor were clustered by performing k-means clustering using R version 3.5.3 and MTVcsc was derived by calculating the volume of the most glycolytic cluster. The predictive values of the MTVcsc, as well as clinicopathologic and conventional metabolic parameters (SUVmax, MTV, TLG) for pCR, were analyzed by multivariable logistic regression. Results: Seventeen patients were excluded from the final analysis due to small tumor size (< 64 voxels). The lower MTVcsc and non-luminal subtypes were significantly associated with achieving pCR following NAC (Table). The MTVcsc outperformed the conventional PET parameters in predicting pCR. Table Univariable and multivariable logistic regression model of clinicopathologic and metabolic parameters for predicting pathologic complete response. Conclusions: MTVcsc, a novel PET parameter for CSC metabolism, provides predictive value for pCR. By further stratifying LABC patients with a combination of MTVcsc and molecular subtype at initial staging workup, achieving pCR after NAC can be early predicted more accurately. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
v102 | Breast Cancer, Locally Advanced
302P
Using nodal ratio to predict recurrence in patients with 4 or more positive lymph nodes early stage breast cancer
B. Graja, M. Nesrine, A. Ghorbel, H. El Benna, Y. Berrazega, N. Daoud, S. Labidi, H. Boussen Medical Oncology, Abderrahmen Mami Hospital, Tunis, Tunisia Background: The purpose of this study was to evaluate the prognostic value of nodal ratio compared to the absolute number of positive lymph nodes in patients with 4 positives nodes early-stage breast cancer. Methods: Between 2010-2015, we identified 111 patients with early-stage pN2-N3 breast cancer. All patients were treated with curative intent and had at least 8 resected lymph nodes. We calculated nodal ratio (NR¼positive over excised lymph nodes) for each patient. Several prognostic factors were evaluated. The Cox proportional hazard model was used to evaluate the prognostic significance for relapse-free survival and overall survival. Results: Median age was 50 years old. Lymph node involvement was pN2 in 61.3% of cases and pN3 in 38.7% of cases. Median tumor size was 46 mm. Hormonal receptors were positive in 73.9% of cases. Her2 Neu was overexpressed in 32.4% of cases. Relapse rate was 34.2% (locoregional 36.2%, metastatic in 63.8%). After a median follow-up of 44 months, we did not observe any difference in terms of relapse rate (30% vs 40%, p ¼ 0.19), time to relapse (25 months, p ¼ 0.94), relapse-free survival and overall survival according to absolute number of involved lymph nodes (pN2 vs pN3 groups). NR 60% was significantly correlated with relapse rate (24% vs 53%, p ¼ 0.02). There was no impact of NR on time to relapse (24 vs 26 months p ¼ 0.81). In univariate analysis we observed a significant difference in 5-year relapse-free survival between patients with NR < 60% vs NR 60% (59% vs 49%, p ¼ 0.04). In multivariate analysis including: grade, hormonal receptors, HER2, Ki67, we observed that NR was as an independent prognostic factor for relapse-free survival. There was no impact on overall survival. Conclusions: NR 60% predicted relapse-free survival better than the absolute number of involved lymph nodes in pN2 and pN3 early-stage breast cancer. Legal entity responsible for the study: Abderrahmen Mami Hospital. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
303P
Re-sentinel node biopsy for local recurrence after breast-conserving surgery
Y. Matsubara1, T. Yamanaka1, T. Yamashita1, S. Okamoto1, S. Toda1, K. Kohagura1, Y. Sugawara1, A. Yamanaka1, N. Suganuma1, H. Nakayama2, T. Yoshida2, H. Iwasaki1, Y. Rino2, M. Masuda2 1 Breast And Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan, 2Surgery, Yokohama City University, Yokohama, Japan Background: The usefulness of re-sentinel node biopsy (re-SNB) is unclear in the management of patients with ipsilateral recurrent breast cancer. Methods: We retrospectively reviewed 52 patients with locally recurrent breast cancer who underwent re-SNB from July 2012 to March 2019. Both radioactive colloid and indocyanine green were used in all cases. Results: Forty-four patients were after SNB and 8 were after axillary lymph node dissection(ALND). SLNs were successfully visualized by lymphoscintigraphy in 94.2% (49/52) of cases (95.4% post-SNB vs. 87.5% post-ALND, Fisher’s exact test, p ¼ 0.401). Among post-SNB patients with successful mapping, 50% had SLNs only in ipsilateral
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz241.010/5576810 by guest on 09 October 2019
p ¼ 0,001) were associated with DFS but no pCR (p ¼ 0,051). On multivariate analysis, only delta TIL remainedstatistically significant (HR ¼ 1.9 [95% CI, 1.1–3.4], p ¼ 0.03). Conclusions: We showed in this retrospective series of 30 TNIBC that dose dense dose intense chemotherapy is efficient in this population. Delta TIL is a strong prognostic factor associated with DFS. We show that a positive Delta TILis, among others, a strong and independent predictor of DFS: in TNIBC contrary to the results obtained in TN non inflammatory breast cancers, an increase in TIL after chemotherapy is associated with a decrease in DFS.The exact impact of LVI must be further investigated. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology