Evaluating TIMP‐1, Ki67, and HER2 as markers for non‐sentinel node metastases in breast cancer patients with micrometastases to the sentinel node

Tvedskov, Tove Filtenborg; Bartels, Annette; Jensen, Maj‐Britt; Paaschburg, Birgitte; Kroman, Niels; Balslev, Eva; Brünner, Nils

doi:10.1111/j.1600-0463.2011.02768.x

Cited by 13 publications

(7 citation statements)

References 49 publications

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“…41 In an earlier minor study, we have tested the ability of Ki67 to predict NSN metastases in breast cancer patients with micrometastases in the sentinel node from a single institution. 42 We found no association between Ki67 and NSN metastases. Ki67 was not measured as a routine in patients included in our study and these earlier results did not justify new analyses of Ki67.…”

Section: Discussioncontrasting

confidence: 52%

High risk of non‐sentinel node metastases in a group of breast cancer patients with micrometastases in the sentinel node

Tvedskov

Jensen

Lisse

et al. 2012

Intl Journal of Cancer

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Axillary lymph node dissection (ALND) in breast cancer patients with positive sentinel nodes is under debate. We aimed to establish two models to predict non-sentinel node (NSN) metastases in patients with micrometastases or isolated tumor cells (ITC) in sentinel nodes, to guide the decision for ALND. A total of 1,577 breast cancer patients with micrometastases and 304 with ITC in sentinel nodes, treated by sentinel lymph node dissection and ALND in [2002][2003][2004][2005][2006][2007][2008] were identified in the Danish Breast Cancer Cooperative Group database. Risk of NSN metastases was calculated according to clinicopathological variables in a logistic regression analysis. We identified tumor size, proportion of positive sentinel nodes, lymphovascular invasion, hormone receptor status and location of tumor in upper lateral quadrant of the breast as risk factors for NSN metastases in patients with micrometastases. A model based on these risk factors identified 5% of patients with a risk of NSN metastases on nearly 40%. The model was however unable to identify a subgroup of patients with a very low risk of NSN metastases. Among patients with ITC, we identified tumor size, age and proportion of positive sentinel nodes as risk factors. A model based on these risk factors identified 32% of patients with risk of NSN metastases on only 2%. Omission of ALND would be acceptable in this group of patients. In contrast, ALND may still be beneficial in the subgroup of patients with micrometastases and a high risk of NSN metastases.Axillary nodal status is the most important prognostic factor in breast cancer. Axillary lymph node dissection (ALND) has previously been standard procedure for staging of the axilla, but ALND is associated with considerable arm morbidity 1,2 and is redundant for women without lymph node metastases. Sentinel lymph node dissection (SLND) causes limited arm morbidity compared to ALND 3,2 and has, therefore, gradually replaced ALND as standard procedure for staging of the axilla. SLND allows more extensive histopathological examinations of the lymph nodes and as a result more metastases, especially more micrometastases and isolated tumor cells (ITC), are found. 4,5 Micrometastases are in Denmark defined as metastases measuring between 0.2 and 2 mm or between 10 and 100 tumor cells and ITC are defined as single cells or cell clusters <0.2 mm or <10 cells. 6 Sentinel node positive patients have generally been recommended additional ALND even if only micrometastases or ITC are found in the sentinel node. However, metaanalyses have shown that only about 20% of patients with micrometastases 7 and 12% of patients with ITC 8 in the sentinel node have metastatic spread to non-sentinel node (NSN) and the benefit from ALND in these patients is now under debate. 9,10 A recent randomized trial from the American College of Surgeons Oncology Group (Z0011) could not show any difference in axillary recurrence and survival between sentinel node positive patients with or without ALND.10 However, the study was closed...

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Section: Discussioncontrasting

confidence: 52%

High risk of non‐sentinel node metastases in a group of breast cancer patients with micrometastases in the sentinel node

Tvedskov

Jensen

Lisse

et al. 2012

Intl Journal of Cancer

Self Cite

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“…It has been shown that large interlaboratory variability exists in the measurements of Ki67, making it difficult to compare results from several different departments 41. In an earlier minor study, we have tested the ability of Ki67 to predict NSN metastases in breast cancer patients with micrometastases in the sentinel node from a single institution 42. We found no association between Ki67 and NSN metastases.…”

Section: Discussionmentioning

confidence: 87%

Adalimumab in severe and acute sciatica: A multicenter, randomized, double‐blind, placebo‐controlled trial

Genevay¹,

Viatte²,

Finckh³

et al. 2010

Arthritis & Rheumatism

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Objective. Based on several experimental results and on a preliminary study, a trial was undertaken to assess the efficacy of adalimumab, a tumor necrosis factor ␣ inhibitor, in patients with radicular pain due to lumbar disc herniation.Methods. A multicenter, double-blind, randomized controlled trial was conducted between May 2005 and December 2007 in Switzerland. Patients with acute (duration of <12 weeks) and severe (Oswestry Disability Index score of >50) radicular leg pain and imagingconfirmed lumbar disc herniation were randomized to receive as adjuvant therapy either 2 subcutaneous injections of adalimumab (40 mg) at 7-day intervals or matching placebo. The primary outcome was the score for leg pain, based on a visual analog scale (0-100 mm), which was recorded every day for 10 days and at 6 weeks and 6 months.Results. Of the 265 patients screened, 61 were enrolled; 31 patients were assigned to receive adalimumab, and 4 patients in the placebo group were lost to followup. Over time, the course of leg pain was more favorable in the adalimumab group than in the placebo group (P ‫؍‬ 0.002). However, the effect size was relatively small, and at the last followup visit the difference was 13.8 (95% confidence interval ؊11.5, 39.0). Compared with patients in the placebo group, approximately twice as many patients in the adalimumab group fulfilled the criteria for "responders" and for "low residual disease impact" (P < 0.05), and fewer surgical discectomies were performed (6 versus 13 in the placebo group; P ‫؍‬ 0.04).Conclusion. The addition of a short course of adalimumab to the treatment regimen of patients experiencing acute and severe sciatica resulted in a small decrease in leg pain and in significantly fewer surgical procedures.

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“…The expansion includes human epidermal growth factor receptor 2 (HER2) status, level of proliferation markers (Ki-67 mitotic index) and the biological type of breast cancer, which became indispensable when making decisions regarding the planned course of treatment [2,7,8,9,10,11,12,13].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of biological types of breast cancer and their influence on disease staging and therapeutic management – a single-center study

Nowikiewicz¹,

Chmielowska²,

Andrusewicz³

et al. 2017

pjp

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According to the St. Gallen 2011 consensus, proper qualification of breast cancer patients for treatment requires taking into consideration the division into biological types of neoplasms. The goal of this work was to assess the prevalence of all biological types of breast cancer in the population of Kuyavian-Pomeranian province. We determined the influence of particular types of neoplasms on the degree of disease progression and the choice of therapeutic management. The study was conducted on a group of 2653 patients treated surgically due to malignant breast tumors in the Oncology Centre in Bydgoszcz. In the analyzed clinical material we determined the biological type of cancer as well as other prognostic factors. The most commonly identified types of cancer were luminal B1 type (38.4%) and luminal A type (27.4% of cases), followed by a triple-negative type, luminal B2 type and HER2-positive type (respectively: 11.4%, 10.2%, and 6.9% of patients). Estrogen receptors were present in 81.1% and progesterone receptors in 71.4% of subjects. HER2 overexpression was identified in 17.3% of patients. Routine use of a biology-based division into cancer types influences the choice of anti-cancer treatment. Diagnosis of luminal A type of tumor more commonly than other biological types of cancer coexists with lower clinical and pathological disease staging. It allows for more frequent use of sparing surgical techniques in patients. It also makes systemic neoadjuvant chemotherapy unnecessary in the majority of patients (differences in such cases exhibit statistical significance of p < 0.0001).

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Evaluating TIMP‐1, Ki67, and HER2 as markers for non‐sentinel node metastases in breast cancer patients with micrometastases to the sentinel node

Cited by 13 publications

References 49 publications

High risk of non‐sentinel node metastases in a group of breast cancer patients with micrometastases in the sentinel node

High risk of non‐sentinel node metastases in a group of breast cancer patients with micrometastases in the sentinel node

Adalimumab in severe and acute sciatica: A multicenter, randomized, double‐blind, placebo‐controlled trial

Prevalence of biological types of breast cancer and their influence on disease staging and therapeutic management – a single-center study

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