Residual metastatic axillary lymph nodes following neoadjuvant chemotherapy predict disease-free survival in patients with locally advanced breast cancer

Kuerer, Henry Mark; Newman, Lisa A.; Buzdar, Aman U.; Hunt, Kelly K.; Dhingra, Kapil; Buchholz, Thomas A.; Binkley, Susan M.; Ames, Frederick C.; Feig, Barry W.; Ross, Merrick I.; Hortobágyi, Gabriel N.; Singletary, S. Eva

doi:10.1016/s0002-9610(98)00253-0

Cited by 142 publications

(80 citation statements)

References 16 publications

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“…The correlation of RAR-b2 with the presence of macroscopic SLN metastasis was significant. Tumor burden in the lymph nodes is a significant prognosticator of patient outcome (37). However, the clinical implication of occult tumor cells in lymph nodes remains a controversial issue (38,39).…”

Section: Discussionmentioning

confidence: 99%

Distinct Hypermethylation Profile of Primary Breast Cancer Is Associated with Sentinel Lymph Node Metastasis

Shinozaki

Hoon

Giuliano

et al. 2005

Clinical Cancer Research

152

132

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Purpose: Gene promoter region hypermethylation is a significant event in primary breast cancer. However, its impact on tumor progression and potential predictive implications remain relatively unknown.Experimental Design: We conducted hypermethylation profiling of 151 primary breast tumors with association to known prognostic factors in breast cancer using methylationspecific PCR for six known tumor suppressor and related genes: RASSF1A, APC, TWIST, CDH1, GSTP1, and RAR-B B2. Furthermore, correlation with sentinel lymph node (SLN) tumor status was assessed as it represents the earliest stage of metastasis that is readily detected. Hypermethylation for any one gene was identified in 147 (97%) of 151 primary breast tumors. The most frequently hypermethylated gene was RASSF1A (81%).Results: Hypermethylation of the CDH1 was significantly associated with primary breast tumors demonstrating lymphovascular invasion (P = 0.008), infiltrating ductal histology (P = 0.03), and negative for the estrogen receptor (P = 0.005), whereas RASSF1A and RAR-B B2 gene hypermethylation were significantly more common in estrogen receptor -positive (P < 0.001) and human epidermal growth factor receptor 2 -positive (P < 0.001) tumors, respectively. In multivariate analysis, hypermethylation of GSTP1 and/or RAR-B B2 was significantly associated with patients having macroscopic SLN metastasis compared with those with microscopic or no sentinel node metastasis (odds ratio, 4.59; 95% confidence interval, 2.02-10.4; P < 0.001). In paired SLN metastasis, CDH1 was the most frequently methylated gene (90%) and provides evidence in patients corroborating its role in the clinical development of metastasis.Conclusion: Hypermethylation profiling of primary breast tumors is significantly associated with known pathologic prognostic factors and may have additional clinical and pathologic utility for assessing patient prognosis and predicting early regional metastasis.

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Section: Discussionmentioning

confidence: 99%

Distinct Hypermethylation Profile of Primary Breast Cancer Is Associated with Sentinel Lymph Node Metastasis

Shinozaki

Hoon

Giuliano

et al. 2005

Clinical Cancer Research

152

132

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“…Pathological complete response (pCR) is clinically significant because it is associated with improved long-term prognosis and decreased risk of recurrence [6,8]. Decisions regarding the continuation of current regimens and the appropriate type and timing of surgery depend on the radiological and clinical assessment of residual tumour size during neoadjuvant chemotherapy [9,10].…”

mentioning

confidence: 99%

Comparison of mammography, sonography, MRI and clinical examination in patients with locally advanced or inflammatory breast cancer who underwent neoadjuvant chemotherapy

Hj¹,

Kim²,

Jh³

et al. 2011

BJR

103

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Objectives: The purpose of this study was to determine the relative accuracies of mammography, sonography, MRI and clinical examination in predicting residual tumour size and pathological response after neoadjuvant chemotherapy for locally advanced or inflammatory breast cancer. Each prediction method was compared with the gold standard of surgical pathology. Methods: 43 patients (age range, 25-62 years; mean age, 42.7 years) with locally advanced or inflammatory breast cancer who had been treated by neoadjuvant chemotherapy were enrolled prospectively. We compared the predicted residual tumour size and the predicted response on imaging and clinical examination with residual tumour size and response on pathology. Statistical analysis was performed using weighted kappa statistics and intraclass correlation coefficients (ICC). Conclusion:Predictions of response and residual tumour size made on MRI were better correlated with the assessments of response and residual tumour size made upon pathology than were predictions made on the basis of clinical examination, mammography or sonography. Thus, the evaluation of predicted response using MRI could provide a relatively sensitive early assessment of chemotherapy efficacy.

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“…19,20 The risk of local recurrence is determined by the initial clinical stage and the pathologic stage after neoadjuvant therapy. 21 Neoadjuvant therapy is indicated in patients with inoperable tumors or if BCT is desired by patients with large tumors otherwise requiring mastectomy. Patients with multicentric tumors generally will not become candidates for BCT with this approach.…”

Section: Local Treatment After Neoadjuvant Systemic Therapymentioning

confidence: 99%

Locoregional treatment of primary breast cancer

Kaufmann

Morrow

Minckwitz

et al. 2010

Cancer

190

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Expert Panel MembersGuidelines for the locoregional treatment of primary breast cancer were last published by the US National Institutes of Health in 1991. Since then, new surgical and radiotherapeutic techniques have been developed, clinical trials have provided new evidence, and intriguing long-term effects have emerged from global metadatabases. A revision of these guidelines is therefore necessary and timely.

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Residual metastatic axillary lymph nodes following neoadjuvant chemotherapy predict disease-free survival in patients with locally advanced breast cancer

Cited by 142 publications

References 16 publications

Distinct Hypermethylation Profile of Primary Breast Cancer Is Associated with Sentinel Lymph Node Metastasis

Distinct Hypermethylation Profile of Primary Breast Cancer Is Associated with Sentinel Lymph Node Metastasis

Comparison of mammography, sonography, MRI and clinical examination in patients with locally advanced or inflammatory breast cancer who underwent neoadjuvant chemotherapy

Locoregional treatment of primary breast cancer

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