Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Lymph Node Ratio Assessment of Brain Metastasis in Early Breast Cancer Cases

  • Demircioglu, Fatih (Department of Radiation Oncology, Rize Recep Tayyip Erdogan University Hospital) ;
  • Demirci, Umut (Department of Medical Oncology, Ataturk Training and Research Hospital) ;
  • Akmansu, Muge (Department of Radiation Oncology, Gazi University Faculty of Medicine)
  • Published : 2013.03.30
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Abstract

Background: Ten to 30% of early breast cancer (EBC) patients develop brain metastasis (BM) during their follow-up. In this study, we aimed to evaluate importance of the lymph node ratio (LNR) in development of BM in EBC cases. Materials and Methods: Ninety patients whom had axillary metastases in lymph nodes at their initial diagnosis and developed BM during 5-year follow-up were detected in 950 EBC patients. LNR values were calculated for all patients and after categorization into 4 molecular sub-types as luminal A, luminal B HER-2 (+), HER-2 overexpressing and basal- like. Comparison was with control group patients who had similar characteristics. Results: In the comparison of all molecular sub-types of LNR, 54.9% and 28.4% values were found in patients with and without BM respectively (p<0.001). In the comparison of the LNR with control groups, a statistically significant differences were found with luminal A with BM (p=0.001), luminal B HER-2 (p=0.001), HER-2 overexpressing (p=0.027) and basal-like groups (p<0.001). In the evaluation of patients with BM, the highest ratio was found in the basal-like group (67.9%) and there was a statistically significant difference between this group and the others (p=0.048). Conclusions: EBC patients developing BM within 5 years follow-up had significantly higher LNRs for all molecular sub-types, especially in the basal-like group. Larger scale studies are now needed for evaluating LNR prognostic importance for EBC regarding BM development.

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References

  1. Alanko A, Heinonen E, Scheinin T, et al (1985). Significance of estrogen and progesterone receptors, disease-free interval, and site of first metastasis on survival of breast cancer patients. Cancer, 56, 1696-700. https://doi.org/10.1002/1097-0142(19851001)56:7<1696::AID-CNCR2820560738>3.0.CO;2-N
  2. Barnholtz-Sloan JS, Sloan AE, Davis FG, et al (2004). Incidence proportions of brain metastases in patients diagnosed (1973e2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol, 22, 2865-72. https://doi.org/10.1200/JCO.2004.12.149
  3. Chia S, Norris B, Speers C, et al (2008). Human epidermal growth factor receptor 2 overexpression as a prognostic factor in a large tissue microarray series of node-negative breast cancers. J Clin Oncol, 26, 5697-704. https://doi.org/10.1200/JCO.2007.15.8659
  4. Dayan A, Koca D, Akman T, et al (2012). The factors that have an impact on the development of brain metastasis in the patients with breast cancer. J Cancer Res Ther, 8, 542-8. https://doi.org/10.4103/0973-1482.106531
  5. Engel J, Eckel R, Aydemir U (2003). Determinants and prognoses of locoregional and distant progression in breast cancer. Int J Radiat Oncol Biol Phys, 55, 1186-95. https://doi.org/10.1016/S0360-3016(02)04476-0
  6. Goldhirsc A, Wood WC, Coates AS, et al (2011). Strategies for subtypes-dealing with the diversity of breast cancer:highlights of the St. gallen international expert consensus on the primary therapy of early breast cancer 2011. Ann Oncol, 22, 1736-47. https://doi.org/10.1093/annonc/mdr304
  7. Gong Y, Han EY, Guo M, Pusztai L, Sneige L (2011). Stability of estrogen receptor status in breast carcinoma: a comparison between primary and metastatic tumors with regard to disease course and intervening systemic therapy. Cancer, 117, 705-13. https://doi.org/10.1002/cncr.25506
  8. Greene FL, Page DL, Fleming ID, et al (2002). American joint committee on cancer. AJCC Cancer Staging Manual. 6th ed. New York: Springer-Verlag.
  9. Hatoum HA, Jamali FR, El-Saghir NS, et al (2009). Ratio between positive lymph nodes and total excised axillary lymph nodes as an independent prognostic factor for overall survival in patients with nonmetastatic lymph node-positive breast cancer. Ann Surg Oncol, 16, 3388-95. https://doi.org/10.1245/s10434-009-0653-8
  10. Hoefnagel LD, van de Vijver MJ, van Slooten HJ, et al (2010). Receptor conversion in distant breast cancer metastases. Breast Cancer Res, 12, 75. https://doi.org/10.1186/bcr2645
  11. Karlsson E, Lindstrom LS, Wilking U, Skoog L, Johansson U (2010). Discordance in hormone receptor status in breast cancer during tumor progression. J Clin Oncol, 28, 1009.
  12. Kennecke H, Yerushalmi R, Woods R, et al (2010). Metastatic Behavior of Breast Cancer Subtypes. J Clin Oncol, 28, 3271-7. https://doi.org/10.1200/JCO.2009.25.9820
  13. Li Y, Holmes E, Shah K, et al (2012). The prognostic value of lymph node cross-sectional cancer area in node-positive breast cancer: a comparison with N stage and lymph node ratio. Patholog Res Int, 2012, 161964.
  14. Lin NU, Bellon JR, Winer EP (2004). CNS metastases in breast cancer. J Clin Oncol, 22, 3608-17. https://doi.org/10.1200/JCO.2004.01.175
  15. Vinh-Hung V, Nguyen NP, Cserni G, et al (2009). Prognostic value of nodal ratios in node-positive breast cancer: a compiled update. Future Oncol, 5, 1585-603. https://doi.org/10.2217/fon.09.129
  16. Vinh-Hung V, Verkooijen HM, Fioretta G, et al (2009). Lymph node ratio as an alternative to pN staging in node-positive breast cancer. J Clin Oncol, 27, 1062-8. https://doi.org/10.1200/JCO.2008.18.6965
  17. Woodward WA, Vinh-Hung V, Ueno NT, et al (2006). Prognostic value of nodal ratios in node-positive breast cancer. J Clin Oncol, 24, 2910-6. https://doi.org/10.1200/JCO.2005.03.1526
  18. Ziaei JE, Pourzand A, Bayat A, Vaez J (2012). Patterns of metastasis and survival in breast cancer patients: a preliminary study in an Iranian population. Asian Pac J Cancer Prev, 13, 937-40. https://doi.org/10.7314/APJCP.2012.13.3.937

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