Hypertensive patients have a higher risk of atrial and ventricular arrhythmias, depending on the degree of LV hypertrophy. But atrial arrhythmias, in contrary to ventricular arrhythmias, are also closely related to abnormalities in LV diastolic function.
Mastectomy rates in comparable health systems differ. Performance of preoperative breast MRI and hospital volume seem to be independent influencing factors for mastectomy rates.
Background: Neoadjuvant chemotherapy (NACT) is increasingly used globally in clinical trials for breast cancer patients. In Germany, NACT has been implemented as a standard option of care for almost a decade. In a population-based benchmark cohort study, the West German Breast Center (WBC) recorded approximately 50% of all breast cancer cases diagnosed in Germany between 2007 and 2010. We compare baseline and treatment pattern of patients treated either with adjuvant (ACT) or NACT. Methods: Approx. 200 accredited breast centers treated 115169 primary breast cancer patients of whom 32609 received ACT and 6795 NACT. Pathological complete response (pCR) was stated if no invasive and no non-invasive tumor residues (ypT0 ypN0) were detected. Follow up information was available for 55% of patients. Results: Use of NACT increased from 16.4% in 2007 to 19.1% in 2010 (p<.0001). Patients treated with NACT were younger, had higher clinical nodal involvement, fewer lobular-invasive cancers, more undifferentiated, hormone-receptor-negative, and HER2-positive cancers, and more multicentric tumors compared to patients treated with ACT (all p<0.002). 34% of patients in the NACT group had cT3/4 tumors compared to 7.7% of pT3/4 tumors in the ACT group. cN0 status was twice as frequent (70.6% vs 37.7%, p<.0001) whereas pN0 status was reported less frequently (47.4% vs 51.4%, p<0.0001) in the ACT and NACT group, respectively. Time between diagnosis and start of systemic treatment or surgery was in median 12 (range 1-902) and 22 (range 1-721) days in the ACT and NACT group, respectively (p<.0001). 66.2% and 91.4% of patients received ACT and NACT with a taxane, respectively (p<.0001). 9.7% and 37.5% of patients receiving treatment for > = 18 weeks, respectively. 35.2% and 69.9% of patients with HER2-positive tumors received adjuvant or neoadjuvant trastuzumab, respectively (p<.0001). 21.7% and 31.4% of patients were treated in ACT or NACT clinical trials, respectively (p<.0001). Breast conservation was possible in 69.4% and 55.2% in the ACT and NACT group, respectively (p<.0001). 30.5% and 37.5% needed two or more surgical interventions in the ACT and NACT group, respectively (p<.0001). Multivariable logistic regression analysis confirmed taxane- and trastuzumab-based treatment, study participation, age, histologic type, grading, and hormone-receptor status as independent predictors of pCR. pCR rate was not dependent on the time between diagnosis and start of treatment or the time between end of chemotherapy and surgery. In univariate analysis patients receiving NACT showed a 4-year overall survival rate of 78%, compared to 92% in patients receiving ACT (p<.0001). However, patients with a pCR after NACT showed a comparable survival to patients in the ACT group, whereas patients without a pCR showed a 4-year overall survival rate of 76%. In the hormone-receptor-positive/HER2-positive and even more in the triple-negative subgroup, survival of patients with a pCR appeared better than in patients with ACT. Conclusion: In this population-based study, NACT was used in patients with unfavorable risk factors and was more intense than ACT. Outcome of patients with pCR after NACT was similar and in aggressive tumor subtypes even better than after ACT. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-01.
106 Background: TNBC is associated with distinctly worse survival rates than non-TNBC unless a pCR is achieved (Liedtke C et al. J Clin Oncol. 2008;26:1275-1281) or almost achieved (Symmans WF. J Clin Oncol. 2007;25:4414-4422). Recent pooled analyses pointed out that pCR defined as "no invasive and no in situ residuals in breast and lymph nodes" can best discriminate between patients with favorable and unfavorable outcomes (Minckwitz von G. J Clin Oncol. 16 April 2012). However, no differentiation has been made with regard to the prognosis within the category of "gross disease" (non-pCR, > 5 mm) after primary systemic therapy (PST). Methods: In this retrospective case series study, we analyzed 506 non-pCR patients out of a cohort of 16,196 patients with neoadjuvant or adjuvant chemotherapy from breast units of the West German Breast Center (WBC) at 24 months after surgery. Results: Overall survival (OS) differed significantly between the non-pCR groups ypT1 a (88%) and ypT1b,c (both 77%) likewise the disease-free survival (DFS) was 79% versus 63% (p< 0.05) at 24 months after surgery. Beyond ypT1-stage, we found that ypT1+2 and ypT3+4 set up two significantly distinct groups in OS and DFS, with OS rates of 79% for ypT1+2 and 60% respectively 68% for ypT3 and ypT4. DFS rates were alike differing with 68 % and 62 % for ypT 1 and ypT2 from both ypT3 and ypT4 (20% and 28%). Distant disease free survival (DDFS) was markedly superior in ypT1a (93%) and ypT1b (88%) versus ypT1c (77%). Stage-dependent DDFS was 82% for ypT1 respectively 81% for ypT2 and thus significantly different from stages ypT3 and ypT4 (43% and 52%) (p< 0.05). Conclusions: Risk stratification currently is made dichotomously: pCR and non-pCR. However it does not differentiate within the group of non-pCR. This case cohort trial investigates the prognosis of non-pCR according to the actual size of the residual disease. Overall survival at 24 months after surgery has to be differentiated between the groups ypT1a and ypTb,c and moreover between ypT1+2 and ypT3+4. This is to our knowledge the largest case cohort study analyzing the effect of gross residual disease on prognosis of patients with TNBC demonstrating: size does matter.
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