MCC is an aggressive cancer, with a high tendency for local recurrence and distant spread. Surgery and adjuvant radiotherapy appear to provide optimal local control. The role of chemotherapy remains to be defined.
ObjectiveTo examine the incidence of local recurrence (LR) and factors associated with it in a population of patients who underwent skin-sparing mastectomy (SSM) and immediate reconstruction for invasive carcinoma. Summary Background DataThe efficacy of SSM has been challenged by concerns about increased risks of LR. MethodsA consecutive series of 173 patients (176 cancers) with invasive carcinoma underwent SSM and immediate breast reconstruction (June 1986 to December 1997). Data were analyzed by the Kaplan-Meier method, the log-rank statistic test, and the Cox proportional hazards model. ResultsMean patient age was 47 Ϯ 9 years (27% were 40 or younger). The AJCC stages were 1 ϭ 43%, 2 ϭ 52%, and 3 ϭ 5%.Thirty percent of tumors were poorly differentiated. With a median follow-up of 73 months, the LR rate was 4.5%. The mean local relapse-free interval was 26 months. Seventy-five percent of patients who presented with LR developed distant metastases and died of disease within a mean of 21 months. On univariate analysis, factors associated with higher LR rate were tumor stage 2 or 3, tumor size larger than 2 cm, nodepositive disease, and poor tumor differentiation. Actuarial 1-, 3-, and 5-year overall survival rates were 98%, 94%, and 88%, respectively. On multivariate analysis, factors associated with decreased survival were advanced stage, presence of LR, and absence of hormone therapy. LR was a highly significant predictor of tumor-related death. ConclusionsThere is a low incidence of LR after SSM, and it is associated with advanced disease at presentation. LR is an independent risk factor for tumor-related death.Skin-sparing mastectomy (SSM) has been advocated as an oncologically safe approach for the management of patients with early-stage breast cancer. This operation also minimizes deformity and improves cosmesis through preservation of the skin envelope of the breast.1-5 Chest wall skin is a common site of local failure after mastectomy, and the incidence of this event after SSM has been reported to be 0% 5 to 7%. 6 Although the results of SSM have been analyzed in previous reports, many of these series included patients with invasive and noninvasive breast cancer with variable lengths of follow-up. The objective of this study was to examine survival rates, incidence of local recurrence (LR), and factors associated with it in a population of patients who underwent SSM and immediate breast reconstruction for invasive breast cancer at a single institution. METHODSA retrospective review was performed of patients who underwent SSM and immediate breast reconstruction from Correspondence: Marshall M.
Our findings emphasize the need for detection of early-stage disease combined with complete surgical extirpation of the cancer, which provide the patient with the best chance for locoregional control and long-term survival.
ObjectiveTo assess the prognostic significance of molecular biomarkers, particularly c-erbB-2 and p53, through study of prospective clinical data and archival breast cancer tissues for women accrued to the Alabama Breast Cancer Project. Summary Background DataDefining molecular abnormalities in breast cancer is an important strategy for early detection, assessment of prognosis, and treatment selection. Evidence is strong that selective biomarkers, including c-erbB-2 and p53, have prognostic significance in breast cancer. Few studies have analyzed the prognostic significance of coexpression of biomarkers. MethodsStudy patients were those accrued to the Alabama Breast Cancer Project (1975Project ( -1978 who had archival breast cancer tissues available for analysis. Criteria for entrance into the Alabama Breast Cancer Project were T1-3 breast cancer with M0 status. Age, nodal status, and histologic grade were also documented. Patients were randomized to radical versus modified radical mastectomy, and node-positive patients were also randomized to adjuvant chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil [CMF]) versus melphalan. Archival breast cancer tissues were studied for c-erbB-2, TGF-␣, p53, cathepsin D, bcl-2, and estrogen and progesterone receptor expression using immunohistochemistry. Survival curves were developed using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test, multivariate analysis using a rank regression model. ResultsThree hundred eleven patients were accrued to the Alabama Breast Cancer Project, and paraffin-embedded breast cancer tissues for 90 patients were available for immunohistochemical analysis of molecular biomarkers. Univariate analysis showed nodal status, c-erbB-2 expression, and p53 expression to have prognostic significance. Coexpression of c-erbB-2 and p53 was also found to have prognostic significance by the log-rank test. Multivariate analysis showed T stage, nodal status, c-erbB-2 expression, and p53 expression to have independent prognostic significance. ConclusionsThese data suggest that c-erbB-2 and p53 expression in breast cancer have prognostic significance. After median follow-up of 16 years, coexpression of c-erbB-2 and p53 may have more prognostic significance than traditional prognostic factors such as T stage and nodal status. Prospective study of large numbers of patients with breast cancer is encouraged to validate these findings.Molecular biomarkers for breast cancer are of several types. Risk biomarkers are those associated with increased cancer risk and include mammographic abnormalities, proliferative breast disease with or without atypia, family clustering, and inherited germ-line abnormalities. Surrogate end-point biomarkers are tissue, cellular, or molecular alterations that occur between cancer initiation and progression. These biomarkers are used as end points in short-term chemoprevention trials. Prognostic biomarkers provide information regarding outcome irrespective of therapy, whereas predictive biomarke...
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