Locally advanced non-metastatic breast cancer: Analysis of prognostic factors in 125 patients homogeneously treated with a combined modality approach

Gardin, G.; Rosso, Riccardo; Campora, E; Repetto, Lazzaro; Naso, C.; Canavese, Giuseppe; Catturich, A.; Corvò, Renzo; Guenzi, M.; Pronzato, P.; Baldini, Editta; Conte, Pierfranco

doi:10.1016/0959-8049(95)00199-s

Cited by 40 publications

(28 citation statements)

References 16 publications

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“…In a retrospective analysis of 100 patients, Victor et al (1999) correlated the presence of IBC and four or more involved axillary nodes with poorer outcome. Their conclusions were supported by Gardin et al (1995) in an analysis of 125 patients, and by others as well (Sanchez-Forgach et al, 1992;Kuerer et al, 1998;Zambetti et al, 1999). The clinical size of the primary tumour (Valagussa et al, 1990;Fein et al, 1994) as well as the clinical nodal status (Valagussa et al, 1990) were also found to correlate with outcome.…”

Section: Discussionsupporting

confidence: 69%

Prediction of outcome in locally advanced breast cancer by post-chemotherapy nodal status and baseline serum tumour markers

et al. 2002

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In spite of the apparent improvement in outcome in locally advanced breast cancer, the prognosis remains dismal in many patients. The aim of this study was to define prognostic subgroups within this heterogeneous entity. Between 1990 and 1999, 104 consecutive patients with locally advanced breast cancer were treated by a multimodality programme consisting of 4 -6 courses of CAF induction chemotherapy followed by surgery, breast-conserving when feasible. In most cases, chemotherapy was then resumed, up to a total of eight courses, followed by locoregional radiation therapy. Patients with hormone receptorpositive tumours received tamoxifen (20 mg day 71 ) for 5 years. At a median follow-up of 57 months, the 5-year overall survival for the entire group and the disease-free survival for the 94 operated patients were 65% and 53%, respectively. Univariate analysis identified 10 prognostic factors of overall and disease-free survival, of which four retained significance on multivariate analysis: inflammatory breast cancer (P=0.0000, P=0.0004, respectively), baseline tumour markers (P=0.003 for both), post-chemotherapy number of involved nodes (P=0.003; P=0.017) and extracapsular spread (P=0.052; P=0.014). In conclusion, besides inflammatory features, baseline tumour markers and post-chemotherapy nodal status are strong predictors of outcome in locally advanced breast cancer.

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Section: Discussionsupporting

confidence: 69%

Prediction of outcome in locally advanced breast cancer by post-chemotherapy nodal status and baseline serum tumour markers

et al. 2002

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“…The magnitude of pathological response, and the presence of involved axillary lymph nodes at pathological examination were also important prognostic factors. Earlier, Feldman and colleagues (1986) reported on the prognostic significance of pathological response after neoadjuvant chemotherapy in LABC patients, whereas others (McGready et al, 1989;Gardin et al, 1995) have stressed the importance of lymph node metastases after neoadjuvant chemotherapy in LABC patients. Certainly, the attainment of a pathological complete remission is an important measure of the efficacy of neoadjuvant chemotherapy, as attested by data from patients with osteosarcoma (Rosen et al, British Journal of Cancer (1998) 77(4), 621-626 I 1982).…”

Section: Discussionmentioning

confidence: 99%

Prognostic role of clinical, pathological and biological characteristics in patients with locally advanced breast cancer

Honkoop

Diest²,

Jong³

et al. 1998

Br J Cancer

171

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Summary Forty-two patients with clinical stage IIIA or IIIB breast cancer were treated with neoadjuvant chemotherapy followed by mastectomy and radiotherapy. The median follow-up was 32 months (range 10-72 months) and the median time to progression was 17 months (range 10-30 months). A multivariate analysis showed that a longer disease-free survival (DFS) was related to more chemotherapy cycles given (P = 0.003), a better pathological response to chemotherapy (P = 0.04) and fewer positive axillary lymph nodes (P = 0.05). A better overall survival (OS) was related to more chemotherapy cycles given (P = 0.03) and better pathological response to chemotherapy (P= 0.04). In patients with residual tumour after neoadjuvant chemotherapy, high levels of staining for Ki-67 was correlated with a worse DFS (P = 0.008). Other biological characteristics, including oestrogen receptor status, microvessel density (CD31 staining), P-glycoprotein (P-gp) staining and nuclear accumulation of p53, were not independent prognostic factors for either DFS or OS. If both P-gp and p53 were expressed, DFS and OS were worse in the uni-and multivariate analysis. The preliminary results of this phase 11 study suggest that coexpression of P-gp/p53 and a high level of staining for Ki-67 after chemotherapy are associated with a worse prognosis, and that prolonged neoadjuvant chemotherapy and the attainment of a pathological complete remission are important factors in determining outcome for patients with this disease.

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“…The number of involved nodes in the ipsilateral axilla is an indicator of a poor prognosis not only after adjuvant therapy but also with preoperative chemotherapy for both locally advanced (Grdhn et al, 1984;Gardin et al, 1995) and large operable breast cancer (Botti et al, 1995); furthermnore, in these studies of preoperative therapy, it was, as in this study, the prognostic factor with the British Journal of Cancer (1997) 76 (8), 1099-1105 64 highest level of statistical significance. However, the only report (although without statistical analysis) of similar 10-year survival rates for primary doxorubicin-based chemotherapy is from the MD Anderson Hospital, where women with stage III breast cancer had survival rates of 65%, 44%, 32% and 9% when there were, respectively, no, 1-3, 4-9 and 10 nodes still involved after chemotherapy (Frye et al, 1995).…”

Section: Response To Primary Hormone Therapymentioning

confidence: 99%

Primary systemic therapy for operable breast cancer - 10-year survival data after chemotherapy and hormone therapy

Cameron

Anderson²,

Levack³

et al. 1997

Br J Cancer

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Summary Between 1984 and 1990, 94 women presenting to the Edinburgh Breast Unit with operable breast cancer of 4 cm or greater in diameter (T2, T3, NO, Ni, MO) were given preoperative systemic therapy. Initially, all women received hormone therapy, with CHOP (cyclophosphamide 1 g m-2, doxorubicin 50 mg m-2, vincristine 1.4 mg m-2 to a maximum of 2 mg and prednisolone 40 mg per day orally for 5 days) chemotherapy being administered to those who failed to respond by 3 months. After April 1987, first-line hormone therapy was only offered to women with oestrogen receptor (ER)-moderate/-rich (> 20 fmol mg-1 protein) tumours, and CHOP was reserved for those women whose tumours failed to respond to hormone therapy and for those with ER-negative/-poor tumours. Response data have been published previously (Anderson et al, 1991). After a median follow-up of 7.5 years, there is no difference in survival between those women given initial hormone therapy and those given chemotherapy, with neither group having yet reached its median survival. The two key factors that predicted for a poor survival were the number of involved axillary nodes after preoperative systemic therapy (P < 0.00001) and a lack of response to preoperative therapy (P < 0.05). These data suggest that many women with ER-moderate/-rich tumours will have a good prognosis after preoperative hormone therapy alone. However, it is possible to identify, by their post-systemic therapy axillary node status, a group of women who still have an appalling prognosis after preoperative chemotherapy or hormone therapy.

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Locally advanced non-metastatic breast cancer: Analysis of prognostic factors in 125 patients homogeneously treated with a combined modality approach

Cited by 40 publications

References 16 publications

Prediction of outcome in locally advanced breast cancer by post-chemotherapy nodal status and baseline serum tumour markers

Prediction of outcome in locally advanced breast cancer by post-chemotherapy nodal status and baseline serum tumour markers

Prognostic role of clinical, pathological and biological characteristics in patients with locally advanced breast cancer

Primary systemic therapy for operable breast cancer - 10-year survival data after chemotherapy and hormone therapy

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