三阴性乳腺癌临床特征分析

目的探讨三阴性乳腺癌的临床病理特征、手术方式、复发转移情况。方法扬州市第一人民医院2009年2月至2014年2月126例经病理及免疫组化证实为三阴性乳腺癌的患者,其中16例行保乳手术,2例行保留乳头乳晕改良根治+即时硅胶假体植入术,其余108例行乳腺癌改良根治术。结果123例患者术后随访2~7年,3例失访。出现脑转移1例、肝转移4例、肺转移5例、骨转移6例、局部复发8例、死亡2例。三阴性乳腺癌占同期乳腺癌发病率的15.7%(126/802),局部复发和远处转移率19.5%(24/123)。结论三阴性乳腺癌对内分泌治疗和靶向治疗不敏感,化疗是唯一的治疗方法;相对于非三阴性乳腺癌,保乳治疗不影响其远处转移率和生存率。     

腋窝淋巴结转移对初次保乳手术乳腺癌患者预后的影响

目的 探讨腋窝淋巴结转移对初次保乳手术乳腺癌患者预后的影响。方法 选取75例初次保乳手术后复发乳腺癌患者作为研究对象，依据术前腋窝淋巴结状态分为阳性组(32例)及阴性组(43例)。所有患者均行保乳手术+腋窝淋巴结清扫术治疗，比较两组局部区域复发情况、临床病理特征，并分析远处转移、生存情况及复发的影响因素。结果 两组局部复发、区域复发及局部+区域复发率相比，差异无统计学意义(P>0.05);75例患者共45例发生远处转移(60.00%),阳性组远处转移率为78.13%(25/32),高于阴性组的46.51%(20/43),有统计学差异(P<0.05);生存分析显示，复发后3年生存率为57.33%(43/75),复发后5年生存率为38.67%(29/75);阳性组复发后总生存率较阴性组低，有统计学差异(P<0.05);多因素分析显示：复发部位、腋窝淋巴结状态为复发患者总生存的独立影响因素(P<0.05)。结论 腋窝淋巴结转移可影响初次保乳手术乳腺癌患者预后，能降低术后生存率，缩短患者总生存时间，增加复发后远处转移风险。     

乳腺癌的保乳治疗(附76例报告)

目的 探讨乳腺癌保乳治疗的相关问题及保乳治疗成功率的影响因素.方法 总结我科2003年-2007年对76例乳腺癌采用外科保乳治疗病例及随访资料,对70例(失访6例)患者的术后乳房外形进行评估,评价乳房美容效果的影响因素.结果 Ⅰ、Ⅱ期乳腺癌保乳治疗67例,9例Ⅲ期乳腺癌经新辅助化疗2周期后,肿块缩小至3 cm以下,行保乳治疗;手术方法的选择:行肿块局部扩大切除21例,区段切除45例,象限切除10例,均行同期腋下淋巴结清扫术;其中,9例行乳腔镜下腋窝淋巴结清扫术.即时局部乳房缺损修复36例,其中胶原蛋白海绵填塞8例,带蒂背阔肌肌(皮)瓣修复缺损28例.术后乳房美容效果评价,"良好"76﹪,"一般"16﹪,"差"8﹪.所有病例术后均给予6周期的化疗、乳房术后根治性辅助放疗及内分泌治疗.随访最长58月,平均32月,2例局部复发,3例发生远处转移,其中1例死亡.结论 对于Ⅰ、Ⅱ期乳腺癌外科治疗,保乳根治术具有美观效果、提高了生活质量;对于Ⅲ期乳腺癌,采用新辅助化疗为主的综合治疗后仍可成功保乳;带蒂背阔肌肌(皮)瓣修复乳房缺损是保乳手术Ⅰ期乳房成形的理想方法;乳腔镜行腋窝淋巴结清扫术具有美观、微创的优势;加强医患沟通、提高保乳意识势在必行.     

乳腺癌保乳手术加术中放疗40例临床分析

目的:研究乳癌保乳手术中采用术中放疗对疾病治疗的远期疗效。方法:对我院1998年1月~1999年12月40例Ⅰ-Ⅱb期的乳腺癌患者行肿瘤广泛切除 腋窝淋巴结清扫术 术中放疗术。结果:经5年随访观察,40例患者仅1例局部复发,其余患者均健在,无远处转移,无明显放疗反应,双乳对称,外形美观。结论:乳腺癌保乳治疗 术中放疗对于患者的局部复发率及远期生存率均有较明显的影响,降低了局部复发率。     

保乳手术治疗乳腺癌37例分析

目的探讨保乳手术治疗乳腺癌方法的选择.方法回顾性分析2001年1月～2005年1月我院接受保乳治疗的37例乳腺癌临床资料.0期3例,Ⅰ期20例, Ⅱ期14例.手术方式为象限切除或肿瘤局部广泛切除联合腋窝淋巴结清扫.术后常规行辅助化疗,放疗和内分泌治疗. 结果手术标本石蜡病理检查各切缘均无癌侵润.经过36个月中位随访期（范围2～36月）,局部复发为5.4%（2/37）,其中腋窝1例,远处转移1例,转移部位为肺转移.对保乳综合治疗满1年的20例患者进行乳房外型的评估,优15%（3/20）,良45%（9/20）,差 40%（8/20）.结论对早期乳腺癌及部分经过新辅助化疗降期后的局部进展期乳腺癌可进行保乳手术治疗.规范化的切除和术后放疗,全身综合治疗是保乳治疗成功的关键 .     

53例早期乳腺癌保乳治疗临床分析

目的探讨早期乳腺癌保乳治疗的手术处理方法及近期疗效。方法 2005年6月至2009年10月共收治女性乳腺癌患者276例,对其中Ⅰ~Ⅱ期原发乳腺癌施行保乳手术治疗,手术方式采用乳腺局部肿物扩大切除加同侧腋窝淋巴结清扫术或同侧前哨腋窝淋巴结活检术,术中对肿物进行切缘冰冻快速病理检查,术后患侧乳房接受放射治疗。结果 53例患者成功实施了保乳手术,手术后随访6个月,对保留乳房治疗的满意率达99%,十分满意占90%,与腋窝前哨淋巴结活检术结合进一步降低了患侧上肢淋巴水肿等并发症的发生,提高了患者的生活质量。经随访2~52个月,中位随访17个月,无乳腺局部复发病例,无远处转移及死亡病例。结论Ⅰ~Ⅱ期乳腺癌保乳治疗近期疗效满意,相关手术的处理方法可行,远期疗效有待长期随访观察。     

保乳术治疗早期乳腺癌疗效观察

目的 观察早期乳腺癌保乳术的疗效.方法 入组保乳术治疗的早期乳腺癌30例,其中Ⅰ期21例,Ⅱ期9例,均行象限切除加腋窝淋巴结清扫,术后均进行辅助化疗、放疗和内分泌治疗等综合治疗.结果 30例全部得到随访,随访时间6～96个月,未发现局部复发或远处转移.5年总生存率90.6%,乳房美容优良率93.3%.结论 保乳手术配合...     

前哨淋巴结活检术在早期乳腺癌保乳术中的应用

目的探讨前哨淋巴结活检术（sentinellymph node biopsy,SLNB）在早期乳腺癌保乳术中的应用效果。方法回顾性分析56例pT1.2N0M0期乳腺癌行保乳术＋前哨淋巴结活检术的临床资料。56例SLN阴性,未行腋窝淋巴结清扫术（axillary lymph node dissection,ALND）。术后辅以化疗、放疗,激素受体阳性患者行内分泌治疗。结果56例成功施行保乳手术,保乳术后双乳对称。SLNB替代ALND者各项术后并发症少。中位随访时间36个月（1～72个月）,1例发现局部复发,行乳腺癌改良根治术时发现腋窝淋巴结转移;1例发现腋窝淋巴结复发转移。结论SLNB可以缩小手术范围,减少术后并发症,保留腋窝形态,提高保乳质量。     

232例早期乳腺癌保乳治疗的中长期预后分析

目的 评价早期乳腺癌保乳治疗的中、长期疗效。方法 回顾性分析1999年1月1日至2005年12月31日接受保乳治疗的232例早期乳腺癌患者的临床特征、复发及生存资料。232例患者均接受肿块扩大切除或乳腺区段切除+腋窝淋巴结清扫术,术后根据情况行放疗、化疗、内分泌治疗等。结果 中位随访时间为54个月,平均随访57.14个月（2～118个月）。局部复发3例,远处转移15例,死亡7例,1例局部复发后行乳房切除手术。发生远处转移的部位包括肺脏8例、肝脏5例、脑6例、骨8例。Kaplan Meier生存分析显示,232例患者的3年、5年生存率分别为99.06％和96.98％,3年、5年无病生存率分别为97.01％和93.23％。171例肿瘤直径≤2cm患者的3年、5年生存率高于其余52例肿瘤直径＞2cm者（P＜0.05）;141例接受内分泌治疗患者的3年、5年生存率高于52例未接受内分泌治疗者（P＜0.05）;腋窝淋巴结阳性患者的3年、5年无病生存率低于腋窝淋巴结阴性者（P＜0.05）。结论 在严格掌握保乳指征的前提下,早期乳腺癌病例进行保乳治疗安全可行。     

早期乳腺癌保乳保腋窝手术38例近期疗效观察

 目的　探讨早期乳腺癌行保乳保腋窝手术的近期疗效。方法　回顾性分析2008年2月至2010年4月在该院接受保乳保腋窝手术治疗的38例早期乳腺癌患者的临床资料。手术方式为乳腺局部肿物切除,术中将肿物及切缘送快速冷冻病理检查,同时行前哨淋巴结活组织病理检查（SLNB）,全组38例均为阴性,予保留腋窝,未做腋窝淋巴结清扫。结果　全部病例术后无皮下积液及上肢水肿,术后随访6～32个月,局部均无复发,其中2例分别于术后6个月、13个月出现腋窝淋巴结转移,经放疗后得到缓解。结论　SLNB阴性的早期乳腺癌患者行保乳保腋窝手术创伤小,术后并发症少,近期疗效满意,严格掌握适应证、规范化的手术和术后综合治疗是保证疗效的关键,保乳保腋窝手术有可能逐步取代简化根治术成为治疗早期乳腺癌的主要术式。     

隐匿性乳腺癌的诊断和治疗

目的 探讨隐匿性乳腺癌的诊断、治疗及预后.方法 收集23例隐匿性乳腺癌患者的临床和随访资料,并进行分析.结果 23例患者均为女性,平均57.7岁.术前行影像学检查22例,其中行乳腺超声检查17例,8例发现可疑结节;行乳腺钼靶摄片9例,阳性3例;行乳腺MRI检查2例,1例发现异常钙化.20例行同侧乳腺癌改良根治术,16例进行化疗,4例放疗.随访期间,2例患者发生肺转移,其中1例多处转移.结论 术前排除其他部位原发癌的可能后,表现为腋窝淋巴结转移癌的患者即可诊断隐匿性乳腺癌.对隐匿性乳腺癌,乳腺必须进行治疗,可行乳腺癌改良根治术或腋窝淋巴结清扫+全乳放疗.     

Outcome after treatment of patients with mammographically occult, magnetic resonance imaging-detected breast cancer presenting with axillary lymphadenopathy

Although magnetic resonance imaging (MRI) for patients with mammographically occult breast cancer with axillary lymphadenopathy has been accepted for staging, treatment outcome data in this patient group is lacking. In this study, 16 patients, median age of 45 years (range, 27-66 years), presented with malignant axillary lymphadenopathy, negative mammograms, negative breast physical examination, and abnormal breast MRI. All 16 patients were found to have >/= 1 suspicious lesions on breast MRI. Ten patients had a solitary enhancing lesion; 1 patient had 2 enhancing lesions; 3 patients had 3 enhancing lesions; 1 patient had a mass lesion and diffuse patchy enhancement in the breast; and 1 patient had regional enhancement but no discrete lesion on MRI. Six patients underwent breast-conservation surgery using MRI-guided wire localization and 10 patients had modified radical mastectomy. Fourteen patients received adjuvant chemotherapy and the remaining 2 patients received neoadjuvant chemotherapy. With a median follow-up of 5 years (range, 1.2-7.6 years), the 5-year actuarial local control was 100%, relapse-free survival was 74%, and overall survival was 87%. Three patients developed distant metastases. Two patients died from distant metastases, and 1 patient is alive with metastatic disease. One patient had a relapse in the contralateral axilla and was treated with paclitaxel and is disease free. Although the patient population is small, the outcome after treatment for this group of patients with a mammographically occult, MRI-detected breast cancer presenting with axillary adenopathy is similar to the expected outcome for patients with breast cancer with positive axillary lymph nodes.     

Prognosis of occult breast carcinoma presenting as isolated axillary nodal metastasis

Axillary metastasis from an occult breast carcinoma is an uncommon presentation and presents a therapeutic dilemma. The objective of this study is to describe the presenting clinical features, management approach and treatment outcomes for occult breast carcinoma. We conducted a retrospective review of patients who presented with axillary nodal metastases from an occult breast carcinoma between 1997 and 2004 at the Roswell Park Cancer Institute; 2,150 patients were diagnosed and treated for breast cancer during this period. After excluding stage I and IV patients, we identified 642 who had disease metastatic to lymph nodes, 10 of these had no primary tumor in the breast despite a thorough evaluation including bilateral mammography and breast ultrasound. Of these, 7 had undergone breast magnetic resonance imaging as well. All patients underwent axillary nodal dissection. The breast was managed with radiotherapy alone in 8 patients, wide local excision with radiation therapy in 1 patient and 1 patient underwent mastectomy. No patient had a recurrence with a median 57 months of follow-up. Breast conservation with radiation therapy alone can be considered as a management option for women with occult breast cancer presenting with axillary nodal metastasis.     

Association of the vitamin D receptor genotype with bone metastases in breast cancer patients

This study was designed in order to evaluate specific vitamin D receptor (VDR) genotypes as indicators of the likelihood of developing osseous metastases in breast cancer patients. Therefore, we determined polymorphisms of the VDR gene in a study group comprising 183 breast cancer patients. Specific fragments spanning over intron 8 and exon 9 of the VDR gene were amplified by polymerase chain reaction. The fragments were then incubated with each of the specific endonucleases APAI, BSMI or TAQI, respectively. The VDR gene polymorphisms were detected by the presence or absence of the particular restriction site using agarose gel electrophoresis. Statistical analyses revealed a significant correlation between both the VDR gene polymorphisms indicated as AA (absence of the APAI restriction site in both alleles) or TT (absence of the TAQI restriction site in both alleles), respectively, and the occurrence of bone metastases. Patients with the AA genotype have a 1.7-fold increased risk of developing bone metastases, whereas patients with the TT genotype have a 0.5-fold risk. Neither other genotypes nor allelic combinations displayed any further correlation with the clinical stage. The data suggest that the AA genotype of the VDR gene might be useful to identify breast cancer patients with a high probability of forming occult bone metastases who are considered to benefit from an adjuvant bone-protective therapy.     

44例隐匿性乳腺癌临床分析

目的 分析隐匿性乳腺癌的诊断、治疗及预后情况,总结其诊断和治疗经验.方法 回顾性分析44例隐匿性乳腺癌患者的临床资料,44例隐匿性乳腺癌患者中,16例行乳腺癌根治术,19例行乳腺癌改良根治术,1例行保留乳腺的腋下淋巴结清扫,8例仅行腋下肿物切除.结果 在接受乳腺癌根治术的35例患者中,有4例(11.4%)在术后病理切片中发现原发灶,原发灶的最大直径为0.6～2.5 cm,其中3例为浸润性导管癌,1例为黏液腺癌;另有3例可在标本中见不典型增生.全组有38例患者获得随访,随访时间为12～132个月.32例行手术治疗且获得随访的患者中,2例死亡,3例术后局部复发并带瘤生存;未接受进一步手术治疗患者中,有2例分别于确诊后16和41个月后因浸润性导管癌行乳腺根治术;其余患者均无病生存.结论 对以腋下淋巴结肿大为惟一临床表现、经肿物活检确认为转移性腺癌的女性患者,应高度怀疑隐匿性乳腺癌的可能性.隐匿性乳腺癌的治疗方式可采用腋窝淋巴结清扫后全乳放疗或乳腺癌根治术.

Abstract：

Objective To summarize the experience of diagnosis and treatment of occult breast cancer in 44 cases. Methods Clinicopathological data of 44 cases of occult breast cancer initially presenting axillary mass alone treated in our department during Jan 1997 to Dec 2008 were retrospectively analyzed. Results The 44 patients with occult breast cancer accounted for 0.42% of all breast cancer patients admitted to our hospital and institute in the same period. The surgery included radical mastectomy in 16 cases, modified radical mastectomy in 19 cases, axillary clearance in 1 case, and simple axillary node excision in 8 cases. Follow-up, ranging from 12-132 months, was available in 38 cases. Among 32 cases who underwent mastectomy or axillary clearance, 2 cases died of distant metastases and 3 cases were still alive with local recurrence at the time of analysis. In two out of six cases who refused further surgical treatment received mastectomy 16 months and 41 months after the primary diagnosis of occult breast cancer, respectively. Others were alive without evidence of recurrence or metastases at the time of analysis. Conclusions Occult breast cancer should be taken into consideration in cases presenting with axillary metastasis of unknown primary origin. The treatment of occult breast cancer should include modified radical mastectomy/radical mastectomy or breast conserving surgery combined with breast irradiation.     

Prognostic significance of occult axillary lymph node metastases after chemotherapy‐induced pathologic complete response of cytologically proven axillary lymph node metastases from breast cancer

BACKGROUND:

Primary systemic chemotherapy has been a standard of care for the management of locally advanced breast cancer (LABC) patients and has increasingly been used for patients with large operable breast cancer. Pathologic complete response (pCR) of axillary lymph node metastases predicted an excellent probability of long‐term disease‐free and overall survival. Although the clinical significance of occult lymph node metastases in patients with breast cancer was extensively studied, their prognostic value in patients with LABC after primary chemotherapy was not known. This study evaluated the detection rate and clinical significance of occult lymph node metastases in lymph nodes that contained metastatic carcinoma at the time of initial diagnosis and converted to negative based on routine pathologic examination after primary systemic chemotherapy.

METHODS:

Fifty‐one patients with LABC and cytologically involved axillary lymph nodes that converted to negative after preoperative chemotherapy were identified from 2 prospective clinical trials. All lymph node sections were reviewed, 1 deeper level hematoxylin and eosin‐stained section of each lymph node was obtained and immunohistochemical staining for cytokeratin (CK) was performed. A total of 762 lymph nodes were evaluated for occult metastases. Kaplan‐Meier survival curves were used for calculating disease‐free and overall survival times.

RESULTS:

Occult axillary lymph node metastases were identified in 8 of 51 (16%) patients. In 6 patients, occult metastases were found in only 1 lymph node. In 7 patients, only isolated CK‐positive cells were identified. In all cases, occult carcinoma cells were embedded within areas of fibrosis, foreign body giant cell reaction, and extensive histiocytosis. Patients with occult lymph node metastases tended to have a higher frequency of residual primary breast tumors than those without occult metastases (4 of 8 vs 7 of 43, respectively). There was no statistically significant difference in disease‐free or overall survival times between patients with and without occult metastases after a median follow‐up 63 months.

CONCLUSIONS:

Persistent occult axillary lymph node metastases were not uncommon in patients with axillary lymph node‐positive LABC who experienced a pCR in involved lymph nodes after preoperative chemotherapy. However, such occult metastases did not adversely affect the good prognosis associated with axillary lymph node pCR. Therefore, routine lymph node CK evaluation was not recommended after primary chemotherapy. Cancer 2009. © 2009 American Cancer Society.     

Yield of staging laparoscopy before treatment of locally advanced pancreatic cancer to detect occult metastases

IntroductionLocally advanced pancreatic cancer (LAPC) is found in 35% of patients with pancreatic cancer. However, these patients often have occult metastatic disease. Patients with occult metastases are unlikely to benefit from locoregional treatments. This study evaluated the yield of occult metastases during staging laparoscopy in patients with LAPC.MethodsBetween January 2013 and January 2017 all patients with LAPC underwent a staging laparoscopy after a recent tri-phasic CT-scan of the chest and abdomen. Data were retrospectively reviewed from a prospectively maintained database. Univariate and multivariable logistic regression analysis was conducted to predict metastasis found at laparoscopy.ResultsA total of 91 (41% male, median age 64 years) LAPC patients were included. The median time between CT-scan and staging laparoscopy was 21 days. During staging laparoscopy metastases were found in 17 patients (19%, 95% CI: 12%–28%). Seven (8%) patients had liver-only, 9 (10%) patients peritoneal-only, and 1 (1%) patient both liver and peritoneal metastases. Univariate logistic regression analysis showed that CEA (OR 1.056, 95% CI 1.007–1.107, p = 0.02) was the only preoperative predictor for occult metastases. In a multivariable logistic regression analysis of the preoperative risk factors again only CEA was an independent predictor for occult metastatic disease (p = 0.03). Patients with a CEA above 5 μg/L had a risk of occult metastasis of 91%. FOLFIRINOX was given to 69 (76%) of the patients with a median number of cycles of 8. Subsequent radiotherapy was given to 44 (48%) patients after the FOLFIRINOX treatment. Six (14%) patients underwent a resection after FOLFIRINOX and radiotherapy. The overall 1-year survival was 53% in patients without occult metastasis versus 29% with occult metastasis (p = 0.11). The 1-year OS for patients that completed FOLFIRINOX and radiotherapy was 84%.ConclusionThe yield of staging laparoscopy for occult intrahepatic or peritoneal metastases in patients with locally advanced pancreatic cancer was 19%. Staging laparoscopy is recomended for patients with LAPC for accurate staging to determine optimal treatment.     

Increased serum interleukin-8 in patients with early and metastatic breast cancer correlates with early dissemination and survival.

PURPOSE: The prognostic significance of serum interleukin (IL)-8 was evaluated in patients with metastatic breast cancer. The predictive value of serum IL-8 for the presence of occult metastatic tumor cells in bone marrow aspirates was evaluated in patients with operable and metastatic breast cancer. EXPERIMENTAL DESIGN: Serum IL-8 was measured in healthy controls, patients with operable breast cancer, and patients with untreated, progressive metastatic breast cancer. In 69 patients with either operable or advanced breast cancer, occult cytokeratin-positive cells were counted in bone marrow aspirates. RESULTS: Serum IL-8 levels are increased in 67% (52 of 77) of patients with advanced breast cancer. Overall, these levels are significantly higher in patients with breast cancer compared with healthy volunteers (P < 0.001). The IL-8 levels increase significantly in patients with more advanced disease. An elevated serum IL-8 is related to an accelerated clinical course, a higher tumor load, and the presence of liver or lymph node involvement. A multivariate analysis indicates that serum IL-8 is an independent significant factor for postrelapse survival. There was a significant difference between serum IL-8 levels in patients with or without occult cytokeratin-positive bone marrow cells (P < 0.04). Serum IL-8 levels also showed an association with the number of these cells (P < 0.01). CONCLUSIONS: Serum IL-8 is increased in patients with breast cancer and has an independent prognostic significance for postrelapse survival. The observations on the relationship between occult cytokeratin-positive bone marrow cells corroborate the concept of IL-8 acting as a contributor to the process of tumor cell dissemination. Similarly, the relationship between serum IL-8 and nodal stage at presentation deserves further study. These results further expand the concept that inflammation and inflammatory cytokines are critical components of tumor progression.     

Breast radiotherapy for occult breast cancer with axillary nodal metastases--does it reduce the local recurrence rate and increase overall survival?

Aims

The optimal management of axillary lymph node metastases from occult breast cancer (TXN1-2M0) is uncertain and practice varies in the use of primary breast radiotherapy. We conducted a retrospective review to examine clinical outcomes for patients managed with or without primary breast radiotherapy.

Materials and methods

Case records from the clinical oncology database were reviewed to identify patients presenting with axillary nodal metastases but no detectable primary tumour between 1974 and 2003. Fifty-three patients with TXN1-2M0 breast cancer were identified, representing 0.4% of patients managed for breast cancer during this period. Of those tested, 59% had oestrogen receptor-positive tumours. Seventy-seven per cent received ipsilateral breast radiotherapy.

Results

There was a trend towards reduced ipsilateral breast tumour recurrence in patients who received radiotherapy (16% at 5 years, 23% at 10 years) compared with those who did not (36% at 5 years, 52% at 10 years). Similarly, the locoregional recurrence rate was 28% at 5 years for patients who received radiotherapy compared with 53.7% at 5 years for non-irradiated patients. Breast cancer-specific survival was higher (P = 0.0073; Log-rank test) in patients who received ipsilateral breast radiotherapy (72% at 5 years, 66% at 10 years) compared with those who did not (58% at 5 years, 15% at 10 years).

Conclusion

Primary breast radiotherapy may reduce ipsilateral breast tumour recurrence and may increase survival in patients presenting with axillary lymph node metastases and occult breast primary (TXN1-2M0). Larger studies or prospective registration studies are needed to validate these findings.     

Adjuvant pamidronate therapy prevents the development of bone metastases in breast cancer patients with four or more positive nodes

Bisphosphonates are strongly efficacious in inhibiting osteoclast bone resorption and have beneficial effects on bone metastasis. Due to their mechanism of action, bisphosphonates are expected to prevent the development of bone metastases in breast cancer patients. Pamidronate is a potent inhibitor of osteoclast activity. We examined whether pamidronate was able to prevent the development of bone metastases in breast cancer patients at high risk for bone metastasis. Between 1997 and 2001, 90 patients with primary breast cancer with ≥4 positive nodes were assigned to receive 45 mg pamidronate 4 times every 2 weeks (33 patients) or standard follow-up (57 patients) based on patient self-preference. Patients underwent surgery and adjuvant therapy. The characteristics of the patients in the two groups were well-balanced. The median follow-up period was 5 years. Bone metastases were detected in 12.1% of patients in the pamidronate group and 40.4% in the control group (p=0.005). Distant metastases (36.4 vs. 56.1%, p=0.071) and non-osseous metastases (33.3 vs. 52.6%, p=0.077) were detected at a lower frequency in the pamidronate group. Thus, the rate of bone metastasis-free survival was significantly higher in the pamidronate group (85.9 vs. 64.0% at 5 years, p=0.023). Overall and disease-free survival rates did not differ between the two groups. In the pamidronate group, the incidence of bone metastases was significantly reduced and bone metastasis-free survival was significantly higher. Adjuvant pamidronate therapy therefore prevents the development of bone metastases in breast cancer patients with ≥4 positive nodes.