Prognosis of pregnancy-associated breast cancer

The survival of patients with pregnancy-associated (PA) breast cancer is difficult to predict for two reasons: The combination is very rare, and the natural history of breast cancer that is not associated with pregnancy is intricate and varies among individuals. Valid data collection and analysis is problematic given that studies gather patients over many years. The charts of 56 women with Stages I, II, and III breast cancer, who were pregnant or within 1 year postpartum at the time of breast cancer diagnosis between 1960 and 1980, were analyzed. Patients with PA breast cancer were compared to nonpregnant women of comparable ages, who were treated at the same hospital, by the same physicians, and during the same period. Four patients were lost before 5-year follow-up, and one patient before 10-year follow-up. These five patients had distant metastases at the time they were lost to follow-up, and are considered to have died within that time. Across stages, patients with PA breast cancer have survival not significantly different from those patients with non-pregnancy-associated (non-PA) breast cancer.     

Prognosis of pregnancy-associated breast cancer: A meta-analysis of 30 studies

Background

Pregnancy-associated breast cancer (PABC) is relatively rare with considerable controversy regarding its prognosis.

Patients &; methods

Two of the authors independently performed a literature search with no date or language restrictions. Eligible studies were control-matched, population-based and hospital-based studies that addressed the outcome of patients diagnosed during pregnancy or 1-year afterwards. The primary and secondary end-points were overall and disease-free survival respectively. Pooling of data was done using the random effect model.

Results

30 studies were included in this meta-analysis (3,628 cases and 37,100 controls). PABC patients had a significantly higher risk of death compared to those with non-pregnancy-related breast cancer (pooled hazard ratio (pHR): 1.44; 95% CI [1.27–1.63]). The same results were encountered on restricting the analysis to HRs of multivariate analyses (pHR: 1.40 [1.17–1.67]). A clearer trend of poorer outcome was seen in those diagnosed postpartum (pHR: 1.84; 95% CI [1.28–2.65]) than those diagnosed during pregnancy (pHR: 1.29; 95% CI [0.74–2.24]). DFS analysis showed a significantly higher risk of relapse associated with PABC as well (pHR: 1.60 [1.19–2.16]).

Conclusion

Our results show that PABC is independently associated with poor survival particularly those diagnosed shortly post-partum. This underscores a possible impact of the pregnant breast microenvironment on the biology and consequently the prognosis of these tumors.     

妊娠相关乳腺癌的研究进展

妊娠相关乳腺癌（PABC）预后很差，肿瘤易于发生转移，所以越来越多地受到了人们的重视，PABC发生机制的研究主要集中在妊娠相关激素的作用和妊娠哺乳后乳腺的复旧上，妇女妊娠期间雌二醇、孕激素和人绒毛膜促性腺激素等激素水平升高与乳腺癌的发生发展关系密切，在妊娠哺乳期间乳腺组织的变化提供了有利于肿瘤发生和转移的微环境。     

妊娠期乳腺癌的研究现状及进展

妊娠期乳腺癌是指妊娠期间及分娩后1年内确诊的乳腺癌。妊娠期乳腺癌患者的临床预后与肿瘤的生物学特征及肿瘤分期相关,妊娠不是导致不良预后的独立危险因素。但妊娠期激素水平变化使得乳腺组织较为致密,妊娠期乳腺癌早期易被漏诊。由于许多诊断治疗方式可能影响胎儿的正常发育,妊娠增加了乳腺癌治疗方案制定的复杂性。妊娠期乳腺癌需多学科专家根据肿瘤生物学特征、肿瘤分期、孕周及患者和家属意愿等共同制定综合治疗策略。     

Prognosis of pregnancy-associated breast cancer: inferior outcome in patients diagnosed during second and third gestational trimesters and lactation

Breast Cancer Research and Treatment - Pregnancy-associated breast cancer, although most commonly defined as breast cancer diagnosed during pregnancy or?≤1 year following...     

Prognosis in node-negative breast cancer

In a selected group of 207 breast cancer patients with tumor-free axillary nodes, clinical and pathological features were evaluated as to their relationship to long-term disease-free survival. No clinical feature was found to be prognostically useful. Of pathologic features studied, four appear to have significance. These are (1) the volume of the primary mass, (2) the histologic or nuclear grade, (3) the presence of invasive lobular carcinoma in the primary mass, and possibly (4) the presence of neoplastic cells in intramammary lymphatic vessels. When two or more of these four features are present, prognosis is less favorable than when there is only one, but the influences are not arithmetically additive.     

妊娠期乳腺癌9例的诊断和综合治疗

目的：研究妊娠期乳腺癌在诊断和手术、化疗、放疗综合治疗方面的特殊性。方法：1992年12月-1999年6月,法国巴黎第十二大学附属Henri Mondor医院放疗科收治9例妊娠期乳腺癌患者,其中3例诊断于妊娠期,6例诊断于分娩后1年内。5例行乳心保留治疗,4例改良根治术。所有病例行术后放疗。7例接受化疗。结果：9例钼靶摄片中7例和所有的5例超声检查提示肿瘤征象,诊断时总体病期晚,I、Ⅱ、Ⅲ期比例分别为11%、44%和44%。中位随访60月（9-89月）时,6例无病生存,3例在治疗结束后14月-48月出现局部复发或远处转移。结论：妊娠期乳腺癌诊断延误较为常见,对分娩后确诊的患者,应重视妊娠、哺乳期乳房体检和超声检查在鉴别诊断房肿块中的作用。治疗原则必须兼顾疾病的迫切性和胎儿的安全性。在可以及时开展化疗和放疗的综合治疗的前提下,乳房保留治疗在早期妊娠期乳腺癌中是可行的。     

Prognosis of early-stage synchronous bilateral invasive breast cancer

Background

Contradictory data exists concerning the prognosis of patients with synchronous bilateral breast cancer (SBBC). Most authors report a worse prognosis for SBBC patients compared to unilateral breast cancer (UBC) patients. There are a few studies that did not support these findings. This study gives a comprehensive picture of SBBC and tests the hypothesis that outcome of this entity is based on the tumor with the worse prognosis (reference lesion).

Patients & methods

The data of two prospective Swiss breast cancer databases covering a 20-year period (1990-2009) was reviewed. Forty-six cases of SBBC were identified. In 34 patients with early-stage SBBC, the reference lesions (defined as the tumor with the more advanced stage or, in cases where both tumors had the same stage, the larger tumor) were compared in a case-control approach with 100 patients having UBC (SBBC/UBC ratio = 1/3). The controls were matched for age, time of diagnosis, tumor size, axillary node status, histological grade and estrogen-receptor status. Differences in terms of survival curves were analyzed using the log rank test; the possible correlation between matched groups was evaluated by a frailty Cox model.

Results

There were no significant differences in disease-specific survival between SBBC and its unilateral controls (HR, 0.932; 95% CI, 0.322-1.07; p = 0.90).

Conclusions

The prognosis of SBBC was determined by the reference lesion; the contralateral second tumor had no additional impact on outcome.     

Prognosis of uterine corpus cancer after tamoxifen treatment for breast cancer

Tamoxifen increases the risk of uterine corpus cancer. Since only few, mostly small, studies have examined prognosis of uterine corpus cancer following tamoxifen, we conducted a large retrospective cohort study to further investigate this. We examined histopathologic and immunohistochemical characteristics of 332 patients with uterine corpus cancer following breast cancer, according to tamoxifen use. Survival was examined in the same patients combined with 309 patients from a previous study with updated follow-up. Histological review of all cancers was performed. Long-term tamoxifen users showed a higher proportion of non-endometrioid tumors than non-users (32.7% vs. 17.4%, P = 0.004), especially serous adenocarcinomas and carcinosarcomas. An increased proportion of FIGO stage III and IV tumors was also observed (20.0% vs. 11.3%, P = 0.049). Within FIGO stage I, both short-term and long-term tamoxifen users showed a higher proportion of tumors limited to the endometrium than non-users (35.7% vs. 22.9%, P = 0.049 and 0.004 respectively). Uterine corpus cancers in long-term tamoxifen users were more often steroid receptor-negative (ERα, PRA and PRB, P < 0.05) and P53-positive (P = 0.015). Three-year uterine corpus cancer-specific survival was worse for long-term tamoxifen users than for non-users (82% vs. 93% P = 0.0001). The survival difference remained after adjustment for histopathologic and immunohistochemical characteristics (hazard ratio (HR) for ≥2 years tamoxifen = 2.4; 95% CI = 1.2–4.6). In conclusion, this large study clearly shows that tamoxifen-associated tumors have less favorable histological features and a worse survival. Our results can be applied when weighing risks and benefits of tamoxifen versus other hormonal agents used in the prevention and treatment of breast cancer. TAMARISK (Tamoxifen Associated Malignancies: Aspects of Risk)-group of the Comprehensive Cancer Centers (CCC): O. Visser (CCC Amsterdam), R. A. M. Damhuis (CCC Rotterdam), W. J. Louwman (CCC South Netherlands), J. A. A. M. van Dijck (CCC East Netherlands), Y. Westerman (CCC Middle Netherlands), M. J. M. Dirx (CCC Limburg), M. L. E. A. Jansen-Landheer (CCC West), L. de Munck (CCC Northern Netherlands), S. Siesling (CCC Stedendriehoek Twente).     

基于全基因组关联研究的乳腺癌预后预测研究现状

全基因组关联研究可用于确认与某些复杂疾病相关的单核苷酸多态性位点,目前运用该方法已鉴定出多个乳腺癌易感基因位点,通过该方法对高风险位点的研究或许能为乳腺癌预后的预测提供重要信息。笔者总结了基于全基因组关联研究的乳腺癌预后预测的研究现状,以期为乳腺癌的治疗提供参考。     

Prognosis and clinical presentation of BRCA2-associated breast cancer

54 female breast cancer patients from 22 families with BRCA2 germ line mutations from Sweden and Denmark were compared with 214 age- and date of diagnosis-matched controls identified among breast cancer patients from South Sweden. At diagnosis, BRCA2-associated cases were more often node-positive (N+). OR=1.9 (95% confidence interval (CI)=1.0-3.6; P=0.036), and were more often clinical stage IV: OR=4.6 (95% CI=1.3-17; P=0.021) than the controls. Bilateral disease was also more common among the BRCA2-associated cases: OR=2. 4 (95% CI=1.1-5.3; P=0.027). Breast cancer-specific survival (BCSS) was significantly worse among the BRCA2-associated cases: RR=2.0 (95% CI=1.2-3.4; P=0.010). When stage was corrected for in a multivariate analysis, BCSS was no longer significantly worse for the BRCA2-associated cases: RR=1.6 (95% CI=0.85-3.1). The corresponding effect after correction for bilateral disease was: RR=1.8 (95% CI=1.0-3.1; P=0.034). The unfavourable prognosis in BRCA2-associated breast cancer seems, to a great extent, to be a consequence of the higher clinical stage at diagnosis. The increased presence of bilateral cancers appears to have less impact on survival in this group of hereditary breast cancer. Data presented here needs to be taken into account when counselling healthy carriers of BRCA2 germ line mutations.     

乳腺癌骨转移患者放疗后的预后分析

目的探讨乳腺癌骨转移患者放疗后的预后情况。方法选取2008年1月至2013年5月间成都市核工业四一六医院收治的60例乳腺癌骨转移患者为研究对象。回顾性分析患者病历,并对患者进行1~3年的随访,收集记录患者放疗后的骨质破坏情况、绝经状态、碱性磷酸酶(ALP)值和血清钙等指标,统计患者初诊乳腺癌治疗后无病生存时间、骨外转移病灶和放疗有效率等情况,并进行比较分析。结果不成瘤乳腺癌患者初诊后无病生存期<2年的病例数占患者总数比例的87.5%,成瘤乳腺癌患者为12.5%;不成瘤乳腺癌患者有骨外转移病灶占患者总数比为88.9%,成瘤乳腺癌患者为11.1%;差异均有统计学意义(均P<0.05)。60例患者中,疼痛完全缓解患者46例(76.7%);部分缓解患者2例(3.3%);无缓解患者12例(20.0%)。疼痛完全缓解患者比例明显高于其他两类患者,差异有统计学意义(P<0.05)。患者放疗后1年生存率为58.3%(35/60),2年生存率为28.3%(17/60),3年生存率为13.3%(8/60)。患者骨转移病灶成瘤样改变、脊髓压迫和骨转移病灶数目是影响乳腺癌骨转移患者预后的独立因素,差异均有统计学意义(均P<0.05)。结论骨转移病灶成瘤样改变、脊髓压迫与骨转移病灶数目是影响患者放疗预后的独立危险因素,应加大对乳腺癌骨转移患者这几方面的观察及随访力度。     

Stage at diagnosis and mortality in women with pregnancy-associated breast cancer (PABC)

Converging evidence indicates that women with pregnancy-associated breast cancer (PABC) have increased mortality compared to women with breast cancer not diagnosed near pregnancy (non-PABC). Our aim was to investigate if the stage distribution differs between PABC and non-PABC and if stage at diagnosis can explain the poorer prognosis observed among women with PABC. We identified 3,282 breast cancers in women aged 15–44 years at diagnosis for whom staging data (tumor size, nodal involvement, metastasis) were available in the Swedish Cancer Register between 2002 and 2009. Information on reproductive history and vital status was obtained from the Multi-Generation Register and the Cause of Death Register. PABC was defined as breast cancers diagnosed during pregnancy and up to 2 years after delivery (n = 317). Non-PABC was defined as cases diagnosed before pregnancy or more than 2 years postpartum. Stage distributions were compared between PABC and non-PABC, and mortality rates were modeled using Cox regression. Compared to women with non-PABC, the mortality was almost 50 % higher in women with PABC [unadjusted hazard ratio (HR) 1.47 (95 % CI 1.04–2.08)], a difference which was reduced after adjustment for age and calendar year of diagnosis [HR 1.27 (95 % CI 0.88–1.83)]. Although advanced stage of breast cancer at diagnosis was more common among PABC than among non-PABC, further adjustment for stage only slightly reduced the HR [1.22 (95 % CI 0.84–1.78)]. The difference in mortality between PABC and non-PABC was more pronounced among women above 35 years and among women with PABC diagnosed within 1 year postpartum. Age, rather than stage at diagnosis, appears to act as the principal driver of the increased mortality observed in women with PABC. However, these findings do not preclude an untoward influence on mortality by pregnancy-associated factors affecting tumor aggressiveness and progression.