TGF-β Signaling in Breast Cancer Cell Invasion and Bone Metastasis

The contribution of transforming growth factor β (TGF-β) signaling to breast cancer has been studied for more than two decades. In an early phase TGF-β may act as a tumour suppressor, while later, when cells have become resistant to its anti-mitogenic effects, the role of TGF-β switches towards malignant conversion and progression. TGF-β stimulates cell invasion and modifies the microenvironment to the advantage of cancer cells. Studies have shown that TGF-β promotes bone and lung metastasis via different mechanisms. The therapeutic strategies to target the TGF-β pathway in breast cancer are becoming increasingly clear. This review will focus on the role TGF-β in breast cancer invasion and metastasis.     

Factors Predicting the Axillary Lymph Node Metastasis in Breast Cancer: Is Axillary Node Clearance Indicated in Every Breast Cancer Patient?: Factors Predicting the Axillary Lymphnode Metastases in Breast Cancer

The study was carried out to find out predictors of axillary lymph node metastasis in breast cancer and to evaluate its significance in selecting the group of patients in whom axillary dissection could be avoided. Ninety-five breast cancer patients who underwent mastectomy and axillary dissection were included in the study. Factors like patient’s age, tumor size, histopathological type, histological grade and estrogen and progesterone receptor status were correlated with the axillary metastases. Out of 95 cases axillary metastasis was found in 47 (49.47%) cases. There was no correlation between patient’s age and tumor size with axillary metastasis (p > 0.05). Based on histopathological typing tumors like ductal carcinoma in situ, tubular carcinoma and mucinous carcinoma showed less tendency for axillary metastasis (p < 0.046). Association was found between histological grade and estrogen receptor and progesterone receptor positivity with presence of axillary metastasis (p < 0.001 and 0.002 respectively). The findings in this study indicate that breast cancer patients having favorable histological type, grade I tumors and estrogen and progesterone receptor negative tumor are good candidates to avoid axillary dissection.     

Do Very Young Korean Breast Cancer Patients Have Worse Outcomes?

Background In general, Korean women with breast cancer are younger than white women. We have compared the clinicopathologic characteristics and prognosis in very young and less young premenopausal Korean women with breast cancer. Methods Of the breast cancer patients treated at the Asan Medical Center in Seoul, Korea, from 1989 to 2002, 381 (9.6%) were younger than 35 years of age (the “very young” group) and 2320 were 35 to 50 years of age (the “less young” group). We retrospectively compared the clinicopathologic factors and survival rates of these two groups. Results The very young group with lymph node metastases had poorer 5-year survival (69.9% vs. 82.7%, P = .0063) and disease-free survival (58.1% vs. 74.1%, P < .0001) rates than their older counterparts. In addition, the very young group had more advanced-stage disease (P = .001), higher T stage (P = .001), and more positive lymph nodes (P = .024) than did their older counterparts, as well as higher percentages of estrogen receptor–negative disease (48.2% vs. 42.1%, P = .047), progesterone receptor–negative disease (53.5% vs. 44.1%, P = .002), and grade 3 histology (52.1% vs. 43.5%, P = .011) tumors. Conclusions Compared with older premenopausal Korean women with breast cancer, those younger than 35 years old had a poorer prognosis as a result of a higher rate of recurrence, a later stage at diagnosis, and more aggressive disease. Thus, in Korean breast cancer patients, age younger than 35 years was an independent predictor of recurrence.     

Lateral Pelvic Node Metastasis in Locally Advanced Rectal Cancer: Are We Exaggerating or Ignoring?

Annals of Surgical Oncology -     

Isolated Tumor Cells in Sentinel Lymph Nodes of Invasive Breast Cancer: Cell Displacement or Metastasis?

The goal of this study was to determine whether the presence of isolated tumoral cells (ITCs) in sentinel lymph nodes (SLNs) after core needle biopsy (CNB) is related to the time interval between CNB and surgery and to histopathologic features of invasive breast cancer. Data from 633 consecutive patients with no micrometastasis or metastasis on both frozen sections and definitive pathologic examination of SLNs were retrieved from a prospective data base. No association was found between ITCs and the time interval between CNB and SLNB. The association was significant with tumor size, the tumor lymphovascular invasion (LVI) and the histologic type of the tumor. This study adds supplementary data to the association between tumoral LVI and ITCs in SLNs, The time interval between CNB procedure and SLNB was not related to affect presence of ITCs, which might not suggest the iatrogenic origin of these cells.     

Does Radiotherapy Have Curative Potential in Metastatic Patients? The Concept of Local Therapy in Oligometastatic Breast Cancer

In 1995, Hellmann and Weichselbaum defined for the first time the term oligometastases which is used to describe limited metastasis with a maximum of 3-4 clinically detectable metastases. It is assumed that these patients have a better prognosis and that local treatment of the metastases plays a significant part in the further development of the disease. Therefore, these patients could benefit from a curative local therapy of the manifested metastases. Local therapy measures include mainly radiotherapeutic methods alongside invasive ablative processes, such as surgical resection and radiofrequency ablation. Patients subjected to radiation therapy benefit especially from the usage of modern precision technology as it reduces the radiation exposure to the normal tissue, and because short radiation sessions with escalating doses are possible (e.g. radiation surgery, image-assisted radiation therapy, stereotactic radiation). Initial clinical studies show very good local tumor control rates which are on a par with resection and ablative methods, but with very few side effects and risks. This article summarizes the integration of the concept of oligometastases in the radiotherapy of limited metastatic breast cancer.