Prediction of survival from first recurrence of breast carcinoma in Japanese women

Lipid-rich carcinoma of the breast clinicopathologic analysis of 17 cases

Lipid-rich carcinoma of the breast is a rare variant of breast cancer, accounted for <1% of all breast malignant tumors. We retrospectively analyzed the clinicopathologic characteristics of lipid-rich carcinomas of the breast. A panel of estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 (HER-2), cytokeratin (CK) 5/6, CK14, and P63 was prepared for detection of lipid-rich carcinoma. Fluorescence in situ hybridization and electron microscope assays were performed for detecting HER-2 gene amplification and ultrastructure. Survival analysis were carried out using Kaplan-Meier and Cox regression methods. Receiver operating characteristic test was also performed. Estrogen receptor, CK5/6, CK14, and P63 were negative. Progesterone receptor (1/17) and HER-2 (17/17) were positive. HER-2 gene amplification was detected in all included cases (ratio values >2.2). Ultrastructure showed fat droplet and electron-dense material in the cytoplasm. Statistical differences were detected among survival and age (P = .033), histologic grade (P = .004), lymph node involvement (P = .001), and HER-2 expression (P = .002), respectively, using Kaplan-Meier methods. Statistical differences were also detected (P = .017) using Cox regression methods. Receiver operating characteristic test displayed significant statistical differences; the prognosis had a correlation between HER-2 expression "+" and HER-2 expression "++" (P = .004). Lipid-rich carcinoma of the breast was an HER-2 overexpressing subtype of the breast carcinoma. Survival of lipid-rich carcinoma might be associated with age, histologic grade, lymph node involvement, and HER-2. The HER-2 expression, however, might play an important role in predicting the prognosis of lipid-rich carcinoma of the breast.

Survival outcomes for patients with metastatic triple-negative breast cancer: implications for clinical practice and trial design

BACKGROUND

Clinical experience suggests that many women with triple-negative metastatic breast cancer (MBC) relapse quickly. This has implications for clinical practice and trial design. We evaluated the duration of first-, second-, and third-line chemotherapy as a surrogate for duration of treatment response.

PATIENTS AND METHODS

We performed a retrospective multicenter chart review of patients with triple-negative MBC receiving palliative chemotherapy. Primary outcome was duration of palliative chemotherapy, and secondary outcome was to identify prognostic variables.

RESULTS

A total of 111 patients were analyzed. Median age at diagnosis was 51 years (range, 26-82 years). Fourteen percent of patients presented with MBC. Twenty-seven percent received neoadjuvant chemotherapy, and 48% received adjuvant chemotherapy. Median distant disease-free interval (DDFI) was 18 months (range, 0-172 months). At presentation of MBC, 68% had visceral and 71% had multiple sites of disease. Median survival with MBC was 13.3 months (range, 0.8-99.8 months). Median duration of first-line palliative therapy was 11.9 weeks (range, 0-73.1 weeks). Eighty-seven patients (78%) went on to receive second-line therapy with a median duration of 9 weeks (range, 0-120.9 weeks), and 55 (49%) received third-line therapy with a median duration of 4 weeks (range, 0-59 weeks). Multivariate analysis revealed that age < 50 years, ALP > 120 U/L, history of previous chemotherapy, DDFI < 12 months, and visceral presentation were all independently associated with a poor prognosis.

CONCLUSION

Despite the poorer overall prognosis of patients with triple-negative disease, there remains considerable heterogeneity in individual outcomes. Many women with recurrent triple-negative disease will progress quickly on first-, second-, and third-line palliative treatment. Future clinical trials in this population must take into account their shorter time to progression when determining optimal trial design.

Orthopedic surgery implications of breast cancer

Breast cancer is the most common malignancy and the second leading cause of death in women. The metastatic involvement of bone denotes disease progression and decreased survival. Controversy exists regarding the exact pathophysiologic mechanism of metastasis and the different pathways that determine an osteoblastic versus osteoclastic bone compromise. Several breakthrough advances in imaging techniques aid in the detection, staging and follow-up of bone metastases. Although usually responsive to hormonal therapy and pharmacologic interventions, skeletal metastases often require some type of surgical intervention. Orthopedic surgeons should establish an active role in the multidisciplinary treatment of patients with breast cancer.