Abstract P2-05-13: Negative progesterone receptor is associate early breast cancer relapse, even among good prognosis tumors

Background/objective: A minority of estrogen-receptor (ER) positive breast cancers lack progesterone receptor (PR) expression, but little is known of the clinical meaning of PR negativity (PR-). In the present study we sought to clarify the association between PR- and outcomes of ER+, human-epidermal growth factor (HER2)-negative breast cancers using a large, single institution database.

Methods: We retrospectively analyzed consecutive, non-metastatic, unilateral HER2- invasive breast cancers diagnosed between 2000 and 2011. Records were reviewed for age at diagnosis, disease stage, tumor features, and histologically confirmed recurrence. ER+ and PR+ status was defined as ≥1% immunoreactive cells. We used Kaplan-Meier curves to determine the association between PR- and early (≤5 years) and late (>5 years) disease recurrence, defined as locoregional or distant breast cancer relapse >6 months after diagnosis.

Results: We identified 1,933 patients with TN (n=337) or ER+/HER2- (n=1,596) breast cancer. Patients with ER+/PR- (n=107) vs. ER+/PR+ (n=1,489) tumors did not differ in age or disease stage at diagnosis; however, PR- tumors were more frequently high grade (37.9% vs. 17.8%, p<0.001), with higher median Ki67 indices (20.0% vs. 10.0%, p<0.001). Median ER expression was also lower in PR- as compared to PR+ tumors (80.0% vs. 90.0%, p<0.001).

Over a median follow-up of 84 months, there were 119 early and 54 late locoregional or distant breast cancer relapses. Negative PR was strongly associated with early relapse, with PR- tumors demonstrating a 2.1-fold higher hazard of relapse in the first 5 years as compared to PR+ tumors (95% CI 1.0-4.2)

Hazards of early (<5 years) breast cancer relapse by hormone status. Shown are univariable Cox proportional hazard ratios and 95% confidence intervals among all tumors, and in subsets defined by %ER, node status, Ki67, and grade. All tumors n=1,933High ER (80-100%) n=1,383TN3.9 (2.6-5.6)*--PR 0%2.1 (1.0-4.2)*1.7 (0.6-4.6)PR 1-100%ReferenceReference Node-negative n=1,299Node-positive n=634TN4.3 (2.5-7.5)*3.6 (2.1-6.0)*PR 0%2.7 (1.0-7.0)*1.6 (0.6-4.5)PR 1-100%ReferenceReference Ki67 <14% n=768Ki67 ≥14% n=997TN**2.4 (1.5-3.8)*PR 0%4.1 (1.2-14.1)*1.6 (0.7-3.8)PR 1-100%ReferenceReference Grade 1/2 n=1,337Grade 3 n=564TN3.4 (1.4-7.9)*1.9 (1.2-3.3)*PR 0%2.0 (0.7-5.7)1.2 (0.4-3.5)PR 1-100%ReferenceReference*p<0.05; **too few subjects/events for analysis.

Negative PR remained significantly associated with a higher hazard of early relapse even in node-negative (HR 2.7, 95%CI 1.0-7.0) and low-proliferating tumors (Ki67<14%, HR 4.1, 95%CI 1.2-14.1). There was no significant association between PR- and late breast cancer relapse (HR 0.7, 95%CI 0.2-2.9).

Conclusions: Compared to ER+/PR+ breast cancers, ER+/PR- breast cancers have a significantly greater risk of early recurrence, similar to triple-negative cancers. These results suggest that negative PR expression is importantly and independently associated with early breast cancer prognosis, and may be an indicator of unique tumor biology.

Citation Format: Winner M, Rosman M, Mylander C, Jackson RS, Pozo ME, Wolff AC, Tafra L, Umbricht CB. Negative progesterone receptor is associate early breast cancer relapse, even among good prognosis tumors [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-13.

Neoadjuvant therapy and vascular resection during pancreaticoduodenectomy: shifting the survival curve for patients with locally advanced pancreatic cancer

BACKGROUND

Neoadjuvant therapy and vascular resection may offer patients with locally advanced pancreatic cancer potential cure.

METHODS

We reviewed medical records of patients with ductal adenocarcinoma who underwent pancreaticoduodenectomy (PD) from 1992 through 2011. We identified patients who received neoadjuvant therapy (NA+) or required vascular resection (VR+) for locally advanced disease and compared outcomes to those who did not.

RESULTS

Of the 643 patients who were initially explored, 506 (143 NA+ and 363 NA- patients) ultimately underwent PD. There were no significant differences in R0 resection or morbidity. Mortality was higher in the NA+ versus NA- group (7.0 vs 3.0 %, p = 0.04). More NA+ patients underwent PD VR+ (p < 0.001). Among VR+ patients, neoadjuvant therapy resulted in significantly lower R1 resection. Among resected patients, survival of NA+ patients was significantly longer than both NA- patients (27.3 vs 19.7 months, p < 0.05) and patients abandoned because of locally advanced disease. Age, tumor grade, lymph node ratio, and R1 resection were independent predictors of poor survival.

CONCLUSIONS

Neoadjuvant therapy and vascular resection offer patients with locally advanced pancreatic cancer the chance for cure with acceptable morbidity and mortality. These patients have improved survival over patients deemed locally inoperable by traditional criteria.

Evaluating the treatment effect of repeated probes

This study investigated the effect of the administration of frequent and infrequent probe lists on generalization to novel stimuli. Four subjects with multiple functional articulation errors were taught to produce two different sounds, and generalization was measured on three probe lists. Two of the probe lists (one for each sound) were administered infrequently, and the third probe list (for one sound) was presented at each treatment session. The results indicated that the frequent rate of administration of probe lists did not produce any predictable effect on the extent of generalization or the occurrence of a practice effect. In general, the data continue to support the use of probe lists as an effective tool to measure generalization.