[Effect of axillary lymph node status on prognosis of different types of invasive breast cancer]

Objective: To investigate the effect of axillary lymph node status on the prognosis of different types of invasive breast cancer. Methods: Patients with invasive breast cancer of different molecular subtypes diagnosed in the breast cancer prevention and treatment center of Beijing Cancer Hospital from January 2000 to July 2011 were collected as a historical cohort, and the influence of lymph node status on the prognosis of different types of breast cancer was analyzed. Results: A total of 4 269 female breast cancer patients with molecular subtypes [aged (50.8±11.2) years] information and 3 824 female breast cancer patients with complete axillary lymph node status information [aged (50.5±10.9) years] were included in the study, including 3 135 cases with both molecular subtypes and lymph node status information. The 10-year event free survival (EFS) rates of hormone receptor (HR)⁺/human epidermal growth factor receptor-2(HER2)^-, HR^-/HER2^-and HER2⁺were 82.2%, 79.0% and 76.8%, respectively; the 10-year overall survival (OS) rates were 88.1%, 83.1% and 84.4%, respectively, and the differences of 3 molecular subtypes in EFS and OS were statistically significant (both P<0.001). The 10-year EFS rate of lymph node positive and negative patients was 68.8% and 88.2%, respectively; the 10-year OS rate was 76.7% and 92.5%, respectively, and the differences of lymph node status in EFS and OS were statistically significant (both P<0.001). In lymph node negative subgroup, 3 subtypes showed similar EFS and OS rate (both P>0.05); In lymph node positive subgroup, 3 subtypes showed significantly different EFS and OS (both P<0.05). No modification effect was detected of lymph node status on the correlation of molecular subtypes and EFS, DDFS and OS(all P_interactive>0.1). Conclusions: Different molecular subtypes of breast cancer have different prognosis. Compared with molecular subtype, lymph node status may be a more important prognostic factor.

[Long-term recurrence rate and survival in different aged patients with breast cancer undergoing breast conserving therapy]

Objective: To examine the difference of long-term recurrence rate and survivals between the young patients and the old patients undergoing breast conserving therapy (BCT). Methods: Women with primary invasive breast cancer receiving BCT between December 1999 and December 2014 were selected retrospectively from the database of Breast Cancer Center, Peking University Cancer Hospital & Institute. The median age of all patients was 47 years (range: 21 to 91 years). The cases were categorized according to age at diagnosis into two subgroups: the ≤40 years group and the>40 years group. A total of 2 778 patients were included: 677 patients in the ≤40 years group and 2 101 patients in the >40 years group. Clinicopathological characteristics between two groups were compared. The recurrence rate and survival were calculated using the Kaplan-Meier method. The differences of outcomes were compared in different aged groups using the Log-rank test. Factors affecting local recurrence, distant disease-free survival (DDFS), disease-free survival (DFS), and breast cancer-specific survival (BCSS) were assessed by multivariable Cox proportional hazard models. Results: Proportions of T1 (301/677 vs. 1 160/2 101, χ²=37.660, P<0.01), involved lymph node (314/677 vs. 713/2 101, χ²=34.966, P<0.01) hormone receptor-negative (490/677 vs. 1 581/2 101, χ²=6.981, P=0.030) and neoadjuvant chemotherapy (413/677 vs. 1 010/2 101, χ²=34.272,P<0.01)in the ≤40 years group were higher than that in the>40 years group. Median follow-up duration was 102 months. No significant difference in 10-year local recurrence was found between the two groups (2.5% vs. 1.6%, P=0.147). Ten-year DDFS rate in the ≤40 years group and in the>40 years group was 90.6% and 95.3%, respectively (P<0.01). Ten-year DFS rate in the ≤40 years group and in the>40 years group was 86.5% and 91.1%, respectively (P=0.001). Ten-year BCSS rate in the ≤40 years group and in the >40 years group was 91.0% and 93.7%, respectively (P=0.105). Age was not the prognosis factor of local recurrence. Lymph node status (positive vs. negative: HR=2.73, 95%CI: 1.94 to 3.84, P<0.01), age (≤40 years vs.>40 years: HR=1.73, 95%CI: 1.24 to 2.42, P=0.001) and T stage (>2 cm vs. ≤2 cm: HR=1.61, 95%CI: 1.14 to 2.28, P=0.001) were the prognosis factors of DDFS, and also for DFS. Hormone receptor status (positive vs. negative: HR=0.54, 95%CI: 0.39 to 0.74, P<0.01), lymph node status (positive vs. negative: HR=2.94, 95%CI: 2.12 to 4.07, P<0.01) and T stage (>2 cm vs. ≤2 cm: HR=1.45, 95%CI: 1.05 to 2.01, P=0.025) were the prognosis factors of BCSS. Conclusions: The risk of local recurrence was similar between ≤40 years patient and >40 years patients receiving breast conserving therapy. Worse survivals in the ≤40 years group were found comparing to those in the >40 years group.

[Clinical analysis of 382 immediately breast reconstruction after mastectomy in Beijing City, Tianjin City and Hebei Province from 2012 to 2016]

Objective: To summarize the status of immediate breast reconstruction (IBR) after mastectomy in Beijing City, Tianjin City and Hebei Province. Methods: A retrospective analysis was made on the data of 382 cases with breast cancer who were treated and followed up successfully with immediate breast reconstruction after mastectomy from January 2012 to December 2016 in Beijing City, Tianjin City and Hebei Province. Clinic data of the followed-up 382 cases (all female, age (38.5±4.2) years (range: 24 to 70 years)), including general information, tumor information, sugery methods, and treatments after surgery were collected. The survival status, metastasis,complications and prognosis were followed up. Cosmetic effcet was evalated by Harris method, and life quality by Functional Assessment of Cancer Therapy-Breast scale (FACT-B). χ(2) test was used to compare the difference between year 2012 and year 2013 to 2016. Bonferroni method was used to correct the inspection level, which was 0.05/10=0.005. The trend of IBR rate (ratio of IBR to modified radical mastectomy) from 2013 to 2016 was analyzed by trend χ(2) test. Results: There was 46 cases in stage 0, 152 cases in stage Ⅰ, 165 cases in stage Ⅱ, 19 cases in stage Ⅲ. Twenty-five cases was treated by neoadjuvant chemotherapy, 231 by chemotherapy and 35 by radiotherapy. The proportion of implant reconstruction was 48.7% (186/382), more than expanded of 21.5% (82/382), with latissimus dorsi of 12.0% (46/382), TRAM of 8.9% (34/382), DIEP of 2.1% (8/382), and latissimus plus implant of 6.8% (26/382). According to the Harris standard, the excellent and good rate of the cosmetic effect of the reconstructed breast was 93.7%. The score of FACT-B was 108.20±16.9 (range: 67 to 144) 1 year postoperatively. Compared with 2012, the IBR rate was significant increased, till 2015, the IBR rate was 153/10 000 cases (χ(2)=47.028, P=0.000). Conclusions: There is a significant increase on IBR rate in Beijing City, Tianjin City and Hebei province by year. Most of cases received IBR is stage Ⅰ to Ⅱ. Implant reconstruction is the main reconstructive method. Postoperative cosmetic effects and quality of life are both meet patients' demon.

Delivery of drugs into brain tumors using multicomponent silica nanoparticles

Glioblastomas are highly lethal cancers defined by resistance to conventional therapies and rapid recurrence. While new brain tumor cell-specific drugs are continuously becoming available, efficient drug delivery to brain tumors remains a limiting factor. We developed a multicomponent nanoparticle, consisting of an iron oxide core and a mesoporous silica shell that can effectively deliver drugs across the blood-brain barrier into glioma cells. When exposed to alternating low-power radiofrequency (RF) fields, the nanoparticle's mechanical tumbling releases the entrapped drug molecules from the pores of the silica shell. After directing the nanoparticle to target the near-perivascular regions and altered endothelium of the brain tumor via fibronectin-targeting ligands, rapid drug release from the nanoparticles is triggered by RF facilitating wide distribution of drug delivery across the blood-brain tumor interface.

Prevalence of BRCA1/2 large genomic rearrangements in Chinese women with sporadic triple-negative or familial breast cancer

The prevalence of BRCA1/2 large genomic rearrangements (LGRs) and their underlying mechanisms have not been fully evaluated in Chinese women with breast cancer. In this study, we determined the prevalence of BRCA1/2 LGRs in 834 patients with familial breast cancer (FBC) and 660 patients with sporadic triple-negative breast cancer (TNBC) who were negative for BRCA1/2 small-range mutations using the multiplex ligation-dependent probe amplification method. We found that 20 index patients (2.4%) in the FBC group carried a BRCA1 or BRCA2 LGR, and the frequencies of BRCA1 and BRCA2 LGRs were 1.6% and 0.8%, respectively. Seven index patients (1.1%) carried a BRCA1 LGR in 660 sporadic TNBC patients, whereas no BRCA2 LGRs were found in these patients. Among the BRCA1/2 LGRs, 48.1% (13/27) were novel, and the breakpoints of the majority of the LGRs were identified. ΨBRCA1-mediated homologous recombination (HR) and Alu-mediated HR/non-homologous end-joining (NHEJ) accounted for 40% and 30% of the BRCA1 LGRs, respectively. Alu-mediated HR accounted for 71.4% of the BRCA2 LGRs, and the remaining one-third was generated through Long interspersed nuclear elements (LINE)-mediated NHEJ. Our findings suggest that both FBC patients and sporadic TNBC patients should be tested for BRCA1/2 LGRs.

Abstract PD2-01: Ultrasound together with clinical indexes cannot predict sentinel lymph node metastasis for ultrasound-axillary lymph node-negative breast cancer patients

Background: Sentinel lymph node (SLN) pathology result is crucial to predict axillary lymph nodes (ALN) metastasis as well as to determine systemic treatment strategy. Ultrasound has been paid great attention to the evaluation of ALN metastasis. Whether the combination of known clinic-pathological indexes to ultrasound could predict SLN metastasis for ultrasound-ALN-negative breast cancer, and ultimately achieve the goal of avoiding the invasive method of sentinel lymph node biopsy (SLNB), is the current focus.

Objective: To discuss the possibility of predicting SLN metastasis using axillary ultrasonography in combination with patients' clinic-pathologic factors by retrospectively analyzing our institution's large cohort of ultrasound-ALN-negative breast cancer patients' data.

Method: This study collected consecutive data from the prospective database of Breast Center of Beijing Cancer Hospital from Oct. 2010 to Apr. 2016. Inclusion criteria: Pathologically diagnosed as primary breast cancer by core needle biopsy (CNB); negative ALN by ultrasound (no ALN detected, or the cortex thickness was even and &lt;3mm); no treatment prior to SLNB. The SLN pathological outcomes were correlated with known clinic-pathologic parameters. Univariate analysis was performed by Chi-Square test, with p&lt;0.05 considered as statistically significant difference. Logistic regression analysis was used for the multivariate analysis, the area under curve &gt;0.75 stands for acceptable predicting accuracy.

Results: Non-selective consecutive data with a total of 4,936 primary breast cancer cases treated from Oct. 2010 to Apr. 2016 was extracted from the prospective database. Exclusion criteria: Pathologically diagnosed by surgical resection (n=492); carcinoma in situ (n=145); abnormal ALN by ultrasound underwent fine needle aspiration (FNA) or CNB (n= 750); systemic treatment prior to SLNB (n=349); no SLN detected after injection (n=81); male (n=4). A total of 3,115 cases met the inclusion criteria. Among which 2,317 (74.3%) cases were negative SLN pathology and 798 (25.7%) cases were positive SLN pathology. The main findings of this study were that the univariate analysis such as, patients' age, menstruation, tumor size, ER/PR, HER-2 were influencial factors, p&lt;0.05. Multivariate analysis showed that the area under the ROC curve was 0.658(95% CI 0.637-0.679), indicating that the combination of all the clinic-pathologic factors with ultrasound could not stand for acceptable predicting accuracy.

Conclusion: Ultrasound together with clinical indexes cannot predict SLN metastasis for ultrasound-ALN-negative breast cancer patients.

The result of univariates related to SLNItemsSLN-Negative%(n)SLN-Positive%(n)p valueAge≤4070.5(324)29.5(136)0.036&gt;4075.1(1,993)24.9(662)Premenopausal71.8(1,215)28.2(477)&lt;0.001Postmenopausal77.4(1,102)22.6(321)T size(cm)≤278.4(1,242)21.6(342)&lt;0.001T size(cm)&gt;270.2(1,075)29.8(456)IDC I83.0(455)17.0(93)&lt;0.001IDC II+III71.1(1,603)28.8(649)Other pathology types82.2(259)17.8(56)ER≤10%85.8(652)14.2(108)&lt;0.001ER&gt;10%70.7(1,665)29.3(690)PR≤10%80.3(851)19.7(208)&lt;0.001PR&gt;10%71.3(1,466)28.7(590) HER-2 0,1+,2+&FISH-73.1(1,729)26.9(635)0.008HER-2 3+,2++78.3(588)21.7(163) 

Citation Format: Chen X, He Y, Huo L, Li J, Xie Y, Wang T, Fan Z, Ouyang T. Ultrasound together with clinical indexes cannot predict sentinel lymph node metastasis for ultrasound-axillary lymph node-negative breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-01.

[Application of decision curve on evaluation of MRI predictive model for early assessing pathological complete response to neoadjuvant therapy in breast cancer]

Objective: To construct a dynamic enhanced MR based predictive model for early assessing pathological complete response (pCR) to neoadjuvant therapy in breast cancer, and to evaluate the clinical benefit of the model by using decision curve. Methods: From December 2005 to December 2007, 170 patients with breast cancer treated with neoadjuvant therapy were identified and their MR images before neoadjuvant therapy and at the end of the first cycle of neoadjuvant therapy were collected. Logistic regression model was used to detect independent factors for predicting pCR and construct the predictive model accordingly, then receiver operating characteristic (ROC) curve and decision curve were used to evaluate the predictive model. Results: ΔArea(max) and Δslope(max) were independent predictive factors for pCR, OR=0.942 (95%CI: 0.918-0.967) and 0.961 (95%CI: 0.940-0.987), respectively. The area under ROC curve (AUC) for the constructed model was 0.886 (95%CI: 0.820-0.951). Decision curve showed that in the range of the threshold probability above 0.4, the predictive model presented increased net benefit as the threshold probability increased. Conclusions: The constructed predictive model for pCR is of potential clinical value, with an AUC>0.85. Meanwhile, decision curve analysis indicates the constructed predictive model has net benefit from 3 to 8 percent in the likely range of probability threshold from 80% to 90%.

[Breast-conserving surgery with immediate partial breast reconstruction using pedicled thoracodorsal artery perforator flap: a clinical analysis of 33 patients]

Objective: To explore the application value of pedicled thoracodorsal artery perforator flap in immediate partial breast reconstruction for breast cancer. Methods: This study is a prospective case series studies. Totally 128 cases of primary breast cancer patients who prepared to receive the breast-conserving surgery combine with immediate partial breast reconstruction of pedicled thoracodorsalartery perforator flap were enrolled in Breast Cancer Prevention and Treatment Center of Peking University Cancer Hospital from June 2013 to March 2016. Finally, the operations had been completed successfully in 33 eligible cases. All patients were female with a median age of 40 years (ranging from 22 to 52 years). The perforator vessel location, the donor area design, the post-operative complications, the influence of radiation and chemotherapy had been evaluated. Results: The average diameter of thoracic dorsal artery perforators measured by Doppler ultrasound before the operation was (1.5±0.4) mm (ranging from 0.6 to 2.7 mm). The average size of flaps was 15 cm×6 cm. The average time of operations was (271±72) minutes (ranging from 120 to 245 minutes). Drainage tube removed on (4.7±2.1) days after operation (ranging from 3 to 12 days). All patients received follow-up, and there was no local recurrence and distant metastasis during a median follow-up of 17(12) months (M(Q(R))) (ranging from 5 to 38 months). All TDAP flaps were survival, the wound complication rates was 6% (2/33). Conclusions: The breast reconstruction of pedicled thoracodorsal artery perforator flap is a good choice of repairing local breast defect of breast conserving surgery.Its advantages are no-influence of latissimus dorsi function and little complications in donor area.

[Impact of adjuvant chemotherapy on the prognosis of hormone receptor negative breast cancer with residual lymph node disease after neoadjuvant chemotherapy]

Objective: To explore the influence of adjuvant chemotherapy on the prognosis of hormone receptor negative breast cancer with residual lymph node disease(RLND)after neoadjuvant chemotherapy. Methods: A total of 110 hormone receptor negative breast cancer patients treated with 4-8 cycles of neoadjuvant chemotherapy were respectively analysed between 2002 and 2012. Residual lymph node disease was comfirmed by subsequent radical mastectomy. Then all these patients were classified into two groups: patients treated with adjuvant chemotherapy(group A) and patients untreated with adjuvant chemotherapy(group B). Results: All patients were female, the median age was 54.5 years old(IQR: 47-59 years). The median follow-up time was 61 months(IQR: 51-88 months). There were 82 patients (74.5%) in group A, and 28 patients (25.5%) in group B. The five-year disease-free survival (DFS) rate was 76.2% in group A and 57.6% in group B. The distant disease-free survival (DDFS) rate was 78.9% in group A and 60.4% in group B. Overall survival (OS) rate was 81.0% in group A and 60.0% in group B. Multivariate analysis showed that there were significant differences for DDFS rate (group A vs group B, P=0.033; hazard ratio [HR], 5.256; 95% confidence interval [95%CI], 1.14-24.17) and OS rates (group A vs group B, P=0.011; HR, 7.478; 95%CI, 1.58-35.30) between two groups. Conclusion: The patients who have hormone receptor negative breast cancer with RLND after neoadjuvant chemotherapy, may benefit from postoperative adjuvant chemotherapy.

[Impact of the response of primary tumor to preoperative chemotherapy and anti-HER2 therapy on survival of HER2-positive breast cancer patients]

OBJECTIVE

To study the impact of anti-HER2 therapy and response of primary tumor on distant disease free survival (DDFS) of the patients with HER2-positive breast cancer.

METHODS

The clinical data of the patients with HER2-positive breast cancer treated with neoadjuvant systemic therapy were analyzed retrospectively.

RESULTS

Patients treated with preoperative anti-HER2 therapy and chemotherapy had a significant improved pathological complete response (pCR) rate (48.4%) compared with those treated with preoperative chemotherapy (17.2%) (P=0.000). The median follow-up period was 62(6-160) months. The 5-year DDFS in patients with anti-HER2 therapy and patients without anti-HER2 therapy was 93.5% and 83.3% respectively (P=0.006). The 5-year DDFS in patients achieving a pCR and patients not achieving a pCR was 94.7% and 82.6% respectively(P=0.001). Among patients achieving a pCR, anti-HER2 therapy did not improve DDFS significantly (P=0.960). Benefits of anti-HER2 therapy in DDFS among patients without a pCR achieved statistical significance (P=0.028).

CONCLUSIONS

Combination of neoadjuvant anti-HER2 therapy and chemotherapy resulted in a higher pCR rate in HER2-overexpressing primary breast cancer. Patients treated with neoadjuvant systemic therapy who achieved a pCR have excellent outcome regardless of whether they received anti-HER2 therapy.

Prevalence of BRCA1 mutations and responses to neoadjuvant chemotherapy among BRCA1 carriers and non-carriers with triple-negative breast cancer

BACKGROUND

The frequency of BRCA1 germline mutations among Chinese women with triple-negative breast cancer is unclear, and the association between BRCA1 mutations and the response to neoadjuvant chemotherapy in women with triple-negative breast cancer has not been determined.

PATIENTS AND METHODS

Nine hundred and fifty-six triple-negative breast cancer patients were treated at our institute between 2003 and 2012; we tested the BRCA1/2 mutations for 956 patients and 953 patients in this cohort, respectively. Among the 956 patients, 652 patients received neoadjuvant chemotherapy.

RESULTS

In this cohort, 7.1% (68/956) and 2.3% (22/953) of patients carried a BRCA1 or BRCA2 mutation, respectively. The BRCA1/2 mutation rates were 10.5% and 3.0% among the patients who were diagnosed at or before the age of 50 in this cohort, respectively. The pCR (pathologic complete response) rate was 31.6% in the 652 patients who received neoadjuvant chemotherapy. BRCA1 carriers had a significantly higher pCR rate than non-carriers (BRCA1 carriers versus non-carriers, 53.8% versus 29.7%, P < 0.001). Among women treated with anthracycline with or without taxane regimens, the pCR rate was 57.1% for BRCA1 carriers, 29.0% for non-carriers (P < 0.001); among women treated with taxane regimens, the pCR rate was 40.0% for BRCA1 carriers, 32.9% for non-carriers (P = 0.73). At a median follow-up of 43 months, the recurrence-free survival was similar between BRCA1 carriers and non-carriers among the 947 patients of this study (adjusted hazard ratio = 0.92; 95% confidence interval: 0.45-1.90; P = 0.82).

CONCLUSIONS

Chinese women with triple-negative breast cancer who are diagnosed at or before age of 50 are candidates for BRCA1 genetic testing. Among triple-negative breast cancer patients, BRCA1 carriers are more likely to respond to neoadjuvant anthracycline-based regimens than are non-carriers.

Promoter methylation of BRCA1 in triple-negative breast cancer predicts sensitivity to adjuvant chemotherapy

BACKGROUND

BRCA1 function is inactivated through BRCA1 promoter methylation in a substantial number of triple-negative breast cancers. We investigated the impact of BRCA1-methylation status on the efficacy of adjuvant chemotherapy in patients with triple-negative breast cancer or with non-triple-negative breast cancer.

METHODS

BRCA1 promoter methylation was assessed in 1163 unselected breast cancer patients. Methylation was evaluated using a methylation-specific PCR (MSP) assay.

RESULTS

In the subgroup of 167 triple-negative breast cancer patients who received adjuvant chemotherapy, patients with BRCA1-methylated tumors had a superior 10-year disease-free survival (DFS)(78% versus 55%, P = 0.009) and 10-year disease-specific survival (DSS) (85% versus 69%, P = 0.024) than those with BRCA1-unmethylated tumors, and BRCA1 methylation was an independent favorable predictor of DFS and DSS in a multivariate analysis in this subgroup [DFS: hazard ratio (HR) = 0.45; 95% confidence interval (CI) 0.24-0.84; P = 0.019; DSS: HR = 0.43; 95% CI = 0.19-0.95; P = 0.044]. In contrast, in 675 non-triple-negative breast cancer patients who received adjuvant chemotherapy, BRCA1 methylation was an unfavorable predictor of DFS and DSS in univariate analysis (DFS: HR = 1.56; 95% CI 1.16-2.12; P = 0.003; DSS: HR = 1.53; 95% CI = 1.05-2.21; P = 0.026).

CONCLUSIONS

Triple-negative breast cancer patients with BRCA1-methylated tumors are sensitive to adjuvant chemotherapy and have a favorable survival compared with patients with BRCA1-unmethylated triple-negative tumors.

P3-07-03: One-Step Nucleic Acid Amplification (OSNA) for the Diagnosis of Sentinel Lymph Nodes of Breast Cancer – Results of the China Multicenter Study CBCSG-001c

Background

With the adoption of sentinel lymph node (SLN) biopsy as the standard of care, there is an increasing need for the rapid and accurate intra-operative diagnosis of SLNs. CBCSG-001c was a prospective multicenter trial to validate the One-step nucleic acid amplification (OSNA) assay in China. The primary endpoint was the concordance rates of intraoperative OSNA assay with the in-depth permanent histological analyses based both on cases and SLNs.

Methods: From Feb. to Dec. 2010, 1188 SLNs from 552 breast cancer patients were enrolled in the CBCSG-001c study at 5 centers. SLNs were cut into alternating ∼2mm sections. One half of the sections were sampled for H&E, with 4 sections at different intervals. The other half was fully tested with the OSNA assay. Predetermined cutoffs were calibrated so only metastases &gt;0.2 mm were detected.

Results: The concordance rate was 89.1% (95% CI, 86.3−91.5%), sensitivity 87.7% (95% CI, 81.0−92.7%), and specificity 89.6% (95% CI, 86.3−92.4%) based on 552 cases, and the concordance rate was 91.4% (95% CI, 89.7−92.9%), sensitivity 83.7% (95% CI, 77.7−88.6%), and specificity 92.9% (95% CI, 91.1−94.4%) based on the 1188 SLNs. This quantitative molecular assessment allows the distinction of the size of the metastasis, and the PPV of OSNA [++] for macrometastases was 83.2% (95% CI, 75.0- 89.1%). Discordant results were thought to be partly due to the fact that different tissue sections were used for OSNA assay and histology, and SLNs with ITCs were not considered as histological positive nodes. After discordant case investigation, the senstivity of OSNA assay was significantly higher than that of intraoprative frozen section and touch imprint cyctology.

Discussion: As the largest OSNA study to date, our results, together with that of Japan, Germany, and France study, proved the OSNA assay based on CK19 mRNA expression to be a reliable and standardized tool for the intraoperative detection of SLN metastases of breast cancer patients as compared to in-depth permanent histology. The high sensitivity of OSNA assay means reducing the risk of second operation for ALND, medical care costs and patients anxiety.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-03.

Abstract P1-11-11: Correlation between ER/PgR/Her-2/Ki67 Expression and Response to Neoadjuvant Endocrine Therapy for HR Positive Post-Menopausal Breast Cancer

Background: Endocrine therapy was standard adjuvant treatment for hormone receptor positive breast cancer. However, there were factors other than receptor status could influence endocrine responsiveness. Neoadjuvant therapy was an excellent platform for predictive factors research, but the standard for evaluating the efficacy of neoadjuvant endocrine therapy was controversy. The aim of this study was to investigate the correlation among the results of different response evaluation system, and the relationships between ER/PgR/Her-2/Ki67 expression and the responses to neoadjuvant endocrine therapy for postmenopausal breast cancer.

Methods: Data of consecutive 133 core needle biopsy (CNB) confirmed hormone receptor strongly positive (more than 50% tumor cell stained ER or PgR) postmenopausal breast cancer treated with neoadjuvant endocrine therapy were analysis retrospectively. All pts. were planned to receive endocrine therapy alone as their adjuvant treatment and prescribed Anastrozole 1 mg per day for 16 weeks before surgery. Clinical response were evaluated by using documented ultrasound records,pathological response was evaluated by one senior pathologist with Miller & Payne classification. Cell cycle complete response was defined as post-treatment Ki67 ≥1%. The new slides of pre-treatment and surgical specimens were made for ER/PgR (ER\PR DakoCytomation)/Her-2 (Her-2 Dako HercepTest TM)/Ki67 (Ki67 Ventana) immunohistochemical staining through Benchmark XT Staining Instrument (Ventana Medical Systems. Inc. Arizona. USA) and classified by using image analysis system Ariol (Applied Imaging Inc., San-Jose, California, USA).

Results: Clinical response were CR:0.8% PR:33.1% SD:66.1%, pathological response were G5:3% G4+G3:47.4% G2+G1:49.6%, Ki67 change were &lt;1%: 22.8% decrease but &gt;1%:45.1% no decrease: 32.1%. The correlation and consistency among the response evaluated differently were poor [table 1]. The per-treatment ER/PR/Her-2/Ki67 showed low degree of correlation with responses [table 2]. Pre-treatment ER≥90% and PR≥90% and Her-2 coudln't predict better response.

The correlation and consistency among response evaluated in different system

Conclusion: The correlation and consistency among the results of response to neoadjuvant endocrine therapy evaluated by different system were poor. ER/PgR/Her-2/Ki67 showed low degree of correlation to responses. It's difficult to predict response to Arimidex neoadjuvant endocrine therapy by using ER/PgR/Her-2/Ki67 expression.

Abstract P1-01-27: Level III and Interpectoral Lymph Nodes Involvement in Breast Cancer with Positive Axillary Lymph Nodes after Neoadjuvant Chemotherapy

Background: In the era of sentinel node biopsy (SNB), mainly aimed at local control, the axillary dissection (AD) was performed for breast cancer with positive node. It was argued that only level I/II lymph nodes dissection might be inadequate because nodes involvement was found in level III and interpectoral region when axillary node was positive. It is necessary to assess the extent of AD after modern preoperative axillary staging. The aim of this study was to investigate the incidence and associated factors of node involvement in level III/interpectoral region. Methods: A consecutive series of 338 core needle biopsy confirmed T0-2 invasive breast cancer cases were included in this study. Axillary node metastases were proved by ultrasound guided needle biopsy (NB) if ultrasonographic abnormal node was detected prior to SNB or by SNB if no abnormal node was detected. Cases of negative NB but positive SNB with image abnormal node were excluded. Prior to AD included level III and interpectoral lymph nodes, 4 to 8 cycles of neoadjuvant chemotherapy with anthrocyclin and/or taxane regimen were completed for each case. The chi-square test was used to determine the relation between level III/interpectoral lymph nodes metastases and clinicopathological factors. Multivariate logistic regression was analyzed for covariate selection. Results: A median of 19 axillary nodes was harvested per case (range: 5-46, average: 19.2). The pathologic complete response rate of axillary nodes was 35.3% (70/198) in NB positive subgroup. Level III and interpectoral lymph nodes were harvested in 76.9% (260/338) of cases (range: 1-8, average: 1.9, median: 1) and 49.7% (168/338) of cases (range: 1-10, average: 1.6, median: 1), respectively. The incidence of positive level III and interpectoral lymph nodes were 8.9% (30/338) and 8.9% (30/338), respectively. Node involvement of level III/interpectoral region was found in 13.3% (45/338) of these cases. The incidence of node involvement in level III/interpectoral region of NB positive subgroup (14.6%, 29/198) was not significantly higher compared with SNB positive subgroup (11.4%, 16/140, P=0.391). Increasing tumor size was significantly correlated with increasing likelihood of node involvement in level III/interpectoral region (T0-1: 6.3% vs T2: 16.7%, P=0.008). In SNB positive T0-1 subgroup, there was no positive node found in level III/interpectoral region. Multivariate analysis showed that tumor size was the only independent factors predicting node involvement in level III/interpectoral region (OR=3.488, 95%CI:1.427-8.528, P=0.006).

Conclusions: The incidence of node involvement in level III/interpectoral region was 13.3% of nodes positive T0-2 breast cancer treated with neoadjuvant chemotherapy. Tumor size may be the predictor of node involvement in this region.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-27.

China Validation Study of GeneSearchTM Breast Lymph Node Assay for the Diagnosis of Sentinel Lymph Nodes of Breast Cancer – CBCSG-001a Interim Results

Background: The use of sentinel lymph node (SLN) biopsy is becoming the standard of care in China. With the adoption of this technique there is an increasing need for rapid and accurate detection of metastases in the SLNs. Histological intra-operative techniques such as touch imprint and frozen section offer limited sensitivity, increasing the risk of intra-operatively missing relevant SLN metastases (&gt;0.2 mm). Post-operative histology (H&E) also risks missing metastases due to tissue sampling limitations and being partially dependent on pathologist expertise. A real-time RT-PCR assay, GeneSearchÔ Breast Lymph Node (BLN) Assay, may offer a standardized intra-operative way to evaluate larger portions of the SLN. CBCSG-001a is a prospective multicenter trial to validate the GeneSearchÔ BLN Assay in China.Methods: Started from February 2009, CBCSG-001a is being conducted at 6 centers with a total enrollment of 540 cases by the end of June 2009. SLNs are cut into alternating ∼2mm sections. One half of the sections are sampled for H&E. The other half is fully tested with the BLN assay. The assay detects the presence of cytokeratin-19 and mammaglobin to assess if metastases are in SLNS. Predetermined cutoffs are calibrated so only metastases &gt;0.2 mm are detected. Each assay run has internal and external controls to confirm a valid result.About 40% cases would receive axillary lymph node dissection (ALND) in spite of the status of SLN in 3 of the 6 centers. Intraoperative frozen section for SLN diagnosis was conducted in 4 of the 6 centers, and intraoperative touch imprint cytological diagnosis for all sections was conduced in 2 of the 6 centers.Results: Interim results are based on 20% (114/540) of the planned breast cancer patients for the study. Current histology positive rate is 30%. The BLN assay shows high performance as compared to H&E. The results are also very similar to those seen in the larger US clinical validation trial.Discussion: Interim results indicate that the BLN assay has high performance as compared to H&E, and allows same surgery ALND avoiding the need to wait for a second surgery. In addition the performance is equivalent to the results seen in the larger US clinical validation trial, indicating the assay performance is fairly robust. So there is clinical potential of using the assay for performance similar to H&E with the advantage of being an intra-operative, objective and standardized test that examines a larger portion on the nodal tissue. The final results of 550 cases will be updated at the SABCS.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1023.

Expression of ER-a36, a novel variant of estrogen receptor a, and resistance to tamoxifen treatment in breast cancer

Abstract #3037

Background: Recently, a 36 kDa variant of estrogen receptor a (ER-a66), ER-a36, has been identified and cloned. ER-a36 predominantly localizes on the plasma membrane and in the cytoplasm and mediates a membrane-initiated “nongenomic” signaling pathway. In this study, we investigated the association between ER-a36 expression and tamoxifen resistance in breast cancer patients.&#x2028; Methods: ER-a36 protein expression in tumors from 710 breast cancer patients with a median follow-up of 7.9 years was assessed using immunohistochemistry (IHC) assay. Survival curves were compared using the log-rank test and multivariate analysis was performed using Cox model. All statistical tests were two-sided.&#x2028; Results: Among the patients with ER-a66 positive tumors who received tamoxifen treatment (n=307), overexpression of ER-a36 was associated with poorer disease-free survival (DFS) and disease-specific survival (DSS) and remained as an unfavorable independent factor of survival in multivariate analyses (DFS: HR=2.27; 95% CI= 1.40 to 3.68; P=. 001; DSS: HR=2.42; 95% CI= 1.37 to 4.28; P= .002). In contrast, among patients with ER-a66 positive tumors who did not receive tamoxifen (n=129), ER-a36 expression was not associated with survival, indicating a correlation between ER-a36 expression and tamoxifen resistance. Furthermore, ER-a36 expression was not associated with survival in ER-a66 negative tumors whether the patients received tamoxifen (n=73) or not (n=149). Our in vitro experiments with MCF7/ER36 cells also confirmed that high ER-a36 expression resulted in tamoxifen resistance.&#x2028; Conclusions: Patients with ER-a66 positive tumors that also express high levels of ER-a36 are less likely to benefit from tamoxifen treatment. ER-a36 is an important predictive marker for tamoxifen therapy in ER-a66 positive breast cancer patients.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3037.

Weekly paclitaxel improved pathological response of primary chemotherapy compared with standard 3 weeks schedule

Abstract #5109

Background: Weekly paclitaxel is superior to every-3-wk schedule in the management of MBC. This single institute, prospective randomized trial was designed to compare the efficacy of the weekly paclitaxel to every-3-wk schedule in terms of pathological response.&#x2028; Material and methods: Histologically confirmed T1-3 N0-1M0 invasive breast cancer pts planed to receive adjuvant chemotherapy were eligible. After the completion of 2 cycles of CTFci ( CTX 500mg/m2 d1/d8, pirarubicin 35 mg/m2 d1/d8, 5-Fu 200 mg/m2.day.ci d1-28, every 4 weeks) primary chemotherapy, pts were randomized to received 4 cycles of PTq3w (arm A: carboplatin AUC 6mg/ml.min day1, paclitaxel 175mg/m2 day1, every 3 weeks) or PTq1w (arm B: carboplatin AUC 6mg/ml.min day1, paclitaxel 60mg/m2 day1/8/15, every 3 weeks) before surgery, stratified by clinical response to 2 cycles of CTFci. Status of axillary node were determined by sentinel node biopsy or ultrasound guided FNA (if abnormal ultrasonographically) before primary chemotherapy. Pathological response of the primary tumor was evaluated by using Miller and Payne system, clinical response was determined by ultrasonography.&#x2028; Results: From 05/2005 to 10/2007, 220 pts ( 196 were planed) under 65yr entered in this trial. 201 pts completed planed treatment and 12 pts(arm A 4 pts, arm B 8 pts)choice to have surgery after 2 cycles of paclitaxel treatment, other 7 pts (5 protocol violation, 1 without surgery, 1 treated in other hospital) were excluded for analysis. Clinical tumor status, node status, estrogen receptor expression, Her-2 expression and clinical response to CTFci were no different between two arms.&#x2028; &#x2028; Arm A resulted more G1/G2(loss of tumor cells less than 30%) and less G5/G4 ( loss of tumor cells more than 90%) than arm B (28.70% vs. 14.28% p=0.011, 44.44% vs. 58.10% p= 0.047 ). The pCR rate of positive node were 39.29%(11/28) in arm A and 54.17%(13/24) in arm B ( p=0.283).&#x2028; &#x2028; There were 17(15.74%) pts in arm A and 67(61.81%)pts in arm B experienced treatment delay caused by neutropenia(G3), thrombocytopenia(G2), anemia(G2) or hepatotoxicity(G2). There was no treatment related death.&#x2028; Conclusion: Weekly paclitaxel was well tolerant and more effective than 3 week schedule.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5109.

Association between CYP2D6 *10 genotype and survival of breast cancer patients receiving tamoxifen treatment

BACKGROUND

Human cytochrome P450 2D6 (CYP2D6) genotype may affect the efficacy of tamoxifen treatment in Caucasian women with breast cancer. The most common polymorphism of CYP2D6 in Chinese women is variant 10 (188 C to T).

PATIENTS AND METHODS

Tamoxifen and 4-hydroxytamoxifen (4OHtam) were measured in the serum of 37 women with breast cancer who were receiving tamoxifen treatment. The association between CYP2D6 *10 genotype and survival was determined in a cohort of 293 women with breast cancer who received tamoxifen (n = 152) or who did not (n = 141).

RESULTS

The serum 4OHtam concentrations were significantly lower in women with the CYP2D6 *10 homozygous variant T/T genotype than in those with the homozygous wild-type C/C genotype (P = 0.04). Among tamoxifen-treated women, women with the T/T genotype had a significantly worse disease-free survival (DFS) than those with the C/C or C/T genotype, and the T/T genotype remained an independent prognostic factor of DFS in multivariate analysis (hazard ratio = 4.7; 95% confidence interval = 1.1-20.0; P = 0.04). Among women who did not receive tamoxifen, there was no significant association between CYP2D6 *10 genotype and survival.

CONCLUSION

In tamoxifen-treated patients, women with the CYP2D6 *10 T/T genotype have a lower 4OHtam level in the serum and a worse clinical outcome.

Nucleophosmin-anaplastic lymphoma kinase associated with anaplastic large-cell lymphoma activates the phosphatidylinositol 3-kinase/Akt antiapoptotic signaling pathway

More than half of anaplastic large-cell lymphomas (ALCLs) have a chromosomal translocation t(2;5) that leads to the expression of a hybrid protein composed of the nucleolar phosphoprotein nucleophosmin (NPM) and the anaplastic lymphoma kinase (ALK) that exhibits an unregulated tyrosine kinase activity. We have previously identified PLC-gamma as a crucial downstream signaling molecule of NPM-ALK that contributes to its mitogenic potential. Here, we show that NPM-ALK recruits the C-terminal SH2 domain of the phosphatidylinositol 3-kinase (PI 3kinase) p85 subunit. PI 3-kinase assays revealed that the kinase is activated by NPM-ALK in vivo, in turn activating PKB/Akt in NPM-ALK-expressing cells. The use of 2 specific PI 3-kinase inhibitors, wortmannin and LY294002, demonstrated the requirement of PI 3-kinase for the growth of NPM-ALK-transformed cell lines, as well as a cell line established from a patient with ALCL. Primary murine bone marrow retrovirally transduced with NPM-ALK showed a transformed phenotype that was reversible on treatment with PI 3-kinase inhibitors. Flow cytometric analysis revealed that wortmannin-treated NPM-ALK-transformed cell lines underwent apoptosis. Furthermore, apoptosis induced by overexpression of the proapoptotic molecule Bad could be partially blocked by the overexpression of NPM-ALK. Thus, NPM-ALK activates the antiapoptotic PI 3-kinase/Akt pathway, which likely contributes to the molecular pathogenesis of ALCL. (Blood. 2000;96:4319-4327)

[Orbital fat preservation and orbicularis muscle flap suspension for lower eyelid pouches]

OBJECTIVE

This is to introduce the experience in the treatment of lower eyelid pouches by orbital fat preservation and orbicularis oculi muscle flap suspension techniques.

METHODS

From Sept. 1996 to May 1997, thirty patients with lower eyelid pouches were treated using Hamra's procedure. During the operation, the arcus marginalis was incised. The orbital fat was released and advanced beyond the infraorbital rim and sutured. A lateral-based orbicularis oculi muscle flap was created, and its pedicle was repositioned to the periosteum of the upper lateral orbital rim in a superiomedial direction.

RESULTS

A total of 26 patients were available for postoperative follow-up for 3 to 8 months (mean 5.6 months). Of them one patient developed unilateral lower eyelid ectropion due to flabby reposition of the orbicularis oculi muscle flap. The rest obtained excellent cosmetic results without complications.

CONCLUSION

This new method has following advantages: 1. The lower eyelid pouches and the infraorbital rim show that may be corrected simultaneously: 2. Sunken eyelids and scleral show that may follow fat removal in conventional lower blepharoplasty can be effectively avoided. 3. "Cheek lift" and a youthful eyelid-cheek complex contour can be obtained.

A streptococcal adhesion system for salivary pellicle and platelets

A Streptococcus sanguis 133-79 adhesin identified by the monoclonal antibody 1.1 (MAb 1.1) binds both saliva-coated hydroxylapatite (sHA) and platelets. The complementary binding site(s) for the adhesin was identified by the anti-idiotypical MAb 2.1. To learn if this adhesion system, marked by the antiadhesin MAb 1.1 and anti-binding site MAb 2.1, is commonly used by strains within the sanguis group and other viridans group streptococci, 42 strains from seven species were tested. Strains that bind to both sHA and platelets use the same adhesin and binding site epitopes. Strains that do not adhere to platelets rely on other adhesin specificities to bind to sHA.

[Clinical application of photodynamic therapy combined with non-coherent light (red light) for treatment of port-wine stains]

OBJECTIVE

This is to report the clinical application of photodynamic therapy (PDT) combined with non-coherent light (red light) for the treatment of port wine stains (PWS).

METHODS

Eleven cases with PWS have been treated with PDT combined with non-coherent light since Dec. 1995.

RESULTS

The facial lesions of PWS in the 11 cases disappeared completely without any scarring.

CONCLUSION

PDT combined with red light that has strong skin-penetrating ability and irradiation just after intravenous injection of photosensitizing drugs are effective to embolize the malformative vasculature in pink lesions, especially in dark purple lesions and purple lesions with proliferation.

[Study on intravascular pressure change during sclerotherapy for cavernous hemangiomas (CHs)]

To investigate the regulation and significance of the intravascular pressure change of cavernous hemangiomas during the treatment of sclerotherapy, we did observations in 29 cases with slowing down the efferent blood flow of the CHs in their treatment. It was found that the baseline intravascular pressure of CHs is 5-15 mmHg, the lowest being at the neck. The efferent rate of CHs is higher than the afferent rate. The higher the efferent rate, the more times of injection and more amount of thrombotic agent were needed. At the beginning of the thrombosis, the CHs pressure rose gradually to a flat curve, which suggested that the efferent veins were being thrombosed one by one. Then the CHs pressure curve became a blunt peak, which suggested that all the efferent veins were thrombosed and it was time to inject the sclerosing agent. Finally the CHs pressure curve became a sharp peak, suggesting that the whole CHs was thrombosed and sclerosed. Follow-up from 6 months to 3 years revealed that CHs disappeared in 26 of 29 cases, recurred in 3 cases. No severe complications were found. The authors concluded that the treatment can improve the curative effect and decrease complications.

[Experimental study on vascularized area of the prefabricated axial skin flap after implantation of vascular bundles]

Thirty-eight New Zealand white male rabbits were used to study vascularized area of the prefabricated axial skin flaps (PASFs) after implantation of vascular bundles (VBs) into subcutaneous tissues of the animal's abdomen. Influential factors were investigated including the interval after implantation, the size of VBs, the subcutaneous layer where VBs were implanted and simultaneous skin expansion. The results indicated that the suitable time for PASFs transferring was 3-4 weeks after implantation of VBs. The VBs of larger diameter prefabricated larger area of PASFs. Larger areas of PASFs were created by implanting VBs into the subcutaneous layers that possessed rich vascular plexuses. It was possible that the expanded PASFs could be transferred.

Platelet receptors for the Streptococcus sanguis adhesin and aggregation-associated antigens are distinguished by anti-idiotypical monoclonal antibodies

Platelets aggregate in response to an adhesin and the platelet aggregation-associated protein (PAAP) expressed on the cell surfaces of certain strains of Streptococcus sanguis. We sought to identify the corresponding PAAP receptor and accessory adhesin binding sites on platelets. Since the adhesion(s) of S. sanguis for platelets has not been characterized, an anti-idiotype (anti-id) murine monoclonal antibody (MAb2) strategy was developed. First, MAb1s that distinguished the adhesin and PAAP antigens on the surface of S. sanguis I 133-79 were selected. Fab fragments of MAb1.2 (immunoglobulin G2b [IgG2b]; 70 pmol) reacted with 5 x 10(7) cells of S. sanguis to completely inhibit the aggregation of human platelets in plasma. Under similar conditions, MAb1.1 (IgG1) inhibited the adhesion of S. sanguis cells to platelets by a maximum of 34%, with a comparatively small effect on platelet aggregation. Together, these two MAb1s inhibited S. sanguis-platelet adhesion by 63%. In Western immunoblots, both MAb1s reacted with S. sanguis 133-79 87- and 150-kDa surface proteins and MAb1.2 also reacted with purified type I collagen. The hybridomas producing MAb1.1 and MAb1.2 were then injected into BALB/c mice. Enlarged spleens were harvested, and a panel of MAb2 hybridomas was prepared. To identify anti-ids against the specific MAb1s, the MAb2 panel was screened by enzyme-linked immunosorbent assay for reaction with rabbit polyclonal IgG antibodies against the 87- and 150-kDa antigens. The reactions between the specific rabbit antibodies and anti-ids were inhibited by the 87- and 150-kDa antigens. When preincubated with platelets, MAb2.1 (counterpart of MAb1.1) inhibited adhesion to platelets maximally by 46% and MAb2.2 (anti-MAb1.2) inhibited adhesion to platelets maximally by 35%. Together, both MAb2s inhibited the adhesion of S. sanguis to platelets by 81%. MAb2.2 also inhibited induction of platelet aggregation. MAb2.2 immunoprecipitated a biotinylated platelet membrane antigen of 170 kDa (unreduced); MAb2.1 precipitated membrane antigens of 175- and 230-kDa (unreduced). Therefore, platelet binding sites and the receptor for the S. sanguis adhesin and PAAP, respectively, are distinguished by the anti-id MAb2s.