Evaluation of physical and psychological status of health care workers infected with COVID-19 during a hospital outbreak in Japan

PURPOSE

COVID-19 causes physical and psychological impacts on health care workers (HCWs), especially when it occurs during an outbreak. As there are few reports on outcomes of HCWs infected with COVID-19 during a hospital outbreak, we investigated the physical and psychological impacts on HCWs infected with COVID-19 during an outbreak in our hospital.

METHODS

During the outbreak in our hospital, 231 people were infected with COVID-19 including patients, HCWs and their families. Among them, 83 HCWs were enrolled in this study. Current quality of life (QOL) was assessed with the EuroQol-visual analogue scales (EQ-VAS), and motivation to keep on working was evaluated by a 10-point analogue scale. Physiological recovery rates including return to work (RTW) period were also analyzed.

RESULTS

One nurse quit work due to anxiety regarding re-infection with COVID-19. The median period to RTW from the diagnosis was 14.0 (12.0-17.0) days. Motivation to keep on working was slightly reduced, and the EQ-VAS was 75.0 (65.0-83.6). There were no significant differences in QOL and motivation between male and female HCWs, nurses and other HCWs, treatment and non-treatment group, and supplemental and non-supplemental oxygen group. The most frequent persistent symptoms at 1,3 and 6 months after infection were anosmia followed by fatigue.

CONCLUSION

Although QOL and motivation to keep on working were slightly reduced, only one HCW quit work. No severe persistent symptoms were observed, and the RTW period was relatively short.

AB0435 RISK OF SERIOUS INFECTION IN LUPUS NEPHRITIS AND RHEUMATOID ARTHRITIS MEASURED USING THE JAPANESE REAL WORLD HOSPITAL CLAIMS DATABASE

Background:

Patients with lupus nephritis (LN) and rheumatoid arthritis (RA) are at risk of serious infections (SIs) due to the impact of the disease itself and treatments that modulate immune system. Though the epidemiology of RA has been well-established by developing many targeted DMARDs (tDMARDs) including biologics and targeted synthesized DMARDs, LN is a very rare disease. Therefore, a large sample size with a significant number of cases is required to determine the exact risk of SIs in LN.

Objectives:

To compare the incidence rates of SIs resulting in an inpatient claim in adult patients with LN compared with RA with or without tDMARDs using hospital claims data in Japan.

Methods:

LN and RA were identified using claims data provided by Medical Data Vision Co., Ltd (Tokyo, Japan) between April 2008 and June 2019 which was extracted 5thSeptember 2019. Data between January 2010 and December 2018 was used for analysis. Patients with LN and RA were identified using modifications to algorithms developed before [1, 2]. LN patients were required to have continuous insurance claim for both systemic lupus erythematosus (SLE) and LN for ≥ 6 months after index date and then RA patients had continuous insurance claim for RA for ≥ 6 months after index date. First incident SIs were defined as those that resulted in an inpatient claim for a pre-specified set of ICD-10 code. Incidence rates (IRs) were calculated along with 95% confidence intervals (CI).

Results:

The LN, RA, RA treated with tDMARDs and RA treated without tDMARDs cohorts included 6,403, 108,317, 16,450, and 91,867 patients, respectively. As anticipated, the LN and RA cohorts were predominantly female and the RA cohort was generally older than the LN cohorts. IRs per 1,000 person-year(PY) [95% CI] for pneumocystis carini pneumonia were 28.2 [26.0-30.4] in LN, 8.5 [8.2-8.8] in RA, 12.6 [11.7-13.5] in RA with tDMARDs and 7.7 [7.4-8.0] in RA without tDMARDs. IRs per 1,000 PY for septicaemia infection were 23.3 [21.3-25.3] in LN, 12.1 [11.7-12.4] in RA, 13.3 [12.3-14.2] in RA with tDMARDs and 11.8 [11.5-12.2] in RA without tDMARDs. IRs per 1,000 PY for cytomegalovirus infection were 13.4 [11.9-14.9] in LN, 4.4 [4.2-4.6] in RA, 6.2 [5.6-6.8] in RA with tDMARDs and 4.1 [3.8-4.3] in RA without tDMARDs. IRs per 1,000 PY for tuberculosis were 7.2 [6.0-8.3] in LN, 6.7 [6.5-7.0] in RA, 18.2 [17.1-19.3] in RA with tDMARDs and 4.4 [4.2-4.7] in RA without tDMARDs.

Conclusion:

In this population-based analysis of claims data from Japan, the IRs of SI such as pneumocystis carini pneumonia, septicemia infection and cytomegalovirus infection were higher in LN than in RA. And also, the incidence of tuberculosis in RA treated with tDMARDs was highest among these cohorts. These findings demonstrate the relative contribution of age, immunosuppressive therapies and disease-related factors in LN and RA.

References:

[1]Pawar A, et al. Ann Rheum Dis. 2019 Apr;78(4):456-464. [2] ChibnikLB et al. Lupus, 2010. May;19(6):741-3.

Table 1.

Description of study population

LNRAtDMARDsNon tDMARDsN%N%N%N%Age (years) 18-34170026.690158.3182811.171877.8 35-44174327.21666215.4281617.11384615.1 45-54156324.42995527.7445227.12550327.8 55-64139721.85268548.6735444.74533149.3Gender Female538584.17841972.41265376.96576671.6 Male101815.92989827.6379723.12610128.4Table 2.

IRs per 1,000 PY [95% CI] of SI for LN and RA patients

LN total PY = 22065RA total PY = 365033tDMARDsNon tDMARDstotal PY = 60999total PY = 304034Pneumocystis carinipneumonia28.2 [26.0-30.4]8.5 [8.2-8.8]12.6 [11.7-13.5]7.7 [7.4-8.0]Septicaemia23.3 [21.3-25.3]12.1 [11.7-12.4]13.3 [12.3-14.2]11.8 [11.5-12.2]Cytomegalovirusinfection13.4 [11.9-14.9]4.4 [4.2-4.6]6.2 [5.6-6.8]4.1 [3.8-4.3]Tuberculosis7.2 [6.0-8.3]6.7 [6.5-7.0]18.2 [17.1-19.3]4.4 [4.2-4.7]Mycosis5.1 [4.1-6.0]2.7 [2.6-2.9]4.6 [4.1-5.1]2.4 [2.2-2.5]Aspergillosis4.7 [3.8-5.6]2.7 [2.5-2.9]2.1 [1.7-2.5]2.8 [2.6-3.0]Herpes3.3 [2.5-4.0]2.4 [2.2-2.6]2.9 [2.5-3.3]2.3 [2.1-2.5]

Disclosure of Interests:

Mariko Nio Employee of: Chugai Pharmaceutical Co., Ltd., Kosei Tajima Employee of: Chugai Pharmaceutical Co., Ltd., Naofumi Sugaya Employee of: Chugai Pharmaceutical Co., Ltd., Tomoyuki Ishiwata Employee of: Chugai Pharmaceutical Co., Ltd., Tatsuhiko Iwase Employee of: Chugai Pharmaceutical Co., Ltd., hiroyuki kato Employee of: Chugai Pharmaceutical Co., Ltd., Misato Hashizume Employee of: Chugai Pharmaceutical Co., Ltd.

Abstract P4-08-29: Lymphatic invasion is an independent risk factor in patients with small node-negative luminal breast cancer

[Background]

In patients with node-negative (N0), hormone receptor-positive, human epidermal growth factor receptor (HER2) -negative (luminal) breast cancer, the impact of lymphatic invasion (ly) on the prognosis remains to be clarified.

[Methods]

Among 3,158 patients with primary breast cancers who underwent surgery in our institute from January 2007 to December 2009, we analyzed 1027 N0 luminal invasive breast cancers without preoperative systemic therapy. The luminal breast cancer was defined as hormone receptor-positive (ER of ≥ 10% or PgR of ≥ 10%) and HER2-negative (immunohistochemistry: 0, 1+ or FISH: ratio < 2.0) cancer in the postoperative pathological specimen. ly was defined as positive when cancer cell nests were detected within the lymph duct in the whole specimen. N0 was confirmed pathologically by the sentinel lymph node biopsy in all the patients. The Fisher's exact test was used for comparison between different categories. The distant recurrence rate (DRR) was analyzed using the Kaplan-Meier method and the log-rank test. For multivariate analysis, Cox's regression analysis was performed.

[Results]

The median follow-up period was 103.8 months (range: 5.6-128.8). Recurrence with distant metastasis occurred in 26 patients (2.5%). There were 5 (0.7%) deaths related to breast cancer. ly was detected in 240 patients (23.4%). In the ly-positive group, the tumor size was larger (p = 0.007), and the nuclear grade (NG) was higher (p < 0.001) than in the ly-negative group. Postoperative endocrine therapy (p < 0.001) and postoperative chemotherapy (p < 0.001) were more frequently employed for patients with ly-positive tumor. The univariate analysis showed that ly positivity (p < 0.001), large tumor size (p < 0.001), high NG (p < 0.001), PgR negativity (p = 0.002) and the history of adjuvant chemotherapy (p < 0.001) were associated with high DRR. In the multivariate analysis, large tumor size (p = 0.007) and PgR negativity (p = 0.015) remained significant. Although positive ly had a risk ratio of 2.2, it was not an independent risk factor.When restricted to T1 tumor (n = 899), the aforementioned factors still showed prognostic value in the univariate analysis, among which ly positivity (p = 0.004)remained significant together with PgR negativity (p = 0.047)in themultivariate analysis.The 8-year DRR was very favorable (0.8%) in patients with ly-negative T1N0 tumor while it was modest (6.6%) in patients with ly-positive T1N0 tumor (p < 0.001). Only 1.3% of the patients had received adjuvant chemotherapy in the ly-negative group while 27% of the patients had in the ly-positive group.

[Conclusion]

Lymphatic invasion was associated with higher DRR although it was not independent in the multivariate analysis among patients with N0 luminal breast cancer. When restricted to patients with T1N0 luminal breast cancer, the presence of ly was independently associated with higher risk of distant recurrence. It suggests that the assessment of ly is clinically more relevant when considering treatment options for small luminal breast cancer.

Citation Format: Abe T, Ito Y, Fukada I, Shibayama T, Ono M, Kobayashi T, Kobayashi K, Takahashi S, Horii R, Akiyama F, Iwase T, Ueno T, Ohno S. Lymphatic invasion is an independent risk factor in patients with small node-negative luminal breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-29.

Abstract P5-18-11: Prognostic impact and possible pathogenesis of lymph node metastasis in ductal carcinoma in situof the breast

Background: By definition, ductal carcinoma in situ (DCIS) does not metastasize to the lymph nodes. However, since the introduction of molecular whole-node analysis using the one-step nucleic acid amplification (OSNA) assay for sentinel node (SN) biopsies, the number of DCIS patients with SN metastasis has increased. The clinical management of node-positive DCIS remains controversial because these patients can be treated as different stages based on the pathogenesis: e.g. occult invasive cancer with true nodal metastasis (T1N1) or true DCIS with iatrogenic dissemination of benign or tumor cells into lymph node (TisN0). In this retrospective cohort study, we aimed to elucidate the pathogenesis of nodal metastasis in DCIS and the clinical management of node-positive DCIS.

Patients and Methods: Subjects comprised of 427 patients with a routine postoperative diagnosis of DCIS who underwent SN biopsy using the OSNA assay between 2009 and 2012. The cut-off values of the OSNA assay for negative/positive results and micro/macrometastasis were defined at 250 and 5,000 copies/μL of cytokeratin 19 mRNA, respectively. In the SN-positive patients, all paraffin blocks containing the primary tumor were step-sectioned with 0.5-mm intervals until the tissue was exhausted, and all microscopic slides were examined for detecting occult invasions. Afterwards, the patients were classified into three cohorts based on the SN status and occult invasion: (1) no SN metastasis (TisN0), (2) SN metastasis without occult invasion (TisN1), and (3) SN metastasis with occult invasion (T1N1). Tumor characteristics including risk factors of occult invasions (e.g. large size, comedo-type), prognosis, and SN and non-SN status were compared among the three cohorts. The median follow-up time was 73.6 months.

Results: Of the 427 patients, 408 (95.6%) were SN-negative and 19 (4.4%) were SN-positive. By examining a total of 1,421 step-sectioned slides, 9 of the 19 SN-positive patients had occult invasions in the primary tumors. Overall, 408 (95.6%), 10 (2.3%), and 9 (2.1%) were classified into the TisN0, TisN1, and T1N1 cohorts, respectively. Either of adjuvant endocrine therapy or chemotherapy was given much more in the TisN1 and T1N1 cohorts than in the TisN0 cohort (80.0% and 88.9% vs. 5.4%).Other tumor characteristics were similar among the three cohorts. Although one patients had distant recurrence in the TisN0 cohort, none had locoregional or distant recurrences in the TisN1 and T1N1 cohorts. Regarding the lymph node status in the TisN1 and T1N1 cohorts, median tumor burdens in the SN are 590 and 310 copies/μL, and 2 (20.0%) and 2 (22.2%) patients had additional non-SN metastasis in the axillary dissection materials, respectively.

Conclusions: Tumor characteristics and prognosis were similar among the three cohorts albeit the TisN1 and T1N1 cohorts tended to received adjuvant systemic therapy. Moreover, the SN and non-SN status were similar between the TisN1 and T1N1 cohorts. Therefore, pathogenesis of nodal metastasis in DCIS cannot uniformly be explained, and tumors with different stages may be mixed in the node-positive DCIS. Thus, considering the favorable prognosis of node-positive DCIS, the clinical management should be determined on a case-by-case basis.

Citation Format: Yonekura R, Osako T, Iwase T, Ogiya A, Ueno T, Ohno S, Akiyama F. Prognostic impact and possible pathogenesis of lymph node metastasis in ductal carcinoma in situof the breast [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-18-11.

Abstract P3-03-23: Which factor of metastatic lymph nodes–The number, tumor volume or anatomical location–Is independently prognostic in breast cancer? - A prospective cohort study using molecular whole-node analysis of all removed axillary nodes

Background: Axillary lymph node status is one of the most powerful prognostic factors in breast cancer. However, it remains unknown which factor of metastatic lymph nodes–the number, tumor volume or anatomical location–is independently prognostic. Conventional pathological examinations of lymph nodes have limited ability to accurately measure metastatic tumor volume due to the partial evaluation of nodes. On the other hand, the one-step nucleic acid amplification (OSNA) assay, a novel molecular method, can quantify the tumor volume in a whole node based on cytokeratin 19 (CK19) mRNA copy number. In this prospective cohort studyusing the OSNA whole-node analysis, we aimed to elucidate the independent prognostic factor of lymph node metastasis in breast cancer.

Patients and Methods: The subjects consisted of 307 cN0 patients with invasive breast cancer, who underwent axillary dissection after a metastatic sentinel node (SN) biopsy and whose SNs and non-SNs were all examined using the OSNA whole-node assaybetween 2009 and 2012.The cut-off values of the OSNA assay for negative/positive results and micro/macrometastasis were defined at 250 and 5,000 copies/μL of CK19 mRNA, respectively. The total tumor volume in the SN or non-SN was defined as the sum of CK19 mRNA copy numbers from all samples in the SN or non-SN. The cut-off value for the total tumor volume in the SN was set at 2,810 copies/μL according to our previous study (Osako et al. Br J Cancer 2017). The anatomical location of metastasis was classified into Level I (confined to SN), Level I (spread to non-SN), or Level II/III. Predictive factors for distant disease-free survival (DDFS) were investigated using the univariate log-rank tests and multivariate Cox proportional hazards models.The median follow-up time was 6.1 years (range, 0.2–8.6).

Results: Of the 307 patients, 130 (42.3%) and 177 (57.7%) had the total tumor volume <2,810 and ≥2,810 copies/μL in the SN, respectively. Five-year DDFS was 96.0% in the entire cohort. In the univariate analysis, DDFS was significantly related to the pT classification, grade, hormone receptor status, triple-negative subtype, total tumor volume in the SN and cytotoxic chemotherapy. However, DDFS was not significantly related to the number of metastatic or macrometastatic nodes in the SN, non-SN, or all nodes (i.e. SN + non-SN); the total tumor volume in the non-SN or all nodes; the AJCC pN classification; or the anatomical location of metastasis. In the multivariate analysis, the total tumor volume in the SN (<2810 vs. ≥2810 copies/μL, hazard ratio 5.2, 95% confidence interval 1.2–23.2, P=0.03) and cytotoxic chemotherapy (- vs. +, hazard ratio 0.05, 95% confidence interval 0.02–0.17, P<0.001) remained significant.

Conclusions: The total tumor volume in the SN was the independent prognostic factor of lymph node metastasis in SN-positive invasive breast cancer. Accurate evaluation of metastatic tumor burden in the SN can be important for predicting prognosis and may help to guide the precise therapeutic decision making for breast cancer patients.

Citation Format: Osako T, Iwase T, Ushijima M, Ogiya A, Ueno T, Ohno S, Akiyama F. Which factor of metastatic lymph nodes–The number, tumor volume or anatomical location–Is independently prognostic in breast cancer? - A prospective cohort study using molecular whole-node analysis of all removed axillary nodes [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-23.

Abstract P5-05-04: Myc as a poor prognostic marker for ER+ inflammatory breast cancer (IBC): Quantitative estrogen receptor (ER) expression analysis and gene expression analysis in ER+ IBC vs non-IBC

Background

Estrogen receptor-positive (ER+) primary inflammatory breast cancer (IBC) has a poorer prognosis than ER+ primary non-IBC. Our objective was to determine the association between ER positivity and survival outcome in order to elucidate the biological reason that ER+ IBC is more aggressive than non-IBC.

Methods

We retrospectively determined the relationship between ER expression by immunohistochemistry staining and neoadjuvant chemotherapy response as well as survival outcome for 189 patients with ER+ and HER2-negative (HER2-) IBC and 896 case-matched patients with stage III non-IBC seen at MD Anderson Cancer Center between January 1989 and April 2015. We performed gene expression (GE) analysis for 39 patients with ER+/HER2- IBC and 40 patients with non-IBC to detect genes that are specifically overexpressed in IBC. Logistic regression and Cox proportional hazards model were used to determine the predictive and prognostic value of percentages of cells positive for ER and progesterone receptor (PR) among the patients with ER+/HER2- IBC and non-IBC. Recursive partitioning analysis (RPA) was used to determine the optimal cutoff points for ER% and progesterone receptor (PR) % that maximized differences in survival. The identified cutoff points were tested in an external cohort of 192 ER+/HER2- IBC patients from Institut Paoli-Calmettes in France.

Results

The median values for ER% for IBC and non-IBC were 85 (range, 1-100) and 90 (range, 1-100), respectively. The logistic regression model demonstrated a lack of a relationship of ER% with pathological complete response rate to neoadjuvant chemotherapy both in IBC (P=0.29) and non-IBC (P=0.14). Expression of ER was significantly associated with distant disease-free survival (DDFS); hazard ratio (HR), 0.56 [95% CI, 0.37-0.83] per 50% increase in ER%; P<0.05). Also, ER% was significantly associated with overall survival (OS) (HR, 0.40 [95% CI, 0.25-0.63] per 50% increase in ER%; P<0.05). RPA showed that 91.5% and 9.0% were the optimal cutoff points for ER% and PR%, respectively, for DDFS and overall survival in IBC patients. However, the cutoff points could not be validated in the French external cohort. In the GE study, 84 genes were detected as significantly distinguishing ER+ IBC from non-IBC. Among the top 15 canonical pathways shown by IPA, the ERK/MAPK signaling pathway, PDGF pathway, insulin receptor signaling pathway, and IL-7 signaling pathway were associated with the ER signaling pathway. MYC upregulation was observed in three of these four pathways. Indeed, ER+/HER- IBC had significantly higher MYC amplification compared to those with non-IBC (P<0.05) and higher MYC level was associated with poor relapse free survival for IBC (HR, 1.85 [95% CI, 1.05-2.70], P<0.05).

Conclusions

Increased ER positivity was significantly associated with improved survival in ER+/HER- IBC patients. ER+/HER- IBC had several activated pathways with MYC upregulation compared to non-IBC. MYC upregulation was associated with a poor survival outcome for ER+/HER- IBC. The results indicate that MYC is a key gene for understanding the aggressive biological behavior of ER+/HER- IBC.

Citation Format: Iwase T, Harano K, Masuda H, Kida K, Espinosa Fernandez JR, Hess KR, Wang Y, Woodward WA, Layman RM, Dirix L, Van Laere SJ, Bertucci F, Ueno NT. Myc as a poor prognostic marker for ER+ inflammatory breast cancer (IBC): Quantitative estrogen receptor (ER) expression analysis and gene expression analysis in ER+ IBC vs non-IBC [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-05-04.

Abstract P1-07-23: The quality and quantity of visceral fat tissue are associated with insulin resistance and survival outcome after chemotherapy for patients with early-stage breast cancer

Background: Obesity and insulin resistance are associated with inferior levels of chemosensitivity and overall prognosis for breast cancer (BC) treatment. Recent studies suggest that the quality and quantity of visceral adipose tissue (VAT) play a significant role in adipocyte function, and are related to insulin resistance. We therefore tested the hypothesis that high amount and low quality of VAT worsen treatment outcomes via insulin resistance mechanisms.

Patients and Methods: We examined two independent studies: a cross-sectional study (cohort 1) and a retrospective study (cohort 2). Cohort 1 included 106 women with early-stage BC who were undergoing surgery. Patients with normal weight (17.5< body mass index [BMI, kg/m2] ≤25, n = 53) and overweight/obese patients (BMI >25, n = 53) were selected by a pair-matching method. Insulin resistance was evaluated by HOMA-R: fasting insulin (microU/L) × fasting glucose (nmol/L)/22.5. And insulin-like growth factor (IGF) family including IGF-1 and IGF-binding protein 3 (IGFBP3) were measured before beginning treatment. The amounts of visceral fat (aVAT) was measured by 3-dimensional volumetric software using the stocked computed tomography (CT) imaging data. The quality of VAT was assessed based on the mode value of CT Hounsfield Unit of VAT (VAT-HU) at navel level of CT axial view. The association between the former variables and the quality and quantity of VAT was analyzed. Cohort 2 included 271 patients who received chemotherapy in the neo-adjuvant (NAC) or adjuvant setting. Imaging analysis was performed in the same way, and the association between those values and survival outcome after chemotherapy was analyzed by retrospective chart review.

Results: In cohort 1, aVAT was significantly correlated with serum insulin and HOMA-R levels (Pearson's R 0.44 and 0.42, respectively; P<0.05). On comparing the two groups divided by BMI, the levels of IGF-1 and IGFBP3 were not significantly different between the normal weight and the overweight/obese groups (P = 0.31 and 0.77, respectively). However, the overweight/obese group demonstrated significantly higher HOMA-R (P<0.05). In cohort 2, aVAT was significantly correlated with BMI (P<0.05). In a multivariate analysis, pathological complete responses were not associated with aVAT (P = 0.60). After a median follow-up of 112 months, tertile stratification revealed that the third tertile of aVAT had a significantly shorter distant disease free survival (DDFS) in the NAC setting (p<0.05). When adjusted by covariates in the Cox proportional regression model, aVAT and VAT-HU demonstrated significant contribution to a worsened DDFS ([p<0.05, hazard ratio {HR} 1.39; 95% confidence interval {CI} 1.11 to 1.75] and [p<0.05, HR 1.20, 95% CI 1.01 to 1.43], respectively).

Conclusions: Our study found that high amounts and low quality of VAT worsen treatment outcomes. Furthermore, we found that insulin resistance was related to those two factors. Although further validation is needed, our present work suggests the importance of evaluating the quality and quantity of visceral fat for estimating insulin resistance and treatment outcomes after chemotherapy for patients with early-stage BC.

Citation Format: Iwase T, Sangai T, Nagashima T, Sakakibara M, Fujimoto H, Sawabe Y, Nagashima K, Otsuka M. The quality and quantity of visceral fat tissue are associated with insulin resistance and survival outcome after chemotherapy for patients with early-stage breast cancer [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 P1-07-23.

Local recurrence risk after previous salvage mastectomy

INTRODUCTION

Breast-conserving surgery is a standard treatment for early breast cancer. For ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery, salvage mastectomy is the current standard surgical procedure. However, it is not rare for patients with IBTR who have received salvage mastectomy to develop local recurrence. In this study, we examined the risk factors of local recurrence after salvage mastectomy for IBTR.

PATIENTS AND METHODS

A total of 118 consecutive patients who had histologically confirmed IBTR without distant metastases and underwent salvage mastectomy without irradiation for IBTR between 1989 and 2008 were included from eight institutions in Japan. The risk factors of local recurrence were assessed.

RESULTS

The median follow-up period from salvage mastectomy for IBTR was 4.6 years. Patients with pN2 or higher on diagnosis of the primary tumor showed significantly poorer local recurrence-free survival than those with pN0 or pN1 at primary tumor (p < 0.001). Multivariate analysis showed that the lymph node status of the primary tumor was a significantly independent predictive factor of local recurrence-free survival (p = 0.02).

CONCLUSION

The lymph node status of the primary tumor might be a predictive factor of local recurrence-free survival after salvage mastectomy for IBTR. Further research and validation studies are needed. (UMIN-CTR number UMIN000008136).

Change in estrogen receptor, HER2, and Ki-67 status between primary breast cancer and ipsilateral breast cancer tumor recurrence

INTRODUCTION

Changes in the biological marker status between primary and recurrent tumors are observed in breast cancer. However, their clinical significance is still uncertain, especially for patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery.

PATIENTS AND METHODS

A total of 117 patients with IBTR without distant metastases were enrolled in this study. All patients were examined for estrogen receptor (ER), HER2, and Ki-67 in both the primary tumors and paired IBTR. We evaluated the impact of changes in these biomarkers between primary tumors and IBTR on the prognosis after IBTR.

RESULTS

There were no associations of changes in the ER, HER2 status with distant disease-free survival (DDFS) after surgical resection of IBTR, whereas the change in the Ki-67 status between the primary tumors and IBTR was significantly correlated with DDFS (unadjusted: p = 0.0094; adjusted: p = 0.013). Patients in the "increased or remained high" Ki-67 group had a significantly shorter DDFS than those in the "decreased or remained low" Ki-67 group (5-year DDFS: 55.5 vs. 79.3%, respectively, p = 0.0084 by log-rank test).

CONCLUSION

An increased or persistently high Ki-67 status in the IBTR was significantly correlated with a poorer prognosis after IBTR.

Denture wearing during sleep doubles the risk of pneumonia in the very elderly

Poor oral health and hygiene are increasingly recognized as major risk factors for pneumonia among the elderly. To identify modifiable oral health-related risk factors, we prospectively investigated associations between a constellation of oral health behaviors and incident pneumonia in the community-living very elderly (i.e., 85 years of age or older). At baseline, 524 randomly selected seniors (228 men and 296 women; mean age, 87.8 years) were examined for oral health status and oral hygiene behaviors as well as medical assessment, including blood chemistry analysis, and followed up annually until first hospitalization for or death from pneumonia. During a 3-year follow-up period, 48 events associated with pneumonia (20 deaths and 28 acute hospitalizations) were identified. Among 453 denture wearers, 186 (40.8%) who wore their dentures during sleep were at higher risk for pneumonia than those who removed their dentures at night (log rank P = 0.021). In a multivariate Cox model, both perceived swallowing difficulties and overnight denture wearing were independently associated with an approximately 2.3-fold higher risk of the incidence of pneumonia (for perceived swallowing difficulties, hazard ratio [HR], 2.31; and 95% confidence interval [CI], 1.11-4.82; and for denture wearing during sleep, HR, 2.38; and 95% CI, 1.25-4.56), which was comparable with the HR attributable to cognitive impairment (HR, 2.15; 95% CI, 1.06-4.34), history of stroke (HR, 2.46; 95% CI, 1.13-5.35), and respiratory disease (HR, 2.25; 95% CI, 1.20-4.23). In addition, those who wore dentures during sleep were more likely to have tongue and denture plaque, gum inflammation, positive culture for Candida albicans, and higher levels of circulating interleukin-6 as compared with their counterparts. This study provided empirical evidence that denture wearing during sleep is associated not only with oral inflammatory and microbial burden but also with incident pneumonia, suggesting potential implications of oral hygiene programs for pneumonia prevention in the community.

Abstract P5-13-12: Risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen negative/ hepatitis B core antibody positive and/or hepatitis B surface antibody positive breast cancer patients who receive chemotherapy

Background: Recently, chemotherapy-induced reactivation of hepatitis B virus (HBV) has been reported not only in patients positive for hepatitis B surface antigen (HBsAg), but also in patients negative for it. Although HBV reactivation is associated with substantial morbidity and mortality in patients undergoing cancer chemotherapy, the exact frequency and risk for HBV reactivation in HBsAg-negative breast cancer patients who receive chemotherapy remains unclear. In this study, we examined the frequency and risk for HBV reactivation in Japanese breast cancer patients who have received chemotherapy.

Methods: A total of 562 HBsAg-negative breast cancer patients received chemotherapy from June 2008 to May 2009 at the Cancer Institute Hospital of JFCR in Japan. Antibody to hepatitis B core antigen (anti-HBc) and antibody to hepatitis B surface antigen (anti-HBs) were screened for before chemotherapy in all patients. In patients who were positive for anti-HBc and/or anti-HBs, serum HBV-DNA levels were measured and monitored during and after chemotherapy.

Results: 93 (17.4%) HBsAg-negative breast cancer patients were found to have resolved hepatitis B (HBsAg-negative, anti-HBc-positive and/or anti-HBs-positive). One patient was found to be positive for HBV DNA before the initiation of chemotherapy and received adjuvant chemotherapy with Entecavir prophylaxis. 65 patients received chemotherapy in adjuvant or neoadjuvant setting, 28 patients received it for metastatic disease. In our monitoring period (median 15.3 months), no HBsAg-negative/ anti-HBc-positive and/or anti-HBs-positive breast cancer patients developed HBV reactivation during and after their chemotherapy.

Conclusions: A number of HBsAg-negative breast cancer patients have received chemotherapy with a risk for HBV reactivation; however, it has been determined that conventional chemotherapy regimens for breast cancer are unlikely to increase the risk of developing HBV reactivation in these patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-13-12.

Estimation of the congestion area volume in potential living donor remnant livers

BACKGROUND

Living donor liver transplantation is widely performed in adult patients. One of the problems in this setting is a small-for-size graft, which results in dysfunction and poor prognosis of a transplantation. A right liver graft was devised to overcome this problem; furthermore, inclusion of the middle hepatic vein (MHV) has been suggested to greatly improve recipient outcomes. However, extended right hepatectomy involves a surgical risk for the living donor in terms of congestion of the left paramedian sector. The volume of the venoocclusive region of a living donor liver possibly varies depending on the collateral patterns of veins draining the cranial part of segment 4 (S4).

PATIENTS AND METHODS

We were analyzed the normal livers of 50 patients who underwent triphasic contrast-enhanced multidetector row computed tomography during preoperative and postoperative examinations. The patient pathologies consisted of gastric cancer (n = 25), colon cancer (n = 1), or renal cancer (n = 24). We calculated the volume of the entire liver as well as those of the right graft and left remnant lobes for comparison with the drainage volume of each hepatic vein and its branches.

RESULTS

On the basis of the anatomic venous drainage of the cranial part of S4 (V4sup), we classified hepatic veins as group A (n = 31), the V4sup joined the left hepatic vein or the MHV distal to the vein draining S8 area (MV8), or group B (n = 19), V4sup joined the MHV proximal to MV8. The mean volume of the congested area was 6.9% in group A and 15.9% in group B. The venoocclusive areas in the remnant livers were estimated to be larger in group B (P < .001).

CONCLUSION

The collateral pattern of V4sup and MV8 as well as preoperative volumetric analysis are important for graft selection to decide the line of transection.

Abstract P1-01-12: The Performance of the One Step Nucleic acid Amplification (OSNA) Assay in Breast Cancer Patients with Receiving Preoperative Systemic Therapy

Background: The OSNA (One Step Nucleic acid Amplification) assay is a semi-automated lymph node examination method using molecular biological technique. The OSNA assay has been validated for breast cancer patients without receiving preoperative systemic therapy (PST) by several clinical studies and has currently become more popular as sentinel lymph node (SLN) examination method with the following two main advantages; 1) to allow examination of the whole portion of a node, 2) to allow intraoperative judgment of metastasis positive or negative. However, the feasibility of the OSNA assay in breast cancer patients treated by PST has never been confirmed. In this multi-central clinical study, we compared the judgments of the OSNA assay and of pathological examination on lymph nodes dissected after receiving PST to evaluate the performance of the OSNA assay.

Material & Methods: Three hundred two nodes dissected from the 80 breast cancer patients who received PST were examined. Each lymph node was divided at 2mm intervals and the slices were alternately applied to the OSNA assay and pathological examination with H&E staining and CK19 immunohistochemical staining of permanent-section. In pathological examination, judgments of metastasis positive or negative were determined by one central-review pathologist according to the criteria of AJCC 7th edition (“positive” if &gt;0.2mm metastases were detected).

Result: The overall concordance rate between the OSNA assay and pathological examination was 91.1% (275/302) with sensitivity of 88.3% (53/60) and specificity of 91.7% (222/242) (Table). These results are very similar to those of the Japanese clinical validation study in breast cancer patients without receiving PST which was conducted by the almost same protocol (Tamaki Y, et al. Clin Cancer Res, 2009, 15: 2879–2884).

Conclusion & Discussion: These results indicate the OSNA assay can be applicable for breast cancer patients after receiving PST as well as breast cancer patients without receiving PST. The OSNA assay will enable to examine the whole portion of nodes, leading to more detection of metastases (especially micrometastases) and more exact nodal staging for breast cancer patients treated by PST. Also, for the patients who receive sentinel lymph node biopsy after PST, the OSNA assay will be useful as intraoperative examination method of SLNs because it is expected to provide more correct judgments than current intraoperative methods such as frozen-section or touch-print cytology.

Sympathectomy attenuates excitability of dorsal root ganglion neurons and pain behaviour in a lumbar radiculopathy model

Objectives

In order to elucidate the influence of sympathetic nerves on lumbar radiculopathy, we investigated whether sympathectomy attenuated pain behaviour and altered the electrical properties of the dorsal root ganglion (DRG) neurons in a rat model of lumbar root constriction.

Methods

Sprague-Dawley rats were divided into three experimental groups. In the root constriction group, the left L5 spinal nerve root was ligated proximal to the DRG as a lumbar radiculopathy model. In the root constriction + sympathectomy group, sympathectomy was performed after the root constriction procedure. In the control group, no procedures were performed. In order to evaluate the pain relief effect of sympathectomy, behavioural analysis using mechanical and thermal stimulation was performed. In order to evaluate the excitability of the DRG neurons, we recorded action potentials of the isolated single DRG neuron by the whole-cell patch-clamp method.

Results

In behavioural analysis, sympathectomy attenuated the mechanical allodynia and thermal hyperalgesia caused by lumbar root constriction. In electrophysiological analysis, single isolated DRG neurons with root constriction exhibited lower threshold current, more depolarised resting membrane potential, prolonged action potential duration, and more depolarisation frequency. These hyperexcitable alterations caused by root constriction were significantly attenuated in rats treated with surgical sympathectomy.

Conclusion

The present results suggest that sympathectomy attenuates lumbar radicular pain resulting from root constriction by altering the electrical property of the DRG neuron itself. Thus, the sympathetic nervous system was closely associated with lumbar radicular pain, and suppressing the activity of the sympathetic nervous system may therefore lead to pain relief.

Incidence and possible pathogenesis of sentinel node micrometastases in ductal carcinoma in situ of the breast detected using molecular whole lymph node assay

Background:

The pathogenesis of lymph node metastases in preinvasive breast cancer – ductal carcinoma in situ (DCIS) – remains controversial. The one-step nucleic acid amplification (OSNA) assay is a novel molecular method that can assess a whole node and detect clinically relevant metastases. In this retrospective cohort study, we determined the performance of the OSNA assay in DCIS and the pathogenesis of node-positive DCIS.

Methods:

The subjects consisted of 623 patients with DCIS who underwent sentinel lymph node (SN) biopsy. Of these, 2-mm-sectioned nodes were examined using frozen-section (FS) histology in 338 patients between 2007 and 2009, while 285 underwent OSNA whole node assays between 2009 and 2011. The SN-positivity rate was compared between cohorts, and the characteristics of OSNA-positive DCIS were investigated.

Results:

The OSNA detected more cases of SN metastases than FS histology (12 out of 285, 4.2% vs 1 out of 338, 0.3%). Most of the metastases were micrometastases. The characteristics of high-risk DCIS (i.e., mass formation, size, grade, and comedo) and preoperative breast biopsy (i.e., methods or time to surgery) were not valid for OSNA assay–positive DCIS.

Conclusion:

The OSNA detects more SN metastases in DCIS than FS histology. Further examination of the primary tumours and follow-up of node-positive DCIS are needed to elucidate the pathogenesis.

P3-07-08: Accurate Staging of Axillary Lymph Nodes from Breast Cancer Patients Using a Novel Molecular Method

Background: In breast cancer, the number of axillary lymph node metastases is the powerful prognostic factor. However, it is obvious that conventional histopathological examinations are non-standardized and limited in their ability to detect metastases accurately due to the partial evaluation of a node. This may lead to underestimation of nodal staging. The one-step nucleic acid amplification (OSNA) assay was developed to overcome this limitation of the histopathological examination. This assay can assess the whole lymph node and yields semi-quantitative results for the detection of clinically relevant nodal metastases by detection and amplification of cytokeratin 19 mRNA. This assay can classify the nodes into 4 categories, (++), (+I), (+), and negative. (++) and (+I) are theoretically regarded as macrometastasis and (+) as micrometastasis according to the American Joint Committee on Cancer (AJCC) staging system. We have shown the OSNA whole node assay detects more sentinel node (SN) metastases, particularly micrometastases than 2-mm-section frozen-section histology. Thus, we had hypothesized that the OSNA assay for non-sentinel nodes (nonSNs) in addition to SNs enables the classification of accurate nodal staging for breast cancer patients. In the present retrospective cohort study, we compared the performance of the OSNA assay with that of routine permanent histology for the detection of nonSN metastases among patients with positive SN biopsy who have undergone axillary dissection.

Patients and methods: Subjects comprised of consecutive 183 patients with clinically and ultrasonographically node-negative pT1-2 breast cancer who had undergone axillary dissection after positive SN biopsy with the OSNA assay between April 2009 and September 2010. Of these, for nonSN evaluation, 64 had single-section permanent histology while 119 patients underwent the OSNA whole node assay. We compared 1) detection rates of nonSN metastasis, including macro- and micrometastases and 2) upstaging rates from SN stage after the nonSN assessment according to the 7th AJCC staging system between both cohorts. We performed the two-population z test.

Results: 1) NonSNs were found to be positive for metastasis more frequently in the OSNA cohort than in the histology cohort (histology 13/64, 20.3%, 95% CI 11.7−32.6% vs. OSNA 66/119, 55.5%, 95% CI 46.1−64.5%; P&lt;0.001). We found no significant difference in the frequency of macrometastasis in nonSNs (12/64, 18.8%, 95% CI 10.5−30.8% vs. 30/119, 25.2%, 95% CI 17.9−34.2%; P=0.42). However, we found significant difference in the frequency of micrometastasis in nonSNs (1/64, 1.6%, 95% CI; 0.1−9.5% vs. 36/119, 30.3%, 95% CI; 22.3−39.5%; P&lt;0.001).

2) Total upstaging rates were similar in both cohorts (histology 9/64, 14.1%, 95% CI 7.0−25.5% vs. OSNA 20/119, 16.8%, 95% CI 10.8−25.0%; P=0.79).

Conclusion: The OSNA whole node assay detects a far greater proportion of nonSN metastases than single-section histology in patients with positive SN biopsy. However, in terms of the AJCC staging system, upstaging rates from the SN stage were similar in both cohorts. Follow-up of the OSNA cohort is required to clarify the prognostic implications of this technique; this may lead to the establishment of a new breast cancer staging.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-08.

P2-15-04: Clinical Significance of Resection with Curative Intent for Isolated Pulmonary Metastases from Breast Cancer. Multi-Institutional Study in Japan

OBJECTIVE: Although resection of isolated pulmonary metastases is a common treatment in other primaries such as colon cancer, the role of lung metastasectomy of breast cancer is still unclear. The objective of the present study was to investigate the clinical outcome of our operated patients with isolated pulmonary breast cancer metastases and discuss the clinical implication of resection with curative intent for them.

METHODS: We retrospectively analyzed 86 female patients with histologically proven isolated pulmonary metastases from breast cancer who were treated with surgery of curative intent between January 1980 and September 2010 at 7 Japanese hospitals. The mean age of them was 50 years, the median disease free interval (DFI) from the definitive surgery for the primary breast cancer was 4.6 years (range: 0.5−20.4 years) and the median follow-up after lung metastasectomy was 4.1 years (range: 0.3−30.9 years).

RESULTS: Lung metastasectomy was performed by thoracotomy in 22 patients and by video-assisted thoracoscopic surgical resection in 64 patients. The number of metastatic foci resected was one for 79 patients, two for 6, and unknown for 1. Lymph node resection was performed for 12 patients, was not done for 69, and unknown for 5. Five-year survival rates after lung metastasectomy were 68% in the patients. The main prognostic factor was the DFI. Five-year survival rates for patients with DFI of longer than 2 years (n = 72) and those with DFI of shorter than 2 years (n=14) were 74.5% and 33.8%, respectively (p = 0.0006). Five-year survival rates after lung metastasectomy were 68% in patients without macroscopic residual pulmonary tumor after lung metastasectomy (n = 69) and 34% in those with macroscopic residual tumor (n = 12) (p = 0.023). Five-year disease free survival after lung metastasectomy for patients without macroscopic residual tumor was 51 %. Five-year survival rates were 78% in patient with endocrine hormonal therapy following lung metastasectomy (n = 51) and 53% in those without endocrine hormonal therapy (n = 35) (p = 0.045). No prognostic influence could be demonstrated for age, number of initial axillary node metastases, primary tumor size.

CONCLUSION: The prognosis of the breast cancer patients with isolated pulmonary metastases who underwent metastasectomy with curative intent was good. It was affected by the biological aspects of the primary tumor, “curativity” of the resection, and systemic treatments after lung resection. It may be expected that some of those patients will be cured by surgery with curative intent.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-04.

Cloning, expression and purification of extracellular serine protease Esp, a biofilm-degrading enzyme, from Staphylococcus epidermidis

AIMS

Staphylococcus epidermidis Esp, an extracellular serine protease, inhibits Staphylococcus aureus biofilm formation and nasal colonization. To further expand the biotechnological applications of Esp, we developed a highly efficient and economic method for the purification of recombinant Esp based on a Brevibacillus choshinensis expression-secretion system.

METHODS AND RESULTS

The esp gene was fused with the N-terminal Sec-dependent signal sequence of the B. choshinensis cell wall protein and a C-terminal hexa-histidine-tag gene. The recombinant Esp was expressed and secreted into the optimized medium as an immature form and subsequently activated by thermolysin. The mature Esp was easily purified by a single purification step using nickel affinity chromatography and showed proteolytic activity as well as Staph. aureus biofilm destruction activity.

CONCLUSIONS

The purification yield of the developed extracellular production system was 5 mg recombinant mature Esp per 20-ml culture, which was much higher than that of an intracellular production system in Escherichia coli (3 mg recombinant Esp per 1-l culture).

SIGNIFICANCE AND IMPACT OF THE STUDY

Our findings will be a powerful tool for the production and purification of recombinant Esp and also applicable to a large variety of recombinant proteins used for basic researches and biotechnological applications.

Accurate staging of axillary lymph nodes from breast cancer patients using a novel molecular method

Background:

The one-step nucleic acid amplification (OSNA) assay is a molecular-based lymph-node metastasis detection procedure that can assess a whole node and yields semi-quantitative results for the detection of clinically relevant nodal metastases. We aimed to determine the performance of the OSNA assay as an accurate nodal staging tool in comparison with routine histological examination.

Methods:

Subjects comprised 183 consecutive patients with pT1-2 breast cancer who underwent axillary dissection after positive sentinel-node (SN) biopsy with the OSNA assay. Of these, for non-SN evaluation, 119 patients underwent OSNA assay evaluation, whereas 64 had single-section histology. We compared the detection rates of non-SN metastasis and upstaging rates from the SN stage according to the American Joint Committee on Cancer staging between the OSNA and histology cohorts.

Results:

OSNA detected more cases of non-SN metastases than histology (OSNA 66/119, 55.5% vs histology 13/64, 20.3% P<0.001), particularly micrometastases (36/119, 30.3% vs 1/64, 1.6% P<0.001). Total upstaging rates were similar in both cohorts (20/119, 16.8% vs 9/64, 14.1%, P=0.79).

Conclusion:

OSNA detects a far greater proportion of non-SN micrometastases than routine histological examination. However, upstaging rates after axillary dissection were not significantly different between both cohorts. Follow-up of the OSNA cohort is required to determine its clinical relevance.

Abstract P1-11-13: Triple Negative or HER2 Positive Subtypes of Breast Cancer Groups Are Chemo-Sensitive, but Higher Rate of Brain Metastasis Contributes Poorer Prognosis

Background: The purpose of this study was to determine the primary chemosensitivity and prognosis among women with four common breast subtypes, Luminal A, Luminal B, HER2 and Triple negative (TN). In this study, we evaluated the response to primary chemotherapy of each subtype, reported the outcome of each subgroup after primary chemotherapy.

Method: We analyzed the outcome and characteristics of patients treated with primary chemotherapy using anthracycline and/or taxanes. Before initiation of chemotherapy, invasive carcinoma was confirmed on initial biopsy specimen obtained and hormone receptor status and HER2/neu status was also determined on this specimen. ER and PgR positivity was recognized at a cut-off of &gt; 10% positive nuclei by immunohistochemistory (IHC). HER2/neu-positive status was defined as either 3+ by IHC or presence of gene amplification by fluorescence in situ hybridization testing. Breast cancer subtypes were defied as follow, TN (ER-, PgR-, HER2-), Luminal A (ER+ and/or PgR+, HER2-), Luminal B (ER+ and/or PgR+, HER2+), HER2 (ER-, PgR-, HER2+).

Result: Between 2000 and 2007, 639 breast cancer patients were treated with primary chemotherapy at Cancer Institute Hospital. Clinical and immunohistochemical data was available on 503 patients. Median observation period was 49.9 months (2.8-122.4). In these cases, 105 cases (20.9%) were defined as TN, 276 cases (54.9%) were defined as Luminal A, 49 cases (9.7%) were defined as Luminal B, 73 cases (14.5%) were defined as HER2, respectively. 138 patients (27.4%) received anthracycline-based regimen, 139 patients (27.6%) received taxane, 227 patients (45.1%) received taxane-anthracycline combination regimen. The pathologic complete response (pCR) rate of each group was 15.2%, 2.0%, 8.2%, 16.4%, in TN, Luminal A, Luminal B, HER2, respectively (P&lt;0.001). The 5-yr disease free survival estimated 69.1%, 74.4%, 62.8%, 70.6% (p=0.140), and the 5-yr overall survival estimated 69.1%, 75.6%, 88.6%, 69.4% in TN, Luminal A, Luminal B, HER2, respectively (p=0.007). Mean survival time from the first recurrence was 21.1 months (95%CI 11.5-30.7), 40.6 months (95%CI 31.6-49.6), 81.8 months (95%CI 59.1-104.5), 30.0 months (95%CI 21.1-38.9), respectively (P&lt;0.001). According to the first recurrence, most frequent visceral metastatic site of TN and HER2 patients was brain (P&lt;0.001), and median time to brain metastasis was

13.2 months (95%CI 8.5-17.9). Surprisingly, three (21.4%) of the patients who had brain metastasis resulted in pCR by primary chemotherapy. Of note, Luminal A patients were more likely to have bone metastasis than other groups at first (p=0.003), and median time to bone metastasis was

16.3 months (95%CI 14.1-18.6).

Conclusions: With primary chemotherapy, pCR rate of TN and HER2 were higher than Luminal groups, but they developed brain metastasis early irrespective of pCR, this might contribute to their worse prognosis. In contrast, Luminal A developed bone metastasis at first, this might result in good prognosis instead of their low pCR rate.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-11-13.