P5-11-05: Measurement of Neoadjuvant Chemotherapy Tumor Response in Locally Advanced Breast Cancer by Three Methodologies. Correlation with Overall Survival

Background

Measurement of residual disease following neoadjuvant chemotherapy that accurate predicts long-term survival in locally advanced breast cancer (LABC) is an essential requirement for new drugs efficacy evaluation. Several methods to assess neoadjuvant chemotherapy tumor response have been described. However, to our knowledge, agreement between methods and correlation with survival in independent prospective cohorts has not been reported.

Patients & Methods: In this study we report neoadjuvant chemotherapy tumor response and survival in 151 consecutive LABC patients, included in a neoadjuvant clinical trial (http://www.clinicaltrials.gov; NCT00123929). Patients were randomized to either neoadjuvant docetaxel 100 mg/m2 every 21 days or neoadjuvant doxorubicin 75mg/m2, every 21 days, for 4 cycles. Following surgery, response was established according to three methodologies: the measurement of residual breast cancer burden (RBC) as described by Symman's (Symmans WF et al. J Clin Oncol. 2007;25:4414–22), Miller and Payne classification (Ogston KN et al. Breast. 2003;12:320–7) and RECIST criteria. Regarding to Symmans classification we have evaluate both RBC index, as a continuous variable, and RBC classes as a categorical variable (RBC-0,I,II,III). Kappa Cohen's coefficient (K) was used to test agreement between methods. We assessed the correlation between treatment outcome and overall survival (OS) by calculating the Harrell's C- statistic.

Results: Median of follow up was 51.9 months. All three methods showed a moderate capacity to classify patients according to OS. The C-statistic to predict OS was 0.76 (IC: 0.67- 0.84) for RBC index and 0.71 (IC: 0.64−0.78) for RBC classes, 0.68 (IC: 0.58−0.78) for RECIST criteria and 0.69 (0.60−0.78) for Miller and Payne classification. Interesting, we did not encountered any death events within RCB-0 class. No significant differences were found between C-statistic when patients were stratified according to therapy. In order to assess the agreement between techniques, we grouped categories 1 and 2 of Miller and Payne classification in 1 category. The agreement between Miller and Payne classification and Symmans method was very high (K=0.87). In contrast, we found a moderate-fair agreement between Miller and Payne classification and RECIST criteria (K=0.46) and Symmans method and RECIST criteria (K=0.27).

Conclusion: All three methods predicted fairly well OS. RCB-0 identified the best outcome group. The agreement between methodologies based in pathology analyses was very high. However, the agreement falls off when these methodologies were compared with RECIST criteria.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-11-05.

Immunohistochemical prognostic index for breast cancer in young women

AIMS

Women under 35 years of age comprise a small proportion of patients with breast cancer, but determining their prognosis can be difficult. This prospective, multivariate study looked at several factors with the aim of obtaining a useful index to evaluate the prognosis of these women.

METHODS

In total, 108 patients below 35 years of age affected by invasive ductal carcinoma without distant metastasis were studied. The mean duration of the follow up period was six years. Histopathological (tumour size, histological grade, and lymph node stage) and immunohistochemical (c-erbB-2, p53, oestrogen receptor, and progesterone receptor) factors were measured in all patients, and the Nottingham prognostic index (NPI) was then calculated. An immunohistochemical prognostic index (IHPI) was created using the arithmetic sum of the four individual immunohistochemical factors.

RESULTS

In univariate assessment of survival, all the studied factors yielded a significant association with either overall survival or disease free survival, except for c-erbB-2 and p53 with disease free survival. In univariate calculation of risk, all the factors gave significant results; however, in multivariate analysis only tumour size, histological grade, and progesterone receptor were significant. Both NPI and IHPI correlated significantly with prognosis. In multivariate regression analysis, IHPI correlated with tumour size and there was a significant interaction between both variables.

CONCLUSION

IHPI is very useful in determining the prognosis of tumours < or = 2 cm and of moderate use for tumours > 2, although it has no use in tumours > 5 cm.

Complications of colonic diverticular disease. Comparative study of two series

OBJECTIVE

To compare the form of presentation and management of the disease in two surgical units covering geographically different populations.

DESIGN

Observational retrospective study.

PATIENTS AND METHOD

203 cases from the 2nd Chair of Surgery of the Hospital Universitario de Clínicas de Asunción, Paraguay and 150 cases from the Hospital Universitario de Lleida, Spain. We analyzed the cause of admission, medical history, treatment and post-operative morbidity and mortality.

RESULTS

Paraguay series: average age: 53 years (range 34-84) for men and 62 years (range 36-92) for women. Fifty-five per cent were hospitalized because of hemorrhagic complications and 45% because of acute diverticulitis. Medical treatment was provided in 109 cases and surgery in 110, 72 of which were emergencies and 38 elective procedures (p < 0.05). Morbidity was 31.8% (40.2% in emergencies and 16% in elective procedures, p < 0.05) and mortality was 15.5% (20.2% in emergencies and 2.6% in elective procedures, p < 0.003). LLEIDA SERIES: Average age: 65.5 years (range 38-85, p < 0.01) for men and 71.4 years (range 30-93, p < 0.01) for women. Eighty-six per cent were hospitalized because of acute diverticulitis and 10.7% because of acute hemorrhage (p < 0.001). Sixteen per cent have had previous attacks (p < 0.001). Medical treatment was provided to 111 patients and surgery to 39 (p < 0.001), 33 of which were emergencies and 6 elective procedures (p < 0.04). Morbidity was 41% and mortality 12.8% (5 cases), all of which were emergencies. The surgical technique was similar in both groups: resection with primary anastomosis in elective procedures and Hartmann's procedure in most emergencies, with a rate of immediate anastomosis of 33 and 21%, respectively.

CONCLUSIONS

Factors related to nutrition and quality of life may influence the development of diverticular disease. Emergency surgery should be prevented. Surgeons must adapt their surgical approach to the socioeconomic and cultural medium of the population.