Abstract P2-14-20: Early locoregional breast surgery improves overall and progression-free survival in oligometastatic breast cancer

Background

Four percent of patients have Metastatic Breast Cancer (MBC) at the time of diagnosis. Surgery in this context is generally not recommended. However, tumour resection may have an effect on tumour load influencing metastatic growth. Some studies have suggested an advantage of locoregional surgery in MBC. The objective was to evaluate the effectiveness of surgery in the year following diagnosis of metastatic disease.

Methods

Data were collected within the ESME breast cancer data platform. Stage IV patients diagnosed between 2008 and 2014 without further personal cancer were included. Patients who died or progressed in 1-year post-diagnosis were excluded. We compared patients operated within the first 12 months after diagnosis with the others.

Results

Among 1977 patients with MBC at diagnosis, alive and progression-free at 12 months, 530 (26.8%) had surgery within this interval. Patients operated in the year of diagnosis had less oligometastatic disease (less than 3 metastases; 9.2% vs 21.8%, p<0.01) compared to patients with no surgery. They had less bone metastasis (57.7% vs 74.4%, p<0.01), more lymph node (33.2% vs 27.8%, p=0.02), lung (19.8%, p<0.01) and less liver metastasis (17.9% vs 26.8%, p<0.01) sites. Other treatments included more chemotherapy and HER2-targeted therapy (89.1% vs 69.6%, p<0.01), locoregional radiotherapy (81.7% vs 32.5%, p<0.01) and the same frequency of hormone therapy (79.8% vs 78.6%, p=0.57). Multivariate survival analysis based on Cox model showed that surgery of primary breast lesion performed within 12 months (Hazard Ratio(HR)=0.75, p<0.01), HER2 positive status (HR=0.42, p<0.01) and the non-visceral metastases (HR=0.80, p=0.02) improved overall survival (OS) whereas an older age than 50 (HR=1.50, p<0.01) and 3 or more metastases (HR=1.45, p<0.01) were associated with poorer survival. Progression-Free Survival (PFS) was also improved for locoregional surgery (HR=0.70, p<0.001) after adjustment on HER2 positive status (HR=0.70, p<0.01), age greater than 50 (HR=1.18, p<0.01) and 3 or more metastases (HR=1.27, p<0.01). Propensity score matching analyses confirmed these results.

Discussion

We demonstrated that surgery of primary breast lesion had a benefit on OS (HR=0.75, p<0.01), and PFS (HR=0.70, p<0.01) in metastatic patient. Metastasis number less than 3 was a complementary protective factor to surgery. Studies have sought to evaluate the population that could benefit from surgery of primary breast lesion in the event of metastatic disease. They showed an increasing morbimortality in plurimetastatic patients. In our study, patients with more than 3 metastases had poorer OS and PFS (HR=1.45, p=0.01 and HR=1.27, p=0.03 respectively).

Conclusion

Results of our study show that surgical control of primary breast lesion could be considered as an option in the locoregional treatment of MBC, particularly in non-visceral oligometastastic breast cancer.

Citation Format: Hotton J, Lusque A, Rauch P, Leufflen L, Buhler J, Pierret M, Salleron J, Marchal F. Early locoregional breast surgery improves overall and progression-free survival in oligometastatic 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 P2-14-20.

Abstract P1-07-30: Predictive factors of sentinel lymph node biopsy invasion in extended ductal carcinoma in situ treated by radical mastectomy

Introduction: The incidence of ductal carcinoma in situ (DCIS) increased with the practice of organized breast cancer screening to reach 14 % in France in 2010. The incidence of positive sentinel lymph node biopsy (SLNB) ranged from 0 to 16.7 %. The main hypothesis would be the presence of an invasive contingent on the definitive analyze not identified preoperatively. The objective was to identify predictive factors of SLNB positivity in the management of extended DCIS treated by radical mastectomy.

Method: This study was retrospective, longitudinal, descriptive conducted at the Cancer Institute of Lorraine from January 2000 to July 2015. All patients whose management consisted of a radical mastectomy for an extended DCIS, associated with a sentinel lymph node procedure were included.

Results: 161 patients were included. The mean age at diagnosis was 56 years; 15 had a clinical nodule. The diagnosis was made in 63.3 % with macrobiopsies. Preoperatively, 16 patients (9.9 %) had DCIS associated with microinvasion (DCIS-MI) and the others were pure DCIS. An average of 3.9 ± 2.7 SLNB were sampled. Twelve patients (7.4 %) had a SLNB invasion. Eleven of them had axillary lymph node dissection (ALND) of which only 1 was positive. The final histological analysis found 104 pure DCIS (64.6 %), 23 DCIS-MI (14.3 %) and 34 occult invasive ductal carcinomas (IDC) (21.1 %). Mean follow-up was 41.1 months. There were 2 recurrences and 2 deaths.

N°Final histologyPreoperative histologyDCIS size (mm)PalpabilitySLNB typeSLNB positivityALND positivity1DCISDCIS60NoMacrometastase542DCISDCIS50NoMicrometastase203DCISDCIS10NoIsolated Tumor Cells1-4DCIS-MIDCIS90YesIsolated Tumor Cells105DCIS-MIDCIS-MI75YesIsolated Tumor Cells106IDCDCIS110YesMicrometastase107IDCDCIS70NoIsolated Tumor Cells108IDCDCIS80YesMicrometastase109IDCDCIS-MI100NoMicrometastase1010IDCDCIS-MI50NoMicrometastase1011IDCDCIS-MI60NoMicrometastase1012IDCDCIS-MI40YesMacrometastase10

Predictive factors were size of palpated mass (mean: 46 mm, p = 0.04) and microinvasion on biopsy (p = 0.02). Positivity of the SLNB was an overstaging risk factor on the final histology (p < 0.001). Postoperative histological results were significantly different from preoperative (p = 0.001) with poor concordance (kappa = 0.15).

Discussion: After SLNB, the rate of secondary lymphedema in the literature was 5%. Our study included 7.4 % (12 cases) of axillary lesions, majority of which were unique micrometastases or isolated tumor cells (ITC). All predictive factors were identified in literature. In our study, mean size of palpated mass was 46 mm whereas it was 30 mm in literature. Of the 9.9 % of DCIS-MI, 4 patients had a positive SLNB. In cases of pure DCIS, the percentage of positive SLNB was reduced to 5.5 %. The rate of occult invasive ductal carcinoma was 21,1%, similarly like in literature where rate was in mean 23%.

Conclusion: The low rate of SLNB invasion in pure DCIS suggests that ALND is carried out in the presence of predictive factors. New techniques for identification of SLNB could report axillary staging after obtaining the definitive histologic results.

Citation Format: Hotton J, Salleron J, Rauch P, Buhler J, Leufflen L, Ameloot S, Marchal F. Predictive factors of sentinel lymph node biopsy invasion in extended ductal carcinoma in situ treated by radical mastectomy [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 P1-07-30.

[Feedback of ultrasound and RMI in the staging of endometrial carcinoma in early stage]

OBJECTIVES

Endometrial cancer is the most common gynecological cancer in France. The therapeutic management is based on preoperative staging. The recommended imaging examination remains the MRI. This is to evaluate ultrasound and MRI in the staging for localized cancers.

METHODS

This is a retrospective observational study, conducted from July 2012 to July 2014, at the University Hospital of Nancy, on all patients care for endometrial cancer stage I, who underwent a pelvic ultrasound and MRI for the assessment of myometrial infiltration.

RESULTS

Twenty-nine patients were included with a mean age of 69 years and a BMI of 30 kg/m(2). Using ultrasound, we have a sensitivity of 58%, a specificity of 100%, a positive predictive value (PPV) of 100%, a negative predictive value (NPV) of 70% and an accuracy of 75%. Using MRI, we have a sensitivity of 83%, a specificity of 100%, a PPV of 83%, a VPN of 88%, and an accuracy of 86%.

CONCLUSION

Transvaginal sonography should be performed before post-menopausal bleeding. It remains possible in the staging of localized cancers.

Undergraduate research. Genomics Education Partnership

The Genomics Education Partnership offers an inclusive model for undergraduate research experiences incorporated into the academic year science curriculum, with students pooling their work to contribute to international data bases.

Undergraduate research. Genomics Education Partnership

The Genomics Education Partnership offers an inclusive model for undergraduate research experiences incorporated into the academic year science curriculum, with students pooling their work to contribute to international data bases.

Detecting protein sequence conservation via metric embeddings

MOTIVATION

Comparing two protein databases is a fundamental task in biosequence annotation. Given two databases, one must find all pairs of proteins that align with high score under a biologically meaningful substitution score matrix, such as a BLOSUM matrix (Henikoff and Henikoff, 1992). Distance-based approaches to this problem map each peptide in the database to a point in a metric space, such that peptides aligning with higher scores are mapped to closer points. Many techniques exist to discover close pairs of points in a metric space efficiently, but the challenge in applying this work to proteomic comparison is to find a distance mapping that accurately encodes all the distinctions among residue pairs made by a proteomic score matrix. Buhler (2002) proposed one such mapping but found that it led to a relatively inefficient algorithm for protein-protein comparison.

RESULTS

This work proposes a new distance mapping for peptides under the BLOSUM matrices that permits more efficient similarity search. We first propose a new distance function on peptides derived from a given score matrix. We then show how to map peptides to bit vectors such that the distance between any two peptides is closely approximated by the Hamming distance (i.e. number of mismatches) between their corresponding bit vectors. We combine these two results with the LSH-ALL-PAIRS-SIM algorithm of Buhler (2002) to produce an improved distance-based algorithm for proteomic comparison. An initial implementation of the improved algorithm exhibits sensitivity within 5% of that of the original LSH-ALL-PAIRS-SIM, while running up to eight times faster.

Integrated genomic and proteomic analyses of a systematically perturbed metabolic network

We demonstrate an integrated approach to build, test, and refine a model of a cellular pathway, in which perturbations to critical pathway components are analyzed using DNA microarrays, quantitative proteomics, and databases of known physical interactions. Using this approach, we identify 997 messenger RNAs responding to 20 systematic perturbations of the yeast galactose-utilization pathway, provide evidence that approximately 15 of 289 detected proteins are regulated posttranscriptionally, and identify explicit physical interactions governing the cellular response to each perturbation. We refine the model through further iterations of perturbation and global measurements, suggesting hypotheses about the regulation of galactose utilization and physical interactions between this and a variety of other metabolic pathways.

Efficient large-scale sequence comparison by locality-sensitive hashing

MOTIVATION

Comparison of multimegabase genomic DNA sequences is a popular technique for finding and annotating conserved genome features. Performing such comparisons entails finding many short local alignments between sequences up to tens of megabases in length. To process such long sequences efficiently, existing algorithms find alignments by expanding around short runs of matching bases with no substitutions or other differences. Unfortunately, exact matches that are short enough to occur often in significant alignments also occur frequently by chance in the background sequence. Thus, these algorithms must trade off between efficiency and sensitivity to features without long exact matches.

RESULTS

We introduce a new algorithm, LSH-ALL-PAIRS, to find ungapped local alignments in genomic sequence with up to a specified fraction of substitutions. The length and substitution rate of these alignments can be chosen so that they appear frequently in significant similarities yet still remain rare in the background sequence. The algorithm finds ungapped alignments efficiently using a randomized search technique, locality-sensitive hashing. We have found LSH-ALL-PAIRS to be both efficient and sensitive for finding local similarities with as little as 63% identity in mammalian genomic sequences up to tens of megabases in length

Linkage analyses in type I diabetes mellitus using CASPAR, a software and statistical program for conditional analysis of polygenic diseases

We have developed software and statistical tools for linkage analysis of polygenic diseases. We use type I diabetes mellitus (insulin-dependent diabetes mellitus, IDDM) as our model system. Two susceptibility loci (IDDM1 on 6p21 and IDDM2 on 11p15) are well established, and recent genome searches suggest the existence of other susceptibility loci. We have implemented CASPAR, a software tool that makes it possible to test for linkage quickly and efficiently using multiple polymorphic DNA markers simultaneously in nuclear families consisting of two unaffected parents and a pair of affected siblings (ASP). We use a simulation-based method to determine whether lod scores from a collection of ASP tests are significant. We test our new software and statistical tools to assess linkage of IDDM5 and IDDM7 conditioned on analyses with 1 or 2 other unlinked type I diabetes susceptibility loci. The results from the CASPAR analysis suggest that conditioning of IDDM5 on IDDM1 and IDDM4, and of IDDM7 on IDDM1 and IDDM2 provides significant benefits for the genetic analysis of polygenic loci.