Annual Meeting Proceedings Part 1 - American Society of Clinical ...

78s Breast Cancer—Triple-Negative/Cytotoxics/Local Therapy
1118 General Poster Session (Board #33C), Sat, 8:00 AM-12:00 PM
Predictors of recurrence in postmastectomy patients with one to three
positive lymph nodes. Presenting Author: Tracy-Ann Moo, New York
Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
Background: Although the role of post mastectomy radiation therapy
(PMRT) is well established in women with � 4 positive axillary lymph nodes
(ALN), its indications in patients with 1-3 positive ALN is controversial. A
recent large meta-analysis suggested a survival benefit in patients with 1-3
positive ALN who received PMRT. However, because recurrence rates in
this group are low, identifying a subgroup of patients at higher risk for
locoregional recurrence (LRR) could aid decision-making about PMRT.
Methods: From an institutional database, 1,333 breast cancer patients who
underwent mastectomy between 1996 and 2006 and had 1-3 positive ALN
were identified. Among these, T3/T4 tumors and those who received PMRT
were excluded. 926 patients were analyzed. The Kaplan-Meier method and
Cox regression was used to explore clinicopathologic features that predicted
LRR, distant metastases (DM), and recurrence-free survival (RFR).
Results: Median follow-up was 7yrs. LRR occurred in 49 patients and DM in
126 patients. LRR and/or DM occurred in 146. On univariate analysis,
factors significantly affecting LRR recurrence were increasing tumor size
(p�0.04), age �50 (p�0.003), histologic grade (p�0.03), nuclear grade
(p�0.008), lymphovascular invasion (LVI) (p�0.0001), and macroscopic
ALN metastases (p�0.02). On multivariate analysis, age �50 (p�0.0012)
and the presence of LVI (p�0.0001) predicted a higher LRR; increasing
tumor size (p�0.0005), age �50 (p�0.04), higher histologic grade
(p�0.01), number of positive ALN (p�0.04), LVI (p�0.02), macroscopic
ALN metastases (p�0.02), and no chemotherapy (p�0.02) predicted a
significantly lower RFR. Conclusions: Pts with T1-2 tumors and 1-3 positive
ALN are at low risk of isolated LRR; however, patients �50 and with LVI
may have additional risk that warrants consideration of PMRT.
1120 General Poster Session (Board #33E), Sat, 8:00 AM-12:00 PM
Feasibility of sentinel node biopsy in patients with locally advanced breast
cancer after neoadjuvant therapy: A pilot study. Presenting Author: Ariadna
Tibau Martorell, Hospital de la Santa Creu i Sant Pau, Medical Oncology
Department, Barcelona, Spain
Background: Sentinel lymph node biopsy (SLNB) is a widely used staging
method for patients with early breast cancer. Neoadjuvant Therapy (NT)
modifies the anatomical conditions in the breast and axilla, and thus
reliability of SLNB after NT remains controversial. The aim of this study is
to prospectively evaluate the feasibility and accuracy of this procedure in
this particular group of patients. Methods: Between December 2007-2011,
69 patients (mean age 56 years) with locally advanced breast cancer
(LABC) were prospectively studied. Patients were T1-4, N0-1, M0. Prior to
surgery, 61 patients received chemotherapy (CT) (adryamicin/cyclophosphamide
followed by docetaxel) and 8 patients endocrine therapy (ET). Thirty
nine patients were initially node-negative (cN0) and 30 patients had
clinical/ultrasound node-positive confirmed by cytology (cN1) at presentation.
All patients were clinical and ultrasound node-negative after NT. The
study contained two groups of patients: group A (validation) included the
first 29, associated with an axillary lymph node dissection (ALND) after NT,
in order to validate the study, and group B included the last 40, only
associated with an ALND when SLNB was positive or not found. Results:
Whole SLNB identification rate was 89.9%, and no significant differences
were found between patients initially cN0 (92%; 36/39) and initially cN1
(87%; 26/30). Four of 7 patients in whom SLNB was not found had
residual nodal metastasis after NT (3 of them were initially cN1). Sentinel
lymph nodes were successfully identified in 87% (7/8) of patients after ET
and in 90% (55/61) of patients after CT. There was one false negative (FN)
case after CT in group A (9% of overall false negative rate, initially cN0) and
there were no FN cases after ET. Positive SLNB were higher in initially cN1
group (53%; 16/30) than in initially cN0 group (18%; 7/39). Conclusions:
SLNB after NT (CT or ET) is safe and feasible in patients with LABC, not
only in initially cN0 but also in initially cN1. It accurately predicts the
status of the axilla and avoids unnecessary ALND.
1119 General Poster Session (Board #33D), Sat, 8:00 AM-12:00 PM
Radiofrequency ablation (RFA) of breast cancer: A multicenter retrospective
analysis. Presenting Author: Toshikazu Ito, Rinku General Medical
Center, Izumisano, Japan
Background: Local ablative therapy of breast cancer represents the next
frontier in the minimally invasive breast-conservation treatment. We
performed a retrospective study of ultrasound-guided percutaneous radiofrequency
ablation (RFA) of breast cancers to determine safety and
complication related to this treatment. Methods: Four hundred and ninetyseven
patients with core biopsy proven breast carcinoma in 10 institutions
of non-surgical ablaton study group underwent RFA without surgical
excision were enrolled in this study. Results: Mean patient age was 54 years
(range 22 - 92 years). Mean tumor size was 1.6 cm. Four hundred and
twenty-five tumors ( 86 %) were � 2 cm. The median follow-up period was
50 months (range 3–92months). The mean required for ablation was 19
minutes (range, 4- 72 minutes), and the average temperature of the tumor
after ablation was 91 degrees Celsius. The local recurrence rate after RFA
was higher in tumors of negative estrogen receptor (8 of 78, 10%) than in
tumors of positive estrogen receptor (17 of 437, 4%; p�0.05), and was
higher in tumors of positive HER2/neu than in tumors of negative
HER2/neu (14.9% vs. 3.2%; p�0.01). The local recurrence rate after RFA
was higher in tumors of positive node than in tumors of negative node
(9.8% vs. 3.6%), and was higher in tumors without irradiation than in
tumors with irradiation (18.2% vs. 3.2%; p�0.001). The local recurrence
rate after RFA was higher in tumors of � 2 cm (13 of 72, 18%) than in
tumors of � 2 cm (11 of 425, 3%; p�0.001). RFA-relating adverse events
were observed in 17 patients of local pain, 14 patients of skin burn and 4
patients of retraction of nipple. Conclusions: RFA is considered to be a safe
and promising minimally invasive treatment of small breast cancer � 2cm
in diameter. Further studies are necessary to optimize the technique and
evaluate its future role as local therapy for breast cancer.
1121 General Poster Session (Board #33F), Sat, 8:00 AM-12:00 PM
Can primary tumor markers of cancer-initiating cells predict lymph node
positivity in breast cancer patients? Presenting Author: Anees B. Chagpar,
Yale University, New Haven, CT
Background: Cancer initiating cells, characterized by ALDH1 positivity
and/or colocalization of ALDH1 and CD44, have been shown to be
associated with poor prognosis in breast cancer patients. The prognostic
value of these tumor markers with respect to prediction of lymph node (LN)
status remains unclear. Methods: Tissue microarrays from a cohort of 223
breast cancer patients diagnosed between 2003 and 2007 were evaluated
using the AQUA method for quantitative immunofluorescence for CD44
and ALDH1. These data, along with other clinicopathologic data, were
correlated with LN positivity. Results: The median patient age of the cohort
was 56 (range; 26-89), with a median tumor size of 1.5 cm. 72 (32.0%)
patients were LN positive. The median number of LNs excised was 3 (range;
1-27). Of the LN positive patients, the median number of positive LNs was
1.5 (range; 1-24). Levels of CD44, ALDH1, and ALDH1 colocalizing with
CD44 did not correlate with number of positive LNs (Spearman rho
coefficients: -0.042, 0.131, and 0.058, respectively), nor overall LN
status. Tumor size and lymphovascular invasion (LVI) were the only factors
found to be significantly correlated with LN status. Conclusions: While
ALDH1 colocalized with CD44 has been found to be associated with poor
prognosis in breast cancer patients, these markers do not predict LN status.
Given that the only factors that reliably predict LN status are tumor size and
LVI, further work is required to find primary tumor markers that may predict
LN status in order to spare patients axillary surgery.
Factor LN - LN � P value
Median total CD44 46.6 41.6 0.499
Median total ALDH1 390.6 442.4 0.193
Median ALDH1 colocalizing with CD44 413.6 454.8 0.562
Median patient age 53 52 0.083
Median tumor size 1.25 2.40 �0.001
LVI� 15.2% 46.7% �0.001
ER� 78.7% 85.7% 0.332
PR� 69.9% 73.0% 0.738
HER2-neu� 12.8% 13.2% 1.000
High-tumor grade 23.1% 27.0% 0.092
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