Predictive Factors for Non-Sentinel Lymph Node Metastasis in Patients with ACOSOG Z0011 Criteria.

BACKGROUND: Nodal staging constitutes an element of great importance in the treatment planning for early breast cancer. The ACOSOG Z0011 trial demonstrated that sentinel lymph node (SLN) biopsy alone results in rates of local control, disease-free survival, and overall survival equivalent to those seen after axillary lymph node dissection. The purpose of this study was to determine the rate of patients that fulfill the ACOSOG Z0011 inclusion criteria and to define predictive factors for non-SLN positivity. METHODS: A retrospective analysis of the breast surgery database of the Argentinian Society of Mastology was carried out. Patients were selected if they fulfilled the ACOSOG Z0011 inclusion criteria. The association of clinical and pathological factors with non-SLN positivity was evaluated in univariate and multivariate analysis. RESULTS: Among 8,262 patients, 973 had positive SLN, and 348 satisfied the inclusion criteria. Histological grade (G3 vs. G1-2, odds ratio (OR) 1.81; p = 0.024), tumor size (T2 vs. T1, OR 2.39; p = 0.001), and age (>50 vs. <50 years, OR 1.95; p = 0.007) were associated with non-SLN positivity in multivariate analysis. CONCLUSION: Although the clinical relevance of our data is not established, older women with tumors bigger than 2 cm and/or high histological grade are at greater risk of having metastatic disease in the lymph nodes if axillary lymph node dissection is avoided. This subgroup of patients represents only 30% of the trial population.

High neutrophil to lymphocyte ratio and decreased CD69+NK cells represent a phenotype of high risk in early-stage breast cancer patients.

PURPOSE: Breast cancer (BC) is a highly heterogeneous disease presenting a broad range of clinical and molecular characteristics. In the past years, a growing body of evidence demonstrated that immune response plays a significant role in cancer outcome. However, immune prognostic markers are not completely validated in clinical practice in BC patients. MATERIALS AND METHODS: With the aim to characterize immune features, several parameters were analyzed in peripheral blood at diagnosis of 85 nonmetastatic BC patients between April 2011 and July 2014. RESULTS: With a median follow-up of 38.6 months, peripheral blood analysis of BC patients (stages I, II, and III) showed that total lymphocyte and T lymphocyte counts were augmented in nonrelapsed patients. Also, a higher neutrophil-to-lymphocytes ratio was associated with prolonged disease-free survival. Natural killer cell receptor analysis revealed that early activation receptor CD69 was associated with a better outcome. CONCLUSION: This preliminary evidence is in accordance with the concept of immune surveillance. We suggest an "immune phenotype" that provides relevant prognostic information in early-stage BC patients and which could be useful in the decision-making process.

High Histologic Grade and High Ki-67 Expression Predict Phenotypic Alterations in Node Metastasis in Primary Breast Cancers.

PURPOSE: Several studies have shown that estrogen receptor (ER) and progesterone receptor (PR) expression and human epidermal growth factor receptor 2 (HER2) expression may vary during tumoral progression. We aimed to describe and compare ER, PR, and HER2 expressions in primary breast tumors and synchronic axillary nodal metastases, and evaluate phenotypic correlations between them. METHODS: Patients were identified prospectively through surgical procedures between September 2013 and July 2016. The status of ER, PR, HER2, and Ki-67 were pathologically analyzed in breast cancers and axillary nodal metastases; these patients were classified based on the breast cancer phenotypes into five subgroups. RESULTS: Synchronic axillary nodal metastases were observed in 127 patients. In breast cancers and nodal metastases, correlation analyses of ER, PR, and Ki-67 expression showed a statistical dependence and concordance between these samples was unambiguously demonstrated through Bland-Altman plots for each determination. Primary breast tumors were classified as follows: luminal A, 41.6%; luminal B, 40.0%; luminal B/HER2, 9.6%; HER2, 2.4%; triple negative, 6.4%. Alterations in phenotype were observed in 28% of patients. The most frequent phenotypic alteration was from luminal B to A (36.4%). Ten cases (30.3%) showed alterations with therapeutic implications; six gained HER2 overexpression, and four, hormonal receptor (HR) expression. A moderate strength of agreement (Cohen's κ coefficient, 0.59; 95% confidence interval, 0.48-0.71) was observed. In multivariate analyses, high histologic grade (odds ratio [OR], 2.79; p<0.047) and high Ki-67 expression (OR, 1.05; p<0.037) were independent factors predictive of phenotypic alterations. CONCLUSION: Strong correlations were observed in HR and Ki-67 expressions between primary breast tumors and axillary nodal metastases, and a moderate concordance was observed in their phenotypical characteristics. Nevertheless, alterations did exist, and one-third of these changes may have therapeutic implications. The nodal metastases of tumors with high grade and high Ki-67 expression may need to be analyzed, to obtain complete therapeutic information.