Pathologic Findings of Residual Tumor according to the Response Rate after Neoadjuvant Chemotherapy for Breast Cancer

PURPOSE: There are questions about selecting the best postoperative chemotherapeutic regimen for breast cancer patients who have different response rates after neoadjuvant chemotherapy. The aim of this study was to examine the pathologic findings of residual tumors according to the response rate after neoadjuvant chemotherapy for breast cancer. METHODS: We obtained specimens of residual tumors from 43 breast cancer patients who received neoadjuvant chemotherapy followed by curative operation at the Department of Breast and Endocrine Surgery, Sacred Heart Hospital, between Oct. 2002 and Oct. 2006. Four patients received 3 cycles of FAC (5-FU, Adriamycin, Cyclophosphamide) and 39 patients received 3 cycles of AT (Adriamycin, Docetaxel). We analyzed the pathologic characteristics according to the response rate. RESULTS: The clinical response rate for neoadjuvant chemotherapy was 69.8%. There was no significant difference in the response rate for neoadjuvant chemotherapy between the AT and the FAC regimen groups. The tumors of the complete response group showed to be more ER-negative, PR-positive, p53-negative and c-erb-B2-positive and they had a lower Ki-67 staining index than the tumors of the partial response group. Moreover, the tumors of the clinical complete response group showed more triple (ER/PR/c-erb-B2) negative tumor than did the tumors of the partial response group. CONCLUSION: Although the tumor responded to neoadjuvant chemotherapy, the pathologic findings of the residual tumors in the clinical complete response group differed from that of the partial response group. So, this should be considered for the selection of postoperative chemotherapeutic agents.

The Role of Heat Shock Proteins 70/90 as Potential Molecular Therapeutic Targets in Breast Cancer / 한국유방암학회지

PURPOSE: Heat shock proteins (hsps) are molecular chaperones that are synthesized by cells in response to various stress conditions. The expression of hsps have been shown to be associated with carcinogenesis and the expression of hsps have been implicated in the biological behavior of tumors. Recently, hsps have emerged as novel molecular targets in anticancer protocols. The objectives of this study were to investigate the significance of hsp 70/90 in breast carcinogenesis and effect of geldanamycin (a blocker of hsp 90) and quercetin (a blocker of hsp 70) on growth inhibition in different breast cancer cell lines. METHODS: Breast tissues from 82 patients were obtained between June 2003 and May 2005 at the Department of Surgery, Hallym University Hospital. Expression of hsp 70/90 was studied by immunohistochemistry (IHC) on tissue sections from 63 breast carcinomas and 19 benign breast tissues. Both cytoplasmic and nuclear expression was measured. Expression of hsp 70/90 was also analyzed by use of a Western blot with the breast cancer cell lines. We next investigated the effects of blockers of hsp 70/90 on cell growth of the human breast cancer cell lines. RESULTS: More prominent hsp 90 expression was observed in malignant tissue than in benign tissue by both cytoplasmic and nuclear IHC staining (p<0.001, p<0.001). Nuclear hsp 90 expression was associated with a positive lymph node status (p=0.003) and the presence of poorly differentiated tumors (p=0.028). Expression of hsp 70 was not different in malignant and benign tissues as determined by both cytoplasmic and nuclear IHC staining. The breast cancer cell lines all expressed hsp 70/90. Geldanamycin markedly inhibited the cell growth of these breast cancer cell lines in a dosedependent manner and induced apoptosis in the cell lines. Quercetin inhibited cell growth of the cell lines less efficiently. CONCLUSION: The expression of hsp 90 was associated with breast carcinogenesis and the presence of more aggressive tumors. Geldanamycin inhibited cell growth of hsp 90 expressing breast cancer cell lines. We suggest that Hsp 90 may be a possible molecular target against breast cancer.

Factors Affecting Osteoporosis Following Renal Transplantation

PURPOSE: Chronic renal failure is known to occur with many disturbances in calcium metabolism including osteoporosis, bone decalcification, osteitis fibrosa cystica, and parathyroid hyperplasia. Renal transplantation may benefit the patients with chronic renal failure by reversing these disturbances, but it can also have deleterious effects on the bone. Osteoporosis remains one of the most frequent and serious complications after renal transplantation. The aim of this retrospective study is to evaluate the factors affecting osteoporosis after renal transplantation. METHODS: Bone mineral density (BMD) was measured a median 46 months (range 1~121) after renal transplantation in 118 of 274 patients between March 1991 and May 2002. At the time of bone examination, sex, age, duration of dialysis before transplantation, posttransplantation period, cumulative doses of prednisone, number of rejection, serum levels of cyclosporine, BUN, Cr, Ca, P, alkaline phosphatase (ALP), osteocalcin, urine levels of deoxypyridinoline, and cumulative doses of prednisone were measured. RESULTS: Duration between renal transplantation and BMD measurement (Ed-confirm this addition) was longer, and cumulative doses of prednisone were higher in patients whose lumbar vertebrae BMD was osteoporotic with statistical significance (P=0.023 and P=0.011, respectively). Longer duration between renal transplantation and BMD measurement and higher cumulative doses of prednisone were also seen in patients whose femoral neck BMD was osteoporotic, but without a statistical significance (P=0.186 and P=0.184, respectively). Cyclosporine level did not correlate well with either lumbar vertebrae or femoral neck BMD (P=0.800 and P=0.474). Nor did other factors show a statistically significant correlation. CONCLUSION: Our data indicated that longer duration between renal transplantation and BMD measurement and higher cumulative doses of prednisone were the statistically significant factors affecting patients with osteoporotic BMD at the lumbar vertebrae and femoral neck. To prevent osteoporosis after renal transplantation, it is important to restrict the cumulative doses of prednisone as early as possible following renal transplantation.