Clinical Outcomes Following Letrozole Treatment according to Estrogen Receptor Expression in Postmenopausal Women: LETTER Study (KBCSG-006) / 한국유방암학회지

Purpose@#In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. @*Methods@#In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. @*Results@#Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. @*Conclusion@#Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

Clinical Outcomes Following Letrozole Treatment according to Estrogen Receptor Expression in Postmenopausal Women: LETTER Study (KBCSG-006) / 한국유방암학회지

Purpose@#In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. @*Methods@#In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. @*Results@#Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. @*Conclusion@#Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

Assessment of Quality of Life and Safety in Postmenopausal Breast Cancer Patients Receiving Letrozole as an Early Adjuvant Treatment / 한국유방암학회지

PURPOSE: There are few reports from Asian countries about the long-term results of aromatase inhibitor adjuvant treatment for breast cancer. This observational study aimed to evaluate the long-term effects of letrozole in postmenopausal Korean women with operable breast cancer. METHODS: Self-reported quality of life (QoL) scores were serially assessed for 3 years during adjuvant letrozole treatment using the Korean version of the Functional Assessment of Cancer Therapy-Breast questionnaires (version 3). Changes in bone mineral density (BMD) and serum cholesterol levels were also examined. RESULTS: All 897 patients received the documented informed consent form and completed a baseline questionnaire before treatment. Adjuvant chemotherapy was administered to 684 (76.3%) subjects, and 410 (45.7%) and 396 (44.1%) patients had stage I and II breast cancer, respectively. Each patient completed questionnaires at 3, 6, 12, 18, 24, 30, and 36 months after enrollment. Of 897 patients, 749 (83.5%) completed the study. The dropout rate was 16.5%. The serial trial outcome index, the sum of the physical and functional well-being subscales, increased gradually and significantly from baseline during letrozole treatment (p<0.001). The mean serum cholesterol level increased significantly from 199 to 205 after 36 months (p=0.042). The mean BMD significantly decreased from −0.39 at baseline to −0.87 after 36 months (p<0.001). CONCLUSION: QoL gradually improved during letrozole treatment. BMD and serum cholesterol level changes were similar to those in Western countries, indicating that adjuvant letrozole treatment is well tolerated in Korean women, with minimal ethnic variation.

Hepatic resection for isolated breast cancer liver metastasis: A single-center experience

PURPOSE: The objective of this study was to investigate the outcomes of selected patients with breast cancer liver metastases (BCLM) without extrahepatic metastases after hepatic resection.METHODS: Patients whose imaging findings did not show extrahepatic disease were selected for hepatic resection. If R0 resection was available and the operative risk was low in preoperative tests, the patients underwent surgery.RESULTS: Between 2011 and 2014, six patients underwent hepatic resection for BCLM. All patients received hepatic resection to achieve an R0 resection. The time interval between initial detection of breast cancer and that of liver metastases in the patients, excluding one patient with synchronous metastases, was 55.2 months. Major liver resection was performed in four patients. Differences were observed in the hormone receptor status between the primary breast tumor and liver metastases; however, no difference was observed in the human epidermal growth factor receptor 2 status. The 1-year and 3-year overall survival rates after hepatic resection were 100% and 83.3%, respectively. The 1-year and 3-year disease free survival rates after hepatic resection were 66.7% and 50.0%, respectively.CONCLUSION: Curative resection may be considered as one of the multimodality treatments for BCLM. It shows benefit in selected patients; its selection criteria needs to be investigated.

The Prevalence of Ovarian Cancer in Korean Women at High-Risk for Hereditary Breast-Ovarian Cancer / 한국유방암학회지

PURPOSE: Few studies have reported ovarian cancer risks in Korean patients with the BRCA1/2 mutation. We investigated the prevalence of ovarian cancer in Korean women at high risk for hereditary breast-ovarian cancer (HBOC) syndrome and reviewed the clinicopathological factors of ovarian cancer. METHODS: Female subjects who were enrolled in the Korean Hereditary Breast Cancer study were included. The questionnaire included a personal and family history of cancer. The BRCA1/2 mutation and CA-125 level were tested at the time of enrollment. A transvaginal ultrasonogram (TVUS) was recommended for subjects with an elevated CA-125 level. RESULTS: A total of 1,689 patients were included. No ovarian cancer was newly diagnosed by CA-125 level or TVUS during the enrollment. The prevalence of ovarian cancer was 1.71% in BRCA1/2 mutation carriers and 0.39% in non-carriers. Among 11 patients with ovarian cancer, five had the BRCA1 mutation and one had the BRCA2 mutation. The most common histopathological type was serous cystadenocarcinoma. No difference in clinicopathological findings between BRCA1/2 mutation carriers and non-carriers was observed. CONCLUSION: The prevalence of ovarian cancer was 58-fold elevated in women at high-risk for HBOC syndrome and 146-fold elevated in the BRCA1 subgroup, compared with the Korean general population. Further investigation with a long-term follow-up is required to evaluate BRCA1/2 gene penetrance.

Depressive Symptom-Related Factors in Patients with Breast Cancer / 한국유방암학회지

PURPOSE: Patients with breast cancer are at risk for developing psychological distress and psychiatric disorders such as depression. The aim of this study was to assess the depressive symptom related factors in women with breast cancer. METHODS: A total of 211 patients with breast cancer who had undergone an operation within 5 years participated in this survey with consent. Depressive symptoms in patients were measured using the 21-item Beck Depression Inventory (BDI) questionnaire in the outpatient clinic and sociodemographic, clinicopathologic factors of the patients were analyzed with a BDI score. The patients were divided into group A (BDI or =16, n=65). RESULTS: The mean age of the patients was 49.2 years and the mean follow-up period was 22 months. In the univariate analyses, postmenopausal status (p=0.014), tumor size (p=0.023) and presence of progesterone receptor (p=0.012) were significantly associated with depressive symptom. In multivariate analysis, only postmenopause (p=0.021) and tumor size (p=0.018) were related with depressive symptom. CONCLUSION: Depressive symptom is common in patients with breast cancer and a screening test for depression is needed in breast cancer patient who experienced menopause or has bigger tumor size.

Comparison of Bone Mineral Density with Breast Cancer Patients after Chemotherapy and Normal Control in Premenopausal Women / 대한골다공증학회지

OBJECTIVES: There is a lack of data on bone loss in premenopausal patients with breast cancer after chemotherapy in Korea. In this study, we compared the bone mineral density of breast cancer patients after chemotherapy with normal control. MATERIALS AND METHODS: We used the data from the fourth Korea National Health and Nutrition Examination Survey (KNHNES) as normal control, and 119 women were enrolled who had surgery and chemotherapy due to breast cancer. They were under the age of 50 and premenopausal state according to their FSH level. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry.

Lateral Decubitus Positioning Stereotactic Vacuum-Assisted Breast Biopsy with True Lateral Mammography / 한국유방암학회지

Stereotactic vacuum-assisted breast biopsy (VAB) has been used to evaluate microcalcifications or non-palpable breast lesions on mammography. Although stereotactic VAB is usually performed in a prone or upright position, an expensive prone table is necessary and vasovagal reactions often occur during the procedure. For these reasons, the lateral decubitus position can be applied for stereotactic VAB, and true lateral mammography can be used to detect the lesion. We report on 15 cases of lateral decubitus positioning for stereotactic VAB with true lateral mammography for non-palpable breast lesions or microcalcifications. The mean procedure time was approximately 30.1 minutes, and no complications occurred during the procedures. Fourteen cases had benign breast lesions and one case had a ductal carcinoma in situ. The lateral decubitus stereotactic VAB with true lateral mammography can be applied for microcalcifications or non-palpable breast lesions and helps to minimize anxiety and vasovagal reactions in patients.

Clinicopathological Characteristics in Invasive Ductal Breast Cancer with Low FDG Uptake in (18)F-FDG PET/CT / 한국유방암학회지

PURPOSE: The aim of this study is to evaluate whether low FDG uptake would be associated with the biological low-aggressiveness of invasive ductal carcinoma. METHODS: The subjects consisted of 124 female patients with primary invasive ductal carcinoma. All the patients were examined with (18)F-FDG PET/CT before neoadjuvant chemotherapy. RESULTS: With regard to histopathologic grading, 117 were histopathologic grade 1 and 2, and 7 were grade 3. Low FDG uptake correlated with well and moderate histopathologic grade (p=0.003) and low (18)F-FDG uptake in invasive ductal carcinoma depended on the presence of axillary lymph node metastases (p=0.014) and small tumor (<2.0 cm, p=0.022). Ki-67 positivity ranged from 0% to 60% (mean 15%). Sixty seven specimens showed low immunoreactivity to Ki-67 antigen (<10% of tumor cells). This revealed a significant correlation between low FDG uptake and Ki-67 (p=0.003). Logistic regression analysis between these factors showed that lower histologic grade, no axillary lymph nodes metastases and low Ki-67 (<10%) were correlated with low FDG uptake. CONCLUSION: Our results demonstrated that an association exists between low FDG uptake and good prognostic factors such as lower histologic grade (1, 2), no axillary lymph node metastases and low Ki-67 (<10%).

Clinicopathological Characteristics in Invasive Ductal Breast Cancer with Low FDG Uptake in (18)F-FDG PET/CT / 한국유방암학회지

PURPOSE: The aim of this study is to evaluate whether low FDG uptake would be associated with the biological low-aggressiveness of invasive ductal carcinoma. METHODS: The subjects consisted of 124 female patients with primary invasive ductal carcinoma. All the patients were examined with (18)F-FDG PET/CT before neoadjuvant chemotherapy. RESULTS: With regard to histopathologic grading, 117 were histopathologic grade 1 and 2, and 7 were grade 3. Low FDG uptake correlated with well and moderate histopathologic grade (p=0.003) and low (18)F-FDG uptake in invasive ductal carcinoma depended on the presence of axillary lymph node metastases (p=0.014) and small tumor (<2.0 cm, p=0.022). Ki-67 positivity ranged from 0% to 60% (mean 15%). Sixty seven specimens showed low immunoreactivity to Ki-67 antigen (<10% of tumor cells). This revealed a significant correlation between low FDG uptake and Ki-67 (p=0.003). Logistic regression analysis between these factors showed that lower histologic grade, no axillary lymph nodes metastases and low Ki-67 (<10%) were correlated with low FDG uptake. CONCLUSION: Our results demonstrated that an association exists between low FDG uptake and good prognostic factors such as lower histologic grade (1, 2), no axillary lymph node metastases and low Ki-67 (<10%).

Oncoplastic Breast Surgery

For the majority of patients with breast cancer, a surgery that minimizes breast loss combined with radiotherapy has become a popular treatment of choice. The wider clearance margins are necessary for the lower risk of local recurrences, although the greater amount of breast tissue should be removed and the risk of deformation of the breast is higher. Satisfactory cosmetic results can be achieved by oncoplastic breast surgery. The aims of this paper are to review articles of oncoplastic surgery for breast cancer and to summarize the full range of immediate reconstructions from local flaps to sophisticated perforator flaps. It is important for a surgeon to minimize breast loss while the operation and maintain the patient's feeling that her breasts are still a part of her own body after the operation. The oncoplastic breast surgery will become an integral element of the surgical treatment of breast cancer in the future.

Quilting Prevents Seroma Formation following Immediate LDMCF Reconstruction after Quadrantectomy

PURPOSE: Latissimus dorsi myocutaneous flap (LDMCF) is a commonly used technique for breast reconstruction following breast-conserving surgery. However, this technique has a high incidence of donor site seroma. The aim of this study is to evaluate the effect of donor-site quilting on seroma formation. METHODS: A retrospective review of 95 patients who underwent immediate breast reconstruction with LDMCF from May of 2006 through February of 2007 was performed. Patients were divided into Group A, in which only a closed suction drain was used, and Group B, in which quilting and a closed suction drain were used. The outcome measures were age, body mass index (BMI), mastectomy volume, duration of drain, total volume of postoperative seroma, length of hospital stay, and incidence of postoperative aspiration. RESULTS: In Group B, the total amount of seroma, duration of drain, and length of hospital stay were significantly reduced (P<0.05). However, the incidence of postoperative aspiration was not different between Group A and Group B (P=0.06). CONCLUSION: The quilting technique reduces the volume of postoperative seroma and may help prevent of seroma after LDMCF.

Immediate Breast Reconstruction with Contralateral Pectoralis Major Myomammary Flap for Breast Conserving Surgery / 한국유방암학회지

PURPOSE: There has been much reported data showing that breast reconstruction surgery does not result in reduced patient survival if the accepted principles of cancer surgery are closely followed. The proper reconstructive technique can be selected according to diverse factors, but breast size and the site of tumor are mostly important. The latissimus dorsi musculocutaneous flap (LDMCF) is one of the most commonly used techniques for early breast cancer patients who have small breasts. But, it has difficulties for supplying enough tissues to the widely excised tumor site. Especially for ptosis patients, reduction mammoplasty by itself is not enough to achieve symmetry of the breast. We suggest that the pectoralis major myomammary flap (PMMF) is a useful technique for the patients with ptosis. METHODS: Seventeen patients with ptosis were treated with breast conserving surgery with PMMF reconstruction. A quadrantectomy rather than lumpectomy was performed through a planned skin incision, and axillary lymph node dissection was performed according to the results of sentinel lymph node biopsy. The PMMF is carefully harvested without perforating branch injury to the internal thoracic artery. Reconstruction was done via the PMMF through the medial tunnel between both breasts. RESULTS: Among the seventeen patients, seroma occurred in two patients and no necrosis occurred at all. The cosmetic result was fair in 15 patients and poor in two patients, based on the four-point scoring system of breast cosmetics. CONCLUSION: After performing enough quadrantectomy to adhere to the accepted principles of cancer surgery, PMMF was quite useful to supply enough proper tissues for breast reconstructions, and especially for the ptosis patients.

External Oblique Myocutaneous Flap for Reconstruction of Large Chest-Wall Defects following Resection of Advanced Breast Cancer

PURPOSE: Major chest wall reconstruction following radical excision of advanced breast cancer is remained a challenging treatment of oncoplastic surgeons. The aims of this study are to introduce a method of external oblique myocutaneous flap (EOMCF) and evaluate the effect of large chest wall reconstruction using external oblique myocutaneous flap. METHODS: A retrospective review of 17 patients who underwent chest wall reconstruction with external oblique myocutaneous flap from January of 2007 through May of 2008 was performed. The upper edge of external oblique myocutaneous flap was lower margin of defect. The medial edge was mid-line of abdomen by umbilicus, vertically along the linea alba. The lower edge was a lateral transverse line at the level of umbilicus. The flap was rotated clockwise in the left side chest wall defects and counterclockwise in the right. RESULTS: The mean chest wall defect was 360.8+/-137.8 cm2 and the mean flap size was 591.1+/-136.2 cm2. The mean reconstruction time was 41.5+/-7.9 min and patients were discharged on 8.8+/-1.2 postoperative day (mean). Three patients had superficial skin loss (<5%) and this lesions are healed with conservative therapy. CONCLUSION: We propose that the external oblique myocutaneous flap may be a safe and feasible method for reconstruction of large chest wall defects after radical mastectomy including all breast skin.

The Multidrug Resistance-related Protein and P-glycoprotein Expressions, and the Washout Rates of 99mTc-MIBI in Infiltrating Ductal Carcinoma of Breast, Correlation with the Response After Neoadjuvant Chemotherapy / 한국유방암학회지

PURPOSE: Numerous non-invasive imaging methods for evaluating the chemotherapy response of breast cancer patients are currently being explored. The aim of present study was to investigate whether the washout rates (WRs) of 99mTc-MIBI could predict the response to chemotherapy in patients suffering with infiltrating ductal carcinoma using the expressions of multidrug resistance-related protein (MRP) and P-glycoprotein (Pgp). METHODS: From May 2002 and March 2004, the patients were randomly and consecutively selected according to the results of immunohistochemical analyses of breast carcinoma specimens before the administration of neoadjuvant chemotherapy. A total 45 infiltrating ductal carcinomas in 45 female patients were selected and they were separated into three groups: group A consisted of tumors with both negative Pgp and MRP expressions (n=15); group B consisted of the tumors that were positive for either a Pgp expression or a MRP expression (n=15); group C consisted of the tumors that were positive for both Pgp and MRP expressions (n=15). All the patients were referred for double phase 99mTc-MIBI mammoscintigraphy after the injection of 925 MBq of 99mTc-MIBI to calculate the WR. The tumor response was evaluated after completion of neoadjuvant chemotherapy. The tumor response was classified as a complete or partial response (the responder group) and stable or progression (the non-responder group). All the patients underwent surgery. RESULTS: The response rate of group C was lower than that of the other groups, but the difference was not statistically significant (p=0.283). The WR of non-responder group was lower than that of the responder group, although the difference was not statistically significant (p=0.674). The washout rates of group C was the highest than other groups and the difference was statistically significant (p=0.001). CONCLUSION: In conclusion, the WR of 99mTc-MIBI is helpful for in vivo determination of both the Pgp and MRP expressions for infiltrating ductal carcinoma of the breast.

Immediate Conservative Breast Reconstruction Technique using Lateral Thoracodorsal Fasciocutaneous Flap / 한국유방암학회지

PURPOSE: A lateral thoracodorsal fasciocutaneous flap (LTFF) is a local fasciocutaneous flap that has been used in breast reconstructions since the 1980s. Although the LTFF is a wellstudied reconstruction procedure after radical surgery in Western countries, there is no report in Korea. By introducing the LTFF procedure, we suggest an easy reconstruction technique that can be performed by the breast surgeon directly. METHODS: Patients with lateral breast cancer and redundant lateral thoracic region might be candidates for this procedure. The flap consists of the lateral and dorsal extensions of the inframammarian fold as well as an extended line from the anterior axillary line. A quadrantectomy is performed through a planned skin incision, and an axillary lymph node dissection can be performed simultaneously if the sentinel lymph node is positive. The skin and subcutaneous fat with the fascia of the serratus anterior and latissimus dorsi muscle should be dissected carefully. A wedge-shaped flap can be acquired successfully. The lateral breast defect is then reconstructed by a rotation of the flap. The axis of the flap is drawn following the inframammarian fold so that the final scar would be under the brassiere line. RESULTS: Nineteen patients were treated with the LTFF after breast conserving surgery. All tumors were located in lateral breast regions. Seroma occurred in three and partial fat necrosis and partial flap necrosis were observed in each one. The cosmetic result based on four-point scoring system of breast cosmesis showed excellent in seventeen and good in two. CONCLUSION: Despite its long scar line, with appropriate patient selection, a LTFF might be a useful method for breast reconstructions.

Clinical Analysis of Breast Cancer Patients Treated with Surgery / 한국유방암학회지

purpose: In Korea, the incidence of breast cancer is continuously increasing. Since 2001, breast cancer is the most common cancer in females.(1) Methods: We analyzed the clinical data of 323 breast cancer patients who were treated in department of surgery at Pusan National University Hospital between January 2001 and December 2002. Results: A total of 323 patients, 322 patients are female and 1 patient is male. The most common prevalent age was the fifth decades. The most common sign and symptom was a painless palpable mass. The most common tumor location was the left upper outer quadrant. The main preoperative histologic diagnostic methods were core needle biopsy (48.3%) and Fine Needle Aspiration (35.6%). Breast conservation surgeries were performed in 259 cases (80.2%), a modified radical mastectomy in 35 cases (10.9%), a radical mastectomy in 3 cases (0.9%), a simple mastectomy in 3 cases (0.9%) and other procedures in 23 cases (7.1%). According to the TNM staging system, the most common stage was stage IIA (121 cases, 37.4%). The most common pathologic type was invasive ductal carcinoma (273 cases, 84.6%). Axillary lymph node metastasis was present in 109 cases (33.7%). The most common distant metastasis site was the bone (12 cases, 3.7%). The average follow-up period was 22.3 months. 19 cases (5.9%) were recurred between 15 to 28 months after surgery. Their mean disease- free interval was 21.2months. During the follow-up, 4 patients died. Conclusion: In spite of the short follow-up period, this study shows that breast conservation surgery is a recommendable modality in breast cancer, in terms of recurrence rate, disease free survival, patient's satisfaction and cosmetics.

Chromogenic In Situ Hybridization Analysis to Determinate HER-2/neu Status in Breast Carcinoma

PURPOSE: The determination of HER-2/neu gene amplification has become necessary for the selection of breast cancer patients to undergo anti-HER-2/neu therapy, using a humanized monoclonal antibody. Chromogenic in situ hybridization (CISH) detection of the HER-2/neu gene, a newly developed method, utilizes a robust and unique-sequence DNA probe labeled with digoxygenin, which is sequentially incubated with antidigoxygenin fluorescein, antifluorescein peroxidase and diaminobenzidine. The aim of this study was to establish a CISH assay for the detection of HER-2/neu amplification. The results were compared with those of the immunohistochemistry (IHC) methods, most frequently used for detecting HER-2/neu alteration. METHODS: CISH was performed in 4 groups of infiltrating breast carcinomas. Each group was comprised of 20 cases in which the HER-2/neu stati had previously been scored on a four value scale: 0, 1+, 2+ and 3+ by IHC. The results of CISH and IHC were compared for each tumor group. The HER-2/neu gene amplification detected by CISH was thpically visualized as large DAB-stained clusters or by many dots in the nucleus. RESULTS: The concordance between the CISH and IHC was 95% (kappa=0.901). Three IHC-positive cases (score 2+) showed no gene amplification and one IHC-negative case (score 1+) showed gene amplification by CISH. CONCLUSION: The current study showed excellent agreement between the CISH and IHC methods. CISH is an accurate, practical and economical approach for determining the HER-2/neu stati in breast carcinomas. It is also a useful methodology for confirming the IHC results in paraffin- embedded tumor samples, so offers a promising alternative to IHC in a routine diagnostic setting.

p53 Mutation and c-erbB2 Over-expression in Predicting Factor of Responsibility to Neoadjuvant Chemotherapy in Patients with Breast Cancer

PURPOSE: The predictive value of c-erbB2 over-expression, and p53 mutation, to the response rate to neoadjuvant chemotherapy, were assessed in patients with breast cancer. METHODS: Between January 2000 and June 2002, 185 patients, with breast cancer, were put forward for two commonly used chemotherapy regimens prior to surgery. The first 135 received the CMF (cyclophosphamide 600 mg/m2, methotraxate 40 mg/m2, 5-FU 500 mg/m2) regimen, and the remaining 50 the CAF (cyclophosphamide 600 mg/m2, adriamycin 50 mg/m2, 5-FU 500 mg/m2) regimen. The expressions of the estrogen receptor (ER), progesterone receptor (PR), p53 mutation and c-erbB2, were evaluated by immunohistochemistry of needle biopsy samples prior to neoadjuvant chemotherapy. Tumor response was categorized according to the WHO criteria, using the largest diameter in ultrasonography or magnetic resonance imaging. RESULTS: The mean age of the patients in the CMF and CAF groups were 48.8 and 47.4 years. Forty eight (35.6%) and 24 (48.0%) of the patients, in the CMF and CAF groups, respectively, had pathologically partial or complete responses. The tumor size, axillary lymph nodes, lymphatic and vascular invasions, as clinicopathological factors, were significantly correlated with the response to chemotherapy in the CAF group. The absences of ER or PR were also significantly associated with a remission in both the CMF and CAF groups. p53 mutation was not correlated to the response rate of either chemotherapy regimen. There was no significant relationship between the expression of c-erbB2 and the response rate in the CMF group, but a higher percentage of patients with c-erbB2 positive tumors had a response to the CAF regimens. CONCLUSION: p53 mutation is not significantly associated with tumor response, but the over-expression of c-erbB2 can predict the response to the different chemotherapies used in breast cancer.

Relationship between the Expression of Sodium Iodide Symporter and the Findings of 99mTc-MIBI Scintimammography in the Primary Breast Cancer / 대한핵의학회잡지

No abstract available.