Complete pathologic response rate to neoadjuvant chemotherapy increases with increasing HER2/CEP17 ratio in HER2 overexpressing breast cancer: analysis of the National Cancer Database (NCDB).

BACKGROUND: HER2-positive breast cancer is an aggressive subtype of breast cancer that overexpresses human epidermal growth factor receptor 2 promoting cancer cell growth. Monoclonal antibodies targeting the HER2 receptor have improved survival for this patient population. Achieving pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) has correlated with disease-free survival in multiple trials, but we do not know why some HER2-positive tumors respond better to these therapies. We evaluated the correlation between HER2/CEP17 ratio and partial versus complete response following NAC. We evaluated whether patients with higher HER2/CEP17 ratios would have higher rates of pCR after NAC. METHODS: Using the National Cancer Database (NCDB), we performed a retrospective review comparing pCR rates after NAC based on HER2 ratio between 2005 and 2014. Patients were excluded if they were HER2 negative, did not undergo NAC, or if the HER2 ratio was not recorded. Trends in percentage of pCR versus partial response were analyzed using SPSS. RESULTS: The NCDB included 237,118 patients with HER2 equivocal or HER2-positive breast tumors. 29,291 of these patients underwent NAC, and HER2/CEP17 ratios were recorded in 14,597 of the NAC cases. A pCR was noted in 9752 patients and 11,402 patients had a partial response. The ratios were significantly different between complete vs. partial response groups (include ratios), P < 0.001. Using linear regression analysis, we identified a direct relationship between increasing the ratio and response to NAC. CONCLUSION: Our study demonstrates a linear relationship between HER2/CEP17 ratio and pCR to NAC in patients included in the NCDB. The NCDB reflects current clinical practices across the country, and in this patient population, higher HER2 ratio is predictive of pCR to NAC and thus may be used in guiding decisions regarding the therapies that a patient receives in order to enhance pCR.

Assessment of aggressiveness of prostate cancer: correlation of apparent diffusion coefficient with histologic grade after radical prostatectomy.

OBJECTIVE: The purpose of this article is to evaluate the relationship between apparent diffusion coefficient (ADC) values, tumor volume, and total Gleason grade in patients with prostate cancer before radical prostatectomy. MATERIALS AND METHODS: A total of 110 patients with prostate cancer who had undergone endorectal prostate MRI at 1.5 T before radical prostatectomy were included. ADC values were derived by drawing a region of interest on the histologically confirmed tumors. Tumor volume was obtained by manual segmentation on T2-weighted images (T2WIs) and ADC maps. The relationship between the ADC value or tumor volume and the Gleason grade was assessed by using multivariate mixed linear and effect models. Multivariate analysis was performed to evaluate the accuracy of ADC and tumor volume in determining the aggressiveness of prostate cancer. RESULTS: A total of 197 tumors were studied; 128 (65%) tumors were found in the peripheral zone and 69 (35%) were found in the central gland. The ADC value was found to be negatively correlated with the Gleason grade (r = -0.39 for peripheral zone cancer). Higher ADC values were found to be associated with lower Gleason grades in the peripheral zone prostate cancers. No association was found in the central zone prostate cancers. Both ADC values and tumor volumes were found to significantly predict tumor aggressiveness, specifically in the peripheral zone (area under the curve, 0.78). CONCLUSION: ADC values were found to be negatively correlated with the postsurgical Gleason grade in patients with prostate cancer. Our results show that ADC values might help to predict prostate cancer, especially for tumors in the peripheral zone. Given the substantial overlap in the ADC values, the addition of other MR parameters, such as volumetry, and technical improvements in diffusion-weighted imaging might improve accuracy in the stratification of patients.

Extension of ovarian tissue into the infundibulopelvic ligament beyond visual margins.

OBJECTIVE: The purpose of our study was to identify microscopic margins of the ovary and possible extension of the ovarian tissue beyond visual margins into the infundibulopelvic (IP) tissue to formulate recommendations for adequate salpingo-oophorectomy. METHODS: An observational study was conducted with thirty female patients who underwent bilateral salpingo-oophorectomy (BSO) as part of their procedure at Bethesda North Hospital between September 2007 and May 2008. RESULTS: Thirty patients underwent BSO as part of their primary procedure. Two ovaries were excluded from the study because of multiple adhesions to the pelvic wall and distortion of the IP ligaments resulting in fifty-eight ovaries accepted for study. Microscopic extension of the ovarian stroma into IP ligament beyond gross visual margins was found in eight ovaries (13.8%), five left ovaries and three right ovaries. The range of the extension was from 0.2 cm to 1.4 cm (four ovaries 0.2 cm, one 0.4 cm, two 0.8 cm and one 1.4 cm). CONCLUSION: Our study demonstrates that ovarian stroma can extend beyond grossly visual margins. To prevent residual ovarian tissue following oophorectomy surgeons need to ligate the IP ligament at or more than 2 cm proximal to the visual ovarian margins. Similar surgical principals need to be applied during oophorectomy by abdominal, laparoscopic and vaginal approach.