RESUMEN
BACKGROUND: The objective of this study was to compare the efficacy of biomarkers in assessing the risk of breast cancer recurrence in patients with node-negative or micrometastatic grade II breast cancer. Specifically, we compared risk assessments based on the St. Gallen clinicopathological criteria, Ki67 expression and urokinase plasminogen activator (uPA)/plasminogen activator inhibitor-1 (PAI-1) expression. METHODS: This retrospective study included 347 patients with breast cancer followed at Limoges University Hospital. The optimal cut-off for high Ki67 expression (Ki67hi) was established as 20%. The threshold for uPA and PAI-1 positivity was 3 ng/mg and 14 ng/mg, respectively. RESULTS: Ki67 expression was lower in uPA/PAI-1-negative than in uPA/PAI-1-positive tumours (227 tumours; P = 0.04). The addition of Ki67 status to the St. Gallen criteria resulted in a 28% increase in the rate of identification of high-risk tumours with a potential indication for chemotherapy (P < 0.001). When considering uPA/PAI-1 levels together with the St Gallen criteria (including Ki67 expression), the number of cases identified as having a high recurrence risk with a potential indication for adjuvant chemotherapy increased by 20% (P < 0.001). Adjuvant chemotherapy was 9% less likely to be recommended by a multidisciplinary board when using the current criteria compared with using a combination of the St. Gallen criteria and Ki67 and uPA/PAI-1 status (P = 0.03). CONCLUSIONS: Taken together, our data show discordance among markers in identifying the risk of recurrence, even though each marker may prove to be independently valid.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Antígeno Ki-67/genética , Recurrencia Local de Neoplasia/tratamiento farmacológico , Inhibidor 1 de Activador Plasminogénico/genética , Activador de Plasminógeno de Tipo Uroquinasa/genética , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/genética , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Quimioterapia Adyuvante/efectos adversos , Supervivencia sin Enfermedad , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Humanos , Ganglios Linfáticos/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/patología , Pronóstico , Factores de RiesgoRESUMEN
Available data on appropriate follow-up in endometrial cancer highlight the need of well-conducted studies. Most recurrences tend to occur within three years and involve symptoms. Routine tests are not advocated without symptoms. In case of suspicious recurrence, TEP/CT seems to be the most sensitive and specific method. There is limited evidence to decide whether follow-up schedules with multiple visits result in survival benefits. An appropriate follow-up should be discussed based upon the risk of recurrence. Counselling on the potential symptoms of recurrence should be a major aim.
Asunto(s)
Neoplasias Endometriales/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Vigilancia de la Población/métodos , Antígeno Ca-125/análisis , Neoplasias Endometriales/mortalidad , Neoplasias Endometriales/terapia , Femenino , Estudios de Seguimiento , Humanos , Recurrencia Local de Neoplasia/mortalidad , Neoplasias Primarias Secundarias/diagnóstico , Tomografía de Emisión de Positrones , Guías de Práctica Clínica como Asunto , Pronóstico , Evaluación de Síntomas , Frotis VaginalRESUMEN
BACKGROUND: The urokinase-type plasminogen activator (UPA) and its main inhibitor plasminogen activator inhibitor-1 (PAI-1) are involved in tumor interactions with the microenvironment. The UPA/PAI-1 content in tumor tissue can be used to identify populations at low-or high-risk of recurrence of breast cancer, even without other standard prognostic markers. MATERIALS AND METHODS: The purpose of the present study was to compare adjuvant chemotherapy decisions made by a multi-disciplinary board for 163 node-negative breast cancer cases, based on clinicopathological (CP) and UPA/PAI-1 risk assessment. RESULTS: The UPA/PAI-1 levels identified 37% of the population as being at low risk. Adjuvant chemotherapy indication was spared in high-CP risk in 17%, but maintained in low-CP risk in 33%. CONCLUSION: The use of UPA/PAI-1 data did not consistently result in a decrease of adjuvant chemotherapy. This study highlighted the difficulties encountered in a local multi-disciplinary board in determining appropriate roles and weights of new prognostic markers (UPA/PAI-1 was not routinely employed in France) when no data are available for assessing their prognostic and predictive power compared to other prognostic factors.
