P53 y otros factores predictores de la carga axilar en los distintos inmunofenotipos del cáncer de mama / P53 and other predictors of axillary tumour load in the distinct phenotypes of breast cancer

Objetivos El objetivo de este estudio es determinar si la p53, así como otros factores, pueden ayudar a definir de manera más precisa la carga tumoral axilar de forma global o en los distintos inmunofenotipos del cáncer de mama. Materiales y métodos Se realizó un estudio retrospectivo de las neoplasias infiltrantes de mama del ámbito del Hospital del Mar de Barcelona del año 2000 al 2014. Se analizaron los factores predictores de la carga tumoral axilar de todas ellas, así como en los diferentes inmunofenotipos. Resultados Un total de 1.762 casos fueron los sujetos de estudio. Hubo un 18,7% de tumores con p53+. La p53+ resultó un factor predictor de baja carga axilar en el análisis multivariado global, así como concretamente en los subtipos Luminal B-HER2− (p=0,025) en el estudio estadístico univariado. Otros factores como la invasión linfovascular o el Ki67 elevado también se asociaron fuertemente a alta carga tumoral axilar. Conclusiones La p53 puede contribuir a definir un perfil específico de neoplasia de mama y de afectación axilar. En la era de la cirugía personalizada, este y otros factores pueden ayudar en un futuro a seleccionar el abordaje terapéutico axilar de manera más precisa en los diferentes inmunofenotipos. (AU)

Objectives The aim of this study was to determine whether p53, as well as other factors, can help to more precisely define axillary tumour load overall or in the distinct breast cancer phenotypes. Materials and methods We conducted a retrospective study of infiltrating breast tumours in Hospital del Mar, Barcelona, from 2000 to 2014. We analysed the factors predictive of axillary tumour load in all cases, as well as in the distinct immunophenotypes. Results We studied 1762 cases. A total of 18.7% of tumours were p53+. Positivity for p53 was a predictive factor for low axillary tumour load in the overall multivariate analysis as well as in luminal B-HER2− subtypes (p=0.025) in the univariate analysis. Other factors such as lymphovascular infiltration and elevated Ki67 were also strongly associated with axillary tumour load. Conclusions p53 can help to define specific breast tumour profile and axillary involvement. In the era of personalized surgery, this and other factors could, in the future, help to select the therapeutic axillary approach more precisely in distinct phenotypes. (AU)

Imaging and pathology features to predict axillary tumor load in breast cancer.

AIM: We investigated if imaging and pathology features could help to identify a high axillary tumor burden (ATB) in breast cancer patients, in order to individualize decisions on axillary lymph node (ALN) dissection (ALND). METHODS: We retrospectively analyzed patients primarily treated with surgery in our unit between 2011 and 2014. We divided the patients in two groups: low ATB (LATB) if ≤ 2 ALN were infiltrated and high ATB (HATB) if > 2 ALN were infiltrated. RESULTS: Data of 105 patients was included in the study. Axillary ultrasound (AUS) features associated with HATB were any sign of ALN infiltration (76 vs 24%, P = 0.027) and > 2 suspicious ALNs (73% vs 27%, P = 0.018); however, when AUS revealed ≤ 2 suspicious ALNs, 39% of these patients had HATB. Any sign of ALN infiltration on magnetic resonance imaging was associated with HATB (48% vs 52%, P = 0.031). Positive preoperative ALN cytology or biopsy was associated with HATB (53% vs 47%, P = 0.008), while p53 positivity (80% vs 20%) and high histological grade (68% vs. 32%) correlated with LATB (P = 0.05 and P = 0.02, respectively). In multivariate analysis, only positive preoperative ALN cytology or biopsy was associated with HATB (P = 0.038). CONCLUSIONS: AUS was useful for detecting HATB but was not as effective in patients with LATB. Proving axillary infiltration with AUS-directed cytology or biopsy is the most effective method to predict HATB.