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  • 1
    Electronic Resource
    Electronic Resource
    In Situ Duct Carcinoma of the Breast: Clinical and Histopathologic Factors and Association with Recurrent Carcinoma (2001)
    Boston, MA, USA : Blackwell Science Inc
    The @breast journal 7 (2001), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: There has been a recent increase in the diagnosis of in situ duct carcinoma of the breast (DCIS) as a result of mammographic screening. DCIS is heterogeneous in appearance and likely in prognosis. There is no generally accepted model to predict progression to invasive carcinoma. We investigated the prognostic effect of clinical presentation and pathologic factors for women diagnosed with primary DCIS. A cohort of 124 patients was accrued between 1979 and 1994 and was followed to 1997; 78 had DCIS detected mammographically, and 88 underwent lumpectomy alone. In this article, we provide details about characteristics affecting the choice of primary therapeutic modality, and we examine the effects of factors on progression for the two patient subgroups. Presentation with bloody nipple discharge was associated with a significant increase in DCIS recurrence (p = 0.07). The pattern of duct distribution was important: DCIS in which the involved ducts were more widely separated had a significantly greater recurrence of DCIS than when the involved ducts were more concentrated (p = 0.08 for mammographically detected DCIS, p = 0.07 for patients who underwent lumpectomy alone). For mammographically detected DCIS, younger patients had more DCIS recurrence (p = 0.07). We found considerable heterogeneity in nuclear grade; 50% of patients exhibited more than one grade. Nuclear grade, necrosis, and architecture were not significantly associated with either recurrence of DCIS or development of invasive carcinoma. Longer follow-up will allow further evaluation of the prognostic relevance of the factors assessed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.2001.99124.x
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  • 2
    Electronic Resource
    Electronic Resource
    The Rate of Breast-Conserving Surgery for Early Breast Cancer Is Not Influenced by the Surgical Strategy of Excisional Biopsy Followed by the Definitive Procedure (2001)
    Boston, MA, USA : Blackwell Science Inc
    The @breast journal 7 (2001), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Increased emphasis on breast conservation and the primacy of the patient's preferences has led to the promotion and increased use of a two-step surgical strategy (definitive operation only after a final tissue diagnosis from a biopsy done on a previous visit) in the treatment of early breast cancer, with the assumption being that this is more conducive to the performance of breast-conserving surgery (BCS). We sought to test this by examining the effect of the surgical strategy (one-step versus two-step) on the operation performed (BCS versus mastectomy). A random sample of women with node-negative breast cancer diagnosed in 1991 in Ontario was drawn from the Ontario Cancer Registry database and matched to the Canadian Institute of Health Information and Ontario Health Insurance Plan databases (n = 643). This provided information on the timing and nature of all surgical procedures performed as well as patient, tumor, hospital, and surgeon characteristics. The surgical strategy was defined as either a one-step procedure (biopsy and definitive surgery performed at the same time) or a two-step procedure (surgical biopsy and pathologic diagnosis, followed by definitive surgery at a later date). The axillary lymph node dissection was used to define the definitive procedure. BCS was employed in 68% of patients, and this did not differ significantly between the one-step and two-step groups (66% versus 70%). Patients with palpable lesions had a significantly lower rate of breast conservation than those with nonpalpable lesions. Other variables associated with a lower rate of BCS were larger tumor size, presence of extensive ductal carcinoma in situ (DCIS), and central or multifocal tumors. The use of a one-step procedure was associated with a patient age of more than 50 years, a palpable mass, tumor size larger than 1 cm, previous fine needle aspiration (FNA) biopsy, absence of extensive DCIS, and surgery in an academic setting. Breast conservation was not affected by the surgical strategy used or the timing of the decision, but was associated with several accepted tumor factors. This study shows that, contrary to the opinion of some, there is a group of breast cancer patients in whom treatment in a one-step manner is appropriate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.2001.007003158.x
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  • 3
    Electronic Resource
    Electronic Resource
    Pathologic Characteristics of Breast Cancer that Predict for Local Recurrence After Lumpectomy Alone (1999)
    Boston, MA, USA : Blackwell Science Inc
    The @breast journal 5 (1999), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: ▪Abstract: Breast conservation surgery (BCS) plus irradiation has been shown to be equivalent to mastectomy in controlling ipsilateral breast cancer recurrence. The purpose of this study is to evaluate the factors that determine the rate of local recurrence in a group of patients treated with partial mastectomy without postoperative radiation, adjuvant hormonal therapy, or chemotherapy. We also assess the role of standard pathologic features, specifically lymphovascular invasion (LVI) in identifying high- and low-risk subsets of patients. We have a cohort of 293 patients treated with partial mastectomy followed prospectively for a median of 8 years. Data collected included patient’s age, tumor size, tumor morphology, tumor grade, the extent of ductal carcinoma in situ (DCIS), the presence of LVI, lymph node status, and hormone receptors. Statistical analyses carried out were Kaplan–Meier plots with Wilcoxon (Peto–Prentice) test statistics for univariate analysis and Cox stepwise regression for multivariate analysis; the end point was local recurrence. The relapse rate in this cohort was 26%. In univariate analysis the significant factors associated with prolonged disease-free survival included older age, negative nodes, positive estrogen receptor (ER) status, and absence of LVI. Small tumor size was significant only in the univariate analysis. In the multivariate analysis, absence of comedocarcinoma entered the model in addition to the other variables. If the variables are stratified, a group of 66 patients with 6% local recurrence rate was identified. These were node-negative women 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:1075122X:TBJ133:ges" location="ges.gif"/〉50 years of age with no LVI, no comedo DCIS, and ER-positive tumors. This study clearly indicates the important role of pathologic parameters in assessing the risk of recurrence. ▪
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.1999.00133.x
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  • 4
    Electronic Resource
    Electronic Resource
    Use of Alternative Therapy in Postmenopausal Breast Cancer Patients Treated with Tamoxifen after Surgery (2004)
    Oxford, UK : Blackwell Science Inc
    The @breast journal 10 (2004), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract:  The goal of this study was to determine the frequency of alternative therapy use in postmenopausal women with early stage breast cancer who were enrolled in a randomized clinical trial designed to determine the value of breast irradiation after treatment with breast-conserving surgery and tamoxifen. A questionnaire was given to 300 patients, ages 52 to 90 years, after completion of radiation therapy (if any). Of the 290 respondents, 78 (27%) had used some form of alternative therapy. Of these, 60.3% started after the diagnosis of breast cancer. Users of alternative therapies were significantly younger than nonusers (67.0 ± 8.4 years versus 70.0 ± 8.7 years, p = 0.009) and they used a median of one type of therapy per person (range 1–13). Users of alternative therapies were more likely to have experienced symptoms (stiffness, pain, numbness, or swelling) in the ipsilateral shoulder or arm after treatment of their breast cancers compared to nonusers (odds ratio [OR] = 2.0, p = 0.02). This relationship between alternative therapy use and symptoms was strongest in the group who started alternative therapies after breast cancer diagnosis (OR = 2.1, p = 0.05). On multivariate analysis, younger age and radiotherapy treatment were related to alternative therapy use. In conclusion, 27% of patients with early stage breast cancer used alternative therapy. Users were more likely to be younger and to experience shoulder or arm symptoms after breast-conserving surgery with radiation. 
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1075-122X.2004.21497.x
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  • 5
    Electronic Resource
    Electronic Resource
    Altered biodistribution of indium-111-labeled monoclonal antibody 96.5 to tumors and normal tissues of nude mice bearing human melanoma xenografts in visceral organs (1989)
    Springer
    Cancer immunology immunotherapy 30 (1989), S. 257-261 
    Details
    ISSN: 1432-0851
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Human melanoma xenografts were produced in the subcutis, kidney, cecum and liver of different nude mice. An111In-labeled anti-(human melanoma) monoclonal antibody (96.5) or an111In-labeled nonspecific control monoclonal antibody (ZCE-025) was injected intravenously in separate groups of mice. Radioactive antibody accumulation was measured in tumor, blood, viscera, and carcasses. mAb 96.5 targeted specifically to tumor tissue regardless of site of growth. Tumors in the liver exhibited significantly (P 〈0.05) higher tumor-to-blood ratios (45±6, mean ±SEM) than xenografts at other visceral organs, the lowest value being found for subcutaneous melanoma (2.6±0.5). The differences in tumor-to-blood ratio were due to significant alterations of antibody biodistribution, since the actual antibody concentration in the different tumor sites was similar. The percentage of recovered anti-melanoma antibody per milliliter of blood in mice with visceral lesions (4.6±1.1%/ml) was significantly lower than that found in mice with subcutaneous tumors (9.5±1.4%/ml,P 〈0.05). Moreover, significantly higher levels (18.2±3.2%/g, 31.0±5.1%/g, respectively) of the melanoma mAb 96.5 were found in normal liver and spleen tissue recovered from mice with visceral tumors as compared to tissue from mice with subcutaneous tumors (9.2±0.9%/g, 13.5±1.9%/g, respectively;P 〈0.05). These results demonstrate that the presence of visceral tumor can significantly affect tumor-to-blood ratios, blood levels, and biodistribution of111In-labeled mAb 96.5.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01744891
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  • 6
    Electronic Resource
    Electronic Resource
    A comparison of all-subset Cox and accelerated failure time models with Cox step-wise regression for node-positive breast cancer (1992)
    Springer
    Breast cancer research and treatment 22 (1992), S. 263-272 
    Details
    ISSN: 1573-7217
    Keywords: breast cancer ; prognostic factors ; Cox regression ; all-subset regression ; accelerated failure time models
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Clinical studies usually employ Cox step-wise regression for multivariate investigations of prognostic factors. However, commercial packages now allow the consideration of accelerated failure time models (exponential, Weibull, log logistic, and log normal), if the underlying Cox assumption of proportional hazards is inappropriate. All-subset regressions are feasible for all these models. We studied a group of 378 node positive primary breast cancer patients accrued at the Henrietta Banting Breast Centre of Women's College Hospital, University of Toronto, between January 1, 1977, and December 31, 1986. 85% of these patients had complete prognostic factor data for multivariate analysis, and 96% of the patients were followed to 1990. There was evidence of marked departures from the proportional hazards assumption with two prognostic factors, number of positive nodes and adjuvant systemic therapy. The data strongly supported the log normal model. The all-subset regressions indicated that three models were similarly good. The variables 1) number of positive nodes, 2) tumour size, and 3) adjuvant systemic therapy were included in all three models along with one of three biochemical receptor variables 1) ER, 2) combined receptor (ER- PgR-; ER+ PgR-; ER- PgR+; ER+ PgR+; or 3) PgR. Better multivariate modeling was achieved by using quantitative prognostic factors, a check for appropriate underlying model-type, and all-subset variable selection. All-subset regressions should be considered for routine use with the many new prognostic factors currently under evaluation; it is very possible that there may not be a single model that is substantially better than others with the same number of variables.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01840839
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  • 7
    Electronic Resource
    Electronic Resource
    RT-PCR amplification of CK19 mRNA in the blood of breast cancer patients: correlation with established prognostic parameters (2000)
    Springer
    Breast cancer research and treatment 60 (2000), S. 143-151 
    Details
    ISSN: 1573-7217
    Keywords: breast cancer; cytokeratin 19 (CK19) mRNA ; reverse transcriptase-polymerase chain reaction(RT-PCR) ; circulating tumor cells
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We optimized the assay for detection of cytokeratin 19 (CK19) mRNA by the reverse transcriptase-polymerase chain reaction (RT-PCR) in blood as an index of circulating tumor cells in breast cancer patients. The limit of detection of 〈1 MCF7 tumor cells per 106 peripheral blood leukocytes (PBL) was achieved in mixing experiments. We did not detect CKl9 mRNA in control bloods (0/30) or in the blood of patients with benign breast disease (0/15). In blood samples from 109 patients with invasive breast cancer, CK19 mRNA was detected in 7/23 patients with node-negative disease, in 21/58 with node-positive disease, and in 20/28 with distant metastases. There was a significant association (P〈0.01) of CK19 positivity with distant metastatic versus both node-negative and node-positive disease, but not with any other histopathological parameter examined. In a small number of patients with distant metastases, increased intensity of the CK19 RT-PCR signal was associated with a reduced survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1006350913243
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  • 8
    Electronic Resource
    Electronic Resource
    Factors Affecting Distant Disease-Free Survival for Primary Invasive Breast Cancer: Use of a Log-Normal Survival Model (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 416-426 
    Details
    ISSN: 1534-4681
    Keywords: Breast cancer ; Disease-free survival ; Prognostic factors.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Invasive breast cancer is a frequently diagnosed disease that now comes with an ever expanding array of therapeutic management options. We assessed the effects of 20 prognostic factors in a multivariate context. Methods: We accrued clinical data for 156 consecutive patients with stage 1–3 primary invasive breast cancer who were diagnosed in 1989–1990 at the Henrietta Banting Breast Center, and followed to 1995. There is complete follow-up for 91% of patients (median follow-up of 4.9 years). The event of interest was distant recurrence (for distant disease-free survival, DFS). We used Cox and log-normal step-wise regression to assess the multivariate effects of the following factors on DFS: age, tumor size, nodal status, histology, tumor and nuclear grade, lymphovascular and perineural invasion (LVPI), ductal carcinoma-in-situ (DCIS) type, DCIS extent, DCIS at edge of tumor, ER and PgR, ERICA, adjuvant systemic therapy, ki67, S-phase, DNA index, neu oncogene, and pRb. Results: There was strong evidence against the Cox assumption of proportional hazards for nodal status, and nodal status was not in the Cox step-wise model. With step-wise log-normal regression, a large tumor size (P 〈 .001), positive nodes (P 5 .002), high nuclear grade (P 5 .01), presence of LVPI (P 5 .03), and infiltrating duct carcinoma not otherwise specified (P 5 .05) were associated with a reduction in DFS. Conclusions: For nodal status, there was strong evidence against the Cox assumption of proportional hazards, and it was not included in the Cox model although it was in the log-normal model. Only traditional factors were included in the step-wise models. Thus, this statistical management of prognostic markers in breast cancer appears to be very important.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0416-z
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  • 9
    Electronic Resource
    Electronic Resource
    Factors associated with local breast cancer recurrence after lumpectomy alone (1996)
    Springer
    Annals of surgical oncology 3 (1996), S. 358-366 
    Details
    ISSN: 1534-4681
    Keywords: Breast cancer ; Local recurrence ; Lumpectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The purpose was to determine the rate of local breast relapse in patients with breast cancer uniformly treated with partial mastectomy but without postoperative radiotherapy and without systemic adjuvant therapy. We also systematically examined the factors associated with local recurrence to determine whether a low-risk subgroup existed. Methods: A retrospective review of a prospectively followed (median, 8 years) cohort of 293 patients was performed. The end-point was ipsilateral local breast cancer recurrence. The patient's age, tumor size, nodal status, estrogen and progesterone receptor status, histology, and tumor and nuclear grade were studied, as were the presence and amount of carcinoma in situ and the presence of tumor emboli using univariate Kaplan-Meier and Cox step-wise multivariate analyses. Results: The overall local relapse rate was 26% (77 recurrences). Univariate factors significantly associated with decreased local relapse included older age, negative nodes, small tumor size, positive estrogen receptor status, and absence of tumor emboli. Significant multivariate variables were age, nodal status, estrogen receptor status, absence of comedo carcinoma in situ, and tumor emboli. A low-risk subgroup of 66 patients was defined with a 6% 10-year local recurrence rate. Conclusion: Important patient and tumor variables associated with local breast cancer relapse after breast-conserving surgery can define a low-risk subgroup.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02305665
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  • 10
    Electronic Resource
    Electronic Resource
    Letter to the Editor (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 510-511 
    Details
    ISSN: 1534-4681
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0510-9
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