PURPOSE: Approximately two-thirds of breast cancer are estrogen-dependent cancers, which express estrogen receptor (ER)/progesterone receptor (PR). We investigated the prognostic value of ER/PR expression in human epidermal growth factor receptor 2 (HER2)-negative and low proliferative (Ki-67 ≤20%) breast cancer. METHODS: A retrospective review was performed of 252 breast cancer data records, identified as ER/PR-positive, low Ki-67 proliferation index (≤20%) and HER2-negative. The data were divided into two subgroups: a strong luminal subgroup and a weak luminal subgroup, according to hormonal receptor expression status. Outcome measures included age at diagnosis, tumor size, tumor-node-metastasis (TNM) stage, ER, PR, Bcl-2, recurrent or metastatic characteristics, disease-free survival and overall survival, of each subgroup. RESULTS: There were no statistical differences in TNM stage or tumor numbers between the two subgroups. The strong luminal subgroup was associated with a higher Bcl-2 expression (p<0.001). The weak luminal subgroup was associated with more frequent neural invasion (p=0.051) and lung (p=0.031), liver (p=0.031) and brain (p=0.033) metastases, than the strong luminal subgroup. Disease-free survival was significantly longer in the strong luminal subgroup than weak luminal subgroup (p=0.015). Overall survival was also significantly improved in the strong luminal subgroup relative to the weak luminal subgroup (p=0.014). CONCLUSION: The weak luminal subgroup showed worse prognosis than the strong luminal subgroup, among ER/PR-positive HER2-negative low proliferative breast cancer patients. Weak ER or PR expression, can be considered a poor prognostic factor in ER/PR-positive HER2-negative low proliferative breast cancer.
Brain ; Breast Neoplasms ; Diagnosis ; Disease-Free Survival ; Epidermal Growth Factor* ; Estrogens* ; Humans* ; Liver ; Lung ; Neoplasm Metastasis ; Outcome Assessment (Health Care) ; Phenobarbital ; Progesterone* ; Prognosis ; Receptor, Epidermal Growth Factor* ; Receptors, Estrogen ; Receptors, Progesterone* ; Retrospective Studies

PURPOSE: The 40S ribosomal protein S6 kinase-1 (S6K1) is a crucial downstream effector of the PI3K/AKT/mTOR pathway. S6K1 overexpression is found in 10% to 30% of breast cancers and is associated with aggressive disease and poor prognosis. Herein, we investigated the relationship between the expression of phosphorylated S6K1 (p-S6K1) and efficacy of lapatinib in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. METHODS: We retrospectively analyzed the data of 36 patients with HER2-positive metastatic breast cancer treated with lapatinib between January 2010 and September 2014. The p-S6K1 expression status of the primary tumor was assessed via immunohistochemistry using a mouse monoclonal antibody. RESULTS: Fourteen of the 36 patients (38.9%) had p-S6K1-positive tumors. The median progression-free survival (PFS) of patients with p-S6K1-positive tumors was significantly longer than that of patients with p-S6K1-negative tumors (13.4 months vs. 7.1 months, p=0.025). In multivariate analysis, p-S6K1 positivity remained an independent, favorable predictive factor for PFS (hazard ratio, 0.32; 95% confidence interval, 0.11–0.97; p=0.044). CONCLUSION: The high expression of p-S6K1 was significantly associated with prolonged PFS, suggesting that p-S6K1 can be a potential biomarker for predicting the efficacy of lapatinib in patients with HER2-positive metastatic breast cancer.
Animals ; Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Epidermal Growth Factor* ; Humans* ; Immunohistochemistry ; Mice ; Multivariate Analysis ; Prognosis ; Receptor, Epidermal Growth Factor* ; Retrospective Studies ; Ribosomal Protein S6 ; Ribosomal Protein S6 Kinases

PURPOSE: Breast-conserving surgery (BCS) is a standard treatment for breast cancer. Occasionally, patients may be dissatisfied with the breast shape due to deformity after BCS. To ensure satisfactory cosmetic results, a procedure with absorbable mesh after BCS was introduced in 2005. The purpose of this study was to identify the safety and effectiveness of this procedure. METHODS: From November 2013 to December 2015, patients who underwent BCS for a malignant breast mass at Jeonju Presbyterian Medical Center were reviewed, and 63 patients were included in this study. Based on data collected from medical records and telephone interviews, the subjects were divided into two groups as follows and retrospectively compared and analyzed: BCS with absorbable mesh (n=31) and BCS without absorbable mesh (n=32). Patient data included age, body mass index, underlying disease, tumor location and size, specimen size, operative time, axillary dissection based on frozen biopsy results, postoperative wound infection, postoperative radiotherapy, adjuvant chemotherapy, and follow-up period. To compare patient satisfaction between the two groups, a brief questionnaire consisting of four items was administered. RESULTS: Infection occurred in six patients (19.4%) in the absorbable mesh group and one (3.1%) in the BCS only group; however, the difference was not significant (p=0.053). Overall satisfaction, postoperative pain and postoperative motion limitation between the two groups were also not statistically significantly different. However, patients who underwent BCS with absorbable mesh insertion were better satisfied with the breast shape than those who underwent BCS without mesh from 1 year after operation (p=0.011). CONCLUSION: BCS with absorbable mesh is a simple and easy method to improve patient satisfaction for breast shape.
Biopsy ; Body Mass Index ; Breast ; Breast Neoplasms ; Congenital Abnormalities ; Drug Therapy ; Follow-Up Studies ; Humans ; Interviews as Topic ; Jeollabuk-do ; Mastectomy, Segmental* ; Medical Records ; Methods ; Operative Time ; Pain, Postoperative ; Patient Satisfaction* ; Polyglactin 910 ; Protestantism ; Radiotherapy, Adjuvant ; Retrospective Studies ; Surgical Wound Infection

PURPOSE: Neoadjuvant chemotherapy (NCT) is a treatment modality that increases the breast-conserving rate in breast cancer. This prospective study was performed to evaluate the actual breast-conserving rate using NCT in a clinical setting in a single institution. METHODS: Between 2014 and 2015, 265 patients who were scheduled to receive NCT and surgery were enrolled in this study. Patients were classified into three groups based on the immunohistochemical results of estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2): ER or PR positive (luminal), ER/PR negative and HER2 positive (HER2+), and triple-negative breast cancer (TNBC). Before starting and immediately after completing NCT, a surgeon decided if breast-conserving surgery (BCS) or total mastectomy (TM) should be performed. We analyzed the rate of type of surgery performed. RESULTS: Before administering NCT, 107 patients (40.4%) and 158 patients (59.6%) were candidates for BCS and TM, respectively. Of the 158 patients, 61 were eligible for BCS after chemotherapy, with a conversion rate of 38.6%. NCT increased the BCS eligible rate from 40.4% to 62.6%. Of the 61 patients, 53 chose to undergo BCS, and BCS was successful in 46 (86.8%). Of the 107 BCS candidates at baseline, 100 patents finally underwent BCS (93.5%). According to the subtype, the conversion rates were 35.4%, 50.0%, and 40.5% for luminal, HER2+, and TNBC groups, respectively. CONCLUSION: NCT increased the eligibility for BCS from 40.4% to 62.6% in a clinical setting. This benefit is similar to that observed in other clinical trials.
Breast Neoplasms* ; Breast* ; Drug Therapy* ; Estrogens ; Humans ; Mastectomy, Segmental ; Mastectomy, Simple* ; Phenobarbital ; Prospective Studies ; Receptor, Epidermal Growth Factor ; Triple Negative Breast Neoplasms

PURPOSE: Both the incidence of breast cancer as well as, the number of patients with metastatic breast cancer has increased. Taxane and anthracycline chemotherapy is known to be effective in metastatic breast cancer; however, the subsequent treatment option when such treatment fails remains unestablished. The aim of the present study was to analyze the effect and response of cisplatin and etoposide treatment along with the predictive factor for patients who failed taxane and anthracycline chemotherapy for metastatic breast cancer. METHODS: Forty-three patients with breast cancer whose regimen was changed to cisplatin and etoposide chemotherapy from taxane and anthracycline chemotherapy owing to treatment failure were included in this study. The chemotherapy regimen consisted of intravenous injection of 100 mg/m2 etoposide and 70 mg/m2 cisplatin on day 1 and then intravenous injection of 100 mg/m2 etoposide on days 2 and 3. This cisplatin and etoposide chemotherapy was repeated at 3 week intervals, and patients were assessed after the 2nd or 3rd cycle of therapy to evaluate the tumor response. RESULTS: The average cycle and progression-free survival of cisplatin and etoposide chemotherapy were 4±3.1 (range, 1–16) and 12±14.2 weeks (range, 0–60 weeks), respectively. The average overall survival was 44±33.9 months (range, 11–149 months). The treatment response group consisted of 23 patients (53.5%) who continuously received cisplatin and etoposide chemotherapy for over four cycles, while the non-response group consisted of 20 patients (46.5%) who underwent three or fewer cycles of chemotherapy. Patients with excellent response to cisplatin and etoposide chemotherapy also showed good response to taxane and anthracycline chemotherapy (p=0.011). CONCLUSION: In patients who show good response to taxane and anthracycline chemotherapy, cisplatin and etoposide chemotherapy is also expected to have a positive result.
Breast Neoplasms* ; Breast* ; Cisplatin* ; Disease-Free Survival ; Drug Therapy* ; Etoposide* ; Humans ; Incidence ; Injections, Intravenous ; Neoplasm Metastasis ; Treatment Failure

PURPOSE: This study aimed to evaluate the usefulness of the axillary lymph node to primary breast tumor maximum standardized uptake value (SUVmax) ratio in 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for predicting the presence of metastasis in axillary lymph nodes. METHODS: Herein, 196 consecutive patients with breast cancer who underwent PET/CT before surgery from January 2009 to January 2013 were included. We calculated the axillary lymph node to primary breast tumor SUVmax ratio using PET/CT. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ratio were compared with those of nodal SUVmax and axillary ultrasonography. Axillary node metastasis was confirmed with sentinel node biopsy or axillary dissection. RESULTS: The SUVmax ratio (cutoff, 0.14; area under the curve, 0.741) had 55.4% sensitivity, 91.6% specificity, 76.6% PPV, and 80.5% NPV for predicting axillary node metastasis. No significant difference was observed in terms of predicting axillary node metastasis among the SUVmax ratio, nodal SUVmax, and ultrasonography. In the multivariate analysis, primary tumor size (p=0.014), SUVmax of the primary tumor (p=0.011), axillary ultrasonography findings, nodal SUVmax, and SUVmax ratio were significantly associated with lymph node metastasis (p<0.001). CONCLUSION: The axillary lymph node to primary breast tumor SUVmax ratio predicted axillary lymph node metastasis, although no significant difference in diagnostic performance was observed between PET/CT and ultrasonography. The axillary lymph node to primary breast tumor SUVmax ratio may be considered an additional method for the preoperative evaluation of axillary lymph node status.

PURPOSE: The purpose of this study was to determine whether magnetic resonance imaging (MRI) could assess the size of ductal carcinoma in situ (DCIS) more accurately compared to mammography and ultrasonography using the histopathological dimension of the surgical specimen as the reference measurement. METHODS: This was a retrospective review study using data from our institution database of breast cancer. Preoperative contrast-enhanced MRI, mammography and ultrasonography were performed to detect and assess the size of DCIS in 131 patients. The greatest dimensions of DCIS determined by the imaging modalities were compared with the histopathological dimensions of the surgical specimens. Intraclass coefficients were calculated to examine the agreement among the MRI, mammography and ultrasonography measurements. The Wilcoxon signed-rank test was used to evaluate the statistical significance of the differences in size among MRI, mammography or ultrasonography and histopathology findings. RESULTS: Of the 131 DCIS lesions, 126 (96.2%) were detected by MRI, 103 (78.6%) were detected by mammography, and 121 (92.4%) were detected by ultrasonography. The mean lesion size was 38.8 mm on histopathology, 36.0 mm on MRI, 28.8 mm on mammography, and 23.3 mm on ultrasonography, and there were no significant differences between sizes determined by histopathology and MRI, while there were significant differences between histopathology and the other modalities. The correlation coefficient between histopathological measurement and MRI was 0.837, versus 0.461 between histopathology and mammography and 0.284 between histopathology and ultrasonography. The lesion size was correctly estimated (±5 mm), under-estimated (<5 mm), or over-estimated (>5 mm), respectively, by MRI in 52.7%, 30.5%, and 16.8% of cases; by mammography in 32.0%, 51.2%, and 16.8% of cases, respectively; and by ultrasonography in 24.4%, 62.6%, and 13.0% of cases, respectively. CONCLUSION: In our study, MRI was more accurate for detection and assessment the size of DCIS compared to mammography and ultrasonography.

PURPOSE: Obesity in women has been shown to have correlation with breast cancer incidence. The proportion of Korean women who are obese has increased recently. However, there is no large-scale study evaluating the relationship between obesity and breast cancer incidence in Korea. In this study, we tried to identify the relationship between obesity and breast cancer incidence in Korean women by using body mass index (BMI). METHODS: A retrospective analysis was performed using single-center data of 28,631 patients screened with breast ultrasonography or mammography between January 2009 to December 2013 in Seoul National University Hospital Healthcare System Gangnam Center. Their clinical characteristics were evaluated. The correlations between breast cancer incidence with BMI and other factors were analyzed using univariate and multivariate logistic regression models. RESULTS: A total of 28,631 patients were enrolled; 67 patients were diagnosed with breast cancer. Among patients without breast cancer, the proportion of patients with BMI under 23 was 68.1%, whereas it was 56.7% among patients with breast cancer (p=0.036). In univariate analysis, patients with a BMI over 25 had an odds ratio of 2.09 for breast cancer compared with those with a BMI under 23 (p=0.012). In addition, patients with a waist circumference over 85 cm had an odds ratio of 1.69 for breast cancer compared with the others (p=0.042). In multivariate analysis, BMI also had significant correlation with breast cancer incidence (odds ratio=1.87, p=0.035). CONCLUSION: An increase in BMI has positive correlation with breast cancer incidence in Korean women. However, a multi-centered prospective study is needed for further evaluation.

PURPOSE: Few studies have reported postdiagnosis differences in distress and quality of life (QOL) for breast cancer (BC) survivors. Here we investigated the differences in distress and QOL for BC survivors in Korea, during follow-up. METHODS: Completed questionnaires were collected from 179 BC survivors in 2013. Functional Assessment of Cancer Therapy-Breast was administered to measure the distress and Distress Thermometer and Problem List was administered to measure the QOL. RESULTS: The mean QOL score was 96.69 (standard deviation, ±20.33). Seventy-nine patients (44.1%) with distress-test scores >4 were assigned to the severe distress group. The patient group with higher family income had high QOL score (p=0.008). In addition, QOL scores were significantly higher in patients who lived longer after diagnosis (p=0.016). Patients at high TNM stage had low QOL scores (p=0.006). Furthermore, older patients tended to have high distress scores (p=0.028). Based on duration of the postdiagnosis period, we divided the patients into two groups. Seventy patients had a postdiagnosis period <2 years; 109 patients, postdiagnosis period ≥2 years. Distress score of the under-2-year group (4.26±2.73) was significantly higher (p=0.044) than that of the longer-than-2-year group (3.47±2.42). CONCLUSION: BC survivors showed improvement in physical well-being, emotional well-being, and functional well-being domain of QOL over time. However, social well-being and BC subscale score were only slightly improved over time. It is possible that cancer patients' supporting programs are focused on the recently diagnosed patients or those currently undergoing treatment. Therefore, more support should be made available to long-term BC survivors.

PURPOSE: The molecular subtype of breast cancer is an important predictive factor. Therefore, we investigated the effects of concurrent or serial radiotherapy and systemic therapy on metastatic brain lesions according to the molecular subtype of breast cancer. METHODS: The present retrospective study examined data from 66 patients with breast cancer and metastatic brain lesions, who were treated using radiotherapy between January 1990 and July 2014. Patients were classified into the following three subtypes based on their hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status: HR+/HER2− (luminal A, 13 patients), HR+/HER2+ (luminal B, 21 patients), HR−/HER2+ (HER2, 22 patients), or HR−/HER2− (triple negative, 10 patients). The brain lesions and their responses to treatment were evaluated using brain computed tomography or magnetic resonance imaging. Progression of brain disease was defined by a ≥20% increase in the sum of the lesion's diameters or the development of a new brain lesion. Progression-free survival was calculated from the initiation of radiotherapy to the first instance of brain disease progression or last follow-up. RESULTS: Patients in the HER2 group who had received concur-rent radiotherapy and systemic therapy (mainly HER2-targeted therapy) exhibited significantly better progression-free survival than did patients who had received radiotherapy followed by systemic therapy (p=0.037). However, concurrent radiotherapy and systemic therapy did not significantly improve progression-free survival in the luminal A (p=0.527), luminal B (p=0.462), or triple negative (p=0.558) groups. CONCLUSION: Concurrent radiotherapy and mainly HER2-targeted systemic therapy significantly prolonged progression-free survival in the HER2 group.