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- Bagwell, C B, et al.
(author)
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Optimizing flow cytometric DNA ploidy and S-phase fraction as independent prognostic markers for node-negative breast cancer specimens
- 2001
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In: Cytometry. - : Wiley. - 0196-4763 .- 1097-0320. ; 46:3, s. 121-135
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Journal article (peer-reviewed)abstract
- Developing a reliable and quantitative assessment of the potential virulence of a malignancy has been a long-standing goal in clinical cytometry. DNA histogram analysis provides valuable information on the cycling activity of a tumor population through S-phase estimates; it also identifies nondiploid populations, a possible indicator of genetic instability and subsequent predisposition to metastasis. Because of conflicting studies in the literature, the clinical relevance of both of these potential prognostic markers has been questioned for the management of breast cancer patients. The purposes of this study are to present a set of 10 adjustments derived from a single large study that optimizes the prognostic strength of both DNA ploidy and S-phase and to test the validity of this approach on two other large multicenter studies. Ten adjustments to both DNA ploidy and S-phase were developed from a single node-negative breast cancer database from Baylor College (n = 961 cases). Seven of the adjustments were used to reclassify histograms into low-risk and high-risk ploidy patterns based on aneuploid fraction and DNA index optimum thresholds resulting in prognostic P values changing from little (P < 0.02) or no significance to P < 0.000005. Other databases from Sweden (n = 210 cases) and France (n = 220 cases) demonstrated similar improvement of DNA ploidy prognostic significance, P < 0.02 to P < 0.0009 and P < 0.12 to P < 0.002, respectively. Three other adjustments were applied to diploid and aneuploid S-phases. These adjustments eliminated a spurious correlation between DNA ploidy and S-phase and enabled them to combine independently into a powerful prognostic model capable of stratifying patients into low, intermediate, and high-risk groups (P < 0.000005). When the Baylor prognostic model was applied to the Sweden and French databases, similar significant patient stratifications were observed (P < 0.0003 and P < 0.00001, respectively). The successful transference of the Baylor prognostic model to other studies suggests that the proposed adjustments may play an important role in standardizing this test and provide valuable prognostic information to those involved in the management of breast cancer patients.
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- Bagwell, CB, et al.
(author)
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Multivariate analyses of flow cytometric S-phase and ploidy as node-negative breast cancer prognostic factors : an international and multi-center study
- 2001
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In: Abstract Issue, 24th Annual San Antonio, Breast Cancer Symposium. December 10-13, 2001 San Antonio Marriott Rivercenter, Texas, USA.. ; , s. 260-260
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Conference paper (peer-reviewed)abstract
- Recently a set of ten adjustments that optimizes the prognostic strength of both DNA ploidy (P) and S-phase (S) was published (Cytometry, 46(3), 2001). Also presented was an optimal method of combining P and S (P+S) that stratifies node-negative patients into highly significant risk groups. The adjustments compensate for many unappreciated complexities in categorizing P into low and high risk groups and eliminate unwanted correlation between P and S. The purpose of this study is to examine P+S in the context of other well-known prognostic factors such as primary size (pT), estrogen and progesterone receptor (ER,PR) and menopausal status (MS). Methods: DNA histograms derived from frozen primary tumors and clinical databases were provided by Baylor College, n=935; Sweden, n=210 (Lund, Linkoping, Stockholm) and France, n=220 (Angers, Marseille, Saint Cloud, Tours). Time to metastasis was the tested clinical outcome. Results: Cox proportional hazards analysis of theBaylor data revealed P+S, p<0.000002, and pT, p<0.003, as independent significant prognostic factors. The Sweden study also showed P+S the mostsignificant prognostic factor, p<0.002, as well as MS, p<0.004 and ER, p<0.007. The French study results were MS, p<0.0005, P+S, p<0.002 and pT, p<0.007.A P+S, MS and pT prognostic model stratified patients in all studies into highly significant categories, Baylor, p<0.000005, Sweden, p<0.00001, and French, p<0.000005, with low and high risk 10-year relapse-free survival fractions of 0.92-0.69, 0.95-0.58 and 0.96-0.60 respectively. Conclusion: A combined P+S, MS and pT prognostic model is a powerful and reliable method of stratifying node-negative breast cancer patients into highly significant prognostic groups.
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- Baldetorp, Bo, et al.
(author)
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DNA and cell cycle analysis as prognostic indicators in breast tumors revisited
- 2001
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In: Clinics in Laboratory Medicine. - 0272-2712 .- 1557-9832. ; 21:4, s. 875-
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Journal article (peer-reviewed)abstract
- Both DNA ploidy and S-phase ploidy are promising prognostic factors for node-negative breast cancer patients. Based largely on the analysis of one large study, much of the reported problems with these factors have been caused by some unappreciated complexities in categorizing DNA ploidy into low- and high-risk groups and the lack of some necessary adjustments to eliminate unwanted correlations between DNA S-phase and ploidy. When both DNA ploidy and S-phase are compensated properly, they become independent prognostic markers, forming a powerful prognostic model.
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- Killander, F., et al.
(author)
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No breast cancer subgroup can be spared postoperative radiotherapy after breast-conserving surgery. Fifteen-year results from the Swedish Breast Cancer Group randomised trial, SweBCG 91 RT
- 2016
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In: European Journal of Cancer. - : Elsevier BV. - 0959-8049 .- 1879-0852. ; 67, s. 57-65
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Journal article (peer-reviewed)abstract
- Background Breast-conserving surgery (BCS) followed by radiotherapy (RT) is an established treatment for women with T1-2N0 breast cancers. Since subgroups of patients have low ipsilateral breast tumour recurrence (IBTR) rates, it is important to study whether RT is necessary for all patients. Patients and methods A total of 1187 women with primary T1-2N0M0 breast cancer were randomised, after standardised sector resection, to postoperative whole breast RT or no local treatment. Adjuvant systemic therapy was offered to patients with stage II cancers. Patients were followed with clinical examinations and annual mammography for 10 years and thereafter referred to the Swedish mammography screening program. Results After 15 years of follow-up, a higher cumulative incidence of IBTR was observed in control patients, 23.9%, versus irradiated patients, 11.5%, P < 0.001. Recurrence-free survival was inferior, 51.7% versus 60.4%, P = 0.0013. The main effect of RT was seen during the first 5 years. However, overall survival was not significantly lower 68.4% versus 71.1%, P = 0.68, nor was breast cancer–specific mortality significantly higher. Conclusions RT after BCS significantly reduced the incidence of IBTR at 15 years of follow-up. We were unable to identify subgroups which could be spared RT. Breast cancer mortality was not significantly reduced after RT. Good predictive markers for radiation sensitivity and improved adjuvant systemic therapy are needed to omit RT after BCS.
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- Killander, F, et al.
(author)
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No increased cardiac mortality or morbidity of radiotherapy in breast cancer patients after breast conserving surgery: 20 years follow-up of the randomised x trial.
- 2020
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In: International journal of radiation oncology, biology, physics. - : Elsevier BV. - 1879-355X .- 0360-3016. ; 107:4, s. 701-9
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Journal article (peer-reviewed)abstract
- Radiotherapy (RT) after breast conserving surgery reduces loco-regional recurrences and improves survival, but may cause late side effects. The main purpose of this paper was to investigate long-term side effects after whole breast RT in a randomised clinical trial initiated in 1991 and to report dose-volume data based on individual 3D treatment plans for organs at risk (OR).The trial included 1187 T1-2 N0 breast cancer patients randomised to postoperative tangential whole breast radiotherapy or no further treatment. The prescription dose to the clinical target volume was 48-54 Gy. We present 20 year follow-up on survival, cause of death, morbidity and later malignancies. For a cohort of patients (n=157) with accessible CT-based 3D treatment plans in Dicom-RT format, dose-volume descriptors for OR were derived. In addition, these were compared with dose-volume data for a cohort of patients treated with contemporary RT techniques.The cumulative incidence of cardiac mortality was 12.4 % in the control group and 13.0 % in the RT group (P= 0.8). There was an increase in stroke mortality, 3.4 % in the control group versus 6.7 % in the RT group (P=0.018). Incidences of contra lateral breast cancer and lung cancer were similar between groups. The median Dmean (range) heart dose for left-sided treatments was 3.0 Gy (1.1-8.1) and the corresponding value for patients treated in 2017 was 1.5 Gy (0.4-6.0).In this trial serious late side effects of whole breast radiotherapy were limited and less than previously reported in large meta-analyses. We observed no increased cardiac mortality in irradiated patients with doses to the heart were median Dmean 3.0 Gy for left-sided RT. The observed increase in stroke mortality may partly be secondary to cardiac side effects, complications to anticoagulant treatment, or to chance, rather than a direct side effect of tangential whole breast irradiation.
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