Abstract
Introduction: The triple negative(TN) breast cancer subtype (ER neg, PR neg, HER 2 neg) represents about 10 to 15% 0f all breast cancer types. It characterizes an aggressive phenotype with ...significantly worsened RFS, OS as well as specific clinical and pathological properties. The aim of this study was: 1.To assess the efficacy of guideline conforming conventional chemotherapy, local recurrence rate, distant recurrence rate, as well as overall survival. 2.To ask for subgroups that show the greatest benefit from conventional chemotherapy and 3. to ask for impact of guidelines violation on RFS and OA.Patients and methods: 3658 breast cancer Patients that were first diagnosed between the years 2000 and 2005 were analyzed in a multicentric retrospective study. A total of 371 (10,1%) were triple negative. Results: Median age was 62 years(26-101) TN: 60years.(28-97). 13,8% of all included patients are triple negative. 90,3% of all TN patients are at intermediate/high risk according to Nottingham risk classification. 76,5 have G3 tumors. The 5 year DFS is 74,8% (95%CI 68,8% - 80,8%) and for none TN 86,5%(95%CI 84,6% - 88,4%) (logrankp<0,0001). The 5 year OS is 75,8%(95%CI:69,9%- 81,8%) and for none TN 86%(95%CI:84,1%-87,9%). (logrank p < 0,0001). The essential parameters for RFS and OS were guidelines conforming surgery and radiation therapy, when chemotherapy conforming to guidelines was provided. The 5 year RFS for TN patients undergoing a 100% guideline according adjuvant therapy is 86.1%(95%CI:78.9%-93.4%), with 1-2 violations 76.0% (95%CI:69.0%-83.1%) and with ≥3 violations 50.6%(95%CI:20.1%-81.1%) (logrank p<0.0001). In total a 66,8% of all TN patients were not treated according to guidelines (ranking of violations: Chemotherapy, radiation therapy, surgery). 18% had 2 or more violations. Summary: The Results show a significant improvement of outcomes in TN breast cancer patients when treatment is conducted in accordance to guidelines. There are subgroups of TN breast cancer patients that profit from therapy according to guidelines. The leading guideline violation was noted for radiation therapy.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2101.
FIGO war die erste Organisation, die ihre eigenen Klassifikation und Staging-System im Jahr 1958 entwickelt hat. Anschließend im Jahr 1966 veröffentlichte die UICC sein eigenes Staging-System gefolgt ...von AJCC im Jahr 1976. Wir sind jetzt mit einer neuen Revision der FIGO-Klassifikation für Ovarialkarzinom konfrontiert.
Ziel dieser Arbeit ist ein Vergleich zwischen der alten und der neuen überarbeiteten Klassifizierung in dem fortgeschrittenen Stadium FIGO IIIC.
Material und Methode:
Wir analysieren unser prospektiv geführtes Klinik-Tumorregister und vergleichen die alte (1988) mit der neuen FIGO Klassifikation von 2014. In die Analyse wurden alle 1.064 Pat. mit primärem Ovarialkarzinom und Therapie in unserer Klinik (2000 – 2010 HSK Wiesbaden, 2011 – 13 KEM Essen)
Ergebnisse:
39 (3,7%) Patientinnen hatten eine mikroskopische Metastasierung extrapelvin ohne Lymphknotenmetastasen (FIGO IIIA1). 14 (1,2%) Patientinnen hatten eine mikroskopische Peritoneal-Beteiligung extrapelvin mit oder ohne positive retroperitoneale Lymphknoten (FIGO III A2). 122 (11,5%) Patientinnen hatten makroskopische Peritonealmetastasen extrapelvin < 2 cm Größe (FIGOIIIB).
363 (34,1%) Patientinnen hatten eine makroskopische Peritonealmetastasen extrapelvin > 2 cm (FIGOIIIC).
In Bezug auf die Überlebensanalyse war das mediane Überleben der Patientinnen im Stadium FIGO IIIA1 noch nicht erreicht. Das mediane Überleben der Patientinnen im Stadium FIGO IIIC lag bei 35 Monate. (p < 0,001)
Das mediane progressionsfreie Überleben der Patientinnen im Stadium FIGO IIIA1 war noch nicht erreicht. Das mediane progressionsfreie Überleben der Patientinnen im Stadium FIGOIIIC betrug 18 Monate.
Fazit:
Die neue überarbeitete FIGO-Klassifikation für Ovarialkarzinom verbessert die Trennungsschärfe zwischen den Stadien und stuft reinen Lymphknotenbefall vom FIGO IIIC auf FIGO IIIA1 runter.
Objective:
The revised 2014 FIGO staging system for epithelial ovarian cancer (EOC) included many changes of the previous system, particularly dividing FIGO stage IV in two subgroups. We evaluated if ...stratifying patients with EOC in FIGO stage IVA and IVB has any prognostic implication.
Patients and methods:
We analyzed our prospectively maintained institutional database for primary EOC and included only consecutive FIGO stage IV patients treated between 2000 and 2014. Patients were stratified in two cohorts: FIGO IVA and FIGO IVB. Patients with abdominal-wall-metastasis as the only manifestation of distant metastasis were excluded (n = 86). Survival analyses included the Kaplan-Meier method, log-rank test and Cox proportional hazards models.
Results:
In total, 240 consecutive patients with FIGO stage IV disease were identified. According to the new classification 102 (42.5%) and 138 (57.5%) patients were classified into FIGO IVA and FIGO IVB, respectively. In 45 of 138 (32.6%) patients with FIGO stage IVB at least two or more metastatic manifestations were detected. Median overall survival was 25 and 28 months in FIGO IVA and IVB (p = 0.299), respectively. In multivariate analysis, only performance status, lymph node status, ascites volume and residual tumor after surgery, but not FIGO stage IV subgroups were significantly associated with overall survival.
Conclusion:
In the present analysis, the revised FIGO system for stage IV did not add prognostic information for patients with FIGO IVA or FIGO IVB. Further analyses should try to confirm or challenge this particular part of the new FIGO system.
Zielsetzung:
Eine neoadjuvante Chemotherapie kann die lokale Kontrolle und wahrscheinlich das Gesamtüberleben bei frühem, lokal fortgeschrittenem Zervixkarzinom verbessern. Unklar sind die ...Ansprechraten und operativen Ergebnisse roboterassistierter Verfahren nach neoadjuvanter Chemotherapie mit Paclitaxel 175 mg/m
2
/Ifosfamid 5 g/m
2
/Cisplatin 75 mg/m
2
Tag1 – 3 q21 (TIP).
Methodik:
Von 2012 bis 2015 erhielten 10 Patientinnen vor einer geplanten roboterassistierten radikalen Hysterektomie eine neoadjuvante Chemotherapie mit TIP an den Kliniken-Essen-Mitte. Die Tumorstadien, das Ansprechen auf Chemotherapie, und die operativen Ergebnisse wurden retrospektive analysiert.
Ergebnis:
Eingeschlossen wurden Patientinnen mit Tumorstadium FIGO IB2 (n = 4), IIA (n = 3), und IIB (n = 3). Insgesamt wurde bei allen Patientinnen bildgebend mindestens eine partielle Remission beobachtet. Bei allen Patientinnen wurde zunächst eine systematische roboterassistierte Lymphadenektomie durchgeführt. Zwei Patientinnen mit pathologisch nachgewiesenem Lymphknotenbefall (ypN1) wurden einer primären Radiochemotherapie zugeführt. Acht Patientinnen erhielten eine radikale Hysterektomie, in allen Fällen wurde eine R0 Resektion erzielt. Das maximale postoperative Tumorstadium war ypT1b1, der maximale Tumordurchmesser betrug 17 mm, in zwei Patientinnen wurde eine pathologische Komplettremission erzielt. Der intra- und postoperative Verlauf war unkompliziert in 9 Fällen, in einem Fall mit ausgedehnter parametraner Fibrosierung kam es zu einer Harnleiterverletzung die eine Harnleiterneuimplantation erforderlich machte.
Schlussfolgerung:
Mittels neoadjuvanter Chemotherapie können hohe Ansprechraten beim frühen lokal fortgeschrittenen Zervixkarzinom erzielt werden. Das roboterassistierte Staging mit radikaler Hysterektomie stellt ein geeignetes Verfahren mit akzeptabler Morbidität dar.
Abstract only
521
Background: Over the past two decades significant progress in treatment of early breast cancer has been accomplished through well designed, clinical trials (CTs). It has been ...hypothesized that trial participation could also be beneficial for the individual breast cancer patient. The BRENDA study group has been analysing quality of care provided by one university based and 16 regional breast cancer centers in south germany. In this study we investigated the impact of study participation on survival in an unselected clinical cohort of early stage breast cancer patients. Methods: The study population includes 5,966 patients who received primary therapy for early breast cancer between 1992 and 2005. Influence on survival by study participation was calculated by Cox proportional hazard analyses. Model adjustments include prognostic factors, type of treatment, age, risk group and time period. Guideline compliant treatment was assessed based on the St Gallen expert consensus recommendations and the German national S3 Guidelines. Results: A total of 738 patients (12%) received adjuvant (n = 552) or neoadjuvant (n = 186) systemic therapy within one out of 42 registered prospective multicenter phase II or III clinical trials. For patients not receiving neoadjuvant systemic therapy trial participation was associated with improved overall and disease free survival (hazard ratio HR = 0.75, 95% confidence interval CI 0.57–0.99, HR = 0.78, CI 0.63 - 0.97, respectively). The calculated effect was of similar magnitude after additional adjustment for co-existing morbidity of patients. Descriptional analysis revealed that guideline violations for locoregional or systemic treatment were more frequently found in patients receiving adjuvant treatment outside CTs. No significant effect on survival was calculated for 183 patients receiving neoadjuvant systemic therapy within CT protocols. Conclusions: In our study population participation in prospective clinical trials for adjuvant systemic therapy was associated with improved survival irrespective of treatment actually given. Intrinsic mechanisms within the framework of clinical trials can improve quality of breast cancer patient care.
No significant financial relationships to disclose.
