The European Society of Breast Cancer Specialists (EUSOMA) has fostered a voluntary certification process for breast centres to establish minimum standards and ensure specialist multidisciplinary ...care. Prospectively collected anonymous information on primary breast cancer cases diagnosed and treated in the units is transferred annually to a central EUSOMA data warehouse for continuous monitoring of quality indicators (QIs) to improve quality of care. Units have to comply with the EUSOMA Breast Centre guidelines and are audited by peers. The database was started in 2006 and includes over 110,000 cancers from breast centres located in Germany, Switzerland, Belgium, Austria, The Netherlands, Spain, Portugal and Italy. The aim of the present study is assessing time trends of QIs in EUSOMA-certified breast centres over the decade 2006–2015.
Previously defined QIs were calculated for 22 EUSOMA-certified breast centres (46122 patients) during 2006–2015.
On the average of all units, the minimum standard of care was achieved in 8 of 13 main EUSOMA QIs in 2006 and in all in 2015. All QIs, except removal of at least 10 lymph nodes at axillary clearance and oestrogen receptor–negative tumours (T > 1 cm or N+) receiving adjuvant chemotherapy, improved significantly in this period. The desirable target was reached for two QIs in 2006 and for 7 of 13 QIs in 2015.
The EUSOMA model of audit and monitoring QIs functions well in different European health systems and results in better performance of QIs over the last decade. QIs should be evaluated and adapted on a regular basis, as guidelines change over time.
•The time trends of quality indicators in EUSOMA-certified breast centres over the decade 2006–2015 are evaluated.•The EUSOMA model of audit and monitoring QIs functions well in different European health systems.•Audit and measuring quality indicators result in better performance.
Survival of patients suffering from cerebral metastases (CM) is limited. Identification of patients with a high risk for CM is warranted to adjust follow-up care and to evaluate preventive ...strategies.
Exploratory analysis of disease-specific parameter in patients with metastatic breast cancer (MBC) treated between 1998 and 2008 using cumulative incidences and Fine and Grays’ multivariable regression analyses.
After a median follow-up of 4.0 years, 66 patients (10.5%) developed CM. The estimated probability for CM was 5%, 12% and 15% at 1, 5 and 10 years; in contrast, the probability of death without CM was 21%, 61% and 76%, respectively. A small tumor size, ER status, ductal histology, lung and lymph node metastases, human epidermal growth factor receptor 2 positive (HER2+) tumors, younger age and M0 were associated with CM in univariate analyses, the latter three being risk factors in the multivariable model. Survival was shortened in patient developing CM (24.0 months) compared with patients with no CM (33.6 months) in the course of MBC.
Young patients, primary with non-metastatic disease and HER2+ tumors, have a high risk to develop CM in MBC. Survival of patients developing CM in the course of MBC is impaired compared with patients without CM.
Purpose
Although the impact of lymph node ratio (LNR: ratio of metastatic to resected LNs) in breast cancer (BC) has been investigated, its prognostic value in molecular subtypes remains unclear. Our ...aim was to evaluate the impact of LNR compared to pN-stage in BC subtypes.
Patients/methods
We analyzed the impact of LNR and pN-stage on disease-free (DFS) and overall survival (OS) in 1,656 patients with primary BC who underwent primary axillary surgery (removal of ≥10 LNs) between 1998 and 2011. The cut-off points for LNR were previously published. Using immunohistochemical parameters tumors were grouped in luminalA, luminalB/HER2−, luminalB/HER2+, HER2+ and triple negative (TNBC).
Results
For the entire cohort 5/10-year DFS and OS rates were 88/77 % and 88/75 %, respectively. LNR and pN-stage were independent prognostic parameters for DFS/OS in multivariate analysis in the entire cohort and each molecular subgroup (
p
< 0.001). However, increasing LNR seemed to discriminated 10-year DFS slightly better than pN-stage in luminalA (intermediate/high LNR 65/44 % versus pN2/pN3 71/53 %), luminalB/HER2− (intermediate/high LNR 48/24 % versus pN2/pN3 41/42 %), and TNBC patients (intermediate/high LNR 49/24 % versus pN2/pN3 56/33 %).
Conclusions
LNR is an important prognostic parameter for DFS/OS and might provide potentially more information than pN-stage in different molecular subtypes.
Abstract
Aim:
The risk of recurrence in breast cancer depends on factors such as treatment but also on the intrinsic subtype. We analyzed the risk factors for local, loco-regional and systemic ...recurrence, evaluated the differences and analyzed the risk of recurrence for different molecular subtypes.
Material and Methods:
A total of 3054 breast cancer patients who underwent surgery followed by adjuvant treatment at HSK hospital or Essen Mitte Hospital between 1998 and 2011 were analyzed. Based on immunohistochemical parameters, cancers were divided into the following subgroups: luminal A, luminal B (HER2-), luminal B (HER2+), HER2+ and TNBC (triple negative breast cancer).
Results:
67 % of tumors were classified as luminal A, 13 % as luminal B (HER2-), 6 % as luminal B (HER2+), 3 % as HER2+ and 11 % as TNBC. After a median follow-up time of 6.6 years there were 100 local (3.3 %), 32 loco-regional (1 %) and 248 distant recurrences (8 %). Five-year recurrence-free survival for the overall patient collective was 92 %. On multivariate analysis, positive nodal status, TNBC subtype and absence of radiation therapy were found to be independent risk factors for all forms of recurrence. Age < 50 years, tumor size, luminal B (HER2-) subtype and breast-conserving therapy were additional risk factors for local recurrence. Compared to the luminal A subtype, the risk of systemic recurrence was higher for all other subtypes; additional risk factors for systemic recurrence were lymphatic invasion, absence of systemic therapy and mastectomy.
Conclusion:
Overall, the risk of local and loco-regional recurrence was low. In addition to nodal status, subgroup classification was found to be an important factor affecting the risk of recurrence.
Zielsetzung:
AR und FOXA1 sind mit einer besseren Prognose assoziiert und könnten Angriffspunkte für zielgerichtete Therapeutika darstellen. Diese Studie untersucht den Einfluss beider Biomarker auf ...das 5-Jahres-erkrankungsfreie-Überleben (EFS) am homogenen Patientenkollektiv der WSG-PlanB-Studie. Zwischen 2009 – 2011 wurden 3198 Brustkrebspatientinnen rekrutiert. Patientinnen mit HR+/HER2-, pN0 – 1 Brustkrebserkrankung und RecurrenceScore < 11 erhielten keine Chemotherapie; 2448 Patientinnen wurden randomisiert: 4 × EC-4 × Doc vs. 6 × TC.
Materialien/Methoden:
ER, PR, Ki67 (LuminalB-cut-off 20%) und Differenzierung wurden in der Zentralpathologie untersucht. AR/FOXA1 wurden an tissue-microarrays mittels immunoreactive-score (IRS) bestimmt. Ab IRS = 3 galt ein Tumor als positiv. Um die Assoziation von AR, FOXA1, AR/FOXA1 und EFS zu untersuchen wurden univariate-Cox-Analysen durchgeführt.
Ergebnisse:
Das mediane Follow-up betrug 55 Monate. In der zentralen Tumorbank sind AR für 2896, FOXA1 für 2911 und beide Marker für 2847 Tumore vorhanden. Es zeigen sich signifikant positive Assoziationen zwischen AR, FOXA1, AR/FOXA1 und EFS in der gesamten Studienpopulation, sowie in der HR±Subpopulation (p < 0,05). FOXA1 ist bei LuminalB-Tumoren signifikant positiv mit EFS (p = 0,048) assoziiert. Zudem zeigt AR+/FOXA1+ und EFS bei LuminalA-Tumoren eine signifikant positive Assoziation (p = 0,033).
AR +
AR -
AR+/FOXA1 +
AR oder FOXA1 -
FOXA1 +
FOXA1 -
HR+
22,9%
77,1%
19,4%
80,6%
60,7%
39,3%
TNBC
4%
96%
2,5%
97,5%
6,3%
93,7%
Luminal A
22,5%
77,5%
22,5%
77,5%
65,8%
34,2%
Luminal B
21,6%
78,4%
18,2%
81,8%
60%
40%
Zusammenfassung:
Diese translationale Substudie der WSG-PlanB-Studie zeigte für die Gesamtstudienpopulation sowie HR+-Subpopulation ein signifikant besseres 5-Jahres-EFS für AR+, FOXA1+ und die Kombination AR+/FOXA1+Tumore. Diese Ergebnisse könnten die Grundlage für weitere AR-gerichtete Therapieansätze darstellen.
PDF
