Lymphovascular space invasion and lack of downstaging after neoadjuvant chemotherapy are strong predictors of adverse outcome in young women with locally advanced breast cancer

Shariq S. Khwaja, Jennifer Ivanovich, Todd DeWees, Laura Ochoa, Daniel F. Mullen, Maria Thomas, Julie A. Margenthaler, Amy Cyr, Michael Naughton, Souzan Sanati, Timothy J. Eberlein, William E. Gillanders, Rebecca L. Aft, Jacqueline E. Zoberi, Imran Zoberi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Younger age diagnosis of breast cancer is a predictor of adverse outcome. Here, we evaluate prognostic factors in young women with locally advanced breast cancer (LABC). We present a retrospective review of 104 patients younger than 40 years with LABC treated with surgery, radiotherapy (RT), and chemotherapy from 2003 to 2014. Patient-, tumor-, and treatment-related factors important for overall survival (OS), local/regional recurrence (LRR), distant metastasis (DM), and recurrence-free survival (RFS) were evaluated. Mean age at diagnosis was 34 years (23-39 years) with a median follow-up of 47 months (8-138 months). Breast-conserving surgery was performed in 27%. Axillary lymph node dissection was performed in 85%. Sixty percent of patients received neoadjuvant chemotherapy with 19% achieving pathologic complete response (pCR), and 61% downstaged. Lymph node positivity was present in 91% and lymphovascular space invasion (LVSI) in 35%. Thirty-two percent of patients had triple negative tumors (TN, ER-/PR-/HER2 nonamplified). Four-year OS and RFS was 84% and 71%, respectively. Factors associated with worse OS on multivariate analysis include TN status, LVSI, and number of positive lymph nodes. LVSI was also associated with DM and LRR, as well as worse RFS. Downstaging was associated with improved 4 year RFS in patients receiving neoadjuvant chemotherapy (74% vs. 38%, P = 0.002). With high risks of recurrence and inferior OS compared to older women, breast cancer in young women can be difficult to treat. Among additional factors, presence of LVSI and lack of downstaging portends a particularly worse prognosis.

Original languageEnglish (US)
Pages (from-to)230-238
Number of pages9
JournalCancer Medicine
Volume5
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

Fingerprint

Breast Neoplasms
Drug Therapy
Survival
Recurrence
Lymph Nodes
Neoplasm Metastasis
Segmental Mastectomy
Lymph Node Excision
Neoplasms
Radiotherapy
Multivariate Analysis

Keywords

  • LVSI
  • Breast cancer
  • Locally advanced
  • Neoadjuvant chemotherapy
  • Young women

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Lymphovascular space invasion and lack of downstaging after neoadjuvant chemotherapy are strong predictors of adverse outcome in young women with locally advanced breast cancer. / Khwaja, Shariq S.; Ivanovich, Jennifer; DeWees, Todd; Ochoa, Laura; Mullen, Daniel F.; Thomas, Maria; Margenthaler, Julie A.; Cyr, Amy; Naughton, Michael; Sanati, Souzan; Eberlein, Timothy J.; Gillanders, William E.; Aft, Rebecca L.; Zoberi, Jacqueline E.; Zoberi, Imran.

In: Cancer Medicine, Vol. 5, No. 2, 01.02.2016, p. 230-238.

Research output: Contribution to journalArticle

Khwaja, SS, Ivanovich, J, DeWees, T, Ochoa, L, Mullen, DF, Thomas, M, Margenthaler, JA, Cyr, A, Naughton, M, Sanati, S, Eberlein, TJ, Gillanders, WE, Aft, RL, Zoberi, JE & Zoberi, I 2016, 'Lymphovascular space invasion and lack of downstaging after neoadjuvant chemotherapy are strong predictors of adverse outcome in young women with locally advanced breast cancer', Cancer Medicine, vol. 5, no. 2, pp. 230-238. https://doi.org/10.1002/cam4.586
Khwaja, Shariq S. ; Ivanovich, Jennifer ; DeWees, Todd ; Ochoa, Laura ; Mullen, Daniel F. ; Thomas, Maria ; Margenthaler, Julie A. ; Cyr, Amy ; Naughton, Michael ; Sanati, Souzan ; Eberlein, Timothy J. ; Gillanders, William E. ; Aft, Rebecca L. ; Zoberi, Jacqueline E. ; Zoberi, Imran. / Lymphovascular space invasion and lack of downstaging after neoadjuvant chemotherapy are strong predictors of adverse outcome in young women with locally advanced breast cancer. In: Cancer Medicine. 2016 ; Vol. 5, No. 2. pp. 230-238.
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abstract = "Younger age diagnosis of breast cancer is a predictor of adverse outcome. Here, we evaluate prognostic factors in young women with locally advanced breast cancer (LABC). We present a retrospective review of 104 patients younger than 40 years with LABC treated with surgery, radiotherapy (RT), and chemotherapy from 2003 to 2014. Patient-, tumor-, and treatment-related factors important for overall survival (OS), local/regional recurrence (LRR), distant metastasis (DM), and recurrence-free survival (RFS) were evaluated. Mean age at diagnosis was 34 years (23-39 years) with a median follow-up of 47 months (8-138 months). Breast-conserving surgery was performed in 27{\%}. Axillary lymph node dissection was performed in 85{\%}. Sixty percent of patients received neoadjuvant chemotherapy with 19{\%} achieving pathologic complete response (pCR), and 61{\%} downstaged. Lymph node positivity was present in 91{\%} and lymphovascular space invasion (LVSI) in 35{\%}. Thirty-two percent of patients had triple negative tumors (TN, ER-/PR-/HER2 nonamplified). Four-year OS and RFS was 84{\%} and 71{\%}, respectively. Factors associated with worse OS on multivariate analysis include TN status, LVSI, and number of positive lymph nodes. LVSI was also associated with DM and LRR, as well as worse RFS. Downstaging was associated with improved 4 year RFS in patients receiving neoadjuvant chemotherapy (74{\%} vs. 38{\%}, P = 0.002). With high risks of recurrence and inferior OS compared to older women, breast cancer in young women can be difficult to treat. Among additional factors, presence of LVSI and lack of downstaging portends a particularly worse prognosis.",
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AU - Ochoa, Laura

AU - Mullen, Daniel F.

AU - Thomas, Maria

AU - Margenthaler, Julie A.

AU - Cyr, Amy

AU - Naughton, Michael

AU - Sanati, Souzan

AU - Eberlein, Timothy J.

AU - Gillanders, William E.

AU - Aft, Rebecca L.

AU - Zoberi, Jacqueline E.

AU - Zoberi, Imran

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N2 - Younger age diagnosis of breast cancer is a predictor of adverse outcome. Here, we evaluate prognostic factors in young women with locally advanced breast cancer (LABC). We present a retrospective review of 104 patients younger than 40 years with LABC treated with surgery, radiotherapy (RT), and chemotherapy from 2003 to 2014. Patient-, tumor-, and treatment-related factors important for overall survival (OS), local/regional recurrence (LRR), distant metastasis (DM), and recurrence-free survival (RFS) were evaluated. Mean age at diagnosis was 34 years (23-39 years) with a median follow-up of 47 months (8-138 months). Breast-conserving surgery was performed in 27%. Axillary lymph node dissection was performed in 85%. Sixty percent of patients received neoadjuvant chemotherapy with 19% achieving pathologic complete response (pCR), and 61% downstaged. Lymph node positivity was present in 91% and lymphovascular space invasion (LVSI) in 35%. Thirty-two percent of patients had triple negative tumors (TN, ER-/PR-/HER2 nonamplified). Four-year OS and RFS was 84% and 71%, respectively. Factors associated with worse OS on multivariate analysis include TN status, LVSI, and number of positive lymph nodes. LVSI was also associated with DM and LRR, as well as worse RFS. Downstaging was associated with improved 4 year RFS in patients receiving neoadjuvant chemotherapy (74% vs. 38%, P = 0.002). With high risks of recurrence and inferior OS compared to older women, breast cancer in young women can be difficult to treat. Among additional factors, presence of LVSI and lack of downstaging portends a particularly worse prognosis.

AB - Younger age diagnosis of breast cancer is a predictor of adverse outcome. Here, we evaluate prognostic factors in young women with locally advanced breast cancer (LABC). We present a retrospective review of 104 patients younger than 40 years with LABC treated with surgery, radiotherapy (RT), and chemotherapy from 2003 to 2014. Patient-, tumor-, and treatment-related factors important for overall survival (OS), local/regional recurrence (LRR), distant metastasis (DM), and recurrence-free survival (RFS) were evaluated. Mean age at diagnosis was 34 years (23-39 years) with a median follow-up of 47 months (8-138 months). Breast-conserving surgery was performed in 27%. Axillary lymph node dissection was performed in 85%. Sixty percent of patients received neoadjuvant chemotherapy with 19% achieving pathologic complete response (pCR), and 61% downstaged. Lymph node positivity was present in 91% and lymphovascular space invasion (LVSI) in 35%. Thirty-two percent of patients had triple negative tumors (TN, ER-/PR-/HER2 nonamplified). Four-year OS and RFS was 84% and 71%, respectively. Factors associated with worse OS on multivariate analysis include TN status, LVSI, and number of positive lymph nodes. LVSI was also associated with DM and LRR, as well as worse RFS. Downstaging was associated with improved 4 year RFS in patients receiving neoadjuvant chemotherapy (74% vs. 38%, P = 0.002). With high risks of recurrence and inferior OS compared to older women, breast cancer in young women can be difficult to treat. Among additional factors, presence of LVSI and lack of downstaging portends a particularly worse prognosis.

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