22644
2019
eng
19
article
1
2021-02-23
--
--
Does the number of removed axillary lymphnodes in high risk breast cancer patients influence the survival?
Background
The decision making process for axillary dissection has changed in recent years for patients with early breast cancer and positive sentinel lymph nodes (LN). The question now arises, what is the optimal surgical treatment for patients with positive axillary LN (pN+). This article tries to answer the following questions:
(1)
Is there a survival benefit for breast cancer patients with 3 or more positive LN (pN3+) and with more than 10 removed LN?
(2)
Is there a survival benefit for high risk breast cancer patients (triple negative or Her2 + breast cancer) and with 3 or more positive LN (pN3+) with more than 10 removed LN?
(3)
In pN + patients is the prognostic value of the lymph node ratio (LNR) of pN+/pN removed impaired if 10 or less LN are removed?
Methods
A retrospective database analysis of the multi center cohort database BRENDA (breast cancer under evidence based guidelines) with data from 9625 patients from 17 breast centers was carried out. Guideline adherence was defined by the 2008 German National consensus guidelines.
Results
2992 out of 9625 patients had histological confirmed positive lymph nodes. The most important factors for survival were intrinsic sub types, tumor size and guideline adherent chemo- and hormonal treatment (and age at diagnosis for overall survival (OAS)). Uni-and multivariable analyses for recurrence free survival (RFS) and OAS showed no significant survival benefit when removing more than 10 lymph nodes even for high-risk patients. The mean and median of LNR were significantly higher in the pN+ patients with ≤10 excised LN compared to patients with > 10 excised LN. LNR was in both, uni-and multivariable, analysis a highly significant prognostic factor for RFS and OAS in both subgroups of pN + patients with less respective more than 10 excised LN. Multivariable COX regression analysis was adjusted by age, tumor size, intrinsic sub types and guideline adherent adjuvant systemic therapy.
Conclusion
The removal of more than 10 LN did not result in a significant survival benefit even in high risk pN + breast cancer patients.
BMC Cancer
10.1186/s12885-019-5292-2
urn:nbn:de:bvb:20-opus-226445
publish
BMC Cancer (2019) 19:90. https://doi.org/10.1186/s12885-019-5292-2
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Florian Ebner
Achim Wöckel
Lukas Schwentner
Maria Blettner
Wolfgang Janni
Rolf Kreienberg
Manfred Wischnewsky
eng
uncontrolled
advanced breast cancer
eng
uncontrolled
axillary dissection
eng
uncontrolled
lymph nodes
eng
uncontrolled
number of
eng
uncontrolled
sentinel
eng
uncontrolled
survival
eng
uncontrolled
guideline adherent treatment
Medizin und Gesundheit
open_access
Frauenklinik und Poliklinik
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/22644/s12885-019-5292-2.pdf
24106
2021
eng
13
13
article
1
--
2021-06-22
--
BRENDA-Score, a hghly significant, internally and externally validated prognostic marker for metastatic recurrence: analysis of 10,449 primary breast cancer patients
Background Current research in breast cancer focuses on individualization of local and systemic therapies with adequate escalation or de-escalation strategies. As a result, about two-thirds of breast cancer patients can be cured, but up to one-third eventually develop metastatic disease, which is considered incurable with currently available treatment options. This underscores the importance to develop a metastatic recurrence score to escalate or de-escalate treatment strategies. Patients and methods Data from 10,499 patients were available from 17 clinical cancer registries (BRENDA-project. In total, 8566 were used to develop the BRENDA-Index. This index was calculated from the regression coefficients of a Cox regression model for metastasis-free survival (MFS). Based on this index, patients were categorized into very high, high, intermediate, low, and very low risk groups forming the BRENDA-Score. Bootstrapping was used for internal validation and an independent dataset of 1883 patients for external validation. The predictive accuracy was checked by Harrell's c-index. In addition, the BRENDA-Score was analyzed as a marker for overall survival (OS) and compared to the Nottingham prognostic score (NPS). Results: Intrinsic subtypes, tumour size, grading, and nodal status were identified as statistically significant prognostic factors in the multivariate analysis. The five prognostic groups of the BRENDA-Score showed highly significant (p < 0.001) differences regarding MFS:low risk: hazard ratio (HR) = 2.4, 95%CI (1.7–3.3); intermediate risk: HR = 5.0, 95%CI.(3.6–6.9); high risk: HR = 10.3, 95%CI (7.4–14.3) and very high risk: HR = 18.1, 95%CI (13.2–24.9). The external validation showed congruent results. A multivariate Cox regression model for OS with BRENDA-Score and NPS as covariates showed that of these two scores only the BRENDA-Score is significant (BRENDA-Score p < 0.001; NPS p = 0.447). Therefore, the BRENDA-Score is also a good prognostic marker for OS. Conclusion: The BRENDA-Score is an internally and externally validated robust predictive tool for metastatic recurrence in breast cancer patients. It is based on routine parameters easily accessible in daily clinical care. In addition, the BRENDA-Score is a good prognostic marker for overall survival. Highlights: The BRENDA-Score is a highly significant predictive tool for metastatic recurrence of breast cancer patients. The BRENDA-Score is stable for at least the first five years after primary diagnosis, i.e., the sensitivities and specificities of this predicting system is rather similar to the NPI with AUCs between 0.76 and 0.81 the BRENDA-Score is a good prognostic marker for overall survival.
Cancers
2072-6694
10.3390/cancers13133121
urn:nbn:de:bvb:20-opus-241064
2021-07-03T21:26:22+00:00
sword
swordwue
attachment; filename=deposit.zip
b0ce74cbe807ba1593545f3a8723dc86
Cancers (2021) 13:13, 3121. https://doi.org/10.3390/cancers13133121
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Manfred Wischnewsky
Lukas Schwentner
Joachim Diessner
Amelie De Gregorio
Ralf Joukhadar
Dayan Davut
Jessica Salmen
Inga Bekes
Matthias Kiesel
Max Müller-Reiter
Maria Blettner
Regine Wolters
Wolfgang Janni
Rolf Kreienberg
Achim Wöckel
Florian Ebner
eng
uncontrolled
breast cancer
eng
uncontrolled
risk
eng
uncontrolled
prediction
eng
uncontrolled
BRENDA
eng
uncontrolled
score
eng
uncontrolled
follow up
Medizin und Gesundheit
open_access
Frauenklinik und Poliklinik
Import
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/24106/cancers-13-03121.pdf
16105
2016
eng
549
16
article
BRENDA Study Group
1
2018-04-24
--
--
The impact of breast cancer biological subtyping on tumor size assessment by ultrasound and mammography - a retrospective multicenter cohort study of 6543 primary breast cancer patients
Background
Mammography and ultrasound are the gold standard imaging techniques for preoperative assessment and for monitoring the efficacy of neoadjuvant chemotherapy in breast cancer. Maximum accuracy in predicting pathological tumor size non-invasively is critical for individualized therapy and surgical planning. We therefore aimed to assess the accuracy of tumor size measurement by ultrasound and mammography in a multicentered health services research study.
Methods
We retrospectively analyzed data from 6543 patients with unifocal, unilateral primary breast cancer. The maximum tumor diameter was measured by ultrasound and/or mammographic imaging. All measurements were compared to final tumor diameter determined by postoperative histopathological examination. We compared the precision of each imaging method across different patient subgroups as well as the method-specific accuracy in each patient subgroup.
Results
Overall, the correlation with histology was 0.61 for mammography and 0.60 for ultrasound. Both correlations were higher in pT2 cancers than in pT1 and pT3. Ultrasound as well as mammography revealed a significantly higher correlation with histology in invasive ductal compared to lobular cancers (p < 0.01). For invasive lobular cancers, the mammography showed better correlation with histology than ultrasound (p = 0.01), whereas there was no such advantage for invasive ductal cancers. Ultrasound was significantly superior for HR negative cancers (p < 0.001). HER2/neu positive cancers were also more precisely assessed by ultrasound (p < 0.001). The size of HER2/neu negative cancers could be more accurately predicted by mammography (p < 0.001).
Conclusion
This multicentered health services research approach demonstrates that predicting tumor size by mammography and ultrasound provides accurate results. Biological tumor features do, however, affect the diagnostic precision.
BMC Cancer
10.1186/s12885-016-2426-7
urn:nbn:de:bvb:20-opus-161050
BMC Cancer (2016) 16:459 DOI 10.1186/s12885-016-2426-7
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Roland Gregor Stein
Daniel Wollschläger
Rolf Kreienberg
Wolfgang Janni
Manfred Wischnewsky
Joachim Diessner
Tanja Stüber
Catharina Bartmann
Mathias Krockenberger
Jörg Wischhusen
Achim Wöckel
Maria Blettner
Lukas Schwentner
eng
uncontrolled
histopathology
eng
uncontrolled
breast cancer
eng
uncontrolled
ultrasound
eng
uncontrolled
mammography
eng
uncontrolled
tumor size
Gynäkologie, Geburtsmedizin, Pädiatrie, Geriatrie
open_access
Frauenklinik und Poliklinik
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/16105/Stein_BMCCancer_2016.pdf
17821
2016
eng
12
11
article
1
2019-03-11
--
--
Do Patients with Luminal A Breast Cancer Profit from Adjuvant Systemic Therapy? A Retrospective Multicenter Study
Background
Luminal A breast cancers respond well to anti-hormonal therapy (HT), are associated with a generally favorable prognosis and constitute the majority of breast cancer subtypes. HT is the mainstay of treatment of these patients, accompanied by an acceptable profile of side effects, whereas the added benefit of chemotherapy (CHT), including anthracycline and taxane-based programs, is less clear-cut and has undergone a process of critical revision.
Methods
In the framework of the BRENDA collective, we analyzed the benefits of CHT compared to HT in 4570 luminal A patients (pts) with primary diagnosis between 2001 and 2008. The results were adjusted by nodal status, age, tumor size and grading.
Results
There has been a progressive reduction in the use of CHT in luminal A patients during the last decade. Neither univariate nor multivariate analyses showed any statistically significant differences in relapse free survival (RFS) with the addition of CHT to adjuvant HT, independent of the nodal status, age, tumor size or grading. Even for patients with more than 3 affected lymph nodes, there was no significant difference (univariate: p = 0.865; HR 0.94; 95% CI: 0.46–1.93; multivariate: p = 0.812; HR 0.92; 95% CI: 0.45–1.88).
Conclusions
The addition of CHT to HT provides minimal or no clinical benefit at all to patients with luminal A breast cancer, independent of the RFS-risk. Consequently, risk estimation cannot be the initial step in the decisional process. These findings–that are in line with several publications–should encourage the critical evaluation of applying adjuvant CHT to patients with luminal A breast cancer.
PLoS ONE
10.1371/journal.pone.0168730
urn:nbn:de:bvb:20-opus-178217
PLoS ONE 2016, 11(12):e0168730. DOI:10.1371/journal.pone.0168730
false
true
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Joachim Diessner
Manfred Wischnewsky
Maria Blettner
Sebastian Häusler
Wolfgang Janni
Rolf Kreienberg
Roland Stein
Tanja Stüber
Lukas Schwentner
Catharina Bartmann
Achim Wöckel
eng
uncontrolled
breast cancer
eng
uncontrolled
hormones
eng
uncontrolled
endocrine therapy
eng
uncontrolled
cancer detection and diagnosis
eng
uncontrolled
cancer treatment
eng
uncontrolled
cancer chemotherapy
eng
uncontrolled
lymph nodes
eng
uncontrolled
hormona therapy
Medizin und Gesundheit
open_access
Frauenklinik und Poliklinik
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/17821/Diessner_Plos_One.pdf
16117
2016
eng
307
16
article
1
2018-04-26
--
--
Evaluation of clinical parameters influencing the development of bone metastasis in breast cancer
Background
The development of metastases is a negative prognostic parameter for the clinical outcome of breast cancer. Bone constitutes the first site of distant metastases for many affected women. The purpose of this retrospective multicentre study was to evaluate if and how different variables such as primary tumour stage, biological and histological subtype, age at primary diagnosis, tumour size, the number of affected lymph nodes as well as grading influence the development of bone-only metastases.
Methods
This retrospective German multicentre study is based on the BRENDA collective and included 9625 patients with primary breast cancer recruited from 1992 to 2008. In this analysis, we investigated a subgroup of 226 patients with bone-only metastases. Association between bone-only relapse and clinico-pathological risk factors was assessed in multivariate models using the tree-building algorithms “exhausted CHAID (Chi-square Automatic Interaction Detectors)” and CART(Classification and Regression Tree), as well as radial basis function networks (RBF-net), feedforward multilayer perceptron networks (MLP) and logistic regression.
Results
Multivariate analysis demonstrated that breast cancer subtypes have the strongest influence on the development of bone-only metastases (χ2 = 28). 29.9 % of patients with luminal A or luminal B (ABC-patients) and 11.4 % with triple negative BC (TNBC) or HER2-overexpressing tumours had bone-only metastases (p < 0.001). Five different mathematical models confirmed this correlation. The second important risk factor is the age at primary diagnosis. Moreover, BC subcategories influence the overall survival from date of metastatic disease of patients with bone-only metastases. Patients with bone-only metastases and TNBC (p < 0.001; HR = 7.47 (95 % CI: 3.52–15.87) or HER2 overexpressing BC (p = 0.007; HR = 3.04 (95 % CI: 1.36–6.80) have the worst outcome compared to patients with luminal A or luminal B tumours and bone-only metastases.
Conclusion
The bottom line of different mathematical models is the prior importance of subcategories of breast cancer and the age at primary diagnosis for the appearance of osseous metastases. The primary tumour stage, histological subtype, tumour size, the number of affected lymph nodes, grading and NPI seem to have only a minor influence on the development of bone-only metastases.
BMC Cancer
10.1186/s12885-016-2345-7
urn:nbn:de:bvb:20-opus-161173
BMC Cancer (2016) 16:307 DOI 10.1186/s12885-016-2345-7
CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International
Joachim Diessner
Manfred Wischnewsky
Tanja Stüber
Roland Stein
Mathias Krockenberger
Sebastian Häusler
Wolfgang Janni
Rolf Kreienberg
Maria Blettner
Lukas Schwentner
Achim Wöckel
Catharina Bartmann
eng
uncontrolled
BRENDA
eng
uncontrolled
breast cancer
eng
uncontrolled
bone metastases
eng
uncontrolled
skeleton
eng
uncontrolled
breast cancer subtypes
Gynäkologie, Geburtsmedizin, Pädiatrie, Geriatrie
open_access
Frauenklinik und Poliklinik
Universität Würzburg
https://opus.bibliothek.uni-wuerzburg.de/files/16117/Diessner_BMCCancer_2016.pdf