Prognostic relevance of peritumoral vascular invasion in immunohistochemically defined subtypes of node-positive breast cancer

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Abstract

Prognostic factors to better identify subcategories of node-positive breast cancer patients candidate to adjuvant chemotherapy are needed. The prognostic significance of the extent of peritumoral vascular invasion (PVI) in patients with positive axillary nodes is a matter of controversy. No data are available on the role of PVI within immunohistochemically defined subtypes. 3,729 consecutive patients with primary invasive breast cancer and positive axillary nodes were operated and referred for interdisciplinary evaluation from April 1997 to December 2005. Patients were classified as Luminal A, Luminal B(HER2 negative), Luminal B(HER2 positive), Triple Negative and HER-2 positive. The distribution of PVI was as follows: absent 2,010 (54 %), moderate/focal 963 (142 + 821) (26 %), and extensive 756 (20 %). Patients with extensive PVI were more likely to be Luminal B(HER2 negative) (49.3 %), younger (35-50 years), to have larger tumors (≥pT2) with higher grade, a higher extent of node involvement (≥4 nodes) and higher proliferative index, compared with patients with absence or moderate/focal PVI (p <0.0001). In the multivariate analysis, extensive PVI (vs. absent) was correlated with a significant higher risk of local recurrence (HR 1.42, 95 %CI, 1.03-1.95, p = 0.0301). The immunohistochemically defined Luminal A-like subtype had a significant better outcome in terms of DFS, OS and reduced incidence of distant metastases when compared with the other subtypes. The occurrence of extensive PVI correlates with an increased risk of local recurrence. Luminal A tumors, classified according to the most recent St. Gallen recommendations, had an excellent outcome irrespective to the occurrence of extensive PVI or lymph node metastases and might be a good candidate to personalized adjuvant treatments.

Original languageEnglish
Pages (from-to)573-582
Number of pages10
JournalBreast Cancer Research and Treatment
Volume146
Issue number3
DOIs
Publication statusPublished - 2014

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Blood Vessels
Breast Neoplasms
Neoplasm Metastasis
Recurrence
Adjuvant Chemotherapy
Neoplasms
Multivariate Analysis
Lymph Nodes
Incidence

Keywords

  • Breast cancer
  • Intrinsic sub-types
  • Node-positive
  • Peritumoral vascular invasion
  • Prognostic factors

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Medicine(all)

Cite this

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title = "Prognostic relevance of peritumoral vascular invasion in immunohistochemically defined subtypes of node-positive breast cancer",
abstract = "Prognostic factors to better identify subcategories of node-positive breast cancer patients candidate to adjuvant chemotherapy are needed. The prognostic significance of the extent of peritumoral vascular invasion (PVI) in patients with positive axillary nodes is a matter of controversy. No data are available on the role of PVI within immunohistochemically defined subtypes. 3,729 consecutive patients with primary invasive breast cancer and positive axillary nodes were operated and referred for interdisciplinary evaluation from April 1997 to December 2005. Patients were classified as Luminal A, Luminal B(HER2 negative), Luminal B(HER2 positive), Triple Negative and HER-2 positive. The distribution of PVI was as follows: absent 2,010 (54 {\%}), moderate/focal 963 (142 + 821) (26 {\%}), and extensive 756 (20 {\%}). Patients with extensive PVI were more likely to be Luminal B(HER2 negative) (49.3 {\%}), younger (35-50 years), to have larger tumors (≥pT2) with higher grade, a higher extent of node involvement (≥4 nodes) and higher proliferative index, compared with patients with absence or moderate/focal PVI (p <0.0001). In the multivariate analysis, extensive PVI (vs. absent) was correlated with a significant higher risk of local recurrence (HR 1.42, 95 {\%}CI, 1.03-1.95, p = 0.0301). The immunohistochemically defined Luminal A-like subtype had a significant better outcome in terms of DFS, OS and reduced incidence of distant metastases when compared with the other subtypes. The occurrence of extensive PVI correlates with an increased risk of local recurrence. Luminal A tumors, classified according to the most recent St. Gallen recommendations, had an excellent outcome irrespective to the occurrence of extensive PVI or lymph node metastases and might be a good candidate to personalized adjuvant treatments.",
keywords = "Breast cancer, Intrinsic sub-types, Node-positive, Peritumoral vascular invasion, Prognostic factors",
author = "Elisabetta Munzone and Vincenzo Bagnardi and Nicole Rotmensz and Andrea Sporchia and Manuelita Mazza and Giancarlo Pruneri and Mattia Intra and Angela Sciandivasci and Oreste Gentilini and Alberto Luini and Giuseppe Viale and Paolo Veronesi and Marco Colleoni",
year = "2014",
doi = "10.1007/s10549-014-3043-2",
language = "English",
volume = "146",
pages = "573--582",
journal = "Breast Cancer Research and Treatment",
issn = "0167-6806",
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TY - JOUR

T1 - Prognostic relevance of peritumoral vascular invasion in immunohistochemically defined subtypes of node-positive breast cancer

AU - Munzone, Elisabetta

AU - Bagnardi, Vincenzo

AU - Rotmensz, Nicole

AU - Sporchia, Andrea

AU - Mazza, Manuelita

AU - Pruneri, Giancarlo

AU - Intra, Mattia

AU - Sciandivasci, Angela

AU - Gentilini, Oreste

AU - Luini, Alberto

AU - Viale, Giuseppe

AU - Veronesi, Paolo

AU - Colleoni, Marco

PY - 2014

Y1 - 2014

N2 - Prognostic factors to better identify subcategories of node-positive breast cancer patients candidate to adjuvant chemotherapy are needed. The prognostic significance of the extent of peritumoral vascular invasion (PVI) in patients with positive axillary nodes is a matter of controversy. No data are available on the role of PVI within immunohistochemically defined subtypes. 3,729 consecutive patients with primary invasive breast cancer and positive axillary nodes were operated and referred for interdisciplinary evaluation from April 1997 to December 2005. Patients were classified as Luminal A, Luminal B(HER2 negative), Luminal B(HER2 positive), Triple Negative and HER-2 positive. The distribution of PVI was as follows: absent 2,010 (54 %), moderate/focal 963 (142 + 821) (26 %), and extensive 756 (20 %). Patients with extensive PVI were more likely to be Luminal B(HER2 negative) (49.3 %), younger (35-50 years), to have larger tumors (≥pT2) with higher grade, a higher extent of node involvement (≥4 nodes) and higher proliferative index, compared with patients with absence or moderate/focal PVI (p <0.0001). In the multivariate analysis, extensive PVI (vs. absent) was correlated with a significant higher risk of local recurrence (HR 1.42, 95 %CI, 1.03-1.95, p = 0.0301). The immunohistochemically defined Luminal A-like subtype had a significant better outcome in terms of DFS, OS and reduced incidence of distant metastases when compared with the other subtypes. The occurrence of extensive PVI correlates with an increased risk of local recurrence. Luminal A tumors, classified according to the most recent St. Gallen recommendations, had an excellent outcome irrespective to the occurrence of extensive PVI or lymph node metastases and might be a good candidate to personalized adjuvant treatments.

AB - Prognostic factors to better identify subcategories of node-positive breast cancer patients candidate to adjuvant chemotherapy are needed. The prognostic significance of the extent of peritumoral vascular invasion (PVI) in patients with positive axillary nodes is a matter of controversy. No data are available on the role of PVI within immunohistochemically defined subtypes. 3,729 consecutive patients with primary invasive breast cancer and positive axillary nodes were operated and referred for interdisciplinary evaluation from April 1997 to December 2005. Patients were classified as Luminal A, Luminal B(HER2 negative), Luminal B(HER2 positive), Triple Negative and HER-2 positive. The distribution of PVI was as follows: absent 2,010 (54 %), moderate/focal 963 (142 + 821) (26 %), and extensive 756 (20 %). Patients with extensive PVI were more likely to be Luminal B(HER2 negative) (49.3 %), younger (35-50 years), to have larger tumors (≥pT2) with higher grade, a higher extent of node involvement (≥4 nodes) and higher proliferative index, compared with patients with absence or moderate/focal PVI (p <0.0001). In the multivariate analysis, extensive PVI (vs. absent) was correlated with a significant higher risk of local recurrence (HR 1.42, 95 %CI, 1.03-1.95, p = 0.0301). The immunohistochemically defined Luminal A-like subtype had a significant better outcome in terms of DFS, OS and reduced incidence of distant metastases when compared with the other subtypes. The occurrence of extensive PVI correlates with an increased risk of local recurrence. Luminal A tumors, classified according to the most recent St. Gallen recommendations, had an excellent outcome irrespective to the occurrence of extensive PVI or lymph node metastases and might be a good candidate to personalized adjuvant treatments.

KW - Breast cancer

KW - Intrinsic sub-types

KW - Node-positive

KW - Peritumoral vascular invasion

KW - Prognostic factors

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