Hee Jeong Kim

Different prognostic significance of CD24 and CD44 expression in breast cancer according to hormone receptor status

OBJECTIVEnCD44(+)CD24(-/low)-expressing tumor cells have been studied as tumorigenic stem cells in vitro study. This study was designed to determine the clinical implication of the CD44 and CD24 expression in breast cancer.nnnMETHODSnTissue microarray blocks containing 643 consecutive cases of invasive breast carcinomas from 1993 to 1998 were immunostained for CD44 and CD24. The median follow-up period was 127 months.nnnRESULTSnCD44(-)CD24(+) phenotype was associated with frequent hormone receptor positivity and Her2/neu positivity (Pxa0=xa00.000; Both). The CD44(+)CD24(-) phenotype was inversely associated with lymph node metastasis (Pxa0=xa00.002), and it showed positive associations with prolonged disease-free survival (DFS; Pxa0=xa00.003) and overall survival (OS; Pxa0=xa00.002). 10-year DFS and OS were 68.9% and 74.6% for CD24 negative group, 55.6% and 60.9% for CD24 positive group (Pxa0=xa00.001; Both). 10-year DFS and OS were 62.2% and 68.1% for CD44 negative group, 73% and 77.7% for CD44 positive group (Pxa0=xa00.012, Pxa0=xa00.013, respectively). In a multivariate analysis, CD24 expression was negatively related to OS only in the receptor positive group (Hazard ratioxa0=xa02.03; Pxa0=xa00.003; 95% CI: 1.27-3.24) and CD44 expression was positively related to OS only in the hormone receptor negative group (hazard ratioxa0=xa00.58; Pxa0=xa00.022; 95% CI: 0.36-0.92).nnnCONCLUSIONSnThe CD44(+)CD24(-) group is considered a favorable prognostic subgroup in breast cancer. CD24 expression was a poor prognosis marker in hormone receptor positive breast cancer, and CD44 expression was a good prognostic marker in the receptor negative group.

Young age is associated with ipsilateral breast tumor recurrence after breast conserving surgery and radiation therapy in patients with HER2-positive/ER-negative subtype

Young breast cancer patients are more likely than old patients to experience ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS). However, the pathological processes underlying this relationship have not been elucidated. We investigated the effect of young age on IBTR in a Korean cohort of women with different molecular subtypes of breast cancer. We analyzed data of 2,102 consecutive breast cancer patients who underwent BCS and post-surgical radiation therapy (RT) at two Korean institutions between 2000 and 2005. Patients were classified as young (≤40xa0years; Nxa0=xa0513) or old (>40xa0years; Nxa0=xa01,589). Breast cancer subtype was determined by estrogen receptor (ER), progesterone receptor (PR), and HER2. Median follow-up duration was 61xa0months.xa0The 5-year IBTR rate was 3.4% in young patients and 1.1% in old patients (Pxa0<xa00.001). Univariate analysis indicated that IBTR rate in young patients with luminal A and HER2 subtypes was significantly greater than in old patients with these subtypes (Pxa0=xa00.015 and Pxa0<xa00.001, respectively). Multivariate analysis, which used luminal A subtype in old patients as reference, indicated that HER2 subtype in young patients was associated with increased risk of IBTR (hazard ratio, HRxa0=xa012.24; 95% CI: 2.54–57.96). Among old patients, HER2 subtype was not associated with increased IBTR. In conclusion, young women had a higher rate of IBTR after BCS and RT than old women. This difference is mainly among women with HER2 subtype. Aggressive local control and adjuvant therapy should be considered for young women with HER2 subtype breast cancer.

Changes in serum hydroxyvitamin D levels of breast cancer patients during tamoxifen treatment or chemotherapy in premenopausal breast cancer patients

BACKGROUNDnWe investigated the effect of breast cancer adjuvant treatment on vitamin D status, as measured by serum hydroxyvitamin D (25OHD).nnnMETHODSnPremenopausal patients (n=483) diagnosed with non-metastatic breast cancer in 2009 at Asan Medical Center had serum 25OHD levels prospectively analysed at diagnosis and 6 and 12months after surgery. We excluded patients who took vitamin D supplements or received neoadjuvant chemotherapy. Vitamin D sufficiency was defined as a serum level of ⩾30ng/ml, insufficiency as 20-29ng/ml and deficiency as <20ng/ml.nnnRESULTSnCompared with baseline serum 25OHD, patients who received chemotherapy had decreased serum 25OHD levels at 6months (-5.52ng/ml, p=0.003) and 12months (-1.24ng/ml, p=0.517) and patients who received anti-hormone therapy had significantly increased serum 25OHD levels at 6months (+3.00ng/ml, p=0.681) and 12months (+6.47ng/ml, p=0.002, respectively). Among patients who received chemotherapy, 49.5% were vitamin D sufficient at diagnosis but only 26.9% were sufficient 6months after finishing chemotherapy and this percentage increased to 45.2% at 12months.nnnCONCLUSIONSnVitamin D levels decrease during chemotherapy but recover after treatment ends. Anti-hormone therapy with tamoxifen causes serum vitamin D levels to increase. Whether the increased serum vitamin D affects the antitumour effect of the tamoxifen has yet to be determined.

Large genomic rearrangement of BRCA1 and BRCA2 genes in familial breast cancer patients in Korea.

We screened large genomic rearrangements of the BRCA1 and BRCA2 genes in Korean, familial breast cancer patients. Multiplex ligation-dependent probe amplification assay was used to identify BRCA1 and BRCA2 genomic rearrangements in 226 Korean familial breast cancer patients with risk factors for BRCA1 and BRCA2 mutations, who previously tested negative for point mutations in the two genes. We identified only one large deletion (c.4186-1593_4676-1465del) in BRCA1. No large rearrangements were found in BRCA2. Our result indicates that large genomic rearrangement in the BRCA1 and BRCA2 genes does not seem like a major determinant of breast cancer susceptibility in the Korean population. A large-scale study needs to validate our result in Korea.

A retrospective prognostic evaluation analysis using the 8th edition of the American Joint Committee on Cancer staging system for breast cancer

PurposeBreast cancer is a group of diseases with different intrinsic molecular subtypes. However, anatomic staging alone is insufficient to determine prognosis. The present study analyzed the prognostic value of the American Joint Committee for Cancer (AJCC) 8th edition cancer staging system.MethodsThis retrospective, single-center study included breast cancer cases diagnosed from January 1999 to December 2008. We restaged patients based on the 8th edition AJCC cancer staging system and analyzed the prognostic value of the anatomic and prognostic staged groups. Follow-up data including disease-free survival (DFS), overall survival (OS), and clinic-pathological data were collected to analyze the differences between the two staging subgroups.ResultsThe study enrolled 7458 breast cancer patients with a 98.7-month median follow-up. Both the 5-year DFS and OS were significantly different between the anatomic and prognostic staged groups. The 5-year OS according to disease subtype was as follows: hormone receptor-positive/human epidermal growth factor receptor 2-negative [HR(+)/HER2(−)], 90.9%; HR(+)/HER2(+), 84.7%; HR(−)/HER2(+), 81.1%; and HR(−)/HER2(−), 80.9%. According to the anatomic stage, the 5-year OS of patients with stage III HR(+)/HER2(−) disease was superior to that of patients with stage II HR(−)/HER2(−) disease (88.3 vs. 86.5%). Per the prognostic stage, both the 5-year DFS and OS rates of patients with stage II HR(−)/HER2(−) disease were higher than those of patients with stage III HR(+)/HER2(−) disease (90.1 and 94.3% vs. 79.1 and 88.9%).ConclusionsThe prognostic staging system is a refined version of the anatomic staging system and encourages a more personalized approach to breast cancer treatment.

Abstract P6-10-12: Metformin increases survival in hormone receptor-positive, Her2-positive breast cancer patients with diabetes

Purpose Metformin use has recently been observed to decrease both the rate and mortality of breast cancer. Our study was aim to determine whether metformin use is associated with survival in diabetic breast cancer patients by breast cancer subtype and systemic treatment Patients and Methods Data from the Asan Medical Center Breast Cancer Database from 1997 to 2007 were analyzed. The study cohort comprised 6,967 nondiabetic patients, 202 diabetic patients treated with metformin, and 184 diabetic patients that did not receive metformin. Patients who were divided into three groups by diabetes status and metformin use were also divided into four subgroups by hormone receptor and HER2-neu status. Results In Kaplan-Meier analysis, the metformin group had a significantly better overall and cancer specific survival outcome compared with non metformin diabetic group ( P Conclusion Patients receiving metformin treatment when breast cancer diagnosis show a better prognosis only if they have hormone receptor-positive, HER2-positive tumors. Metformin treatment might provide a survival benefit when added to systemic therapy in diabetic patients. Citation Format: Hee Jeong Kim, Hyun Wook Kwon, Jong Won Lee, Sae Byul Lee, Hee Seung Park, Sei Hyun Ahn, Hae Na Shin. Metformin increases survival in hormone receptor-positive, Her2-positive breast cancer patients with diabetes [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-10-12.

Abstract P3-08-05: Association of mammographic density in high risk BRCA mutated tumors compared to average risk tumors and healthy controls: Analysis of Korean Hereditary Breast and Cancer Study (KOHBRA)

Introduction: Mammographic density is a well-known risk factor of breast cancer as a whole. Nonetheless only few studies have examined the association of density among high risk breast cancer regarding BRCA mutation. We examined mammographic density of 2019 breast cancer patients and 2029 healthy controls, regarding risk factors and BRCA mutation status. Method: Total 2019 breast cancer patients diagnosed between 1980 to 2011 were divided into two groups- high versus average risk group. Women with 1)family history of breast/ovarian cancer or 2)younger than age 40 or 3)bilateral cases were considered high risk group and were participants of ‘Korean Hereditary Breast Cancer study’ (KOHBRA) whom undergone BRCA testing. Density of 2029 healthy women who took screening mammogram during the same period were analyzed for comparison. Density was measured of the unaffected contralateral CC view using computer-assisted method Cumulus by single observer (10% randomly selected, intra-class correlation coefficient=0.96). Percent density (PD, dense area/breast area, %) among three groups, association with BRCA mutation status and breast cancer subtypes were examined. Results and Discussion: Percent density (PD) was significantly higher in high risk group compared to average risk and controls in a consecutive manner. This finding was consistent after adjusting age and BMI (p* High mammographic density showed to be a significant risk factor throughout different subtypes. Among the 1066 high risk group, 81.5% (869) undergone BRCA testing and 70(6.6%) had BRCA1, 78(7.3%) had BRCA2 mutations without significant difference in density. Similar strong magnitude association of mammographic density was observed in both BRCA mutated/non-mutated tumors and among subtypes. The ongoing GWAS and whole exome analysis of this population-subset will give insight into the tumor etiology and how density could stratify breast cancer risk for personalized screening especially in high risk population. Citation Format: Jisun Kim, Jong Won Lee, Sung Won Park, Hee Jung Shin, Hak Hee Kim, Sae-Byul Lee, Jong Han Yu, Hee Jeong Kim, Beom Seok Koh, Byung Ho Son, Sei-Hyun Ahn. Association of mammographic density in high risk BRCA mutated tumors compared to average risk tumors and healthy controls: Analysis of Korean Hereditary Breast and Cancer Study (KOHBRA) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-08-05.

Sparganosis infection presenting as a palpable mass in male breast

Figure 1. Mammography showing a 5-cm-sized highly attenuated or multiple clustered 1-cm-sized nodular lesions with intervening normal fatty tissue (left). Ultrasonography revealed a serpentine tubular low echoic or cystic lesion with an internal echogenic soft lesion (right). Figure 2. The resected specimen revealed multiple tubular structures. Within the tubular tract there was a tapeworm, measuring 1.2 cm in length with a crosssection of 0.4 0.1 cm (white arrow).