K. Ushimado

Differences in subtype distribution between screen-detected and symptomatic invasive breast cancer and their impact on survival

PurposeStage shift is considered a major reason for more favorable outcomes in patients with screen-detected breast cancer. However, even after adjusting for clinical stage, unresolved issues concerning the reasons for a survival benefit associated with screening programs remain. This study aims to evaluate differences in subtype distribution and outcomes among patients with screen-detected and symptomatic invasive breast cancer and assess whether variations in subtype distribution could explain differences in prognosis.MethodsSurvival analysis was performed to estimate the likelihood of distant recurrence and death in 1132 patients. Subtypes were defined as luminal A [estrogen receptor (ER)+ and/or progesterone receptor (PR)+, human epidermal growth factor receptor 2 (HER2)−, and Ki67 low], luminal B (HER2−) (ER+ and/or PR+, HER2−, and Ki67 high), luminal B (HER2+) (ER+ and/or PR+ and HER2+), HER2 overexpressing (ER−, PR−, and HER2+), and triple negative (ER−, PR−, and HER2−).ResultsScreen-detected cancers had favorable clinicopathological characteristics, such as smaller tumor size and a lower frequency of lymph node involvement. Women with screen-detected cancers had a survival advantage. Subtype distribution differed significantly among women with screen-detected and symptomatic cancer. Screen-detected cancers were more likely to be luminal A and less likely to be HER2 overexpressing or triple negative cancer compared with symptomatic cancers (luminal A 61.3 vs. 44.2%, HER2 overexpressing 4.0 vs. 8.0%, triple negative 8.0 vs. 15.9%). Node status, mode of detection, and subtype were independent prognostic factors in the multivariate analysis.ConclusionsDifferences in subtype distribution between screen-detected and symptomatic cancer could partially explain differences in outcomes.

A Hypoglycemia-inducing Giant Borderline Phyllodes Tumor Secreting High-molecular-weight Insulin-Like Growth Factor II: A Case Report with Immunohistochemistry and a Western Blot Analysis

A 50-year-old woman with a large right breast mass was emergently hospitalized for generalized weakness and fatigue. A histological examination of tumor biopsy specimens revealed a phyllodes tumor (PT). She suddenly lost consciousness due to severe hypoglycemia. Non-islet cell tumor hypoglycemia (NICTH) due to the PT was suspected. The tumor was emergently resected. A histological examination revealed a borderline PT. The patient recovered from the hypoglycemic episode. High-molecular-weight insulin-like growth factor II was detected in serum that had been collected preoperatively and in the tumor tissue, but not in serum that had been collected postoperatively. We herein present a case of a borderline PT with NICTH.

276PBIOLOGICAL AND CLINICAL IMPLICATIONS OF AROMATASE INHIBITORS FOR NEOADJUVANT THERAPY IN BREAST CANCER

ABSTRACT Aim: Neoadjuvant aromatase inhibitors (AIs) therapy has become acceptable. Estrogens play a major role in promoting the growth of breast cancers (BCs). Androst-5-ene-3b,17b-diol (ADIOL) possesses estrogenic properties. Here we report the efficacy of AIs and the influence of letrozole (LET) on BC tissue and plasma levels of estrone (E1), estradiol (E2), estrone sulfate (E1S), ADIOL, and androstendione (AONE) in postmenopausal women undergoing neoadjuvant therapy for estrogen receptor (ER)–positive BCs. Methods: Twenty-nine postmenopausal patients with stage I (n = 3), IIA (n = 11), IIB (n = 5), IIIA (n = 2) and IIIB (n = 9) BCs were treated with anastrozole, LET or exemestane as neoadjuvant treatment. One patient had bilateral BC. Plasma and BC tissue samples were obtained from 9 patients before and after 4 months of neoadjuvant therapy with LET. Steroids concentrations were measured by liquid chromatography/ electrospray tandem mass spectrometry. Results: One of 30 tumors showed complete response (CR), 15 showed partial response (PR) and 14 showed stable disease (SD). All treatments were well tolerated. After treatment, a decrease of progesterone receptor expression was more frequent in responding tumors (93.8%) than in non-responding tumors (35.7%). Suppression of Ki67 after treatment was significantly greater in responding tumors than in non-responding tumors (P = 0.002). The mean BC tissue levels of E1, E2, E1S, ADIOL, and AONE at base line were 0.534, 0.409, 0.13, 1.65, and 6.09 pmol/g, respectively. After neoadjuvant therapy, the levels of E1, E2, E1S, ADIOL, and AONE were 0.002, 0008, 0.002, 2.22, and 5.63 pmol/g, respectively. The mean plasma levels of E1, E2, E1S, ADIOL, and AONE at base line were 621.5, 27.0, 1799.5, 1033, and 2258 pmol/l, respectively. After therapy, the levels of E1, E2, E1S, ADIOL, and AONE were 1.7, 1.6, 3.4, 1111, and 2826 pmol/l, respectively. LET significantly suppressed estrogens. Although plasma and tissue ADIOL levels were high after treatment, there was no progress disease in the 9 cases. With a median follow up of 69 months, there was no significant difference in overall survival between patients with CR or PR and those with SD. Conclusions: Neoadjuvant AIs therapy provided satisfactory efficacy and safety profiles. The activity of AIs was correlated with significantly reduced estrogens levels, but not with ADIOL levels. Disclosure: All authors have declared no conflicts of interest.