Miho Yoshida

Sentinel Lymph Node Biopsy Alone Has No Adverse Impact on the Survival of Patients with Breast Cancer

Abstract:  We do not yet know the results from multicenter randomized trials comparing survival after sentinel lymph node biopsy (SLNB) alone and axillary lymph node dissection (ALND). Therefore, in this study, the prognostic significance of the type of axillary surgery is analyzed in combination with other known prognostic factors in patients with breast cancer. In a series of 1325 consecutive patients with unilateral breast cancer who underwent SLNB between January 1999 and June 2004 at a single institution, 884 underwent SLNB alone following an intraoperative negative histologic investigation and 441 underwent ALND. Disease‐free survival (DFS) and overall survival (OS) were analyzed to correlate with clinicopathologic features and treatment methods using both univariate and multivariate analyses Cox proportional hazard regression models. With a median follow‐up period of 31 months, 29 (3.3%) and 37 (8.4%) patients relapsed after SLNB alone and ALND, respectively. Tumor size (Tis, T1–2 versus T3–4), histologic nodal involvement (negative versus positive), nuclear grade (NG) (1, 2 versus 3), lymphatic vessel invasion (LVI) (absent, weak versus intense), estrogen receptor (ER) status (positive versus negative), type of axillary surgery (SLNB alone versus ALND), type of breast surgery (partial versus total mastectomy), and radiation therapy (yes versus no) significantly correlated with DFS by univariate analysis, demonstrating better DFS in the former category than the latter for each variable. The multivariate analysis revealed that NG, LVI, ER status, and radiation therapy significantly correlated with DFS, and ER and histologic nodal involvement correlated with OS. As the type of axillary surgery had no impact on the prognosis of patients with breast cancer, a SLNB alone is safe as determined by a negative histologic investigation. 

Long-Term Suppression of Lymphangitic Lung Metastasis from Breast Cancer Using Biweekly Docetaxel: A Case Report

A 45-year-old woman underwent a modified radical mastectomy for right breast cancer in July 1996. As lymph node metastases were quite advanced, chemotherapy was started with anthracyclines. Four years after surgery, cough and dyspnea appeared. Chest radiograph and CT showed reticular shadows bilaterally and slight pleural effusion, suggesting lymphangitic lung metastasis of breast cancer. Biweekly intravenous docetaxel (TXT, 45 mg/m2) was initiated. Four courses of TXT ameliorated her complaints and radiographic findings. A total of 30 continuous courses of TXT suppressed disease exacerbation for 18 months until new lesions manifested in January 2002. The main side effects were grade 2 leukopenia and alopecia. This case report describes a patient with long-term suppression of lymphangitic lung metastasis of breast cancer using biweekly TXT without severe side effects or worsening quality of life.

Human leukocyte antigen as a predictive factor of developing bilateral breast cancer in Japanese women.

Abstract:  To investigate the relationship between human leukocyte antigen (HLA) type and bilateral breast cancer, a total of 213 female breast cancer patients were entered into this study. The lymphocyte cytotoxicity test was used for HLA typing. HLA frequency and haplotype antigen frequency were calculated with a microcomputer. A chi‐squared test was used for comparing HLA frequency. At the start point of follow‐up, 187 patients (87.8%) had unilateral and 26 patients (12.2%) had bilateral breast cancer. After a 10‐year follow‐up, 183 patients (85.9%) were unilateral and 30 patients (14.1%) were bilateral. Haplotype frequency of A24‐Cw7 was significantly higher in bilateral breast cancer patients compared with unilateral breast cancer patients (p < 0.001). After the 10‐year follow‐up, 4 of 187 patients (2.1%) with unilateral breast cancer developed bilateral breast cancer. Two of 19 patients (10.5%) with haplotype A24‐Cw7 developed bilateral breast cancer, whereas only 2 of 168 patients (1.2%) without haplotype A24‐Cw7 developed bilateral breast cancer (p < 0.01). The true frequency of developing contralateral breast cancer in patients with haplotype A24‐Cw7 was 93 per 100,000 per year. The risk of bilateral breast cancer in patients with haplotype A24 and Cw7 is 12 times higher compared with those without the haplotype. HLA typing is useful for selecting patients who are at high risk of contralateral breast cancer.