Purpose: Distant metastasis of breast cancer significantly affects the prognosis. Serum markers such as CEA and cancer antigen (CA) 15-3 are used for surveillance. However, the nonspecificity and nonmalignant elevation of CEA limit its absolute value in predicting metastatic recurrence. We reevaluated the clinical value of CEA kinetics in predicting metastatic recurrence in breast cancer. Methods: In this multicenter retrospective cohort study, we utilized electronic medical record data from eight institutions (2008-2023), including 4,872 surgically treated patients with invasive breast cancer. Novel CEA kinetic indices were defined. Predictive capabilities were assessed using logistic regression, Kaplan-Meier survival curves, and Cox proportional hazards models. Results: CEA velocity (vCEA) and last-interval vCEA (vCEA-L) showed higher accuracy and sensitivity in predicting distant metastasis than absolute CEA indices. All tumor marker indices were independent predictors; vCEA, vCEA-L, and maximum vCEA (vCEAmax) showed the highest association. In the 5-year distant disease-free survival analysis of patients, vCEA showed the most significant difference based on whether its cutoff value was exceeded (84.1% vs. 47.2%) (P < 0.001). Cox analysis showed that vCEA was the strongest predictor (hazard ratio, 4.509; P < 0.001). vCEAmax remained prognostic even when CEAmax was below its cutoff value. Conclusion: Analysis of dynamic CEA changes, particularly velocity-based indices, offers superior predictive power than the static-based CEA indices for metastatic recurrence in breast cancer. These kinetic markers enhance prognostic accuracy when combined with CA 15-3. Future research should integrate these markers with imaging, liquid biopsy, and artificial intelligence for personalized follow-up.

Purpose:B-cell lymphoma 2 (BCL2) has an antiapoptotic role, however, has resulted in it being a powerful favorable prognostic factor in breast cancer. Several studies revealed BCL2 is strongly associated with a lower rate of early recurrence after initial treatment in breast cancer patients, but study of a prolonged effect after 5 years is lacking. We investigated BCL2 as a prognostic factor in breast cancer in comparison to early and late recurrence.Methods:We retrieved data from 2,198 patients with primary breast cancer who underwent surgical treatment and adjuvant treatment at the breast cancer center between 2005 and 2015. Each molecular subtype was classified, and Ki-67 and BCL2 were also assessed by immunohistochemistry. BCL2 and the association between molecular subtypes were assessed in early and late recurrences, respectively. Five-year postrecurrence survival and BCL2 were also assessed.Results:The BCL2-positive group was associated with favorable clinicopathologic characteristics. The time to recurrence was significantly longer in the BCL2-positive group (P = 0.035). Late recurrence after 5 years was higher in the BCL2-positive group (P = 0.029). In multivariate survival analysis, tumor size and BCL2-positive expression were the only independent prognostic factors for late recurrence (P = 0.004). In the patients with recurrence, 5-year postrecurrence survival was significantly higher in the BCL2-positive group (P < 0.001).Conclusion:Our result showed that prognosis was better in BCL2-positive patients compared to BCL2-negative patients at late recurrence. We suggested that BCL2 expression could be used as a marker to help determine additional adjuvant therapy or extended hormone therapy in hormone-dependent breast cancer.

Background Although the incidence of isolated ipsilateral local and regional recurrence (IILRR) in human epidermal growth factor 2 (HER2)-negative luminal breast cancer is low, it is important because of its potential risk of distant metastasis and breast cancer related mortality. The aim of this study was to investigate prognostic factor and survival of IILRR using a large multi-center cohort. Methods Data on patients with HER2-negative luminal breast cancer between 2005 and 2015 were retrieved. The endpoint was IILRR rate, post-recurrence progression-free survival (P-PFS), and post-recurrence overall survival (P-OS). Prognostic factors for progression and overall survival (OS) after IILRR were assessed by multivariate analysis. Results Eighty (2.37%) patients experienced IILRR. Of them, 27 (33.7%) experienced a disease progression, including 23 (85.2%) who had distant metastasis. The median DFS was 48.5 months (range, 4–138 months). In 72.5% of cases, the first IILRR occurred after 3 years. Estimated 5-year P-PFS rates were 86.2%, 69.7%, 69.0%, 42.7%, and 82.2% for patients with age < 40 at diagnosis ( p = 0.015), T1 stage ( p = 0.012), stage I ( p < 0.001), lymphovascular invasion ( p = 0.003), and patients with post-recurrence endocrine therapy ( p < 0.001), respectively. The 5-year Kaplan–Meier P-OS rate for patients was 81.4%. Post-recurrence endocrine therapy was independent factor for progression (HR: 0.176, p < 0.001) and OS (HR: 0.080, p < 0.001). Conclusions Although there is no standardized treatment for IILRR yet, endocrine therapy after local resection plays a more important role in improving prognosis than chemotherapy or radiotherapy in HER2-negative luminal breast cancer.

Breast metastases from extramammary malignancies are rare. Here, we report a case of breast metastasis from hepatocellular carcinoma (HCC) after breast mass excision in a 63-year-old woman. A new breast nodule was noticed after transarterial chemoembolization, transarterial radioembolization, and stereotactic body radiation therapy for HCC. Breast ultrasound and core needle biopsy were performed to differentiate between the breast tumors. The biopsy result was invasive breast carcinoma, and wide excision of the breast was performed. The final pathological diagnosis was HCC breast metastasis based on histological findings and immunohistochemical staining results. After 9 months of follow-up, HCC and breast metastasis recurred. Despite palliative treatment, the patient died due to complications and general health deterioration. Although breast metastasis due to HCC is very rare, HCC breast metastasis should be considered when a new breast mass is discovered in a patient with a history of HCC for effective treatment and management.

Purpose: Young age at diagnosis has been considered a poor prognostic factor. However, considering young age itself as an independent poor prognostic factor for all breast cancers is unwarranted. We analyzed the different prognostic effects of age as a prognostic factor according to molecular subtype. Methods: We retrieved data from 1,819 patients with primary breast cancer at the breast cancer center between 2007 and 2012. We classified each molecular subtype in 3 age cohorts (<40, 40-50, and >50 years). The associations of age and molecular subtypes with relapse-free survival (RFS) and disease-specific survival (DSS) were assessed. Results: Patients aged <40 years showed a poor histologic grade, hormone receptor negative expression than older patients, and had a higher proportion of triple-negative breast cancer (TNBC) (P < 0.001). This was thought to have led to a significantly shorter RFS than that of older patients (P < 0.001). In the subgroup analysis according to molecular subtypes, the poorer RFS was observed only in patients aged <40 years with luminal type breast cancer (P < 0.001). Age was an independent prognostic factor of RFS in luminal-type breast cancer (P = 0.001). However, no difference in RFS between age groups was found for patients with other subtypes (human epidermal growth factor receptor 2 overexpression, TNBC). No significant effect between age groups was found in DSS for patients with all molecular subtypes. Conclusion: Age at diagnosis of breast cancer affected prognosis differently according to molecular subtype. Age itself is not an independent prognostic factor. Age of <40 years showed a limited worse prognostic impact of recurrence in luminal type breast cancer only.

Purpose: To evaluate whether the recently updated 8th edition of the American Joint Committee on Cancer (AJCC) staging systems represents better refinement of the 7th edition for breast cancer. Methods: Data of 3,140 patients who were newly diagnosed with malignant breast cancer between January 2005 and December 2015 at a single institute were retrospectively reviewed. Invasive breast cancer was restaged according to the 8th edition of the AJCC staging system distributed on December 15th 2017. Five-year recurrence and survival rates were compared between the 7th edition and the 8th edition. Results: According to the 7th edition and the 8th edition staging system, stage migration was observed in 947 (38.4%) patients. Of these, 214 (22.6%) patients showed upgraded stage while 733 (77.4%) patients showed downgraded stage with the 8th edition compared to those with the 7th edition. Using the 7th edition staging system, 5-year Recurrence Free Survival (RFS) rates for patients with stage IIB disease and stage IIIB were lower (p<0.001) than those of patients with stage IIIA and IIIC. Five-year Disease-Specific Survival (DSS) and Overall Survival (OS) rates for patients with stage IB disease were lower (p<0.001) than those of patients with stage IIA disease. Conclusion: The recently updated 8th edition of AJCC staging system provides finer stratification of breast cancer with more accurate information about prognosis than the 7th edition staging system.

Intramammary Paget’s disease is an uncommon disease in which 90% of the cases are accompanied by invasive or noninvasive ductal carcinoma. It comprises approximately 0.7%-4.3% of all breast cancers. Typically, extramammary Paget’s disease is accompanied by dermal invasion; however, in intramammary Paget’s disease, dermal invasion through the basement membrane of the skin is very rare. Intramammary Paget’s disease with dermal invasion has been reported infrequently worldwide, and its management and prognosis remain unknown. We report a case of intramammary Paget’s disease with dermal invasion in a 64-year-old woman, accompanied by review of the literature. Keywords: Breast; Dermis; Mammary; Paget’s disease

BACKGROUND:A prediction model with high sensitivity for the detection of negative axillary involvement can reduce additional axillary surgery in patients with ductal carcinoma in situ (DCIS) upstaged to invasive cancer while saving patients with pure DCIS from unnecessary axillary surgeries. Using a nationwide database, we developed and validated a scoring system for guidance in selective sentinel lymph node biopsy omission.PATIENTS AND METHODS:A total of 41,895 patients with clinically node-negative breast cancer from the Korean Breast Cancer Registry were included. The study cohort was randomly divided for the development and validation of the prediction model. Missing data were filled in using multiple imputation. Factors that were significantly associated with axillary lymph node (ALN) metastasis in > 50% of datasets were included in the final prediction model.RESULTS:The frequency of ALN metastasis in the total cohort was 24.5%. After multivariable logistic regression analysis, variables that were associated with ALN metastasis were palpability, multifocality, location, size, histologic type, grade, lymphovascular invasion, hormone receptor expression, and Ki-67 level. A scoring system was developed using these factors. The areas under the receiver operating characteristic curve for the scoring system was 0.750 in both training and validating sets. The cutoff value for performing sentinel lymph node biopsy was determined as a score of 4 to obtain prediction sensitivity higher than 95%.CONCLUSIONS:A scoring system to predict the probability of ALN metastasis was developed and validated. The application of this system in the clinic may reduce unnecessary axillary surgeries in patients with DCIS and minimize additional axillary surgery for upstaged patients with invasive cancer.

Abstract This abstract was withdrawn by the authors. Citation Format: Yoo T-K, Chae BJ, Ahn JY, Ryu J, Eom YH, Park WC, Song BJ. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-28.

PURPOSE:Triple-positive breast cancer is defined by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) positivity. Several systemic breast cancer therapies target hormonal and HER2 responsiveness. We compared clinical outcomes of triple-positive disease with those of HER2-enriched and luminal HER2-negative disease and investigated the clinical efficacy of anti-HER2 therapy for triple-positive disease.METHODS:We retrospectively compared overall and recurrence-free survival among cases included in the Korean Breast Cancer Society (KBCS) and Seoul St. Mary's Hospital breast cancer registries and the therapeutic efficacy of trastuzumab for triple-positive and HER2-enriched cases.RESULTS:KBCS registry data (2006-2010; median follow-up, 76 months) indicated that patients with triple-positive breast cancer had intermediate survival between those with luminal A and HER2-enriched subtypes (p<0.001). Trastuzumab did not improve overall survival among patients with triple-positive breast cancer (p=0.899) in contrast to the HER2-enriched subtype (p=0.018). Seoul St. Mary's Hospital registry data indicated similar recurrence-free survival outcomes (p<0.001) and a lack of improvement with trastuzumab among patients with triple-positive breast cancer (median follow-up, 33 months; p=0.800). Multivariate analysis revealed that patients with triple-positive breast cancer had better overall survival than those with HER2-enriched disease and similar survival as those with the luminal A subtype (triple-positive: hazard ratio, 1.258, p=0.118; HER2-enriched: hazard ratio, 2.377, p<0.001).CONCLUSION:Our findings showed that anti-HER2 therapy was less beneficial for treatment of triple-positive breast cancer than for HER2-enriched subtypes of breast cancer, and the triple-positive subtype had a distinct prognosis.

Sparganosis is a parasitic infection caused by the sparganum, the plercercoid of the genus Spirometra. The preoperative diagnosis of breast sparganosis is difficult in most cases because it is a rare parasitic infection less than 2% of all cases. We report a 62-year-old woman case of breast sparganosis that were confirmed by surgical removal of worms from the right breast. The radiologic images of the patient also revealed characteristic features of breast sparganosis. The patient described the migrating palpable breast mass, which strongly suggested the possibility of breast sparganosis. The treatment of choice and confirmative diagnosis for sparganosis are complete surgical extraction of the sparganum irrespective of infected site. Inspection of the mass site with detailed medical history and radiological examinations are important for preoperative diagnosis of sparganosis patients.

Background: B-Cell lymphoma/leukemia 2 (BCL2) and p53 involve in growth control and the apoptosis pathways, which appear to play a key role in tumor progression and prognosis. We analyzed the prognostic and predictive significance of BCL2 and p53 expression in estrogen receptor(ER)-positive breast cancer. Methods: We retrieved the data of 3,186 patients who were newly diagnosed with malignant breast cancer between August 2006 and December 2013. We analyzed BCL2/p53 index representing the relative expression of each protein and assessed its association with recurrence free survival(RFS), breast cancer-specific survival(BCSS), and overall survival(OS). Results: A total of 511(60.2%) cases of ER-positive breast cancer showed BCL2-positive/p53-negative expression. 97 (11.4%) were BCL2-positive/p53-positive expression, 169(19.9%) were BCL2-negative/p53-negative expression, and 72(8.5%) were BCL2-negative/p53-positive expression. BCL2-positive/p53-negative expression showed an associated with favorable prognostic factors, such as well histological grade (p<0.001), no lymphovascular invasion (p=0.004), lower pathologic stage(p=0.033), progesterone receptor(PR)-positive (p<0.001), HER2 negative (p<0.001), lower Ki-67 level (<14%; p<0.001), and EGFR negative (p=0.001). BCL2/p53 expression showed a significant association with BCSS and OS in ER-positive breast cancer (p=0.002 and p=0.026, respectively). BCL2-positive/p53-negative and BCL2-positive/p53-positive breast cancer showed similar clinical prognostic course in recurrence and survival. In multivariate analysis, lymph node metastasis and BCL2-positive expression were independent prognostic factors for BCSS and OS. However, there was no correlation between BCL2/p53 expression and RFS. Conclusion: BCL2/p53 expression could be a predictor of BCSS and OS in ER-positive breast cancer. Legal entity responsible for the study: N/A Funding: None Disclosure: All authors have declared no conflicts of interest.

Abstract This abstract was withdrawn by the authors.

Abstract This abstract was withdrawn by the authors.

Purpose: Pathological complete response (pCR) of axillary lymph node (LN) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC). Treatment of the axilla after NAC is not well established and the value of sentinel LN biopsy following NAC remains unclear. This study investigated the predictive value of axillary response following NAC and evaluated the predictive value of a model based on axillary response. Methods: Data prospectively collected on 201 patients with clinically node-positive breast cancer who were treated with NAC and underwent axillary LN dissection (ALND) were retrieved. A model predictive of axillary pCR was developed based on clinicopathologic variables. The overall predictive ability between models was compared by receiver operating characteristic (ROC) curve analysis. Results: Of 201 patients who underwent ALND after NAC, 68 (33.8%) achieved axillary pCR. Multivariate analysis using axillary LN pCR after NAC as the dependent variable showed that higher histologic grade (p=0.031; odds ratio [OR], 2.537; 95% confidence interval [CI], 1.087-5.925) and tumor response rate >= 47.1% (p=0.001; OR, 3.212; 95% CI, 1.584-6.515) were significantly associated with an increased probability of achieving axillary pCR. The area under the ROC curve for estimating axillary pCR was significantly higher in the model that included tumor response rate than in the model that excluded this rate (0.732 vs. 0.649, p=0.022). Conclusion: Tumor response rate was the most significant independent predictor of axillary pCR in response to NAC. The model that included tumor response rate was a significantly better predictor of axillary pCR than the model that excluded tumor response rate.

Despite many high-quality programs in basic surgical-skill education, the surgical skill of junior doctors varies widely. This, together with the waning interest in surgery as a career among medical students, is a serious issue confronted by hospitals and healthcare systems worldwide. We, therefore, developed and implemented an intensive one-day surgical-skill training course for two purposes; it would improve surgical skills and increase interest in surgery among medical students.

PURPOSE:The prognostic role of primary tumor surgery in women with metastatic breast cancer at diagnosis is contentious. A subset of patients who will benefit from aggressive local treatment is needed to be identified. Using a nationwide database, we developed and validated a predictive model to identify long-term survivors among patients who had undergone primary tumor surgery.METHODS:A total of 150,043 patients were enrolled in the Korean Breast Cancer Registry between January 1990 and December 2014. Of these, 2332 (1.6%) presented with distant metastasis at diagnosis. Using Cox proportional hazards regression, we developed and validated a model that predicts survival in patients who undergo primary tumor surgery, based on the clinicopathological features of the primary tumor.RESULTS:A total of 2232 metastatic breast cancer patients were reviewed. Of these, 1541 (69.0%) patients had undergone primary tumor surgery. The 3-year survival rate was 62.6% in this subgroup. Among these patients, advanced T-stage, high-grade tumor, lymphovascular invasion, negative estrogen receptor status, high Ki-67 expression, and abnormal CA 15-3 and alkaline phosphatase levels were associated with poor survival. A prediction model was developed based on these factors, which successfully identified patients with remarkable survival (score 0-3, 3-year survival rate 87.3%). The clinical significance of the model was also validated with an independent dataset.CONCLUSIONS:We have developed a predictive model to identify long-term survivors among women who undergo primary tumor surgery. This model will provide guidance to patients and physicians when considering surgery as a treatment modality for metastatic breast cancer.

Background Neoadjuvant chemotherapy (NAC) is the standard treatment for patients withclinicallynode-positivebreastcancer. Anaxillarypathologiccompleteresponse (pCR) isassociatedwith excellentprognosis, andpatients whoachieveaxillarypCRcan besparedaxillarylymphnodedissection(ALND). Theaimofthisstudywastoassess the factors thatpredictedaxillarypCR and evaluateda model predicting ofaxillarypCR in our patient population. Methods We retrospectively identified 201 patients with clinically node-positive breast cancer who were treated with NAC and underwent ALND between 2010 and 2015 at Seoul St. Mary's Hospital, Catholic University ofKorea. We analyzed the Baseline patient and tumor characteristics, clinical tumor response rate, pathologic nodal responses.Thetumorresponseratewascalculatedbytherateoftumorandnodalsize reductionbytheResponseEvaluationCriteriainSolidTumorsver.1.1.Theoverall predictionofthemodelincludingtumorresponseratewasassessedbythe discriminative performance by receiver operating characteristic (ROC) curve analysis. Results AxillarypCR was achieved for68 patients (33.8%) who underwentALND after NAC.Patientspresentingwithhighnucleargrade[grade3vs.1 and2,oddsratio(OR) 2.59], higherKi-67 value [>14% vs.(14%, odds ratio (OR) 1.97] andtumorresponse rate [>47.1% vs. < 47.1%, odds ratio (OR) 3.86] were morelikelyto achieve nodalpCR. In multivariate analysis, tumor response rate was the only independent predictor of a pCR (p = 0.0006). The analysis oftumor response ratevalues revealed that 47.1%was a reasonablecutoffvalueforpredictingtheresponsetonodalpCR.Thediscriminationof the model using tumor response rate status versus excluding tumor response rate status [areaunderthecurve(AUC)67.5%,95%CI,0.59-0.76]wassignificantlyimproved using tumorresponseratestatus[areaunderthecurve(AUC) 74.9%,95% CI, 0.68-0.82, P=0.01]. Conclusions Tumor response rate can predict axillary pCR in node-positive patients receiving NAC. This prediction model including tumor response rate shows reasonable accuracy for predicting axillary pCR and may have utility for informing treatment decisions. Legal entity responsible for the study Seoul St. Mary's Hospital Funding Seoul St. Mary's Hospital Disclosure All authors have declared no conflicts ofinterest.