C. Mazouni (Villejuif, France)

Institut Gustave Roussy

Author Of 2 Presentations

 On-Demand ePoster Display

50P - Early breast cancer in women aged 35 years or younger: a French population-based case control-matched analysis

Abstract

Background

There is a scarcity of data exploring prognostic factors in young patients with breast cancer (BC), and the independent negative impact of age by itself is still debated. We aimed to assess shared and intrinsic prognostic factors in a large cohort of patients aged 35 years or younger, compared to a control group aged from 36 to 50.

Methods

Patients ≤50 years old were retrospectively identified from a large cohort of 23 134 early BC patients who underwent primary surgery in 18 academic centers between 1990 and 2014. Multivariate Cox analysis aiming to identify factors associated with disease-free and overall survival (DFS and OS) were built for the total cohort, and then for the ≤35 years cohort only. To further assess the independent impact of age on DFS and OS, 1 to 3 case control analysis was performed by matching ≤35 and 36 to 50 according to histology, grade, tumor size, lymphovascular invasion (LVI), nodal status, endocrine receptors (ER), endocrine therapy (ET) and chemotherapy (CT).

Results

On 6 481 patients included, 556 were aged ≤35 years, and 5 925 from 36 to 50. Compared to the 36-50 group, age ≤35 was significantly associated with larger tumors, higher grade, ER negativity, macroscopic lymph node involvement, LVI, and higher rates of mastectomy and chemotherapy use. In multivariate analysis, age ≤35 was associated with worse DFS (HR 1.59, 95% CI 1.35-1.88; p<0.001), and OS (HR 1.32, 95% CI 1.06-1.64; p=0.014), as were high grade, large tumor size, LVI, macroscopic lymph node involvement, ER negativity, and absence of ET or CT. Adverse prognostic impact of age ≤35 was maintained in the case control-matched analysis for DFS (HR 1.56, 95%CI 1.28-1.91, p<0.001), and OS (HR 1.33, 95%CI 1.02-1.73, p=0.032). When considering patients ≤35 for multivariate analysis, only ER, tumor size, lymph node involvement and LVI remained statistically significantly associated with OS and DFS.

Conclusions

An age ≤35 years is associated with less favorable features at BC diagnosis, and more aggressive treatment strategies. Our results support the poor prognosis value of young age, which independently persisted when adjusting for other prognostic factors and treatments, as well as in the control-matched analysis.

Legal entity responsible for the study

Institut Paoli-Calmettes.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Collapse

83P - Axillary Reverse Mapping Using Near-infrared fluorescence Imaging in Invasive Breast Cancer (ARMONIC Study)

Abstract

Background

Axillary lymph node dissection (ALND) in patients with breast cancer has the potential to induce side effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the breast from that of the upper limb in the axillary lymph node (LN) basin. We aimed to determine ARM node identification rate by near-infrared (NIR) fluorescence imaging during total mastectomy with ALND and then to analyze potential predictive factors of ARM node involvement.

Methods

The study enrolls 119 patients diagnosed with invasive breast cancer with an indication for ALND. NIR imaging using indocyanine green dye was finally performed in 109 patients during standard ALND to identify ARM nodes and their corresponding lymphatic’s ducts, both in case of direct surgery than neoajduvant chemotherapy.

Results

94.5% of patients had ARM nodes identified. No difference was found between the 2 groups, with or without neoajuvant chemotherapy.The ARM nodes were localized in D zone in 64.4% of cases. The rate of metastatic axillary lymph nodes was 55.3 % in the all cohort, 19.4 % also in ARM nodes with 7.7% of metastatic ARM lymph nodes in D zone. Two patients had metastatic ARM lymph nodes and not in the remaining axillary lymph nodes. Beside number of mitosis (p 0.04), no predictive factor of ARM nodes involvement was found

ARM ARM Total
neg pos
ALND neg 44.7% 1.9% 46.6%
ALND pos 35.9% 17.4% 53.4%
TOTAL 80.6% 19.4% 100%
.

Conclusions

Axillary reverse mapping by NIR fluorescence imaging appears as a reliable technique to identify in realtime arm node when ALND. Performing pre-operative chemotherapy, a known factor of lymphatics modification, did not significantly influence the detection rate. Our study shows that ARM node is a potential drainage route of cancer cells, finding metastasis in 19.4% of cases, raising the question on its impact on the prognosis. The collected clinical data compared with arm node histological diagnosis showed only the number of mitosis in diagnostic biopsy as a potential predictive factor of arm node involvement.

Legal entity responsible for the study

PHRC of French National Institute for Cancer.

Funding

French INCa agency (French National Institute for Cancer), grant PHRC K15-222.

Disclosure

All authors have declared no conflicts of interest.

Collapse