Cargando…

Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab

Breast cancer related lymphedema (BCRL) is frequent but strategies for an individualized risk assessment are lacking. We aimed to define whether tumor-specific pathological features, coupled with clinical and therapeutic data, could help identify patients at risk. Data from 368 patients with node-po...

Descripción completa

Detalles Bibliográficos
Autores principales: Invernizzi, Marco, Michelotti, Anna, Noale, Marianna, Lopez, Gianluca, Runza, Letterio, Giroda, Massimo, Despini, Luca, Blundo, Concetta, Maggi, Stefania, Gambini, Donatella, Fusco, Nicola
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406664/
https://www.ncbi.nlm.nih.gov/pubmed/30682851
http://dx.doi.org/10.3390/jcm8020138
_version_ 1783401368600444928
author Invernizzi, Marco
Michelotti, Anna
Noale, Marianna
Lopez, Gianluca
Runza, Letterio
Giroda, Massimo
Despini, Luca
Blundo, Concetta
Maggi, Stefania
Gambini, Donatella
Fusco, Nicola
author_facet Invernizzi, Marco
Michelotti, Anna
Noale, Marianna
Lopez, Gianluca
Runza, Letterio
Giroda, Massimo
Despini, Luca
Blundo, Concetta
Maggi, Stefania
Gambini, Donatella
Fusco, Nicola
author_sort Invernizzi, Marco
collection PubMed
description Breast cancer related lymphedema (BCRL) is frequent but strategies for an individualized risk assessment are lacking. We aimed to define whether tumor-specific pathological features, coupled with clinical and therapeutic data, could help identify patients at risk. Data from 368 patients with node-positive breast cancers were retrospectively collected, including 75 patients with BCRL (0.4–25.6 years follow-up). BCRL was assessed during the standard follow-up oncology visits using the circumferential measurement. Clinicopathologic and therapeutic factors associated with BCRL were integrated into a Cox proportional hazards regression model. Lymphovascular invasion (LVI) was more common in BCRL patients (n = 33, 44% vs. n = 85, 29%, p = 0.01), akin extra nodal extension (ENE) of the metastasis (n = 57, 76% vs. n = 180, 61%, p = 0.02). Sentinel lymph node excision without axillary dissection and extra-axillary radiotherapy were BCRL-unrelated. A higher number of BCRL-positive patients were treated with taxane-based chemotherapy with or without trastuzumab, compared to BCRL-negative patients (p < 0.01). Treatment with trastuzumab and/or taxanes, adjusted for systemic infections, laterality, therapy, and pathological features (i.e., LVI and ENE), had a significant impact in BCRL-free survival (p < 0.01). This work offers new insights on BCRL risk stratification, where the integration of clinical, therapeutic, and tumor-specific pathological data suggests a possible role of anti-human epidermal growth factor receptor 2 (HER2) therapy in BCRL pathogenesis.
format Online
Article
Text
id pubmed-6406664
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-64066642019-03-22 Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab Invernizzi, Marco Michelotti, Anna Noale, Marianna Lopez, Gianluca Runza, Letterio Giroda, Massimo Despini, Luca Blundo, Concetta Maggi, Stefania Gambini, Donatella Fusco, Nicola J Clin Med Article Breast cancer related lymphedema (BCRL) is frequent but strategies for an individualized risk assessment are lacking. We aimed to define whether tumor-specific pathological features, coupled with clinical and therapeutic data, could help identify patients at risk. Data from 368 patients with node-positive breast cancers were retrospectively collected, including 75 patients with BCRL (0.4–25.6 years follow-up). BCRL was assessed during the standard follow-up oncology visits using the circumferential measurement. Clinicopathologic and therapeutic factors associated with BCRL were integrated into a Cox proportional hazards regression model. Lymphovascular invasion (LVI) was more common in BCRL patients (n = 33, 44% vs. n = 85, 29%, p = 0.01), akin extra nodal extension (ENE) of the metastasis (n = 57, 76% vs. n = 180, 61%, p = 0.02). Sentinel lymph node excision without axillary dissection and extra-axillary radiotherapy were BCRL-unrelated. A higher number of BCRL-positive patients were treated with taxane-based chemotherapy with or without trastuzumab, compared to BCRL-negative patients (p < 0.01). Treatment with trastuzumab and/or taxanes, adjusted for systemic infections, laterality, therapy, and pathological features (i.e., LVI and ENE), had a significant impact in BCRL-free survival (p < 0.01). This work offers new insights on BCRL risk stratification, where the integration of clinical, therapeutic, and tumor-specific pathological data suggests a possible role of anti-human epidermal growth factor receptor 2 (HER2) therapy in BCRL pathogenesis. MDPI 2019-01-24 /pmc/articles/PMC6406664/ /pubmed/30682851 http://dx.doi.org/10.3390/jcm8020138 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Invernizzi, Marco
Michelotti, Anna
Noale, Marianna
Lopez, Gianluca
Runza, Letterio
Giroda, Massimo
Despini, Luca
Blundo, Concetta
Maggi, Stefania
Gambini, Donatella
Fusco, Nicola
Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab
title Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab
title_full Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab
title_fullStr Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab
title_full_unstemmed Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab
title_short Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab
title_sort breast cancer systemic treatments and upper limb lymphedema: a risk-assessment platform encompassing tumor-specific pathological features reveals the potential role of trastuzumab
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406664/
https://www.ncbi.nlm.nih.gov/pubmed/30682851
http://dx.doi.org/10.3390/jcm8020138
work_keys_str_mv AT invernizzimarco breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab
AT michelottianna breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab
AT noalemarianna breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab
AT lopezgianluca breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab
AT runzaletterio breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab
AT girodamassimo breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab
AT despiniluca breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab
AT blundoconcetta breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab
AT maggistefania breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab
AT gambinidonatella breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab
AT fusconicola breastcancersystemictreatmentsandupperlimblymphedemaariskassessmentplatformencompassingtumorspecificpathologicalfeaturesrevealsthepotentialroleoftrastuzumab