Pozdravljeni!
Tudi letos je v San Antoniu veliki simpozij o raku dojke. Tukaj sem prilepil zelo zanimiv članek, ki je čisto nov, in govori o tem,da 70-genski podpis posameznega tumorja v dojki lahko precej bolje napove verjetnost ponovitve bolezni v prvih 10-ih letih po diagnozi karcinoma in to predvsem pri bolnicah z 1-3 pozitivnimi aksilarnimi bezgavkami.Gre za to,da se tiste, ki so uvrščene v low-risk group, se pravi nizko rizične bolnice, lahko izognejo agresivni kemoterapiji. Skratka, preberite si;)

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[1064] The Amsterdam 70-gene signature predicts outcome in breast cancer patients with 1-3 positive axillary lymph nodes.

Mook S, Rutgers EJT, Peterse JL, Nuyten DSA, Horlings H, van de Vijver MJ, van ‘t Veer LJ. Netherlands Cancer Institute, Amsterdam, Netherlands

Introduction
The axillary lymph node status is considered to be the most powerful prognostic factor for operable breast cancer, with a direct relationship between number of positive nodes and disease outcome. However, approximately 30% of lymph node-positive patients will remain free of distant metastases without adjuvant chemotherapy. Identifying patients with lymph node-positive disease who are at low risk of recurrence might lead to changes in guidelines for adjuvant chemotherapy. The aim of this study was to identify a low risk group with an excellent disease outcome in breast cancer patients with 1-3 positive lymph nodes, using the 70-gene signature (MammaPrint).
Methods
One-hundred-six patients with 1-3 positive lymph nodes were separately selected from the previous described series of 295 patients (Van de Vijver et al. NEJM 2002). Patients were diagnosed between 1984 and 1995 at the Netherlands Cancer Institute, and under the age of 53 at diagnosis. Tumors were primary invasive breast carcinomas less than 5 cm, treated by modified radical mastectomy or breast-conserving therapy, including dissection of the axillary lymph nodes. Eighty-two percent received adjuvant systemic treatment, consisting of chemotherapy (59,4%), hormonal therapy (12,3%) or a combination (10,4%). Gene expression signatures had been obtained previously; clinical follow-up data were updated.
Results
Of the 106 patients 18 developed distant metastasis, and 88 were free of disease at a median follow-up of 10.3 years. The median time to distant metastasis was 2.8 years. Using the 70-gene signature 43 patients were classified as having a good-prognosis signature, while 63 patients were classified as having a poor-prognosis signature. At 10 years, the probability of remaining free of distant metastases and overall survival was 94% (SE 4%) and 97% (SE 3%) in patients with a good-prognosis signature versus 66% (SE 7%) and 62% (SE 7%) in those with a poor-prognosis signature, respectively. The estimated hazard ratio (HR) for overall survival in the poor-prognosis signature group as compared with the good-prognosis signature group was 7.0 (95% CI 2.1-23.3). When adjusted for clinicopathological prognostic factors, the 70-gene signature was the strongest predictor with an estimated HR for overall survival of 4.2 (95% CI 1.0-17.7). Other independent prognostic factors were angioinvasion and adjuvant systemic therapy with hazard ratios of 2.7 (95% CI 1.1-6.7) and 0.3 (95% CI 0.1-0.8) respectively.
Conclusion
Our results show that the 70-gene signature outperforms other prognostic factors in selecting a low risk group that has a 10-year survival of > 90%. After validation in an independent sample series the prognostic value of the 70-gene signature in patients with 1-3 positive nodes will be prospectively validated in the MINDACT trial. Incorporation of the 70-gene signature in clinical decision-making for patients with 1-3 positive nodes may lead to reconsider the need of adjuvant chemotherapy.

Spodaj pa se link do povezave:

http://www.abstracts2view.com/sabcs/view.php?nu=SABCS07L_630