Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.
PROGNOSTIC AND
PREDICTIVE FACTOR IN
BREAST CANCER
Dr ANKITA SINGH PATEL
MBBS,MD(KGMU)
CONSULTANT
Apex Hospital Cancer Inst...
 Tumor size (all 3 dimensions)
 Tumor type
 Tumor grade (Modified Richardson Bloom Score)
 Presence of extensive intra...
 Prognostic factor defined as measurement taken at time
of diagnosis or treatment that is associated with outcome.
 Pred...
CATEGORY I : They were proven to be of prognostic importance and
useful in clinical patient management.
CATEGORY II: Facto...
Category I
1. Tumor size
2. Lymph node status
3. Micrometastasis
4. Histological grade
5. Mitotic count
6. Hormonal recept...
Strongest predictors of distant metastasis, disease-free,
and overall survival.
Strongly correlates with the presence and ...
2) Axillary Nodal Status
 Primary factor that governs breast cancer staging .
 Strongest predictor of disease-free and o...
5-year survival
rate
Category I Node negative 82.8%
Category II 1 to 3 LN+ve 73%
Category III 4 to 12 LN +ve 45.7%
Categor...
 By using a combination of blue dye and radiolabeled colloid
techniques the sentinel node can be identified in >95% of
ca...
 The tubular, mucinous, and medullary subtypes have been
shown to have a more favorable prognosis, compared to
invasive d...
The Scarff-Bloom-Richardson classification system utilizes
 mitotic index
 differentiation
 pleomorphism
each with scor...
 Patients with hormonal receptors have a significantly
higher survival rate .
 LIGAND BINDING ASSAY
Estrogen – I-125 estradiol
Progesteron – H3-R5020
considered to be positive if ER>3fmol/mg of
prote...
 IHC – Antibodies against receptor are used
 Receptor +ve if score >2
NO OF +VE CELLS INTENSITY OF STAINING
None o O no ...
Receptor status Pre menopausal Post menopausal
ER/PR + 45% 63%
ER/PR - 28% 17%
ER+ only 12% 15%
witteff jl.steroid harmone...
 Also a independent prognostic factor.
 Rosen et al. (632)
RECURRENCE
RATE
LVI-positive (stage I) 38%
LVI-negative
patie...
 Proliferative rate of a tumor is correlate with distant
metastasis and survival.
 The most common marker are the fracti...
 Measured by flow cytometry
 Toikkanen et al. (746), in 351 patients monitored for a
minimum of 22 years, observed a 25-...
 Member of EGFR family
 Also k/a CD340 & p185
 Her2 is a cell membrane surface bound receptor tyrosine
kinase
 Her2 ge...
 IHC
 FISH – Probe tagged with fluorescent label if >2 fluorescent light
come out cell considered to be overexpressing H...
Bilous M, et al. Mod Pathol 2003;16:173–82
FISH
Patient Tumour Sample
Transtuzumab
therapy
+–2+ 3+1+0
+–
FISH
IHC
Transtuz...
 TRANSTUZUMAB(herceptin)-
- Monoclonal antibody.
- Acts on cell membrane bound her 2 receptor.
- Duration- 1 yr.
- Initia...
 The p53 is a tumor suppressor gene .
 Encodes a nuclear phosphoprotein that is thought to be
important to cell cycle re...
 Node-negative patients with low UpA/PAI-1 have an
excellent prognosis .
 Based on DNA-microarray technologies .
 Mamma Print is a 70 gene signature developed in Nethetland,
approved by FDA in ...
RESULT:
 LOW RISK: <10% risk of coming back within 10 years w/o
any additional treatment after surgery .
 With hormonal...
 Analyzes 80 different genes to classify your tumor into its own
unique molecular subtype.
 Different molecular subtypes...

TargetPrint is a test that will determine if you are a candidate for
hormonal treatment.
 It quantifies your ER, PR, an...
The Oncotype DX assay is based on reverse
transcriptase polymerase chain reaction assays.
 To quantify expression of sel...
A. Estimate the risk of recurrence of early stage ,hormonal
receptor +ve ca breast .
B. Estimate how much she will be bene...
 Young age(35 year) is a predictor of local relapse following
breast-conserving surgery.
 It has prognostic significance...
African American women are commonly diagnosed with more
advanced stages of breast cancer than white women
 On multivariate analysis, obesity remained a statistically
significant prognostic factor after controlling for tumor siz...
 The RRs for smokers and exsmokers, compared with those
who had never smoked, is 1.44 and 1.13, respectively.
Women with primary childbirth between 20 - 29 years,
significantly reduced risk of death compared with women
with primary ...
Medially located tumors have a poorer prognosis than laterally
located tumors.
Gaffney et al. demonstrated that the hazard...
 CA 15-3 is a used tumor marker in carcinoma of the breast.
 Its role in the management of patients with early disease
i...
 Thank you…….
PROGNOSTIC AND PREDICTIVE FACTORS FOR METASTATIC CARCINOMA BREAST
PROGNOSTIC AND PREDICTIVE FACTORS FOR METASTATIC CARCINOMA BREAST
PROGNOSTIC AND PREDICTIVE FACTORS FOR METASTATIC CARCINOMA BREAST
PROGNOSTIC AND PREDICTIVE FACTORS FOR METASTATIC CARCINOMA BREAST
PROGNOSTIC AND PREDICTIVE FACTORS FOR METASTATIC CARCINOMA BREAST
PROGNOSTIC AND PREDICTIVE FACTORS FOR METASTATIC CARCINOMA BREAST
PROGNOSTIC AND PREDICTIVE FACTORS FOR METASTATIC CARCINOMA BREAST
PROGNOSTIC AND PREDICTIVE FACTORS FOR METASTATIC CARCINOMA BREAST
Nächste SlideShare
Wird geladen in …5
×
Nächste SlideShare
Teratoma
Weiter

Teilen

PROGNOSTIC AND PREDICTIVE FACTORS FOR METASTATIC CARCINOMA BREAST

PROGNOSTIC AND PREDICTIVE FACTORS FOR BREAST CANCER.

Ähnliche Bücher

Kostenlos mit einer 30-tägigen Testversion von Scribd

Alle anzeigen

Ähnliche Hörbücher

Kostenlos mit einer 30-tägigen Testversion von Scribd

Alle anzeigen

PROGNOSTIC AND PREDICTIVE FACTORS FOR METASTATIC CARCINOMA BREAST

  1. 1. PROGNOSTIC AND PREDICTIVE FACTOR IN BREAST CANCER Dr ANKITA SINGH PATEL MBBS,MD(KGMU) CONSULTANT Apex Hospital Cancer Institute TRAINING AND FELLOWSHIP Fortis Research Institute ,New Delhi Tata Memorial Hospital,MUMBAI Mob. 8765845035,9305421547 Email: dr.ankitapatel.onco@gmail.com WEBSITE: www.apexhospitalvaranasi.com
  2. 2.  Tumor size (all 3 dimensions)  Tumor type  Tumor grade (Modified Richardson Bloom Score)  Presence of extensive intraductal carcinoma(EIC)  Lymphovasular embolism  Cut margin status  Num of positive/total axillary lymph node dissected  Receptor status : ER/PR (IHC or EIA) Gross positive cut margin Extensive involvment of a cut margin or more than 3 foci of invasive or in situ carcinoma in any inked margin (requires revision excision or mastectomy) False positive cut margin Is 3 or less foci of invasive or in situ carcinoma in any inked margin (revision surgery only if EIC positive) EIC Presence of DCIS in>25% of any low power field within or outside the tumor and is a strong predictor of local recurrence after BCT.
  3. 3.  Prognostic factor defined as measurement taken at time of diagnosis or treatment that is associated with outcome.  Predictive factor is a measurement that predict response or lack of response to a specific treatment.  Prognostic factors for systemic relapses and for local relapse differ significantly
  4. 4. CATEGORY I : They were proven to be of prognostic importance and useful in clinical patient management. CATEGORY II: Factors had been extensively studied biologically and clinically, but their importance remains to be validated in studies. CATEGORY III: Included all other factors not sufficiently studied to demonstrate their prognostic value.
  5. 5. Category I 1. Tumor size 2. Lymph node status 3. Micrometastasis 4. Histological grade 5. Mitotic count 6. Hormonal receptor status Category II 1. HER-2/neu expression 2. p53 mutation 3. Lymphovascular invasion 4. DNA ploidy Category III 1. Tumor angiogenesis 2. EGFR 3. Transforming growth factor
  6. 6. Strongest predictors of distant metastasis, disease-free, and overall survival. Strongly correlates with the presence and number of involved axillary lymph nodes. Rosen et al. (632)--: Recurrence-free survival rate Tumor size 88% <1 cm 72% 1.1 to 3 cm 59% 3.1 to 5 cm
  7. 7. 2) Axillary Nodal Status  Primary factor that governs breast cancer staging .  Strongest predictor of disease-free and overall survival.  Direct relationship between the number of axillary nodes involved and the risk of distant metastasis.  There are four prognostic category.
  8. 8. 5-year survival rate Category I Node negative 82.8% Category II 1 to 3 LN+ve 73% Category III 4 to 12 LN +ve 45.7% Category IV >13 LN+ve 28.4%
  9. 9.  By using a combination of blue dye and radiolabeled colloid techniques the sentinel node can be identified in >95% of cases.  Prognosis of sentinel node-negative patients is similar to node-negative patients who have undergone a complete axillary dissection.
  10. 10.  The tubular, mucinous, and medullary subtypes have been shown to have a more favorable prognosis, compared to invasive ductal.  Invasive lobular tumors appear to have a prognosis similar to invasive ductal tumors.  Poor prognostic categories include metaplastic, undifferentiated.  Rosen et al. reported more favorable relapse rates in medullary, mucinous, tubular, and papillary subtypes, compared to invasive ductal and invasive lobular tumors.
  11. 11. The Scarff-Bloom-Richardson classification system utilizes  mitotic index  differentiation  pleomorphism each with scores of 1 to 3.  This is commonly employed and has been shown to be of independent prognostic significance. SCORE DEGREE OF DIFFERENTIATION 3 to 5 well differentiated 6 to 7 moderately differentiated 8 to 9 poorly differentiated
  12. 12.  Patients with hormonal receptors have a significantly higher survival rate .
  13. 13.  LIGAND BINDING ASSAY Estrogen – I-125 estradiol Progesteron – H3-R5020 considered to be positive if ER>3fmol/mg of protein
  14. 14.  IHC – Antibodies against receptor are used  Receptor +ve if score >2 NO OF +VE CELLS INTENSITY OF STAINING None o O no staining < 1/100 1 1 weak 1/100 – 1/10 2 2 Intermediate 1/10 - 1/3 3 3 strong 1/3 - 2/3 4 > 2/3 5
  15. 15. Receptor status Pre menopausal Post menopausal ER/PR + 45% 63% ER/PR - 28% 17% ER+ only 12% 15% witteff jl.steroid harmone receptors in breast cancer. cancer 53:630,1984 ER+PR+ (25%) ER+PR- (7.4%) ER-PR+ (21.1%) ER-PR- (46.5%) Receptor status in Indian population Tata Memorial Hospital Breast. 2000 Oct;9(5):267-70
  16. 16.  Also a independent prognostic factor.  Rosen et al. (632) RECURRENCE RATE LVI-positive (stage I) 38% LVI-negative patients(stage I) 22%
  17. 17.  Proliferative rate of a tumor is correlate with distant metastasis and survival.  The most common marker are the fraction of cells in S- phase (SPF), TLI, mitotic index, or antibodies directed against proliferative markers such as Ki-67 and PCNA (proliferating cell nuclear antigen).  Thymidine labeling represents the fraction of cells in the S-phase of the cell cycle .  TLI is able to identify patients at different levels of risk for locoregional or distant metastases .
  18. 18.  Measured by flow cytometry  Toikkanen et al. (746), in 351 patients monitored for a minimum of 22 years, observed a 25-year survival rate of 28% for patients with nondiploid tumors, in contrast to 48% for those with a diploid DNA pattern. LOW GRADE DIPLOID BETTER PROGNOSIS ER+VE HIGH GRADE ANEUPLOID POOR PROGNOSIS ER-VE
  19. 19.  Member of EGFR family  Also k/a CD340 & p185  Her2 is a cell membrane surface bound receptor tyrosine kinase  Her2 gene is a proto-oncogene located at long arm of ch.17.  Neu terminology is used, as it was derived from a rodent glioblastoma cell line, a type of neural tumor .  15-20% of breast cancers have an amplification of Her2neu gene.  Over-expression of this receptor in breast cancer is associated with increased disease recurrence and worse prognosis.
  20. 20.  IHC  FISH – Probe tagged with fluorescent label if >2 fluorescent light come out cell considered to be overexpressing HER - 2 SCORING GRADING 0 Absence of staining or < 10% cells are +ve 1 Weak & incomplete staining in > 10% cells 2 Weak & moderate staining in > 10 % cells 3 Strong & complete staining in >10 % cells
  21. 21. Bilous M, et al. Mod Pathol 2003;16:173–82 FISH Patient Tumour Sample Transtuzumab therapy +–2+ 3+1+0 +– FISH IHC Transtuzumab therapy Transtuzumab therapy
  22. 22.  TRANSTUZUMAB(herceptin)- - Monoclonal antibody. - Acts on cell membrane bound her 2 receptor. - Duration- 1 yr. - Initial trastuzumab dose of 4 mg/kg i.v. over 90 minutes, followed by a weekly maintenance dose of 2 mg/kg i.v. administered over 30 minutes if the initial dose is well tolerated - Toxicity- cardiac dysfunctioning.
  23. 23.  The p53 is a tumor suppressor gene .  Encodes a nuclear phosphoprotein that is thought to be important to cell cycle regulation and DNA repair and that also may regulate induction of apoptosis by ionizing radiation .  Most frequently mutated in sporadic breast cancer.
  24. 24.  Node-negative patients with low UpA/PAI-1 have an excellent prognosis .
  25. 25.  Based on DNA-microarray technologies .  Mamma Print is a 70 gene signature developed in Nethetland, approved by FDA in 2007.  It analyses 70 genes from an early stage breast cancer tissue sample to figure out if the cancer has LOW RISK or HIGH RISK of coming back in 10 years.  ELIGIBILITY:  Stage I and II  Invasive  <5cm  ER+
  26. 26. RESULT:  LOW RISK: <10% risk of coming back within 10 years w/o any additional treatment after surgery .  With hormonal therapy risk reduces to 5%  HIGH RISK : cancer has 29% risk of coming back within 10years w/o additional treatment after surgery.
  27. 27.  Analyzes 80 different genes to classify your tumor into its own unique molecular subtype.  Different molecular subtypes respond differently to different categories of drugs.   High Risk patients can benefit by being further divided into subtypes that will help fine tune their treatment plans.  BluePrint also identifies a specific subtype of patient who will not benefit from chemotherapy.  -
  28. 28.  TargetPrint is a test that will determine if you are a candidate for hormonal treatment.  It quantifies your ER, PR, and HER2 levels, often referred to as “markers”, by measuring the messenger RNA (mRNA) gene- expression levels.  In certain circumstances it is critical to measure mRNA gene- expression levels for these markers in order to more precisely select what the best options are to treat your cancer.
  29. 29. The Oncotype DX assay is based on reverse transcriptase polymerase chain reaction assays.  To quantify expression of selected genes in paraffin- embedded tissues.  A panel of 16 cancer-related genes and five reference genes were employed to compute a recurrence score (0 to 100). RISK SCORE Low risk <18 Intermediate risk 18-30 High risk 31-100
  30. 30. A. Estimate the risk of recurrence of early stage ,hormonal receptor +ve ca breast . B. Estimate how much she will be benefited from CT after breast surgery. C. Estimate recurrance risk of DCIS or new invasive Ca in same breast. D. Estimate benefit from RT after surgery.
  31. 31.  Young age(35 year) is a predictor of local relapse following breast-conserving surgery.  It has prognostic significance for distant metastasis and overall survival .  Vanlemmens et al. (773) demonstrated that younger women had a higher proportion of patients with ER- negative and high-grade tumors, and lower disease-free and breast cancer specific survival.  In multivariate analysis, young age at diagnosis was an independent poor prognostic factor.
  32. 32. African American women are commonly diagnosed with more advanced stages of breast cancer than white women
  33. 33.  On multivariate analysis, obesity remained a statistically significant prognostic factor after controlling for tumor size, number of positive axillary lymph nodes, age at diagnosis, and adjuvant chemotherapy.  Recurrent disease OBESE 32% NON OBESE 19%
  34. 34.  The RRs for smokers and exsmokers, compared with those who had never smoked, is 1.44 and 1.13, respectively.
  35. 35. Women with primary childbirth between 20 - 29 years, significantly reduced risk of death compared with women with primary childbirth<20 years (20 to 24 years, RR = 0.88; 25 to 29 years, RR = 0.80). Women with a history of breast cancer should be reassured that there is no strong evidence to suggest that subsequent pregnancy will increase the risk of recurrence.
  36. 36. Medially located tumors have a poorer prognosis than laterally located tumors. Gaffney et al. demonstrated that the hazard ratio for inner quadrant location compared to outer quadrant is 1.27 . They postulate that this may be due to occult spread to internal mammary nodes.
  37. 37.  CA 15-3 is a used tumor marker in carcinoma of the breast.  Its role in the management of patients with early disease is controversial.  stage II and III breast cancer, CA 27-29 had a high probability of predicting posttreatment recurrence.
  38. 38.  Thank you…….
  • NaveenK143

    Sep. 12, 2021
  • nagasudharani1

    Jul. 17, 2021
  • AnuSharan1

    May. 29, 2021
  • RavishankarSingh52

    May. 27, 2021
  • khusubuparichha

    May. 5, 2021
  • RajavelThangavel1

    Apr. 8, 2021
  • lingba

    Apr. 4, 2021
  • MuokaChibuzor1

    Mar. 10, 2021
  • raghwendrasinghmathu

    Feb. 27, 2021
  • OjasviRamesh

    Feb. 26, 2021
  • NandakishoreBommeri

    Feb. 23, 2021
  • JDeekshanya

    Jan. 30, 2021
  • Drsachinbalevia

    Jan. 15, 2021
  • MonirBhuiyan3

    Nov. 4, 2020
  • cutiepiepoo

    Oct. 28, 2020
  • VanyaSrivastava3

    Sep. 18, 2020
  • AmareshBhowmik

    Aug. 17, 2020
  • JamunaJayachandran

    Aug. 6, 2020
  • manikumarsdr

    Aug. 6, 2020
  • MedhaYadav1

    Jun. 6, 2020

PROGNOSTIC AND PREDICTIVE FACTORS FOR BREAST CANCER.

Aufrufe

Aufrufe insgesamt

5.387

Auf Slideshare

0

Aus Einbettungen

0

Anzahl der Einbettungen

15

Befehle

Downloads

0

Geteilt

0

Kommentare

0

Likes

64

×