Capítulo 2. Periferias urbanas y escuela
2.2. Jóvenes en el instituto
2.2.2. El instituto: aquellos tiempos de “éxito” y de “prestigio”
There were nineteen published studies (Table 3.2), comprising data on 12, 893 patients, reported that the presence of LVI was associated with reduced survival, primarily relapse free survival, in primary breast cancer (Clayton, 1991; Clemente et al., 1992; Neville, 1992; Gasparini 1994; Genta et al., 1994; Nixon et al., 1994; Lauria et al., 1995; D'Eredita et al., 2001; Fisher et al., 2001; Kato et al., 2003; Schoppmann et al., 2004; Dinshaw et al., 2005; Arnaout-Alkarain et al., 2007; Yamauchi et al., 2007; Gudlaugsson et al., 2011; Kurebayashi et al., 2012; Tezuka et al., 2007; Mohammed et al., 2011; Matsunuma et al., 2012).
Six of these studies reported prognostic value of LVI independent of T stage and lymph node status (Nixon et al., 1994; Lauria et al., 1995; Schoppmann et al., 2004; Dinshaw et al., 2005; Yamauchi et al., 2007; Kurebayashi et al., 2012). One of these studies examined the prognostic significance of LVI in three different areas (intra-tumoural area, non- tumoural area and advanced tumoural area) using H&E and D2-40 staining, reported that LVI predicted poorer relapse free survival independently regardless of the area examined or stain used, and that number of LVI identified gradually increased from the intra- tumoural area to the non-tumoural area (Yamauchi et al., 2007).
Six studies reported prognostic value of the LVI in patients with node negative breast cancer (Clayton, 1991; Neville, 1992; Lauria et al., 1995; Arnaout-Alkarain et al., 2007; Gudlaugsson et al., 2011; Mohammed et al., 2011) five of them were independent of T stage (Clayton, 1991; Neville, 1992; Lauria et al., 1995; Gudlaugsson et al., 2011; Mohammed et al., 2011).
Two studies, comprising data on 1056 patients, reported that the presence of LVI was not associated with cancer specific survival in primary breast cancer (Rosen et al., 1991;
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91 Saimura et al., 1999), both studies used homogenous group of patients with node negative tumours though sample size were relatively small.
The majority of the studies (19/21) reported that LVI was a predictor of poor relapse free, overall or cancer specific survival. Most of these studies (15/21) detected the presence of LVI in peri-tumural area using H&E stained sections. Six recent studies used immunostaining, four of which reported independent prognostic value (Table. 3.4). The overall weighted average of LVI was 33% using H&E and 25% using immunostaining. The rate of LVI using H&E was wide ranging from 10-49% and was narrower using immunostaining ranging from 21-42%.
In conclusion, there is good evidence from the majority of studies (19/21) that the presence of LVI predicted poorer outcomes in patients with primary operable breast cancer. Further, LVI provides independent prognostic information in subgroup of patients with node negative breast cancer. Half of the studies were conducted on relatively large number of patients and reported a high rate of LVI. Giving that the weighted average of LVI was similar using H&E and IHC and that the rate of LVI was narrower using immunostaining, immunostaining appears to be more reliable approach to identify LVI in patients with primary operable breast cancer.
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Table 3-2 Lymphatic vessel invasion (LVI) in primary operable breast cancer
Author Patients n. (LVI %) Follow up months Lymph node status
Location Technique Comment
Clayton, 1991 378 (20) 182 -ve LN Peri-tumoural H&E Predicts poor CSS independently
Rosen et al., 1991 293 (12) 238 -ve LN N/D H&E No significant association with
survival
Clemente et al., 1992 506 66 -ve LN Peri-tumoural H&E Predicts poorer OS and RFS in
both routine and re-viewed reports Neville et al., (1992) 1203 (42) 60 -ve LN Peri-tumoural H&E Predicts poorer RFS independently Gasparini et al., (1994) 254 (10) 62 -ve LN Peri-tumoural H&E Predicts poorer RFS independently
Genta et al., (1994) 318 (49) 102 mixed Peri-tumoural H&E Predicts poorer OS and RFS
independently
Nixon et al., (1994) 1398 (29) 99 mixed N/D H&E Predicts poorer RFS independently
Lauria et al., (1995) 1408 (34) 76 mixed Peri-tumoural H&E Predicts increased risk of death in both node negative and positive subgroups
Saimura et al., (1999) 763 (35) 74 -ve LN N/D H&E No significant association with
survival
D'Eredita et al., (2001) 402 (15) 120-192 mixed Peri-tumoural H&E Predicts poorer OS
Fisher et al., (2001) 1036 (N/D) 180 mixed N/D H&E Predicts poorer OS
Kato et al., (2003) 509 (23) 108 mixed N/D H&E Predicts poorer OS and RFS
Schoppmann et al., (2004)
374 (28) 268 mixed Intra-tumoural
Invasive area
D2-40 Predicts poorer OS and RFS independently
Chapter 3 93 independently Arnaout-Alkarain et al., (2007) 303 D2-40 (27) H&E (17.5)
89 -ve LN Invasive area H&E
D2-40, CD31
Predicts poorer OS
Tezuka et al., (2007) 131
D2-40 (42), H&E (51)
69 mixed Peri-tumoural Intra-
tumoural H&E, D2-40, CD34 Predicts poorer RFS Yamauchi et al., (2007) 151 H&E: Intra-tumoural area (13) Non tumour area (34) Advance tumour area (23) D2-40:
Intra-tumoural area (20) Non tumour area (46)
Advance tumour area (26)
101 mixed Intra-tumoural
Non tumour area Advance tumour area
H&E,D2-40 Predicts poorer RFS independently
Gudlaugsson et al., (2011)
240 (21) 117 -ve LN Intra-tumoural
Peri-tumoural
D2-40, p63 D2-40+ve/p63-ve predicts poorer OS independently when only combined with high PPH3 in older women
Mohammed et al., (2011) 1005 (21) 107 -ve LN Intra-tumoural
Peri-tumoural
CD34, CD31, D2-40
Predicts poorer OS and RFS independently
Kurebayashi et al., (2012)
261 (3)
≥4 LVI/specimen
99 mixed Peri-tumoural H&E Predicts poorer RFS and CSS particularly with PR -ve and high Ki67
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94 Matsunuma et al., (2012) 1994(45) All
(30) extensive
112 +ve LN N/D H&E Predicts poorer RFS independently
Follow-up (Mean/median), N/D: not described, CSS cancer specific survival, OS overall survival, RFS relapse free survival, PPH3 phosphohistone H3, PR progesterone receptor, Ki67 tumour proliferation index.
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