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Old 05-13-2009, 09:31 AM   #1
Lani
Senior Member
 
Join Date: Mar 2006
Posts: 4,778
another bit of dogma questioned--does LVI(lvasc invasn) really imply worse prognosis?

Lymphovascular Invasion Is Not an Independent Risk Factor for Breast Cancer Recurrence
[Eureka News Service]
Lymphovascular invasion was associated with poorer outcomes in patients already classified as having high risk breast cancer, but not in patients classified as having low-risk disease.
Prior studies have suggested that lymphovascular invasion by tumor cells was associated with poorer outcome. It has not been clear, however, whether lymphovascular invasion was sufficient reason to upstage a patient from a low-risk category to a high-risk category in the absence of other high-risk disease features.
In the current study, Bent Ejlertsen, M.D., Ph.D., of the Copenhagen University Hospital in Denmark, and colleagues examined the association between lymphovascular invasion and patient outcomes in more than 15,000 women diagnosed with breast cancer between 1996 and 2002 and included in the Danish Breast Cancer Cooperative Group registry.
Lymphovascular invasion was associated with a greater than two-fold increased risk of disease recurrence and nearly a 2.5-fold increased risk of death in women who were classified by other methods as having high risk of disease. It was not associated with a difference in outcomes for patients classified by other methods as having low-risk disease.
"Based on a cohort of more than 15,000 breast cancer patients, our results do not support that lymphovascular invasion has sufªficient independent prognostic influence to move patients from a low-risk group to a high-risk group," the authors conclude.
In an accompanying editorial, Nancy E. Davidson, M.D., of the University of Pittsburgh Medical School, and colleagues note that the newly reported data are in conflict with previous reports supporting the association between lymphovascular invasion and poorer patient outcomes. ".[T]he study gave the unexpected and somewhat disappointing result that lymphovascular invasion was associated with adverse outcome in patients who are at high risk for recurrence by other recognized prognostic factors, but not in those who are low risk by the same criteria," the editorialists write. "It is therefore apparently not useful as a means to subdivide the low risk group, the group in which many clinicians and patients would like assistance."

based on
ABSTRACT: Population-Based Study of Peritumoral Lymphovascular Invasion and Outcome Among Patients With Operable Breast Cancer
[Journal of the National Cancer Institute]
Background: Lymphovascular invasion has been associated with poor prognosis in women with breast cancer, but it is unclear whether the presence of lymphovascular invasion should be considered sufficient to reclassify breast cancer patients who are at a low risk of recurrence into a high-risk category.
Methods: Of the 16 172 patients with operable breast cancer who were entered into the Danish Breast Cancer Cooperative Group Registry from January 1, 1996, to December 31, 2002, lymphovascular invasion was classified at primary diagnosis in 16 121 patients as present (n = 2453, 15%) or as absent (n = 13 206, 82%). Patients with at least one of the risk criteria (positive lymph nodes, tumor size > 2 cm, high grade, hormone receptor-negative tumor, or younger than 35 years) were assigned to the high-risk group; the other patients were assigned to the low-risk group. All procedures, including report forms, central review, and querying, were specified in advance. Kaplan-Meier analyses were used to estimate disease-free intervals and overall survival rates among patients with and without lymphovascular invasion, and multivariable analysis was used to adjust for differences in baseline characteristics and therapy. All statistical tests were two-sided.
Results: Complete follow-up was achieved for 15 659 patients. The median estimated potential follow-up was 6.4 years for invasive disease-free interval and 7.7 years for overall survival. Invasive disease-free interval and overall survival were statistically significantly associated with lymphovascular invasion within the high-risk group (hazard ratio [HR] for invasive disease = 2.29, 95% confidence interval [CI] = 2.14 to 2.45, P < .001; and HR for death = 2.42, 95% CI = 2.25 to 2.61, P < .001) but not within the low-risk group. At 5 years after surgery, 65.4% (95% CI = 63.5% to 67.3%) and 85.2% (95% CI = 84.5% to 85.9%) of those in the high-risk group with and without lymphovascular invasion were alive; 98.1% (95% CI = 87.6% to 99.7%) and 94.1% (95% CI = 93.2% to 94.8%) of those in the low-risk group with and without lymphovascular invasion were alive. These differences persisted in a multivariable analysis, and for overall survival, a statistically significant interaction (P = .03) was observed between lymphovascular invasion and risk group.
Conclusions: In this prospective population-based study, lymphovascular invasion was not an independent high-risk criterion. Lymphovascular invasion should not by itself be considered sufficient to move patients from a low-risk group to a high-risk group.

the accompanying EDITORIAL: Small Beginnings: Do They Matter? The Importance of Lymphovascular Invasion in Early Breast Cancer
[Journal of the National Cancer Institute]
Two key questions for the future are determining the molecular determinants that play a role in lymphovascular invasion and the clinical implications of their alterations. This study provides an unparalleled opportunity to assess the clinical impact of newer markers of lymphovascular invasion like CD31 and D2-40 on well-annotated specimens from a very large and unselected population; it is conceivable that such staining could refine our ability to discriminate prognosis more precisely. In addition, the utility of anti-angiogenic therapies is under evaluation in breast cancer. A role for bevacizumab in conjunction with taxane therapy has been supported by two trials in metastatic breast cancer, and its utility in high-risk early-stage breast cancer is under evaluation. It has been suggested that low-dose weekly or metronomic chemotherapy might have anti-angiogenic qualities. Multitargeted small molecule inhibitors with anti-angiogenic effects are in clinical testing in breast cancer. Predictive markers for these approaches are sorely needed. Whether markers that are associated with lymphovascular invasion might also predict for success of antiangiogenic therapy is an area for investigation.
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