S92 ABSTRACTS

220. Predictive value of serum HER2 and CA 15-3 in patients with

HER2 positive breast cancer and relapse of the disease: Preliminary

study

F. Lumachi1, L. Foltran2, M. Bonamini3, G.B. Chiara3, S.M.M. Basso3

1 University of Padova School of Medicine, Surgery Oncology &

Gastroenterology, Padova, Italy2 S. Maria degli Angeli Hospital, Medical Oncology, Pordenone, Italy3 S. Maria degli Angeli Hospital, Surgery 1, Pordenone, Italy

Background: Cancer antigen (CA) 15-3 is encoded by the MUC1

gene. It is overexpressed in breast cancer (BC) tissue, and released into

the bloodstream. The human-epidermal-growth-factor receptor 2 (HER2)

is a transmembrane glycoprotein with intracellular tyrosine kinase activity,

that can also be measured in the blood. The role of circulating HER2 and

CA 15-3 as predictive markers of relapse of the disease and in monitoring

therapy in patients with metastatic BCare not well defined. The aim of this

study was to analyze whether a correlation exists between preoperative

serum CA 15-3 and HER2, and relapse of the disease in patients who un-

derwent surgery for tissue HER2 positive (HER2+)BC.

Materials and Methods: Data regarding a series of 12 women (me-

dian age 57 years, range 35-62 years) with stage I (pT1, N0-1mi, M0) tis-

sue HER2+ BC (Group 1) who developed locoregional or distant

metastases during follow-up were reviewed. Controls were 14 women

with age- and stage-matched tissue HER2+ BC (Group 2) who did not

developed relapse of the disease. All patients underwent preoperative

CA 15-3 and HER2serum levels measurement, by a two-site sandwich

immunoassay using direct chemiluminescent technology, and enzyme-

linked immunosorbent assay (ELISA), respectively. A serum CA 15-3

and HER2 concentration of 30 U/mL and 15 ng/mL were defined as the

upper limit of normal, respectively. A p-value<0.05 was considered statis-

tically significant.

Results: Overall, the mean preoperative CA 15-3 and HER2 levels

were 26.0�10.8 U/mL, and 18.5�9.3 ng/mL, respectively. CA 15-3 and

HER2were above the cut-off in 7 and 10 patients of Group 1, respectively.

The sensitivity, specificity, positive predictive value (PPV), negative pre-

dictive value, and negative likelihood ratio weighted by prevalence were

(CA15-3 vs.HER2) 0.78 vs 0.77 (p¼0.86), 0.70 vs. 0.85 (p¼0.011), 0.58

vs. 0.83 (p<0.001),0.85 vs. 0.78 (p¼0.20), and 0.17 vs. 0.27 (p¼0.08),

respectively. A weak correlation between CA 15-3 and HER2 (R¼0.46,

p¼0.05) was found. There was no significant relationship between age

of the patients, CA 15-3 (R¼-0.28, p¼0.25)or HER2 (R¼0.02, p¼0.92).

Conclusions: In patients with stage I BC HER2+ BC, baseline serum

CA 15-3 and HER2 are independent of age. Both have low sensitivity in

detecting primary tumor, but the specificity and PPVof HER2 were signif-

icantly higher than that of CA 15-3. Those serum markers do not condition

the therapeutic decision-making of patients, but are useful as prognostic

factor in patients who will develop locoregional or distant metastases dur-

ing follow-up.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.214

221. VEGF and nitric oxide metabolites as markers of lymph node

metastases in early breast carcinoma

K. Franciszkiewicz-Pietrzak1, A. Kurylcio1, J. Mielko1, B. Cisel1, M.

Sk�orzewska1, J. Kurzepa2, W.P. Polkowski1

1Medical University of Lublin, Department of Surgical Oncology, Lublin,

Poland2Medical University of Lublin, Chair and Department of Medical

Chemistry, Lublin, Poland

Background: Serum concentrations of vascular endothelial factor

(VEGF) and nitrate/nitrite are raised in breast cancer patients showing cor-

relation with the clinical stage of the disease. However, the measurement

of the unbound fraction of VEGF and its isoform C (VEGF-C) in relation

to nitric oxide metabolites (NOx) may give in-depth insight into the role of

those compounds in the pathogenesis of breast cancer growth and metas-

tasis. Aim of the study is to investigate correlation between serum levels

of free VEGF, VEGF-C and NOx and clinical and pathological features

of non-metastatic breast cancer.

Material and Methods: The study groups consisted of 45 female pa-

tients with breast cancer from 32 to 77 years old, 55 median. The control

group included 14 healthy female volunteers from 34 to 72 years old, 48

median. Tumour staging was based on the 7th edition of the TNM classi-

fication according to the UICC. The involvement of lymph nodes and the

histological types were determined by the post-operative pathological ex-

amination of the surgical specimens. Breast cancer patients were divided

into two subgroups based on lymph node involvement and labelled as

’non-metastatic’ (n¼29) and ’metastatic’ (n¼16) groups. Preoperative

serum samples were collected and free VEGF and VEGF-C were measured

using ELISA assays while total NOx with the colorimetric vanadium-

based assay.

Results: The serum NOx (p¼0.01) and VEGF-C (p¼0.01) but not of

VEGF (p>0.05) levels were significantly higher in breast cancer group

compared to controls. The sub-group analysis revealed that the NOx

(p<0.05) and VEGF-C (p<0.01) concentrations were the highest in meta-

static patients as compared to controls. There was no significant overall

correlation between NOx and VEGF-C and total free VEGF concentrations

in entire group of breast cancer patients. In the sub-group analysis, there

was significant association between NOx and VEGF-C in the metastatic

sub-group (r¼0.5; p¼0.04), but not in the non-metastatic sub-group

(p>0.05).

Conclusion: These findings indicate that VEGF-C and NOx, but not

VEGF, are associated with lymph node metastases, especially in the early

breast cancer. Further research on larger sample size is needed in order to

elucidate the potential of these markers of early lymphatic spread in breast

carcinoma.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.215

222. Predictors of sentinel lymph node metastases in women with early

breast cancer in India

K. Ashwin1

1Manipal Comprehensive Cancer Center, Surgical Oncology, Bangalore,

India

Introduction: The presence of axillary lymph node metastases is an

important prognostic factor in breast cancer and guides the surgeon to

the appropriate therapy. Sentinel lymph node biopsy (SLNB) is an

emerging method for the staging of the axilla in India. Although SLN bi-

opsy is widely accepted as a minimally invasive method of nodal staging,

failure to identify an SLN mandates a level I/II axillary node dissection

and associated morbidity. The objective of this study was to elucidate

various clinical, pathological and immunohistochemical factors that inde-

pendently predict axillary lymph node involvement in early breast cancer

in the Indian population. With these factors, we will be better able to iden-

tify groups of patients most likely to benefit from SLNB.

Materials and Methods: 228 consecutive patients of both sex, with

cytology or biopsy proven carcinoma breast, clinical stage T1/T2 N0 M0

at were subjected to SLNB and intra operative frozen examination. Age

of the patient and primary tumor characteristics like size, grade, lympho-

vascular invasion (LVI), perineural invasion, ER/PR status, Her2-neu status

and histological sub-types were evaluated for predicting the SLN

metastasis.

Results: Incidence of nodal metastases was correlated with clinico-

pathological factors and analyzed by univariate and multivariate analyses.

The age of the patient ranged from 23 to 87 years and its association

with SLN spread was not significant. Primary tumor characteristics like

histological subtypes, grade (P ¼ 0.353), ER/PR status (P ¼ 0.839),

Her2-neu status (P ¼0.296) were not significantly associated with SLN

metastasis.