title: Prognostic Role of Nodal Status and Clinically Asymptomatic Valvular Insufficiency in Patients with HER2-positive Breast Cancer Treated with Chemotherapy, Radiotherapy and Trastuzumab in an Adjuvant Setting.
abstract: OBJECTIVE
  The aim of the present study was to assess metastasis-free survival of 134 patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer treated with chemotherapy, radiotherapy and trastuzumab in an adjuvant setting, according to sub-clinical cardiac side-effects (parameters not tested previously) evaluated before, during and after trastuzumab therapy, as well as selected clinicopathological parameters.
  
  
  RESULTS
  In our series, left ventricular ejection fraction decreased significantly from 68.1% before trastuzumab treatment to 66.7% after therapy (p<0.001). Further analysis revealed that this decrease was significant only in patients who received radiotherapy and developed valve insufficiency during or after (but not before) trastuzumab therapy (p<0.001). Cox multivariate analysis revealed that both pN2a tumor stage and valve regurgitation during/after trastuzumab therapy (vs. lack of valve insufficiency or insufficiency before trastuzumab therapy) were significant independent factors for a negative prognosis.
  
  
  CONCLUSIONS
  Valve insufficiency diagnosed during or after trastuzumab application might be cancer-unrelated indicator of decreased sensitivity to trasuzumab.
authors.affiliation: Department of Systemic and Generalized Malignancies, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland agw10@interia.pl.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Grela-Wojewoda
authors.affiliation: Department of Applied Radiobiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Niemiec
authors.affiliation: Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Sas-Korczyńska
authors.affiliation: Department of Systemic and Generalized Malignancies, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland.
authors.forename: Ida
authors.initials: I
authors.lastname: Cedrych
authors.affiliation: Department of Systemic and Generalized Malignancies, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Domagała-Haduch
authors.affiliation: Department of Applied Radiobiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Adamczyk
authors.affiliation: Department of Tumour Pathology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Ambicka
authors.affiliation: Polikmed Clinic, Krakow, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kołacz
authors.affiliation: The Oncology Unit, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Jakubowicz
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: Breast cancer; HER2-positive; left ventricular ejection fraction; trastuzumab; valvular regurgitation