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Adverse prognostic value of peritumoral vascular invasion: is it abrogated by adequate endocrine adjuvant therapy? Results from two International Breast Cancer Study Group randomized trials of chemoendocrine adjuvant therapy for early breast cancer
Annals of Oncology, 07/31/09

Viale G et al. - In a trial to ascertain whether peritumoral vascular invasion (PVI) assists in assigning optimal adjuvant systemic therapy for women with early breast cancer, it was reported that adequate endocrine adjuvant therapy appears to abrogate the adverse impact of PVI in node-negative disease, while PVI may identify pts who will benefit particularly from adjuvant therapy.

Methods

Pts participated in 2 International Breast Cancer Study Group randomized trials testing chemoendocrine adjuvant therapies in premenopausal (trial VIII) or postmenopausal (trial IX) node-negative breast cancer.
PVI was assessed by institutional pathologists and/or central review on hematoxylin–eosin-stained slides in 99% of pts (analysis cohort 2754 pts, median follow-up >9 yrs).

Results

PVI, present in 23% of tumors, was associated with higher grade tumors and larger tumor size (trial IX only).
Presence of PVI increased locoregional and distant recurrence and was significantly associated with poorer disease-free survival.
Adverse prognostic impact of PVI in trial VIII was limited to premenopausal pts with endocrine-responsive tumors randomized to therapies not containing goserelin, and conversely the beneficial effect of goserelin was limited to pts whose tumors showed PVI.
In trial IX, all pts received tamoxifen: the adverse prognostic impact of PVI was limited to pts with receptor-negative tumors regardless of chemotherapy.

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