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Ultrasonic dissection system technology in breast cancer: a case-control study in a large cohort of patients requiring axillary dissection
No full textIn the sentinel node era, axillary dissection (ALND) for breast cancer (BC) is required much less frequently than in the past. However, complications, such as prolonged drainage output and seroma formation, are still observed. Harmonic dissection devices (HDDs) are widely used in laparoscopic and minimally invasive surgery to reduce collateral damage during tissue dissection, but its usefulness in breast surgery is unclear. The aim of this study was to evaluate the efficacy of HDDs compared to that of conventional dissection in performing ALND. One hundred thirty-nine women (median age 61 years, range 34-71 years) with confirmed pT1-2 primary infiltrating ductal BC undergoing curative surgery were enrolled in the study. The population was prospectively randomized between two age- and stage-matched arms: group A (cases)-68 (48.9 %) patients (HDD technique), versus group B (controls)-71 (51.1 %) patients (conventional technique). In group B, skin flaps were obtained using a scalpel, scissors, and electrocautery which was never used for ALND. In group A, for each operation time, the HDDs were used exclusively. The mean operative time, intraoperative blood loss, and drainage output were (A vs. B) 95 +/- A 22 versus 109 +/- A 25 min, 56 +/- A 12 versus 86 +/- A 15 mL, and 412 +/- A 83 versus 456 +/- A 69 mL, respectively (p < 0.01). Twenty-nine (20.9 %) patients developed an axillary seroma: 9 (13.2 %) and 20 (28.2 %) for groups A and B, respectively (p = 0.030). Our study confirms that in patients with BC requiring ALND the use of HDDs is more time efficient than conventional surgery, and reduces intraoperative bleeding, the amount of drainage, and the risk of seroma formation. These results may lead to several short- and long-term advantages. Thus, a careful evaluation of the cost-benefits of nontraditional tools, such as HDDs, should be performed in all patients undergoing modified radical or partial mastectomy and ALND for BC
Urokinase-type plasminogen activator and inhibitor as prognostic markers in patients with non-small cell lung cancer and lymph node metestases
No full textBackground: Several biological markers have shown their usefulness in patients with lung cancer. Urokinase-type plasminogen activator (u-PA) is a member of the serine protease, an extracellular matrix protease strictly related to tumor aggression. It is localized on the tumor cells surface by binding to a specific receptor (u-PAR), which regulates the proteolytic activity around the cells. Plasminogen activator inhibitor 2 (PAI-2) regulates the u-PA activity. The expression of u-PA and PAR is elevated in malignant tumors, while low levels of PAI-2 expression correlates with the presence of metastases. We retrospectively assayed the expression of u-PA, u-PAR, and PAI-2 in specimens from non-small cell lung carcinoma (NSCLC), with the aim of evaluating possible relationship between these prognostic markers and the presence of lymph node metastasis.
Patients and methods: Paraffin-embedded archival tumor tissues from 59 patients with NSCLC were used to assess by immunohistochemical staining expressions of u-PA and u-PAR, and to measure by enzyme-linked immunosorbent assay levels of PAI-2 antigen. The analysis was performed by reverse transcriptase polymerase chain reaction (RT-PCR). Patients were 42 (71.2%) males and 17 (28.8%) females, with a median age of 62 years (range 54-68). LN metastases were found in 25 (42.3%, Group A) patients, while 34 (57.7%, Group B) were node-negative (pN0). A positive-staining area of more than 10% was considered as a positive result. The Pearson chi-square (χ2) test was used to compare data.
Results: Positive markers (A vs. B) were found in 15 of 25 vs. 24 of 34 (u-PA), 10 of 25 vs. 24 of 34 (u-PAR), and 13 of 25 vs. 23 of 34 (PAI-2) specimens, respectively. A significant relationship between u-PAR positivity and LN metastasis (χ2=5.52, p=0.018) was found, while both u-PA (χ2=0.72 p=0.39) and u-PAR PAI-2 (χ2=1.48, p=0.22) were not related to LN status.
Conclusions: In patients with NSCLC, u-PAR seems to be the key molecule for extracellular matrix degradation enzyme and the target molecule of cancer metastasis prevention, representing a sensitive marker of prognosis
Risk factors of invasive ductal breast carcinoma in elderly (≥65 years) women. Retrospective study in a cohort of 299 postmenopausal patients who underwent curative surgery
No full textBackground: In patients with breast cancer (BC) a number of risk factors (RF) have been studied. Unfortunately, many RFs associated with BC cannot be changed. However, several observational trials showed that the use of oral contraceptive (OC) and hormone replacement therapy (HRT), together with familial and reproductive RFs, can be useful in active or passive prevention of BC. The aim of this retrospective study was to evaluate the weight of the main data obtained from patients’ medical history (MH) in a population of elderly (≥65 years) women with confirmed invasive BC.
Materials and Methods: We retrospectively reviewed data regarding a series of 299 consecutive postmenopausal women (mean age, 62.3±9.1 years), who underwent curative surgery for pT1-2, N0-1 (stage I and IIA) invasive ductal breast carcinoma. Two Groups of patients were considered: elderly (≥64 years) patients (Group 1, N=93, median age 73, range 65-86 years), and younger (<65 years) patients (Group 2, N=206, median age 57, range 45-64 years). Odds ratio (OR) estimates and the associated 95% confidence interval (95%CI) were obtained. Ninety-eight (47.6%) and 64 (68.8%) patients, respectively, underwent dual-energy X-ray absorptiometry for studying bone density.
Results: At univariate analysis, HRT (OR=5.62, 95%CI=3.21-9.87, p30 years (OR=3.00, 95%CI=1.13-8.00, p=0.02) were strong RFs in younger patients (Group 2), while BMI>25 (OR=1.81, 95%CI=1.02-3.20, p=0.04) was a weak RF in elderly patients (Group 1). As expected, the presence of osteopenia or osteoporosis (OR=0.46, 95%CI=0.24-0.88, p=0.02) represented a protective factor in Group 1. Other data obtained from patients’ MH, including family history of BC (p=0.79), no pregnancies (p=0.58) or breast-feeding (p=0.09), and history of benign breast diseases (p=0.43) did not differ significantly between Groups. At multivariate analysis, only HRT was an independent RF, and the area under the curve (ROC) was 0.68.
Conclusions: In older (≥65 years) patients, most of whom (62.1% vs. 22.6%, χ2=31.1, p<0.001) had taken HRT, such as MH represents a significant RF for BC, and should be more carefully considered in the prevention campaigns
Anomalie dei capelli in corso di terapia con inibitori del 'EGFR ed antiepilettici. studio su 10 casi.
No full textPrognostic significance of circulating tumor cells in patients with colorectal cancer and liver metastases.
No full textBACKGROUND:
Despite the reduction in colorectal cancer (CRC) incidence rates in recent years, this tumor remains the most common gastrointestinal cancer in Western countries. CRC is a systemic disease (stage IV) in about 20% of patients, and metastases are most commonly found in the liver and lung. Unfortunately, patients undergoing surgery for CRC liver metastases are at risk for tumor recurrence. Several prognostic criteria have been proposed to improve patient selection for liver resection and adjuvant or neoadjuvant chemotherapy, including specific molecular or genetic assay and circulating tumor cells (CTC) dissemination detection. CTC can be revealed by reverse transcription-polymerase chain reaction (RT-PCR) based on mRNA detection. Since blood contains RNAse able to rapidly destroy extracellular RNA, the detection of mRNA can be accepted as an indicator of the presence of CTC. The aim of this study was to evaluate whether the presence of CTC in blood may predict tumor recurrence in patients who underwent resection for CRC liver metastases (LMs). The Fisher exact probability test, relative risk (RR) and associated 95% confidence interval (CI) calculation were used to analyze results.
PATIENTS & METHODS:
Preoperative blood samples were obtained form 12 patients (8 men, 4 women, median age 67 years, range 58-72 years) with stage IV CRC and LMs. Blood samples were examined by immunomagnetic enrichment with RT-PCR technique based on specific molecular biological markers to detect CTC. The results were expressed as CTC-positive or CTC-negative samples. Patients underwent both spiral CT-scan and MRI to better define the size e number of metastases. CT-scan of the chest and whole-body 99mTc-MDP scintigraphy were also performed to exclude pulmonary and bone metastases, respectively. 18F-FDG-PET was used only in selected patients. Intraoperative ultrasound of the liver was performed in all patients. The chi-square test was used to analyze results.
RESULTS:
Nine patients showed CTC positivity, while three were CTC-negative. At 12-month follow-up, 9 patients developed relapse of the disease (CTC-positive=8, CTC-negative=1), and 3 were disease-free (CTC-positive=1, CTC-negative=2). A significant relationship between CTC-positivity and recurrence (chi-square=3.7, p=0.05) was found. The risk ratio (RR) was 2.66 (95%CI 0.53-13.43).
CONCLUSIONS:
In patients with CRC and LMs who underwent surgery, CTC detection by RT-PCR represents a reliable tool for selecting those at risk of relapse, and should be suggested in all patients with advanced CRC
Risk factors for lung metastases from invasive ductal breast carcinoma. A case-control study at five-year follow-up in a population of women who underwent curative surgery
No full textBackground: Breast cancer (BC) accounts for about one-third of cases of cancer in women. BC occurs predominantly in elderly women, continue to be one of the most common causes of cancer death, and mainly metastasizes to the skeleton and lung. Although complete excision of primary tumor improves survival in patients with advanced metastatic disease, pulmonary metastasectomy plays a role in the management of patients. However, patients with small metastasis have a better overall survival, and thus the early detection of lung metastases (LM) is crucial. Indeed, in several studies, risk factors (RFs) such as age, stage of the disease, serum tumor markers, and other biological parameters obtained from pathological specimen, have been evaluated. The aim of this study was to analyze their role in differentiating patients at risk of having LMs among a cohort of women with BC.
Patients and methods: We retrospectively reviewed data regarding a series of 348 women (median age 60 years, range 28-85) who underwent curative surgery for pT1-2, N0-1 (stage I and IIA) invasive ductal breast carcinoma. During five-year follow-up, 15 (4.3%) patients developed LMs (cases), and 39 (11.2%) other type of cancer relapse, while 294 (84.5%) were disease-free (controls). The followings parameters were considered: age of the patients, size of the tumor (T), axillary lymph node (AN) status (N), estrogen (ER) and progesterone (PR) receptor negativity, human epidermal growth factor receptor 2 (HER2) and nuclear antigen Ki67 overexpression, adjuvant chemotherapy. Odds ratio (OR) estimates and the associated 95% confidence interval (CI) were obtained, and the significance level was set at p<0.01.
Results: Age2 cm (T2) (OR=2.90, 95% CI 1.02-8.27, p=0.041), and ER negativity (OR=3.51, 95% CI 1.21-10.17, p=0.018) were weak RFs, while PR negativity (OR=2.01, 95% CI 0.70-5.73, p=0.14), HER2 (OR=1.48, 95% CI 0.49-4.49, p=0.32) and Ki67 (OR=1.72, 95% CI 0.59-4.99, p=0.23) overexpression, and no chemotherapy administration (OR=1.06, 95% CI 0.35-3.20, p=0.55) were independent of LMs onset
Adjuvant hormonal therapy in women with early-stage breast cancer
No full textFor decades, adjuvant hormonal therapy has become the standard treatment of patients with estrogen receptor-positive breast cancer. Currently, the drugs available are GnRH agonists, selective estrogen receptor modulators, and aromatase inhibitors. The use of GnRH agonists represents a potentially reversible treatment that can restore ovarian function after chemotherapy. In premenopausal women, systemic therapy based on selective estrogen receptor modulators administration (e.g., tamoxifen) usually represents the standard adjuvant treatment. There are not sufficient data to recommend the routine addition of GnRH agonists to other endocrine therapies. In postmenopausal women, the disease-free survival was significantly prolonged in patients treated with aromatase inhibitor compared with those treated with tamoxifen, but the survival benefit was modest. Better results were obtained when the two drugs were administered sequentially. According to the ASCO guidelines, after 5 years of tamoxifen treatment, either tamoxifen or aromatase inhibitors therapy should be suggested for an additional 5 years. Unfortunately, most adverse events are consistent with estrogen deprivation and are common to all therapies, and the cumulative toxicity causes discontinuation and nonadherence to therapy in up to 50% of patients. Switching tamoxifen to an aromatase inhibitor may reduce adverse event incidence. Molecular-targeted therapy is useful in patients with advanced, relapsed or hormonal therapy-resistant tumors, usually as second- or third-line treatment. These drugs are usually added to aromatase inhibitors; however, currently, they have not yet been used in patients with early breast cancer
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy as salvage treatment for a late wound recurrence of endometrial cancer.
No full textEndometrial cancer (EC) is usually diagnosed at an early stage, when surgery alone may be curative, but 20-25% of patients with EC have higher-risk early-stage disease requiring radiation therapy alone or in combination with chemotherapy, in addition to surgery. Most EC relapses are either pelvic or distant metastases and occur within the first three years after hysterectomy. Laparotomy wound recurrences of EC are extremely rare, and only a few cases have been previously reported. We describe the unusual case of a late wound recurrence from an EC surgically removed 10 years previously which was successfully treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) after response to a hormonal therapy. Ten years after abdominal hysterectomy and bilateral salpingo-oophorectomy, on computed tomographic (CT) scan, a 70-year-old woman exhibited an abdominal mass of 3.5 cm, strictly adherent to the abdominal rectal muscle. CT-guided biopsy revealed estrogen- and progesterone receptor-positive metastasis from EC and the patient was treated with megestrole acetate. The whole body 18F-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET)/CT showed a marked metabolic response at the single metastatic site, with no further metastases, and the patient underwent surgical resection of the mass followed by immediate HIPEC perfusion with cisplatin. No residual macroscopic disease was present at the end of surgery and no complications occurred during the hospital stay. At 12-month follow-up, the patient is alive without evidence of disease. Although this approach is still being investigational for peritoneal recurrence of EC, our report confirms its feasibility and its promising results in highly selected patients
Vascular Endothelial Growth Factor as Prognostic Factor in Patients with Breast Cancer. A Multicentric Long-term Follow up Study
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