Role of microsatellite instability and HER2 positivity in locally advanced esophago-gastric cancer patients treated with peri-operative chemotherapy

Purpose Neoadjuvant chemotherapy (NAC) significantly improved the prognosis of patients with locally advanced gastric cancer (LAGC). Several biomarkers, including HER2 and MMR/MSI are crucial for treatment decisions in the advanced stage but, currently, no biomarkers can guide the choice of NAC in clinical practice. Our aim was to evaluate the role of MSI and HER2 status on clinical outcomes. Methods We retrospectively collected LAGC patients treated with NAC and surgery +/- adjuvant chemotherapy from 2006 to 2018. HER2 and MSI were assessed on endoscopic and surgical samples. Pathologic complete response (pCR) rate, overall survival (OS), and event‐free survival (EFS) were estimated and evaluated for association with downstaging and MSI. Results We included 76 patients, 8% were classified as MSI-H, entirely consistent between endoscopic and surgical samples. Six percent of patients were HER2 positive on endoscopic and 4% on surgical samples. Tumor downstaging was observed in 52.5% of cases, with three pCR (5.1%), none in MSI-H cancers. According to MSI status, event-free survival (EFS) and overall survival (OS) were higher for MSI-H patients to MSS [EFS not reached vs 30.0 months, p = 0.08; OS not reached vs 39.6 months, p = 0.10]. Conclusion Our work confirms the positive prognostic effect of MSI-H in the curative setting of LAGC, not correlated with pathologic tumor downstaging. Prospective ad-hoc trial and tumor molecular profiling are eagerly needed (AU)

Morbimortality after 1321 consecutive CRS+HIPEC procedures: seeking excellence in surgery for peritoneal surface malignancy

Purpose Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) treatment has classically presented a percentage of associated complications that have limited its expansion. The aim of this study is to describe the morbimortality results obtained from a referral center implemented with the support of a governmental health agency and directed by a surgical team experienced in CRS for Peritoneal Surface Malignancies (PSM). Methods Data from the Peritoneal Carcinomatosis Program of Catalonia (PCPC) prospective database, including patients who underwent CRS + HIPEC between September 2006 and January 2021, were analyzed. Results A total of 1151 consecutive patients underwent 1321 CRS + HIPEC procedures. Colonic origin of peritoneal metastasis was the most frequent (47.3%). Median PCI was 7 and most patients had CC0-1 (96.1%). Multivisceral resection was performed in 44% of all patients, 57% required digestive anastomosis. Median hospital stay was 11 days (range 6–144 days). High-grade complications occurred in 20% of all patient, most of them surgical complications. Anastomotic leak occurred in 0.6% of all cases. The overall in-stay and 30-day mortality rate was 0.4%. The low-rate of complications and the high rate of complete CRS were achieved from the beginning of the PCPC. Median overall survival was 54.7 months, with a 5-year survival rate of 47.5%. Conclusions Implementation of a CRS + HIPEC referral program for the treatment of PSM with preferably an experienced surgical team enables acceptable rates of severe morbidity (20%) and mortality (< 1%) (AU)

Calidad de vida en pacientes con tumor vesical no músculo-invasivo sometidos a tratamiento adyuvante intravesical / Quality of life in patients with non-muscle invasive bladder tumor undergoing adjuvant intravesical treatment

Introducción El objetivo del estudio fue establecer posible relación entre los tratamientos con mitomicina-C (MMC) y bacilo de Calmette-Guérin (BCG) y la afectación en la calidad de vida. Material y métodos Estudio cuasiexperimental, prospectivo y longitudinal, recogiendo pacientes sometidos a tratamiento adyuvante en TVNMI. Se utilizaron los cuestionarios Short form-12 (SF-12) y Urogenital Distress Inventory-6 (UDI-6) para medir la calidad de vida. Se compararon las puntuaciones de los cuestionarios entre casos con MMC y BCG antes de iniciar la inducción (M1), a las 4 semanas (M2) y a los dos meses (M3). Resultados Se recogieron 90 pacientes, 54 en el grupo de BCG y 36 en el de MMC. Se comprobó que los pacientes con BCG percibían peor calidad de vida física comparados con los de MMC en M2 (OR:2,59, p=0,046). Además, se hallaron cambios significativos en la calidad de vida urinaria de los pacientes en tratamiento con MMC entre los diferentes momentos temporales (puntuación del UDI-6: 33,33 en M1, 27,78 en M2 y 16,67 en M3, p=0,001). Conclusiones No existen diferencias en la calidad de vida urinaria entre los pacientes tratados con MMC y BCG. Los pacientes con MMC muestran una recuperación significativa de la calidad de vida urinaria a partir de la finalización de la inducción, que aumenta aún más a los dos meses de la misma. Además, los pacientes tratados con BCG presentan peor calidad de vida física a las 4 semanas de tratamiento que aquellos tratados con MMC (AU)

Introduction The objective of the study was to establish a possible relationship between mitomycin-C (MMC) and bacillus Calmette-Guérin (BCG) treatments and quality of life impairment. Material and methods Quasi-experimental, prospective, and longitudinal study including patients undergoing adjuvant treatment in NMIBC. The Short form-12 (SF-12) and Urogenital Distress Inventory-6 (UDI-6) questionnaires were used to measure quality of life. Questionnaire scores were compared between cases with MMC and BCG before induction (M1), at 4 weeks (M2) and at 2 months (M3). Results Of the 90 patients enrolled, 54 were in the BCG group and 36 in the MMC group. It was found that BCG patients had worse perceived physical quality of life compared to MMC patients in M2 (OR:2.59, p=0.046). In addition, significant changes were found in the urinary quality of life of patients on MMC treatment between the different time points (UDI-6 score: 33.33 in M1, 27.78 in M2 and 16.67 in M3, p=0.001). Conclusions There are no differences in urinary quality of life between patients treated with MMC and BCG. Patients with MMC show a significant recovery of urinary quality of life from the completion of the induction course, which becomes even more significant after 2 months. In addition, BCG-treated patients have worse physical quality of life after 4 weeks of treatment than those treated with MMC (AU)

Percepción de enfermedad y calidad de vida en pacientes con inyecciones ilícitas de biopolímeros cosméticos: estudio transversal / Disease perception and quality of life in patients with illicit cosmetic biopolymers injections: a cross-sectional study

Introducción y objetivo: La enfermedad inducida por adyuvantes (EIA) secundaria a inyección de biopolímeros es reciente pero compleja, con un alto impacto en la mortalidad, la salud de los pacientes y en su calidad de vida. La percepción de enfermedad se considera un factor influyente para que los pacientes busquen ayuda y prevengan la evolución de la misma. El objetivo del presente estudio es evaluar cómo los pacientes con EIA por inyección ilícita de biopolímeros perciben su enfermedad y cómo el proceso de la enfermedad afecta a su calidad de vida. Material y método: Estudio descriptivo transversal utilizando el Cuestionario Brief IPQ que incluyó pacientes mayores de 18 años con inyecciones ilícitas de biopolímeros; fueron excluidos los pacientes con resección completa del biomaterial. Resultados: Un total de 441 mujeres con una edad media de 35 años respondieron a la encuesta. Observamos una asociación significativa entre mala percepción de la enfermedad y deterioro de la calidad de vida con la inyección ilícita de biopolímeros. Conclusiones: Nuestro estudio sugiere que la EIA por inyección ilícita de biopolímeros tiene un alto impacto en la calidad de vida de los pacientes. El uso ilegal de estos materiales es una práctica que no solo tiene repercusiones en la calidad de vida, sino que puede tener riesgos y consecuencias letales. (AU)

Background and objective: Adjuvant human disease (AHD) by injection of modeling substances is a relatively recent yet complex disease with a high impact on mortality, health of patients and their quality of life. Disease perception is considered an influential factor for patients to seek help and prevent disease evolution to detrimental outcomes. The objective of this study is to assess how patients with AHD by injection of illicit cosmetic biopolymers perceive their illness and how the disease process impacts their quality of life. Methods: Descriptive cross-sectional study using the Brief IPQ Questionnaire which included female patients with biopolymer injection. Inclusion criteria were patients older than 18 years with illicit cosmetic biopolymer injections; patients with complete surgical resection of the biomaterial were excluded. Results: A total of 441 females with a mean age of 35 years responded to the survey. A significant association between poor illness perception, quality of life deterioration, and illicit cosmetic biopolymer injection was observed. Conclusions: Our study suggests that AHD by injection of illicit cosmetic biopolymers has a high impact on the patient's quality of life. The illegal use of these materials is a practice that carries not only repercussions on quality of life but is considered to have life-threatening risks and lethal consequences. (AU)

The impact of HER2-low status on response to neoadjuvant chemotherapy in clinically HER2-negative breast cancer

Purpose Low expression of HER2 (HER2-low expression) in breast cancer (BC) has unique biological characteristics. However, whether HER2-low expression has an impact on neoadjuvant chemotherapy (NACT) in HER2-negative breast cancer remains unclear. Methods This study reviewed the clinicopathological data of patients with BC treated with NACT at a single hospital from January 2018 to July 2022. Baseline patient characteristics, efficacy of NACT, and survival data were compared between the HER2-0 and HER2-low groups. The impact of NACT on HER2 status also was investigated. Subgroup analyses based on hormone receptor (HR) status were performed to explore the impact of HR signaling on HER2 status during chemotherapy. Results The progesterone receptor-positive rate in the HER2-low group was significantly higher than that in HER2-0 group. The local treatment response of the HER2-low group was worse, but the disease-free survival rate of the HER2-low group was significantly better than that of the HER2-0 group. The proportion of patients with increased HER2 immunohistochemistry score after NACT was significantly higher in the HER2-0 group. Subgroup analysis showed that the efficacy of chemotherapy in HR + patients was significantly worse than in HR− patients, and HR + patients had a higher proportion of increased HER2 immunohistochemistry score after chemotherapy. Mechanistic studies suggested that MLH1 expression loss during chemotherapy might link HR signaling and regulation of HER2 expression. Conclusions We found that HER2-low expressing BC exhibits differential sensitivity to chemotherapy compared to HER2-0 expressing BC. The regulation of HER2 expression by HR signaling may mediate aspects of chemoresistance (AU)

The Role of Adjuvant Therapy in the Management of Chronic Urticaria / El papel de la terapia adyuvante en el tratamiento de la urticaria crónica espontánea

Recent guideline on the management of urticaria recommends second-generation H1-antihistamine as the first-line therapy, with dose increases of up to fourfold if inadequately controlled. However, the treatment of chronic spontaneous urticaria (CSU) is often disappointing, so additional adjuvant therapies are needed to increase the effectiveness of first-line therapy, especially in patients who are refractory to the increase of antihistamine doses. Recent studies recommend various adjuvant therapy modalities for CSU, such as biological agents, immunosuppressants, leukotriene receptor antagonists, H2-antihistamine, sulfones, autologous serum therapy, phototherapy, vitamin D, antioxidants, and probiotics. This literature review was made to determine the effectiveness of various adjuvant therapies in managing CSU (AU)

Las directrices actuales para el tratamiento de la urticaria crónica recomiendan los antihistamínicos H1 de segunda generación como tratamiento de primera línea, con un aumento de hasta 4 veces la dosis si no se controla. Sin embargo, la terapia en la urticaria crónica espontánea suele ser decepcionante, por lo que es necesario un tratamiento adyuvante adicional para mejorar la eficacia de la terapia, especialmente en los pacientes que son refractarios a dosis mayores de antihistamínicos. Las investigaciones más recientes recomiendan varias modalidades de tratamiento adyuvante para la urticaria crónica espontánea, como los agentes biológicos, los inmunosupresores, los antagonistas de los receptores de leucotrienos, los antihistamínicos H2, las sulfonas, la terapia con suero autólogo, la fototerapia, la vitamina D, los antioxidantes y los probióticos. Esta revisión bibliográfica presenta estudios recientes sobre la eficacia de diversas terapias adyuvantes en el tratamiento de la urticaria crónica espontánea (AU)

[Artículo traducido] El papel de la terapia adyuvante en el tratamiento de la urticaria crónica espontánea / The Role of Adjuvant Therapy in the Management of Chronic Urticaria

Las directrices actuales para el tratamiento de la urticaria crónica recomiendan los antihistamínicos H1 de segunda generación como tratamiento de primera línea, con un aumento de hasta 4 veces la dosis si no se controla. Sin embargo, la terapia en la urticaria crónica espontánea suele ser decepcionante, por lo que es necesario un tratamiento adyuvante adicional para mejorar la eficacia de la terapia, especialmente en los pacientes que son refractarios a dosis mayores de antihistamínicos. Las investigaciones más recientes recomiendan varias modalidades de tratamiento adyuvante para la urticaria crónica espontánea, como los agentes biológicos, los inmunosupresores, los antagonistas de los receptores de leucotrienos, los antihistamínicos H2, las sulfonas, la terapia con suero autólogo, la fototerapia, la vitamina D, los antioxidantes y los probióticos. Esta revisión bibliográfica presenta estudios recientes sobre la eficacia de diversas terapias adyuvantes en el tratamiento de la urticaria crónica espontánea (AU)

Recent guideline on the management of urticaria recommends second-generation H1-antihistamine as the first-line therapy, with dose increases of up to fourfold if inadequately controlled. However, the treatment of chronic spontaneous urticaria (CSU) is often disappointing, so additional adjuvant therapies are needed to increase the effectiveness of first-line therapy, especially in patients who are refractory to the increase of antihistamine doses. Recent studies recommend various adjuvant therapy modalities for CSU, such as biological agents, immunosuppressants, leukotriene receptor antagonists, H2-antihistamine, sulfones, autologous serum therapy, phototherapy, vitamin D, antioxidants, and probiotics. This literature review was made to determine the effectiveness of various adjuvant therapies in managing CSU (AU)

DNA ploidy and stroma predicted the risk of recurrence in low-risk stage III colorectal cancer

Background For clinically low-risk stage III colorectal cancer, the decision on cycles of adjuvant chemotherapy after surgery is disputed. The present study investigates the use of additional biomarkers of ploidy and stroma-ratio(PS) to stratify patients with low-risk stage III colorectal cancer, providing a basis for individualized treatment in the future. Method This study retrospectively enrolled 198 patients with clinical-low-risk stage III colorectal cancer (T1-3N1M0) and analyzed the DNA ploidy and stroma ratio of FFPE tumor tissues. The patients were divided into PS-low-risk group (Diploidy or Low-stroma) and PS-high-risk group (Non-diploid and High-stroma). For survival analyses, Kaplan–Meier and Cox regression models were used. Results The results showed that the 5-year DFS of the PS-high-risk group was significantly lower than that in the PS-low-risk group (78.6 vs. 91.2%, HR = 2.606 [95% CI: 1.011–6.717], P = 0.039). Besides, in the PS-low-risk group, the 5 year OS (98.2 vs. 86.7%, P = 0.022; HR = 5.762 [95% CI: 1.281–25.920]) and DFS (95.6, vs 79.9%, P = 0.019; HR = 3.7 [95% CI: 1.24–11.04]) of patients received adjuvant chemotherapy for > 3 months were significantly higher than those received adjuvant chemotherapy for < 3 months. We also found that the PS could stratify the prognosis of patients with dMMR tumors. The 5-year OS (96.3 vs 71.4%, P = 0.037) and DFS (92.6 vs 57.1%, P = 0.015) were higher in the PS-low-risk dMMR patients than those in the PS-high-risk dMMR patients. Conclusion In this study, we found that PS can predict the prognosis of patients with stage III low-risk CRC. Besides, it may guide the decision on postoperative adjuvant chemotherapy (AU)

Epidemiología del melanoma en España: estimación de los pacientes con melanoma con estadio III candidatos al tratamiento adyuvante / Epidemiology of Melanoma in Spain: Estimation of Number of Patients With Stage III Disease Eligible for Adjuvant Therapies

Antecedentes y objetivo: Para estimar la carga real del melanoma y el impacto de las nuevas terapias adyuvantes sobre las recaídas y la supervivencia, se precisa conocer con mayor exactitud la incidencia por estadios y analizar la transición entre ellos. Este estudio pretende estimar dicha incidencia y determinar el número de pacientes en estadio III que podrían beneficiarse del tratamiento sistémico adyuvante en España. Materiales y método: Se elaboró un modelo epidemiológico basado en datos de pacientes diagnosticados de melanoma o en recaída, recogidos prospectivamente durante 2012-2016 por cuatro unidades de melanoma de centros sanitarios públicos. Resultados: Las tasas brutas de incidencia estimadas para estadios I y II se situaron en 7 y 2,9 casos por 100.000 personas-año, respectivamente. Para estadio III se estimó en 1,9 (25,8% en IIIA, 47% en IIIB, y 27,3% en IIIC), siendo la de estadio IV de 1,3. La tasa de recaídas en estadio III se estimó en 1,1, siendo para estadio IV de 0,9. El 54% de recaídas a estadio III procedían de estadios I/II, mientras que el resto progresaban desde subestadios III. En estadio III, un 85% de nuevos diagnósticos y un 80% de recaídas fueron resecables, por tanto, candidatos a adyuvancia, de los cuales el 47% presentaba mutación en BRAF. Conclusiones: Estas estimaciones podrían tener un impacto importante en la planificación de los recursos sanitarios. La proyección en el número de potenciales candidatos a adyuvancia puede ayudar a decisores y clínicos a anticiparse a futuras necesidades en el manejo del melanoma (AU)

Background and objective: Accurate information on the incidence of melanoma by stage and a better understanding of transition between stages are important for determining the burden of disease and assessing the impact of new adjuvant therapies on recurrence and survival. The aim of this study was to estimate the incidence rates of the various stages of melanoma in Spain and to estimate the number of patients with stage III disease who are eligible for adjuvant systemic therapies. materials and method: We built an epidemiological model using prospectively collected data from patients diagnosed with de novo or recurrent melanoma between 2012 and 2016 in the melanoma units of 4 public hospitals. Results: The estimated crude incidence rates for stage I and II melanoma were 7 and 2.9 cases per 100,000 person-years, respectively. The corresponding rates for stage III and IV melanoma were 1.9 and 1.3 cases per 100,000 person-years; 25.8% of patients with stage III melanoma were stage IIIA, 47% were stage IIIB, and 27.3% were stage IIIC. The respective estimated incidence rates for recurrent stage III and IV melanoma were 1.1 and 0.9 cases per 100,000 person-years. Overall, 54% of patients with recurrent stage III melanoma had progressed from stage I or II; the other cases corresponded to changes in substage. Of the patients with stage III melanoma, 85% of those with a de novo diagnosis and 80% of those who had relapsed had resectable disease, meaning they were eligible for adjuvant therapy; 47% of these patients had a BRAF mutation. Conclusions: The above estimates could have a major impact on health care resource planning. Assessing the number of patients with melanoma who are eligible for adjuvant therapies in melanoma could help decision-makers and clinicians anticipate future needs for the management of this disease (AU)

[Translated article] Epidemiology of Melanoma in Spain: Estimation of Number of Patients With Stage III Disease Eligible for Adjuvant Therapies / Epidemiología del melanoma en España: estimación de los pacientes con melanoma con estadio III candidatos al tratamiento adyuvante

Background and objective: Accurate information on the incidence of melanoma by stage and a better understanding of transition between stages are important for determining the burden of disease and assessing the impact of new adjuvant therapies on recurrence and survival. The aim of this study was to estimate the incidence rates of the various stages of melanoma in Spain and to estimate the number of patients with stage III disease who are eligible for adjuvant systemic therapies. materials and method: We built an epidemiological model using prospectively collected data from patients diagnosed with de novo or recurrent melanoma between 2012 and 2016 in the melanoma units of 4 public hospitals. Results: The estimated crude incidence rates for stage I and II melanoma were 7 and 2.9 cases per 100,000 person-years, respectively. The corresponding rates for stage III and IV melanoma were 1.9 and 1.3 cases per 100,000 person-years; 25.8% of patients with stage III melanoma were stage IIIA, 47% were stage IIIB, and 27.3% were stage IIIC. The respective estimated incidence rates for recurrent stage III and IV melanoma were 1.1 and 0.9 cases per 100,000 person-years. Overall, 54% of patients with recurrent stage III melanoma had progressed from stage I or II; the other cases corresponded to changes in substage. Of the patients with stage III melanoma, 85% of those with a de novo diagnosis and 80% of those who had relapsed had resectable disease, meaning they were eligible for adjuvant therapy; 47% of these patients had a BRAF mutation. Conclusions: The above estimates could have a major impact on health care resource planning. Assessing the number of patients with melanoma who are eligible for adjuvant therapies in melanoma could help decision-makers and clinicians anticipate future needs for the management of this disease (AU)

Antecedentes y objetivo: Para estimar la carga real del melanoma y el impacto de las nuevas terapias adyuvantes sobre las recaídas y la supervivencia, se precisa conocer con mayor exactitud la incidencia por estadios y analizar la transición entre ellos. Este estudio pretende estimar dicha incidencia y determinar el número de pacientes en estadio III que podrían beneficiarse del tratamiento sistémico adyuvante en España. Materiales y método: Se elaboró un modelo epidemiológico basado en datos de pacientes diagnosticados de melanoma o en recaída, recogidos prospectivamente durante 2012-2016 por cuatro unidades de melanoma de centros sanitarios públicos. Resultados: Las tasas brutas de incidencia estimadas para estadios I y II se situaron en 7 y 2,9 casos por 100.000 personas-año, respectivamente. Para estadio III se estimó en 1,9 (25,8% en IIIA, 47% en IIIB, y 27,3% en IIIC), siendo la de estadio IV de 1,3. La tasa de recaídas en estadio III se estimó en 1,1, siendo para estadio IV de 0,9. El 54% de recaídas a estadio III procedían de estadios I/II, mientras que el resto progresaban desde subestadios III. En estadio III, un 85% de nuevos diagnósticos y un 80% de recaídas fueron resecables, por tanto, candidatos a adyuvancia, de los cuales el 47% presentaba mutación en BRAF. Conclusiones: Estas estimaciones podrían tener un impacto importante en la planificación de los recursos sanitarios. La proyección en el número de potenciales candidatos a adyuvancia puede ayudar a decisores y clínicos a anticiparse a futuras necesidades en el manejo del melanoma (AU)

Cirugía radioguiada con semillas de yodo-125 en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante / Radioguided surgery with iodine-125 seeds in breast cancer patients treated with neoadjuvant chemotherapy

Objetivo: Evaluar la utilización de las semillas radiactivas de yodo-125 (SRI-125) en la cirugía de mama o axila, en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante (QtNeo).Material y métodos: Estudio prospectivo, entre enero del 2016 y junio del 2020; 80 mujeres T1-3, N0-2, M0: 30 marcaje SRI-125 del tumor en mama, 36 tanto del tumor como del ganglio axilar positivo biopsiado, y 14 solo de axila. Edad: 54,7±11,4 años. Tamaño tumoral: 34,1±14,6mm. Tipo histológico: ductal infiltrante 90,0%. Subtipos moleculares: luminal-A 23,8%; luminal-B/HER2- 33,7%; luminal-B/HER2+ 18,8%; HER2+ 7,5%; triple negativo 16,2%.Resultados: De las 66 pacientes con marcaje SRI-125 del tumor (51 pre-QtNeo, 15 post-QtNeo), el 92,1% presentaba márgenes quirúrgicos libres, con un volumen de las piezas de 126,7±111,2 cm3. De las 5 reintervenciones, en 3 la ampliación fue positiva (una mastectomía).De las 50 pacientes N1 con marcaje SRI-125 (GM), 44 pre-QtNeo y 6 post-QtNeo, se identificó el GM en el 97,2%: negativo en 23, positivo en 26. En 45 se realizó biopsia selectiva del ganglio centinela y se identificó en el 93,3%: negativo en 26, positivo en 16. En un caso la SRI-125 no se colocó correctamente y tampoco se localizó GC por no migración.En el 61,9% de las pacientes el GM se encontraba entre el/los GC identificados en la cirugía. En 5 pacientes, con GC y GM no coincidentes, el resultado anatomopatológico del GC fue negativo y el GM positivo. En 53,8% de las pacientes se realizó linfadenectomía axilar. Conclusión: Las SRI-125 permiten realizar cirugía conservadora de la mama y mejorar la detección de enfermedad residual axilar, en pacientes tratadas con QtNeo (AU)

Objective: To evaluate the use of radioactive iodine-125 seed (RIS) in breast and/or axillary surgery, in patients with breast cancer treated with neoadjuvant chemotherapy (NAC).Material and methods: Prospective study between January 2016 and June 2020. 80 women T1-3,N0-2,M0: 30 RIS marking the breast tumor, 36 both the tumor and the biopsied positive axillary node, and 14 only the axilla. Age: 54.7±11.4 years. Tumor size: 34.1±14.6mm. Histological type: invasive ductal carcinoma 90.0%. Molecular subtypes: luminal-A 23.8%, luminal-B/HER2- 33.7%, luminal-B/HER2+ 18.8%, HER2+ 7.5%, basal-like 16,2%.Results: Of the 66 patients with RIS marking of the tumor (51 pre-NAC, 15 post-NAC), 92.1% had tumor-free surgical margins, with a specimen volume of 126.7±111.2 cm3. Of the 5 second local excisions, in 3 the resection margin was involved (1 mastectomy).Of the 50 patients N1 with RIS marking (MLN), 44 pre-NAC and 6 post-NAC, MLN was identified in 97.2%: negative 23, positive 26. In 45/50 patients, sentinel node biopsy (SNB) was performed and it was identified in 93.3%: negative 26, positive 16. In 1 case RIS was not placed correctly and SNB was not identified due to non-migration.In 61.9% of the patients, MLN was among the SNB identified in the surgery. In 5 patients with mismatched SNB and MLN, the pathological result of the SNB was negative and the MLN was positive. Axillary lymph node dissection was performed in 53.8% of the patients.Conclusion: RIS allow to perform breast-conserving surgery and improve detection of residual axillary disease in patients treated with NAC (AU)

Hypofractionated whole breast irradiation after IORT treatment is safe in patients receiving adjuvant chemotherapy

Introduction Hypofractionated whole breast irradiation (hWBI) and intraoperative radiotherapy (IORT) could be associated in breast cancer patients showing high-risk factors of local recurrence after breast conserving therapy (BSC). The aim of this trial was to evaluate, for the first time, the toxicity and cosmesis of hWBI after photon-IORT in high-risk patients treated by adjuvant chemotherapy. Materials and methods Thirty-one high-risk localized breast cancer patients treated by BCS, IORT (20 Gy), and adjuvant chemotherapy were included from February 2019 to August 2020 in this prospective trial, of hWBI (40.5 Gy/2.67 Gy/15 fractions). Acute and late toxicity (CTCAEv5.0) and cosmesis (Harvard scale), were assessed after treatment. Results All patients completed their treatment and were evaluable after treatment. No patients showed severe (G3) acute/late toxicity. Excellent/good cosmesis at least 6 months after completing the treatment, was present in 93.6% of the patients. Conclusion hWBI in high-risk localized breast cancer patients treated by chemotherapy seems to have similar toxicity and cosmetic results than conventionally fractionated WBI in combination to photon-IORT after BCS (AU)

Predicción del resultado del test Oncotype DX con RM mamaria de 1.5T en tumores con receptores hormonales positivos y HER2 negativo / Prediction of the Oncotype DX test result with 1.5T breast MRI in estrogen receptor-positive HER2-negative tumours

Objetivo Evaluar la relación del resultado del test Oncotype DX en tumores luminales con el valor del coeficiente de difusión aparente (CDA) en la secuencia de difusión en resonancia magnética (RM) mamaria y con otros parámetros radiológicos y anatomopatológicos. Pacientes y método Se revisaron retrospectivamente las RM mamarias de estadificación de las pacientes con cáncer de mama (CM) con receptores de estrógenos (RE) positivos y HER2 negativo a las que se les había solicitado el test Oncotype DX en los últimos cuatro años. Se recogieron los antecedentes familiares y personales, el tamaño y tipo de realce de la lesión, el CDA, el porcentaje de restricción a la difusión y la anatomía patológica. Todo ello se relacionó con el riesgo de recidiva (bajo: < 18, intermedio: 18-30 y alto: > 30) estimado en el test Oncotype DX. Resultados Se incluyeron 70 pacientes. Las lesiones categorizadas como bajo riesgo de recidiva asociaron valores de CDA significativamente más altos que el resto de grupos (p = 0,04) y las clasificadas como alto riesgo menor expresión de receptores de progesterona (RP) (p = 0,038). El valor de CDA clasificó como riesgo bajo o intermedio-alto según Oncotype DX con un área bajo la curva (AUC) de 0,73 (p = 0,001) para todos los tumores y de 0,76 (p < 0,001) en lesiones con RP positivos. Conclusiones Se encontraron valores más altos del CDA en el grupo clasificado como riesgo bajo de recidiva y menor expresión de RP en el grupo de riesgo alto. El CDA podría ser útil en el pronóstico del CM, aunque son necesarios más estudios. (AU)

Objective To assess the relationship of the Oncotype DX test result with the apparent diffusion coefficient (ADC) value in the diffusion sequence in breast magnetic resonance imaging (MRI) and with other radiological and anatomical-pathological parameters. Patients and methods We reviewed the pre-surgical staging breast MRIs of breast cancer (BC) patients with positive oestrogen receptors (ER) and negative HER2, for which the Oncotype DX test had been requested over the last four years. The ADC and the diffusion restriction percentage were obtained. Personal and family background were collected, along with pathological anatomy findings. We determined the association between all these factors and the risk of recurrence (low: < 18, intermediate: 18-30 and high: > 30) estimated by the Oncotype DX test. Results A total of 70 patients were included. Lesions categorized as being at low risk of recurrence according to the Oncotype DX test were associated with significantly higher ADC values than the rest of the groups (p = 0.04), and those classified as high risk were associated with lower progesterone receptor (PR) expression (p = 0.038). The ADC value classified the risk as low or intermediate-high according to the Oncotype DX test with an area under the curve (AUC) of 0.73 (p = 0.001) for all tumours and 0.76 (p < 0.001) in lesions with positive PR. Conclusions Higher ADC values were found in the group classified as being at low risk of tumour recurrence according to Oncotype DX. Lesions with high risk scores expressed lower PR. The ADC value may be useful in the prognosis of breast cancer, although further studies are required. (AU)

Extended intraoperative peritoneal lavage as prophylactic peritoneal recurrence for locally advanced gastric cancer: a prospective randomized trial

Background To demonstrate whether extensive intraoperative peritoneal lavage (EIPL) could yield better results in overall survival and less recurrence, regardless of peritoneal cytology, compared to standard peritoneal lavage (SPL). Methods A prospective randomised multicenter study including 94 patients (47 per arm) to detect a 20% difference in 3-year overall survival in patients with locally advanced tumours without peritoneal carcinomatosis. Three samples of peritoneal fluid were obtained (at the beginning, the end of procedure and after the assigned peritoneal lavage). Clinicopathological and surgical data were analysed by group. Postoperative complications, location of recurrence and surgical approach were evaluated. Overall survival was calculated by the Kaplan–Meier method and the uni/multivariate analysis for prognostic factors was carried out using Cox regression analysis. Results A total of 86 patients were analysed (4 excluded per group). No statistical differences were observed in clinicopathological or surgical data between groups, considering both groups well-balanced for analysis. Overall survival at 3 years was 64.3% for SPL vs. 62.3% for EIPL (p 0.421). Only three patients had at least one positive peritoneal cytology (1:2). There were no differences regarding postoperative complications (SPL: 37.2% vs. EIPL: 32.5%, p 0.65) or between location of recurrence and number of recurrences. The number of recurrences did not differ between surgical approaches, but locoregional and peritoneal recurrences were fewer with the laparoscopic approach (p 0.048). Conclusions The regular use of extensive peritoneal lavage in patients with locally advanced gastric cancer, regardless of peritoneal cytology, has not been effective as prophylaxis of peritoneal recurrence or better survival (AU)

Impact of adjuvant therapy toxicity on quality of life and emotional symptoms in patients with colon cancer: a latent class analysis

Objective To identify distinct trajectories of toxicity in colorectal cancer (CRC) patients after adjuvant chemotherapy and its impact on quality of life (QoL) and psychological symptoms. Methods A prospective, multicenter study was conducted in 157 patients. A latent class analysis defined the unobserved latent constructs that can be predicted as symptom clusters, considering the intensity of four types of adverse events (AEs). Patients completed EORTC-QLQ-C30, BSI-18, PDRQ-9, and DRS scales. Results Ninety-six percent had some degree of toxicity, with grades 3–4 being the most common: neurotoxicity (7.2%), hematological (13.1%), digestive (5.2%), and skin toxicity (1.4%). Three distinct latent classes were identified (high [72.5%], mild [16.9%], and low [10.6%] toxicity). Patients with high toxicity had the worst QoL scores and moderately high somatization and psychological distress scores. Conclusions Adjuvant chemotherapy for CRC was associated with frequent toxicity that negatively impacted QoL and psychological wellbeing (AU)

Evaluación de la respuesta patológica a quimioterapia neoadyuvante en cáncer de mama: correlación con el fenotipo molecular / Evaluation of pathological response to neoadjuvant chemotherapy in breast cancer: correlation with molecular phenotype

INTRODUCCIÓN Y OBJETIVO: El cáncer de mama se clasifica en distintos fenotipos moleculares con importantes implicaciones terapéuticas y pronósticas. La quimioterapia neoadyuvante (QTNA) aumenta las posibilidades de realizar una cirugía conservadora y permite testar in vivo la sensibilidad del tumor al tratamiento. Nuestro objetivo fue evaluar la respuesta patológica a QTNA con relación al fenotipo molecular y a las diferentes definiciones de respuesta patológica. PACIENTES: Se seleccionaron de nuestra base de datos de cáncer de mama 228 pacientes tratadas mediante QTNA y posterior cirugía entre 2012 y 2018. Los fenotipos moleculares se definieron según los criterios de la Conferencia de St. Gallen 2013. La respuesta patológica se evaluó según los criterios de Miller-Payne (mama) y Sataloff (axila). RESULTADOS: El fenotipo molecular más frecuente fue el luminal B/HER2 negativo (30,3%), seguido del luminal B/HER2 positivo (26,3%), triple negativo (24,6%), HER2 positivo (13,2%) y luminal A (5,7%). Las tasas de respuesta patológica completa (RPC) fueron del 35,5% en la mama y del 15,3% en la axila. La RPC considerando mama y axila conjuntamente fue del 26,8%. El fenotipo con mayor tasa de RPC fue el HER2 positivo (66,7%), seguido del triple negativo (30,4%), luminal B/HER2 positivo (21,7%), luminal B/HER2 negativo (14,5%) y luminal A (7,7%) (p < 0,001). Estas diferencias se mantuvieron con las distintas definiciones de RPC evaluadas. CONCLUSIONES: La respuesta patológica a QTNA está condicionada por el fenotipo molecular tumoral, independientemente de la definición de RPC, con mayores tasas de respuesta en mama y axila en los fenotipos HER2 positivo y triple negativo

INTRODUCTION AND OBJECTIVE: Breast cancer can be classified into different molecular subtypes with important therapeutic and prognostic implications. Neoadjuvant chemotherapy (NAC) increases the possibility of performing conservative surgery and allows in vivo testing of the sensitivity of the tumor. Our aim was to evaluate the pathological response to NAC in relation to the molecular phenotype and the different definitions of the pathological response. PATIENTS: 228 patients treated with NAC and subsequent surgery between 2012 and 2018 were selected from our breast cancer database. Molecular phenotypes were established based on the criteria of the St Gallen 2013 Conference. Pathological response was evaluated following Miller-Payne (breast) and Sataloff (axilla) classification systems. RESULTS: The most frequent molecular phenotype was luminal B/HER2 negative (30.3%), followed by luminal B/HER2 positive (26.3%), triple negative (24.6%), HER2 positive (13.2%), and luminal A (5.7%). The rate of pathological complete response (pCR) was 35.5% in breast and 15.3% in axilla. The rate of pCR considering breast and axilla together was 26.8%. The molecular phenotype with the highest rate of pCR was HER2 positive (66.7%) followed by triple negative (30.4%), luminal B/HER2 positive (21.7%), luminal B/HER2 negative (14.5%), and luminal A (7.7%) (p < 0.001). The same results were found with the different definitions of pCR we evaluated. CONCLUSIONS: Complete pathological response to NAC in breast cancer depends largely on the molecular phenotype of the tumor, regardless of the definition of pCR, with the highest response rates in the breast and axilla in the HER2 positive and triple negative phenotypes

Computed tomography reconstruction for evaluating response in axillary lymph nodes of breast cancer after neoadjuvant chemotherapy

Purpose To assess the performance of computed tomography (CT) reconstruction in evaluating the response in metastatic lymph nodes after neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods Patients undergoing pre-NAC and post-NAC CT were identified from the Peking University Cancer Hospital database. Axillary Lymph nodes (ALNs) that shrunk to < 5 mm in short-axis diameter after NAC on CT reconstruction images were classified as clinical complete response. Evaluations of CT reconstruction on ALNs were correlated with residual nodal disease in the final pathology. Overall, 53 invasive breast cancer patients between October 2016 and March 2018 were eligible for our study. The median age was 48 (range 35–70) years. Most women presented with T2 tumors (35/53, 66.0%). Results After NAC, 20 (37.7%) patients without residual nodal disease were defined as pCR. Of 53 patients, 18 (33.9%) showed negative conversion of ALNs on CT reconstruction evaluation; axillary pCR was present in 16/18 (88.9%) patients. Among 35 patients with abnormal nodes on post-NAC CT reconstruction, 31 (88.6%) had axillary metastasis on the final pathology. The sensitivity and specificity of CT reconstruction in predicting node-negative status were 80.0% and 93.9%, respectively. The positive predictive value was 84.9% for lymph node pCR. The area under the receiver operating characteristic curve of each imaging modality was 0.870 (95% confidence interval 0.755–0.984). Conclusions CT reconstruction was useful for evaluating ALNs response following NAC and may be used to predict axillary nodes’ pCR with adequate accuracy (AU)

Patterns of relapse and treatment outcome after active surveillance or adjuvant carboplatin for stage I seminoma: a retrospective study of the Spanish Germ Cell Cancer Group

Purpose Active surveillance (AS) and adjuvant chemotherapy (AC) with carboplatin are valid alternatives for managing stage I seminoma, and most relapses can be cured with cisplatin-based chemotherapy. However, some reports suggest that AC may modify the classical pattern of recurrences. Methods We analyzed all relapses observed in a series of 879 patients with stage I seminoma included in 4 consecutive studies of the Spanish Germ Cell Cancer Group. After a median follow-up of 67 months, recurrences were detected in 56/467 (12%) low-risk cases on AS and 13/412 (3%) high-risk cases after AC (p < 0.001). The objective was to describe clinical features, treatment and outcome. Univariate comparisons were performed between both groups. Results No significant differences were found between relapses on AS and those after AC in terms of time to relapse (13 vs 17 months), size (26 vs 27 mm), location (retroperitoneum in 88% vs 85%), and method of detection (computed tomography in 77% vs 69%). Treatment consisted of chemotherapy (etoposide + cisplatin ± bleomycin) in 89% and 92%, respectively. Late relapses (after > 3 years) were seen in 11% vs 7.7% (p = NS) and second or successive recurrences in 1.8 vs 23% (p < 0.05). With a median follow-up of 130 moths, two patients died of seminoma-unrelated causes (AS group) and the rest are alive and disease-free. Conclusion In the setting of a risk-adapted treatment of stage I seminoma, the administration of two courses of AC in patients with tumor size > 4 cm and/or rete testis invasion is associated with a higher incidence of second recurrences but does not significantly modify the pattern of relapses or their outcome (AU)

Neoplasias quísticas hepáticas: experiencia en un único centro y revisión de la literatura / Cystic liver neoplams: A single centre experience and literature review

INTRODUCCIÓN: La neoplasia quística hepática es una neoplasia poco frecuente, que representa aproximadamente el 5% de las lesiones quísticas del hígado. El diagnóstico preoperatorio es difícil y puede causar confusión. El objetivo del estudio es analizar una serie de casos operados en nuestro centro con diagnóstico anatomopatológico de neoplasia quística hepática y describir la sintomatología, diagnóstico y tratamiento de acuerdo con la actual clasificación. MÉTODOS: Se realizó un análisis retrospectivo de todas las neoplasias quísticas hepáticas operadas entre enero de 2000 y diciembre de 2019. El estudio se basó en los informes de anatomía patológica ya existentes. Los casos anteriores al 2010 fueron reclasificados según la clasificación de la OMS del año 2010. RESULTADOS: La muestra total del estudio resultó en 10 pacientes: 6 fueron neoplasias mucinosas quísticas hepáticas y 4 neoplasias papilares intraductales biliares. La mayoría de los pacientes fueron mujeres (8/10) y la edad media fue de 47 años. En cuanto al tratamiento, hubo 3 hepatectomías y 7 enucleaciones. En ningún caso se realizó una biopsia intraoperatoria de los márgenes quirúrgicos. En un caso se observó atipia celular variable con zonas de adenocarcinoma, por lo que el paciente recibió quimioterapia adyuvante con taxol y carboplatino. En todos los casos los márgenes de resección fueron negativos. CONCLUSIÓN: Las neoplasias quísticas hepáticas son tumores poco frecuentes, que plantean un dilema en el diagnóstico diferencial, por lo que, ante la sospecha radiológica, el tratamiento de elección debería ser la resección completa del tumor para evitar su malignización y la recidiva

INTRODUCTION: The hepatic cystic tumour is a very rare neoplasm, representing about 5% of all cystic liver neoplasms. The preoperative diagnosis is difficult and can lead to confusion. The aim of this study is to analyze a number of cases operated at our centre with an histologic diagnosis of liver cystic neoplasms and also to describe the sintomathology, diagnosis and management as per the recent classification. METHODS: A retrospective analysis was performed including all the cystic liver neoplasms operated between January 2000 and December 2019. The study was performed based on the pre-existing pathology archives. The 2010 previous cases were reclassified following the new 2010 OMS classification. RESULTS: The study sample was of 10 patients, identifying 6 of them as mucinous cystic liver neoplasms, and the other 4 as intraductal papillary biliary neoplasms. The majority of the patients were women (8/10) and the median age was 47 years. Regarding the treatment, 3 hepatectomy and 7 enucleations were performed. Frozen section intraoperatively was not required in any case. In one case, variable cellular atypia with areas of adenocarcinoma was observed, and the patient received neoadyuvant chemotherapy with taxol and carboplatin. In all cases the resection margins were negative. CONCLUSION: Cystic liver neoplasms are infrequent tumours with a difficult differential diagnosis. Therefore, with a high radiological suspicious, the treatment should be a complete resection to avoid recurrences and malignancies