Long-term locoregional recurrence in patients treated for breast cancer.

BACKGROUND/PURPOSE: Locoregional control in breast cancer is a fundamental part of treatment and determinant for survival outcomes. It has been reported that most locoregional recurrence (LRR) events occur in the first 5 years after treatment. However, LRR continue to occur after this timeline, with unclear risk factors and unknown survival impact. METHODS: Retrospective singe-centered cohort of patients treated for primary breast cancer, between January 2002 and December 2004. Primary outcome was LRR; secondary outcomes were overall survival (OS), disease-free survival (DFS), and predictive factors for LRR. RESULTS: This analysis included 1001 patients, of which 959 (95%) had invasive carcinoma. A mastectomy was performed in 501 (50%) and 500 (50%) had breast conservative surgery (BCS). Median follow-up time was 197 [Inter-quartile range (IQR) 96-211] months. Global LRR rate was 7.6%, with median time to recurrence of 45 [IQR 21-91] months. There was no difference in LRR rate after mastectomy vs BCS, adjusted to tumor stage (p > 0.05). The 10-year OS and DFS rates were 68.4 and 77.8%, respectively. Factors associated with LRR were metastatic axillary lymph nodes and high histologic grade (p < 0.05). Estrogen-negative (ER) tumors had higher LRR rates than ER-positive tumors in the first 5 years (p < 0.05); but no difference was observed with longer follow-up (p > 0.05). LRR was associated with OS (p < 0.05). DISCUSSION AND CONCLUSIONS: Global LRR in this cohort was 7.6% (with over 16 years of follow-up). LRR associates with decreased OS. Time to LRR varies significantly with tumor biology, supporting differentiation of follow-up regimens.

Lymph node yield in the pathological staging of resected nonmetastatic colon cancer: The more the better?

INTRODUCTION: Guidelines recommend regional lymphadenectomy with a lymph node yield (LNY) of at least 12 lymph nodes (LN) for adequate colon cancer (CC) staging. LNY ≥22LN may improve survival, especially in right-sided CC [Lee et al., Surg Oncol, 27(3), 2018]. This multicentric retrospective cohort study evaluated the impact of LNY and tumor laterality on CC staging and survival. MATERIALS AND METHODS: Patients with stage I-III CC that underwent surgery from 2012 to 2018 were grouped according to LNY: <22 and ≥ 22. Primary outcomes were LN positivity (N+ rate) and disease-free survival (DFS). Overall survival (OS) was the secondary outcome. Exploratory analyses were performed for laterality and stage. RESULTS: We included 795 patients (417 < 22LN, 378 ≥ 22LN); 53% had left-sided CC and 29%/37%/38% had stage I/II/III tumors. There was no association between LNY ≥22LN and N+ rate after adjustment for grade, T stage, lymphovascular invasion (LVI) and perineural invasion; a trend for a higher N+ rate in left-sided CC was identified (interaction p = 0.033). With a median follow-up of 63.6 months for DFS and 73.2 months for OS, 254 patients (31.9%) relapsed and 207 (26.0%) died. In multivariate analysis adjusted for age, ASA score, laparoscopic approach, T/N stage, mucinous histology, LVI and adjuvant chemotherapy, LNY ≥22LN was significantly associated with both DFS (HR 0.75, p = 0.031) and OS (HR 0.71, p = 0.025). Restricted cubic spline analysis showed a more significant benefit for right-sided CC. CONCLUSION: LNY ≥22LN was associated with longer DFS and OS in patients with operable CC, especially for right-sided CC.

Invasive Pleomorphic Lobular Carcinoma of The Male Breast: A Rare Diagnosis with Radiologic-Pathologic Correlation.

Male breast cancer is a rare disease, representing approximately 1% of all breast cancers, but its incidence appears to be increasing over the years. As normal male breast does not develop acini and lobules, lobular carcinoma is very rare, accounting for 1% - 2% of all cases of male breast cancer. Pleomorphic lobular carcinoma is an aggressive variant of invasive lobular carcinoma with only six cases of male breast reported in the literature until now, and none with associated Paget's disease. We report a case of an invasive pleomorphic lobular carcinoma with axillary lymph node involvement and associated Paget's disease in a high-risk man. Low awareness among men and a lack of a screening program often lead to a late diagnosis of male breast cancer, and consequently, at a later stages of disease, with lower survival rates compared to women. Early diagnosis is essential in order to improve patient outcomes and achieve better survival rates in men.

O cancro da mama no homem é uma doença rara, representando aproximadamente 1% de todos os cancros da mama, embora a sua incidência pareça estar a aumentar. Como a mama masculina normal não é constituída por lóbulos, o carcinoma lobular é muito raro, representando 1% - 2% de todos os cancros da mama no homem. Apresentamos um caso clínico de um carcinoma lobular pleomórfico invasivo com envolvimento ganglionar axilar e doença de Paget do mamilo associada num homem de alto risco; trata-se de um caso extremamente raro, existindo apenas seis casos publicados na literatura até agora, e nenhum com doença de Paget associada. A falta de um programa de rastreio e a reduzida consciencialização da doença por parte da população masculina levam a diagnósticos tardios de cancro da mama no homem e consequentemente em estadios mais avançados da doença, com taxas de sobrevida baixas. A deteção precoce é essencial para melhorar alcançar melhores taxas de sobrevida nestes pacientes.

Locoregional recurrence in skin-sparing and nipple-sparing mastectomies.

BACKGROUND: Skin- and nipple-sparing mastectomies (SSMs/NSMs) present as an alternative for patients requiring mastectomy, with better aesthetic results. We aimed to evaluate the locoregional recurrence (LRR) rate and its predictive factors. METHODS: Retrospective analysis of all consecutive cases of SSM and NSM for a primary diagnosis of in situ or invasive breast cancer, at a national cancer center, from January 1st, 2013 to May 31st, 2019. The primary outcome was LRR. Secondary outcomes included LRR predictive factors, overall survival (OS), and disease-free survival (DFS). RESULTS: There were included 461 patients; 402 (87%) with invasive carcinoma. The median age was 46 (interquartile range [IQR]: 40-53) years. Ninety (20%) patients had locally advanced disease. LRR rate was 3.0%, with a median follow-up time of 39 (IQR: 21-59) months. The median time to recurrence was 22 (IQR: 10-45) months. Factors independently associated with LRR were high histological grade, negative estrogen receptor status, and high Ki67 (p < 0.05). OS was 94.8% and DFS was 92.8%. LRR was associated with decreased OS. DISCUSSION: SSM and NSM present as a safe approach to breast cancer requiring mastectomy, including selected patients with a locally advanced tumor. The associated LRR rate is 3.0%, with risk factors being high grade, negative estrogen receptor status, and high Ki67.