Impacto de los subtipos intrínsecos del cáncer de mama en la predicción de metástasis en los ganglios axilares / Impact of intrinsic subtypes of breast cancer in predicting axillary node metastases

Resumen: Introducción: Observamos que el compromiso axilar es uno de los factores de pronóstico más importantes. Aunque la asociación entre el compromiso axilar y el tamaño tumoral ha sido estudiada en varias series, la relación del subtipo según la inmunohistoquímica (IHQ) para predecir compromiso axilar, no es muy conocida. El objetivo de este estudio es correlacionar los subtipos intrínsecos según la IHQ con la afectación axilar. Como objetivos secundarios evaluamos la sobrevida global y libre de enfermedad. Material y métodos: Se incluyeron en este estudio 1.413 pacientes operadas en forma consecutiva en el Hospital Italiano de Buenos Aires con diagnóstico de cáncer de mama primario (se excluyeron los estadios IV) entre los años 2007 y 2012. Fueron analizados los datos clínicos y patológicos de las pacientes que realizaron la biopsia del ganglio centinela o la linfadenectomía axilar. Los subtipos se clasificaron en cuatro grupos según la IHQ: luminal A (RE+, RP+, HER–, Ki67 <15%); luminal B (RE+, RP+, HER+, Ki67 >14%); HER2 (RE–, RP–, HER+); y triple negativo (RE–, RP–, HER–). Resultados: Evaluamos 1.413 pacientes de las cuales se analizaron 1.248 casos, donde 386 casos (31%) mostraron metástasis en los ganglios axilares. Tomando como referencia al grupo luminal A encontramos que la presencia de compromiso axilar es significativo en aquellos subtipos luminal B y HER (p<0,0001), no así en el subtipo TN (p=0,4468). Mediante un modelo de regresión logística múltiple se evaluó la probabilidad de compromiso axilar ajustado por cada uno de los diferentes subtipos tumorales, tamaño tumoral. En aquellos tumores menores de 2 cm observamos que los tumores luminal B y los TN aumentan el riesgo de compromiso axilar con un OR=2,73 (95% IC: 1,73-4,31; p>0,000), y un OR=2,05 (95% IC: 1,13-3,70; p=0,017), respectivamente, y los tumores HER2 aumentan el riesgo con un OR=6,62 (95% IC: 3,02-14,50; p>0,000).

Children with chronic organ failure possibly ending in organ transplantation: a survey in an Italian region of 5,000,000 inhabitants.

AIM: The Italian Piedmont region sponsored in 2005 a population-based registry to assess the epidemiology of childhood chronic organ failure involving kidneys, liver, heart or lungs. METHODS: Patients in chronic organ failure who were younger than 18 years were selected, and entered the registry when accomplishing the standard failure criteria for each organ. The cases were reported by the general paediatricians of the region and integrated with the data gathered by the Children University Hospital, a tertiary care centre. RESULTS: In Piedmont (647,727 inhabitants < 18 years), a total of 146 children (217 cases per million of paediatric population) were found to be affected by chronic organ failure (mean age 10 years; range 0-17). The organ failure involved kidneys in 68 subjects (48%), liver in 24 (17%), heart in 21 (15%) and lungs in 28 (20%), and was severe in 32 subjects (6 on transplantation waiting list). The most represented disease leading to chronic renal failure was renal hypodysplasia (79%). Chronic liver failure was mostly caused by biliary atresia (30%), autoimmune hepatitis (25%) and Wilson's disease (21%). Dilated cardiomyopathy (62%) and surgically treated congenital cardiopathy were the two leading causes of chronic heart failure. The most represented disease leading to chronic lung failure was cystic fibrosis (89%). CONCLUSION: This is the first report of the literature focusing on the epidemiology of chronic organ failure in children encompassing a region of 4,000,000 inhabitants. This clinical condition is rare, but medically and socially very demanding not only in childhood but the life along, as most of these patients will need solid organ transplantation decades later.

Association between drinking water disinfection and somatic parameters at birth.

We conducted an epidemiological study in Liguria, Italy, on the association between somatic parameters at birth and drinking water disinfection with chlorine dioxide and/or sodium hypochlorite. Over 2 years (1988-1989), 676 births at two public hospitals, one in Genoa (548 cases) and another in Chiavari (128 cases) were examined and data regarding both mother and child were obtained from hospital records. Results indicate a higher frequency of small body length (< or = 49.5 cm) and small cranial circumference (< or = 35 cm) in infants born to mothers who drank water treated with chlorine compounds. In particular, the statistical analysis (by simultaneous variance analysis and Scheffé test) indicated that there may be an association between infants with smaller body length and mothers who drank water treated with chlorine dioxide [adjusted odds radio (OR) = 2.0; 95% CI = 1.2-3.3] or sodium hypoclorite (adjusted OR = 2.3; 95% CI = 1.3-4.2) and between infants with smaller cranial circumference and mothers who drank water treated with chlorine dioxide (adjusted OR = 2.2; 95% CI = 1.4-3.9) or sodium hypochlorite (adjusted OR = 3.5; 95% CI = 2.1-8.5). The presence of neonatal jaundice is almost twice as likely (adjusted OR = 1.7; 95% CI = 1.1-3.1) in infants whose mothers drank water treated with chlorine dioxide.