Low neutrophil-to-lymphocyte ratio and pan-immune-inflammation-value predict nodal pathologic complete response in 1274 breast cancer patients treated with neoadjuvant chemotherapy: a multicenter analysis.

Background: Systemic inflammatory markers draw great interest as potential blood-based prognostic factors in several oncological settings. Objectives: The aim of this study is to evaluate whether neutrophil-to-lymphocyte ratio (NLR) and pan-immune-inflammation value (PIV) predict nodal pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in node-positive (cN+) breast cancer (BC) patients. Design: Clinically, cN+ BC patients undergoing NAC followed by breast and axillary surgery were enrolled in a multicentric study from 11 Breast Units. Methods: Pretreatment blood counts were collected for the analysis and used to calculate NLR and PIV. Logistic regression analyses were performed to evaluate independent predictors of nodal pCR. Results: A total of 1274 cN+ BC patients were included. Nodal pCR was achieved in 586 (46%) patients. At multivariate analysis, low NLR [odds ratio (OR) = 0.71; 95% CI, 0.51-0.98; p = 0.04] and low PIV (OR = 0.63; 95% CI, 0.44-0.90; p = 0.01) were independently predictive of increased likelihood of nodal pCR. A sub-analysis on cN1 patients (n = 1075) confirmed the statistical significance of these variables. PIV was significantly associated with axillary pCR in estrogen receptor (ER)-/human epidermal growth factor receptor 2 (HER2)+ (OR = 0.31; 95% CI, 0.12-0.83; p = 0.02) and ER-/HER2- (OR = 0.41; 95% CI, 0.17-0.97; p = 0.04) BC patients. Conclusion: This study found that low NLR and PIV levels predict axillary pCR in patients with BC undergoing NAC. Registration: Eudract number NCT05798806.

Development of a novel nomogram-based online tool to predict axillary status after neoadjuvant chemotherapy in cN+ breast cancer: A multicentre study on 1,950 patients.

BACKGROUND: Type of axillary surgery in breast cancer (BC) patients who convert from cN + to ycN0 after neoadjuvant chemotherapy (NAC) is still debated. The aim of the present study was to develop and validate a preoperative predictive nomogram to select those patients with a low risk of residual axillary disease after NAC, in whom axillary surgery could be minimized. PATIENTS AND METHODS: 1950 clinically node-positive BC patients from 11 Breast Units, treated by NAC and subsequent surgery, were included from 2005 to 2020. Patients were divided in two groups: those who achieved nodal pCR vs. those with residual nodal disease after NAC. The cohort was divided into training and validation set with a geographic separation criterion. The outcome was to identify independent predictors of axillary pathologic complete response (pCR). RESULTS: Independent predictive factors associated to nodal pCR were axillary clinical complete response (cCR) after NAC (OR 3.11, p < 0.0001), ER-/HER2+ (OR 3.26, p < 0.0001) or ER+/HER2+ (OR 2.26, p = 0.0002) or ER-/HER2- (OR 1.89, p = 0.009) BC, breast cCR (OR 2.48, p < 0.0001), Ki67 > 14% (OR 0.52, p = 0.0005), and tumor grading G2 (OR 0.35, p = 0.002) or G3 (OR 0.29, p = 0.0003). The nomogram showed a sensitivity of 71% and a specificity of 73% (AUC 0.77, 95%CI 0.75-0.80). After external validation the accuracy of the nomogram was confirmed. CONCLUSION: The accuracy makes this freely-available, nomogram-based online tool useful to predict nodal pCR after NAC, translating the concept of tailored axillary surgery also in this setting of patients.

[Incidental gallbladder carcinoma]. / Il carcinoma incidentale della colecisti.

Carcinoma detected at histological examination of the gallbladder is defined as incidental. It is a fairly rare event, but the increase in the number of cholecystectomies performed has led to a rise in detection of incidental gallbladder carcinoma. Histologically, in most cases, these are pT1 and pT2 carcinomas. Up until the 'nineties it was believed that these carcinomas could be adequately treated by simple cholecystectomy, whereas today the treatment of choice entails a second operation. This study constitutes a review of 20 years' experience. The database consists of 3012 cholecystectomies. Survival data are calculated in relation to the evolution of surgical treatment, thus making it possible to correlate tumour staging, patient survival and surgical therapy. The incidence of IGC was about 0.66% (20 cases). The survival rates of patients operated on by extended cholecystectomy, compared with those achieved previously with simple cholecystectomy, have risen from 92% to 100% at 1 year and from 26% to 66% at 5 years, respectively. The contributions made by literature reports since the 'nineties have prompted hepatobiliary surgeons to modify their attitudes towards incidental gallbladder carcinoma. Detection of previously unrecognised microinfiltrations of the serosa and of neoplastic involvement of distant lymph-node stations has led to the introduction of the concept of extended cholecystectomy. Comparison between our historical survival curve of patients treated with simple cholecystectomy and the distinctly better curve of those treated with a radical second operation accounts for the evolution of surgical treatment over the past two decades.

Abdominal incisional hernia repair. Intraperitoneal prosthetic technique using Bard Kugel Composix Mesh.

The treatment of choice for incisional hernia is prosthetic repair Extensively debated issues are the materials used and the implantation site of the mesh. The authors report their personal experience with 17 cases operated on by placement of an intraperitoneal Bard Kugel Composix Mesh. From May 2003 to August 2005, 10 female and 7 male patients with incisional hernia, aged from 43 to 76 years (mean age: 65 years), were submitted to intraperitoneal prosthetic mesh implantation and monitored over a follow up period ranging from 2 to 28 months (median: 15 months). The technical aspects and the rationale for this approach are described. The advantages of this procedure are its simplicity and rapidity of execution, a reduced incidence of complications, and good tolerance in terms of patient pain and comfort. The mesh was removed in one case owing to infection of the prosthesis. Follow-up to date has revealed no instances of recurrence.

Intravascular large B-cell lymphoma associated with silicone breast implant, HLA-DRB1*11:01, and HLA-DQB1*03:01 manifesting as macrophage activation syndrome and with severe neurological symptoms: a case report.

BACKGROUND: Silicone implants have been successfully used for breast augmentation and reconstruction in millions of women worldwide. The reaction to the silicone implant is highly variable; it can lead to local inflammatory symptoms, and sometimes to systemic symptoms and disease. Over 80 cases of anaplastic lymphoma kinase-negative anaplastic large cell lymphoma have been reported in patients with silicone breast implants and have been accepted as a new clinical entity. To the best of our knowledge, an intravascular large B-cell lymphoma associated with a silicone breast implant has not been reported previously. CASE PRESENTATION: A 48-year-old Caucasian woman who presented with high fever was found to have splenomegaly on physical examination. A laboratory diagnosis revealed pancytopenia, hypertriglyceridemia, and hyperferritinemia. She developed signs of altered sensorium, hemiparesis, aphasia, and cauda equina syndrome. On further evaluation, she fulfilled the necessary five out of eight criteria for diagnosis of macrophage activation syndrome/hemophagocytic lymphohistiocytosis. Dexamethasone administration was followed by prompt improvement; however, 3 days later she again manifested high fever, which persisted despite administration of immunoglobulin and cyclosporine A. Her silicone breast implant was considered a possible contributor to her macrophage activation syndrome and was therefore removed. A histological examination of the capsule tissue showed an extensive lymphohistiocytic/giant cell foreign body reaction suggestive of autoimmune/inflammatory syndrome induced by adjuvants. However, the histological examination unexpectedly also revealed an intravascular large B-cell lymphoma. CONCLUSIONS: The genetic background of our patient with silicone breast implants might have predisposed her to three rare and difficult to diagnose syndromes/diseases: macrophage activation syndrome/hemophagocytic lymphohistiocytosis, autoimmune/inflammatory syndrome induced by adjuvants, and intravascular large B-cell lymphoma. The simultaneous manifestation of all three syndromes suggests causal interrelationships. Human leukocyte antigen testing in all women who undergo silicon breast implantation could in the future enable us to better evaluate the risk of potential side effects.

[Surgical treatment of breast tumors in patients after mammography screening. Personal experience in the first 3 years of operation of the screening program in the province of Verona]. / Il trattamento chirurgico dei tumori della mammella nelle pazienti sottoposte a screening mammografico. Esperienza personale nei primi tre anni di attività del programma di screening nella provincia di Verona.

A mammographic screening program was started in 1999 in the Province of Verona and was offered to women aged 50-69. The purpose of this study was to analyse and compare our data, particularly the type of surgery and histotype, with the literature data where no screening program was implemented. During the first three years of the screening, 113 patients underwent surgical treatment in our Institute. The histology of the mammary lesions was benign neoplasia in 28 (24.7%) and breast cancer in 85 (75.3%) patients. Seventy-three women (85.9%) with malignant neoplasms were submitted to conservative treatment. Mastectomy was performed in 12 (14.1%) patients, 8 of whom with immediate breast reconstruction. Patients coming from screening programs benefit in a high percentage of cases from conservative treatment, which, together with the reduced aggressiveness of the cancers, permits alternative treatments for the axillary lymph nodes and a reduction in adjuvant chemotherapy.

Results of pancreaticoduodenectomy for pancreatic cancer: extended versus standard procedure.

In Western experience, the long-term survival benefit after extended pancreaticoduodenectomy (EPD) in patients with pancreatic ductal adenocarcinoma is still controversial. The aim of this work was to evaluate weather EPD for pancreatic ductal adenocarcinoma prolongs long-term survival compared to standard pancreaticoduodenectomy (SPD). From November 1992 to September 1996, we performed pancreatic resections in 30 patients affected by stage I-III pancreatic ductal adenocarcinoma: 13 patients underwent SPD and 17 patients underwent EPD, consecutively. The two groups of patients were similar for all the demographic, clinical, and pathological characteristics, and all the intraoperative factors considered except the number of resected lymph nodes (mean number per case = 34.2 +/- 15.5 in the EPD group versus 12.8 +/- 3.6 in the SPD group, p <0.001) and the operative time (median time per case = 375 minutes in the EPD group versus 270 minutes in the SPD group, p = 0.009). Patients in the two groups experienced a similar postoperative course. The estimated survival probability at 1 and 3 years after operation was 0.76 (95% confidence interval [CI]: 0.49 to 0.90) and 0.24 (95% CI: 0.07 to 0.45) in the EPD group; 0.31 (95% CI: 0.09 to 0.55) and 0.08 (95% CI: 0.00 to 0.29) in the SPD group (p = 0.014). According to a Cox model, the treatment was associated with R0 patients' long-term survival (SPD versus EPD: hazard ratio (HR) = 4.82, 95% CI: 1.66 to 14.00, p = 0.004). Grading of tumor differentiation was confirmed to be a relevant prognostic factor (poor versus moderate: HR = 4.33, 95% CI: 1.49 to 12.61, p = 0.007), whereas type of resection had no significant effect (pylorus-preserving versus hemigastrectomy: HR = 1.49, 95% CI: 0.56 to 3.95, p = 0.42). The proportion of R0 patients with local recurrence was lower in the EPD group (20.0% versus 70.0%, p = 0.034).