Validation of the FACT-B+4-UL questionnaire and exploration of its predictive value in women submitted to surgery for breast cancer. / Validación del cuestionario FACT-B+4-MS y exploración de su capacidad predictora en mujeres intervenidas de cáncer de mama.

INTRODUCTION AND OBJETIVE: The early detection of upper limb complications is important in women operated on for breast cancer. The "FACT-B+4-UL" questionnaire, a specific variant of the Functional Assessment of Cancer Therapy-Breast (FACT-B) is available among others to measure the upper limb function. PATIENTS AND METHODS: The Spanish version of the upper limb subscale of the FACT-B+4 was validated in a prospective cohort of 201 women operated on for breast cancer (factor analysis, internal consistency, test-retest reliability, construct validity and sensitivity to change were determined). Its predictive capacity of subsequent lymphoedema and other complications in the upper limb was explored using logistic regression. RESULTS: This subscale is unifactorial and has a great internal consistency (Cronbach's alpha: 0.87), its test-retest reliability and construct validity are strong (intraclass correlation coefficient: 0.986; Pearson's R with "Quick DASH": 0.81) as is its sensitivity to change. It didn't predict the onset of lymphedema. Its predictive capacity for other upper limb complications is low. CONCLUSIONS: FACT-B+4-UL is useful in measuring upper limb disability in women surgically treated for breast cancer; but it does not predict the onset of lymphoedema and its predictive capacity for others complications in the upper limb is low.

[Surgical treatment of the primary tumor in stage IV breast cancer]. / Tratamiento quirúrgico del tumor primario en pacientes con cáncer de mama en estadio IV.

INTRODUCTION: The aim of the study was to analyze the impact of loco-regional surgery on survival of patients with stage IV breast cancer. PATIENTS AND METHODS: Retrospective study that included patients with breast cancer and synchronous metastases. Patients with ECOG above 2 and high-risk patients were excluded. The following variables were evaluated: age, tumor size, nodal involvement, histological type, histological grade, hormone receptor status, HER2 overexpression, number of affected organs, location of metastases and surgical treatment. The impact of surgery and several clinical and pathologic variables on survival was analyzed by Cox regression model. RESULTS: A total of 69 patients, of whom 36 (52.2%) underwent surgery (study group) were included. After a mean follow-up of 34 months, the median survival of the series was 55 months and no significant differences between the study group and the group of patients without surgery (P=0.187) were found. Two factors associated with worse survival were identified: the number of organs with metastases (HR=1.69, IC 95%: 1.05-2.71) and triple negative breast cancer (HR=3.49, IC 95%: 1.39-8.74). Loco-regional surgery, however, was not associated with survival. CONCLUSIONS: Loco-regional surgical treatment was not associated with improved survival inpacientes with stage IV breast cancer. The number of organs with metastases and tumors were triple negative prognostic factors for survival.

[Cyclooxygenase-2 expression as a prognostic factor in sporadic colorectal cancer]. / Estudio de la expresión de ciclooxigenasa-2 como factor pronóstico en el cáncer colorrectal esporádico.

INTRODUCTION: The aims of the present study were to investigate cyclooxygenase-2 expression in neoplastic cells from colorectal carcinoma and to study the role of cyclooxygenase-2 expression as a prognostic factor related to distant metastases and survival. PATIENTS AND METHOD: A retrospective study of 105 patients with sporadic colorectal cancer was performed. The patients underwent surgery at the General Surgery Department of the University Hospital of Jaén between 1991 and 1997. Several clinicopathological features were recorded: gender, tumor location, TNM stage, histological type and grade and the presence of venous or lymphatic invasion. The mean time of follow-up was 54 months. Immunohistochemistry: cyclooxygenase-2 expression was tested using avidin-biotin-peroxidase immunostaining. Both the intensity and extension of the stain were assessed. RESULTS: Cyclooxygenase-2 expression in neoplastic cells was considered to be positive in 38 cases (36.2%). No statistically significant relationship was found between cyclooxygenase-2 expression and the clinicopathological features recorded (P >.05). Tumor recurrence: Distant metastases were diagnosed in 14 patients (13.3%). Cyclooxygenase-2 did not show a significant relationship with metastases in the multivariate analysis (HR: 0.36; 95% confidence interval [CI]: 0.07-1.69). Survival: Mean survival time was 55 months. Multivariate analysis did not show cyclooxygenase-2 as an independent risk factor of death (HR: 0.51; 95% CI: 0.22-1.21). CONCLUSIONS: Cyclooxygenase-2 expression was not significantly related to clinical and histopathological features of the tumors nor was it an independent risk factor of tumour recurrence or survival.

[Prognostic value of invasive growth pattern in sporadic colorectal cancer]. / Valor pronóstico del patrón de invasión tumoral en el cáncer colorrectal esporádico.

INTRODUCTION: Invasive growth pattern refers to the type of growth of the tumoral margins, whether infiltrating or noninfiltrating. The aim of the present study was to evaluate the invasive growth pattern (infiltrating/noninfiltrating) in colorectal cancer as a prognostic factor related to tumoral recurrence and survival. PATIENTS AND METHOD: We studied 105 patients with colorectal cancer who underwent radical surgery in the General Surgery Department of the Hospital Universitario Médico-Quirúrgico of Jaen between 1991 and 1997. The mean length of follow-up was 54 months. Regarding invasive growth pattern, 2 types of growth have been described: infiltrating and noninfiltrating. RESULTS: Tumoral invasion was infiltrating in 65 patients (62%). Tumoral recurrence: in 14 patients (13.3%) distant metastases were diagnosed. In the univariate analysis, infiltrative pattern was a statistically significant risk factor for distant metastases; however, this factor did not retain statistical significance in the multivariate analysis. Survival: 30 patients (28.5%) died from causes directly related to the neoplastic disease. The mean survival was 55 months. Infiltrating growth pattern was a statistically significant independent risk factor for death (HR = 2.50; 95% CI = 1.05-5.88). CONCLUSIONS: Infiltrating growth pattern was significantly related with the disease-free interval before metastases. Infiltrating growth was an independent prognostic factor of survival in colorectal cancer.