Prognostic value of androgen receptor expression in different molecular types of breast cancer in women.

BACKGROUND: Breast cancer is a common women's disease. Usually, oestrogen is blamed in the aetiology and correlated with the prognosis; however, androgens are recently raising concern about its role in the breast cancer treatment and prognosis. METHODS: In this study we retrieved archival paraffin blocks of breast cancer patients and stained it for androgen. Thereafter, we compared clinico-epidemiologic parameters, histopathology, neoadjuvant response and recurrence rate and pattern among patients with and without androgen receptor (AR) expression. RESULTS: In total, 119 patients fulfilled enrolment criteria; AR expression were present in 77.3% of the patients. AR expression was associated with less grade III (6.8% versus 36.4%), and less triple negative (6.2% versus 25%), but similar overall recurrence rate (25% versus 22.2%). However, distant recurrence was significantly higher in androgen positive patients (91.3% versus 33.3% of all recurrences). CONCLUSION: Androgen expression appears to be common among breast cancer, but with no clear implication in tumour aggressiveness or effect on the rate of recurrence. However, being commonly associated with distant spread may have an impact on survival of the patients.

Mini Sternotomy and Mini Thoracotomy for Aortic Valve Replacement: Is There a Difference?

BACKGROUND: Minimally invasive valve replacement is increasingly accepted among surgeons and patients alike. Ministernotomy and minithoracotomy are the most used incisions in the minimally aortic valve replacement. The superiority of one incision over the other still is debatable with a few centers having the opportunity to compare them head-to-head. METHODS: A retrospective analysis of 260 patients, who underwent mini AVR, with 132 patients in the ministernotomy group and 128 patients in the minithoracotomy group. Operative details, mortality, wound cosmetics, and postoperative pain were among the primary end points. RESULTS: A predominance of female gender has been observed in both groups. The cross-clamp and total bypass times were significantly lower in MS compared with the MT approach (63.61±16.115 vs. 70.75±33.274 min, P = 0.028, and 91.90±26.365 vs. 112.24±51.634 min, P < 0.001, respectively). The minithoracotomy group had significantly shorter lengths of wounds (5.1 ± 0.6 vs. 8.48±0.344 cm, P < 0.001). The ministernotomy group had significantly lower postoperative pain scores either in the ICU, at hospital discharge, or after 30 days at the outpatient clinic, where scores compared with MT (4.46±1.23 vs. 5.23±1.12, P < 0.001, 1.6±0.84 vs. 1.83±0.72, P = 0.019, and 1.28±0.67 vs. 1.47±0.53, P = 0.012, respectively). CONCLUSION: Both minimally invasive incisions for AVR proved their safety and efficacy. While the ministernotomy has the advantage of less postoperative pain and pleural complications, the minithoracotomy incision has its unmatched aesthetic appeal.

The prognostic significance of extramural deposits and extracapsular lymph node invasion in colon cancer.

BACKGROUND: The status of resected lymph nodes in colon cancer determines prognosis and further treatment. The American Joint Committee on Cancer staging system has designated extramural nodules as nonnodal disease and classified them as extensions of the T category in the sixth edition and as site-specific tumor deposits in the seventh edition. Extracapsular lymph node extension is an established poor prognostic indicator in many cancers. Its significance in colon cancer has not been extensively investigated. OBJECTIVE: This study aimed to determine the prognostic significance of extramural nodules and extracapsular lymph node extension in colon cancer. DESIGN: A pathological review of 114 stage III and 80 stage II colon cancers was undertaken to analyze for p-T stage, p-N stage (using the fifth, sixth, and seventh editions), and the size and contour of nodal and extramural deposits. Multivariate Cox regression models were used to determine the prognostic significance of clinicopathological parameters on survival estimates. RESULTS: According to the sixth and seventh editions of the guidelines, extramural deposits were present in 29% and 31% of patients with stage III colon cancer and in 5% of patients with stage II colon cancer. Extracapsular lymph node invasion was present in 68% of cases. Multivariate analysis demonstrated that lymph node ratio, extracapsular lymph node extension, and adjuvant chemotherapy were independent prognostic factors affecting 5-year disease-free survival. The same 3 variables, in addition to extramural deposits, were independent prognostic factors affecting overall survival. The presence of extramural deposits was associated with an 11% 5-year survival, and extracapsular lymph node invasion was associated with a 33% 5-year survival. CONCLUSIONS: Instead of extramural nodules being included as part of the T category or as site-specific tumor deposits, they should perhaps be classified in the metastasis category. This has major prognostic implications and may broaden the application of a number of adjuvant agents.