Triple-negative breast cancer in Peru: 2000 patients and 15 years of experience.

BACKGROUND: Epidemiological studies commonly identify the clinical characteristics and survival outcomes of patients with breast cancer at five years. Our study aims to describe the sociodemographic, clinicopathological characteristics and determine the long-term event-free survival (EFS) and overall survival (OS) of a Peruvian population with triple-negative breast cancer. METHODS: We reviewed the medical records of new cases treated at a single institution in the period 2000-2014. The survival analysis included patients with stages I-IV. Survival estimates at 10 years were calculated with the Kaplan-Meier method and compared with the Log-rank test. We further used multivariate Cox regression analysis to calculate prognostic factors of recurrence and mortality. RESULTS: Among the 2007 patients included, the median age at diagnosis was 49 years (19-95 years). Most patients presented histologic grade III (68.7%), tumor stage II (34.2%), and III (51.0%) at diagnosis. Local and distant relapse was present in 31.9 and 51.4% of the patients, respectively. The most frequent sites of metastasis were the lungs (14.5%), followed by bone (9.7%), brain (9.6%), and liver (7.9%). The median follow-up was 153 months. At 3, 5, and 10 years, the EFS of the population was 55%, 49%, and 41%, respectively, while the OS was 64%, 56%, and 47%, respectively. Moreover, an N3 lymph node status was the most important prognostic factor for both disease relapse (HR: 2.54, 95% CI: 2.05-3.15) and mortality (HR: 2.51, 95% CI: 2.01-3.14) at ten years. An older age and higher T staging were associated with a worse OS, while patients who received radiotherapy and adjuvant chemotherapy had better survival rates. CONCLUSION: The sociodemographic features of Peruvian patients with TNBC are similar to those of other populations. However, our population was diagnosed at more advanced clinical stages, and thus, EFS and OS were lower than international reports while prognostic factors were similar to previous studies.

Breast-conserving surgery vs. total mastectomy in patients with triple negative breast cancer in early stages: A propensity score analysis.

BACKGROUND: Breast-conserving surgery (BCS) as an alternative to total mastectomy (TM) in patients with early-stage triple-negative breast cancer (TNBC) is not widely spread. OBJECTIVE: We aimed to compare the overall survival (OS) and disease-free survival (DFS) between both surgical approaches in early-stage TNBC patients at 10 years. METHODS: We conducted a retrospective cohort study in TNBC female patients with stage I-IIa, treated at a single-center during the period of 2000-2014. We estimated and compared the survival rates with the Kaplan Meier and Long-rank test. Propensity scores were calculated with the generalized boosted regression model and were used in the multivariate Cox regression analysis with the covariate adjustment method. RESULTS: We included 288 patients, 111 in the BCS vs. 177 in the TM group. The median follow-up was 102 months. Moreover, the patients in the BCS group had superior OS (85% vs. 81%, p = 0.56) and DFS (83% vs. 80%, p = 0.42) at 10 years. In the multivariate Cox analysis, BCS decreased the mortality risk (HR: 0.79, 95% CI: 0.37-1.67, p = 0.538), and the locoregional or distant recurrence risk (HR: 0.67, 95% CI: 0.32-1.41, p = 0.294), albeit with no statistical significance. CONCLUSION: BCS is a safe alternative to TM in Latin-American patients with early-stage TNBC.

Diabetes mellitus tipo 2 y toxicidad por quimioterapia en adultos mayores con cáncer prostático / Type 2 Diabetes mellitus and chemotherapy toxicity in older adults with prostate cancer

Introducción: Siendo el cáncer prostático una neoplasia prevalente, el envejecimiento es un factor para la toxicidad quimioterapéutica, adicionalmente puede incrementarse por enfermedades crónicas, destacando la diabetes. A pesar de estos conocimientos, no hay estudios que evalúen la asociación entre la diabetes y el riesgo de toxicidad quimioterapéutica en estos pacientes. Objetivo: Determinar la asociación entre Diabetes Mellitus tipo 2 y riesgo de toxicidad por quimioterapia en adultos mayores con cáncer prostático del Servicio de Geriatría del Centro Médico Naval del Perú. Material y métodos: Estudio analítico de cohorte retrospectiva, análisis secundario de una base de datos. Se evaluaron los efectos adversos de quimioterapia y factores asociados de 161 marinos retirados con cáncer prostático entre 2013 y 2015. Se construyó un modelo de regresión de Cox sobre la toxicidad ajustado por el antecedente de diabetes, edad, antecedentes patológicos, antecedentes de consumo de tabaco, circunferencia de pantorrilla, actividad física, dependencia para ABVD, caídas, polifarmacia, fragilidad y vulnerabilidad. Resultados: El 23.6 por ciento presentó diabetes. La prevalencia de fragilidad fue del 39.7 por ciento y de vulnerabilidad, de 24.2 por ciento(G8) y 26.71 por ciento (VES-13). Los efectos adversos frecuentes fueron gastrointestinales (13.04 por ciento) y hematológicos (8.07 por ciento). Mediante el modelo de regresión ajustado, el antecedente de Diabetes Mellitus tipo 2, 3 o más antecedentes patológicos, antecedente de consumo de tabaco, circunferencia de pantorrilla, actividad física, dependencia de ABVD, caídas, polifarmacia, vulnerabilidad y fragilidad presentaron asociación significativa. Conclusiones: El antecedente de Diabetes Mellitus tipo 2 es un factor predictivo para el riesgo de toxicidad por quimioterapia en adultos mayores con cáncer prostático(AU)

Introduction: Prostate cancer is considered a predominant type of neoplasia and aging is a factor for chemotherapeutic toxicity, which can increase due to chronic diseases, particularly diabetes. Despite all this knowledge, there are no studies to evaluate the association between diabetes and the risk of chemotherapeutic toxicity in these patients. Objective: To determine the association between Type 2 Diabetes Mellitus and the risk of chemotherapy toxicity in in older adults with prostate cancer in the Geriatric Service of the Peruvian Naval Medical Center. Material and methods: Analytical retrospective cohort study and secondary database analysis. The adverse effects of chemotherapy and the associated factors of 161 retired sailors with prostate cancer were evaluated between 2013 and 2015. Cox Regression Model for Adjusted Toxicity was constructed for antecedents of diabetes, age, pathological antecedents, smoking antecedents, calf circumference, physical activity, dependence on ABVD, falls, polypharmacy, fragility, and vulnerability. Results: The 23.6 percent of patients had diabetes. The prevalence of fragility was 39.7 percent and the one of vulnerability was 24.2 percent (G8) and 26.71 percent (VES-13). The frequent adverse effects were: gastrointestinal (13.04 percent) and hematological (8.07 percent). The most significant associations by adjusted regression model were the antecedent of Type 2 Diabetes Mellitus, 3 or more pathological antecedents, smoking antecedents, calf circumference, physical activity, dependence on ABVD, falls, polypharmacy, fragility, and vulnerability. Conclusions: The antecedent of Type 2 Diabetes Mellitus is a predictive factor for the risk of chemotherapy toxicity in older adults with prostate cancer(AU)