RESUMEN
PURPOSE: In patients with clinically lymph node-negative (cN0) breast cancer, performing sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) has been preferentially embraced in comparison to before NACT. However, survival outcomes associated with both strategies remain understudied. We aimed to compare the axillary lymphadenectomy (ALND) rate, disease-free survival (DFS), and overall survival (OS), between two strategies. METHODS: We included 310 patients in a retrospective observational study. SNLB was performed before NACT from December 2006 to April 2014 (107 cases) and after NACT from May 2014 to May 2020 (203 patients). An inverse probability of treatment weighting (IPTW) method was applied to homogenize both groups. Hazard ratios (HR) and odd ratios (OR) are reported with 95% confidence intervals (95%CI). RESULTS: The lymphadenectomy rate was 29.9% before NACT and 7.4% after NACT (p < 0.001), with an OR of 5.35 95%CI (2.7-10.4); p = .002. After 4 years of follow-up, SLNB after NACT was associated with lower risk for DFS, HR 0.42 95%CI (0.17-1.06); p = 0.066 and better OS, HR 0.21 CI 95% (0.07-0.67); p = 0.009 than SLNB before NACT. After multivariate analysis, independent adverse prognostic factors for OS included SLNB before NACT, HR 3.095 95%CI (2.323-4.123), clinical nonresponse to NACT, HR 1.702 95% CI (1.012-2.861), and small tumors (cT1) with high proliferation index, HR 1.889 95% (1.195-2.985). CONCLUSION: Performing SLNB before NACT results in more ALND and has no benefit for patient survival. These findings support discontinuing the practice of SLNB before NACT in patients with cN0 breast cancer.
Asunto(s)
Axila , Neoplasias de la Mama , Escisión del Ganglio Linfático , Terapia Neoadyuvante , Puntaje de Propensión , Biopsia del Ganglio Linfático Centinela , Humanos , Biopsia del Ganglio Linfático Centinela/métodos , Femenino , Neoplasias de la Mama/patología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/cirugía , Terapia Neoadyuvante/métodos , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Anciano , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Estadificación de Neoplasias , Metástasis Linfática , Supervivencia sin Enfermedad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Pronóstico , Quimioterapia Adyuvante , MorbilidadRESUMEN
PURPOSE: To evaluate the differences in nodal positivity if the sentinel lymph node biopsy (SLNB) is performed before or after neoadjuvant endocrine therapy (NET) in breast cancer patients, and its impact on prognosis. METHODS: A retrospective cohort study was performed in a single center including 91 postmenopausal cases with clinically node-negative and hormone receptor-positive/HER2-negative (HR + /HER2-) breast cancer, treated with NET and SLNB. SLNB was done pre-NET until 2014, and post-NET thereafter. Axillary lymph node dissection (ALND) was indicated only in SLNB macrometastasis, although in selected elderly patients, it was omitted. Kaplan-Meier survival curves were estimated in relation to the status of the axilla, and the differences assessed using the log-rank test. RESULTS: Between December 2006 and March 2022, SLNB was performed pre-NET in 14 cases and post-NET in 77. Both groups were similar in baseline tumor and patient characteristics. SLNB positivity was similar regardless of whether SLNB was performed before (5/14, 35.7%) or after NET (27/77, 37%), with 2/14 SLN macrometastases in the pre-NET cohort and 17/77 in the post-NET cohort. Only three patients (18.7%) with SLN macrometastasis had > 3 positive nodes following ALND. The 5-year overall survival and distant disease-free survival were 92.4% and 94.8%, respectively, with no significant differences according to SLNB status (p 0.5 and 0.8, respectively). CONCLUSION: SLN positivity did not differ according to its timing (before or after NET). Therefore, NET has no effect on lymph node clearance. Furthermore, the prognosis is good regardless of the axillary involvement. Therefore, factors other than axillary involvement may affect the prognosis in these patients.
Asunto(s)
Neoplasias de la Mama , Anciano , Femenino , Humanos , Axila/patología , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Escisión del Ganglio Linfático , Terapia Neoadyuvante , Posmenopausia , Pronóstico , Estudios Retrospectivos , Biopsia del Ganglio Linfático CentinelaRESUMEN
PURPOSE: To report the outcomes of implementing the ACOSOG Z0011 and AMAROS trials relevant to clinical practice, and to define target groups in whom to avoid or recommend axillary radiotherapy (ART). We also aimed to analyse the reduction in morbidity when axillary lymph node dissection (ALND) was omitted. METHODS: A retrospective cohort study of T1-T2 patients with macrometastases at sentinel lymph node (SLN) who were treated between 2011 and 2020. Breast surgery included either lumpectomy or mastectomy. Patients with ≤ 2 positive SLN were divided into two cohorts by whether they received ART or not. Survival outcomes and morbidity were analysed by Kaplan-Meyer curves and Cox-regression, respectively. RESULTS: 260 pN1a patients were included and ALND was avoided in 167 (64.2%). According the Z0011 results, 72 (43.1%) received no further ART; and based on AMAROS criteria 95 (56.9%) received ART. Median follow-up was 54 months. The 5-year overall survival was 96.8% in the non-RT cohort and 93.4% in the RT cohort (p = 0.19), while the respective 5-year disease-free survivals were 100% and 92.3% (p = 1.06). Lymphedema developed in 3.6% of patients after SLNB versus 43% after ALND (OR 20.25; 95%CI 8.13-50.43). Decreased upper-extremity range of motion appeared in 8.4% of patients after SLNB versus 31.2% after ALND (OR 4.95; 95%CI 2.45-9.98%). CONCLUSIONS: Our study confirms that omitting ALND is safe and has high survival rates in patients with T1-T2 tumours and ≤ 2 positive SLNs. Adding ART could be a treatment option for patients who present other risk factors. Avoiding ALND with or without ART was associated with significantly less arm morbidity.
Asunto(s)
Neoplasias de la Mama , Ganglio Linfático Centinela , Axila , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Estudios de Cohortes , Disección , Femenino , Humanos , Escisión del Ganglio Linfático , Mastectomía , Estudios Retrospectivos , Biopsia del Ganglio Linfático CentinelaRESUMEN
PURPOSE: To find a group of cN2 patients or patients with high axillary burden who become ypN0 after neoadjuvant chemotherapy (NACT) and who may benefit from avoiding a lymphadenectomy. METHODS: A retrospective observational cohort study was conducted with 221 clinically staged N2 patients or patients with at least 3 suspicious lymph nodes found by ultrasound at diagnosis. The predictive factors for ypN0 analysed were age, MRI-determined tumour size, histological subtype, the Nottingham histologic grade, surrogate molecular subtype, ki-67 and vascular invasion when present. Clinical and radiological responses after NACT were also evaluated. Univariate and multivariate analyses by logistic regression were performed. Distant disease-free survival (DDFS) was calculated in relation to the status of the axillary lymph nodes after NACT. RESULTS: After NACT, 89 patients (40.3%) had axillary pathologic complete response (pCR) (ypN0) and 132 (59.7%) had residual axillary disease (ypN+). Molecular surrogate subtype, Ki-67 expression, and the clinical and radiological responses to NACT were the only independent factors associated with ypN0. Axillary pCR was observed more often in HER2-positive and triple-negative tumours than in luminal ones (OR 7.5 and 3.6, respectively). DDFS was 88.7% (95% CI 80.7-96.7%) for ypN0 and 56.2% (95% CI 32.1-80.3%) for ypN+ (p = 0.09). CONCLUSIONS: In HER2-positive and triple-negative breast cancer patients staged as cN2 or with high axillary burden before NACT, a sentinel lymph node biopsy after NACT could be recommended if there is a clinical and radiological response.
Asunto(s)
Neoplasias de la Mama , Neoplasias de la Mama Triple Negativas , Axila , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/cirugía , Terapia Neoadyuvante , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela , Neoplasias de la Mama Triple Negativas/tratamiento farmacológicoRESUMEN
A pathologic complete response (pCR) in the axilla occurs in 30%-40% of patients with initially node-positive breast cancer after neo-adjuvant chemotherapy (NACT). Debate persists about whether to perform systematic axillary lymphadenectomy (ALND) in patients with initial node-positive disease and clinical complete response after NACT. We aimed to identify predictive factors of axillary pCR (ypN0) after NACT. This retrospective study analyzed data for all patients with initial biopsy-proven node-positive disease who underwent ALND after NACT between June 2008 and December 2016 at our institution. Clinical and pathologic features, recurrence and specific mortality rates were compared between patients who achieved an axillary pCR and those who did not (ypN0 vs ypN+, respectively). A total of 331 patients were included, of whom 128 (38.7%) became ypN0 after NACT. Among patients with >2 suspicious axillary lymph nodes before treatment, 54 (38%) achieved ypN0 status. The independent predictors of ypN0 were Ki-67 > 30 (OR 1.98; 95% CI, 1.146-3.381), HER2 positivity (OR 2.6; 95% CI, 1.354-5.108), nonluminal molecular-like subtype (OR 4.15; 95% CI, 2.068-5.108), and clinical complete response, defined as negative clinical and ultrasonographic findings (OR 2.8; 95% CI, 1.110-7.081). After a mean follow-up of 61 months, distant disease-free and overall survival rates were higher in patients with ypN0 disease (HR 4.14; 95% CI, 2.03-8.43) than ypN+ patients. Complete clinical response and the presence of nonluminal molecular-like subtypes independently predicted ypN0. Patients meeting these criteria might be suitable form omitting ALND and just performing targeted axillary procedures to patients meeting these criteria.
Asunto(s)
Neoplasias de la Mama , Axila , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Terapia Neoadyuvante , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Biopsia del Ganglio Linfático CentinelaRESUMEN
Molecular evidence has linked the pathophysiology of lymphangioleiomyomatosis (LAM) to that of metastatic breast cancer. Following on this observation, we assessed the association between LAM and subsequent breast cancer. An epidemiological study was carried out using three LAM country cohorts, from Japan, Spain, and the United Kingdom. The number of incident breast cancer cases observed in these cohorts was compared with the number expected on the basis of the country-specific incidence rates for the period 2000-2014. Immunohistochemical studies and exome sequence analysis were performed in two and one tumors, respectively. All cohorts revealed breast cancer standardized incidence ratios (SIRs) ≥ 2.25. The combined analysis of all cases or restricted to pre-menopausal age groups revealed significantly higher incidence of breast cancer: SIR = 2.81, 95 % confidence interval (CI) = 1.32-5.57, P = 0.009; and SIR = 4.88, 95 % CI = 2.29-9.99, P = 0.0007, respectively. Immunohistochemical analyses showed positivity for known markers of lung metastatic potential. This study suggests the existence of increased breast cancer risk among LAM patients. Prospective studies may be warranted to corroborate this result, which may be particularly relevant for pre-menopausal women with LAM.
Asunto(s)
Neoplasias de la Mama/epidemiología , Linfangioleiomiomatosis/complicaciones , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Femenino , Humanos , Incidencia , Japón/epidemiología , Linfangioleiomiomatosis/genética , Linfangioleiomiomatosis/metabolismo , Metástasis de la Neoplasia , Análisis de Secuencia de ADN , España/epidemiología , Reino Unido/epidemiologíaRESUMEN
Introduction: Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response. Material and Methods: A retrospective single-institution cohort of 482 stage II and III breast cancer patients treated with neoadjuvant chemotherapy based on anthracycline and taxans, plus antiHEr2 in Her2-positive cases, was studied. Survival was calculated at 5 and 10 years. Kaplan-Meier curves with a log-rank test were calculated for differences according to age, BRCA status, menopausal status, TNM, pathological and molecular surrogate subtype, 20% TIL cut-off, surgical procedure, response to chemotherapy and the presence of vascular invasion. Results: The pCR rate was 25.3% and was greater in HER2 (51.3%) and TNBC (31.7%) and in BRCA carriers (41.9%). The factors independently related to patient survival were pathology and molecular surrogate subtype, type of surgery, response to NACT and vascular invasion. BRCA status was a protective prognostic factor without reaching statistical significance, with an HR 0.5 (95%CI 0.1-1.4). Mastectomy presented a double risk of distant recurrence compared to breast-conservative surgery (BCS), supporting BCS as a safe option after NACT. After a mean follow-up of 126 (SD 43) months, luminal tumors presented a substantial difference in survival rates calculated at 5 or 10 years (81.2% compared to 74.7%), whereas that for TNBC was 75.3 and 73.5, respectively. The greatest difference was seen according to the response in patients with pCR, who exhibited a 10 years DDFS of 95.5% vs. 72.4% for those patients without pCR, p < 0001. This difference was especially meaningful in TNBC: the 10 years DDFS according to an RCB of 0 to 3 was 100%, 80.6%, 69% and 49.2%, respectively, p < 0001. Patients with a particularly poor prognosis were those with lobular carcinomas, with a 10 years DDFS of 42.9% vs. 79.7% for ductal carcinomas, p = 0.001, and patients with vascular invasion at the surgical specimen, with a 10 years DDFS of 59.2% vs. 83.6% for those patients without vascular invasion, p < 0.001. Remarkably, BRCA carriers presented a longer survival, with an estimated 10 years DDFS of 89.6% vs. 77.2% for non-carriers, p = 0.054. Conclusions: Long-term outcomes after neoadjuvant chemotherapy can help patients and clinicians make well-informed decisions.
RESUMEN
Rapid and reliable diagnosis of endometrial cancer (EC) in uterine aspirates is highly desirable. Current sensitivity and failure rate of histological diagnosis limit the success of this method and subsequent hysteroscopy is often necessary. Using quantitative reverse transcriptase-polymerase chain reaction on RNA from uterine aspirates samples, we measured the expression level of 20 previously identified genes involved in EC pathology, created five algorithms based on combinations of five genes and evaluated their ability to diagnose EC. The algorithms were tested in a prospective, double-blind, multicenter study. We enlisted 514 patients who presented with abnormal uterine bleeding. EC was diagnosed in 60 of the 514 patients (12%). Molecular analysis was performed on the remnants of aspirates and results were compared to the final histological diagnoses obtained through biopsies acquired by aspiration or guided by hysteroscopy, or from the specimens resected by hysterectomy. Algorithm 5 was the best performing molecular diagnostic classifier in the case-control and validation study. The molecular test had a sensitivity of 81%, specificity of 96%, positive predictive value (PPV) of 75% and negative predictive value (NPV) of 97%. A combination of the molecular and histological diagnosis had a sensitivity of 91%, specificity of 97%, PPV of 79% and NPV of 99% and the cases that could be diagnosed on uterine aspirate rose from 76 to 93% when combined with the molecular test. Incorporation of the molecular diagnosis increases the reliability of a negative diagnosis, reduces the need for hysteroscopies and helps to identify additional cases.
Asunto(s)
Neoplasias Endometriales/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biopsia/métodos , Estudios de Casos y Controles , Método Doble Ciego , Neoplasias Endometriales/patología , Femenino , Humanos , Histerectomía/métodos , Histeroscopía/métodos , Persona de Mediana Edad , Patología Molecular/métodos , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/patología , Neoplasias Uterinas/genética , Neoplasias Uterinas/patología , Adulto JovenRESUMEN
Introduction: Breast cancer surgery currently focuses on de-escalating treatment without compromising patient survival. Axillary radiotherapy (ART) now replaces axillary lymph node dissection (ALND) in patients with limited sentinel lymph node (SLN) involvement during the primary surgery, and this has significantly reduced the incidence of lymphedema without worsening the prognosis. However, patients treated with neoadjuvant systemic treatment (NST) cannot benefit from this option despite the low incidence of residual disease in the armpit in most cases. Data regarding the use of radiotherapy instead of ALND in this population are lacking. This study will assess whether ART is non-inferior to ALND in terms of recurrence and overall survival in patients with positive SLN after NST, including whether it reduces surgery-related adverse effects. Methods and analyses: This multicenter, randomized, open-label, phase 3 trial will enroll 1660 patients with breast cancer and positive SLNs following NST in approximately 50 Spanish centers over 3 years. Patients will be stratified by NST regimen and nodal involvement (isolated tumoral cells or micrometastasis versus macrometastasis) and randomly assigned 1:1 to ART without ALND (study arm) or ALND alone (control arm). Level 3 and supraclavicular radiotherapy will be added in both arms. The primary outcome is the 5-year axillary recurrence determined by clinical and radiological examination. The secondary outcomes include lymphedema or arm dysfunction, quality of life based (EORTC QLQ-C30 and QLQ-BR23 questionnaires), disease-free survival, and overall survival. Discussion: This study aims to provide data to confirm the efficacy and safety of ART over ALND in patients with a positive SLN after NST, together with the impact on morbidity. Ethics and dissemination: The Research Ethics Committee of Bellvitge University Hospital approved this trial (Protocol Record PR148/21, version 3, 1/2/2022) and all patients must provide written informed consent. The involvement of around 50 centers across Spain will facilitate the dissemination of our results. Trial registration: ClinicalTrials.gov, identifier number NCT04889924.
RESUMEN
The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn't compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.
Asunto(s)
Puntaje de Gravedad del Traumatismo , Factores de TiempoRESUMEN
BACKGROUND: In patients with breast cancer who are candidates for neoadjuvant therapy (NAT), the timing of when to perform sentinel lymph node biopsy (SLNB) remains under discussion. The aim of this study was to compare the advantages and disadvantages of SLNB performed before and after NAT. PATIENTS AND METHODS: One hundred seventy-two patients, T1c to T3 and N0 (clinically and according to ultrasound) candidates for NAT were included. We compared the outcomes of 2 groups: (1) 122 patients of whom SLNB was performed before NAT (pre-NAT) from December 2006 to April 2014; and (2) 50 patients with SLNB performed after NAT (post-NAT) from May 2014 to July 2016. RESULTS: Both groups were homogeneous in baseline patient characteristics. The SLNB was positive in 50 patients [41.7%] (33 macrometastases [66%] and 17 micrometastases [34%]) versus 6 patients [12%] (5 macrometastases [83.3%] and 1 micrometastases [16.7%]) in pre- and post-NAT groups, respectively. The lymphadenectomy was performed in 34 patients [28.3%] versus 4 patients [8%], with an odds ratio of 3.48 (95% confidence interval, 1.3-9.3). The recurrences in the pre-NAT group after a median follow-up of 62 months were 12 systemic, 2 local and systemic, and none axillary. In the post-NAT group were no recurrences after a median follow-up of 16 months. Finally, SLNB after NAT reduces the delay in starting NAT from 24 to 14 days (medians; P < .001) and the identification of the SLNB was in 122 patients [100%] versus 49 patients [98%]. CONCLUSION: SLNB performed after NAT significantly reduces the rate of lymphadenectomies without any increase in recurrences at early follow-up. Furthermore, it allows systemic treatment to be started earlier without interfering in the SLNB identification rate.
Asunto(s)
Neoplasias de la Mama/patología , Ganglios Linfáticos/patología , Metástasis Linfática/diagnóstico , Recurrencia Local de Neoplasia/epidemiología , Biopsia del Ganglio Linfático Centinela/métodos , Adulto , Anciano , Axila , Neoplasias de la Mama/terapia , Femenino , Estudios de Seguimiento , Humanos , Escisión del Ganglio Linfático/estadística & datos numéricos , Metástasis Linfática/patología , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Factores de TiempoRESUMEN
[This corrects the article DOI: 10.1371/journal.pone.0132546.].
RESUMEN
BACKGROUND AND OBJECTIVE: It remains controversial whether sentinel lymph node biopsy (SLNB) should be performed before or after neoadjuvant therapy (NAT). We aimed to evaluate the feasibility and accuracy of SLNB before NAT at a single institution, and to determine its relation to patient prognosis. METHODS: A prospective study of T1c-T2-T3 N0 breast cancer patients, after ultrasound examination, who underwent SLNB prior to NAT. Overall, disease-specific and disease-free survival were calculated by Kaplan-Meier curves. RESULTS: SLNB before NAT was performed in 123 patients from December 2006 to May 2014. The identification rate was 100%. SLNB was positive in 42.3% of cases (27.6% macrometastases). NAT was chemotherapy in 88.6% of cases and endocrine-therapy in 11.4%. Lymphadenectomy was avoided in 72.4% of cases. Median follow-up was 40 months (range 8-100). Overall and disease-free survival was 90.2% and 88.6% respectively.SLN involvement was not related to patient outcome (p 0.72); however there were significant differences in survival according to molecular-like subtypes (p < 0.025) and NAT response (p < 0.0001). CONCLUSIONS: SLNB prior to NAT is an accurate method of axillary staging associated with a high identification rate. It avoided lymphadenectomy in more than 70% of patients. SLN involvement did not worsen the prognosis in our cohort.
Asunto(s)
Neoplasias de la Mama/patología , Terapia Neoadyuvante/métodos , Biopsia del Ganglio Linfático Centinela/métodos , Ganglio Linfático Centinela/patología , Factores de Tiempo , Adulto , Anciano , Axila , Neoplasias de la Mama/terapia , Supervivencia sin Enfermedad , Estudios de Factibilidad , Femenino , Humanos , Estimación de Kaplan-Meier , Escisión del Ganglio Linfático/estadística & datos numéricos , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios ProspectivosRESUMEN
Lymphangioleiomyomatosis (LAM) is a rare lung-metastasizing neoplasm caused by the proliferation of smooth muscle-like cells that commonly carry loss-of-function mutations in either the tuberous sclerosis complex 1 or 2 (TSC1 or TSC2) genes. While allosteric inhibition of the mechanistic target of rapamycin (mTOR) has shown substantial clinical benefit, complementary therapies are required to improve response and/or to treat specific patients. However, there is a lack of LAM biomarkers that could potentially be used to monitor the disease and to develop other targeted therapies. We hypothesized that the mediators of cancer metastasis to lung, particularly in breast cancer, also play a relevant role in LAM. Analyses across independent breast cancer datasets revealed associations between low TSC1/2 expression, altered mTOR complex 1 (mTORC1) pathway signaling, and metastasis to lung. Subsequently, immunohistochemical analyses of 23 LAM lesions revealed positivity in all cases for the lung metastasis mediators fascin 1 (FSCN1) and inhibitor of DNA binding 1 (ID1). Moreover, assessment of breast cancer stem or luminal progenitor cell biomarkers showed positivity in most LAM tissue for the aldehyde dehydrogenase 1 (ALDH1), integrin-ß3 (ITGB3/CD61), and/or the sex-determining region Y-box 9 (SOX9) proteins. The immunohistochemical analyses also provided evidence of heterogeneity between and within LAM cases. The analysis of Tsc2-deficient cells revealed relative over-expression of FSCN1 and ID1; however, Tsc2-deficient cells did not show higher sensitivity to ID1-based cancer inhibitors. Collectively, the results of this study reveal novel LAM biomarkers linked to breast cancer metastasis to lung and to cell stemness, which in turn might guide the assessment of additional or complementary therapeutic opportunities for LAM.
Asunto(s)
Biomarcadores de Tumor/sangre , Neoplasias de la Mama/sangre , Neoplasias Pulmonares/sangre , Linfangioleiomiomatosis/sangre , Células Madre Neoplásicas/patología , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Perfilación de la Expresión Génica , Humanos , Neoplasias Pulmonares/secundario , Linfangioleiomiomatosis/patología , Metástasis de la Neoplasia , Proteína 1 del Complejo de la Esclerosis Tuberosa , Proteína 2 del Complejo de la Esclerosis Tuberosa , Proteínas Supresoras de Tumor/genéticaRESUMEN
An expanded Spanish version of the Measure of Affect Regulation Styles (MARS), was applied to episodes of anger and sadness, in a sample of 355 graduate students from Chile, Spain, and Mexico. The study examines the association between affective regulation, adaptation to episodes and dispositional coping and emotional regulation, and psychological well-being. With regard to perceived improvement of adaptive goals, the following adaptive affect regulation strategies were confirmed: Instrumental coping, seeking social support, positive reappraisal, distraction, rumination, self-comfort, self-control, and emotional expression were functional; whereas inhibition and suppression were dysfunctional. Adaptive strategies were positively associated with psychological well-being, reappraisal and humor as a coping strategy. Negative associations were found between adaptive strategies and suppression and alexithymia. Maladaptive strategies show the opposite profile. Confrontation, instrumental coping, social support as well as social isolation were more frequently found in anger, an approach emotion.
Asunto(s)
Adaptación Psicológica , Afecto , Inventario de Personalidad , Encuestas y Cuestionarios , Adulto , Síntomas Afectivos/psicología , Ira , Chile , Emociones , Femenino , Humanos , Masculino , México , Valores de Referencia , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Factores Sexuales , Aislamiento Social , Apoyo Social , España , Adulto JovenRESUMEN
Objetivos: Analizar el impacto en la evolución y la supervivencia de pacientes con enfermedad de Paget mamaria con tratamiento conservador versus mastectomía. Material y métodos: Estudio retrospectivo de 31 pacientes con enfermedad de Paget mamaria, durante el periodo 2005-2012, en el Institut Català dOncologia del Hospital Universitario de Bellvitge. Se incluyó a pacientes operadas con diagnóstico anatomopatológico de enfermedad de Paget mamaria. Se excluyeron casos con diseminación sistémica al diagnóstico. Se analizaron: características radiológicas e histológicas del tumor, estadio, afectación axilar y tipo de cirugía realizada sobre la evolución de la enfermedad (recidiva locorregional o metástasis), mediante test exacto de Fisher. La supervivencia global y libre de enfermedad según tipo de cirugía y tipo histológico se valoró con el test de Kaplan Meyer y el log rank de Mantel-Haenszel. Resultados: Se realizó cirugía conservadora en 14 (45,1%) pacientes y mastectomía en 17 (54,8%). Se detectaron 7 (22,6%) pacientes con metástasis o recidiva locorregional, tras seguimiento medio de 29 meses (20,6 DE). La media de supervivencia global y libre de enfermedad del tratamiento conservador fue de 36 (19,9 DE) y 31 meses (19,2 DE) respectivamente, que no fue inferior a la del grupo de mastectomía de 23 (19,5 DE) y 20 meses (18,9 DE). La invasión de la dermis apareció en el 100% de las pacientes que recidivaron y no se evidenció ningún caso de recaída cuando estuvo ausente. Conclusiones: El tratamiento quirúrgico conservador de pacientes con enfermedad de Paget mamaria no empeora la supervivencia libre de enfermedad ni la global. La invasión dérmica puede ser un factor pronóstico a tener en cuenta en futuros estudios (AU)
Objectives: To analyze the impact of conservative surgery versus mastectomy on recurrence and survival in mammary Paget disease. Material and methods: A retrospective study of 31 patients with a diagnosis of breast cancer from 2005 to 2012 was conducted at the Institut Català dOncologia-Hospital Universitario Bellvitge. We included patients with a histological diagnosis of mammary Paget disease who underwent surgery, and excluded patients with metastatic disease at diagnosis. The impact of radiologic and histologic features of the tumor, stage, axillary involvement and type of surgery on disease course (local and/or systemic recurrences) was evaluated by Fisher's exact test. Overall survival and disease-free survival depending on the type of surgery and histology were analyzed by the Kaplan Meier and log rank Mantel-Haenzel tests. Results: Conservative surgery was performed in 14 (45.1%) patients and mastectomy in 17 (54.8%). Seven (22.6%) patients developed metastases and/or recurrence of the primary tumor after a mean follow-up of 29 months (SD 20.6). The mean overall survival and disease-free survival with conservative treatment was 36 months (SD 19.9) and 31 months (SD 19.2), respectively, which was not inferior to that in the mastectomy group, with 23 months (SD 19.5) and 20 months (SD 18.9). Dermal invasion was present in 100% of patients with recurrent disease and in none of those without recurrence. Conclusions: Conservative treatment in mammary Paget disease does not worsen overall and free-disease survival. Future studies should analyze dermal invasion as a prognostic factor (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Enfermedad de Paget Mamaria/cirugía , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Mastectomía Segmentaria , Espectroscopía de Resonancia Magnética , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the effectiveness of the Perinatal Continuing Education Programme (PCEP) in a Latin American country. METHODS: We carried out a study within secondary and tertiary care, and rural Mexican Institute of Social Security (IMSS) hospitals on the Yucatan Peninsula. Participants were doctors, nurses and nursing assistants working with pregnant women and newborns at each hospital. The PCEP was translated into Spanish and then implemented between January 1998 and December 2001. Two nurses at each hospital were trained to co-ordinate the programme and the personnel were invited to participate. Participation involved purchasing the self-teaching books, study outside work hours and participation in skills demonstration and practice sessions. Evaluation included the percentage of personnel who participated in and those who completed the programme, an opinion survey of the programme, level of pre- and post-intervention knowledge, and the quality of neonatal care according to expert-recommended routines. Results were analysed with chi-square and Student's t-tests. RESULTS: A total of 65.3% of the 1421 people in the study population began the programme and 72% of those completed it. Improvement was observed in 14 of 23 (P<0.05) evaluated neonatal care practices. Participants rated the written material as very clear and useful in daily practice. CONCLUSIONS: The PCEP is an effective strategy for improving the level of knowledge and perinatal care in all regional hospitals on the Yucatan Peninsula, Mexico. This initial application of the PCEP in a Spanish-speaking country was successful.
Asunto(s)
Educación Médica Continua/organización & administración , Atención Perinatal/normas , Perinatología/educación , Enseñanza/métodos , Personal Administrativo , Educación a Distancia , Femenino , Humanos , Recién Nacido , México , Embarazo , Evaluación de Programas y Proyectos de Salud , Materiales de EnseñanzaRESUMEN
O processo de desindustrialização e urbanização crescente no município de São Paulo revelaram o seu legado: o passivo ambiental relacionado às áreas contaminadas (AC) devido ao manejo indevido das substâncias químicas utilizadas nos processos produtivos. As AC podem impactar os compartimentos ambientais solo, água e ar, expondo os trabalhadores da construção civil a novos riscos ocupacionais e formas de adoecimento em escalas espaciais e temporais. Os trabalhadores da construção civil são os primeiros a se exporem aos contaminantes nessas áreas. A Vigilância em Saúde Ambiental (VSA) deve desenvolver ações conjuntas com a Vigilância em Saúde do Trabalhador (VSAT) para populações expostas ao solo contaminado. Devido ao crescente número das AC no município de São Paulo este estudo visa apresentar as substâncias ou grupos de substâncias químicas de interesse ambiental identificadas nas AC e os riscos à saúde do trabalhador e da trabalhadora da construção civil. Objetivo geral: Identificar os riscos químicos aos trabalhadores da construção nas áreas contaminadas sob processo de licenciamento ambiental. Metodologia: Foi realizado levantamento bibliográfico no período de 2010 a 2015 na base de dados BVS com enfoque em risco químico ao trabalhador da construção. Por meio do Relatório de Áreas Contaminadas de julho 2015, foi realizada a análise dos dados disponibilizados online no site da Secretaria Municipal do Verde e Meio Ambiente de São Paulo (SMVA) Resultados: Em São Paulo existem 436 AC em fase de licenciamento ambiental. Destas 410 são de empreendimentos privados e 26 públicos abrangendo os territórios das 06 Coordenadorias Regionais de Saúde (CRS) e quase 82% das subprefeituras de São Paulo. As substâncias ou grupos de substâncias que mais ocorreram nas AC foram os metais presentes em 78% das AC seguido por hidrocarbonetos aromáticos policíclicos (PAH) com 31% e hidrcarbonetos torais do petróleo (TPH) com 30%. Os riscos à saúde que essas substâncias podem proporcionar ao ser humano vão desde lesões em órgãos chaves como cérebro, coração, pulmãos, fígado e rins até problemas carcinogênicos/mutagênicos, teratogênicos e da ordem de desreguladores endócrinos a depender das características fisicoquímicas, tempo de exposição, dose de exposição, toxicidade, susceptibilidade do indivíduo e vulnerabilidades socioambientais do trabalhador.
Asunto(s)
Contaminación QuímicaRESUMEN
The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn't compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.
Estudio de revisión bibliográfica cuyo objetivo es presentar el panorama sobre investigaciones que utilizan el Injury Severity Score (ISS) en comparación con el New Injury Severity Score (NISS). Las búsquedas fueron realizadas en las bases de datos, utilizando el término NISS. Encontrados 42 artículos, 23 de los cuales no realizaron la comparación de los índices en cuestión. Gran parte de los 19 artículos seleccionados, encontraron que el NISS al ser comparado, mostró una mejor relación con los resultados del ISS, principalmente en lesiones graves y específicas. Para estudios cuyas muestras variaron entre 1.000 y 10.000 casos, se observaron resultados favorables para el NISS. Muestras superiores a 10.000 e inferiores a 1.000 mostraron tanto preferencia como igualdad para el NISS. En ningún estudio el ISS superó al NISS, para el caso del diagnósticos de situaciones analizadas. Estas observaciones y un mejor cálculo del NISS frente al ISS, parecen indicar la futura substitución del ISS por el NISS.
Trata-se de revisão bibliográfica, cujo objetivo é apresentar o panorama das pesquisas que utilizam o New Injury Severity Score (NISS) e que o comparam com o Injury Severity Score (ISS). Foram realizadas buscas em bases de dados utilizando-se o termo NISS. Foram localizados 42 artigos, 23 não comparavam os índices em questão. A maioria dos 19 artigos selecionados afirmou que NISS se relacionou melhor com os resultados do que o ISS, principalmente em ferimentos graves e específicos. Em estudos, cuja amostra variou de 1.000 a 10.000 casos, observou-se resultado favorável ao NISS; amostras maiores que 10.000 e menores que 1.000 indicaram ora preferência ao NISS, ora igualdade. Em nenhum estudo o ISS superou o NISS para prever os eventos analisados. Essas observações e maior facilidade do cálculo do NISS em relação ao ISS direcionam a futura substituição do ISS pelo NISS.
Asunto(s)
Puntaje de Gravedad del Traumatismo , Heridas y Lesiones , Índices de Gravedad del TraumaRESUMEN
Se presenta una versión de la Measure of Affect Regulation Styles (MARS) ampliada, aplicada a episodios emocionales de ira y tristeza en una muestra de 355 estudiantes de licenciatura de Chile, España y México. El estudio examinó la asociación entre formas de regulación afectiva con la adaptación en estos episodios y con medidas disposicionales de afrontamiento, de regulación emocional y bienestar psicológico. Se confirmó que las estrategias de regulación emocional efectivas en cuanto a la mejora percibida de metas adaptativas son el afrontamiento instrumental, la búsqueda de apoyo, la reevaluación, la distracción, la rumiación, autoreconfortarse, el autocontrol y la expresión regulada; mientras que las disfuncionales fueron la supresión de la expresión y la inhibición. Se encontraron asociaciones positivas entre las estrategias adaptativas y el bienestar, la reevaluación y uso del humor como forma de afrontar el estrés, así como negativas con la supresión y alexitimia. Las estrategias inadaptativas mostraron el perfil opuesto. En la ira, emoción de aproximación, se hace congruentemente un mayor uso de la confrontación, el afrontamiento directo y tanto del apoyo como del aislamiento social (AU)
An expanded Spanish version of the Measure of Affect Regulation Styles (MARS), was applied to episodes of anger and sadness, in a sample of 355 graduate students from Chile, Spain, and Mexico. The study examines the association between affective regulation, adaptation to episodes and dispositional coping and emotional regulation, and psychological well-being. With regard to perceived improvement of adaptive goals, the following adaptive affect regulation strategies were confirmed: Instrumental coping, seeking social support, positive reappraisal, distraction, rumination, self-comfort, self-control, and emotional expression were functional; whereas inhibition and suppression were dysfunctional. Adaptive strategies were positively associated with psychological well-being, reappraisal and humor as a coping strategy. Negative associations were found between adaptive strategies and suppression and alexithymia. Maladaptive strategies show the opposite profile. Confrontation, instrumental coping, social support as well as social isolation were more frequently found in anger, an approach emotion (AU)