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

Introducción y objetivo: La detección precoz de las complicaciones del miembro superior en mujeres intervenidas de cáncer de mama es importante. El cuestionario FACT-B+4-MS, variante del Functional Assessment of Cancer Therapy-Breast (FACT-B) es una escala específica de la función del miembro superior en estas pacientes. Pacientes y métodos: Se valida el FACT-B+4-MS en una cohorte prospectiva de 201 mujeres intervenidas por cáncer de mama (análisis factorial, consistencia interna, fiabilidad test-retest, validez del constructo y sensibilidad al cambio) y se explora mediante regresión logística su capacidad predictora de linfedema y otras complicaciones. Resultados: El FACT-B+4-MS es unifactorial y goza de gran consistencia interna (alfa de Cronbach: 0,87), alta fiabilidad test-retest (coeficiente de correlación intraclase: 0,98), validez de constructo (R de Pearson con el 'Quick DASH': 0,81) y sensibilidad al cambio. En los modelos de regresión, no aparece como variable explicatoria de linfedema, pero sí de otras complicaciones del miembro superior. Conclusiones: El FACT-B+4-MS es útil para medir la discapacidad del miembro superior en mujeres operadas por cáncer de mama. No predice el establecimiento de linfedema, pero sí, aunque débilmente, otras alteraciones (AU)

Introduction and objective: 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 (AU)

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.

Estudio comparativo del uso de implante mamario únicamente o implante y malla biológica en reconstrucción inmediata tras mastectomía ahorradora de piel / Comparative study of the use of immediate implant-based breast reconstruction with or without biological dermal mesh after skin-sparing mastectomy

Objetivo. Valorar las complicaciones postoperatorias en pacientes intervenidas mediante mastectomía ahorradora de piel o piel y aréola-pezón, con reconstrucción inmediata e implantación de prótesis o prótesis más malla biológica. Pacientes y métodos. Estudio prospectivo. Periodo de estudio: octubre de 2011-octubre de 2014. Criterios de inclusión: cáncer de mama multicéntrico, carcinoma ductal in situ con indicación de mastectomía y tumores cT2 que no tuvieron respuesta a tratamiento sistémico primario. Criterios de exclusión: edad > 75 años. Grupo control: pacientes reconstruidas mediante prótesis. Grupo estudio: pacientes reconstruidas mediante prótesis y malla biológica de dermis porcina acelular, no entrecruzada, de 1,6 mm e hidratada. Resultados. Se incluyeron en el grupo de estudio 34 pacientes, y en el grupo control, 38 pacientes. Extrusión de prótesis: grupo estudio uno (2,9%); grupo control 9 (23,7%) (p = 0,015). Infecciones: grupo estudio 3 (8,8%); grupo control 3 (7,9%) (p = 1). Necrosis cutánea: grupo estudio 5 (14,7%); grupo control 5 (13,2%) (p = 1). Seroma: grupo estudio 5 (14,7%); grupo control 5 (13,2%) (p = 1). Conclusión. Se ha observado una disminución significativa de la extrusión de la prótesis en las mujeres en las que se implantaron mallas biológicas. En seromas, infección y necrosis cutánea no observamos diferencias significativas (AU)

Objective. To evaluate postoperative complications after skin- or nipple-sparing mastectomy with immediate implant-based breast reconstruction with or without biological dermal mesh. Patients and methods. Prospective study. Study period: October 2011-October 2014. Inclusion criteria: multicentre breast cancer, ductal carcinoma in situ with indication for mastectomy, and cT2 tumours with no response to primary systemic treatment. Exclusion criteria: patients older than 75 years. Control group: breast reconstructions with mammary prosthesis exclusively. Study group: breast reconstructions with implant and non-crosslinked biological 1.6 mm hydrated acellular porcine dermal mesh. Results. Thirty-four patients were included in the treatment group and 38 patients in the control group. Number of prosthesis extrusions: study group one (2.9%); control group 9 (23.7%) (P = .015). Infections: study group 3 (8.8%); control group 3 (7.9%) (P = 1). Skin necrosis: study group 5 (14.7%); control group 5 (13.2%) (P = 1). Seroma: study group 5 (14.7%); control group 5 (13.2%) (P = 1). Conclusion. The number of extrusions was significantly lower in breast reconstructions with prosthesis and biological mesh. No significant differences were observed in seroma, infection, or skin necrosis (AU)

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

INTRODUCCIÓN: El objetivo del estudio fue analizar el impacto de la cirugía locorregional en la supervivencia de pacientes con cáncer de mama estadio IV. PACIENTES Y MÉTODOS: Estudio retrospectivo que incluyó a pacientes con cáncer de mama y metástasis sincrónicas. Se excluyó a pacientes con ECOG superior a 2 y elevado riesgo anestésico-quirúrgico. Se evaluaron las siguientes variables: edad, tamaño tumoral, afectación ganglionar, tipo histológico, grado histológico, receptores hormonales, sobreexpresión de HER2, número de órganos afectos, localización de las metástasis y tratamiento quirúrgico. El impacto de la cirugía y las distintas variables clínico-patológicas sobre la supervivencia se analizó mediante un modelo de regresión de Cox. RESULTADOS: Se incluyó a 69 pacientes, de los que 36 (52,2%) fueron intervenidos quirúrgicamente (grupo estudio). Tras un seguimiento medio de 34 meses, la supervivencia media de la serie fue de 55 meses y no se encontraron diferencias significativas entre el grupo estudio y el grupo de pacientes sin intervención quirúrgica (p = 0,187). Se identificaron 2 factores relacionados con una peor supervivencia: el número de órganos con metástasis (HR = 1,69; IC 95%: 1,05- 2,71) y el cáncer triple negativo (HR = 3,49; IC 95%: 1,39-8,74). La cirugía locorregional, sin embargo, no se relacionó con la supervivencia. CONCLUSIONES: El tratamiento quirúrgico locorregional no se asoció con mayor supervivencia en pacientes con cáncer de mama en estadio IV. El número de órganos con metástasis y los tumores triple negativo fueron factores de mal pronóstico de supervivencia

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

Angiosarcoma secundario de mama: recidiva multifocal en colgajo autólogo utilizado en la reconstrucción / Secondary breast angiosarcoma: Multifocal recurrence in a postmastectomy breast reconstruction flap

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[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.

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

Introducción. Los objetivos de este estudio fueron investigar la expresión de ciclooxigenasa-2 (COX-2) en células tumorales de cáncer colorrectal y estudiar la COX-2 como factor pronóstico de metástasis a distancia y supervivencia. Pacientes y método. Se ha estudiado de forma retrospectiva una serie de 105 pacientes con cáncer colorrectal esporádico intervenidos en el Servicio de Cirugía General del Hospital Universitario Médico-Quirúrgico de Jaén entre los años 1991 y 1997. Se estudiaron las siguientes características: sexo, localización tumoral, estadio TNM, tipo histológico, grado histológico, invasión venosa e invasión linfática. El tiempo medio de seguimiento fue de 54 meses. Inmunohistoquímica: la inmunotinción para COX-2 se realizó por el método avidina-biotina-peroxidasa y se valoraron la intensidad y la extensión de la tinción. Resultados. La expresión de COX-2 en las células tumorales se consideró positiva en 38 casos (36,2%). No hubo una relación estadísticamente significativa entre la expresión de COX-2 y las características clínicas e histopatológicas estudiadas (p > 0,05). En 14 pacientes (13,3%) se diagnosticaron metástasis a distancia. En el análisis multivariable la expresión de COX-2 no se relacionó significativamente con las metástasis a distancia (harzard ratio [HR] = 0,36; intervalo de confianza [IC] del 95%, 0,07-1,69). La supervivencia media fue de 55 meses. En el análisis multivariable, la COX-2 no se comportó como factor independiente de riesgo de muerte (HR = 0,51; IC del 95%, 0,22-1,21). Conclusiones. La COX-2 no se relacionó significativamente con las características clínicas e histopatológicas del tumor. La COX-2 no fue un factor pronóstico independiente de recurrencia tumoral y supervivencia (AU)

Introduction. The aims of the present study were to investigate cyclooxigenase-2 expression in neoplastic cells from colorectal carcinoma and to study the role of cyclooxigenase-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: cyclooxigenase-2 expression was tested using avidin-biotin-peroxidase immunostaining. Both the intensity and extension of the stain were assessed. Results. Cyclooxigenase-2 expression in neoplastic cells was considered to be positive in 38 cases (36.2%). No statistically significant relationship was found between cyclooxigenase-2 expression and the clinicopathological features recorded (P >.05). Tumor recurrence: Distant metastases were diagnosed in 14 patients (13.3%). Cyclooxigenase-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 cyclooxigenase-2 as an independent risk factor of death (HR: 0.51; 95% CI: 0.22-1.21). Conclusions. Cyclooxigenase-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 (AU)

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

Introducción. Por patrón de invasión tumoral entendemos el tipo de crecimiento, infiltrante o no infiltrante, de los márgenes del tumor. El objetivo de estudio es valorar el patrón de invasión tumoral (infiltrantes/no infiltrantes) en el cáncer colorrectal como factor pronóstico relacionado con la recidiva tumoral y la supervivencia. Pacientes y método. Se ha estudiado a 105 pacientes con cáncer colorrectal en los que se realizó cirugía radical en el Servicio de Cirugía General de Hospital Universitario Médico-Quirúrgico de Jaén entre los años 1991 y 1997. El tiempo medio de seguimiento fue de 54 meses. En cuanto al patrón de invasión del tumor, se han descrito 2 tipos de crecimiento del margen tumoral: infiltrante y no infiltrante o desplazante. Resultados. El frente invasor del tumor presentaba una configuración infiltrante en 65 casos (62%). Respecto a la recidiva tumoral, en 14 pacientes (13,3%) se diagnosticaron metástasis a distancia. En el análisis univariable, la configuración infiltrante se comportó como un factor de riesgo de metástasis a distancia con significación estadística; sin embargo, en el análisis multivariable no mantuvo la significación estadística. En cuanto a la supervivencia, fallecieron 30 pacientes (28,5%) por causas relacionadas directamente con la enfermedad neoplásica. La super- vivencia media fue de 55 meses. El crecimiento infiltrante fue un factor independiente de riesgo de muerte con significación estadística (harzad ratio = 2,50; intervalo de confianza del 95%, 1,05-5,88). Conclusiones. La configuración infiltrante del patrón de invasión del tumor se relacionó significativamente con el intervalo libre de metástasis. El crecimiento infiltrante fue un factor pronóstico independiente de la supervivencia en el cáncer colorrectal (AU)

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 (AU)

[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.