Prognostic stratification ability of the CPS+EG scoring system in HER2-low and HER2-zero early breast cancer treated with neoadjuvant chemotherapy.

BACKGROUND: The CPS+EG scoring system was initially described in unselected early breast cancer (eBC) patients treated with neoadjuvant chemotherapy (NAC), leading to refined prognostic stratification, and thus helping to select patients for additional post-NAC treatments. It remains unknown whether the performance is the same in new biological breast cancer entities such as the HER2-low subtype. PATIENTS AND METHODS: Outcomes (disease-free (DFS) and overall survival OS)) of 608 patients with HER2-non amplified eBC and treated with NAC were retrospectively analyzed according to CPS-EG score. We compared the prognostic stratification abilities of the CPS+EG in HER2-low and HER2-0 eBC, analyzing ER+ and ER- tumors separately. RESULTS: In ER+ eBC, the CPS+EG scoring system seems to retain a prognostic value, both in HER2-low and HER2-0 tumors, by distinguishing populations with significantly different outcomes (good: score 0-1, poor: score 2-3, and very poor: score 4-5). Using C-indices for DFS and OS, CPS+EG provided the highest prognostic information in ER+ eBC, especially in HER2-0 tumors. In contrast, in ER- eBC, the CPS+EG does not appear to be able to distinguish different outcome groups, either in HER2-low or HER2-0 tumors. In ER- eBC, C-indices for DFS and OS were highest for pathological stage, reflecting the predominant prognostic importance of residual disease in this subtype. CONCLUSIONS: HER2-low status does not influence the prognostic performance of the CPS+EG score. Our results confirm the usefulness of the CPS+EG score in stratifying the prognosis of ER+ eBC after NAC, for both HER2-0 and HER2-low tumors. For ER- eBC, HER2-low status does not influence the performance of the CPS+EG score, which was lower than that of the pathological stage alone.

[Updated indications and techniques for immediate breast reconstruction, particularly in the case of adjuvant radiotherapy]. / Actualisation des indications et techniques de reconstruction mammaire immédiate, notamment en cas de radiothérapie adjuvante.

In 2023, 62,000 patients were diagnosed with breast cancer in France. Every year, 22,000 mastectomies are performed. Breast reconstruction (BR) should be an integral part of breast cancer management. Yet the MR rate in France is only 28% within 3 years of mastectomy, of which 14% are immediate breast reconstruction (IBR). The number of contraindications to RMI has steadily declined over the last few decades, although some of them remain definitive, such as inflammatory cancer (T4d). Today, many specialists involved in the management of breast cancer consider that IBR can be proposed in cases where adjuvant chemotherapy and/or radiotherapy is indicated, if it is not expected to delay carcinological management. The surgical team must then inform the patient of all available BR techniques. If a team does not offer a particular technique, the patient should be referred to a center that does. In all cases, the proposal for curative and reparative treatment should be the subject of a multidisciplinary discussion involving, in particular, a surgeon, a radiotherapist and a medical oncologist. When adjuvant radiotherapy is indicated, the patient must be informed of the increased risk of complications and deterioration of the aesthetic result. In this indication, RMI by prosthesis is a validated technique. However, if the patient has a history of radiotherapy, autologous techniques should be preferred. In a context of shared decision-making, the choice of whether or not to undergo MR and the type of technique must ultimately be made by the patient, in agreement with the multidisciplinary team.

The use of the cap and underwater technique as an aid in endoscopic diagnosis and treatment of upper gastrointestinal bleeding: case series.

BACKGROUND AND AIMS: Upper GI bleeding (UGIB) is a medical emergency associated with elevated mortality and significant costs to the health care system. EGD is currently the method of choice for the diagnosis and management of these conditions. However, the location of bleeding lesions and technical difficulties in achieving endoscope stability may challenge even the most experienced endoscopists. Herein, we demonstrate the use of the cap and underwater technique as a helpful aid in these situations. METHODS: We present a case series of 4 patients with acute UGIB who underwent EGD with suboptimal endoscopic visualization or technical difficulties in identifying the source of bleeding. A transparent plastic cap was attached to the distal tip of the gastroscope, and the water immersion technique (underwater) was used for endoscopic re-evaluation of the bleeding site. RESULTS: Three patients presented with duodenal bleeding, and 1 was diagnosed with diffuse bleeding from the esophagus. The clear and accurate identification of the source of bleeding and effective hemostasis were possible after cap and underwater technique evaluation in all patients. CONCLUSION: The use of the cap and underwater technique is a simple, safe, and low-cost strategy that improves the identification and control of UGIB in locations with poor visibility and technical challenges during endoscopic evaluation.

Perfil dos pacientes com hemorragia digestiva alta no Hospital do Servidor Público Municipal de SP e suas etiologias mais prevalentes / Profile of patients with high digestive hemorrhage in the Hospital do Servidor Público Municipal de SP and their most prevalent etiologies

RESUMO Introdução: A hemorragia digestiva alta é definida pelo sangramento do trato gastrointestinal decorrente de lesões em localização proximal ao ângulo de Treitz (ou flexura duodenojejunal), incluindo esôfago, estômago e duodeno. É uma condição médica de grande morbidade, mortalidade e custos médicos. A endoscopia digestiva alta é o método diagnóstico de escolha. Uma vez identificada a origem do sangramento, a terapia endoscópica pode realizar hemostasia e prevenir sua recorrência. Sabe-se que as etiologias de hemorragia digestiva alta são diversas e suas frequências vem mudando ao longo do tempo. Objetivos: Estudar um grupo de pacientes com hemorragia digestiva alta encaminhados para endoscopia digestiva alta no Hospital do Servidor Público Municipal de São Paulo, nos meses de janeiro, fevereiro e março de 2019 e avaliar a etiologia do sangramento retrospectiva dos laudos dos exames endoscópicos. Método: Estudo retrospectivo, transversal, onde foram analisados laudos endoscópicos dos pacientes que realizaram endoscopia digestiva alta no serviço de endoscopia do Hospital do Servidor Público Municipal de São Paulo devido a hemorragia digestiva alta no período de janeiro, fevereiro e março de 2019. Resultados: Foram solicitadas 32 endoscopias diagnósticas para hemorragia digestiva alta no período estudado. A média de idade foi de 65 anos e o sexo feminino foi ligeiramente predominante. A maior causa de sangramento neste estudo foi a doença ulcerosa péptica, com 31% dos casos. Esofagite foi causa da hemorragia em 15% dos pacientes. Apenas 1 paciente apresentou varize como causa do sangramento. Tratamento endoscópico foi realizado em apenas 3 casos. Conclusão: A doença ulcerosa péptica foi a etiologia mais prevalente de hemorragia digestiva alta no HSPM. Por outro lado, a prevalência de varizes como causa da hemorragia foi consideravelmente menor do que o encontrado na literatura atual. Sendo assim, é importante conhecer o perfil etiológico pois o mesmo varia com o passar do tempo e seu conhecimento é essencial para maiores investimentos em terapia endoscópica otimizada. Palavras-Chave: Hemorragia gastrointestinal, Endoscopia, Úlcera péptica, Esofagite.