ABSTRACT
BACKGROUND: Primary tumor characteristics, which are readily available to all clinicians, may aid in selecting the optimal adjuvant therapy for patients with breast cancer (BC). Herein, we investigated the relationship between tumor size, hormone receptor and HER2 status, Ki67 and age with axillary lymph node metastases (ALNM) in early-BC patients. METHODS: We analyzed data on consecutive 2600 early-BC cases collected in the registry of Fondazione IRCC Istituto Nazionale dei Tumori, Milano, Italy. Correlation between Ki67 and primary tumor size (T-size) was calculated by Spearman's rank correlation coefficient. Association of ALNM with Ki67 and other tumor characteristics was investigated by logistic regression. Adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) were estimated in all cases, and separately analyzed according to age, T-size and BC subtype. RESULTS: Large tumor size strongly associated to ALNM, with an adjusted odds ratio (OR) for each 5-mm increase of 1.32 (95% CI 1.24-1.41), except for triple-negative BC (TNBC) cases. In tumors =10 mm, without lymphovascular invasion, representing the strongest predictor of ALNM (OR 6.09, 95% CI 4.93-7.53), Ki67 resulted particularly informative, with a fourfold increased odds of ALNM for values > 30%. CONCLUSIONS: These results raise the question whether axillary node status is redundant in cases with exceptionally good features, i.e., small tumors with low Ki67, or in those candidate to adjuvant systemic treatment/radiotherapy anyway including TNBC, and support the incorporation of primary BC tumor characteristics as stratification factors in ongoing trials aiming at de-escalating axillary surgical procedures.
Subject(s)
Breast Neoplasms/pathology , Lymph Nodes/pathology , Aged , Axilla , Biomarkers, Tumor/metabolism , Breast Neoplasms/epidemiology , Breast Neoplasms/surgery , Female , Humans , Italy/epidemiology , Ki-67 Antigen/metabolism , Logistic Models , Lymph Nodes/surgery , Lymphatic Metastasis , Middle Aged , Odds Ratio , Predictive Value of Tests , Receptor, ErbB-2/metabolism , Receptors, Steroid/metabolism , Tumor BurdenABSTRACT
PURPOSE: Over the last decade a dramatic improvement in the treatment and prognosis of human epidermal growth factor receptor-2 (HER2) positive metastatic breast cancer (MBC) has been achieved. This study aimed to describe pattern, timing of metastases, and time to progression (TTP) of MBC patients (pts) treated with multiple lines of therapy with trastuzumab and/or lapatinib. METHODS: Clinical-pathologic features, treatment-lines and metastatic sites were collected from the institutional database; TTP was evaluated for each treatment-line. A meta-analysis of treatment-line estimates was performed; Q test and I (2)-index were used to detect and estimate heterogeneity. Cox's proportional hazards model and Fine and Gray's proportional subhazards model in a competing risks setting were used to detect differences in hazard rate and to estimate relative risks. RESULTS: 112 pts were analyzed. The median number of treatment-lines administered was 6 (range 1-17) and 524 (86 %) disease progression events were observed (median follow up 4.2 years). Distribution of metastases at baseline remained consistent across all lines. Having a given site affected by metastasis was a major risk factor of progression in that site. Hormone-receptor-positive pts resulted more likely to progress on bone (HR = 1.88). Elderly pts were less likely to progress on CNS (HR = 0.73). Median TTP resulted superior to 5 months up to the 6th line of treatment, reaching a plateau at the 9th treatment-line. CONCLUSIONS: These data suggest that risk factors for progression in HER2 positive MBC do not significantly differ between various distributions of metastases, and that MBC pts benefit from anti-HER2 therapy even in late treatment-lines.
Subject(s)
Antineoplastic Agents/therapeutic use , Bone Neoplasms/drug therapy , Breast Neoplasms/drug therapy , Carcinoma, Ductal, Breast/drug therapy , Carcinoma, Lobular/drug therapy , Lung Neoplasms/drug therapy , Quinazolines/therapeutic use , Trastuzumab/therapeutic use , Adult , Aged , Bone Neoplasms/secondary , Breast Neoplasms/metabolism , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/metabolism , Carcinoma, Ductal, Breast/secondary , Carcinoma, Lobular/metabolism , Carcinoma, Lobular/secondary , Central Nervous System Neoplasms/drug therapy , Central Nervous System Neoplasms/secondary , Disease Progression , Female , Humans , Lapatinib , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Lung Neoplasms/secondary , Middle Aged , Prognosis , Proportional Hazards Models , Receptor, ErbB-2/antagonists & inhibitors , Receptor, ErbB-2/metabolism , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
The objective was to verify the occurrence of antibodies to Leptospira and to evaluate the spatial dispersion of free living mash deer (Blastocerus dichotomus) reactors, in the basin of Paraná River, states of São Paulo and Mato Grosso do Sul. Through the microscopic agglutination test, we examined 217 serum samples (77 males and 140 females) of mash deer caught in six locations in the Paraná river basin between the states of São Paulo and Mato Grosso do Sul. From this total, 130 (59.91%) samples reacted to 12 different serovars of pathogenic Leptospira, and 87 (40.09%) did not react. The more prevalent serovars found were Autumnalis (20.28% of the samples examined), Castellonis (13,36%) and Hardjo (11,98%). The serologic titers obtained in the reactive samples ranged from 100 to 800. Regarding the gender, 52 (67.5%) of the males and 78 (55.7%) of the females were reactors. There was no statistically significant difference between genders (P>0.05). The comparison between the frequency of reactors among adult and among young animals revealed a significant difference (P<0.01); 65.1% of the adult and 34.9% of the young animals were reactors. A significant difference was also observed among the local where animals were captured. The spatial dispersion, obtained by satellite images and georeferenced information of each mash deer captured, showed the distribution of mash deer reactors on the area studied.
Objetivou-se verificar a ocorrência de anticorpos contra Leptospira e avaliar espacialmente a dispersão de cervos-do-pantanal (Blastocerus dichotomus) de vida livre, que fossem reagentes, na bacia do Rio Paraná, estados de São Paulo e Mato Grosso do Sul. Foram examinadas, por meio do teste de soroaglutinação microscópica (SAM), 217 amostras de soro sanguíneo (77 machos e 140 fêmeas) de cervos-do-pantanal capturados em seis localidades na bacia do rio Paraná, entre os estados de São Paulo e Mato Grosso do Sul. Desse total, 130 (59,91%) amostras foram reagentes contra 12 diferentes sorovariedades de leptospiras patogênicas e 87 (40,09%) foram não reagentes. As sorovariedades mais encontradas foram: Autumnalis (20,28% dos animais examinados), Castellonis (13,36%) e Hardjo (11,98%). Os títulos sorológicos obtidos nas amostras reagentes variaram de 100 a 800. Com relação ao sexo, 52 (67,5%) machos e 78 (55,7%) fêmeas foram reagentes, não sendo observada diferença estatisticamente significativa (P>0,05). A comparação entre os animais jovens e adultos sororreagentes revelou que houve diferença significativa (P 0,01) com relação à idade; 65,1% dos adultos e 34,9% dos jovens foram reagentes. Quanto ao local de captura, observou-se que as frequências de reagentes diferiram significativamente. A dispersão espacial, obtida por imagens de satélite aliadas às informações do geoposicionamento de cada cervo-do-pantanal capturado, mostrou distribuição de cervos-do-pantanal reagentes na área estudada.
Subject(s)
Animals , Antibodies , Deer/immunology , Leptospira , Serotyping/veterinary , Animal Distribution , Serologic Tests/veterinaryABSTRACT
The objective was to verify the occurrence of antibodies to Leptospira and to evaluate the spatial dispersion of free living mash deer (Blastocerus dichotomus) reactors, in the basin of Paraná River, states of São Paulo and Mato Grosso do Sul. Through the microscopic agglutination test, we examined 217 serum samples (77 males and 140 females) of mash deer caught in six locations in the Paraná river basin between the states of São Paulo and Mato Grosso do Sul. From this total, 130 (59.91%) samples reacted to 12 different serovars of pathogenic Leptospira, and 87 (40.09%) did not react. The more prevalent serovars found were Autumnalis (20.28% of the samples examined), Castellonis (13,36%) and Hardjo (11,98%). The serologic titers obtained in the reactive samples ranged from 100 to 800. Regarding the gender, 52 (67.5%) of the males and 78 (55.7%) of the females were reactors. There was no statistically significant difference between genders (P>0.05). The comparison between the frequency of reactors among adult and among young animals revealed a significant difference (P<0.01); 65.1% of the adult and 34.9% of the young animals were reactors. A significant difference was also observed among the local where animals were captured. The spatial dispersion, obtained by satellite images and georeferenced information of each mash deer captured, showed the distribution of mash deer reactors on the area studied.(AU)
Objetivou-se verificar a ocorrência de anticorpos contra Leptospira e avaliar espacialmente a dispersão de cervos-do-pantanal (Blastocerus dichotomus) de vida livre, que fossem reagentes, na bacia do Rio Paraná, estados de São Paulo e Mato Grosso do Sul. Foram examinadas, por meio do teste de soroaglutinação microscópica (SAM), 217 amostras de soro sanguíneo (77 machos e 140 fêmeas) de cervos-do-pantanal capturados em seis localidades na bacia do rio Paraná, entre os estados de São Paulo e Mato Grosso do Sul. Desse total, 130 (59,91%) amostras foram reagentes contra 12 diferentes sorovariedades de leptospiras patogênicas e 87 (40,09%) foram não reagentes. As sorovariedades mais encontradas foram: Autumnalis (20,28% dos animais examinados), Castellonis (13,36%) e Hardjo (11,98%). Os títulos sorológicos obtidos nas amostras reagentes variaram de 100 a 800. Com relação ao sexo, 52 (67,5%) machos e 78 (55,7%) fêmeas foram reagentes, não sendo observada diferença estatisticamente significativa (P>0,05). A comparação entre os animais jovens e adultos sororreagentes revelou que houve diferença significativa (P 0,01) com relação à idade; 65,1% dos adultos e 34,9% dos jovens foram reagentes. Quanto ao local de captura, observou-se que as frequências de reagentes diferiram significativamente. A dispersão espacial, obtida por imagens de satélite aliadas às informações do geoposicionamento de cada cervo-do-pantanal capturado, mostrou distribuição de cervos-do-pantanal reagentes na área estudada.(AU)
Subject(s)
Animals , Antibodies , Leptospira , Deer/immunology , Serotyping/veterinary , Serologic Tests/veterinary , Animal DistributionABSTRACT
Objetivou-se verificar a ocorrência de anticorpos contra Leptospira e avaliar espacialmente a dispersão de cervos-do-pantanal (Blastocerus dichotomus) de vida livre, que fossem reagentes, na bacia do Rio Paraná, estados de São Paulo e Mato Grosso do Sul. Foram examinadas, por meio do teste de soroaglutinação microscópica (SAM), 217 amostras de soro sanguíneo (77 machos e 140 fêmeas) de cervos-do-pantanal capturados em seis localidades na bacia do rio Paraná, entre os estados de São Paulo e Mato Grosso do Sul. Desse total, 130 (59,91%) amostras foram reagentes contra 12 diferentes sorovariedades de leptospiras patogênicas e 87 (40,09%) foram não reagentes. As sorovariedades mais encontradas foram: Autumnalis (20,28% dos animais examinados), Castellonis (13,36%) e Hardjo (11,98%). Os títulos sorológicos obtidos nas amostras reagentes variaram de 100 a 800. Com relação ao sexo, 52 (67,5%) machos e 78 (55,7%) fêmeas foram reagentes, não sendo observada diferença estatisticamente significativa (P>0,05). A comparação entre os animais jovens e adultos sororreagentes revelou que houve diferença significativa (P