Modified neoadjuvant clinicopathological risk stratification as a prognostic score in early and locally advanced triple-negative breast cancer.

Background: Triple-negative subtype is an aggressive breast cancer with inferior survival. Pathological complete remission (pCR) is a good surrogate endpoint for survival among patients receiving neoadjuvant chemotherapy (NACT). We attempted to validate the clinical pathological score (CPS) with a modified risk grouping among Triple-negative breast cancer (TNBC) patients receiving NACT at our center. Methodology: Data of patients with TNBC who underwent NACT between January 2014 to July 2017 were retrospectively analyzed. The composite CPS score included cTN stage and y pTN stage and ranged from 0 to 4. This was calculated using an available online software developed by MD Anderson Center. The score obtained from the calculator was used to develop a risk grouping into low risk (0, 1) and high risk (2, 3, 4). Invasive disease-free survival (iDFS) and locoregional recurrence-free survival (LRFS) were calculated using the Kaplan-Meier method. Results: Seventy-eight patients with TNBC (median age: 45 [24-75]) had received NACT (anthracyclines and taxanes). Early and locally advanced breast cancer constituted 17 (21.8%) and 61 (78.2%), respectively, and 22 (28.2%) achieved pCR. After a median follow-up of 25 months (5-62), 3-year iDFS and OS were 59% and 81%, respectively, for the entire population. The 3-year iDFS in low-risk (n = 18) and high-risk (n = 60) patients was 85% and 51%, respectively (P = 0.03). The 3-year LRFS in low risk and high risk was 93% versus 58% (P = 0.03). The 3-year OS in the low and high risk was 93% and 77%, respectively (P = 0.24, NS). Conclusion: Our study supports the use of the modified neoadjuvant clinicopathological score as a prognostic marker in patients with nonmetastatic triple-negative breast cancer. This needs to be validated in a larger subset of patients.

147 Pancreatoduodenectomies: a Single Center's Perspective into the Epidemiology and Surgical Outcomes of Periampullary and Pancreatic Cancers in South India.

BACKGROUND: Pancreatoduodenectomy (PD) is the only curative procedure for resectable periampullary cancers. This study aims to survey the various outcome variables of the procedure at our institute, which is in the early process of evolving into a high-volume center for PDs. METHODS: Data of patients, who underwent PDs, was collected retrospectively from January 2010 to December 2017 and prospectively from January 2018 to December 2019. Various preoperative, intraoperative, and histopathological parameters were compared with the outcome variables-morbidity and mortality rates. RESULTS: A total of 147 patients underwent PDs over the last decade. From January 2010 to December 2014 (period A), 29 patients underwent PD, while 118 patients underwent PD from January 2015 to December 2019 (period B). Clinically relevant (CR) delayed gastric emptying (44.8% vs 23.7%), CR post-pancreatectomy hemorrhage (37.9% vs 18.6%), and blood loss (850 ml (400-5300 ml) vs 600 ml (150-2500 ml)) improved in period B with no improvement in CR postoperative pancreatic fistula (20.7% vs 28.8%). The rates of SSI (63.6%), pulmonary complications (29.9%), and mean postoperative stay (19.87 ± 11.59 days) were found to be higher than most of the major centers. Mortality rates decreased significantly from 27.6% in period A to 10.2% in period B (p = 0.029). Median overall survival was 30 months (95% CI 20.76-39.23 months) CONCLUSION: Over the last decade, there has been a significant improvement in the mortality rate, but morbidity remains high and must be looked into as the department enters the new decade as a young high-volume center.

Allele and genotype distributions of DNA repair gene polymorphisms in South Indian healthy population.

Various DNA repair pathways protect the structural and chemical integrity of the human genome from environmental and endogenous threats. Polymorphisms of genes encoding the proteins involved in DNA repair have been found to be associated with cancer risk and chemotherapeutic response. In this study, we aim to establish the normative frequencies of DNA repair genes in South Indian healthy population and compare with HapMap populations. Genotyping was done on 128 healthy volunteers from South India, and the allele and genotype distributions were established. The minor allele frequency of Xeroderma pigmentosum group A (XPA) G23A, Excision repair cross-complementing 2 (ERCC2)/Xeroderma pigmentosum group D (XPD) Lys751Gln, Xeroderma pigmentosum group G (XPG) His46His, XPG Asp1104His, and X-ray repair cross-complementing group 1 (XRCC1) Arg399Gln polymorphisms were 49.2%, 36.3%, 48.0%, 23.0%, and 34.0% respectively. Ethnic variations were observed in the frequency distribution of these polymorphisms between the South Indians and other HapMap populations. The present work forms the groundwork for cancer association studies and biomarker identification for treatment response and prognosis.

Frequency distribution of DNA repair genes ERCC1 and ERCC2 polymorphisms in South Indian healthy population.

DNA repair genes are crucial in maintaining the integrity of the whole genome. Single nucleotide polymorphisms (SNPs) in DNA repair genes have been attributed to the development of various cancers. SNPs of DNA repair genes (ERCC1 and ERCC2) have been implicated in the causation of various cancers as well as inter-individual variability in the therapeutic outcomes of platinum based therapy. Thus establishing the frequency of these functional SNPs in the healthy population is of significance. The present study was aimed to establish the allele and genotype frequencies of ERCC1 (19007C>T, rs11615; 8092C>A, rs3212986) and ERCC2 (Asp312Asn, rs1799793) genes in South Indian healthy population and to compare the data from HapMap populations. The study population consisted of 128 healthy South Indian unrelated individuals of either sex aged between 18 and 60 years. Standard phenol-chloroform method was used to extract DNA from peripheral leukocytes. The genotype of DNA repair gene polymorphisms was determined by quantitative real-time polymerase chain reaction using TaqMan genotyping assay. The observed frequency of the studied polymorphisms followed Hardy-Weinberg equilibrium (p>0.05). The frequencies of the minor alleles of the SNPs rs11615 (T), rs3212986 (A) and rs1799793 (A) were 43.8%, 29.3% and 35.6%, respectively. Gender-based analysis showed no significant difference in the frequency pattern. The observed allele and genotype frequencies showed significant ethnic difference between South Indians and other HapMap populations. This is the first study to provide the normative frequency data of allele and genotype distribution of three SNPs of ERCC1 and ERCC2 in South Indian healthy population. It might be useful in future genotype-phenotype association studies, especially for predicting the efficacy and adverse events of platinum based drugs.

Skeletal muscle metastasis from carcinoma cervix: a case report / 부인종양

Cervical cancer is the most common malignancy in Indian women. Cervical cancer usually spread by local extension and through the lymphatics to the retroperitoneal lymph nodes. Direct invasion of muscles by primary growth is more common than by metastatic involvement. We present a case of carcinoma of the cervix post radiotherapy to pelvis who on follow up presented with biceps muscle metastases as the initial sign of disseminated disease.