Expression of somatostatin type-2 and -4 receptor and correlation with histological type in breast cancer.

BACKGROUND: Somatostatin is produced by hypothalamic cells and also by tumors. We were interested to evaluate the somatostatin type 2 (SSTR2) and type 4 (SSTR4) receptor expression on a large sample cohort of breast cancer cases. MATERIALS AND METHODS: We used two different Tissue Micro Arrays (TMA) to evaluate SSTR2 and SSTR4 distribution. We evaluated the correlation between SSTR2 and SSTR4 expression and 18 tumor cells markers. We also assessed SSTR mRNA expression on an independent breast cancer population and correlated levels of SSTR2 and SSTR4 expression to molecular breast cancer subtypes. RESULTS: 268 tumors were analyzed. The tumor overexpression of estrogen receptor was significantly correlated to the expression of SSTR2 (p=0.05) and SSTR4 (p=0.04). On principal component analysis, SSTR2 subtype characterized the luminal tumor type. On an independent breast cancer population, expression of SSTR2 and SSTR4 are independent from Human Epidermal Growth Factor Receptor 2 (Her2) and correlated with luminal tumors. CONCLUSION: Expression of somatostatin receptors is a marker of luminal breast tumors.

Pregnancy-associated breast cancers: do they differ from other breast cancers in young women?

The impact of pregnancy in the physiopathology of pregnancy-associated breast cancer (PABC) is still unclear. We compared the characteristics of PABCs and breast cancers not associated with pregnancy (non-PABCs) in terms of their loco-regional invasion and histological phenotype. We conducted a retrospective chart review on women less than 43 years of age treated for breast cancer from January 1, 2004 to December 31, 2010. We compared age at diagnosis, loco-regional invasion and histological data. We recorded 282 breast cancers in 276 patients. Forty-one tumors (14.5%) were PABCs. PABC patients were significantly younger than non-PABC patients. Compared with the non-PABCs, PABCs were twice more frequent advanced tumors (T3-4) and have twice more frequent HER2 over-expression and hormone negative status. The more aggressive histological profile observed in the PABCs, especially in post-partum tumors and women older than 35 years of age, seems to be a direct consequence of the association with pregnancy.

Trends in of late-stage squamous cell vulvar carcinomas: analysis of the surveillance, epidemiology, and end results (SEER) database.

OBJECTIVE: To describe the trends in the rate, treatment, and survival of late-stage vulvar carcinomas (LSVCs) over a 20-year period in the United States. METHODS: Demographic, pathologic, treatment, and survival data were collected from the Surveillance, Epidemiology, and End Results registry between 1988 and 2007. Trends concerning the rate of LSVC (International Federation of Gynecology and Obstetrics [FIGO] stages III and IV), its management, and outcome were studied. Five-year overall and disease-specific survival rates were calculated. RESULTS: The rate of LSVC (32.4%) as compared with early-stage disease (67.6%) did not change significantly from 1988 to 2007 (P = 0.59). Of the 2630 patients with LSVC, the median age at diagnosis was 72 years, with 88.5% of them being white. Surgery and radiation therapy were performed in 73.8% and 60.6% of cases, respectively, with 37% of the patients having no lymph node dissection. A significant trend toward removing fewer lymph nodes (P = 0.02) and offering more radiation therapy (P = 0.02) has been observed across the study period. Five-year overall and disease-specific survival rates did not change (P = 0.44 and P =0.26, respectively) from 1988 to 2007. On multivariate analysis, node positivity (hazard ratio, 3.12 [95% confidence interval, 2.30-4.24]) and surgery (hazard ratio, 0.41 [95% confidence interval, 0.24-0.69]) were found to be the 2 most predictive variables for cancer mortality, followed by age and tumor size. CONCLUSION: Less extensive surgery and more radiation therapy did not compromise survival of LSVC over the 20-year period.

Expression of MMP-2, -7, -9, MT1-MMP and TIMP-1 and -2 has no prognostic relevance in patients with advanced epithelial ovarian cancer.

Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are involved in tumor invasion, but their prognostic significance is still under discussion. We set out to analyze the epithelial and stromal expression of MMP-2, MMP-7, MMP-9, MT1-MMP, TIMP-1 and TIMP-2 in advanced epithelial ovarian cancers and to assess their prognostic value. A tissue microarray of malignant ovarian tumors from 69 patients was constructed. Immunostaining results were scored using the HSCORE and assessed by univariate analysis with Bonferroni correction and classical multidimensional scaling (CMDS). Kaplan-Meier survival curves calculated with regard to patient and tumor characteristics were compared by the log-rank test. Patients treated by primary surgery (n=43) had a higher tumor size and a trend toward higher epithelial MMP and TIMP expression than those treated by interval surgery (n=26). Optimal cytoreduction (residue ≤ 1 cm) was obtained in 27 and 18 patients, respectively. Clinical and histological characteristics were not different in patients with optimal cytoreduction and those with suboptimal cytoreduction. The expression of epithelial MMP-9 (P=0.002) and TIMP-2 (P=0.026) were higher in the latter group. CMDS failed to demonstrate any influence of MMP and TIMP expression with regard to cytoreduction outcome. MMP and TIMP expression did not influence survival. Their prognostic values were outweighed by histological type, lymph node involvement and cytoreduction. Standard statistical analysis adjusted after Bonferroni correction and CMDS reduced the relevance of MMPs and TIMPs in the prognosis of patients with advanced ovarian cancer.

Predictive factors for complete excision and underestimation of one-pass en bloc excision of non-palpable breast lesions with the Intact(®) breast lesion excision system.

OBJECTIVE: Image-guided percutaneous biopsy is the recommended initial diagnostic procedure for suspicious mammographic lesions. This study was conducted to determine the accuracy of the Intact(®) breast lesion excision system (BLES) and to identify predictive factors for complete excision and underestimation. MATERIAL AND METHODS: A prospective study was conducted between January 28, 2008 and April 30, 2009 on 166 biopsy procedures using Intact(®) biopsy device. Diagnoses obtained from biopsy specimen were compared with to final diagnosis on surgical excision specimen. RESULTS: Of the 166 patients, 15 (9%) displayed lesions with cell atypia, 28 (17%) had an intra ductal carcinoma (IDC) and 9 (5%) had an invasive carcinoma. Eight of 15 patients with cell atypia had open surgical excision, and none showed underestimation. All patients with IDC underwent surgical excision: we found an invasive carcinoma in 6 cases (21.4% underestimation) and a complete removal of the lesion by the Intact(®) BLES in 11 cases (39%). All 9 patients with invasive carcinoma had a surgical excision, with 1 complete removal of the lesion by Intact(®) BLES. Multivariate analyses did not identify predictive factors for underestimation; clear margins ≥1mm on biopsy specimen was the only independent predictive factor of complete excision (OR=8.51, p=0.02). CONCLUSIONS: Intact(®) BLES provides a safe alternative to vacuum assisted core needle biopsy (VACNB) with an underestimation rate comparable to those previously reported for VACNB. The high rate of complete removal of the lesions, particularly ISC, offers an interesting perspective of avoiding subsequent excisional surgery for small lesions and thus requires further confirmational study.

Fertility after colorectal resection for endometriosis: results of a prospective study comparing laparoscopy with open surgery.

OBJECTIVE: To determine whether the surgical route of colorectal resection for endometriosis is a determinant factor for fertility. DESIGN: Prospective study. SETTING: Tertiary-care university hospital. PATIENT(S): Fifty-two patients with endometriosis were randomly assigned to laparoscopic or open surgery. INTERVENTION(S): Laparoscopically assisted vs. open colorectal resection. MAIN OUTCOME MEASURE(S): Evaluation of fertility outcomes spontaneously and after assisted reproductive therapy. RESULT(S): The mean follow-up was 29 months. Among the 28 patients wishing to conceive, 11 (39.3%) became pregnant. Overall cumulative pregnancy rate at 52 months for these patients was 45.1%. For patients with or without infertility, the cumulative pregnancy rate was 37.6% and 55.6%, respectively, and the cumulative spontaneous pregnancy rate 13.3% and 36.5%, respectively. All the spontaneous pregnancies were observed in the laparoscopy group. CONCLUSION(S): This study demonstrates that spontaneous pregnancy is more frequent after laparoscopy compared with open surgery for colorectal endometriosis.

Discordance with local guidelines for adjuvant chemotherapy in breast cancer: reasons and effect on survival.

INTRODUCTION: Adjuvant treatments are usually decided according to guidelines. However, many individual factors, such as performance status, patient refusal, complex interactions between factors (eg, discrepancies between grade and Ki 67), and complex clinical features (borderline age or tumor size) may introduce discrepancies. The aim of this study was to quantify discrepancies between local guidelines and patient management. PATIENTS AND METHODS: From 2003 and 2005, 581 consecutive patients underwent surgery for invasive breast cancer. Patient, tumor characteristics, and outcome were recorded. We compared patient characteristics according to whether local guidelines had been followed. RESULTS: In 90% of cases local guidelines were followed. Patients who inadequately did not receive chemotherapy were older (P < .0001), with positive hormonal receptor status (P = .02), and less aggressive tumors (P < .05). Main reasons for not administering chemotherapy were age, patient refusal, and micrometastatic node involvement. Patients from the other discordant group (ie, those who inadequately received chemotherapy), had larger (P = .01) and more aggressive tumors (P < .0001). In these cases, the clinical decision was mainly based on multifocal tumors and limit lower age. For disease-free survival (DFS), we found a significant difference between groups (P = .001). The best overall survival and DFS was found for patients who adequately received no adjuvant treatment. Survival among groups were similar when stratified on treatment modality. CONCLUSION: The main reasons for discrepancy were age (advanced or lower limit), patient refusal, and multifocal tumors. In this series, deviations from recommendations had no affect on survival and raised the question of new indications for chemotherapy such as multifocal tumors.

Prognostic value of lymph node involvement in ovarian serous borderline tumors.

OBJECTIVE: This study was conducted to evaluate the prognosis value of lymph node involvement (LN positive) lymph node involvement for borderline ovarian tumor (BOT). STUDY DESIGN: This was a retrospective study on 49 patients treated at our institution for advanced-stage serous BOT (International Federation of Gynecology and Obstetrics [FIGO] III or IV). Pathological characteristics and survival were compared according to the lymph node status. The same analysis was performed on 1503 patients of the Surveillance, Epidemiology, and End Results (SEER) database. RESULTS: In our institution, 14 patients were LN positive. Eight patients have been upstaged after lymph node dissection. No patient has died during follow-up (median 53 months). LN positivity was not associated with recurrence. In the SEER registry, 93 patients (6.2%) had LN positivity. These patients were younger and with more advanced local extension. Survival curves were similar after adjustment for FIGO stage. CONCLUSION: Lymph node involvement does not appear as a prognosis factor for advanced-stage BOT.

Cervical Metastasis From Colorectal Cancer.

Metastatic carcinoma from colorectal cancer to the uterine cervix is rare. We report a case of metastatic carcinoma from a right colon cancer to the cervix with vaginal extension 3 years after primary treatment. Our report highlights the importance of immunohistochemical analysis to determine the origin of uterine cervix cancer in the event of adenocarcinoma in a patient with a history of colorectal cancer to adapt therapeutic strategy accordingly.

Direct comparison of logistic regression and recursive partitioning to predict chemotherapy response of breast cancer based on clinical pathological variables.

The purpose was to compare logistic regression model (LRM) and recursive partitioning (RP) to predict pathologic complete response to preoperative chemotherapy in patients with breast cancer. The two models were built in a same training set of 496 patients and validated in a same validation set of 337 patients. Model performance was quantified with respect to discrimination (evaluated by the areas under the receiver operating characteristics curves (AUC)) and calibration. In the training set, AUC were similar for LRM and RP models (0.77 (95% confidence interval, 0.74-0.80) and 0.75 (95% CI, 0.74-0.79), respectively) while LRM outperformed RP in the validation set (0.78 (95% CI, 0.74-0.82) versus 0.64 (95% CI, 0.60-0.67). LRM model also outperformed RP model in term of calibration. In these real datasets, LRM model outperformed RP model. It is therefore more suitable for clinical use.

Blue dye injection in the arm in order to conserve the lymphatic drainage of the arm in breast cancer patients requiring an axillary dissection.

BACKGROUND: Despite the widespread use of the sentinel lymph node biopsy technique, many patients with invasive breast cancer still undergo an axillary lymph node dissection and are at risk of arm lymphedema. With the new awareness of lymphatic spread in the axillary nodes, it should be possible to define a new surgical approach between sentinel lymph node biopsy and complete axillary dissection, a procedure preserving specifically lymph nodes in relation to the arm. METHODS: Twenty-one patients with an operable breast cancer requiring an axillary dissection underwent surgery with an attempt to separate nodes related to the breast from specific nodes related to the arm. After an injection of blue dye in the arm, the surgeon performed the axillary dissection trying to identify blue nodes and ducts in order to preserve lymphatic arm drainage (LAD). If the blue nodes were located in the normal axillary dissection, they were removed separately. RESULTS: In 15 of 21 patients (71%), blue nodes in relation with LAD were identified. In 10 (47%) patients, it was possible to dissect the LAD with the preservation lymphatic ducts. In 10 patients, the LAD nodes were removed: none of them contained metastases, despite the fact that the non-LAD axillary nodes contained metastases in 7 of 10 cases. CONCLUSIONS: Identifying the LAD with blue dye injection in the arm is possible. A subsequent study can now begin to determine if this procedure is safe for patients and able to prevent lymphedema of the arm.