Impacto do fenótipo triplo-negativo no prognóstico de pacientes com câncer de mama de uma unidade de referência no Brasil central / Impact of triple negative phenotype on prognosis of breast cancer patients from a reference cancer unity in the central of Brazil

Introdução: o câncer de mama triplo-negativo inclui os tumores que não expressam receptores de estrógenos, receptores de progesterona e HER2. O subtipo triplo-negativo apresenta características mais agressivas, como aparecimento em idade mais precoce, estágio avançado ao diagnóstico, alta graduação histológica e nuclear, alto índice mitótico, maior frequência de metástases regionais e à distância, além de menor sobrevida. Objetivo: comparar os aspectos clínicos e patológicos de 345 pacientes com carcinomas mamários tratadas em um hospital de referência na região Centro-oeste do Brasil, a fim de avaliar o impacto do fenótipo triplo-negativo no prognóstico das pacientes. Metodologia: as pacientes foram selecionadas no Laboratório de Anatomia Patológica da instituição e os dados clínicos e patológicos coletados a partir dos respectivos prontuários. A análise estatística empregou análise univariada e análise de sobrevida pelo método de Kaplan-Meier e Log-rank. Resultados: os fatores prognósticos clássicos foram comprovados para o grupo, incluindo comprometimento de linfonodos regionais (p<0,001), metástase à distância (p<0,001) e tamanho do tumor (p<0,001). Quando os tumores, distribuídos em dois grupos (TN e NTN), foram comparados, diferenças estatisticamente significativas foram observadas com relação ao grau nuclear (p<0,0001) e à sobrevida em cinco anos (p<0,0001), que variou de 70,3% para as pacientes NTN a 47,1% para as pacientes TN. Conclusão: nossos resultados confirmaram o perfil mais agressivo dos tumores TN que, independentemente dos fatores prognósticos clássicos dos carcinomas de mama, cursam com maior agressividade e maior taxa de mortalidade, requerendo assim maior atenção assistencial.

Introduction: Triple-negative breast cancers are tumors that don't express estrogen receptors, progesterone receptors and HER2. The triple-negative phenotype exhibits more aggressive characteristics, including early onset, high stage on diagnosis, elevated nuclear grade, high mytotic index, agressive patterns of regional and distant metastasis, besides poor prognosis. Objective: To compare the clinical and pathological aspects of a group with 345 breast cancer patients treated in a referral hospital in the center of Brazil, in order to compare the impact of triple-negative phenotype on the patient prognosis. Methods: Patients were selected in the Pathology Laboratory of the institution. Clinical and pathological data were collected from the respective clinical files. Statistical methods comprised univariate analysis and survival curves were generated by using Kaplan-Meier and Log-rank tests. Results: Classic prognostic factors were confirmed for the whole group, including regional lymph nodes metastasis (p<0.001), distant metastasis (p<0.001) and tumor size (p<0.001). By comparing the two groups of breast tumors (TN and NTN), significant statistical differences were observed concerning nuclear grade (p<0.0001) and five year survival (p<0.0001), which varied from 70.3% for NTN patients to 47.1% for TN patients. Conclusion: Our results reinforce the aggressive profile of triple-negative breast cancer that, despite of the classic prognostic factors described for breast cancer, evolves with higher aggressiveness and elevated mortality rates, requiring special attention

The impact of cyclooxygenase-2 and vascular endothelial growth factor C immunoexpression on the prognosis of penile carcinoma.

PURPOSE: We assessed the influence of cyclooxygenase-2 and vascular endothelium growth factor-C immunoexpression on groin metastasis and cancer survival, and their association with histological variables in patients with penile carcinoma. MATERIALS AND METHODS: We evaluated the histological and cyclooxygenase-2/vascular endothelium growth factor-C immunohistochemical profiles of patients with penile carcinoma treated at a single institution between 2001 and 2008. Univariate and multivariate analysis was done to determine the impact of histological and immunohistochemical markers on the risk of inguinal metastasis and on cancer survival. Survival analysis of relevant variables was also done. RESULTS: Of the 127 patients enrolled 76 and 30 had positive cyclooxygenase-2 and vascular endothelium growth factor-C immunoexpression, respectively. Univariate analysis identified an association between vascular endothelium growth factor-C immunoexpression and groin metastasis, and certain histological variables. Logistic regression showed that high tumor grade, Jackson stage and vascular endothelium growth factor-C immunoexpression were independent predictors of inguinal metastasis. Cancer survival was only influenced by advanced Jackson stage and groin metastasis. CONCLUSIONS: Findings suggest that vascular endothelium growth factor-C expression may help identify patients with an unfavorable clinical course of penile carcinoma. Cyclooxygenase-2 did not alter the risk of groin metastasis or cancer death. Inguinal disease and advanced Jackson stage were independent prognostic factors for worse cancer survival.

Análise imunoistoquímica do ki-67 em 140 pacientes com câncer de mama - correlação com fatores clínico-patológicos e sobrevida / Immunohistochemical analysis of ki-67 in 140 patients with breast cancer- correlation with clinicopathological factors and survival

O antígeno Ki-67 é utilizado para avaliar a atividade proliferativa em vários tumores. No entanto, o papel do Ki-67 como fator prognóstico em câncer de mama é ainda indefinido. O objetivo do trabalho foi analisar a expressão do antígeno Ki-67 correlacionando com fatores clínico-patológicos e sobrevida em pacientes com câncer de mama. Realizou-se a análise imunoistoquímica utilizando anticorpos monoclonais MIB-1 em 140 amostras de câncer de mama de mulheres com idade entre 27 e 90 anos, atendidas no Hospital Araújo Jorge da Associação de Combate ao Câncer de Goiás. O ponto de corte para a análise foi de 25%. A sobrevida global em cinco anos foi de 77,1%. Houve sobrevida significativamente pior nos casos com linfonodos positivos (p < 0,0001), tumores maiores (p < 0,0001), estádios mais avançados (p < 0,0001) e pacientes com receptores hormonais negativos (p = 0,019). Pacientes com imunodetecção de Ki-67 em mais de 25% das células tiveram pior sobrevida quando comparadas àquelas que expressaram Ki-67 em menos de 25% das células examinadas (70,8% x 82,7%), porém essa diferença não foi estatisticamente significativa (p = 0,094). A hiperexpressão do Ki-67 não se correlacionou com pior sobrevida no grupo de pacientes analisadas.

The Ki-67 antigen is used to evaluate proliferative activity in several tumors. However the role of the Ki-67 as a prognostic factor in breast cancer is still undefined. The aim of present study was to analyze the expression of Ki-67 antigen correlating with clinicopathological factors and survival in patients with breast cancer. We carried out an immunohistochemical analysis using MIB-1 monoclonal antibody in 140 specimen of breast cancer of women with age between 27 and 90 years. The cut-off point was 25%. The five year overall survival was 77.1%. There was a significant worse survival of patients with node positive (p < 0.0001), larger tumors (p < 0.0001), more advanced stages (p < 0.0001) and with negative hormonal receptors (p = 0.019). Patients with Ki-67 immunodetection in more than 25% of the tumors cells showed a poorer outcome when compared with those that express Ki-67 in less than 25% of the cells examined (70.8% x 82.7%), however this difference was not statistically significative (p = 0,094). The overexpression of Ki-67 did not correlate with a worse survival in the group of patients analyzed.