Change in Red Blood Cell Distribution width During the Last Years of Life in Geriatric Patients.

OBJECTIVES: Most of the studies that evaluate the association between red blood cell distribution width (RDW) and mortality assess it on a single occasion instead of doing so through serial measurements. Very few studies have investigated repeated measurements of RDW and its prognostic value, and most of them are focused on patients with cardiovascular diseases. RDW is a dynamic value so we aimed at determining the prognostic value of sequential RDW assessment in the last years of life in patients enrolled in a Department of Geriatrics. DESIGN: This work is part of a prospective study derived from a cohort of 122 patients over 75 years hospitalized in 2005 for the purpose of assessing the prognostic significance of several comorbidity and prognostic indices. SETTING: Patients were consecutively recruited for the study at admission in a tertiary hospital and then followed up for at least 5 years. PARTICIPANTS: A total of 55 patients with repeated RDW assessments during all the five years before their death were selected from the total cohort of 122 patients. RESULTS: We found a strong correlation between progressive rise in RDW and mortality risk, especially during the last year of life. There was a gradual significant increase in the RDW values along the last five years of life, with means growing up from 14,8 (95% CI: 13,98-15.62) to 16,37 (15,80-16,94). CONCLUSION: In our cohort of geriatric patients, RDW is a dynamic variable that is modified during the last five years of life, irrespective of their age, and especially during the last year.

Subtipos moleculares del cáncer de mama: implicaciones pronósticas y características clínicas e inmunohistoquímicas / Molecular subtypes of breast cancer: prognostic implications and clinical and immunohistochemical characteristics

Fundamento. Los carcinomas de mama representan un grupoheterogéneo de tumores, tanto en su comportamiento clínicocomo pronóstico. El objetivo del presente trabajo es clasificarlos carcinomas de mama en subtipos moleculares mediantemarcadores inmunohistoquímicos y analizar las característicasclinicopatológicas e inmunohistoquímicas y los patronesde supervivencia y recaída de los distintos subtipos.Material y métodos. Se han clasificado 272 pacientes condiagnóstico de carcinoma de mama en cinco subtipos: carcinomasde mama de tipo basal, de tipo HER2, de tipo luminalA, de tipo luminal B y normal.Resultados. Los carcinomas de mama más frecuentes fueronlos de tipo luminal A (62,5%), carcinomas de tipo luminal B(18%), carcinomas de tipo HER2 (9,9%), carcinomas de tipobasal (8,4%) y los de fenotipo normal (1,4%). Los carcinomasde mama de tipo luminal mostraron ser, con mayor frecuencia,de forma significativa, tumores bien diferenciados, depequeño tamaño tumoral, con ganglios axilares negativos,estadio precoz en el momento del diagnóstico, niveles altosde BCL-2 y bajo índice de proliferación con Ki-67. En cambio,los carcinomas de mama de tipo basal y HER2 presentabantumores de mayor tamaño, pobremente diferenciados, mayorcompromiso ganglionar y estadios más avanzados en elmomento del diagnóstico. Expresaban con mayor frecuenciaíndices de proliferación altos con Ki 67 y fueron los subtiposque en curvas de supervivencia global y de supervivencia librede progresión mostraron un peor pronóstico.Conclusión. La clasificación del cáncer de mama basada enparámetros inmunohistoquímicos (IHQ) permite una mejordefinición pronóstica. Tanto los carcinomas de mama detipo basal como HER2 presentan características histopatológicase IHQ más desfavorables así como peor supervivenciay menor tiempo de recaída mientras que los carcinomasde mama de tipo luminal manifiestan características másbenignas y mejor pronóstico(AU)

Background. Breast carcinomas are a heterogeneous groupof tumours, in both their clinical behavior and their prognosis.The aim of this article is to classify breast carcinomasaccording to molecular subtypes by means of immunohistochemicalmarkers and to analyse the clinicopathologicaland immunohistochemical characteristics and the patternsof survival and relapse of the different subtypes.Methods. Two hundred and seventy-two patients diagnosedwith breast cancer were classified into five subtypes: breastcarcinomas of the basal type, HER2 type, luminal A type,luminal B type and normal.Results. The most frequent breast carcinomas were: luminalA type carcinomas (62.5%), luminal B type carcinomas(18%), HER2 type carcinomas (9.9%), basal type carcinomas(8.4%) and normal phenotype carcinomas (1.4%). Significantlyand with greater frequency, the luminal type breastcarcinomas proved to be well differentiated tumours, ofsmall tumoral size, with negative axillary lymph nodes, at anearly stage at the time of diagnosis, with high levels of BCL-2 and a low Ki-67 proliferation index. On the contrary, thebasal type and HER2 carcinomas presented larger tumours,poorly differentiated, greater ganglionar involvement andmore advanced stages at the time of diagnosis. They expressedhigh Ki-67 proliferation indexes with greater frequencyand were the subtypes that showed a worse prognosis onglobal survival and progression-free survival curves.Conclusion. Breast cancer classification based on immunohistochemical(IHC) parameters makes a better prognosticdefinition possible. Both the basal type and the HER2 typebreast carcinomas present more unfavourable histopathologicaland IHC characteristics, as well as a worse survivaland less relapse time, while the luminal type breast carcinomasshow more benign characteristics and a better prognosis(AU)