Validation of a Risk Score Incorporating Tumor Characteristics into the American Joint Committee on Cancer Anatomic Stage for Breast Cancer / 한국유방암학회지

PURPOSE: The American Joint Committee on Cancer 8th edition (AJCC8) prognostic stage (PS) was implemented January 1, 2018, but it is complex due to multiple permutations. A North American group proposed a simpler system using the anatomic stage with a risk score system (RSS) of 1 point each for grade 3 tumor and human epithelial growth factor receptor 2 (HER2) and estrogen receptor (ER) negativity. Here we aimed to evaluate this risk score system with our database of Asian breast cancer patients and compare it against the AJCC8 PS. METHODS: Patients diagnosed with breast cancer stage I–IV in 2006–2012 were identified in the SingHealth Joint Breast Cancer Registry. Five-year breast cancer-specific survival (CSS) and overall survival (OS) were calculated for each anatomic stage according to the risk score and compared with the AJCC8 PS. RESULTS: A total of 6,656 patients were analyzed. The median follow-up was 61 (interquartile range, 37–90) months. There was a high receipt of endocrine therapy (84.6% of ER+ patients), chemotherapy (84.3% of node-positive patients), and trastuzumab (86.0% of HER2+ patients). Within each anatomic stage, there were significant differences in survival in all sub-stages except IIIB. On multivariate analysis, the hazard ratio for negative ER was 1.74 (1.48–2.06), for negative HER2 was 1.49 (1.26–1.74), and for grade 3 was 1.84 (1.55–2.19). On multivariate analysis controlled for age, ethnicity, and receipt of chemotherapy, the RSS (Akaike information criterion [AIC] = 10,649.45; Harrell's Concordance Index [C] = 0.85) was not inferior to the AJCC8 PS (AIC = 10,726.65; C = 0.84) for CSS, nor was the RSS (AIC = 14,714.4; C = 0.82) inferior to the AJCC8 PS (AIC = 14,784.69; C = 0.81) for OS. CONCLUSION: The RSS is comparable to the AJCC8 PS for a patient population receiving chemotherapy as well as endocrine- and HER2-targeted therapy and further stratifies stage IV patients.

Nutritional profile and its correlation with the main prognostic factors in women with breast cancer undergoing surgical treatment / Perfil nutricional e sua correlação com os principais fatores prognósticos em mulheres com câncer de mama submetidas a tratamento cirúrgico

Objective: To analyze the association of nutritional status and fasting blood glucose with the main tumor prognostic factors in invasive breast cancer in women undergoing surgical treatment. Methods: Retrospective study with women aged 18 years or older, diagnosed with invasive breast cancer, admitted for surgical treatment at Cancer Hospital III ­ National Cancer Institute José Alencar Gomes da Silva. The variables collected were: age, Body Mass Index (BMI), comorbidities (hypertension and diabetes mellitus), neoadjuvant chemotherapy, menopausal status, fasting blood glucose, clinical staging, and tumor markers (estrogen and progesterone receptor/HER2/Ki-67). Categorical data were expressed by frequency and percentage, and numerical data by mean and standard deviation. We used the following tests to perform the statistical analysis: Kruskal-Wallis, Mann-Whitney, Pearson's χ2, and Spearman tests. P-values <0.05 were considered statistically significant. Results: 166 patients participated in the study. The mean age was 59.1 (±12.4) years, and the mean fasting blood glucose was 109.5±23.7 mg/dL. According to BMI, 62.1% of the sample was overweight. The high BMI was related to hypertension and hyperglycemia, and no association with prognostic factors was found. Hyperglycemia was associated with more advanced age, higher lymph node involvement, hormone receptor positive, and post-menopausal status. Conclusion: The nutritional status classified by BMI was not related to prognostic factors in breast cancer, suggesting the need for other complementary anthropometric methods for better nutritional diagnosis

Objetivo: Analisar a associação do estado nutricional e glicemia de jejum com os principais fatores prognósticos tumorais no câncer de mama invasivo em mulheres submetidas a tratamento cirúrgico. Métodos: Estudo retrospectivo com mulheres maiores de 18 anos, diagnosticadas com câncer de mama invasivo, admitidas para tratamento cirúrgico no Hospital de Câncer III ­ Instituto Nacional de Câncer José Alencar Gomes da Silva. As variáveis coletadas foram: idade, Índice de Massa Corporal (IMC), comorbidades (hipertensão arterial sistêmica e diabetes mellitus), quimioterapia neoadjuvante, estado menopausal, glicemia de jejum, estadiamento clínico e marcadores tumorais (Receptor de Estrogênio e Progesterona/Her-2/Ki 67). Os dados categóricos foram expressos pela frequência e percentual e os dados numéricos pela média e desvio padrão. A análise estatística foi realizada por meio dos testes de: Kruskal-Wallis, Mann-Whitney, χ2 de Pearson e Sperman. P-valores <0,05 foram considerados estatisticamente significantes. Resultados: 166 pacientes participaram da pesquisa. A média de idade foi de 59,1 (±12,4) anos e a média de glicemia de jejum foi 109,5±23,7 mg/dL. De acordo com o IMC, 62,1% da amostra foi classificada com excesso de peso. O IMC elevado estava associado à presença de hipertensão e hiperglicemia, e não foi observada associação com fatores prognósticos. A hiperglicemia estava relacionada com idade mais avançada, maior comprometimento linfonodal, receptor hormonal positivo e estado pós-menopausal. Conclusão: O estado nutricional classificado pelo IMC não foi associado com fatores prognósticos no câncer de mama, sugerindo a necessidade de outros métodos antropométricos complementares para melhor diagnóstico nutricional.

The significance of high-mobility group alarmins expression in the prognosis of NSCLC patients / 天津医药

@#Objective To explore the relationship between expressions of high mobility group B1 and N1(HMGB1 and HMGN1) and clinical pathological parameters and prognosis in patients with non-small cell lung cancer (NSCLC). Methods Ninety-one postoperative tumor tissue specimens from the patients with NSCLC were collected in Tianjin Medical University Cancer Institute and Hospital from January 2004 to May 2011. Immune histochemical assay was used to detect the expressions of HMGB1 and HMGN1. According to the staining intensity, expressions of HMGB1 and HMGN1 were divided into positive and negative groups. Kaplan-Meier was used to analyze the correlation between the expressions of HMGB1/HMGN1 and clinical pathological parameters/prognosis. Results The cytoplasmic expressions of HMGB1 (40%, 36/91) was positively correlated with cytoplasmic expression of HMGN1 (31%, 28/91, rs=0.319，P<0.001). The expression level of HMGN1 was significantly higher in patients with late stage of NSCLC (Ⅲ~Ⅳ) than that in patients with early stage of NSCLC (Ⅰ~Ⅱ, P＜0.05). It was also found that the expression level of HMGN1 was significantly higher in patients with lymph node metastasis than that in patients without lymph node metastasis (P＜0.05). The poor prognosis of NSCLC was slightly lower in patients with high expression of HMGN1 than that in patients with low expression of HMGN1, but the difference was not statistically significant. Conclusion The HMGN1 can be used as a promising prognostic biomarker for predicting the prognosis of NSCLC patients.

Impact of occult micrometastasis of lymph node on the prognosis of patients with non-small cell lung cancer: a prospective study / 中华胸心血管外科杂志

Objective: To diagnose occult micrometastasis of mediastinal lymph node in patients with non small cell lung cancer (NSCLC) and to evaluate its prognostic significance. Methods: Using assays of reverse transcriptase polymerase chain reaction (RT PCR), two hundred and forty two stations of mediastinal lymph node, which were free from tumor determined by routine histopathological examination (pN 0), from fifty eight patients were studied to detect mRNA for MUC1 gene and diagnose nodal occult micrometastasis. Survival rate was calculated by method of Kaplan Meier and survival difference between patients with and without nodal occult micrometastasis was compared with Log Rank test; Logistic regression analysis was carried to determined independent predictive factors of prognosis. Results: The mRNA for MUC1 gene was identified in twenty three stations of lymph node from sixteen patients (27 6%), and nodal occult micrometastasis was diagnosed in those patients. TNM staging for those patients was up regulated from stage I A～II B to stage III A. The survival rate of 3 year in patients with nodal occult micrometastasis (43.7%) was lower than that in patients without nodal occult micrometastasis (73.8%) (P