Nottingham Prognostic Index is an Applicable Prognostic Tool in Non-Metastatic Triple-Negative Breast Cancer

Introduction: Triple-negative breast cancer (TNBC) is characterized by a poor prognosis due to high mortality and early relapse, requiring the study of its prognostic factors. Tumor size, histological grade and lymph node status represent important parameters that are widely studied in breast cancer, and are retained as prognostic factors by several international guidelines. The Nottingham team combined these parameters into a prognostic score called the Nottingham prognostic index (NPI). In this study, we investigated the influence of NPI on outcomes in non metastatic TNBC. Methodology: This retrospective cohort study included all female patients with non metastatic TNBC who received treatment at the Regional Oncology Center Hassan II Oujda - Morocco, between January 2009 and December 2011. The prognostic impact of the NPI on the survival curves at 5 years was studied using multivariate Cox proportional hazards models. Results: The analysis of the data involved 98 patients, 39 patients (39.8%) were classed in the poor prognosis group with a NPI > 5.4. The Overall survival (OS) and Disease free survival (DFS) rates at 5 years, in this group, were 70 and 55.6 % respectively. After adjusting for clinic-pathological variables, a NPI > 5.4 was associated with mortality (HR: 2.598, 95% CI: 1.423 ­ 4.744, p = 0.002) and disease progression (HR: 2.512, CI to 95%: 1.496 ­ 4.219, p <0.001) in patients with non-metastatic TNBC. Conclusion: This retrospective cohort analysis showed that NPI was an independent prognostic factor for OS and DFS at 5 years in women with non metastatic TNBC. Once validated, the impact of this score on survival outcomes could be considered in the clinical management of TNBC.

Triple Negative Breast Cancer at the University Hospital Mohammed VI ­ Oujda

Introduction: The triple-negative breast cancer (TNBC), defined by the absence of receptors to oestrogen and progesterone and no histochemical expression of human epidermal receptor -2, is associated with a particularly aggressive behavior. The aim of our study was to determine the clinico-pathological, therapeutic and prognostic features associated with this type of breast cancer in Morocco. Methods: A cohort retrospective study, spread over 3 years, was conducted of 116 breast cancer patients, diagnosed between January 2009 and December 2011 at the Regional Center of Oncology. Epidemiological, clinical, histological and therapeutic data were analyzed. Survival curves at 3 years were estimated by Kaplan-Meier analysis with use of the log-rank test. Results: The proportion of triple-negative breast cancer in our series was 13.2%. The average age was 46.5 years and 20,7% had a previous history of familial breast cancer. Some 56,9% of tumors were greater than 3 cm in diameter. infiltrating ductal carcinoma being the histological type in the majority of cases (75.9%). TNBC was most often associated with a high grade, grade III accounting for 50.9%. Vascular invasion was found in 58.6% of cases. Regarding lymph node involvement, 42.2% had positive lymph nodes and 15.5% featured distant metastases. Neoadjuvant chemotherapy was administrated to 20% of patients with a 23.5% complete pathologic response. The rates for overall survival and disease-free-survival at 3 years for localized stages were 70 and 55.6%, respectively. With metastatic lesions, the figures were 27.5% and 10.3% respectively. Conclusion: The TNBC is correlated with a poor prognosis with a high mortality and early relapse requiring identification of new target therapies and markers for prediction of tumoral response to various treatments.

[Psycho-social and religious impact of cancer diagnosis on Moroccan patients: experience from the National Oncology Center of Rabat]. / Impact psychosocial et religieux du diagnostic de cancer chez les patients marocains: expérience de l'Institut national d'oncologie de Rabat.

The impact cancer occurrence is variable according to the sociocultural issue, specific to each context and each area. In order to determine the psychosocial profile of Moroccan patients that have developed cancers, four studies were performed at the National institute of oncology (INO) in Rabat. These studies were prospective, included between 125 and 1,600 patients and were based on questionnaires developed by a medical oncologist, a psychologist and a sociologist. These studies were focused on the psychosocial characteristics of the Moroccan cancer occurrence on patients, the impact of cancer on the religious practice as well as the impact of cancer and its treatments on patients' sexuality. In this article, we will develop the particular characteristics of moroccan patients that were specific to their sociocultural context.

[Phyllodes tumors of the breast: analysis of 53 patients]. / Tumeurs phyllodes du sein à propos de 53 cas.

PURPOSE: Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. These are composed of a connective tissue stroma and epithelial elements. They are rare with an incidence of 0.3-0.9% of all breast neoplasms. The present study demonstrates the recent experiences in diagnosis, therapeutical management and clinical follow-up of this disease. PATIENTS AND METHODS: This is a retrospective study of the experience of the Institut National d'Oncologie (INO, Rabat) from 1998 to 2006. RESULTS: We included 53 patients. Median age was 37.2 years (15-67), tumor size was 1-30cm (median 10.25cm). The histological diagnosis was based on the biopsy in (7.8%) cases and extemporany in 22% cases, distant metastasis occurred in two patients; the treatment consisted of a surgery. The median follow-up was three years. Local recurrence occurred in ten patients. Distant metastasis occurred in two patients and five patients have died. CONCLUSION: The confrontation of our results to the data of the international literature shows that the diagnosis of the phyllodes tumours is histological. The basis of the treatment is surgery. The adjuvant radiotherapy is very important in patients at high risk for local recurrence; chemotherapy has a badly defined place. The prognostic is based on the histological characters of the tissue conjunctive component of these tumours.

[Chemotherapy in nasopharyngeal carcinoma]. / La chimiothérapie dans les cancers du cavum.

UNLABELLED: Nasopharyngeal carcinoma (NC), especially the undifferenciated type, is a rare malignant disease. Prevalence is high in Southeast Asia and North Africa. OBJECTIVES: To determine the role of chemotherapy in the treatment of cancers of the nasopharynx. MATERIAL AND METHODS: [corrected] A search of the MEDLINE databases from 1970 to 2005, for articles testing chemotherapy in nasopharyngeal carcinoma. The key words: Nasopharyngeal carcinoma, chemotherapy, concurrent chemo-radiation, were used to access to principal trials. RESULTS: Nine phase III randomised trials, testing the combination of chemotherapy and radiotherapy in nasopharyngeal carcinoma were found. There us increasing evidence attesting to the beneficial effect of adding of chemotherapy to radiotherapy in the treatment of locally advanced disease (stage III and IV), especially concurrent chemo-radiation, considering the benefit in terms of overall survival. Associations containing cisplatin proved to be most effective. New molecules (capecitabine, taxanes, gemcitabine...) are currently in the course of testing, in phase II studies, for recurrent and metastatic NC, for which there is not still standard treatment. CONCLUSION: Medline review reveals that concurrent chemo-radiation, containing cisplatin, is standard treatment for locally advanced nasopharyngeal carcinoma. Metastatic disease is treated by palliative chemotherapy.