Prognostic Factors Affecting Survival of Patients With Single Primary Breast Cancer vs Patients With Multiple Primary Cancers in Lifetime, One of Which is Breast Cancer.

PURPOSE: The aim of this study was to investigate the demographic and molecular characteristics, overall survival (OS), cancer-specific survival (CSS), and prognostic factors affecting the survival of patients with single primary breast cancer (SPBC) and patients with multiple primary cancers in their life time in which one of them is breast cancer (MPC). METHODS: Using data from SEER 17 Research Plus, patients with breast cancer diagnosed between 2010 and 2019 were included in this study. Race, marital status, laterality, tumor size, molecular subtype, grade, stage, radiotherapy-chemotherapy treatment, and surgery data were analyzed in the data obtained after excluding patients with missing values. Kaplan-Meier survival analysis was used for survival analysis, and Cox regression analysis was used to evaluate the prognostic factors. RESULTS: 573175 patients were included in the study. The mean age of MPC patients was significantly higher than SPBC patients (65.99 ± 12.68, 60.33 ± 13.47, P < .001, respectively). Patients with SPBC had significantly more hormone receptor (HR)-positive/Her2 positive, HR-negative/Her2-negative, and HR-negative/Her2-positive molecular subtypes; patients with MPC had more HR-positive/Her2-negative subtypes (P < .001). Grade 3 tumor status, locoregional spread, and distant metastasis were significantly higher in SPBC patients (P < .001). Overall survival and CSS rates were significantly higher in SPBC patients (P < .001). In MPC patients, overall hazard ratio was 1.631 times higher than SPBC, and the cancer-specific hazard ratio was 1.096 times higher (95% CI [1.606-1.656], 95% CI [1.071-1.121], respectively). CONCLUSION: Although patients with SPBC have worse prognostic tumor characteristics, OS and CSS rates are better than patients with MPC.

Secretory Carcinoma of Breast: A Population-Based Study.

AIM: In this study, it was aimed to evaluate the characteristic features and survival of secretory carcinoma of the breast (SCB), which is one of the rare malignant tumors of the breast. METHODS: Data of patients with histopathological diagnosis of SCB between 2010 and 2019 were extracted from the SEER database. These patients were evaluated in terms of age, race, molecular subtype, grade, estrogen receptor (ER), progesterone receptor (PR), HER2 receptor, TNM stage, surgical status, chemotherapy and radiotherapy treatment. Overall survival (OS) and breast cancer-specific survival (BCSS) of the whole population and subgroups [in terms of surgery procedure (mastectomy/breast-conserving surgery), and hormone receptor status (positive/negative)] were analyzed. RESULTS: 70 patients were included in the study. The mean age was 57 years (range 2-82). 32.9% of the patients were diagnosed under the age of 50. 97.1% of the patients were female; 2.9% were male. The vast majority of patients were white race (81.4%). Although the rates of localization were higher in the upper outer quadrant (31.4%), centrally located tumors (18.5%) were also quite common. The most frequently detected molecular subtype was hormone positive/HER2 negative. All patients were non-metastatic, 81.4% of patients did not have lymph node metastases, and most of the patients were stage IA. Median follow-up was 37 months (range 0-118 months). Considering all patients, OS was 76.3%, 5-year OS was 91.8%, and BCSS was 88%, 5-year BCSS was 97.8%. There was no statistically significant difference in OS and BCSS according to subgroups (P > .01). CONCLUSION: SCB, a rare histopathologic type, has high OS and BCSS rates.

Is There a Survival Difference Between Male and Female Breast Cancer Subtypes According to the Prognostic Staging System? A Population-Based Cohort Study.

BACKGROUND: In retrospective studies investigating the difference in survival by gender, there are conflicting results. It was aimed to compare overall survival (OS) and breast cancer-specific survival (BCSS) in male and female breast cancer subtypes according to the prognostic staging system. METHODS: Overall survival rates and BCSS rates of patients diagnosed with breast cancer between 2010 and 2019 compared by gender for all cohorts, stages, and molecular subtypes using the SEER Database. The stage has been rearranged according to the eighth edition of the AJCC. RESULTS: 364 039 patients were included in the study. .7% (n = 2503) of all breast cancers were male breast cancer. Overall survival (male: 5-year OS 73.9%, female = 5-year OS 86%) and BCSS rates (male: 5-year BCSS 78.9%, female = 5-year BCSS 94.7%) were significantly higher in females than in males for all cohorts. OS (male: 5-year OS 66.2% vs female: 5-year OS 88.3%), and BCSS (male: 5-year BCSS 88.4% vs female: 5-year 93.6%) rates were higher in hormone receptor (HR)-positive/Her2-negative female patients. Overall survival rate is higher in females in stage I (male: 5-year OS 81.5%, female: 5-year OS 92.8%), and BCSS rate is higher in stage I (male: 5-year BCSS 94.8%, female: 5-year BCSS 97.5%). Males have 2 times (HR = 2.023) higher overall mortality risk than females, but the risk of dying from breast cancer is only 1.6 times (HR = 1.596) higher. CONCLUSIONS: Breast cancer-specific mortality is significantly higher in male breast cancers, especially in the early stage, and HR-positive subtype than females.

Should the Breast Cancer Staging System be Revised?

OBJECTIVE: The purpose of this study was to determine whether breast cancer patients at stage T2N0 with tumor size ≥4 cm and <4 cm. METHOD: Patients with T2N0 stage breast cancer diagnosed between 2010 and 2019 were analyzed in 2 groups as <4 cm (T2a) and ≥4 cm (T2b) in the study using the SEER 17 Research Plus database. The patients' clinicopathological characteristics and oncological outcomes were included. Group comparisons of prognostic factors, overall survival (OS), and cancer-specific survival (CSS) were made. RESULTS: In this study, which involved 70971 patients, the T2a group had higher 5-year OS rate (87.2 ± .2 vs 80.8 ± .5%) and 5-year CSS rate (93.7 ± .1% vs 89.4 ± .4%) than the T2b group (P < .001). Univariate analysis revealed that the overall risk of death was 1.5 times higher in T2b than T2a (HR: 1.533 [95% CI: 1.450-1.622], P < .001), whereas multivariate analysis demonstrated the risk was 1.4 times higher (HR: 1.384 [95% CI: 1.307-1.466], P < .001). The risk of cancer-specific death was 1.7 times higher in univariate analysis (HR: 1.691 [95% CI: 1.561-1.832], P < .001) and 1.4 times higher in multivariate analysis (HR: 1.420 [95% CI: 1.309-1.541], P < .001). CONCLUSION: Overall survival and BCSS rates in stage T2b breast cancer patients are significantly lower than in T2a patients. Tumor size ≥4 cm in breast cancer is a negative predictor of prognosis.

A case report: zoledronic acid-induced anterior uveitis.

BACKGROUND: Bisphosphonates prevent bone loss by binding on active sites of bone remodeling and inhibiting osteoclast-mediated bone resorption. Zoledronic acid is recommended for patients with bone metastases from breast, prostate, and lung cancers. OBJECTIVE: To report a case of anterior uveitis after the infusion of zoledronic acid. CASE SUMMARY: A breast cancer patient with bone metastasis was admitted with pain, visual loss, hyperemia, and periorbital swelling in her right eye 24 h after the first dose of zoledronic acid. Biomicroscopic anterior segment examination of the right eye showed corneal keratic precipitates, ciliary injection, and moderate amount of cells in anterior chamber. With the diagnosis of right anterior uveitis, topical prednisolone acetate (1%) was started, and her symptoms completely resolved within 1 week. Use of the Naranjo probability scale indicated a probable relationship between uveitis and zoledronic acid therapy in our patient. DISCUSSION: Uveitis is a rare complication of zoledronic acid. The mechanism is unclear. Proinflammatory cytokines such as TNF-alpha and IL-6 may also play a role in pathogenesis of zoledronic acid-related uveitis. CONCLUSION: Zoledronic acid may be associated with inflammatory eye diseases and result in serious ocular damage.

Concomitant Mycobacterium tuberculosis and Aspergillus niger infection in a patient with acute myeloid leukemia.

Primary cutaneous infection by Aspergillus spp. is an uncommon form of aspergillosis in patients with severe immunosuppression, e.g. patients with HIV infection or hematological malignancies. Disruption of the dermal integrity by trauma or maceration, followed by colonization of the wound by Aspergillus spp. creates a suitable environment for cutaneous infection. Despite aggressive therapy with amphotericin, primary cutaneous aspergillosis can lead to disseminated disease with fatal consequences. Tuberculosis is another rare infection in patients with hematological malignancies, but when present it is usually disseminated. We present a 46-year-old woman with acute myeloid leukemia who developed concomitantly Mycobacterium tuberculosis and Aspergillus niger infection. Cutaneous aspergillosis was diagnosed during neutropenia after induction therapy, which later became disseminated disease during antifungal therapy. Tuberculosis infection was diagnosed in a scalene lymph node biopsy specimen. The patient achieved remission of her underlying disease and responded very well to antituberculous and antifungal therapy.

Effects of growth factors on doxorubicin-induced skin necrosis: documentation of histomorphological alterations and early treatment by GM-CSF and G-CSF.

Extravasation of vesicant antineoplastic agents such as doxorubicin into the skin or subcutaneous tissues may result in loss of the full thickness of the skin or underlying structures. Several treatment methods have been advocated but none has demonstrated any superiority to the others. The authors designed a controlled animal study in 88 rats to test three methods of early treatment of extravasation of the vesicant antineoplastic agent doxorubicin. The first step of the study included 48 Sprague-Dawley rats. All animals received intradermal injections of 1 mg doxorubicin superficially to the panniculus carnosus in the dorsum. The rats were then divided into four groups of 12 rats each, as follows: group 1, no treatment; group 2, immediate intradermal injection of 0.1 ml saline to the same site; group 3, immediate intradermal injection of 10 microg granulocyte macrophage-colony stimulating factor (GM-CSF) in 0.1 ml saline to the same site; group 4, immediate intradermal injection of 10 microg granulocyte-colony stimulating factor (G-CSF) in 0.1 ml saline to the same site. During the next 6 weeks the rats were observed for the development of necrosis. Ulcers developed and reached maximum size two weeks after the injections. The largest ulcers according to area were observed in group 1 and the mean value was 21.25 mm (p < 0.05). Although wound areas were significantly smaller in the saline group than in the control group and the mean value was 7.58 mm (p < 0.05), the smallest lesions were observed in groups 3 and 4, and the mean values were 1.08 mm and 0.83 mm respectively (p < 0.05). There was statistically no difference with regard to mean ulcer area between groups 3 and 4. During the second step of the experiment, the remaining 40 Sprague-Dawley rats were used. Groups containing 10 rats each were designed similarly after all animals received intradermal injections of 1 mg doxorubicin into the back. On the 10th day after the injection, the entire area of the ulcer together with the underlying panniculus carnosus was excised for pathological examination and for determination of glucose 6-phosphate dehydrogenase (G6PD) activity. On microscopic examination, the extravasated ulcer consisted of a large area of ischemic necrosis. There was marked damage to small blood vessels in the form of fibrinoid necrosis and vasculitis. Injured vessel counts were higher in the control group (group 1; p < 0.05). No difference was observed in G6PD activity between the groups. The authors conclude that both saline and tissue growth factors (GM-CSF and G-CSF) are useful for the early treatment of doxorubicin extravasation; however, GM-CSF and G-CSF are more beneficial.

Modified ESHAP as salvage chemotherapy for recurrent or refractory non-Hodgkin's lymphoma: results of a single-center study of 32 patients. Modified etoposide, methylprednisolone, cytarabine and cisplatin.

BACKGROUND: We have evaluated the clinical efficacy and toxicity of a modified etoposide, methylprednisolone, cytarabine and cisplatin (ESHAP) chemotherapy regimen that has been used by the Hacettepe University Department of Medical Oncology (Ankara, Turkey) since 1993. METHODS: Thirty-two patients (18 men and 14 women) with refractory or recurrent non-Hodgkin's lymphoma (NHL) were treated with this protocol. The median age of the patients was 39 years (range 21-66 years). Patients were hospitalized during therapy. On the first day, 2 g/m(2) cytarabine was given, followed on days 2-5 by 60 mg/m(2) etoposide, 500 mg of methylprednisolone and 25 mg/m(2) cisplatin. After two cycles of chemotherapy, clinical efficacy was assessed by clinical examination, chest radiography, ultrasonography and/or computed tomography. The complications were assessed on the basis of the World Health Organization criteria. RESULTS: Nine patients (28%) had a complete response and 8 patients (25%) had a partial response. In responders, the median duration of remission was 6 months. By the end of the first year, 27% of the patients were still disease free and 66% were alive. High serum levels of lactate dehydrogenase had an adverse effect on disease-free survival, but no effect on overall survival (OS). The only unfavorable prognostic factor for OS was the presence of bulky disease. Neutropenia developed in 59% of patients, and febrile neutropenia developed in 74% of these patients, requiring hospitalization for an average of 8 days. Three patients died of neutropenia-associated sepsis despite broad-spectrum antibacterial and antifungal treatment. Thrombocytopenia was detected in 10 patients and anemia in 3 patients; among these, 7 patients with thrombocytopenia and 1 patient with anemia required transfusions. CONCLUSIONS: The modified ESHAP regimen induced remission in more than half of the patients with refractory or recurrent NHL. However, the duration of remission was brief. Moreover, significant myelotoxicity was common, and the risk of treatment-related death was 9%.

Paclitaxel and doxorubicin combination in the first-line treatment of metastatic breast cancer.

Anthracyclines and taxanes are currently the most effective drugs in the treatment of metastatic breast carcinoma. The aim of this study was to determine the efficacy and toxicity of paclitaxel and doxorubicin combination in the first-line treatment of metastatic breast cancer. Forty-five women with metastatic breast cancer were recruited in the study. Median age was 49 years (range, 33-70). Treatment protocol: doxorubicin (50 mg/m2/day, 30-min infusion) followed by paclitaxel (200 mg/m2/day, 3-hr infusion) every 3 weeks. Response rates included complete response in 13 (28.9%) patients and partial response in 19 (42.2%) patients, with an overall response rate of 71%. Five (11%) patients had stable disease and 8 (18%) patients had progressive disease. At a median follow-up of 19.7 months, median time to progression for all patients was 19.9 months (95% confidence interval, 12.8 to 27 months). Median overall survival time was 28.4 months. Grade 3-4 nausea/vomiting and hematological toxicities were observed in 12 (26%) and 6 (13.3%) patients, respectively. Cardiac toxicity was observed in 2 (4.4%) patients. In this trial, paclitaxel and doxorubicin combination was demonstrated to be a favorable and active regimen in the first-line treatment of metastatic breast cancer.

Reverse seeding of recurrent intraspinal malignant meningioma.

Meningiomas are common intracranial and intraspinal tumors and constitute 15-20% of all primary brain tumors. Ten to 15% of all meningiomas are considered malignant. The main treatment of meningiomas is surgical resection. Meningioma recurrence following surgery is frequent. However, it is not clear whether recurrent meningiomas, close or distant to the primary resection site, arise from incomplete resection, dissemination of tumor fragments or from independent tumor growth. We herein describe a 40-year-old woman with intraspinal malignant meningioma recurring each time upwards, i.e. apparently by reverse way of seeding, via cerebrospinal fluid.

Thoracic paravertebral leiomyosarcoma: rare but it does occur.

STUDY DESIGN: Marginal resection of a paraspinal tumor in the thoracic vertebra was performed. OBJECTIVE: To document a very rare pathology for a paraspinal tumor. SUMMARY OF BACKGROUND DATA: Primary leiomyosarcoma of the spine or paravertebral space is extremely rare. A case of a patient who was operated on for a mass in the spinal canal and whose pathology was reported to be leiomyosarcoma is presented. METHODS: Marginal resection of the paravertebral mass was performed. RESULTS: The pathology of the tumor was reported as leiomyosarcoma. CONCLUSION: Leiomyosarcomas may develop at any site where smooth muscle cells are present. However, primary leiomyosarcoma of the spine or paravertebral space is extremely rare. Leiomyosarcoma, although rare, should be kept in mind as one of the possible diagnoses when a patient with a paraspinal tumor is presented.

Neoadjuvant chemotherapy with taxotere-epirubicin-5-fluorouracil (TEF) in local-regionally advanced breast cancer: a preliminary report.

AIMS AND BACKGROUND: Sixty-three patients with local-regionally advanced breast cancer were treated with neoadjuvant chemotherapy consisting of docetaxel (Taxotere), epirubicin, and 5-fluorouracil (TEF). METHODS AND STUDY DESIGN: Preoperatively, patients received four cycles of Taxotere (80 mg/m2), epirubicin (60 mg/m2), and 5-fluorouracil (500 mg/m2), repeated every 21 days. Following completion of four cycles of chemotherapy, appropriate surgery was performed. After the surgery, patients received one cycle of the TEF chemotherapy regimen; following chemotherapy, radiotherapy was applied, and at the end two more cycles of TEF chemotherapy regimen were given. RESULTS: Sixty-three patients with locally advanced breast cancer were treated. Three patients were excluded from the study before the evaluation of response. Median age of the patients was 50 years (range, 25-77). Twenty-seven and 33 patients were premenopausal and postmenopausal, respectively. Thirty-nine patients were in stage IIIA and 21 in stage IIIB. Complete and partial responses were observed in 15 (25%) and 42 (70%) of the patients following four cycles of preoperative TEF chemotherapy regimen, respectively. Overall response was 95%, and primary lesion progressed only in 3 (5%) patients. The mean disease-free survival was 15.9 +/- 6.8 (range, 3.5-28) months and the mean overall survival was 18.6 +/- 7.2 (range, 5-30) months. The most frequent side effects were nausea-vomiting, mucositis, alopecia and leukopenia. CONCLUSIONS: TEF therapy is a treatment with a high overall response rate and toxicities similar to other taxotere combinations. A longer follow-up of patients is necessary for the determination of disease-free survival and overall survival.