Benefit of adjuvant chemotherapy in lymph node-negative, T1b and T1c triple-negative breast cancer.

INTRODUCTION: Current guidelines recommendations regarding chemotherapy in small (T1b and T1c), node-negative triple-negative breast cancer (TNBC) differ due to lack of high-quality data. Our study aimed to assess the benefit of adjuvant chemotherapy in patients with T1bN0M0 and T1cN0M0 TNBC. METHODS: We obtained data from the Surveillance, Epidemiology, and End Results database for patients with node-negative, T1b/T1c TNBC diagnosed between 2010 and 2020. Logistic regresion models assessed variables associated with chemotherapy administration. We evaluated the effect of chemotherapy on overall survival (OS) and breast cancer specific survival (BCSS) with Kaplan-Meier methods and Cox proportional hazards methods. RESULTS: We included 11,510 patients: 3,388 with T1b and 8,122 with T1c TNBC. During a median follow-up of 66 months, 305 patients with T1b and 995 with T1c died. After adjusting for clinicopathological, demographic and treatment factors, adjuvant chemotherapy improved OS in T1b TNBC (HR, 0.52; 95% CI, 0.41-0.68 p < 0.001) but did not improve BCSS (HR, 0.70; 95% CI, 0.45-1.07; p = 0.10); the association between chemotherapy and BCSS was not statistically significant in any subgroup. In T1c TNBC, adjuvant chemotherapy improved OS (HR, 0.54; 95% CI, 0.47-0.62; p < 0.001) and BCSS (HR, 0.79; 95% CI, 0.63-0.99; p = 0.043); the benefit of chemotherapy in OS varied by age (Pinteraction=0.024); moreover, the benefit in BCSS was similar in all subgroups. CONCLUSIONS: Our study results support the use of adjuvant chemotherapy in patients with node-negative, T1c TNBC. Patients with node-negative, T1b TNBC had excellent long-term outcomes; furthermore, chemotherapy was not associated with improved BCSS in these patients.

Racial disparities in treatment and outcomes between non-Hispanic Black and non-Hispanic White women with nonmetastatic inflammatory breast cancer.

PURPOSE: The incidence rate of inflammatory breast cancer (IBC) is higher among non-Hispanic Black (NHB) than non-Hispanic White (NHW) women. We examined the differences in treatment and outcomes between NHB and NHW women with IBC, accounting for demographic, clinicopathological, and socioeconomic factors. METHODS: We collected data from the Surveillance, Epidemiology, and End Results database for NHB and NHW women with IBC diagnosed between 2010-2016. We analyzed the odds of receiving chemotherapy, radiation, and surgery between NHB and NHW women. We evaluated overall survival (OS) with Kaplan-Meier methods and Cox proportional hazards methods. Competing risk analysis was used to compare the risk of breast cancer death between NHB and NHW women. We also evaluated the magnitude of survival disparities within the strata of demographic, socioeconomic, and treatment factors. RESULTS: Among 1,652 NHW and 371 NHB women with IBC, the odds of receiving chemotherapy, surgery, and radiation were similar for NHB and NHW. After 39-month follow-up, the median OS was 40 and 81 months for NHB and NHW, respectively (p < 0.0001). The risk of breast cancer death was higher for NHB than NHW women (5-year risk of breast cancer death, 51% vs. 35%, p < 0.0001). CONCLUSION: After adjustment for demographic, clinicopathological, and socioeconomic factors; NHB women with IBC had similar odds of receiving surgery, chemotherapy, and radiation therapy, but were more likely to die of the disease compared to their NHW counterparts. Our findings suggest the presence of masked tumor biology, treatment, or socioeconomic factors associated with race that can lead to worse IBC outcomes.

Racial disparities in overall survival after the introduction of cyclin-dependent kinase 4/6 inhibitors for patients with hormone receptor-positive, HER2-negative metastatic breast cancer.

PURPOSE: CDK4/6 inhibitors (CDK4/6i) combined with endocrine therapy have improved HR + /HER2- metastatic breast cancer (MBC) outcomes. However, it is still unclear whether the response to CDK4/6i is similar for all races. Therefore, we aimed to assess overall survival (OS) trends stratified by race in patients with HR + /HER2- MBC after the approval of CDK4/6i, as part of the standard of care, in 2015. METHODS: We performed a population-based study using the SEER database. Patients with HR + /HER2- MBC were divided into two time-based cohorts: 1) pre-CDK4/6i era (diagnosed in 2011-2013) and 2) post-CDK4/6i era (diagnosed in 2015-2017). We used propensity score matching and identified 2,684 patients in each cohort that matched in several characteristics. Kaplan-Meier methods were used to estimate 2-year OS. Association between cohort and OS was evaluated using marginal Cox proportional hazards models with robust sandwich variance estimator. We conducted competing risk analysis to estimate the risk of breast cancer death in both cohorts. RESULTS: The 2-year OS rate was 65% for the post-CDK4/6i era and 62% for the pre-CDK4/6i era (stratified log-rank p = 0.025). The 2-year OS for non-Hispanic White (NHW) patients improved in the post-CDK4/6i era compared to the pre-CDK4/6i era (67% vs. 63%, p = 0.033). However, OS did not improve for non-Hispanic Black (NHB) (54% vs. 54%, p = 0.876) or Hispanic (67% vs. 65%, p = 0.617) groups. The risk of breast cancer death decreased in the post-CDK4/6i era as compared to the pre-CDK4/6i era (2-year risk of breast cancer death: 33% vs. 30%, p = 0.015); however, this effect was observed only in NHW (sHR 0.84, p = 0.005) women, but not in NHB (sHR 0.94, p = 0.630) or Hispanic (sHR 0.91, p = 0.550) women. CONCLUSIONS: Our study confirms that outcomes for HR + /HER2- MBC have improved after CDK4/6i were introduced in 2015. However, this effect is primarily driven by the improved OS in NHW patients, without significant improvement in OS in NHB or Hispanics.

2-Pyridone-stabilized iridium silylene/silyl complexes: structure and QTAIM analysis.

Iridium(iii) complexes of the general formula [Ir(X)(κ2-NSiiPr2)2] (NSiiPr2 = (4-methyl-pyridine-2-yloxy)diisopropylsilyl; X = Cl, 3; CF3SO3, 5; CF3CO2, 6) have been prepared and fully characterized, including X-ray diffraction studies and theoretical calculations. The presence of isopropyl substituents at the silicon atom favours the monomeric structure found in complexes 3 and 5. The short Ir-Si bond distances (2.25-2.28 Å) indicate some degree of base-stabilized silylene character of the Ir-Si bond in 3, 5 and 6 assisted by the 2-pyridone moiety. However, the shortening of these Ir-Si bonds might be a consequence of the constrained 2-pyridone geometry, and consequently the silyl character of these bonds can not be excluded. A DFT theoretical study on the nature of the Ir-Si bonds has been performed for complex 3 as well as for four other iridium complexes finding representative examples of different bonding situations between Ir and Si atoms: silylene, base-assisted silylene (both with an anionic base and with a neutral base), and silyl bonds, using the topological properties of the electron charge density. The results of these studies show that the Ir-Si bonds in Ir-NSiiPr2 complexes can be considered as an intermediate between the base-stabilized silylene and silyl cases, and therefore they have been proposed as 2-pyridone-stabilized iridium silylene/silyl bonds.

Selective reduction of formamides to O-silylated hemiaminals or methylamines with HSiMe2Ph catalyzed by iridium complexes.

The reaction of (4-methyl-pyridin-2-iloxy)ditertbutylsilane (NSitBu-H, 1) with [IrCl(coe)2]2 affords the iridium(iii) complex [Ir(H)(Cl)(κ2-NSitBu)(coe)] (2), which has been fully characterized including X-ray diffraction studies. The reaction of 2 with AgCF3SO3 leads to the formation of species [Ir(H)(CF3SO3)(κ2-NSitBu)(coe)] (3). The iridium complexes 2 and 3 are effective catalysts for the reduction of formamides with HSiMe2Ph. The selectivity of the reduction process depends on the catalyst. Thus, by using complex 2, with a chloride ancillary ligand, it has been possible to selectively obtain the corresponding O-silylated hemiaminal by reaction of formamides with one equivalent of HSiMe2Ph, while complex 3, with a triflate ligand instead of chloride, catalyzed the selective reduction of formamides to the corresponding methylamine.

Caracterización de algunos estados emocionales en pacientes con retinosis pigmentaria típica en dos de sus estadios / Characterization of some emotional states in patients with typical retinitis pigmentary in two of its stages

La presente investigación se realizó con el objetivo de caracterizar los estados emocionales en pacientes con retinosis pigmentaria típica en sus dos primeros estadios que fueron atendidos en el Hospital Clínico Quirúrgico Arnaldo Milián Castro, de la Ciudad de Santa Clara, Provincia de Villa Clara, entre septiembre de 2011 y abril de 2012. Se partió tanto para el diseño metodológico como para el análisis de los resultados del paradigma mixto de investigación; se vincularon datos cuantitativos y cualitativos en la investigación psicológica. Se realizó un estudio de tipo descriptivo transversal en una muestra de 10 pacientes de cada uno de los dos primeros estadios de la enfermedad a partir de un muestreo de tipo probabilístico aleatorio simple; se establecieron criterios de inclusión y exclusión para conformar las muestras. La información para el estudio se obtuvo de la aplicación de distintos instrumentos psicológicos de exploración. Se concluyó que la depresión, seguida de la ansiedad, predomina por encima de los demás estados emocionales estudiados en ambos grupos, que ambas tuvieron su repercusión, principalmente, en el área personal de estos sujetos y que se encontraron una expectativa incierta del futuro y un grado importante de afectación psicológica. Los estados emocionales más fuertemente vivenciados se encontraron en el estadio II de la enfermedad estrechamente relacionados con su progresión; apareció también mayor afectación en sus relaciones sociales(AU)

Evaluación de un sistema de filtro de pacientes con lesiones pigmentadas mediante teleconsulta diferida / Evaluation of a screening system for patients with pigmented lesions using store-and-forward teleconsultation

Introducción. Las clínicas de lesiones pigmentadas (CLP) se desarrollaron como un sistema de referencia rápida para pacientes con lesiones pigmentadas. Sin embargo, el método adecuado para la selección de pacientes que precisan atención en estas unidades no está claramente definido. La teledermatología es una herramienta cuya utilidad como sistema de selección de pacientes en las CLP precisa de evaluación. Objetivo. Evaluar la teleconsulta como sistema de filtro de pacientes con lesiones pigmentadas en términos de eficacia, exactitud y satisfacción. Método. Se evalúan las teleconsultas recibidas en una CLP en un periodo de 12 semanas. Los pacientes teleconsultados refirieron cambios en una lesión pigmentada, lesión de aparición reciente, lesiones múltiples, sintomáticas o preocupación acerca de un nevo. Se calcularon los intervalos de tiempo en remitir el informe de teleconsulta y en ser atendido en la consulta «física» de la CLP, los coeficientes k intraobservador, interobservador y con el patólogo, así como el grado de satisfacción de pacientes y médicos de atención primaria. Resultados. Se evaluaron 219 teleconsultas de las cuales el 49,3 % se derivaron a la consulta «física». El motivo más frecuente de teleconsulta fue la preocupación acerca de un nevo (37,0 %). Las teleconsultas fueron respondidas en un tiempo medio de 43,9 h, y los pacientes fueron atendidos en la consulta «física» antes de 2 semanas. La concordancia intraobservador fue de k = 0,93 (intervalo de confianza del 95 % [IC 95 %]: 0,87-0,98); concordancia interobservador k = 0,91 (IC 95 %: 0,87-0,96) y la concordancia entre el teledermatólogo y el patólogo k = 0,79 (IC 95 %: 0,70-0,89). El 86 % de los pacientes y el 91 % de los médicos de atención primaria refirieron estar «muy satisfechos» con la implantación de este nuevo sistema. Conclusiones. La teleconsulta es un sistema de filtro preciso para pacientes con lesiones pigmentadas. Mediante esta metodología, los tiempos de espera para pacientes con lesiones malignas o sospechosas de malignidad pueden ser acortados al mismo tiempo que disminuye la sobrecarga de trabajo de las CLP. Sin embargo, es necesaria una mayor experiencia para establecer la utilidad real de este sistema de filtro en el diagnóstico precoz del melanoma

Introduction. Pigmented lesion clinics (PLC's) were developed as a quick referral system for patients with pigmented lesions. However, the most appropriate method of selecting patients who need to be seen in these units is not clearly defined. Teledermatology is a tool whose usefulness as a patient selection system for PLC's needs to be evaluated. Objective. To evaluate teleconsultation as a screening system for patients with pigmented lesions in terms of efficacy, accuracy and satisfaction. Method. Teleconsultations received at a PLC over a period of 12 weeks were evaluated. Teleconsultation patients reported changes in a pigmented lesion, a lesion that had recently appeared, multiple lesions, symptomatic lesions or concern about a nevus. We calculated the time intervals in sending the teleconsultation report and in patients being seen at the «physical» PLC consultation, the intraobserver, interobserver and pathologist k coefficients, as well as the degree of satisfaction of patients and Primary Care (PC) physicians. Results. 219 teleconsultations were evaluated, 49.3 % of which were referred to the «physical» consultation. The most frequent reason for the teleconsultation was concern about a nevus (37.0 %). The teleconsultations received responses in an average time of 43.9 hours, and patients were seen at the «physical» consultation within 2 weeks. The intraobserver agreement was k = 0.93 (95 % CI 0.87-0.98); interobserver agreement, k = 0.91 (95 % CI 0.87-0.96); and the agreement between the teledermatologist and the pathologist, k = 0.79 (95 % CI 0.70-0.89). 86 % of the patients and 91 % of the Primary Care physicians said that they were «very satisfied» with the implementation of this new system. Conclusions. Teleconsultation is an accurate screening system for patients with pigmented lesions. With this methodology, waiting times for patients with malignant lesions or those suspected of malignancy can be shortened at the same time as the PLC's excess workload is decreased. However, more experience is needed to establish the true usefulness of this filtering system in the early diagnosis of melanoma

[Evaluation of a screening system for patients with pigmented lesions using store-and-forward teleconsultation]. / Evaluación de un sistema de filtro de pacientes con lesiones pigmentadas mediante teleconsulta diferida.

INTRODUCTION: Pigmented lesion clinics (PLC's) were developed as a quick referral system for patients with pigmented lesions. However, the most appropriate method of selecting patients who need to be seen in these units is not clearly defined. Teledermatology is a tool whose usefulness as a patient selection system for PLC's needs to be evaluated. OBJECTIVE: To evaluate teleconsultation as a screening system for patients with pigmented lesions in terms of efficacy, accuracy and satisfaction. METHOD: Teleconsultations received at a PLC over a period of 12 weeks were evaluated. Teleconsultation patients reported changes in a pigmented lesion, a lesion that had recently appeared, multiple lesions, symptomatic lesions or concern about a nevus. We calculated the time intervals in sending the teleconsultation report and in patients being seen at the "physical" PLC consultation, the intraobserver, interobserver and pathologist kappa coefficients, as well as the degree of satisfaction of patients and Primary Care (PC) physicians. RESULTS: 219 teleconsultations were evaluated, 49.3 % of which were referred to the "physical" consultation. The most frequent reason for the teleconsultation was concern about a nevus (37.0 %). The teleconsultations received responses in an average time of 43.9 hours, and patients were seen at the "physical" consultation within 2 weeks. The intraobserver agreement was kappa = 0.93 (95 % CI 0.87-0.98); interobserver agreement, kappa = 0.91 (95 % CI 0.87-0.96); and the agreement between the teledermatologist and the pathologist, kappa = 0.79 (95 % CI 0.70-0.89). 86 % of the patients and 91 % of the Primary Care physicians said that they were "very satisfied" with the implementation of this new system. CONCLUSIONS: Teleconsultation is an accurate screening system for patients with pigmented lesions. With this methodology, waiting times for patients with malignant lesions or those suspected of malignancy can be shortened at the same time as the PLC's excess workload is decreased. However, more experience is needed to establish the true usefulness of this filtering system in the early diagnosis of melanoma.