ABSTRACT
BACKGROUND AND AIM: Breast cancers (BCs) involve the left side (LS) more than the right side (RS). Among the Egyptians, neither BC laterality nor its association with demographic factors, tumor locations, treatments and outcomes were previously reported. PATIENTS AND METHODS: Laterality was analyzed among 5459 BCs from the Gharbiah population-based cancer registry covering >5% of the Egyptian population. Cox proportional model was used to assess the independent effect of stage, ER, and laterality on overall survival (OS). RESULTS: In Egypt, BCs involve LS more than RS with LS-to-RS ratio (LRR) of 1.16. LS predominance was evident among men and women and both younger (< 45 years) and older patients. HER2 over-expression and ductal cancers were significantly more in RSBCs while lobular cancers were significantly more in LSBCs. There were no significant differences in localization within the breast between LSBCs and RSBCs (p = 0.51). LS predominance was noticed across all subgroups except in patients with HER2 positive tumors (LRR = 0.63; p = 0.02). OS was significantly better in stage II and ER positive tumors than stage III and ER negative tumors. Despite OS of LSBCs being generally lower than RSBCs, this was not statistically significant. The significant impact of stage on OS was lost in LSBCs. CONCLUSIONS: Among Egyptian patients, the left breast is at greater risk of cancer than the right one. Despite right-sided tumors seemed more aggressive, Left-sided ones tend to confer worse survival than right-sided tumors.
Subject(s)
Breast Neoplasms/pathology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Axilla , Breast Neoplasms/mortality , Breast Neoplasms/therapy , Breast Neoplasms, Male/mortality , Breast Neoplasms, Male/pathology , Breast Neoplasms, Male/therapy , Combined Modality Therapy , Female , Humans , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Tumor Burden , Young AdultABSTRACT
The current study reports the clinical features and treatment outcome of 67 patients with acute promyelocytic leukemia (APL) treated at National Cancer Institute (NCI-Cairo), in Egypt from January 2007 to January 2011. The median age at presentation was 29 years. Bleeding was the most common presenting symptom (79%). Most patients had an intermediate risk Sanz score (49%) and 34% had a high risk score. The median follow-up time was 36 months. All evaluable patients were treated for induction with the simultaneous administration of all-trans retinoic acid (ATRA) and an anthracycline. The original AIDA treatment protocol was modified due to resource limitations at the NCI-Cairo by replacing of idarubicin with daunorubicin or doxorubicin in most of the cases and the inclusion of cytarabine during the consolidation phase only in pediatric patients. All patients who achieved molecular complete remission after consolidation received two-year maintenance treatment with low dose chemotherapy composed of 6 mercaptopurine, methotrexate and intermittent ATRA courses. Five patients died before treatment initiation due to bleeding, three died during induction chemotherapy due to infectious complications (n=2) and bleeding (n=1) and one patient died during consolidation therapy due to infection. The main therapeutic complications during the induction phase were febrile neutropenia (42%), bleeding (18%) and differentiation syndrome (11%). All patients achieved molecular CR at end of consolidation therapy at a median time of 100 days. The 3-year OS was 89%. Two patients relapsed at 13 and 24 months, respectively. Adapting standard AIDA treatment protocols to limited resources by reducing dose-intensity during consolidation, using ATRA in the consolidation phase and alternative anthracyclin (doxorubicin) may be a valid treatment option for APL in developing countries. In spite of the increased incidence of high and intermediate risk disease in our cohort, we reported an acceptable CR rate, toxicity and OS.
