Prognostic value of KI-67 proliferation index in luminal breast cancers.

AIM: This study aimed to examine the prognostic significance of the KI-67 proliferation index, especially in breast cancer (BC) patients without HER-2 expression and no nodal involvement. MATERIAL AND METHODS: The database of hormone-receptor-positive patients who underwent surgery for BC in our Surgical Oncology Clinic between 2008 and 2020 was retrospectively reviewed and recorded. Patients were categorized based on their KI-67 level, considering the cutoff value of 20%. RESULTS: Our study revealed that tumors with high KI-67 levels were more likely to have a more advanced histological grade (p = 0.00) and size (p = 0.038). In the univariant analysis, KI-67 level was effective on overall survival (p = 0.044) and disease-free survival (p = 0.048). However, we found that there was no independent prognostic factor in the multivariant analysis. CONCLUSION: Although the Ki-67 proliferation index does not yet have an agreed threshold value and scoring methodology, it can also be used to determine prognosis and evaluate treatment response in some patients.

OBJETIVO: Este estudio tuvo como objetivo examinar la importancia pronóstica del índice de proliferación KI-67, especialmente en pacientes con cáncer de mama sin expresión de HER-2 y sin compromiso ganglionar. MATERIAL Y MÉTODOS: Se revisó y registró retrospectivamente la base de datos de pacientes con receptores hormonales positivos intervenidas de cáncer de mama en nuestra Clínica de Oncología Quirúrgica entre 2008 y 2020. Las pacientes fueron categorizadas de acuerdo con su nivel de KI-67, considerando el valor de corte del 20%. RESULTADOS: Nuestro estudio reveló que los tumores con valores elevados de KI-67 eran más propensos a tener un grado histológico (p = 0.00) y un tamaño (p = 0.038) más avanzados. En el análisis univariado, el nivel de KI-67 fue efectivo sobre la supervivencia global (p = 0.044) y la supervivencia libre de enfermedad (p = 0.048). Sin embargo, encontramos que no había ningún factor pronóstico independiente en el análisis multivariante. CONCLUSIONES: Aunque el índice de proliferación Ki-67 aún no tiene un valor de umbral acordado ni una metodología de puntuación, también se puede utilizar para determinar el pronóstico y evaluar la respuesta al tratamiento en algunas pacientes.

Relationship between lymphovascular invasion and molecular subtypes in invasive breast cancer.

PURPOSE: The aim of this study is to evaluate the relation between LVI and molecular subtypes in invasive breast cancers and to find out whether LVI which is a histopathologic indicator has a role in subtype classification or not. METHODS: One hundred and seventy-six patients who had mastectomy for breast cancer between 2013 and 2018 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University were retrospectively analysed. One hundred and thirty-two patients who had LVI, ER, PR, Her 2 and Ki-67 index status information provided in their pathology results were included in the study. The relationship between molecular subtypes and LVI was investigated. RESULTS: One hundred and thirty-two patients were analysed retrospectively. Eighty-two patients had LVI and 50 patients had not. We found a relationship between Luminal B with Her2(-) and LVI, basal like and LVI (P = .00). No significant statistical difference was found between LVI and other molecular subtypes. We confirmed these results with multiple variable analysis (%77.3 correlation). CONCLUSIONS: As a result, we found that LVI can affect molecular subtypes. This showed that a histopathological factor may affect tumour biology. In other words, breast cancer is a heterogeneous disease with many different predictors and prognostic variables.

The Predictive Value of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio in Patients with Recurrent Idiopathic Granulomatous Mastitis.

OBJECTIVE: The aim of this study was to investigate the relationship between the inflammatory parameters including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the prognosis of idiopathic granulomatous mastitis (IGM). MATERIALS AND METHODS: In this retrospective study, a total of 41 patients with IGM who had no malignant disease or inflammatory pathologies were included between January 2010 and December 2017. The patients were divided into two groups according to presence or absence of recurrence. Subsequently, the relationship between patient characteristics, pre- and postoperative NLR and PLR levels and disease recurrence were evaluated. RESULTS: With a mean follow-up period of 28.4 months, 19.5% of patients were found to have recurrent IGM. Age, body mass index, patient characteristics such as oral contraceptive use, smoking status, and family history, surgical treatment and postoperative NLR, preoperative PLR, and postoperative PLR were not statistically significant between groups. However, only preoperative NLR was significantly associated with a recurrent IGM (p=0.024). Preoperative NLR predicted recurrence with a sensitivity of 62.5% and specificity of 84.8%. CONCLUSION: These results demonstrated that a high level of NLR was predictive of poor outcome in patients with IGM.

Regression in local recurrence in the contralateral breast following mastectomy in bilateral locally advanced breast cancer: A comparison of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios.

The neutrophil-to-lymphocyte ratio is clinically accepted as a marker of systemic inflammatory response. In breast cancer patients, neutrophil-to-lymphocyte ratio can be used as an important prognostic indicator of survival. In routine laboratory tests, the platelet-to-lymphocyte ratio can also be examined in addition to neutrophil-to-lymphocyte ratio. Although the effects on breast cancer survival of platelet-to-lymphocyte ratio, which is accepted as the twin of neutrophil-to-lymphocyte ratio, are not as widely accepted as those of neutrophil-to-lymphocyte ratio, platelet activation is known to be a feature of cancer. Here, we present the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of a patient with locally advanced cancer of the left breast who underwent a simple mastectomy that reduced the tumor load. Following surgical therapy, a remarkable regression was observed in the local recurrence area of the right mastectomy site; at the same time, the patient's neutrophil-to-lymphocyte ratio and PLR values significantly decreased.

Vascular endothelial growth factor (VEGF)-C, VEGF-D, VEGFR-3 and D2-40 expressions in primary breast cancer: Association with lymph node metastasis.

BACKGROUND: Two members of the vascular endothelial growth factor (VEGF) family, VEGF-C and -D, are known as lymphangiogenic growth factors and play an important role in tumor lymphangiogenesis via activation of the VEGF receptor (VEGFR)-3, which is expressed in lymphatic endothelial cells. D2-40 is a specific antibody for lymphatic vessel density (LVD). OBJECTIVES: In the present study, we have aimed to evaluate whether intraand peri-tumoral D2-40-positive lymphatic vessels affect lymph node metastasis and to investigate the relationship between LVD and lymph node metastasis in breast cancer. MATERIAL AND METHODS: We have evaluated the relationships between lymph node metastasis and VEGF-C, VEGF-D, VEGFR-3 and D2-40 expressions in breast cancer cells using immunohistochemistry. VEGF-C, VEGF-D and VEGFR-3 expression were found in tumor cells in the majority of the cases (83.75, 97.5 and 95%, respectively). RESULTS: There was a significant positive relationship between VEGF-D expression and lymph node metastasis (p < 0.05) however no significant association was found in VEGF-C and VEGFR-3 expressions. It was found that patients with high-expression of VEGF-D have a high level of both periand intra-tumoral LVD compared to those with low expression of VEGF-D (p < 0.05). CONCLUSIONS: Our results support that examination of VEGF-D expression in breast cancer cells may be beneficial in the identification of lymph node metastasis.

The Utility of Intraoperative Handheld Gamma Camera for Detection of Sentinel Lymph Nodes in Melanoma.

Accurate identification of the sentinel lymph node (SLN) is an important prognostic factor for melanoma. In a minority of cases drainage to interval nodal basins, such as the epitrochlear region, are possible. Intraoperative handheld gamma cameras have been used to detect SLNs which are located in different anatomical localizations. In this case we report the utility of an intraoperative handheld gamma camera in the localization of epitrochlear drainage of distal upper extremity melanoma and its impact on surgical procedure.

[Multiple small bowel perforations due to Behcet's disease]. / Behçet hastaligina bagli multipl ince bagirsak perforasyonu.

Behcet's disease is a chronic, relapsing, multisystemic, idiopathic, and inflammatory disease. A common gastrointestinal site other than the mouth is the ileocecal region. Intestinal ulcers, due to Behcet's disease, can cause perforation. A 19-year-old male patient was admitted to our hospital for Behcet's disease. The patient developed acute abdomen, and laparotomy revealed multiple perforations throughout the terminal ileum. He underwent partial ileum resection. Postoperative period was uneventful, and the patient was discharged. The patient's ileostomy was closed two months after the first operation. He was clinically well during the 16-month follow-up period. This study aimed to report multiple ileum perforations as an unusual complication of Behcet's disease at the time of presentation and review of the current literature of reported cases.

Thrombophilic polymorphisms are not associated with disease-free survival in breast cancer patients.

BACKGROUND: Thrombosis is one of the most common complications in cancer patients, however the effect of thrombophilic polymorphisms on cancer specific survival is still unclear. OBJECTIVES: The aims of the study were to analyze the effect of factor V Leiden (FVL), prothrombin (PT) G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms on disease-free survival (DFS) in breast cancer and to evaluate the proportional odds model. METHODS: Relationship between thrombophilic polymorphisms and DFS was evaluated in 197 breast cancer patients. Data regarding patient's age, menopausal status, tumor size (T), lymph node status (N), cancer stage, tumor grade (G), estrogen and progesterone receptors, c-erbB2 expression, MTHFRC677T, FVL, and PTG20210A polymorphisms in DFS were examined by log-rank test and multivariate analyses. The proportional odds model was tested as an alternative to Cox model because of its insufficient proportional hazards assumption. RESULTS: According to log-rank test, T, N, G, tumor stage, and c-erbB2 were associated with DFS. T, N, G, and c-erbB2 were significantly related to DFS by log-normal regression model. PTG20210A, MTHFRC677T and FVL polymorphisms were not related to DFS in breast cancer (P>0.05). CONCLUSION: Our study suggests that thrombophilic polymorphisms are not associated with DFS when the proportional odds model is applied.

National practice in antibiotic prophylaxis in breast cancer surgery.

BACKGROUND: Although breast cancer surgery is regarded as a "clean" surgery, surgical site infection (SSI) rates are higher than expected. There is no consensus regarding the use of antibiotic prophylaxis in elective breast surgery. The nationwide survey was conducted to determine the trend of antibiotic prophylaxis in breast cancer among Turkish surgeons. METHODS: The survey was sent to surgeons who are member of Turkish Surgical Association (TSA) via e-mail from TSA web address. A 15 item web-based survey consisted of surgeon demographics and the use of prophylactic antibiotic in patients with risk factors related to SSI. RESULTS: The number of completed questionnaires was 245. The most common antibiotic used was first generation of cephalosporins. A majority of respondents indicated that prophylaxis was preferred in patients with high risk of SSI including preoperative chemotherapy or radiotherapy, older age, diabetes mellitus, immunodeficiency, immediate reconstruction (P < 0.05). However, the use of drain did not significantly influence antibiotic prophylaxis (P = 0.091). CONCLUSIONS: The use of prophylactic antibiotic was strongly dependent on the presence of some risk factors; however, the variation in current practice regarding antibiotic prophylaxis demonstrated a lack of its effect on preventing SSI after breast cancer surgery.

The role of Factor V Leiden in adult patients with venous thromboembolism: a meta-analysis of published studies from Turkey.

Factor V Leiden (FVL) is the most common inherited risk factor for venous thromboembolism (VTE). The frequency of FVL in patients with VTE has been reported from different parts of Turkey. A meta-analysis was performed to estimate the risk of VTE associated with FVL in Turkish population. Published studies were retrieved from Pubmed and Science Citation Index/Expanded. We selected studies comparing the prevalence of FVL in patients with VTE with controls. The analysis was performed by the software comprehensive meta-analysis. The analysis consisted of 10 studies including 1202 patients with VTE and 1283 controls. The pooled frequency of FVL was significantly higher in patients with VTE (22.8%) than controls (7.6%). The pooled odds ratio (OR) was 3.4 (95% confidence interval [CI], 2.6-4.5). The study showed homogeneity (Q value, 9.955). No publication bias was observed in any comparison model. Our meta-analysis showed an association of FVL with VTE in Turkey.

The association of protease activated receptor 1 gene -506 I/D polymorphism with disease-free survival in breast cancer patients.

BACKGROUND: Recent data have shown that tumor development and dissemination may be regulated by procoagulant/anticoagulant axis. The aim of the present study was to search for an association of the protease activated receptor (PAR)1 gene -506 insertion/deletion (I/D), factor V Leiden (FVL), prothrombin (PT) G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms with disease-free survival (DFS) in breast cancer. METHODS: Genotyping of -506 I/D in the promoter region of PAR1 gene was performed by single-strand conformation polymorphism analysis and sequencing. FVL, PT G20210A, and MTHFR C677T were also determined by the method of polymerase chain reaction-based DNA analysis. Data regarding patient's age, menopausal status, tumor size, lymph node status, disease stage, tumor grade, estrogen and progesterone receptor, c-erb B2 expression, PAR1 -506 I/D, MTHFR C677T, FVL, and PT G20210A polymorphisms were examined by the univariate and multivariate analyses. RESULTS: Recurrent disease occurred in 29 patients (19.6 %) within a median of 20 months. It was found that tumor size, lymph node status, tumor stage, tumor grade, c-erbB2 expression, and PAR1 -506 I/D polymorphism were associated with DFS when Kaplan-Meier method was applied (P<.05). By Cox proportional hazards model, the presence of allele D at -506 locus (P=.0249) and small tumor size (P=.0001) were significant favorable prognostic factor, but c-erbB2 expression was an adverse prognostic factor (P=.0049). CONCLUSION: Our study suggested the protective effect of the allele D at -506 locus of PAR1 gene on the recurrence of breast cancer.

Association between the -402GA, -401GT, and -323ins10-bp polymorphisms of factor VII gene and breast cancer.

BACKGROUND AND PURPOSE: Recent data have shown that the hemostatic system may play a role in cancer development and progression. To test whether factor VII (FVII) can be a candidate factor for breast cancer, we have evaluated the distribution of FVII gene polymorphisms in breast cancer patients and healthy subjects. METHODS: The nested case-control study consisted of 92 women with breast cancer (group 1) and 80 control subjects (in age-matched women) (group 2). Genotyping of the -323ins10-bp, -401GT, and -402GA polymorphisms of the FVII gene was performed by the method of single-strand conformation polymorphism analysis and sequencing. RESULTS: A significant difference was observed in the distribution of the -402GA genotype and allele frequencies in breast cancer and control cases (p < 0.05). For other polymorphisms of the FVII gene, the distributions of genotypes and allele frequencies were not significantly different between two groups (p > 0.05). There was also a significant difference between the distributions of the haplotypes in breast cancer patients and control subjects (p < 0.05). CONCLUSION: Although the number of cases in this study was small, the preliminary findings revealed a possible contribution of the FVII -402GA polymorphism in the development of breast cancer. However, further case-control studies with larger series are needed to confirm our findings.