Implications of tumor-infiltrating lymphocytes in early-stage triple-negative breast cancer: clinical oncologist perspectives.

Breast cancer (BC) is the most common neoplasm in women worldwide and one of the leading causes of female death. The triple-negative subtype, characterized by the absence of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2), tends to occur in younger patients, be more aggressive and less differentiated. Furthermore, this subtype is considered the most immunogenic and associated with higher levels of tumor cell infiltration, mainly lymphocytes. Tumor-infiltrating lymphocytes (TILs) play a crucial role in the interaction of the host's immune system and cancer cells. The microenvironment is critical in tumor development and progression. Assessment of infiltrating lymphocytes can provide valuable information about the immune response and, given the lack of biomarkers to guide treatment decisions and predict outcomes in triple-negative tumors and can be considered as a potential biomarker. Some evidence suggests that higher levels of these lymphocytes are associated with better responses to systemic treatment, longer progression-free survival and overall survival (OS). However, treatment escalation or de-escalation strategies for triple-negative BC (TNBC) currently do not consider the presence or density of TILs for therapeutic decisions. TILs appear to be useful predictive and prognostic indicators. Further clinical studies are needed to confirm these relationships and integrate TILs as a biomarker consistently into clinical practice. This article summarizes key concepts relating to the role of the immune infiltrate in BC, along with the current status and future prospects regarding TILs as a predictive and prognostic biomarker.

Highlights of the 17th St Gallen International Breast Cancer Conference 2021: customising local and systemic therapies.

The 17th edition of the St Gallen International Breast Cancer Conference was held in March 2021 in an entirely virtual mode. More than 3,300 participants took part in this important bi-annual critical review of the 'state of the art' in the multidisciplinary care of early-stage breast cancer (BC). Seventy-four experts from all continents discussed and commented on the previously elaborated consensus questions as well as numerous interrogations on early-BC diagnosis and treatment asked by the audience. The theme of this year's Conference was 'Customising local and systemic therapies'. This paper summarises the results of the 2021 international panel votes as a quick news update. We discuss the most important issues on genetics, pathology, surgery, radiotherapy and systemic therapies presented and debated throughout the conference. We selected the topics based on applicability into the personalised care of BC patients and focused on questions that have a clear impact on our current clinical practice.

PET-CT has low specificity for mediastinal staging of non-small-cell lung cancer in an endemic area for tuberculosis: a diagnostic test study (LACOG 0114).

BACKGROUND: The present study aims to assess the performance of 18F-FDG PET-CT on mediastinal staging of non-small cell lung cancer (NSCLC) in a location with endemic granulomatous infectious disease. METHODS: Diagnostic test study including patients aged 18 years or older with operable stage I-III NSCLC and indication for a mediastinal lymph node biopsy. All patients underwent a 18F-FDG PET-scan before invasive mediastinal staging, either through mediastinoscopy or thoracotomy, which was considered the gold-standard. Surgeons and pathologists were blinded for scan results. Primary endpoint was to evaluate sensitivity, specificity and positive and negative predictive values of PET-CT with images acquired in the 1st hour of the exam protocol, using predefined cutoffs of maximal SUV, on per-patient basis. RESULTS: Overall, 85 patients with operable NSCLC underwent PET-CT scan followed by invasive mediastinal staging. Mean age was 65 years, 49 patients were male and 68 were white. One patient presented with active tuberculosis and none had HIV infection. Using any SUV_max > 0 as qualitative criteria for positivity, sensitivity and specificity were 0.87 and 0.45, respectively. Nevertheless, even when the highest SUV cut-off was used (SUV_max ≥5), specificity remained low (0.79), with an estimated positive predictive value of 54%. CONCLUSIONS: Our findings are in line with the most recent publications and guidelines, which recommend that PET-CT must not be solely used as a tool to mediastinal staging, even in a region with high burden of tuberculosis. TRIAL REGISTRATION: The LACOG 0114 study was registered at ClinicalTrials.gov , before study initiation, under identifier NCT02664792.

Incidence and epidemiological features of synchronous and metachronous colorectal cancer / Incidencia e perfil epidemiologico do cancer colorretal sincronico e metacronico

INTRODUCTION: patients with sporadic colorectal cancer or cases associated with syndromes are at risk of having synchronous or metachronous cancer. Although it is an important subject, Brazilian data on the subject are scarce. OBJECTIVE: to evaluate the incidence and epidemiological features in patients with synchronous and metachronous colorectal cancer in a reference service of proctology in the Rio Grande do Sul. Methods: cross-sectional observational study, performed between January and July 2012, analyzing all patients admitted in the service that met the inclusion criteria. A retrospective review of records was performed, noting demographic variables, comorbidities and tumor-related variables. RESULTS: 150 records were analyzed, of which 53.3% were males and mean age was 63 (± 13.01) years old. The most frequently found tumor location was the sigmoid colon and high rectum (50.67%), followed by the lower rectum (36%). Adenocarcinomas were the most prevalent histological subtype (88%), followed by epidermoid tumors (1.33%). Hereditary syndromes were identified in five patients (3.33%), with four being Familial adenomatous polyposis (FAP) and one hereditary nonpolyposis colorectal cancer (HNPCC). Among the analyzed patients, four (2.67%) had synchronous and one (0.67%) had metachronous cancer. CONCLUSION: the incidence of synchronous and metachronous colorectal cancer was, respectively, 2.67% and 0.67%, results that corroborate those reported in international literature. (AU)

INTRODUÇÃO: pacientes com diagnóstico de câncer colorretal esporádico ou associado a síndromes correm risco de apresentar lesões sincrônicas ou metacrônicas. Embora seja relevante, há escassez de informações sobre o tema na literatura nacional. OBJETIVO: avaliar a incidência e o perfil epidemiológico dos pacientes com tumor colorretal sincrônico e metacrônico em um serviço de referência em proctologia do Rio Grande do Sul. MÉTODO: estudo observacional transversal, realizado entre janeiro e julho de 2012, avaliando-se pacientes atendidos no serviço que preencheram os critérios de inclusão. Revisaram-se os prontuários, registrando-se variáveis demográficas, comorbidades e variáveis relacionadas ao tumor. RESULTADOS: analisaram-se 150 prontuários, sendo 53,3% do sexo masculino com média de idade de 63 (+13,01) anos. A topografia mais incidente foi cólon sigmoide e reto alto (50,67%) seguido do reto baixo (36%). O adenocarcinoma foi o subtipo histológico mais prevalente (88%) seguido pelo epidermoide (1,33%). Síndromes hereditárias foram identificadas em cinco pacientes (3,33%), sendo quatro com polipose adenomatosa familiar e um paciente com câncer colorretal hereditário não polipose. Dos 150 pacientes, quatro (2,67%) apresentaram neoplasia sincrônica e um (0,67%) lesão metacrônica. Conclusão: a incidência de tumor colorretal sincrônico e metacrônico na população avaliada foi, respectivamente, 2,67% e 0,67%, resultados que corroboram achados da literatura estrangeira. (AU)