Impact of Number of Positive Lymph Nodes and Lymph Node Ratio on Survival of Women with Node-Positive Breast Cancer.

OBJECTIVE: This study aimed to evaluate the association of axillary lymph node ratio (LNR) and number of positive lymph nodes (pN) with the risk of breast cancer recurrence and death. MATERIALS AND METHODS: A retrospective cohort study of node-positive stage II and III breast cancer patients diagnosed and treated between 2008 and 2009 at the Brazilian National Cancer Institute (INCA), Brazil. Overall and disease-free survival curves for number of positive lymph nodes (pN) and lymph node ratio (LNR) risk groups were constructed using the Kaplan-Meier method and compared by the log-rank test. Multivariate analysis was performed using stepwise forward Cox regression models. RESULTS: In total, 628 women with node-positive breast cancer were included. Most patients (69.5%) had advanced clinical stage tumors (≥IIB). The median follow-up was 58 months (range: 3-92 months). The adjusted recurrence hazard of pN2 and pN3 patients was 2.47 (95% Confidence Interval [CI] 1.72-3.56) and 2.42 (1.62-3.60), respectively, compared to pN1 patients (p<0.001), while the hazard of intermediate (0.21-0.65) and high-risk (>0.65) LNR was 2.11 (1.49-3.00) and 3.19 (2.12-4.80), respectively, compared to low-risk LNR (≤0.20) patients (p<0.001). On the other hand, the hazard of death of pN2 and pN3 patients was 2.17 (1.42-3.30) and 2.41 (1.53-3.78), respectively (p<0.001), and the hazard of intermediate (0.21-0.65) and high-risk (>0.65) LNR patients was 1.70 (1.13-2.56) and 2.74 (1.75-4.28), respectively (p≤0.001). CONCLUSION: Higher pN and LNR were associated with shorter disease-free survival and overall survival times.

Qualidade de Vida Relacionada à Saúde e Risco de Comorbidade Cardiovascular ao Diagnóstico de Câncer de Mama / Health-Related Quality of Life and Cardiovascular Comorbidity Risk for Breast Cancer Diagnosis / Calidad de Vida Relacionada con la Salud y Riesgo de Comorbilidad Cardiovascular al Diagnóstico de Cáncer de Mama

INTRODUÇÃO: A literatura sugere que mulheres com doenças cardiovasculares apresentam pior qualidade de vida ao diagnóstico de câncer de mama. OBJETIVO: Avaliar a associação entre a qualidade de vida relacionada à saúde (QVRS) e as doenças cardiovasculares ao diagnóstico de câncer de mama. MÉTODO: Estudo transversal com mulheres diagnosticadas com câncer de mama. A QVRS foi avaliada pelos questionários European Organization for Research and Treatment of Cancer Quality of Life Questionnarie (EORTC QLQ-C30) and Breast Câncer Module (QLQ-BR23) e a comorbidade por meio da Cumulative Illness Rating Scale Geriatric (CIRS-G). Foram calculadas as diferenças entre as médias dos escores de QVRS e comorbidade. A associação foi avaliada por regressão logística múltipla. RESULTADOS: Foram incluídas 953 mulheres com média de idade de 54 anos (DP±11,7). Apresentavam alguma comorbidade ao diagnóstico de câncer de mama 84,1% das mulheres. O sistema coração foi afetado em 10,8% e o sistema vascular em 48,2%. Após ajuste, observou-se associação entre os escores das funções física e sexual e problemas nos sistemas coração e vascular. Foi ainda observada associação entre os piores escores de dor e dispneia e o sistema coração. Em relação à presença de doenças no sistema vascular, este esteve associado à melhor satisfação sexual, melhor perspectiva futura e piores sintomas na mama. CONCLUSÃO: A QVRS se mostrou associada a doenças cardiovasculares em pacientes com câncer de mama em relação à função física, sexual, satisfação sexual, a perspectivas futuras e às escalas de sintomas (dor, dispneia e sintomas na mama).

INTRODUCTION: The literature suggests that women with cardiovascular diseases have worse quality of life when diagnosed with breast cancer. OBJECTIVE: To evaluate the association between health-related quality of life (HRQoL) and cardiovascular disease at diagnosis of breast cancer. METHOD: Cross-sectional study with women diagnosed with breast cancer. HRQoL was assessed by the questionnaires of the European Organization for Research and Treatment of Cancer Quality of Life Questionnarie (EORTC QLQ-C30) and Breast Cancer Module (QLQ-BR23) and comorbidity was assessed by the Cumulative Illness Rating Scale Geriatric (CIRS-G). It were calculated the differences between mean HRQoL values and comorbidity. Logistic multiple regression was used to evaluate the association. RESULTS: 953 women with a mean age of 54 years (SD±11.7) were included. Comorbidity was presented at diagnosis of breast cancer in 84.1% of the women. The heart system was affected in 10.8% and the vascular system in 48.2%. After adjustment, an association between physical and sexual function scores and heart and vascular system problems was observed. An association between worse pain and dyspnea scores and the heart system was also noticed. Regarding the presence of diseases in the vascular system, this was associated with better sexual satisfaction, better future outcome and worse breast symptoms. CONCLUSION: HRQoL was associated with cardiovascular disease in breast cancer patients, in relation to physical and sexual function, sexual satisfaction, future perspectives and symptom scales (pain, dyspnea and breast symptoms).

INTRODUCCIÓN: La literatura sugiere que las mujeres con enfermedad cardiovascular tienen una peor calidad de vida cuando se les diagnostica cáncer de la mama. OBJETIVO: Evaluar la asociación entre la calidad de vida relacionada con la salud (CVRS) y la enfermedad cardiovascular en el diagnóstico de cáncer de mama. MÉTODO: Estudio transversal con mujeres diagnosticadas con cáncer de mama. La CVRS se evaluó mediante los cuestionarios European Organization for Research and Treatment of Cancer Quality of Life Questionnarie (EORTC QLQ-C30) and Breast Câncer Module (QLQ-BR23) y la comorbilidad se evaluó mediante Cumulative Illness Rating Scale Geriatric (CIRS-G). Se calcularon las diferencias entre las puntuaciones medias de CVRS y la comorbilidad. La asociación se evaluó mediante regresión logística múltiple. RESULTADOS: Se incluyeron 953 mujeres con una edad media de 54 años (DP±11,7). Algunas tenían comorbilidad en el diagnóstico de cáncer de mama 84,1% de las mujeres. El sistema cardíaco se vio afectado en 10,8% y el sistema vascular en 48,2%. Después del ajuste, se observó una asociación entre las puntuaciones de la función física y sexual y los problemas del corazón y del sistema vascular. También se observó una asociación entre puntajes de dolor y disnea peores y el sistema cardíaco. Con respecto a la presencia de enfermedades en el sistema vascular, esto se asoció con una mejor satisfacción sexual, una mejor perspectiva futura y peores síntomas mamarios. CONCLUSIÓN: La CVRS se asoció con la enfermedad cardiovascular en pacientes con cáncer de mama, con respecto a la función física, la función sexual, la satisfacción sexual, las perspectivas futuras y las escalas de síntomas (dolor, disnea y síntomas de mama).

Effectiveness of four inflammatory markers in predicting prognosis in 2374 women with breast cancer.

OBJECTIVE: To analyze the association between four biomarkers and overall survival in patients with breast cancer (BC). METHODOLOGY: This cohort study had a sample of 2374 women over the age of 18, diagnosed and treated in a single reference center for BC in Brazil, during the year 2008-2009. The following pretreatment indices were analyzed: neutrophil-lymphocyte ratio (NLR), a derived neutrophil-lymphocyte ratio (dNLR), absolute neutrophil count (ANC) and platelet-lymphocyte ratio (PLR). A descriptive analysis was performed using median (range) and absolute and relative frequency as categorical variables. Exploratory survival evaluation was performed using the Kaplan-Meier method and the log-rank test for comparison between survival curves, with a statistical significance level of 5%. The variables with p<0.20 were selected for inclusion in a multivariate Cox regression model, considering as statistically significant p<0.05. RESULTS: After adjusting for clinical variables, the biomarkers associated with worse overall survival were NLR >5 (HR=1.66 95%CI 1.08-2.55; p=0.021) and PLR >300 (HR=1.82 95%CI 1.10-2.99; p=0.019). When stratified by molecular subtype, the independent markers related to death were PLR >300 for triple negative (HR 3.27 95%CI 1.38-7.76; p=0.007); NLR >5 (HR 2.47 95%CI 1.16-5.28; p=0.019), ANC >7500 (HR 1.84 95%CI 1.17-2.90; p=0.008) and dNLR >3 (HR 2.45 95%CI 1.29-4.66; p=0.006) for luminal. CONCLUSION: NLR and PLR are independent markers of prognosis in BC. Further studies are needed in patients with overexpression of HER 2.

Determinants of advanced stage presentation of breast cancer in 87,969 Brazilian women.

BACKGROUND: Breast cancer is commonly diagnosed at an advanced stage in Brazil. AIM: Analyze the determinants of advanced staging in Brazilian women with breast cancer. METHODS: Crosssectional study, including women diagnosed with breast cancer in Brazil, between 2000 and 2009. RESULTS: A total of 59,317 women were included, 53.5% being classified as advanced stage (≥IIB). Younger age (18 to 49 years old) (OR=1.61 95% CI 1.51 to 1.72) or between 40 and 49 years old (OR=1.08 95% CI 1.03 to 1.14), having low educational level (OR=1.53 95% CI 1.48 to 1.58), living in less developed geographical regions (OR=1.27 95% CI 1.21 to 1.33), having invasive ductal carcinoma (OR=2.70 95% CI 2.56 to 2.84) and invasive lobular carcinoma (OR=2.63 95% CI 2.42 to 2.86) were associated with advanced breast cancer. CONCLUSION: We conclude that future interventions should focus on these high risk groups.

Quality of Life and Volume Reduction in Women with Secondary Lymphoedema Related to Breast Cancer.

Purpose. To assess the quality of life (QOL) as a predictor of volume reduction in women undergoing complex physical therapy (CPT) for lymphoedema following breast cancer. Methods. Clinical trial in 57 women undergoing CPT. Results. At baseline, in measuring quality of life for the EORTC QLQ-C30 questionnaire subscale of functionality, the worst scores for emotional function (55 points) and better social function (89 points) were observed. The symptom scales showed the worst pain averaged (66 points). The overall quality of life showed a low score (40 points). In the BR 23 module, low scores were observed in the field of future perspective (47 points). After treatment of lymphoedema, absolute reduction of excess volume between the upper limbs of 282 mL was observed, representing a reduction of 15%. No association was observed between the domains of quality of life and response to treatment of lymphoedema. Conclusion. This study included 57 women with advanced and chronic lymphoedema in early treatment with CPT and low scores for quality of life. The lymphoedema therapeutic response was not influenced by the QOL at the beginning of treatment.

Fatores prognósticos em mulheres jovens com câncer de mama / [Prognostic factors in young women with breast cancer]

Introdução: O câncer de mama é a neoplasia mais comum entre as mulheres no mundo. Quando diagnosticado em idade jovem, é comum a presença de tumores mais agressivos, que podem estar relacionados à apresentação de subtipos moleculares de pior prognóstico, como o subtipo triplo negativo e com super expressão de HER2. Objetivos: Identificar a influência da idade e dos subtipos moleculares no estadiamento clínico do câncer de mama e avaliar a sobrevida de mulheres jovens com câncer de mama diagnosticadas em um hospital de referência no Rio de Janeiro, Brasil. Métodos: Foram selecionadas todas as mulheres com câncer de mama, diagnosticadas e tratadas entre os anos de 2008 e 2009, no Hospital do Câncer III/INCA. Inicialmente foi realizado um estudo transversal com mulheres com idade igual ou superior a 18 anos (artigo 1). Em um segundo momento, foi realizado um estudo de coorte com mulheres na faixa etária de 18 a 40 anos (artigo 2). Os dados clínico-tumorais foram coletados dos prontuários físicos e eletrônico. Foi realizada a análise descritiva da população utilizando medidas de tendência central e de dispersão, frequências absolutas e relativas, em ambos os estudos. Para o estudo transversal a associação entre variáveis independentes e os desfechos foi realizada por análise univariada, por meio de Odds Ratio (OR), assumindo-se intervalos de 95% de confiança. Os dados considerados clínica e estatisticamente relevantes nessa análise foram incluídos na análise de regressão logística. No estudo de sobrevida foi utilizado o método deKaplan-Meier. Para análise múltipla, foi utilizado o modelo de regressão de Cox, por meio do método Stepwise Forward, sendo incluídas todas as variáveis que apresentaram valor de p<0,20 na análise univariada. As análises foram realizadas no programa estatístico SPSS (Statistical Package for the Social Sciences) versão 21.0...

Backgroung: Breast cancer is the most common cancer among women worldwide. When diagnosed at a young age, it is common to have more aggressive tumors which can be related to presentation in aggressive molecular subtypes as the triple negative subtype and overexpressing HER2. The more aggressive behavior this age group leads to worse prognosis, reflected in the increase in relapse rates and poor survival. Objective: Identify the influence of age and molecular subtypes in clinical staging of breast cancer and to evaluate the survival of youngwomen with breast cancer diagnosed in a referral hospital in Rio de Janeiro, Brazil. Methods: Women with breast cancer, diagnosed and treated were selected between the years 2008 and2009, identified from the Hospital Cancer Registry of the Cancer Hospital III/INCA. A crosssectional study was conducted with women aged over 18 years (Article 1). In a second step, weconducted a cohort study of women aged 18-40 years (Article 2). Clinical and tumor data were collected from physical and electronic records. The descriptive analysis was performed using means ± standard deviation (SD) for continuous variables and percentages for categoricalvariables for both studies. For the cross-sectional study the association between independent variables and the outcome was assessed using odds ratio (OR) with 95% confidence intervals(95%CI). All variables clinically and statistically important were included in the logistic regression analysis. In the survival study used the Kaplan-Meier method. For multivariate analysis, we used the Cox regression model, using the stepwise forward method, and included all variables with p<0.20 in the univariate analysis. The analyzes were performed in SPSS (Statistical Package for Social Sciences) version 21.0...

Câncer de mama em mulheres jovens: análise de 12.689 casos / Breast Cancer in Young Women: Analysis of 12.689 Cases

Introdução: O câncer de mama em mulheres com idade inferior a 40 anos é incomum. Entretanto, nessa população,a doença cursa, em geral, com pior prognóstico. Objetivos: Descrever o perfil clínico e epidemiológico de mulheres jovens diagnosticadas com câncer de mama no Brasil e comparar as características clínicas entre mulheres com idade inferior a 34 anos e aquelas entre 35 e 39 anos. Método: Estudo transversal dos casos analíticos de câncer de mama em mulheres de 18 a 39 anos, inseridos no Módulo Integrador dos Registros Hospitalares de Câncer e no Registro Hospitalar de Câncer do Estado de São Paulo, entre 2000 a 2009. Foi realizada a análise descritiva das variáveis. Resultados: Foram incluídos 12.689 casos. A idade mediana foi de 36 anos, a maioria das mulheres possuía ensino médio (32,3%)e era proveniente do Sistema Único de Saúde (74,6%). O estadiamento avançado (≥IIB) foi registrado em 62,8% dos casos e, ao final do primeiro tratamento, 44,4% das pacientes encontravam-se sem evidência da doença. Mulheres muito jovens apresentaram mais frequentemente tamanho do tumor >2cm, status dos linfonodos positivo, presença demetástase, estadiamento clínico avançado (≥IIB) e ausência de resposta terapêutica ao primeiro tratamento. Conclusão: No Brasil, mulheres jovens com câncer de mama apresentam estadiamento avançado ao diagnóstico. Aquelas muitojovens (<35 anos) apresentam doença ainda mais avançada e pior resposta terapêutica que aquelas entre 35 e 39 anos

Introduction:Breast cancer in women under 40 years old is unusual. However, in this population the disease usually progresses with worse prognosis.Objectives:to describe the clinical and epidemiological profile of young women diagnosed with breast cancer in Brazil and to compare the clinical characteristics among women aged less than 34 years and those between 35 and 39 years...

Post-mastectomy pain syndrome: incidence and risks.

BACKGROUND: Post-mastectomy pain syndrome is defined as a chronic pain that persists beyond the normal healing time of 3 months. It is considered a neuropathic condition that arises after surgery for breast cancer. AIM: To evaluate the incidence and risk factors of pain syndromes in patients undergoing surgical treatment of breast cancer in the National Cancer Institute. METHODS: This study is a prospective cohort of women undergoing surgical treatment for breast cancer from September 2008 to June 2009, followed up until 6 months postoperatively. RESULTS AND CONCLUSIONS: One hundred seventy-four women were examined. The mean age was 58 years. The incidence of pain syndrome was 52%. Younger women (<40 years) and those who were submitted to axillary lymph node dissection (with more than 15 lymph nodes excised) have shown a significantly increased risk of pain syndrome after surgery for breast cancer (relative risk (RR) =5.23 95% confidence interval (CI): 1.11-24.64) and (RR=2.01 95% CI: 1.08-3.75).