Epidemiological and anatomopathological profile of breast cancer in the region of North-West of Tunisia.

INTRODUCTION: Breast cancer is a common and serious disease. It represents the first cause of mortality and morbidity from cancer of Tunisian women and worldwide. AIM: To analyze the clinico-pathological and evolutionary characteristics of the patients followed at the carcinology's pole in the region of the North-West of Tunisia. METHODS: We conducted a retrospective descriptive study of 114 patients, who were diagnosed with non metastatic breast cancers over a 6-year period, from January 2011 to December 2016. RESULTS: Among the 289 patients treated in the medical carcinology department of the Jendouba regional hospital for invasive breast carcinoma over a period of 6 years, 114 patients had localized breast carcinoma, they were the subject of our study. The average age was 51 years. Nonspecific invasive cancer was the most frequent histological type (95.6%). The mean histological size was 29.3 mm. SBR grade II was most prevalent. Histological lymph node involvement was observed in 50.9%. Lymphovascular invasion was detected in 23.9% of cases and perineural sheaths was detected in 21.9% of cases. The most common molecular subtype was Luminal B. After discussion in a multidisciplinary concertation meeting, the patients received locoregional treatment: surgery, radiotherapy and systemic treatment: chemotherapy, endocrine hormone therapy. After a median follow-up of 45 months, OS and PFS at 5 years were 85.6% and 79.2% respectively. CONCLUSION: In the region of the North-West of Tunisia, breast cancer is characterized by its occurrence at a young age, the importance of tumor size, the importance of lymph node involvement, the frequency of inflammatory breast carcinoma and especially by the predominance of the molecular groups Luminal B and HER2 neu.

Carcinoma of unknown primary: retrospective study of 437 patients treated at Salah Azaiez Institute.

BACKGROUND: Carcinoma of unknown primary (CUP) origin is defined as histologically confirmed metastatic carcinoma in the absence of a detectable primary site at the time of making therapeutic decision. AIM: To report epidemiological, clinical, histopathological, therapeutic, and prognostic features of CUP's patients collected at the Salah Azaiez institute (SAI). METHODS: We reviewed retrospectively the files of 437 CUP-patients in SAI between January 1994 and December 2006. We analyzed their epidemiological, clinical, histological and therapeutic features and classify patients in favourable and unfavourable subsets. Statistical analysis was performed with R software. Survival curves were made with the method of Kaplan-Meier. RESULTS: We collected 437 patients with a median age of 60 years and a sex-ratio of 1.8. CUP are metastatic to lymph nodes (56.5%), bones (29.7%) and liver (28%). 33% of patients had a unique site of metastases. Adenocarcinoma represented 50.5% of cases while 10.5% are classified in the favourable subgroup. 141 out 437 patients received palliative chemotherapy, 83% of them by cisplatin-based regimens obtaining 13% (58 patients) of objective response. Median survival was 7 months. 24 out 58 patients (41%) relapsed. Poor prognostic factors for survival were: multiple metastases (p=0.00033), >3 sites (p=0.03), undifferentiated carcinoma and adenocarcinoma (p>0.0001), liver metastases (p=0.0137), bone (p=0.00653) and adrenal gland (p=0.0334) metastatic sites. Patients who underwent chemotherapy (p>0.001) and who received cisplatbased regimen had better survival (p=0.01). CONCLUSION: Our retrospective study done in the context of a minimal and biological work-up confirmed the difficulty to find the primary in CUP.