Breast cancer survival by immunohistochemistry-determined subtype: A retrospective study.

BACKGROUND: Breast cancer subtype classification according to hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2) using immunohistochemistry is the standard practice for therapeutic decision making. OBJECTIVE: To design future studies information on characteristics and survival of each subtype is essential. METHOD: We conducted a retrospective study to analyze clinical and pathologic features as well as survival data according to breast cancer immunohistochemistry subtype. RESULTS: There were 211 women with a RH(+)/HER2(-) breast cancer subtype, 53 HR(+)/HER2(+), 16 HER2(+) and 23 HR(-)/HER2(-), with a median overall survival in months of 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) and 26 (11-78), respectively, for a 3.7 hazard ratio of death (95% Confidence Interval [CI]: 1.3-10.3) for the triple negative group as compared to the HR(+)/HER2(-) group (p = 0.01). CONCLUSIONS: HR positive subtypes by immunohistochemistry where most frequent and showed a greater overall survival compared to the triple negative subtype.

[Supervivencia en cáncer de mama por subtipo mediante inmunohistoquímica: Un estudio retrospectivo].

BACKGROUND: Breast cancer subtype classification according to hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2) using immunohistochemistry is the standard practice for therapeutic decision making. OBJECTIVE: To design future studies information on characteristics and survival of each subtype is essential. METHOD: We conducted a retrospective study to analyze clinical and pathologic features as well as survival data according to breast cancer immunohistochemistry subtype. RESULTS: There were 211 women with a RH(+)/HER2(-) breast cancer subtype, 53 HR(+)/HER2(+), 16 HER2(+) and 23 HR(-)/HER2(-), with a median overall survival in months of 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) and 26 (11-78), respectively, for a 3.7 hazard ratio of death (95% Confidence Interval [CI]: 1.3-10.3) for the triple negative group as compared to the HR(+)/HER2(-) group (p = 0.01). CONCLUSIONS: HR positive subtypes by immunohistochemistry where most frequent and showed a greater overall survival compared to the triple negative subtype.

ANTECEDENTES: La clasificación del cáncer de mama en subtipos mediante la expresión de receptores hormonales (RH) y del receptor 2 del factor de crecimiento epidérmico humano (HER2) por inmunohistoquímica (IHQ) es una práctica estándar para la toma de decisiones terapéuticas. OBJETIVO: Conocer las características y supervivencia de cada subtipo de pacientes, que es indispensable para poder diseñar futuros estudios. MÉTODO: Realizamos un estudio retrospectivo evaluando las características clinicopatológicas y la supervivencia por subtipo mediante IHQ en mujeres con cáncer de mama. RESULTADOS: 211 mujeres con cáncer de mama RH(+)/HER2(­), 53 con RH(+)/HER2(+), 16 con HER2(+) y 23 con RH(­)/HER2(­), con una mediana de supervivencia global en meses de 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) y 26 (11-78), respectivamente, para un cociente de riesgo (HR por sus siglas en inglés, Hazard Ratio): 3.7 (IC 95%: 1.3-10.3) en el grupo triple negativo comparado con RH(+)/HER2(­) (p = 0.01). CONCLUSIÓN: Los subtipos con RH positivos por IHQ son los más frecuentes y este grupo de pacientes tienen una mejor supervivencia global comparada con las pacientes triple negativo.

Supervivencia en cáncer de mama por subtipo mediante inmunohistoquímica: Un estudio retrospectivo / Survival in breast cancer by subtype by immunohistochemistry: A retrospective study

Resumen Antecedentes: La clasificación del cáncer de mama en subtipos mediante la expresión de receptores hormonales (RH) y del receptor 2 del factor de crecimiento epidérmico humano (HER2) por inmunohistoquímica (IHQ) es una práctica estándar para la toma de decisiones terapéuticas. Objetivo: Conocer las características y supervivencia de cada subtipo de pacientes, que es indispensable para poder diseñar futuros estudios. Método: Realizamos un estudio retrospectivo evaluando las características clinicopatológicas y la supervivencia por subtipo mediante IHQ en mujeres con cáncer de mama. Resultados: 211 mujeres con cáncer de mama RH(+)/HER2(-), 53 con RH(+)/HER2(+), 16 con HER2(+) y 23 con RH(-)/HER2(-), con una mediana de supervivencia global en meses de 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) y 26 (11-78), respectivamente, para un cociente de riesgo (HR por sus siglas en inglés, Hazard Ratio): 3.7 (IC 95%: 1.3-10.3) en el grupo triple negativo comparado con RH(+)/HER2(-) (p = 0.01). Conclusión: Los subtipos con RH positivos por IHQ son los más frecuentes y este grupo de pacientes tienen una mejor supervivencia global comparada con las pacientes triple negativo.

Abstract Background: Breast cancer subtype classification according to hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2) using immunohistochemistry is the standard practice for therapeutic decision making. Objective: To design future studies information on characteristics and survival of each subtype is essential. Method: We conducted a retrospective study to analyze clinical and pathologic features as well as survival data according to breast cancer immunohistochemistry subtype. Results: There were 211 women with a RH(+)/HER2(-) breast cancer subtype, 53 HR(+)/HER2(+), 16 HER2(+) and 23 HR(-)/HER2(-), with a median overall survival in months of 39 (20.5-62.7), 42 (25.5-65), 42 (13.7-67.7) and 26 (11-78), respectively, for a 3.7 hazard ratio of death (95% Confidence Interval [CI]: 1.3-10.3) for the triple negative group as compared to the HR(+)/HER2(-) group (p = 0.01). Conclusions: HR positive subtypes by immunohistochemistry where most frequent and showed a greater overall survival compared to the triple negative subtype.

[Laparoscopic hysterectomy assisted with robot. Report of first case in Mexico ]. / Histerectomía laparoscópica asistida con robot. Reporte del primer caso en Mexico.

UNLABELLED: Some 15 years ago since the DaVinci system is launched in the market and since then has been gaining ground in the field of surgery. There have been published case series and large casuisticals comparing the benefits from robotic surgery versus laparoscopic. In 2005 the Food & Drug Administration (FDA) approves its use for gynecological surgery. In Mexico, we have no experience in the use of this technology in this field of medicine. To describe the first laparoscopic hysterectomy case assisted with a robot (LHAR) intervened in Mexico, the results and review of the literature reported at the global level. CLINICAL CASE: this is a 47 year-old patient with clinical and ultrasonographic diagnosis of uterine fibroids of large items, who is scheduled for laparoscopic hysterectomy assisted with robot at Hospital Angeles del Pedregal in May of 2014. It examines the parameters of surgical time, transoperative bleeding, surgical complications, postoperative pain and hospital stay. It is also a review of the literature and compared the results obtained with what is reported in the literature world. The surgery had a duration of 2 hours 35 minutes. Blood loss was less than 50 mL. There were no complications and the patient had an EVA test of 2 at 24 hours after surgery. Hospital stay was 2 days. Laparoscopic hysterectomy assisted with a robot is a reliable procedure according to what is reported at the global level, offering benefits to both the surgeon and the patient.

[Use of simulators for the training of resident physicians]. / Uso de simuladores en el adiestramiento de residentes.

BACKGROUND: Laparoscopy has had a notable evolution in the last years, being nowadays one of the most common practices in our medical centers. It is indispensable that every surgical specialist develop the necessary skill level to perform this kind of surgery. The ideal way to initiate will be by pelvitrainers that could be virtual or with direct vision. OBJECTIVE: To evaluate the effect of structured practices in pelvitrainers after 3 days of constant training. MATERIAL AND METHODS: We studied 15 residents without previous laparoscopy experience, there were announced 6 exercises that were performed for 3 daily hours in 3 consecutive days with a LAPA-PRO(MR) pelvitrainer, the time was taken in every exercise during the first and final day. RESULTS: A statistical descriptive and graphical analysis was realized. All exercises presented a significant difference between the times before and after the training. A difference was verified between both averages, no matter the exercise type, which means that the constant training in pelvitrainers offers a major skill acquisition. CONCLUSIONS: The pelvitrainer is a viable tool for the development of laparoscopic skills across the accomplishment of structured practices in medical students without a previous surgical experience.