HER-2, p53, p21 and hormonal receptors proteins expression as predictive factors of response and prognosis in locally advanced breast cancer treated with neoadjuvant docetaxel plus epirubicin combination.

BACKGROUND: Neoadjuvant chemotherapy has been considered the standard care in locally advanced breast cancer. However, about 20% of the patients do not benefit from this clinical treatment and, predictive factors of response were not defined yet. This study was designed to evaluate the importance of biological markers to predict response and prognosis in stage II and III breast cancer patients treated with taxane and anthracycline combination as neoadjuvant setting. METHODS: Sixty patients received preoperative docetaxel (75 mg/m2) in combination with epirubicin (50 mg/m2) in i.v. infusion in D1 every 3 weeks after incisional biopsy. They received adjuvant chemotherapy with CMF or FEC, attaining axillary status following definitive breast surgery. Clinical and pathologic response rates were measured after preoperative therapy. We evaluated the response rate to neoadjuvant chemotherapy and the prognostic significance of clinicopathological and immunohistochemical parameters (ER, PR, p51, p21 and HER-2 protein expression). The median patient age was 50.5 years with a median follow up time 48 months after the time of diagnosis. RESULTS: Preoperative treatment achieved clinical response in 76.6% of patients and complete pathologic response in 5%. The clinical, pathological and immunohistochemical parameters were not able to predict response to therapy and, only HER2 protein overexpression was associated with a decrease in disease free and overall survival (P = 0.0007 and P = 0.003) as shown by multivariate analysis. CONCLUSION: Immunohistochemical phenotypes were not able to predict response to neoadjuvant chemotherapy. Clinical response is inversely correlated with a risk of death in patients submitted to neoadjuvant chemotherapy and HER2 overexpression is the major prognostic factor in stage II and III breast cancer patients treated with a neoadjuvant docetaxel and epirubicin combination.

Hysteroscopic appearance of malignant and benign endometrial lesions: a case-control study.

OBJECTIVE: To analyze hysteroscopic appearance of benign and malignant endometrial lesions in order to identify patterns to estimate the risk of malignance. STUDY DESIGN: Matched case-control study; two controls per case. The cases were 21 women (age range 40-90 years, median 63) with histologically confirmed endometrial malignancy, and the control group 42 women submitted to diagnostic hysteroscopy for benign lesions (age range 37-81 years, median 57). RESULTS: Hysteroscopic findings associated with malignancy were papillary aspect (OR 26.0, 95%CI 6.4-105.3), size>1/2 uterine cavity (OR 22.0, 95%CI 5.1-95.8), irregular surface (OR 8.0, 95%CI 2.7-23.2), mixed color (OR 10.0, 95%CI 3.6-28.0), diffuse vascular arrangement (OR 5.3, 95%CI 1.3-21.5), little branched vessels (OR 15.0, 95%CI 3.0-74.9), and discordance between the main vascular axe and the direction of the lesion growth (OR 37.0; 95% CI 10.7-128.3). Ulcerated surface and anarchic vascular aspect were present only in malignant cases. CONCLUSION: The analyzes of general aspect, size, surface, color, vascular arrangement and vascular aspect allowed the estimation of the risk of malignancy, and the identification of points for targeted sampling.