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OBJECTIVES: The COVID-19 pandemic has had a significant global impact since its declaration in March 2020. The COVID-19 pandemic has disproportionately impacted cancer patients, particularly those with breast cancer. This study aims to analyze the effects of the pandemic on women diagnosed with breast cancer recurrence. METHODS: A cohort study was conducted at a tertiary public hospital in São Paulo State, Brazil. Data were collected from electronic records. Patients diagnosed with breast cancer and experiencing recurrence between January 2011 and March 2022 were included. Survival analysis was performed using the Kaplan-Meier estimator and Cox regression. RESULTS: The study included 187 patients, 45 in the pandemic group (recurrence after March 23, 2020) and 142 in the pre-pandemic group. Distant recurrences were more frequent in both groups (pre-pandemic: 62.7 %, pandemic: 75.5 %). Compared to the pre-pandemic group (1.8 years), the pandemic group experienced a longer mean time to recurrence detection (2.9 years) and significantly decreased median survival (9 months vs. 22 months). The Cox regression analysis confirmed an increased risk of death for women diagnosed with breast cancer recurrence during the pandemic period (HR = 1.92, 95 % CI 1.19â3.12). CONCLUSION: The present study is among the first to investigate the pandemic's specific effects on breast cancer recurrence, revealing concerning delays in detection and a decrease in survival rates. Prompt diagnosis, timely treatment initiation, and comprehensive support are crucial during public health crises. These findings urge healthcare systems to prioritize tailored care for breast cancer patients during pandemics.
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Neoplasias da Mama , COVID-19 , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Pandemias , Estudos de Coortes , Diagnóstico Tardio , Brasil/epidemiologia , Teste para COVID-19RESUMO
Abstract Objective Neoadjuvant chemotherapy (NACT) has become the standard of care for patients with triple-negative breast cancer (TNBC) with tumors > 1 cm or positive axillary nodes. Pathologic complete response (pCR) has been used as an endpoint to select patients for treatment scaling. This study aimed to examine the benefit of adding adjuvant capecitabine for TNBC patients who did not achieve pCR after standard NACT in a real-world scenario. Methods This retrospective cohort study included all patients with TNBC who underwent NACT between 2010 and 2020. Clinicopathological data were obtained from the patient records. Univariate and multivariate analyses were conducted at the 5 years follow-up period. Results We included 153 patients, more than half of whom had stage III (58.2%) and high-grade tumors (60.8%). The overall pCR rate was 34.6%, and 41% of the patients with residual disease received adjuvant capecitabine. Disease-specific survival (DSS) among the patients who achieved pCR was significantly higher (p<0.0001). Residual disease after NACT was associated with detrimental effects on DSS. In this cohort, we did not observe any survival benefit of adding adjuvant capecitabine for patients with TNBC subjected to NACT who did not achieve pCR (p=0.52). Conclusion Our study failed to demonstrate a survival benefit of extended capecitabine therapy in patients with TNBC with residual disease after NACT. More studies are warranted to better understand the indication of systemic treatment escalation in this scenario.
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Abstract Objectives The COVID-19 pandemic has had a significant global impact since its declaration in March 2020. The COVID-19 pandemic has disproportionately impacted cancer patients, particularly those with breast cancer. This study aims to analyze the effects of the pandemic on women diagnosed with breast cancer recurrence. Methods A cohort study was conducted at a tertiary public hospital in São Paulo State, Brazil. Data were collected from electronic records. Patients diagnosed with breast cancer and experiencing recurrence between January 2011 and March 2022 were included. Survival analysis was performed using the Kaplan-Meier estimator and Cox regression. Results The study included 187 patients, 45 in the pandemic group (recurrence after March 23, 2020) and 142 in the pre-pandemic group. Distant recurrences were more frequent in both groups (pre-pandemic: 62.7 %, pandemic: 75.5 %). Compared to the pre-pandemic group (1.8 years), the pandemic group experienced a longer mean time to recurrence detection (2.9 years) and significantly decreased median survival (9 months vs. 22 months). The Cox regression analysis confirmed an increased risk of death for women diagnosed with breast cancer recurrence during the pandemic period (HR = 1.92, 95 % CI 1.19‒3.12). Conclusion The present study is among the first to investigate the pandemic's specific effects on breast cancer recurrence, revealing concerning delays in detection and a decrease in survival rates. Prompt diagnosis, timely treatment initiation, and comprehensive support are crucial during public health crises. These findings urge healthcare systems to prioritize tailored care for breast cancer patients during pandemics.
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Despite all the advances in understanding the mechanisms involved in ovarian cancer (OC) development, many aspects still need to be unraveled and understood. Tumor markers (TMs) are of special interest in this disease. Some aspects of clinical management of OC might be improved by the use of validated TMs, such as differentiating subtypes, defining the most appropriate treatment, monitoring the course of the disease, or predicting clinical outcome. The Food and Drug Administration (FDA) has approved a few TMs for OC: CA125 (cancer antigen 125; monitoring), HE4 (Human epididymis protein; monitoring), ROMA (Risk Of Malignancy Algorithm; HE4+CA125; prediction of malignancy) and OVA1 (Vermillion's first-generation Multivariate Index Assay [MIA]; prediction of malignancy). Proteomics can help advance the research in the field of TMs for OC. A variety of biological materials are being used in proteomic analysis, among them tumor tissues, interstitial fluids, tumor fluids, ascites, plasma, and ovarian cancer cell lines. However, the discovery and validation of new TMs for OC is still very challenging. The enormous heterogeneity of histological types of samples and the individual variability of patients (lifestyle, comorbidities, drug use, and family history) are difficult to overcome in research protocols. In this work, we sought to gather relevant information regarding TMs, OC, biological samples for proteomic analysis, as well as markers and algorithms approved by the FDA for use in clinical routine.
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Biomarcadores Tumorais/metabolismo , Neoplasias Ovarianas/metabolismo , Proteômica , Feminino , HumanosRESUMO
OBJECTIVE: Chemotherapy is a type of systemic treatment that inhibits neoplastic cells (cancer cells), produces immunosuppression, and may lead to changes in the oral mucosa and, consequently, in the oral microbiota. The aim of this systematic review was to analyze, in the scientific literature, evidence of the impact of chemotherapy on the oral microbiota. STUDY DESIGN: The authors conducted a search in PubMed/MEDLINE, Scientific Electronic Library Online (SciELO), LILACS, ScienceDirect, Web of Science, and Cochrane Library; to identify studies that discussed change in the oral microbiota of patients with during chemotherapy. Articles published in English until July 2017 were included. The quality of a study was assessed by using the Ottawa-Newcastle scale. RESULTS: Of 5252 articles potentially relevant to this review, 17 were included in this study. Of the 17 studies included, 16 had used culture techniques, and 1 had used genetic sequencing. The most frequently observed bacteria were aerobic gram-negative (Klebsiella spp., Escherichia coli, Enterobacter, Pseudomonas spp.), anaerobic gram-negative (Veillonella spp., Capnocytophaga), and gram-positive bacteria (Streptococcus spp., Staphylococcus spp.). CONCLUSIONS: During chemotherapy, patients with cancer present a more complex oral microbiota under favorable conditions for their development during immunosuppression, and these may be responsible for different serious local or systemic pathologies.
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Microbiota/efeitos dos fármacos , Mucosa Bucal/efeitos dos fármacos , Mucosa Bucal/microbiologia , Neoplasias/tratamento farmacológico , Carga Bacteriana , HumanosRESUMO
BACKGROUND: This aim of this study was to assess and compare arterial and venous circulation in women with axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) before and after breast cancer surgery. METHODS AND RESULTS: Fifty-two women took part in the study, divided into three groups: those undergoing ALND at levels I, II, and III (ALNDG), with mean age of 56.29 ± 10.85 years old; those undergoing sentinel lymph node biopsy (SLNBG), with mean age of 57.7 ± 7.07 years old; and controls without diagnosis of breast cancer (CG), with mean age of 53.92 ± 8.85 years old. Maximum venous and arterial flow velocities in upper limbs were assessed before and after surgical treatment for breast cancer by means of Doppler ultrasonography (Nicolet Vascular Versalab SE®). Data normality was assessed by using the Shapiro-Wilk's test, with normally distributed variables being analyzed with analysis of variance (ANOVA) and post hoc Tukey's test or t-test. For variables with non-normal distribution, Kruskal-Wallis' test and post hoc Dunn's test were used at p < 0.05. There was significant difference in the maximum blood flow velocities, both venous (ALNDG) and arterial (SLNBG). CONCLUSION: The results suggest that ALND and SLNB can interfere with the upper limp blood circulation.
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Neoplasias da Mama/complicações , Excisão de Linfonodo/efeitos adversos , Fluxo Sanguíneo Regional , Biópsia de Linfonodo Sentinela/efeitos adversos , Extremidade Superior/irrigação sanguínea , Extremidade Superior/fisiopatologia , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Evaluate reliability and accuracy of infrared thermography in the assessment of women wth breasts cancer. Thirty-five participants had unilateral breast cancer and 17 control subjects were assessed using infrared thermography. To evaluate reliability, two professionals, who were experienced, measured the temperature of the infrared images in two different moments, with a one-week interval. Biopsy was used as a gold standard exam with regard identify breast cancer. The analysis illustrated excellent reliability in terms of the affected, contralateral and control breasts with the intra-class correlation coefficient values ranging from 0.948 to 0.999. Standard measurement error ranged from 0.04 to 0.28 °C, and minimum detectable change deviated from 0.11 to 0.78 °C. Moreover, low to moderate accuracy were observed in terms of the establishment of the breast cancer diagnosis with values of the area under the receiver operating characteristic (ROC) curve ranging from 0.571 and 0.749. Breasts affected by cancer present higher skin temperature compared to contralateral and control. Furthermore, excellent reliability of the analysis of the infrared images and low-moderate accuracy in terms diagnosis were observed. Considering the results, infrared thermography can be applied as an instrument complement the assessment of breast cancer patients, but not for diagnostic purposes.
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Neoplasias da Mama , Feminino , Humanos , Raios Infravermelhos , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Temperatura Cutânea , TermografiaRESUMO
OBJECTIVE: to evaluate the effect of physical therapy on the range of motion of the shoulders and perimetry of the upper limbs in women treated with radiotherapy for breast cancer. METHODS: a total of 35 participants were randomized into two groups, with 18 in the control group (CG) and 17 in the study group (SG). Both of the groups underwent three evaluations to assess the range of motion of the shoulders and perimetry of the upper limbs, and the study group underwent supervised physical therapy for the upper limbs. RESULTS: the CG had deficits in external rotation in evaluations 1, 2, and 3, whereas the SG had deficits in flexion, abduction, and external rotation in evaluation 1. The deficit in abduction was recovered in evaluation 2, whereas the deficits in all movements were recovered in evaluation 3. No significant differences in perimetry were observed between the groups. CONCLUSION: the applied supervised physical therapy was effective in recovering the deficit in abduction after radiotherapy, and the deficits in flexion and external rotation were recovered within two months after the end of radiotherapy. Registration number of the clinical trial: NCT02198118. OBJETIVO: avaliar o efeito da fisioterapia na amplitude de movimento do ombro e na perimetria do membro superior, aplicada durante o período da radioterapia nas mulheres em tratamento para o câncer de mama. MÉTODOS: 35 voluntárias foram randomizadas em dois grupos, 18 para o grupo controle e 17 para o grupo de estudo. Os dois grupos foram submetidos a três avaliações da amplitude de movimento do ombro e perimetria do membro superior, sendo o grupo de estudo também submetido à fisioterapia supervisionada para os membros superiores. RESULTADOS: o grupo controle apresentou déficit entre os membros para o movimento de rotação externa nas avaliações 1, 2 e 3. O grupo de estudo apresentou déficit entre os membros para os movimentos de flexão, abdução e rotação externa na avaliação 1. Houve recuperação do déficit de movimento de abdução na avaliação 2 e, na avaliação 3, os déficits de todos os movimentos estavam recuperados. Na análise da perimetria não foi observada diferença significativa. CONCLUSÃO: o protocolo fisioterapêutico supervisionado aplicado foi efetivo na recuperação do déficit de abdução pós-radioterapia e de flexão e rotação externa quando avaliados até 2 meses após o término da radioterapia. Número do registro do ensaio clínico: NCT02198118. OBJETIVO: evaluar el efecto de la terapia física en el rango de movimiento de los hombros y la perimetría de las extremidades superiores en mujeres tratadas con radioterapia debido a cáncer de mama. MÉTODOS: un total de 35 participantes fueron aleatorizadas en dos grupos, 18 en el grupo control y 17 en el grupo de estudio. Ambos grupos fueron sometidos a tres evaluaciones para evaluar el rango de movimiento de los hombros y la perimetría de las extremidades superiores, y el grupo de estudio fue sometido a terapia física supervisada de las extremidades superiores. RESULTADOS: el grupo de control tuvo déficits en la rotación externa en la evaluación 1, 2, y 3, mientras que el grupo de estudio tuvo déficits en la flexión, abducción y rotación externa en la evaluación 1. El déficit en la abducción fue recuperado en la evaluación 2, mientras que los déficits en todos los movimientos fueron recuperados en la evaluación 3. No se observaron diferencias significativas en la perimetría. CONCLUSIÓN: la terapia física supervisada aplicada fue efectiva en la recuperación del déficit en la abducción después de la radioterapia y los déficits en flexión y rotación externa fueron recuperados dos meses después de terminada la radioterapia. Número de registro del ensayo clínico: NCT02198118.
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Neoplasias da Mama/radioterapia , Modalidades de Fisioterapia , Lesões por Radiação/terapia , Lesões do Ombro/terapia , Neoplasias da Mama/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Lesões por Radiação/fisiopatologia , Amplitude de Movimento Articular , Lesões do Ombro/etiologia , Lesões do Ombro/fisiopatologiaRESUMO
ABSTRACT Objective: to evaluate the effect of physical therapy on the range of motion of the shoulders and perimetry of the upper limbs in women treated with radiotherapy for breast cancer. Methods: a total of 35 participants were randomized into two groups, with 18 in the control group (CG) and 17 in the study group (SG). Both of the groups underwent three evaluations to assess the range of motion of the shoulders and perimetry of the upper limbs, and the study group underwent supervised physical therapy for the upper limbs. Results: the CG had deficits in external rotation in evaluations 1, 2, and 3, whereas the SG had deficits in flexion, abduction, and external rotation in evaluation 1. The deficit in abduction was recovered in evaluation 2, whereas the deficits in all movements were recovered in evaluation 3. No significant differences in perimetry were observed between the groups. Conclusion: the applied supervised physical therapy was effective in recovering the deficit in abduction after radiotherapy, and the deficits in flexion and external rotation were recovered within two months after the end of radiotherapy. Registration number of the clinical trial: NCT02198118.
RESUMO Objetivo: avaliar o efeito da fisioterapia na amplitude de movimento do ombro e na perimetria do membro superior, aplicada durante o período da radioterapia nas mulheres em tratamento para o câncer de mama. Métodos: 35 voluntárias foram randomizadas em dois grupos, 18 para o grupo controle e 17 para o grupo de estudo. Os dois grupos foram submetidos a três avaliações da amplitude de movimento do ombro e perimetria do membro superior, sendo o grupo de estudo também submetido à fisioterapia supervisionada para os membros superiores. Resultados: o grupo controle apresentou déficit entre os membros para o movimento de rotação externa nas avaliações 1, 2 e 3. O grupo de estudo apresentou déficit entre os membros para os movimentos de flexão, abdução e rotação externa na avaliação 1. Houve recuperação do déficit de movimento de abdução na avaliação 2 e, na avaliação 3, os déficits de todos os movimentos estavam recuperados. Na análise da perimetria não foi observada diferença significativa. Conclusão: o protocolo fisioterapêutico supervisionado aplicado foi efetivo na recuperação do déficit de abdução pós-radioterapia e de flexão e rotação externa quando avaliados até 2 meses após o término da radioterapia. Número do registro do ensaio clínico: NCT02198118.
RESUMEN Objetivo: evaluar el efecto de la terapia física en el rango de movimiento de los hombros y la perimetría de las extremidades superiores en mujeres tratadas con radioterapia debido a cáncer de mama. Métodos: un total de 35 participantes fueron aleatorizadas en dos grupos, 18 en el grupo control y 17 en el grupo de estudio. Ambos grupos fueron sometidos a tres evaluaciones para evaluar el rango de movimiento de los hombros y la perimetría de las extremidades superiores, y el grupo de estudio fue sometido a terapia física supervisada de las extremidades superiores. Resultados: el grupo de control tuvo déficits en la rotación externa en la evaluación 1, 2, y 3, mientras que el grupo de estudio tuvo déficits en la flexión, abducción y rotación externa en la evaluación 1. El déficit en la abducción fue recuperado en la evaluación 2, mientras que los déficits en todos los movimientos fueron recuperados en la evaluación 3. No se observaron diferencias significativas en la perimetría. Conclusión: la terapia física supervisada aplicada fue efectiva en la recuperación del déficit en la abducción después de la radioterapia y los déficits en flexión y rotación externa fueron recuperados dos meses después de terminada la radioterapia. Número de registro del ensayo clínico: NCT02198118.
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Humanos , Feminino , Pessoa de Meia-Idade , Lesões por Radiação/terapia , Neoplasias da Mama/radioterapia , Modalidades de Fisioterapia , Lesões do Ombro/terapia , Lesões por Radiação/fisiopatologia , Neoplasias da Mama/fisiopatologia , Estudos Prospectivos , Amplitude de Movimento Articular , Lesões do Ombro/etiologia , Lesões do Ombro/fisiopatologiaRESUMO
A doença periodontal (DP) é uma patologia inflamatória comumente relacionada à perda dental, na qual, em resposta à microbiota subgengival, o hospedeiro libera uma série de mediadores inflamatórios e enzimas que levam à degradação dos tecidos periodontais. Atualmente, tem sido sugerido que a inflamação associada ao câncer é similar àquela vista em inflamações crônicas. As células inflamatórias são recrutadas para dentro dos processos neoplásicos e liberam fatores que podem atuar na supressão do tumor por estímulo da resposta imune antitumoral ou, sob certas condições, parecem estimular o desenvolvimento do câncer. A ideia de que a resposta imunoinflamatória é o fator-chave que poderia explicar uma possível associação entre DP e câncer tem levado a comunidade científica a investigar quais os possíveis mecanismos envolvidos nessa relação. Diante disso, o objetivo deste trabalho foi analisar, na literatura científica, evidências da associação entre câncer de mama e DP, utilizando as bases de dados Pubmed, Cochrane, Lilacs e SciELO, abrangendo estudos publicados na última década.
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Neoplasias da Mama , Tratamento Farmacológico , Inflamação , Doenças PeriodontaisRESUMO
OBJECTIVE: Oral health can affect a patient's general health and quality of life. Given the increase in breast cancer survival rates, investigations of factors influencing the quality of life of survivors have gained importance. Therefore, the objective of our study was to characterize oral health in postmenopausal breast cancer survivors. METHODS: We conducted a matched case-control study. Forty-eight women who survived breast cancer (age 62.1±9.1 years) and 48 healthy controls (age 61.8±8.6 years) were included. For each case and control, a complete oral evaluation chart was completed. RESULTS: The prevalence of chronic periodontal disease was 98% in breast cancer survivors and 87% in controls. The breast cancer survivors had a median of 16 remaining teeth, whereas controls had a median of 22 remaining teeth (p = 0.03). The percentage of sites with gingival bleeding was 16.05% (0-100%) in breast cancer survivors and 0% (0-72%) in controls (p = 0.04). CONCLUSION: Chronic periodontal disease and tooth loss were highly prevalent in postmenopausal breast cancer survivors. To improve survivors' quality of life, a preventive oral health evaluation should be available prior to cancer treatment.
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Neoplasias da Mama/terapia , Saúde Bucal , Periodontite/epidemiologia , Pós-Menopausa , Sobreviventes/estatística & dados numéricos , Idoso , Antineoplásicos/efeitos adversos , Neoplasias da Mama/complicações , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Índice Periodontal , Periodontite/etiologia , Prevalência , Qualidade de Vida , Radioterapia/efeitos adversos , Estatísticas não Paramétricas , Perda de Dente/etiologiaRESUMO
Introdução: A reconstrução mamária é etapa fundamental no tratamento de pacientes com câncer de mama, sendo a lipoenxertia um importante recurso para melhora no resultado estético. Todavia, recentemente, alguns autores têm questionado a segurança da lipoenxertia, sugerindo que essa técnica possa aumentar o risco de recidiva tumoral local. Métodos: Estudo retrospectivo, tipo coorte transversal, realizado por meio de revisão de prontuários médicos de pacientes submetidas a reconstrução mamária com lipoenxertia pela Divisão de Cirurgia Plástica do Hospital das Clínicas da FMRP-USP, no período de 2006 a 2010. Resultados: Foram selecionadas 18 pacientes, sendo que oito (44%) apresentaram tumor do tipo histológico ductal. Três pacientes (17%) foram submetidas a quimioterapia neoadjuvante, sendo que destas, duas (11%) foram submetidas também a quimioterapia adjuvante; nove (50%) foram submetidas apenas a quimioterapia adjuvante. Onze pacientes (61%) foram submetidas a radioterapia adjuvante, e treze (72%) fizeram tratamento hormonal. Quanto à reconstrução da mama, oito pacientes (44,4%) realizaram TRAM, seis (33,3%), expansor mais prótese e quatro (22,2%), grande dorsal mais prótese. O número de sessões de lipoenxertia variou entre um e quatro. Não foi identificado nenhum caso de recidiva tumoral locorregional. Conclusão: Não foi evidenciado nenhum caso de recidiva tumoral locorregional, o que acrescenta, até o momento, confiabilidade e segurança à lipoenxertia como arsenal para os procedimentos que visam melhorar os resultados da reconstrução mamária após o tratamento oncológico.
Introduction: Breast reconstruction is an essential step in the treatment of patients with breast cancer. Fat grafting is an important resource for improved esthetic results. Recently, however, some authors have questioned the safety of fat grafting, suggestoncolóing that this technique can increase the risk of local tumor recurrence. Methods: A retrospective, cross-sectional cohort study was conducted through a review of medical records of patients who underwent breast reconstruction with fat grafting by the Plastic Surgery Division of the Clinical Hospital of the Ribeirão Preto Faculty of Medicine of the University of São Paulo (FMRP-USP), from 2006 to 2010. Results: We selected 18 patients, of whom eight (44%) had ductal carcinoma by histology. Three patients (17%) underwent neoadjuvant chemotherapy, and of these, two (11%) were also subjected to adjuvant chemotherapy. Nine (50%) received only adjuvant chemotherapy. Eleven patients (61%) underwent adjuvant radiotherapy, and thirteen (72%) had hormonal therapy. For breast reconstruction, eight patients (44.4%) underwent a transverse rectus abdominis myocutaneous (TRAM) flap procedure, six (33.3%) had an expander and prostheses, and four (22.2%) underwent a procedure with the latissimus dorsi muscle flap and prostheses. The number of fat grafting sessions ranged from one to four. No cases of locoregional recurrence of breast cancer were identified. Conclusion: There has been no evidence of locoregional recurrence to date, demonstrating that fat grafting is a reliable and safe procedure for improving the results of breast reconstruction after cancer treatment.
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Humanos , Feminino , Pessoa de Meia-Idade , Idoso , História do Século XXI , Recidiva , Mama , Estudo Comparativo , Prontuários Médicos , Estudos Transversais , Estudos Retrospectivos , Estudos de Coortes , Procedimentos de Cirurgia Plástica , Estudo de Avaliação , Glândulas Mamárias Humanas , Mastectomia , Metástase Neoplásica , Mama/cirurgia , Mama/lesões , Prontuários Médicos/normas , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Glândulas Mamárias Humanas/cirurgia , Glândulas Mamárias Humanas/lesões , Mastectomia/efeitos adversos , Mastectomia/métodos , Metástase Neoplásica/patologiaRESUMO
Considering that downregulation of HLA expression could represent a potential mechanism for breast carcinogenesis and metastasis, the aim of the present study was to use immunohistochemical methods to analyze the expression of HLA-Ia, HLA-DR, HLA-DQ, HLA-E, and HLA-G in invasive ductal carcinoma (IDC) of the breast and to relate this HLA profile to anatomopathological parameters. Fifty-two IDC from breast biopsies were stratified according to histological differentiation (well, moderately, and poorly differentiated) and to the presence of metastases in axillary lymph nodes. The expression of HLA molecules was assessed by immunohistochemistry, using a computer-assisted system. Overall, 31 (59.6%) out of the 52 IDC breast biopsies exhibited high expression of HLA-G, but only 14 (26.9%) showed high expression of HLA-E. A large number (41, 78.8%) of the biopsies showed low expression of HLA-Ia, while 45 (86.5%) showed high expression of HLA-DQ and 36 (69.2%) underexpressed HLA-DR. Moreover, 24 (41.2%) of 52 biopsies had both low HLA-Ia expression and high HLA-G expression, while 11 (21.2%) had low HLA-Ia expression and high HLA-E expression. These results suggest that, by different mechanisms, the downregulation of HLA-Ia, HLA-E, and HLA-DR and the upregulation of HLA-G and HLA-DQ are associated with immune response evasion and breast cancer aggressiveness.
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Os tumores neuroendócrinos primários de mama (TNPMs) são incomuns e não há consenso quanto a tratamento e prognóstico. No presente trabalho, foram revisados os diagnósticos de 1.184 pacientes com câncer de mama atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP/USP), identificando três casos que preenchiam os critérios de TNPM, segundo classificação estabelecida pela Organização Mundial da Saúde (OMS) em 2003. Foram avaliados os achados clinicopatológicos e imuno-histoquímicos e as terapias realizadas, buscando caracterizar os padrões histopatológicos e de comportamento distintos dos carcinomas convencionais de mama.
Primary neuroendocrine breast carcinomas (NECs) are uncommon. Moreover, there is no consensus as to its treatment and prognosis. In this study, the diagnoses of 1,184 cases of breast cancer treated at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto/Universidade de São Paulo (HCFMRP/USP) were reviewed. Three among them fulfilled the criteria for primary NEC according to the classification established by the World Health Organization (WHO) in 2003. Clinicopathological, immunohistochemical features and treatments were assessed in order to characterize histopathological and distinct patterns of conventional breast carcinomas.
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Humanos , Feminino , Adulto , Idoso , Neoplasias da Mama , Carcinoma Neuroendócrino , Imuno-HistoquímicaRESUMO
The presence of tumor-initiating cells (CD44(+)/CD24(-)) in solid tumors has been reported as a possible cause of cancer metastasis and treatment failure. Nevertheless, little is know about the presence of CD44(+)/CD24(-) cells within the primary tumor and metastasis. The proportion of CD44(+)/CD24(-) cells was analyzed in 40 samples and in 10 lymph node metastases using flow cytometry phenotyping. Anti-human CD326 (EpCam; FITC), anti-human CD227 (MUC-1; FITC), anti-human CD44 (APC), and anti-human CD24 (PE), anti-ABCG2 (PE), and anti-CXCR4 (PeCy7) were used for phenotype analysis. The mean patient age was 60.5 years (range, 33-87 years); mean primary tumor size (pT) was 1.8 cm (0.5-3.5 cm). The Wilcoxon or Kruskal-Wallis test was used for univariate analyses. Logistic regression was used for multivariate analysis. The median percentage of CD44(+)/CD24(-) cells within primary invasive ductal carcinomas (IDC) was 2.7% (range, 0.2-71.2). In lymph node metastases, we observed a mean of 6.1% (range, 0.07-53.7). The percentage of CD44(+)/CD24(-) cells in IDCs was not associated with age, pT, tumor grade and HER2. We observed a significantly enrichment of CD44(+)/CD24(-) and ABCG2(+) cells in ESA(+) cell population in patients with positive lymph nodes (P = 0.02 and P = 0.04, respectively). Our data suggest that metastatic dissemination is associated with an increase in tumor-initiating cells in stage I and II breast cancer.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Metástase Linfática/patologia , Células-Tronco Neoplásicas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno CD24/análise , Feminino , Citometria de Fluxo , Humanos , Receptores de Hialuronatos/análise , Imuno-Histoquímica , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de NeoplasiasRESUMO
INTRODUÇÃO: O câncer de mama apresenta relevantes efeitos físicos e psicológicos. Entre as formas de tratamento, as cirurgias conservadoras, muitas vezes com esvaziamento linfático axilar e seguidas por radioterapia, têm papel preponderante. Uma importante complicação pós-tratamento é o surgimento do linfedema no membro superior homolateral. A principal terapêutica para o linfedema é a fisioterapia complexa descongestiva. A estimulação elétrica vem sendo utilizada na prática clínica para a redução do edema, sendo, por isso, uma nova alternativa para o tratamento do linfedema a ser pesquisada. OBJETIVO: Realizar um estudo piloto para comparar os efeitos da fisioterapia complexa descongestiva com um protocolo que inclui estimulação elétrica, exercícios terapêuticos e uso da braçadeira elástica na redução do linfedema secundário com o esvaziamento linfático axilar. MATERIAIS E MÉTODOS: Doze voluntárias foram divididas aleatoriamente em dois grupos e submetidas a diferentes protocolos terapêuticos (FCD e EAV). A redução do linfedema foi avaliada por meio da perimetria e da volumetria de ambos os membros superiores. As intervenções foram realizadas duas vezes por semana por um período de sete semanas. RESULTADOS: Não se observou diferença na redução do linfedema entre os protocolos utilizados. CONCLUSÃO: Com uma amostra pequena de pacientes, não se observaram diferenças entre as técnicas na redução do linfedema quando aplicadas na fase de manutenção. Fatores como tempo de instalação do linfedema, grau de esvaziamento axilar, radicalidade da cirurgia e aplicação de radioterapia na região afetada contribuem para o estágio do linfedema e sucesso de seu tratamento.
INTRODUCTION: Breast cancer is an illness with physical and psychological important effects. Its treatment forms include axillary dissection sugery. A considerable postoperative consequence is the upper limb lymphedema. The principal therapy of lymphedema is descongestive lymphatic therapy. Electrical stimulation has been applied clinically in reduction of edema. Due to this, it is a new alternative for lymphedema treatment to be studied. OBJECTIVE: To compare the descongestive lymphatic therapy with a protocol that includes electrical stimulation, upper limb exercises and compression by bandages in the reduction of axillary dissection secondary lymphedema. METHOD: twelve volunteers were distributed randomly in the two groups and they were submitted to different treatments (FCD and EAV). The reduction of lymphedema was valued by perimetry and volumetry of upper limb. The interventions were realized twice a week during a period of seven weeks. RESULTS: It did not reach statistic significance in reduction of edema. CONCLUSION: With a small sample of patients, there was no difference between the techniques in reducing lymphedema when applied to the maintenance phase. The time of installation of lymphedema, axillary dissection, sugery and radiotherapy contribute for degree of lymphedema and its treatment. The use of bandages compressive by the patients influences the success of therapy.
Assuntos
Humanos , Feminino , Neoplasias da Mama , Estimulação Elétrica , Linfedema , Modalidades de FisioterapiaRESUMO
In the present study, we investigated the relationship between polymorphisms in the estrogen-metabolizing genes CYP17, CYP1B1, CYP1A1, and COMT and genomic instability in the peripheral blood lymphocytes of 62 BC patients and 62 controls considering that increased or prolonged exposure to estrogen can damage the DNA molecule and increase the genomic instability process in breast tissue. Our data demonstrated increased genomic instability in BC patients and that individuals with higher frequencies of MN exhibited higher risk to BC when belonging Val/Met genotype of the COMT gene. We also observed that CYP17 and CYP1A1 polymorphisms can modify the risk to BC depending on the menopause status. We can conclude that the genetic background in estrogen metabolism pathway can modulate chromosome damage in healthy controls and patients and thereby influence the risk to BC. These findings suggest the importance to ally biomarkers of susceptibility and effects to estimate risk groups.
Assuntos
Neoplasias da Mama/genética , Estrogênios/genética , Instabilidade Genômica/genética , Adulto , Hidrocarboneto de Aril Hidroxilases/genética , Neoplasias da Mama/epidemiologia , Catecol O-Metiltransferase/genética , Células Cultivadas , Citocromo P-450 CYP1A1/genética , Citocromo P-450 CYP1B1 , Estrogênios/metabolismo , Feminino , Genótipo , Humanos , Pessoa de Meia-Idade , Polimorfismo Genético , Fatores de Risco , Esteroide 17-alfa-Hidroxilase/genéticaRESUMO
PURPOSE: To evaluate the outcomes and diagnostic performance of ultrasonography after a Breast Imaging Reporting and Data System (Bi-RADS) category 0 mammogram. MATERIAL AND METHODS: This retrospective study reviewed 4,384 consecutive patients who underwent a screening mammography from January 2005 to July 2006; 391 of the 4,384 exams were classified as Bi-RADS category 0. After exclusions, 241 patients received subsequent sonogram. Ultrasonography was considered diagnostic when the Bi-RADS category was changed to 2, 4, or 5, and it was considered indeterminate (Bi-RADS 3) when the results indicated that the patients should return for a mammographic follow-up. The outcomes of these patients were assessed to evaluate the diagnostic performance of ultrasonography. RESULTS: The mean age of the patients was 53.3 years (ranging from 35 to 81). Of the 241 patients, ultrasonography was considered diagnostic in 146 (60.6%) patients and indeterminate in 95 (39.4%) patients. In the diagnostic group, 111 out of 146 patients (70.2%) had a sonogram result of Bi-RADS category 2 after a 2-year follow-up without evidence of malignancy. Furthermore, 35 out of 146 patients (29.8%) had a suspicious sonogram with a result of Bi-RADS category 4. After a tissue sampling procedure, 10 patients were confirmed to have breast cancer, and 25 had benign histopathological features without any evidence of malignancy after a 2-year follow-up. The sensitivity of ultrasonography was 100%, specificity was 89.1%, and overall accuracy was 89.6%. CONCLUSIONS: Based on the degree of resolution and its diagnostic performance, ultrasonography was determined to be an excellent method for the subsequent evaluation of Bi-RADS 0 mammograms.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Mamografia/métodos , Ultrassonografia Mamária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To evaluate the outcomes and diagnostic performance of ultrasonography after a Breast Imaging Reporting and Data System (Bi-RADS) category 0 mammogram. MATERIAL AND METHODS: This retrospective study reviewed 4,384 consecutive patients who underwent a screening mammography from January 2005 to July 2006; 391 of the 4,384 exams were classified as Bi-RADS category 0. After exclusions, 241 patients received subsequent sonogram. Ultrasonography was considered diagnostic when the Bi-RADS category was changed to 2, 4, or 5, and it was considered indeterminate (Bi-RADS 3) when the results indicated that the patients should return for a mammographic follow-up. The outcomes of these patients were assessed to evaluate the diagnostic performance of ultrasonography. RESULTS: The mean age of the patients was 53.3 years (ranging from 35 to 81). Of the 241 patients, ultrasonography was considered diagnostic in 146 (60.6 percent) patients and indeterminate in 95 (39.4 percent) patients. In the diagnostic group, 111 out of 146 patients (70.2 percent) had a sonogram result of Bi-RADS category 2 after a 2-year follow-up without evidence of malignancy. Furthermore, 35 out of 146 patients (29.8 percent) had a suspicious sonogram with a result of Bi-RADS category 4. After a tissue sampling procedure, 10 patients were confirmed to have breast cancer, and 25 had benign histopathological features without any evidence of malignancy after a 2-year follow-up. The sensitivity of ultrasonography was 100 percent, specificity was 89.1 percent, and overall accuracy was 89.6 percent. CONCLUSIONS: Based on the degree of resolution and its diagnostic performance, ultrasonography was determined to be an excellent method for the subsequent evaluation of Bi-RADS 0 mammograms.