Conditional Disease-Free and Overall Survival of 1,858 Young Women with Non-Metastatic Breast Cancer and with Participation in a Post-Therapeutic Rehab Programme according to Clinical Subtypes

BackgroundBreast cancer in young women is associated with unfavourable tumour biology and is the main cause of death in this group. Conditional survival analysis estimates survival rates under the pre-condition of already having survived a certain time.ObjectivesTo describe conditional disease-free and overall survival of female breast cancer patients according to clinical subtypes and age.MethodsThis study analyses information from 1,858 breast cancer patients aged between 21 and 54 years, who were taking part in a post-therapeutic rehab programme (time between diagnosis and rehab start: maximum 24, median 11 months). Mean follow-up time was 3.6 years. We describe biological, clinical and pathological features in regard to different age groups (<40 and ≥40 years) and report conditional 5-year survival rates for overall and disease-free survival, and Cox proportional hazard models.ResultsVery young and young patients differed in regard to hormone receptor negativity, tumour grade, lymphovascular invasion, and molecular subtypes. Young women bore triple-negative and HER2-like disease more frequently. Conditional 5-year overall survival did not differ substantially between women <40 and 40–54 years of age (95 vs. 96%). It was highest for women with cancer of the luminal A subtype (98%) and lowest for the triple-negative subtype (91%). Lymphangiosis was a significant predictor of death. Results for disease-free survival were comparable.ConclusionsConditional 5-year overall survival after non-metastatic breast cancer was as high as 95.5%, and disease-free survival was 85.2%. When controlling for time between diagnosis and rehab start, molecular subtypes influenced overall and disease-free survival prospects. When additionally controlling for clinical characteristics, this effect only remained stable for disease-free survival.     

Outcomes of non-metastatic triple negative breast cancers: Real-world data from a large Indian cohort

BackgroundTriple negative Breast tumor (TNBC) is an aggressive tumor with sparse data worldwide.MethodsWe analyzed non-metastatic TNBC from 2013 to 2019 for demographics, practice patterns, and survival by the Kaplan Meir method. Prognostic factors for OS and DFS were evaluated using Cox Proportional Hazard model estimator for univariate and multivariable analysis after checking for collinearity among the variables.ResultsThere were 1297 patients with median age of 38 years; 41 (33.3%) among 123 tested were BRCA-positives. Among these 593 (45.7%) had stage III disease, 1279 (98.6%) were grade III, 165 (13.0%) had peri-nodal extension (PNE), 212 (16.0%) lympho-vascular invasion (LVI), and 21 (1.6%) were metaplastic; 1256 (96.8%) received chemotherapy including 820 (63.2%) neoadjuvant with 306 (40.0%) pCR. Grade ≥3 toxicities occurred in 155 (12.4%) including two deaths and 3 s-primaries. 1234 (95.2%) underwent surgery [722 (55.7%) breast conservations] and 1034 (79.7%) received radiotherapy.At a median follow-up of 54 months, median disease-free (DFS) was 92.2 months and overall survival (OS) was not reached. 5-year estimated DFS and OS was 65.9% and 80.3%. There were 259 (20.0%) failures; predominantly distant (204, 15.7%) - lung (51%), liver (31.8%).In multivariate analysis presence of LVI (HR-2.00, p-0.003), PNE (HR-2.09 p-0.003), older age (HR-1.03, p-0.002) and stage III disease (HR-4.89, p-0.027), were associated with poor OS.ConclusionRelatively large contemporary data of non-metastatic TNBC confirms aggressive biology and predominant advanced stage presentation which adversely affects outcomes. The data strongly indicate the unmet need for early detection to optimize care.     

Factores clínicos determinantes para la realización de pruebas de imagen en cáncer de próstata resistente a la castración no metastásico en la práctica clínica: resultados del estudio IDENTIFICA

IntroductionThe aim of the study was to describe the clinical drivers that lead physicians to perform imaging tests in search of metastasis in non-metastasic castration prostate resistant cancer (nmCRPC) patients.MethodsObservational, cross-sectional study conducted at the Departments of Urology of 38 Spanish hospitals. The study included 188 patients diagnosed with nmCRPC who underwent an imaging test for the assessment of metástasis. In one study visit, physicians were requested to specify the clinical factors that led them to perform these tests. The results of the imaging tests and the clinical characteristics of the patients since the time of prostate cancer (PC) diagnosis, were reported. Regression analyses were used to determine predictors of imaging test results.ResultsProstate-specific antigen (PSA) level was the most important driver to order imaging tests (57.1%), followed by regular follow-up (16.5%) and PSA doubling time (PSADT) (12.0%). Although these drivers were not associated to detection of metastasis, patients with PSA levels ≥20 ng/mL had a greater risk of metastasis than patients with PSA levels < 4ng/mL (P=.004) and CRPC patients diagnosed with metastasis (mCRPC) had higher median PSA levels (20.9; interquartile range [IQR]: 6.7-38.6) than nmCRPC (9.1; IQR: 5.0-18.0) (P=.005). Sixty-six percent of the patients did not undergo any imaging test after CRPC diagnosis until the study visit (10.6, IQR: 4.0-19.5 months). Curative-intent treatment at PC diagnosis and Gleason score predicted longer time from PC to CRPC diagnosis.ConclusionsPhysicians based their decisions to order imaging tests for metastasis detection in nmCRPC patients mainly on PSA and PSA kinetics, including the regular follow-up stated by guideline recommendations.     

宝石 CT 能谱成像在乳腺浸润性导管癌腋窝转移淋巴结诊断中的初步应用

目的：探讨宝石 CT 能谱成像（gemstone spectral imaging,GSI）在乳腺浸润性导管癌腋窝转移淋巴结诊断中的价值。方法：收集绵阳市中心医院2013年2月～2014年12月期间经病理证实并行 GSI 检查的乳腺浸润性导管癌患者32例,所有患者均行腋窝淋巴结清扫术。GSI 扫描时间为动脉后期（33s）,图像后处理采用 ADW4．6工作站及 GSI-view 软件。根据手术病理结果将纳入研究的淋巴结分为转移组（15枚）和非转移组（62枚）。由软件自动生成 KeV-CT 值（电子千伏值-CT 值）曲线,同时记录每枚淋巴结的碘基值和相应层面主动脉碘基值、不同 KeV下淋巴结 CT 值和相应层面主动脉的 CT 值。计算每枚淋巴结40～70KeV 的斜率值（斜率 K ＝（HU40KeV-HU70KeV ）／30）、标化碘基值（淋巴结碘基值／主动脉碘基值）、不同 KeV 下的标化 CT 值（淋巴结 CT 值／主动脉 CT 值）。统计分析运用 spss17．0。结果：在40～70KeV 区间内,转移组淋巴结与非转移组淋巴结的 KeV-CT 值曲线斜率差异具有统计学意义（P ＜0．05）。转移组的碘基值、标化碘基值均小于非转移组,差异有统计学意义（P ＜0．05）。不同KeV 下标化 CT 值的差异均无统计学意义。以曲线斜率3．92作为诊断转移淋巴结的阈值时,灵敏度和特异度分别为77．4％、71．4％;以碘基值19．44作为诊断阈值时,灵敏度和特异度分别为73．3％、72．6％;以标化碘基值0．1677作为诊断阈值时,灵敏度和特异度分别为82．3％、80．0％。结论：CT 能谱成像作为一种新的无创性检查方法,对诊断乳腺浸润性导管癌腋窝转移淋巴结有重要价值。     

Improving the Stratification of Patients With Intermediate-risk Prostate Cancer

BackgroundIntermediate-risk prostate cancer (IR PCa) phenotypes may vary from favorable to unfavorable. National Comprehensive Cancer Network (NCCN) criteria help distinguish between those groups. We studied and attempted to improve this stratification.Patients and MethodsA total of 4048 (NCCN favorable: 2015 [49.8%] vs. unfavorable 2033 [50.2%]) patients with IR PCa treated with radical prostatectomy were abstracted from an institutional database (2000-2018). Multivariable logistic regression models predicting upstaging and/or upgrading (Gleason Grade Group [GGG] IV-V and/or ≥ pT3 or pN1) in IR PCa were developed, validated, and directly compared with the NCCN IR PCa stratification.ResultsAll 4048 patients were randomly divided between development (n = 2024; 50.0%) and validation cohorts (n = 2024; 50.0%). The development cohort was used to fit basic (age, prostate-specific antigen, clinical T stage, biopsy GGG, and percentage of positive cores [all P < .001]) and extended models (age, prostate-specific antigen, clinical T stage, biopsy GGG, prostate volume, and percentage of tumor within all biopsy cores [all P < .001]). In the validation cohort, the basic and the extended models were, respectively, 71.4% and 74.7% accurate in predicting upstaging and/or upgrading versus 66.8% for the NCCN IR PCa stratification. Both models outperformed NCCN IR PCa stratification in calibration and decision curve analyses (DCA). Use of NCCN IR PCa stratification would have misclassified 20.1% of patients with ≥ pT3 or pN1 and/or GGG IV to V versus 18.3% and 16.4% who were misclassified using the basic or the extended model, respectively.ConclusionBoth newly developed and validated models better discriminate upstaging and/or upgrading risk than the NCCN IR PCa stratification.     

Practice Patterns and Outcomes for Pemetrexed Plus Platinum Doublet as Neoadjuvant Chemotherapy in Adenocarcinomas of Lung: Looking Beyond the Usual Paradigm

AimsNeoadjuvant chemotherapy (NACT) is the standard of care in non-small cell lung cancers (NSCLC) with locally advanced N2 disease. There is a scarcity of data for the pemetrexed–platinum regimen as NACT. Also, apart from N2 disease, the role of NACT in locally advanced NSCLCs for tumour downstaging is unclear.Materials and methodsNon-metastatic adenocarcinomas of lung treated with pemetrexed–platinum-based NACT were analysed. The patients with locoregionally advanced N2 disease and those who were borderline candidates for upfront definitive treatment were planned for NACT after discussion in a multidisciplinary clinic. In total, four cycles of 3-weekly pemetrexed and platinum were delivered in the combined neoadjuvant and adjuvant setting. A response assessment was carried out using RECIST criteria. Progression-free (PFS) and overall survival were calculated using the Kaplan–Meier method.ResultsOf 114 patients, 96 evaluable patients received NACT with pemetrexed–platinum. The most common indication for NACT was N2 disease at baseline (46.8%). The objective response rate was 36.4% (95% confidence interval 22–52%), including two complete and 32 partial responses, whereas 12.5% of patients had progressive disease on NACT. The median PFS was 14 months (95% confidence interval 10.7–17.3) and the median overall survival was 22 months (95% confidence interval 15.6–28.4) at a median follow-up of 16 months. There was a significant improvement in the overall survival of patients undergoing definitive therapy versus no definitive therapy (median overall survival 25 months [95% confidence interval 19.6–30.4] versus 12 months [95% confidence interval 3.2–20.7], respectively; P = 0.015, hazard ratio 0.56 [95% confidence interval 0.3–0.9]). Among patients who could not undergo definitive chemoradiation upfront due to dosimetric constraints (n = 34), 24 (70.6%) patients finally underwent definitive therapy after NACT.ConclusionsPemetrexed–platinum-based NACT seems to be an effective option and many borderline cases, where upfront definitive therapy is not feasible, may become amenable to the same after incorporation of NACT.     

阿比特龙联合泼尼松治疗非转移性去势抵抗性前列腺癌的对比研究

目的 评估和比较阿比特龙联合泼尼松和多西他赛联合泼尼松在治疗非转移性去势抵抗性前列腺癌（nm-CRPC）中的疗效和安全性。方法 收集经病理证实的78例nm-CRPC患者资料,其中接受阿比特龙联合泼尼松方案治疗的39例患者为治疗组、接受多西他赛联合泼尼松方案治疗的39例患者为对照组。以病灶影像学出现转移为主要研究终点,Kaplan-Meier法分析2组患者的无进展生存情况,同时监测2组治疗前后血清前列腺特异性抗原（PSA）水平变化,计算2组PSA反应率,并以原发病灶客观缓解率（ORR）和疾病控制率（DCR）作为次要观察指标,观察2组治疗期间3级或以上不良反应的发生情况。结果 治疗组18个月无进展生存率为34%、中位无进展生存期12个月,对照组无进展生存率为8%、中位无进展生存期9个月,治疗组无进展生存率高于对照组（P < 0.05）。治疗后,2组患者血清PSA水平均比治疗前有不同程度下降,其中治疗组血清PSA水平低于对照组（P均< 0.05）。治疗组的PSA反应率为69%,高于对照组的46% （P < 0.05）。治疗后,治疗组ORR为79%、DCR为92%,对照组相应为56%、74%,治疗组的ORR和DCR均高于对照组（P均< 0.05）。治疗过程中,2组患者均出现了不同程度的不良反应,但均无发生需停药情况, 2组患者3级及以上主要不良反应总发生率比较差异无统计学意义（P > 0.05）。结论 阿比特龙联合泼尼松治疗nm-CRPC的效果优于多西他赛联合泼尼松,可考虑作为国人nm-CRPC治疗策略的其中一个选择。     

MR扩散加权成像对转移性淋巴结的诊断价值

扩散加权成像是通过检测活体组织内水分子的扩散运动,在细胞水平反映生物组织微环境和微结构变化的一种功能成像技术,在良恶性肿瘤的鉴别诊断中显示出良好的应用前景。对扩散加权成像技术及其鉴别良恶性肿瘤的原理、淋巴结病变的诊断现状、扩散加权成像在转移与非转移性淋巴结诊断中的应用研究及现状予以综述。