Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer

<p>Abstract</p> <p>Background</p> <p>Dexamethasone has been reported to reduce postoperative symptoms after different surgical procedures. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting (PONV), and pain after mastectomy.</p> <p>Methods</p> <p>In this prospective, double-blind, placebo-controlled study, 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after randomization to treatment with 8 mg intravenous dexamethasone (<it>n </it>= 35) or placebo (<it>n </it>= 35). All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain score were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded.</p> <p>Results</p> <p>Demographic and medical variables were similar between groups. The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation (28.6% <it>vs</it>. 60%; <it>p </it>= 0.02) and at 6 h (17.2% <it>vs</it>. 45.8%; <it>p </it>= 0.03). More patients in the placebo group required additional antiemetic medication (21 <it>vs</it>. 8; <it>p </it>= 0.01). Dexamethasone treatment significantly reduced postoperative pain just after surgery (VAS score, 4.54 ± 1.55 <it>vs</it>. 5.83 ± 2.00; <it>p </it>= 0.004), at 6 h (3.03 ± 1.20 <it>vs</it>. 4.17 ± 1.24; <it>p </it>< 0.0005) and at 12 h (2.09 ± 0.85 <it>vs</it>. 2.54 ± 0.98; <it>p </it>= 0.04). Analgesics were required in more patients of the control group (21 <it>vs</it>. 10; <it>p </it>= 0.008). There were no adverse events, morbidity or mortality.</p> <p>Conclusions</p> <p>Preoperative intravenous dexamethasone (8 mg) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer.</p> <p>Trial registration number</p> <p>NCT01116713</p

<i>HLA-G</i> 14 bp Ins/Del (rs66554220) Variant Is Not Associated with Breast Cancer in Women from Western Mexico

HLA-G is a physiology and pathologic immunomodulator detrimentally related to cancer. Its gene is heavily transcriptionally and post-transcriptionally regulated by variants located in regulator regions like 3′UTR, being the most studied Ins/Del of 14-bp (rs66554220), which is known to influence the effects of endogen cell factors; nevertheless, the reports are discrepant and controversial. Herein, the relationship of the 14-bp Ins/Del variant (rs66554220) with breast cancer (BC) and its clinical characteristics were analyzed in 182 women with non-familial BC and 221 disease-free women as a reference group. Both groups from western Mexico and sex–age-matched (sm-RG). The rs66554220 variant was amplified by SSP-PCR and the fragments were visualized in polyacrylamide gel electrophoresis. The variant rs66554220 was not associated with BC in our population. However, we suggest the Ins allele as a possible risk factor for developing BC at clinical stage IV (OR = 3.05, 95% CI = 1.16–7.96, p = 0.01); nevertheless, given the small stratified sample size (n = 11, statistical power = 41%), this is inconclusive. In conclusion, the 14-bp Ins/Del (rs66554220) variant of HLA-G is not associated with BC in the Mexican population, but might be related to advanced breast tumors. Further studies are required

Evaluation of psychosocial aspects in participants of cancer genetic counseling

Abstract Background The instrument called “Hospital Anxiety and Depression Scale” (HADS) is frequently used to evaluate anxious and depressive symptomatology in patients who receive Cancer Genetic Counseling (CGC). However, this instrument cannot identify all of the psychosocial factors, such as the antecedents of the patients’ emotional states or their concerns. The objective of the present research was to compare cases detected with psychosocial alterations by means of HADS and a Psychological Health Interview (PHI). Methods A transversal analytical design was used. One hundred ten participants were included (97.3% females and 2.7% males). The average age was 45 years ±10 years. Results The PHI identified twice the amount of participants with psychosocial alterations than did HADS, which only detected 43% of these participants. Conclusions The results of our study suggest that the PHI should be applied in addition to HADS to identify participants who would require psychological support due to recurrent concerns

The Transcriptomic Portrait of Locally Advanced Breast Cancer and Its Prognostic Value in a Multi-Country Cohort of Latin American Patients

Purposes: Most molecular-based published studies on breast cancer do not adequately represent the unique and diverse genetic admixture of the Latin American population. Searching for similarities and differences in molecular pathways associated with these tumors and evaluating its impact on prognosis may help to select better therapeutic approaches. Patients and Methods: We collected clinical, pathological, and transcriptomic data of a multi-country Latin American cohort of 1,071 stage II-III breast cancer patients of the Molecular Profile of Breast Cancer Study (MPBCS) cohort. The 5-year prognostic ability of intrinsic (transcriptomic-based) PAM50 and immunohistochemical classifications, both at the cancer-specific (OSC) and disease-free survival (DFS) stages, was compared. Pathway analyses (GSEA, GSVA and MetaCore) were performed to explore differences among intrinsic subtypes. Results: PAM50 classification of the MPBCS cohort defined 42·6% of tumors as LumA, 21·3% as LumB, 13·3% as HER2E and 16·6% as Basal. Both OSC and DFS for LumA tumors were significantly better than for other subtypes, while Basal tumors had the worst prognosis. While the prognostic power of traditional subtypes calculated with hormone receptors (HR), HER2 and Ki67 determinations showed an acceptable performance, PAM50-derived risk of recurrence best discriminated low, intermediate and high-risk groups. Transcriptomic pathway analysis showed high proliferation (i.e. cell cycle control and DNA damage repair) associated with LumB, HER2E and Basal tumors, and a strong dependency on the estrogen pathway for LumA. Terms related to both innate and adaptive immune responses were seen predominantly upregulated in Basal tumors, and, to a lesser extent, in HER2E, with respect to LumA and B tumors. Conclusions: This is the first study that assesses molecular features at the transcriptomic level in a multicountry Latin American breast cancer patient cohort. Hormone-related and proliferation pathways that predominate in PAM50 and other breast cancer molecular classifications are also the main tumor-driving mechanisms in this cohort and have prognostic power. The immune-related features seen in the most aggressive subtypes may pave the way for therapeutic approaches not yet disseminated in Latin America. Clinical Trial Registration: ClinicalTrials.gov (Identifier: NCT02326857). Copyright © 2022 Llera, Abdelhay, Artagaveytia, Daneri-Navarro, Müller, Velazquez, Alcoba, Alonso, Alves da Quinta, Binato, Bravo, Camejo, Carraro, Castro, Castro-Cervantes, Cataldi, Cayota, Cerda, Colombo, Crocamo, Del Toro-Arreola, Delgadillo-Cisterna, Delgado, Dreyer-Breitenbach, Fejerman, Fernández, Fernández, Fernández, Franco-Topete, Gabay, Gaete, Garibay-Escobar, Gómez, Greif, Gross, Guerrero, Henderson, Lopez-Muñoz, Lopez-Vazquez, Maldonado, Morán-Mendoza, Nagai, Oceguera-Villanueva, Ortiz-Martínez, Quintero, Quintero-Ramos, Reis, Retamales, Rivera-Claisse, Rocha, Rodríguez, Rosales, Salas-González, Sanchotena, Segovia, Sendoya, Silva-García, Trinchero, Valenzuela, Vedham, Zagame, United States-Latin American Cancer Research Network (US-LACRN) and Podhajcer.Fil: Llera, Andrea Sabina. Fundación Instituto Leloir-CONICET. Molecular and Cellular Therapy Laboratory; ArgentinaFil: Abdelhay, Eliana Saul Furquim Werneck. Instituto Nacional de Câncer. Bone Marrow Transplantation Unit; BrasilFil: Artagaveytia, Nora. Universidad de la República. Hospital de Clínicas Manuel Quintela; UruguayFil: Daneri-Navarro, Adrián. Universidad de Guadalajara; MéxicoFil: Müller, Bettina. Instituto Nacional del Cáncer; ChileFil: Velazquez, Carlos. Universidad de Sonora; MéxicoFil: Alcoba, Elsa B. Hospital Municipal de Oncología María Curie; ArgentinaFil: Alonso, Isabel. Centro Hospitalario Pereira Rossell; UruguayFil: Alves da Quinta, Daniela B. Fundación Instituto Leloir-CONICET. Molecular and Cellular Therapy Laboratory; ArgentinaFil: Alves da Quinta, Daniela B. Universidad Argentina de la Empresa (UADE). Instituto de Tecnología (INTEC); ArgentinaFil: Binato, Renata. Instituto Nacional de Câncer. Bone Marrow Transplantation Unit; BrasilFil: Bravo, Alicia Inés. Hospital Regional de Agudos Eva Perón; ArgentinaFil: Camejo, Natalia. Universidad de la República. Hospital de Clínicas Manuel Quintela; UruguayFil: Carraro, Dirce Maria. AC Camargo Cancer Center. Centro Internacional de Pesquisa (CIPE). Laboratory of Genomics and Molecular Biology; BrasilFil: Castro, Mónica. Instituto de Oncología Angel Roffo; ArgentinaFil: Castro-Cervantes, Juan M. Hospital de Especialidades CMNO-IMSS; MéxicoFil: Cataldi, Sandra. Instituto Nacional del Cáncer; UruguayFil: Cayota, Alfonso. Institut Pasteur de Montevideo; UruguayFil: Cerda, Mauricio. Universidad de Chile. Instituto de Neurociencias Biomédicas. Facultad de Medicina. Centro de Informática Médica y Telemedicina. Instituto de Ciencias Biomédicas (ICBM). Integrative Biology Program; ChileFil: Colombo, Alicia. Universidad de Chile. Facultad de Medicina y Hospital Clínico. Department of Pathology; ChileFil: Crocamo, Susanne. Instituto Nacional de Câncer. Oncology Department; BrasilFil: Del Toro-Arreola, Alicia. Universidad de Guadalajara; MéxicoFil: Delgadillo-Cisterna, Raúl. Hospital de Especialidades CMNO-IMSS; MéxicoFil: Delgado, Lucía. Universidad de la República. Hospital de Clínicas Manuel Quintela; UruguayFil: Dreyer-Breitenbach, Marisa. Universidade do Estado do Rio de Janeiro. Instituto de Biologia Roberto Alcantara Gomes; BrasilFil: Fejerman, Laura. University of California Davis. Department of Public Health Sciences and Comprehensive Cancer Center; Estados UnidosFil: Fernández, Elmer A. Universidad Católica de Córdoba. CONICET. Centro de Investigación y Desarrollo en Inmunología y Enfermedades Infecciosas [Centro de Investigación y Desarrollo en Inmunología y Enfermedades Infecciosas (CIDIE); ArgentinaFil: Fernández, Elmer A. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Fernández, Wanda. Hospital San Borja Arriarán; ChileFil: Franco-Topete, Ramón A. Universidad de Guadalajara. Hospital Civil de Guadalajara. Organismo Público Descentralizado (OPD); MéxicoFil: Gabay, Carolina. Instituto de Oncología Angel Roffo; ArgentinaFil: Gaete, Fancy. Hospital Luis Tisne; ChileFil: Garibay-Escobar, Adriana. Universidad de Sonora; MéxicoFil: Gómez, Jorge. Texas A&M University; Estados UnidosFil: Greif, Gonzalo. Institut Pasteur de Montevideo; UruguayFil: Gross, Thomas G. Center for Global Health, National Cancer Institute; Estados UnidosFil: Guerrero, Marisol. Hospital San José; ChileFil: Henderson, Marianne K. Center for Global Health, National Cancer Institute; Estados UnidosFil: Lopez-Muñoz, Miguel E. Universidad de Sonora; MéxicoFil: Lopez-Vazquez, Alejandra. Universidad de Sonora; MéxicoFil: Maldonado, Silvina. Hospital Regional de Agudos Eva Perón; ArgentinaFil: Morán-Mendoza, Andrés J. Hospital de Gineco-Obstetricia CMNO-IMSS; MéxicoFil: Nagai, Maria Aparecida. Sao Paulo University Medical School. Cancer Institute of São Paulo (ICESP). Center for Translational Research in Oncology; BrasilFil: Oceguera-Villanueva, Antonio. Instituto Jalisciense de Cancerologia; MéxicoFil: Ortiz-Martínez, Miguel A. Hospital General Regional No. 1. IMSS; MéxicoFil: Quintero, Jael. Universidad de Sonora; MéxicoFil: Quintero-Ramos, Antonio. Universidad de Guadalajara; MéxicoFil: Reis, Rui M. Hospital de Câncer de Barretos. Molecular Oncology Research Center; BrasilFil: Retamales, Javier. Grupo Oncológico Cooperativo Chileno de Investigación; ChileFil: Rivera-Claisse, Ernesto. Centro Estatal de Oncologia; MéxicoFil: Rocha, Darío. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Rodríguez, Robinson. Hospital Central de las Fuerzas Armadas; UruguayFil: Rosales, Cristina. Hospital Municipal de Oncología María Curie; ArgentinaFil: Salas-González, Efrain. Hospital de Gineco-Obstetricia CMNO-IMSS; MéxicoFil: Sanchotena, Verónica. Hospital Municipal de Oncología María Curie; ArgentinaFil: Segovia, Laura. Hospital Barros Luco Trudeau; ChileFil: Sendoya, Juan Martín. Fundación Instituto Leloir-CONICET. Molecular and Cellular Therapy Laboratory; ArgentinaFil: Silva-García, Aida A. Universidad de Guadalajara. Hospital Civil de Guadalajara. Organismo Público Descentralizado (OPD); MéxicoFil: Trinchero, Alejandra. Hospital Regional de Agudos Eva Perón; ArgentinaFil: Valenzuela, Olivia. Universidad de Sonora; MéxicoFil: Vedham, Vidya. National Cancer Institute. Center for Global Health; Estados Unido

The Transcriptomic Portrait of Locally Advanced Breast Cancer and Its Prognostic Value in a Multi-Country Cohort of Latin American Patients.

PurposesMost molecular-based published studies on breast cancer do not adequately represent the unique and diverse genetic admixture of the Latin American population. Searching for similarities and differences in molecular pathways associated with these tumors and evaluating its impact on prognosis may help to select better therapeutic approaches.Patients and methodsWe collected clinical, pathological, and transcriptomic data of a multi-country Latin American cohort of 1,071 stage II-III breast cancer patients of the Molecular Profile of Breast Cancer Study (MPBCS) cohort. The 5-year prognostic ability of intrinsic (transcriptomic-based) PAM50 and immunohistochemical classifications, both at the cancer-specific (OSC) and disease-free survival (DFS) stages, was compared. Pathway analyses (GSEA, GSVA and MetaCore) were performed to explore differences among intrinsic subtypes.ResultsPAM50 classification of the MPBCS cohort defined 42·6% of tumors as LumA, 21·3% as LumB, 13·3% as HER2E and 16·6% as Basal. Both OSC and DFS for LumA tumors were significantly better than for other subtypes, while Basal tumors had the worst prognosis. While the prognostic power of traditional subtypes calculated with hormone receptors (HR), HER2 and Ki67 determinations showed an acceptable performance, PAM50-derived risk of recurrence best discriminated low, intermediate and high-risk groups. Transcriptomic pathway analysis showed high proliferation (i.e. cell cycle control and DNA damage repair) associated with LumB, HER2E and Basal tumors, and a strong dependency on the estrogen pathway for LumA. Terms related to both innate and adaptive immune responses were seen predominantly upregulated in Basal tumors, and, to a lesser extent, in HER2E, with respect to LumA and B tumors.ConclusionsThis is the first study that assesses molecular features at the transcriptomic level in a multicountry Latin American breast cancer patient cohort. Hormone-related and proliferation pathways that predominate in PAM50 and other breast cancer molecular classifications are also the main tumor-driving mechanisms in this cohort and have prognostic power. The immune-related features seen in the most aggressive subtypes may pave the way for therapeutic approaches not yet disseminated in Latin America.Clinical trial registrationClinicalTrials.gov (Identifier: NCT02326857)

Socioeconomic, Clinical, and Molecular Features of Breast Cancer Influence Overall Survival of Latin American Women

Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status ≦̸1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher’s exact tests and the OS by Kaplan–Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60 months was 83.9%. Multivariable-adjusted death hazard differences were found for women living in Argentina (2.27), Chile (1.95), and Uruguay (2.42) compared with Mexican women, for older (≥60 years) (1.84) compared with younger (≤40 years) women, for basal-like subtype (5.8), luminal B (2.43), and HER2-enriched (2.52) compared with luminal A subtype, and for tumor clinical stages IIB (1.91), IIIA (3.54), and IIIB (3.94) compared with stage IIA women. OS was associated with country of residence, PAM50 intrinsic subtype, age, and tumor stage at diagnosis. While the latter is known to be influenced by access to care, including cancer screening, timely diagnosis and treatment, including access to more effective treatment protocols, it may also influence epigenetic changes that, potentially, impact molecular subtypes. Data derived from heretofore understudied populations with unique geographic ancestry and sociocultural experiences are critical to furthering our understanding of this complexity. Copyright © 2022 de Almeida, Cortés, Vilensky, Valenzuela, Cortes-Sanabria, de Souza, Barbeito, Abdelhay, Artagaveytia, Daneri-Navarro, Llera, Müller, Podhajcer, Velazquez, Alcoba, Alonso, Bravo, Camejo, Carraro, Castro, Cataldi, Cayota, Cerda, Colombo, Crocamo, Del Toro-Arreola, Delgadillo-Cristerna, Delgado, Breitenbach, Fernández, Fernández, Fernández, Franco-Topete, Gaete, Gómez, Gonzalez-Ramirez, Guerrero, Gutierrez-Rubio, Jalfin, Lopez-Vazquez, Loria, Míguez, Moran-Mendoza, Morgan-Villela, Mussetti, Nagai, Oceguera-Villanueva, Reis, Retamales, Rodriguez, Rosales, Salas-Gonzalez, Segovia, Sendoya, Silva-Garcia, Viña, Zagame, Jones, Szklo and United States-Latin American Cancer Research Network (US-LACRN).Fil: de Almeida, Liz Maria. Instituto Nacional de Cáncer; BrasilFil: Cortés, Sandra. Pontificia Universidad Católica de Chile; ChileFil: Vilensky, Marta. Instituto de Oncología Angel Roffo; ArgentinaFil: Valenzuela, Olivia. Universidad de Sonora; MéxicoFil: Cortes-Sanabria, Laura. Hospital de Especialidades, CMNO-IMSS; MéxicoFil: de Souza, Mirian. Instituto Nacional de Cáncer; BrasilFil: Barbeito, Rafael Alonso. Facultad de Medicina; ArgentinaFil: Abdelhay, Eliana. Instituto Nacional de Cáncer; BrasilFil: Artagaveytia, Nora. Hospital de Clínicas Manuel Quintela. Universidad de la República; UruguayFil: Daneri-Navarro, Adrian. Universidad de Guadalajara; MéxicoFil: Llera, Andrea S. CONICET. Fundación Instituto Leloir; ArgentinaFil: Müller, Bettina. Instituto Nacional del Cáncer; ArgentinaFil: Podhajcer, Osvaldo L. CONICET. Fundación Instituto Leloir; ArgentinaFil: Velazquez, Carlos. Universidad de Sonora; MéxicoFil: Alcoba, Elsa. Hospital Municipal de Oncología María Curie; ArgentinaFil: Alonso, Isabel. Centro Hospitalario Pereira Rossell; ArgentinaFil: Bravo, Alicia I. Hospital Regional de Agudos Eva Perón; ArgentinaFil: Camejo, Natalia. Hospital de Clínicas Manuel Quintela. Universidad de la República; UruguayFil: Carraro, Dirce Maria. AC Camargo Cancer Center; BrasilFil: Castro, Mónica. Instituto de Oncología Angel Roffo; ArgentinaFil: Cataldi, Sandra. Instituto Nacional de Cáncer; UruguayFil: Cayota, Alfonso. Institut Pasteur de Montevideo; UruguayFil: Cerda, Mauricio. Universidad de Chile; ChileFil: Colombo, Alicia. Universidad de Chile; ChileFil: Crocamo, Susanne. Instituto Nacional de Cáncer; BrasilFil: Del Toro-Arreola, Alicia. Universidad de Guadalajara; MéxicoFil: Delgadillo-Cristerna, Raul. Hospital de Especialidades. CMNO-IMSS; MéxicoFil: Delgado, Lucia. Hospital de Clínicas Manuel Quintela; UruguayFil: Breitenbach, Marisa Dreyer. Universidade do Estado do Rio de Janeiro; BrasilFil: Fernández, Elmer. Universidad Católica de Córdoba. CONICET. Centro de Investigaciones en Bioquímica Clínica e Inmunologia; ArgentinaFil: Fernández, Jorge. Instituto de Salud Pública; ChileFil: Fernández, Wanda. Hospital San Borja Arriarán; ChileFil: Franco-Topete, Ramon A. OPD Hospital Civil de Guadalajara. Universidad de Guadalajara; MéxicoFil: Gaete, Fancy. Hospital Luis Tisne; ChileFil: Gómez, Jorge. Texas A&M University; Estados UnidosFil: Gonzalez-Ramirez, Leivy P. Universidad de Guadalajara; MéxicoFil: Guerrero, Marisol. Hospital San José; ChileFil: Gutierrez-Rubio, Susan A. Universidad de Guadalajara; MéxicoFil: Jalfin, Beatriz. Hospital Regional de Agudos Eva Perón; ArgentinaFil: Lopez-Vazquez, Alejandra. Universidad de Sonora; MéxicoFil: Loria, Dora. Instituto de Oncología Angel Roffo; ArgentinaFil: Míguez, Silvia. Hospital Municipal de Oncología María Curie; ArgentinaFil: Moran-Mendoza, Andres de J. Hospital de Gineco-Obstetricia CMNO-IMSS; MéxicoFil: Morgan-Villela, Gilberto. Hospital de Especialidades. CMNO-IMSS; MéxicoFil: Mussetti, Carina. Registro Nacional de Cancer; UruguayFil: Nagai, Maria Aparecida. Instituto de Câncer de São Paulo; BrasilFil: Oceguera-Villanueva, Antonio. Instituto Jalisciense de Cancerologia; MéxicoFil: Reis, Rui M. Hospital de Câncer de Barretos; BrasilFil: Retamales, Javier. Grupo Oncológico Cooperativo Chileno de Investigación; ChileFil: Rodriguez, Robinson. Hospital Central de las Fuerzas Armadas; UruguayFil: Rosales, Cristina, Hospital Municipal de Oncología María Curie; ArgentinaFil: Salas-Gonzalez, Efrain. Hospital San José; ChileFil: Segovia, Laura. Hospital Barros Luco Trudeau; ChileFil: Sendoya, Juan M. CONICET. Fundación Instituto Leloir,; ArgentinaFil: Silva-Garcia, Aida A. OPD Hospital Civil de Guadalajara. Universidad de Guadalajara; MéxicoFil: Viña, Stella. Instituto de Oncología Angel Roffo; ArgentinaFil: Zagame, Livia. Instituto Jalisciense de Cancerologia; MéxicoFil: Jones, Beth. Yale University. Yale School of Public Health; Estados UnidosFil: Szklo, Moysés. Johns Hopkins University. Johns Hopkins Bloomberg School of Public Health; Estados Unido