Obstetric and Neonatal Outcomes 1 or More Years After a Diagnosis of Breast Cancer

OBJECTIVE:To evaluate obstetric and neonatal outcomes of the first live birth conceived 1 or more years after breast cancer diagnosis.METHODS:We performed a population-based study to compare live births between women with a history of breast cancer (case group) and matched women with no cancer history (control group). Individuals in the case and control groups were identified using linked data from the California Cancer Registry and California Office of Statewide Health Planning and Development data sets. Individuals in the case group were diagnosed with stage I-III breast cancer at age 18-45 years between January 1, 2000, and December 31, 2012, and conceived 12 or more months after breast cancer diagnosis. Individuals in the control group were covariate-matched women without a history of breast cancer who delivered during 2000-2012. The primary outcome was preterm birth at less than 37 weeks of gestation. Secondary outcomes were preterm birth at less than 32 weeks of gestation, small for gestational age (SGA), cesarean delivery, severe maternal morbidity, and neonatal morbidity. Subgroup analyses were used to assess the effect of time from initial treatment to fertilization and receipt of additional adjuvant therapy before pregnancy on outcomes of interest.RESULTS:Of 30,021 women aged 18-45 years diagnosed with stage I-III breast cancer during 2000-2012, 553 met the study inclusion criteria. Those with a history of breast cancer and matched women in the control group had similar odds of preterm birth at less than 37 weeks of gestation (odds ratio [OR], 1.29; 95% CI 0.95-1.74), preterm birth at less than 32 weeks of gestation (OR 0.77; 95% CI 0.34-1.79), delivering an SGA neonate (less than the 5th percentile: OR 0.60; 95% CI 0.35-1.03; less than the 10th percentile: OR 0.94; 95% CI 0.68-1.30), and experiencing severe maternal morbidity (OR 1.61; 95% CI 0.74-3.50). Patients with a history of breast cancer had higher odds of undergoing cesarean delivery (OR 1.25; 95% CI 1.03-1.53); however, their offspring did not have increased odds of neonatal morbidity compared with women in the control group (OR 1.15; 95% CI 0.81-1.62).CONCLUSION:Breast cancer 1 or more years before fertilization was not strongly associated with obstetric and neonatal complications

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Use of Ki-67 in residual disease following preoperative chemotherapy to predict of recurrence and death in breast cancer patients.

none9Background: The achievement of a pathologic complete response (pCR) after preoperative chemotherapy (PCT) is a powerful predictor of long term outcome, while the prognosis in case of less than pCR is heterogeneous. In two independent studies, posttherapy ki67 was a significant predictor of outcome in breast cancer (BC) patients with residual disease after PCT. The aim of the present study was to evaluate the prognostic significance of posttherapy Ki-67 in an independent patient cohort. Methods: Patients with residual disease following PCT and with posttherapy Ki-67 evaluation by IHC were identified by searching the Breast Medical Oncology database. Patient characteristics including clinical stage, hormone receptors and HER2 status, type of chemotherapy and nodal status after PCT were recorded. The 15% cut-off to define high posttherapy Ki-67 was selected from our previous study (Guarneri, Ann Oncol 2009). Survival rates were estimated with the Kaplan-Meier method; hazard ratios (HRs) by Cox model. Results: Ninety-four patients were included. Median age was 48 years. 69% of the patients had clinical stage I-IIB BC. According to the expression of ER, PgR, and HER2, tumors were classified in the following subtypes: hormone receptor positive/HER2 negative (58%), HER2 positive (18%), and triple receptor negative (18%). All the patients received anthracycline-taxane-containing PCT. The mean posttherapy Ki-67 was 27%. In univariate analyses, clinical stage at diagnosis, posttherapy Ki-67 and BC subtypes were significantly associated with disease-free and overall survival. In multivariate analyses, the HRs for relapse were 6.7 in case of clinical stage III (p < 0.001), 2.9 in case of triple negative disease (p = 0.017), and 6.8 in case of high posttherapy Ki-67 (p < 0.001). The HRs for death were 4.4 in case of clinical stage III (p = 0.005), 3.6 in case of triple negative disease (p = 0.004), and 2.7 in case of high posttherapy Ki-67 (p = 0.026). Conclusions: High posttherapy proliferation is confirmed as an independent predictor of disease-free and overall survival in BC patients with residual disease after PCT.noneV. Guarneri; M. Chavez-Mac Gregor; L. Hsu; W. F. Symmans; J. K. Litton; E. A. Mittendorf; P. F. Conte; G. N. Hortobagyi; A. M. Gonzalez-AnguloGuarneri, Valentina; M., Chavez Mac Gregor; L., Hsu; W. F., Symmans; J. K., Litton; E. A., Mittendorf; Conte, Pierfranco; G. N., Hortobagyi; A. M., Gonzalez Angul