The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model

To study whether the effects of prognostic factors associated with the occurrence of distant metastases (DM) at primary diagnosis change after the incidence of loco-regional recurrences (LRR) among women treated for invasive stage I or II breast cancer. The study population consisted of 3,601 women, enrolled in EORTC trials 10801, 10854, or 10902 treated for early-stage breast cancer. Data were analysed in a multivariate, multistate model by using multivariate Cox regression models, including a state-dependent covariate. The presence of a LRR in itself is a significant prognostic risk factor (HR: 3.64; 95%-CI: 2.02-6.5) for the occurrence of DM. Main prognostic risk factors for a DM are young age at diagnosis (</=40: HR: 1.79; 95%-CI: 1.28-2.51), larger tumour size (HR: 1.58; 95%-CI: 1.35-1.84) and node positivity (HR: 2.00; 95%-CI: 1.74-2.30). Adjuvant chemotherapy is protective for a DM (HR: 0.66; 95%-CI: 0.55-0.80). After the occurrence of a LRR the latter protective effect has disappeared (P = 0.009). The presence of LRR in itself is a significant risk factor for DM. For patients who are at risk of developing LRR, effective local control should be the main target of therapy

Implications of Extreme Life Span in Clonal Organisms: Millenary Clones in Meadows of the Threatened Seagrass Posidonia oceanica

The maximum size and age that clonal organisms can reach remains poorly known, although we do know that the largest natural clones can extend over hundreds or thousands of metres and potentially live for centuries. We made a review of findings to date, which reveal that the maximum clone age and size estimates reported in the literature are typically limited by the scale of sampling, and may grossly underestimate the maximum age and size of clonal organisms. A case study presented here shows the occurrence of clones of slow-growing marine angiosperm Posidonia oceanica at spatial scales ranging from metres to hundreds of kilometres, using microsatellites on 1544 sampling units from a total of 40 locations across the Mediterranean Sea. This analysis revealed the presence, with a prevalence of 3.5 to 8.9%, of very large clones spreading over one to several (up to 15) kilometres at the different locations. Using estimates from field studies and models of the clonal growth of P. oceanica, we estimated these large clones to be hundreds to thousands of years old, suggesting the evolution of general purpose genotypes with large phenotypic plasticity in this species. These results, obtained combining genetics, demography and model-based calculations, question present knowledge and understanding of the spreading capacity and life span of plant clones. These findings call for further research on these life history traits associated with clonality, considering their possible ecological and evolutionary implications

Complications of Axillary Lymph Node Dissection in Treatment of Early Breast Cancer: A Comparison of MRM and BCS

ALND is part of primary management of breast cancer. In spite of complications it causes, its use in prognostication and planning adjuvant treatment in carcinoma breast is unquestioned. Prospective study was conducted on 100 patients of EBC [clinical stage I&II]. 50 underwent MRM, 50 WLE&AC. Patients were asked to rate on likert scale various symptoms on follow up. Multivariate regression analysis was carried out between pain, numbness, limitation of shoulder or arm motion, arm swelling, infection and age, BSA, clinical status of axilla, no. of LNs removed, no. of positive LNs, co-morbidities, chemotherapy, radiotherapy, hormone therapy, type of surgery. 60% patients reported one or more symptoms. Numbness, pain were reported by 39% each, arm swelling by 25%, limitation of arm movement by 16%, infection by 11%. Symptoms were mild in majority. On regression analyses numbness was associated with EBRT, co-morbidity, type of operation (p value- <0.01, <0.01, <0.05), pain had no significant association, swelling with EBRT, no. of LNs positive for metastases, co-morbidity, type of operation (p value- <0.01, <0.05, <0.05, <0.01), limitation of arm motion with no. of positive LNs (p value < 0.01), infection with no. of positive LNs, co-morbidity (p value <0.05, <0.05). There was no statistically significant difference in reporting of symptoms by patients in two groups. ALND caused morbidity in majority of patients but few reported severe symptoms and interference with daily activities