Expressão da proteina p53 como indicadora da resposta a quimioterapia primaria do carcinoma mamario : estudo clinico e correlação com tamanho tumoral, grau nuclear e receptor de estrogeno

Orientadores: Luiz Carlos Teixeira, Maria Salete Costa GurgelTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasDoutorad

Associação de status menopausal, expressão de receptor de progesterona e de Ki67 à resposta clínica à quimioterapia neoadjuvante no câncer luminal de mama

To identify the biomarkers of response to neoadjuvant chemotherapy in early luminal breast cancer. Methods A cross-sectional study that included all patients with early or locally-advanced luminal breast cancer submitted to neoadjuvant chemotherapy between 2013 and 2014. Demographic, clinic and pathologic data were retrieved from patient records. The expressions of the estrogen receptor (ER), the progesterone receptor (PR), and Ki67 were analyzed by immunohistochemistry (IHC). The status of the human epidermal growth factor receptor 2 (HER2) was evaluated by IHC and fluorescent in situ hybridization (FISH). Independent predictors of clinic and pathologic response were evaluated by stepwise logistic regression models and receiver operating characteristic (ROC) curve analysis. Results Out of 298 patients identified, 115 were included in the analysis. Clinical complete response (cCR) was observed in 43.4% of the patients (49/113), and pathologic complete response (pCR) was observed in 7.1% (8/115) of the patients. The independent predictors of cCR were premenopausal status (p 50%; p = 0.048), and Ki67 expression >= 14% (versus 50%; p ¼ 0.048), e expressão de Ki67 14% (versus < 14%; p ¼ 0.01). Pacientes com RCc apresentaram maior probabilidade de serem submetidas a cirurgia conservadora da mama (34.7% versus 7.8%; p < 0.001). Aumento no ponto de corte para expressão de Ki67 foi associado a aumento da especificidade e redução da sensibilidade na identificação de pacientes com RCc. Conclusão Status premenopausal, baixa expressão de RP e maior expressão de Ki67 estiveram associados a maior taxa de RCc à quimioterapia neoadjuvante no câncer luminal de mam

Anaphylactic reaction to patent blue dye during sentinel lymph node biopsy in early-stage breast cancer: a case report

Sentinel lymph node biopsy in the treatment of breast cancer has been replacing lymph node resection in early cases. This treatment may be performed with blue dye and/or radiopharmaceuticals. There are reports of allergic reactions to blue dye with different degrees of severity. A case of severe anaphylactic reaction after intradermal injection of patent blue dye was reported in a patient diagnosed with ductal carcinoma in situ. The patent blue dye facilitates the detection of the sentinel lymph node, but there is the risk of triggering anaphylactic reactions. It is recommended the team involved to be very knowledgeable and prepared to diganose and treat this complication.A biópsia do linfonodo sentinela no tratamento do câncer de mama vem substituindo a linfadenectomia em casos iniciais. Este tratamento pode ser realizado com o corante azul vital e/ou radiofármaco. Há relatos de reações alérgicas ao corante com diferentes graus de severidade. Relata-se um caso de reação anafilática severa após injeção intradérmica do corante azul patente, em paciente com diagnóstico de carcinoma ductal in situ. O corante azul patente, apesar de facilitar a detecção do linfonodo, apresenta risco de desencadear reações anafilactóides. É necessário que a equipe envolvida tenha preparo para diagnosticar e tratar esta complicação.72873

Efeito da quimioterapia primaria no carcinomade mama com diametro entre 21 e 50mm : avaliação clinica, mamografica e anatomopatologica

Orientador: Kazue PanettaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: O carcinoma de mama cujo maior diâmetro seja de 21 a 50mm é considerado um tumor potencialmente operável. Pela rotina do atual protocolo de tratamento, estes casos são submetidos inicialmente a uma terapêutica cirúrgica, na maioria das vezes mastectomia radical, seguida de tratamento quimioterápico adjuvante. A partir do final da década de 80, surgiram alguns ,estudos utilizando para estes casos o tratamento quimioterápico primário prévio à cirurgia, com o intuito de iniciar precocemente a terapêutica sistêmica no combate às micrometástases, bem como, em se obtendo a redução local do tumor, de permitir a realização de uma cirurgia menos extensa. Este estudo é clínico, experimental e prospectivo, realizado em 30 pacientes atendidas no Ambulatório de Patologia Mamária da Universidade Estadual de Campinas e que apresentavam carcinoma da mama medindo entre 21 e 50mm ao exame mamográfico. . Teve como objetivo avaliar o efeito da quimioterapia primária no tamanho tumoral ao exame clínico e mamo gráfico, e de acordo com algumas variáveis: estado menstrual, receptor estrogênico, grau histológico, grau nuclear e tamanho inicial do tumor. Os resultados mostraram que a quimioterapia primária promoveu uma redução maior que 25% do volume tumoral em mais de 60% das pacientes e uma redução total em 3,3 %, porém nenhuma das variáveis estudadas influenciou significativamente a redução tumoral. Após o tratamento quimioterápico, a avaliação do tamanho tumoral através da mamografia foi mais concordante com o tamanho patológico do que o exame clínicoAbstract: The carcinoma of the breast whose largest diameter is between 21mm and 50mm is considered a potentially operable tumor. Nowadays , the routine protocol of treatment consists of an initial surgical procedure, generally a radical mastectomy, followed by adjuvant chemotherapy. Since the late eighties some studies have arisen using the primary chemotherapy prior the surgery for i these cases, with the purpose of to early start the systemic therapy against the micrometastasis and to achieve a less extensive surgical procedure through the reduction of the tumor. This is a clinical, experimental and prospective study performed in thirty patients cared at the Breast Disease Outpatient Clinic of University of Campinas, who presented mammary carcinoma measuring from 21mm to 50 mm by mammographyc exam. The objective was to evaluate the effect of the primary chemothert;lpy on the tumor size through both the clinical and mammographyc examinatión, according to some variables: menstrual status, estrogenic receptor, histologyc grade, nuclear grade and initial size of tumor. The results showed that the primary chemotherapy promoted a reduction of tumor volume larger than 25% in more of 60% of these patients and a complete reduction in 3.3%, although none of these variables studied was significantly associated with the tumor reduction. After the primary chemotherapy, the evaluation of tumor size through mammography was more agreeable with real pathological measure than through clinical examinationDoutoradoTocoginecologiaMestre em Ciências Médica

Downstaging in opportunistic breast cancer screening in Brazil: a temporal trend analysis

Breast cancer is the most common female cancer in Brazil with an estimated 60 thousand new cases per year. Widespread use of mammography opportunistic screening has been observed in the last 20years, including women under 50years old. The present study aimed to analyse the trends in breast cancer stage distribution at diagnosis as a function of age in the study period.MethodsThis paper examined temporal trends of stage distribution in women with breast cancer diagnosed between 2000 and 2015 in SAo Paulo state, Brazil. Data from the Hospital Cancer Registry of the region were utilized. Completeness was high. The sample was described according to age, stage and date of diagnosis using absolute frequency and proportions (%). For trends, the Cochran-Armitage test was used with a 5% level of significance (P-value<0.05).ResultsA total of 93,674 women were included in the analysis with a median age of 56years old. One-third (34.4%) of the women were younger than 50years old, and stage II was the most frequent stage (36.4%), even when analysed by age groups. Stage 0 corresponded to 7.7% (7247 women) of cases. In the study period, there was a significant trend towards an increase in Stages 0, I and IV (P<0.01) and a trend towards a decrease in Stages IIA, IIB and IIIB (P<0.001). Stage IIA was more prevalent until 2009, and stage I was more prevalent thereafter. The trends to increase the proportion of Stages 0 and I and to decrease the proportion of stages IIA, IIB and IIIB were significant in all age groups.ConclusionsBreast cancer cases are diagnosed mainly at early stages, and approximately one-third of cases are younger than 50years old. Downstaging has been shown. Opportunistic screening may have supported these results. Further studies are needed to show whether these results will impact the prognosis.19FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2017/21908-

Clinical and pathological implications of GSTM1 and GSTT1 gene deletions in sporadic breast cancer

There is a lack of consensus about the influence of GST M1/T1 gene deletions (DEL) on sporadic breast cancer (SBC). To evaluate the occurrence of DEL in 177 SBC cases and in 169 controls, and compare clinical and biological characteristics. A lower frequency of GSTM1 DEL was observed in mulatto women, OR=0.48 (0.24–0.98). The risk of nuclear grade 3 tumors (GN3) was lower in patients with GSTT1 DEL, OR=0.37 (0.15–0.90). DEL of at least one gene (ALOG) was associated with women who had not breastfed, OR=0.41 (0.19–0.88), and with negative hormone receptor, HR–, ORadj=2.25 (1.03–4.90). Both genes deleted (BGD) was associated with non-classic invasive ductal carcinoma (NCDC), ORadj=12.09 (1.03–142.03). Mulatto women with SBC had a lower frequency of GSTM1 DEL, while tumors differentiated were related to GSTT1 DEL. HRtumors were related with DEL ALOG, and the BGD was associated with a greater risk of NCDC