In situ ductails emlőcarcinoma kombinált sebészi- és sugárkezelése: Multicentrikus prospektív randomizált vizsgálat = Combined surgical and radiotherapy treatment of ductal carcinoma in situ of the breast: Multicentric prospective randomized study

289 duktális in situ emlőrák (DCIS) miatt emlőmegtartó műtéttel kezelt beteget randomizáltunk a lokális recidíva szempontjából meghatározott rizikó csoportok szerinti besorolás után. Immunhisztokémiai (IHK) módszerrel vizsgáltuk a lehetséges molekuláris prognosztikai markerek (ER, PR, Her2, p53, Bcl2 és Ki-67) expresszióját. A pozitív IHK reakció a Her2 (38%), p53 (36%) és Ki-67 (47%) markereknél a nukleáris grade-del korrelált. Ezzel szemben az ER (77%), PR (67%) és Bcl2 (67%) pozitivitás szignifikáns inverz összefüggésben volt a grade-del. A klinikai eredményeket 3 éves medián követési idő után 278 betegnél elemeztük. A magas rizikójú betegcsoportban emlőmegtartó műtét és sugárkezelés után 4 (1,7%) lokális recidíva és 1 (0,4%) távoli áttét alakult ki, emlődaganatos haláleset nem volt. A helyi daganatkiújulás 3 és 5 éves valószínűsége 1,1% és 3,1% volt. Tapasztalataink alapján a DCIS egyértelmű diagnózisa esetén az őrszem nyirokcsomó biopszia rutinszerű elvégzése nem indokolt. Korai eredményeink alapján az emlő DCIS kezelésében az emlőmegtartó műtét és posztoperatív sugárkezelés alkalmazásával a helyi daganatkiújulás éves aránya 1% alatt marad. A tumorágy "boost" kezelés hatékonyságának megítélésére és a vizsgált molekuláris markerek prognosztikai/prediktív értékének elemzésére hosszabb követési idő után lesz lehetőségünk. A molekuláris prognosztikai faktorok IHK vizsgálata segítségünkre lehet a DCIS biológiai heterogenitásának feltérképezésében. | 289 patients with ductal carcinoma in situ (DCIS) treated by breast-conserving surgery were randomised according to predetermined risk groups. Immunohistochemistry (IHC) was performed to detect the expression of potential molecular prognostic markers (ER, PR, Her2, p53, Bcl2, and Ki-67). The positive immunostaining for Her2 (38%), p53 (36%), and Ki-67 (47%) correlated with a high nuclear grade. Significant inverse correlation was found between the expression of ER (77%), PR (67%), Bcl2 (67%) and grade. Clinical results was analysed for 278 patients at a median follow-up of 36 months. In the high-risk patient group 4 (1.7%) local recurrences and 1 (0.4%) distant metastasis occurred. No patient died of breast cancer. The 3- and 5-year probability of local recurrence was 1.1% and 3.1%, respectively. Based on our experience, the definitive diagnosis of DCIS does not warrant sentinel lymph node biopsy. Preliminary results suggest that breast-conserving surgery followed by radiotherapy yields an annual local recurrence rate of less than 1% in patients with DCIS. Further follow-up is needed to define the clinical benefit of tumour bed boost irradiation and to analyse the prognostic/predictive value of molecular prognostic factors. IHC of molecular prognostic markers can assist to gain insight into the biologic heterogeneity of DCIS

Nem tapintható emlődaganatok sebészi kezelése

METHOD: Between 1997 and 2000 the authors performed 110 fine-wire localized breast biopsies in patients with nonpalpable suspicious lesions. RESULTS: 108 target lesions (98.1%) were accurately excised during the initial surgery. Overall, 56 lesions were malignant, among these cases 50 invasive carcinomas and 6 DCIS were found. Breast conservation was achieved in 48 patients (88.5%), simple mastectomy with axillary lymph node sampling was performed in 8 cases. 86% of the invasive malignant lesions belonged to the good prognostic subgroup of the Nottingham Prognostic Index. CONCLUSION: There in an importance of the close cooperation between radiologist, surgeon, pathologist and oncologist in the treatment of nonpalpable preclinical breast carcinomas

Elevated levels of circulating insulin-like growth factor-I, IGF-binding globulin-3 and testosterone predict hormone-dependent breast cancer in postmenopausal women: a case-control study

There is increasing evidence that different types of breast cancers are related to distinct risk factors. We analyzed the risk of breast cancer with respect to circulating insulin-like growth factor (IGF)-I, IGF-binding protein (IGFBP)-3, 17beta-estradiol, estrone, testosterone, androstenedione and sex hormone-binding globulin (SHBG), taking into consideration the characteristics of the tumors. Plasma hormone levels of 102 postmenopausal patients with breast cancer detected by mammography screening, and 102 matched controls were analyzed in relation to the histological type, the status of the estrogen receptor (ER), the progesterone receptor (PR) and the HER2 in the tumors. Significant positive associations were revealed between the IGF-I concentration and the overall risk of breast cancer (OR=3.1, 95% CI: 1.5-6.2), ER+PR+ breast cancer (OR=2.4, 95% CI: 1.1-5.4) and ER+PR- breast cancer (OR=4.3, 95% CI: 1.2-14.3) when the highest and the lowest ranges of IGF-I were compared. Significant associations were also found between the highest and the lowest quartiles of testosterone, resulting in OR=4.1 (95% CI: 1.8-9.4) for the risks of breast cancer and OR=5.8 (96% CI: 2.1-16.2) of ER+PR+ breast cancer. A synergy was seen between IGF-I and testosterone levels. When both plasma IGF-I and testosterone were in the highest quartile ranges, an OR=26.4 (95% CI: 1.6-426.5, p=0.021) was computed for breast cancer overall. No significant synergistic effects could be demonstrated with other parameters. There were significant, 2.5-fold (95% CI: 1.2-5.6), and 16-fold (95% CI: 2.0-133.5) increases in the overall risks of breast cancer and of ER+PR- breast cancer, respectively, when the highest and the lowest quartiles of IGFBP-3 were compared. No associations were found between any of the hormones and the risk of ER-PR- tumors. The increased prevalence of ER+ breast cancers in patients with higher levels of IGF-I, IGFBP-3 or testosterone implicate these hormones in the etiology of hormone-dependent breast cancer. Additional analyses specific for breast cancer subtypes may shed light on the value of hormone determinations for tailored chemoprevention

Chlamydia pneumoniae exacerbates aortic inflammatory foci caused by murine cytomegalovirus infection in normocholesterolemic mice

Inflammatory foci induced by murine cytomegalovirus infection in normocholesterolemic mice were present temporarily in the aortic wall, but some of these foci developed into advanced lesions that persisted late after infection. The early foci induced by virus infection were significantly exacerbated following a single inoculation with Chlamydia pneumoniae