Breast cancer and smoking: A comparison of 955 breast cancer patients according to their smoking status

Aim and objective Smoking is among the risk factors of breast cancer. The aim of this study was to compare breast cancer patients’ characteristics according to their smoking status. Methods This study is a retrospective evaluation of all breast cancer patients treated at the General Surgery Department of University of Health Sciences, Izmir Bozyaka Research and Training Hospital, between 1982 and 2018. A total of 1459 breast cancer patients’ charts were reviewed and 955 contained data on smoking and were included in this study. There patients were classified as ever versus never smokers. Pack-years data was available for 32.3% or ever smokers. Chi square, t test, Spearman’s correlation, Kaplan Meierand Cox Regression were used for analyses. Results Among the 955 breast cancer patients, 30.5% (n=291) were ever- and 69.5% (n=664) never smokers. According to years of diagnosis, the ratio of smokers was significantly increasing with 21.6% before 2000, 21.9% in 2000-2004, 31.1% in 2005-2009, 32.1% in 2010-2014 and 41.5% in 2015-2018 (p trend <0.001). Ever smokers were diagnosed at a younger age (49.9±11.8 vs.54.1±13.5, p<0.001). This was not confounded by year of diagnosis, since age at diagnosis significantly increased with increasing year of diagnosis (r=0.161, p<0.001). ER positivity was higher among ever smokers (70.5% vs.63.2%, p=0.040) and with significant changes according to pack-year groups.No difference was found in PR positivity, mean CEA, ER%, PR%, p53%, Ki67% values and number of positive sentinel or axillary lymph nodes of ever and never smokers, while the mean CA15-3 values were significantly lower among ever smokers (17.4±10.1 vs.24.5±27.8, p<0.001). Never smokers had a higher ratio of metastasis overall (19.5% vs.13.7%, p=0.040) and among sites, of bone metastasis (12.7% vs.6.8%, p=0.039). After adjustment for age at diagnosis, there was no significant difference in mean overall survival of ever and never smokers. Conclusions Among breast cancer patients, ever smokers are diagnosed at a younger age compared to never smokers. More detailed evaluations could provide deeper insight in smoking-induced breast cancer

Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications

Missing Screw as a Rare Complication of Anterior Cervical Instrumentation

Although anterior cervical arthrodesis is an effective procedure for the treatment of cervical disorders, the method has some complications. Here, we describe this rare complication of cervical instrumentation with a literature review. A 23-year-old male patient was operated for a C6-C7 dislocation. At postoperative month 10, he presented with hemoptysis and dysphagia. Cervical roentgenograms showed anterior migrations of one broken screw and a plate-locking screw at the C6 corpus. One screw was missing. We concluded that the missing screw had perforated the esophagus and had been eliminated spontaneously through the gastrointestinal tract. No screw should migrate. Even loose screws should be noted in follow-up X-ray studies. If such findings are detected, a second operation for revision should be considered as soon as possible to prevent potentially fatal complications

Molecular Classification ofBreast Carcinoma From Traditional Old fashioned Way to a new age and a new way Review

Breast carcinoma comprises a group of diseases with specific clinical, histopathologic and molecular properties. Traditional classification use morphology to divide tumors into separate categories with differing behavior and prognosis. However, there are limitations of traditional classification systems, and new molecular methods are expected to improve classification systems. Molecular subtypes of breast carcinomas have been characterized in the last 11 years, and have been studied extensively. Much of the information accumulated in recent years, and molecular taxonomy seems to be still developing and undergoing change. The main question is whether new molecular techniques such as gene expression profiling will be accepted as gold standard in determining breast cancer subtypes, and whether molecular classification is useful in specific subtypes of breast cancer as it is in ductal carcinoma (nonspecific type). In addition, critical review of the literature reveals major problems such as poor definition, lack of reproducibility and lack of quality control in current molecular techniques and classifications. Therefore, current molecular approaches are not yet used in routine clinical practice and treatment guidance since they are immature and can even lead to incorrect assessment

Can the ratio of metastatic to examined lymph nodes (N ratio) be used as an independent prognostic factor in patients with gastric cancer? Is the hypothetical TRM (tumor-ratio-metastasis) staging system an alternative to the TNM (tumor-node-metastasis) staging system?

Aim: Lymph node metastasis is the most important prognostic factor in patients with gastric cancer. However, lymph node classification is controversial. We reported the prognostic factors of gastric cancer and the impact of N ratio classification in predicting prognosis and the suitability of TRM classification as an alternative to TNM(tumor-node-metastasis) classification for lymph nodes to avoid stage migration in gastric cancer

Molecular Classification of Breast Carcinoma: From Traditional, Old-Fashioned Way to A New Age, and A New Way

Breast carcinoma comprises a group of diseases with specific clinical, histopathologic and molecular properties. Traditional classification use morphology to divide tumors into separate categories with differing behavior and prognosis. However, there are limitations of traditional classification systems, and new molecular methods are expected to improve classification systems. Molecular subtypes of breast carcinomas have been characterized in the last 11 years, and have been studied extensively. Much of the information accumulated in recent years, and molecular taxonomy seems to be still developing and undergoing change. The main question is whether new molecular techniques such as gene expression profiling will be accepted as gold standard in determining breast cancer subtypes, and whether molecular classification is useful in specific subtypes of breast cancer as it is in ductal carcinoma (nonspecific type). In addition, critical review of the literature reveals major problems such as poor definition, lack of reproducibility and lack of quality control in current molecular techniques and classifications. Therefore, current molecular approaches are not yet used in routine clinical practice and treatment guidance since they are immature and can even lead to incorrect assessment

Prognostic Value of Receptor Change After Neoadjuvant Chemotherapy in Breast Cancer Patients

Objective: The aim of this study was to investigate the relationship between hormone receptors (HR) and human epidermal growth factor receptor 2 (HER-2) discordance with prognosis, before and after neoadjuvant chemotherapy (NAC) in breast cancer patients. Materials and Methods: Histopathological data of 142 breast cancer patients attending a single center between 2001 and 2018 and were operated after NAC were evaluated retrospectively. Results: The median (range) age of patients was 58 (32-69) years. In patients who underwent Tru-cut biopsy before NAC, 77 patients were ER+, 30 were ER (-), 73 were PR (+), 33 were PR-, 14 were HER-2 (+), and 94 patients were HER-2 (-). In terms of ER change, five patients were found to have changed status and 85 had no receptor change. The mean overall survival of patients with receptor changes was 31 months against 60 months in patients with no receptor changes, which was not significant (p = 0.351). In sub-group analysis of patients undergoing receptor change, the ER (+) -> 0 (-) group had significantly shorter survival (p = 0.003). For PR change, mean survival was 38 months in seven patients with a receptor change and 59 months in 87 patients without a receptor change, which was not significant (p = 0.603). Sub-group analysis of PR status change showed that survival was significantly shorter in the PR (+) -> 0 (-) group (p = 0.012). Conclusion: These results suggest there is a need for reassessment of HR and HER-2 status in surgical samples from patients following NAC, and that NAC-induced changes in the HR state may be used as a prognostic factor

Molecular subtyping of breast cancer patients with long time follow up and its prognostic value on survival: a single center analysis

The importance of molecular subtyping in breast cancer is an unresolved issue. In this study we aimed to evaluate the significance of molecular subtyping, and the correlation between the disease-free, and overall survival in breast cancer based on molecular subtypes. A total of 536 patients with the diagnosis of breast cancer between the years 1980 and 2014 were included in the study. Tumors were divided into five molecular subtypes according to their expression profiles as follows: Luminal A: (n=220; 41%); Luminal B: (n=72; 13.4%); Luminal B-like: (n=97, 18.1%); HER2: (n=44; 8.2%); and Triple-negative (n=103; 19.2%). We found significant differences between molecular subtypes, and histological subtype of the tumor (P=0.004) in terms of local recurrence (P=0.043), and metastasis (P=0.006). A statistically significant difference was found between the number of metastases, and molecular subgroups. (P=0.037). Among all molecular subtypes, local recurrences (11.4%), and metastasis (38.6%) were most frequently seen in the HER2 subtype, while the least number of metastases (15.3%) were detected in the Luminal A subtype. A statistically significant difference was found between Luminal A, and HER2 subgroups as for incidence of metastatic lesions (P=0.007). However in the Luminal A subgroup metastases developed in the long term (at the end of 50 months after onset of the disease). Overall, and disease-free survival curves in the Luminal A subgroup indicated risk of mortality in the long run. Based on molecular subtyping the worst, and the most favourable survival rates were observed in the HER2, and Luminal A subgroups, respectively. Impact: In this study which encompassed multiple number of breast cancer patients encountered within 30 years, HER2 tumors had the worst survival rates Interestingly, Luminal A subgroup which displayed a very favourable prognosis during the early stage of the follow-up period, demonstrated a bad prognosis in the long term