Chance Of Long-term Survival Research Articles

Use of adrenaline in cardiac arrest - impact on survival to discharge from the hospital

Introduction and objective: Epinephrine is the most important and primary drug that resuscitation team use to reverse cardiac arrest. The provision of epinephrine is currently suggested by both the American Heart Association and the European Resuscitation Council. It is vital to improving the return of spontaneous circulation (ROSC), however the evidence for the use of adrenaline in resuscitation is inconclusive.
 Materials and methods: The literature was reviewed in the Pubmed database, in the Via Medica Journals database, and in the guidelines of the Polish Society of Anesthesiology, European Resuscitation Council and the American Heart Association with the use of keywords.
 State of knowledge: There is a clear evidence of an association between epinephrine and increased return of spontaneous circulation (ROSC). Its action is based on stimulation of alpha- and beta-adrenergic receptors. Epinephrine have a role in resuscitation, during CPR it increases the probability of restoring cardiac activity with pulses, which is intermediate step toward long-term survival. However, there are conflicting results regarding long-term survival and functional recovery, particularly neurological outcome.
 Conclusions: Research shows that epinephrine administration in patients with cardiac arrest increases the chance of restoring spontaneous circulation and patient survival to hospital admission and discharge. However, there are arguments questioning the validity of using epinephrine in resuscitation. Publications show that the compound contributes to post-resuscitation syndrome, which reduces a patient's chance of long-term survival. There are a number of conflicting studies that vary widely in the results presented. The current evidence is insufficient to either confirm or exclude the efficacy of epinephrine, which is why it is still recommended in the latest resuscitation guidelines by the European Resuscitation Council (ERC 2021) and the American Heart Association (AHA 2020).

Time intervals to care and health service use experiences of uninsured cancer patients treated under public financing in Mexico City

BackgroundThe present study assesses the time intervals from symptom discovery to treatment start and describes the health service use experiences of uninsured patients with cancer of the breast, cervix uteri, testicle, and prostate before their arrival to the cancer hospital. MethodsThis cross-sectional study included 1468 patients who were diagnosed between June 2016 and May 2017 and received treatment for the selected cancers in two of the largest public cancer hospitals in Mexico City, financed through Seguro Popular. Data was collected through a survey administered via face-to-face interviews with patients and a review of their medical files. ResultsThe median time between detection (symptom discovery or first abnormal screening test) and treatment start was 6.6 months. For all types of cancer, the longest interval was the diagnostic interval –between the first use of healthcare services and the confirmation of cancer. Less than 20% cancer patients were diagnosed in the earliest stages that are associated with the best chances of long-term survival. The participants described a high use of private services for their first consultation, the use of several different types of health services and multiple consultations before arrival to the cancer centers, and 35% perceived being misdiagnosed by the first doctor they consulted. ConclusionsMost cancer patients treated in the two largest public institutions available for the uninsured faced long delays to get diagnosed and started treatment at advanced stages. Strengthening quality and access for effective early cancer diagnosis and treatment is key to improve patient outcomes in low and middle-income settings.

Combination of bendamustine-azacitidine against Syk target of breast cancer: an in silico study

Breast cancer (BC) is the most serious and second leading cause of death in women worldwide. When breast cancer is diagnosed and treated early, the chance of long-term survival is up to 90%. On the other hand, 90% of BC patient deaths are due to metastasis and a lack of effective early diagnosis. The existing conventional chemotherapy provides negative feedback due to transportation barriers towards the action sites, multidrug resistance, poor bio-availability, non-specific delivery and systemic side effects on the healthy tissue. Syk protein Kinase has been reported in BC, as a tumor modulator, providing a pro-survival signal and also by restricting epithelial-mesenchymal transition, enhancing cell-cell interactions and inhibiting migration. In the present study, we explored the possibility of targeting BC by attenuating Syk protein Kinase. Hence, we have conjugated the hydrophobic Bendamustine (BEN) and hydrophilic Azacitidine (AZA) anticancer drugs to evaluate their efficacy against BC. The native drugs (BEN and AZA) and designed drug-drug conjugate (BEN-AZA) were docked with Syk protein. Then, the docked complex was performed for Binding Free Energy and Molecular Dynamics Simulations. Furthermore, DFT and ADME properties were carried out. The results revealed that the designed drug-drug conjugate has a better docking score, ΔGbind and admirable stability throughout the simulation when compared with native drugs. In DFT and ADME analyses, the designed drug-drug conjugate has shown good stereo electronic features and pharmaceutical relevant parameters than that of native drugs. The overall results suggested that the designed drug-drug conjugate may be a suitable candidate for BC treatment.Communicated by Ramaswamy H. Sarma

Optical coherence tomography combined with convolutional neural networks can differentiate between intrahepatic cholangiocarcinoma and liver parenchyma ex vivo

PurposeSurgical resection with complete tumor excision (R0) provides the best chance of long-term survival for patients with intrahepatic cholangiocarcinoma (iCCA). A non-invasive imaging technology, which could provide quick intraoperative assessment of resection margins, as an adjunct to histological examination, is optical coherence tomography (OCT). In this study, we investigated the ability of OCT combined with convolutional neural networks (CNN), to differentiate iCCA from normal liver parenchyma ex vivo.MethodsConsecutive adult patients undergoing elective liver resections for iCCA between June 2020 and April 2021 (n = 11) were included in this study. Areas of interest from resection specimens were scanned ex vivo, before formalin fixation, using a table-top OCT device at 1310 nm wavelength. Scanned areas were marked and histologically examined, providing a diagnosis for each scan. An Xception CNN was trained, validated, and tested in matching OCT scans to their corresponding histological diagnoses, through a 5 × 5 stratified cross-validation process.ResultsTwenty-four three-dimensional scans (corresponding to approx. 85,603 individual) from ten patients were included in the analysis. In 5 × 5 cross-validation, the model achieved a mean F1-score, sensitivity, and specificity of 0.94, 0.94, and 0.93, respectively.ConclusionOptical coherence tomography combined with CNN can differentiate iCCA from liver parenchyma ex vivo. Further studies are necessary to expand on these results and lead to innovative in vivo OCT applications, such as intraoperative or endoscopic scanning.

Pemigatinib for the treatment of myeloid/lymphoid neoplasms with FGFR1 rearrangement

ABSTRACT Introduction Myeloid/lymphoid neoplasms with fibroblast growth factor receptor-1 (FGFR1) rearrangements (MLNFGFR1) are rare entities with aggressive features and poor prognosis. Presentation is heterogeneous, ranging from myeloproliferative neoplasms (with or without eosinophilia) to T-cell lymphoma and acute leukemia. Historical treatments have been guided by the presenting phenotype with induction chemotherapy frequently used. Pemigatinib is a FGFR1–3 tyrosine kinase inhibitor that has demonstrated high complete hematologic and cytogenetic response rates in MLNFGFR1. Areas covered We discuss the pathogenesis, presentation, and historical treatments for MLNFGFR1, in addition to clinical data using pemigatinib and other targeted therapies. Discussion of the mechanism of action and adverse events is also included. Expert opinion Pemigatinib represents a significant advance in the management of MLNFGFR1. High rates of complete hematologic and cytogenetic response have been observed. While direct comparative data are unavailable, outcomes appear favorable compared to conventional approaches. Long-term efficacy and tolerability are not yet known, and allogeneic hematopoietic stem cell transplant (alloHSCT) continues to be the treatment with the highest chance of long-term disease free survival in responding patients. Combinations of pemigatinib and chemotherapy, particularly for more aggressive phenotypes, warrant future investigation as does the use of pemigatinib maintenance following alloHSCT.

Congenital Athymia: Unmet Needs and Practical Guidance.

Inborn errors of thymic stromal cell development and function which are associated with congenital athymia result in life-threatening immunodeficiency with susceptibility to infections and autoimmunity. Athymic patients can be treated by thymus transplantation using cultured donor thymus tissue. Outcomes in patients treated at Duke University Medical Center and Great Ormond Street Hospital (GOSH) over the past three decades have shown that sufficient T-cell immunity can be recovered to clear and prevent infections, but post-treatment autoimmune manifestations are relatively common. Whilst thymus transplantation offers the chance of long-term survival, significant challenges remain to optimise the outcomes for the patients. In this review, we will discuss unmet needs and offer practical guidance based on the experience of the European Thymus Transplantation programme at GOSH. Newborn screening (NBS) for severe combined immunodeficiency (SCID) and routine use of next-generation sequencing (NGS) platforms have improved early recognition of congenital athymia and increasing numbers of patients are being referred for thymus transplantation. Nevertheless, there remain delays in diagnosis, in particular when the cause is genetically undefined, and treatment accessibility needs to be improved. The majority of athymic patients have syndromic features with acute and chronic complex health issues, requiring life-long multidisciplinary and multicentre collaboration to optimise their medical and social care. Comprehensive follow up after thymus transplantation including monitoring of immunological results, management of co-morbidities and patient and family quality-of-life experience, is vital to understanding long-term outcomes for this rare cohort of patients. Alongside translational research into improving strategies for thymus replacement therapy, patient-focused clinical research will facilitate the design of strategies to improve the overall care for athymic patients.

A step-by step guide for autotransplantation of teeth.

Tooth loss is an adverse consequence of oral diseases and traumatic dental injuries. Although several treatment options exist to treat a missing or hopeless tooth, especially in young individuals, most of the existing alternatives (such as orthodontic treatment, removable or fixed partial dentures, and dental implants) impose a challenge in children due to the nature of the developing jaw bones. Tooth autotransplantation is the replacement of a tooth with another functional tooth within the patient's dentition. Autotransplantation can serve as a promising treatment alternative in cases of tooth loss not only in children and adolescents but also in adult patients. Autotransplantation is a technique-sensitive procedure, that requires proper and thorough planning as well as careful and knowledgeable execution in order to improve the chances for long-term success and survival of the transplanted tooth. Thus, the aim of this article was to provide a step-by-step clinical guide, emphasizing key points and highlights for planning and performing a successful autotransplantation procedure. Autotransplantation is a very predictable treatment modality that can serve as a viable option to replace a missing tooth, especially in young patients. Proper planning and careful execution of the procedure are important to achieve optimal long-term results.

Pancreatic head adenocarcinoma – long term survival

Background: Pancreatic cancer is one of most aggressive tumours. Its incidence is rising. Radical surgery is the only chance for long term survival. But most of the patients die shortly (months) after diagnosis. The unsatisfactory results are unfortunately influenced by late diagnosis

Combined robotic hepatectomy & high anterior resection for stage IV CRC at a solo private practice

Background: Colorectal cancer frequently metastasizes to the liver. Limited liver disease can be resected with curative intent. A minimally invasive approach facilitated by the robotic platform offers the opportunity to resect all disease in one operation with minimal morbidity, permitting expeditious administration of adjuvant therapy and the best chance for long term survival.

Planned oesophagectomy after chemoradiotherapy versus salvage oesophagectomy following definitive chemoradiotherapy: a systematic review and meta-analysis.

Oesophageal cancer is the eighth most common cancer and sixth leading cause of cancer-related mortality worldwide. Salvage oesophagectomies are associated with an increased risk of mortality, although recent data suggests that long-term survival rates following salvage oesophagectomy are similar to planned oesophagectomy. The aim was therefore to meta-analyse outcomes for patients undergoing salvage versus planned oesophagectomies to assess the differences in short-term mortality and long-term survival. A systematic review of Medline, Scopus, Web of Science and PubMed was performed to identify relevant studies. Data were extracted and compared by meta-analysis, using odds ratio and mean differences with 95% confidence intervals. Nineteen studies meeting inclusion criteria were included in the meta-analysis, which compared patients in the planned oesophagectomy group (n= 23 555) to patients in the salvage oesophagectomy group (n= 2227). There were significant differences between the groups in terms of rates of postoperative mortality (5.7% salvage oesophagectomy versus 3.1% planned oesophagectomy, P= 0.0004), anastomotic leak (20.6% salvage oesophagectomy versus 14.5% planned oesophagectomy, P< 0.00001), pulmonary complications (37.1% salvage oesophagectomy versus 24.2% planned oesophagectomy, P< 0.0001) and R0 margin (87.6% salvage oesophagectomy versus 91.3% planned oesophagectomy, P< 0.0001). There was no statistical difference between long-term survival rates at 5 years with 39.2% for salvage and 42.6% for planned oesophagectomy (P= 0.28). Salvage oesophagectomies do offer a meaningful chance of long-term survival (at 5 years) for select patients with oesophageal cancer, but the elevated risk of post-operative complications and mortality following salvage oesophagectomy should be recognized.

Surgical Aspects of Intrahepatic Cholangiocarcinoma.

Intrahepatic cholangiocarcinoma (ICC) is a rare and aggressive malignancy. It originates from the bile ducts and is the second most common primary cancer of the liver. Surgery is considered the only curative treatment of ICC, offering the best chance for long-term survival. The purpose of this article is to review the available literature on ICC, with a focus on the various aspects of the surgical care in this potentially lethal malignancy.

Tumor Differentiation is the Dominant Prognostic Factor for Patients with Colorectal Neuroendocrine Neoplasms with Distant Metastasis.

Colorectal neuroendocrine neoplasms (NENs) are rare tumors. The prognosis and prognostic factors of metastatic colorectal NENs have not been fully elucidated. We retrospectively enrolled 77 consecutive patients diagnosed with colorectal NENs with synchronous distant metastases between 2000 and 2021. All patients were assigned to the neuroendocrine tumor (NET) group or the neuroendocrine carcinoma (NEC) group based on histological differentiation. Propensity score matching (PSM) was performed to minimize confounding bias. The Kaplan-Meier method was used to calculate the survival rates. Univariate and multivariate logistic regression analyses were performed to identify prognostic factors. In total, 35 (45.5%) and 42 (54.5%) patients had well-differentiated NETs and poorly differentiated NECs, respectively. The median overall survival (OS) was 26 months for the entire cohort, and the 1-year, 3-year, and 5-year OS rates were 69.4%, 41.4%, and 27.8%, respectively. In the subgroup analysis, the median OS was 62 and 10 months for NETs and NECs, respectively. Univariate analysis demonstrated that patients with a primary tumor located in the colon, ulcerative tumors and poorly differentiated tumors were at higher risk for poorer progression-free survival (PFS) and OS. However, only histological differentiation was identified as an independent factor affecting OS (hazard ratio (HR) = 8.28, 95% confidence interval (CI): 2.98-23.01, P < 0.001) in multivariate analysis. After PSM, histological differentiation was further confirmed as the dominant factor affecting OS (HR = 6.09, 95% CI: 1.96-18.95, P=0.002)). Histological differentiation was the most dominant prognostic factor in patients with metastatic colorectal NENs. Patients with well-differentiated NETs had a good chance of long-term survival.

Treatment of metastatic uveal melanoma

Uveal melanoma is a rare malignancy with a poor prognosis. The risk of metastatic disease (mainly to the liver) exceeds 50% and is often observed many years after the primary treatment. The methods of local surgical treatment of meta­static lesions in the liver provide some chance for long-term survival but are possible in a small percentage of patients. The therapies currently used as a standard for cutaneous melanoma are not as effective in ocular melanoma. The first drug that prolongs the survival of patients is tebentafusp, but its applicability depends on the presence of HLA-A*02: 01 expression.

Effects of Neoadjuvant Radiotherapy on Survival in Patients with Stage IIIA-N2 Non-Small-Cell Lung Cancer Following Pneumonectomy.

Background: Pneumonectomy is a drastic but sometimes inevitable treatment option for patients with non-small-cell lung cancer (NSCLC) to improve their chances for long-term survival. However, the optimal adjuvant radiotherapy used for patients with N2 NSCLC following pneumonectomy remains unclear in the literature. Methods: T1-4N0-2M0 NSCLC patients registered in the Surveillance, Epidemiology, and End Results database were retrospectively analyzed. Propensity score matching was applied to balance the assignment of patients. Cox proportional hazards models and Kaplan−Meier analyses were used to identify the factors related to overall survival rates. Restricted cubic splines were used to detect the possible nonlinear dependency of the relationship between the risk of survival and age. Results: A total of 4308 NSCLC patients were enrolled in this study. In N2 patients, the long-term outcome of the chemotherapy and postoperative radiotherapy groups was the worst (p = 0.014). Subgroup analyses showed that the influence of age on survival outcome was confined to patients who received chemotherapy and neoadjuvant radiotherapy (p = 0.004). Meanwhile, patients >65 years of age who received chemotherapy and neoadjuvant radiotherapy had significantly worse prognoses than those in the chemotherapy group (p = 0.005). Conclusions: Our results show that neoadjuvant radiotherapy may have potential benefits in patients aged ≤ 65 years who are scheduled for pneumonectomy, but not in elderly patients.

Oral Cancer in HSCT Pediatric Patients Arising on GVHD: A Comprehensive Review.

After haematopoietic stem cell transplantation and a history of GVHD, the risk of developing secondary malignancies, including oral cancer, is higher. This risk increases with time post-transplantation; therefore, pediatric patients undergoing HSCT, who have long-term survival chances, are in a high-risk category. The aim of this review is to provide data on HSCT, GVHD, clinical manifestations, histological features and treatment of oral cancer, and outcomes in HSCT pediatric patients, affected by oral GVHD, who have been developed OSCC. Descriptive statistics were used to validate data. Fifteen studies on a total of 33 patients were selected. Data on oral cancer showed that the tongue was the most frequently involved site (13 pts; 39.39%), followed by the floor of the mouth (4 pts; 12.12%), and buccal mucosa (4 pts; 12.12%). Oral squamous cell carcinoma was the histological feature reported. There were 19 (57.58%) deaths occurring between 2 and 46.5 months after OC diagnosis. Eleven patients survived with a median follow-up of 34 months. Considering the high risk of developing oral cancer, a conventional oral examination every 6 months is recommended for HSCT pediatric patients who have developed GVHD.

Management of adenocarcinoma of the pancreatic tail in the elderly.

Elderly patients with adenocarcinoma of the pancreatic head can achieve reasonable survival with multimodal therapy. An analysis specific to cancers of the pancreatic tail has not been published. We identified patients ≥65 years with localized adenocarcinoma of the pancreatic tail in the National Cancer Database (2011-2017). Patients were grouped by age (65-79 and ≥80 years) and categorized by treatment regimen. Postoperative outcomes and survival were analyzed using propensity score matching and multivariable logistical regression. 2168 patients were included: 73.9% were 65-79 years and 26.1% were ≥80 years. 34.1% of octogenarians did not receive any treatment, relative to 15.9% of younger patients (p < 0.001). Thirty-day mortality rates were similar in operatively managed patients; however, the 90-day mortality rate among octogenarians was greater (3.0% vs. 7.8%, p < 0.001; odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.07-3.19). Age ≥ 80 was not associated with survival on multivariable hazards regression (hazard ratio[HR] = 1.08, 95%CI = 0.95-1.24). After propensity matching, the addition of chemotherapy was not associated with improved survival relative to distal pancreatectomy alone among octogenarians (HR = 1.09, 95%CI = 0.72-1.65). Management of adenocarcinoma of the pancreatic tail varies based on patient age. Resection appears to play a key role in management, but there is substantial upfront risk. Shared decision making should be employed to balance the chance for long-term survival with the risk of early mortality.

S1667 Isolated Intramural Gastric Metastasis of Pancreatic Ductal Adenocarcinoma (PDAC) Detected on Surveillance Esophagogastroduodenoscopy (EGD) Before Endoscopic Ultrasound (EUS) Guided Biopsy

Introduction: PDAC is an aggressive malignancy that requires prompt diagnosis and treatment to provide the patient with the best chance of long-term survival. Patients who have an imaging-confirmed solitary pancreatic mass generally undergo a EUS-guided biopsy for histological confirmation of the diagnosis. We describe a rare case of solitary intramural gastric metastases discovered on surveillance EGD prior to EUS-guided biopsy. Case Description/Methods: 63-year-old male with a past medical history of hypertension, chronic pancreatitis, and tobacco use presented with 2 months history of epigastric pain, and 5lbs weight loss. He denied jaundice, loss of appetite, pale-colored stools, or generalized itching. Initial CT abdomen showed a 2.7cm x2.6cm mass in the pancreas body with associated proximal pancreatic duct dilatation and atrophy, suspicious of pancreatic neoplasm. Ca19-9 was 111, and CEA was 1.1. No evidence of metastasis was found on the CT chest/abdomen. EUS-guided biopsy of the mass was scheduled. At the beginning of the procedure, a surveillance EGD was performed which showed a 2cm submucosal, non-circumferential mass in the gastric fundus (Figure a). EUS was performed next which confirmed a 2.1 cm intramural mass in the gastric fundus originating from the muscularis propria (Figure b), and a 3.9cm x 3.8cm mass in the pancreatic body with invasion into superior mesenteric vein, splenic vein, and splenoportal confluence with no noted arterial involvement (Figure c). EUS-guided fine needle biopsy of both lesions was obtained using separate needles. Histopathology from both biopsies demonstrated invasive adenocarcinoma, histomorphologically similar and suggestive of a pancreatic primary. This changed the staging of the patient from borderline resectable to metastatic and he was referred for palliative chemotherapy. Discussion: Isolated gastric metastasis of PDAC is extremely rare, and documented cases in the literature are from a prior diagnostic biopsy that created a seeding tract. Our case highlights 2 major points: 1) Though rare, isolated intramural gastric metastasis can occur and can be missed on cross-sectional imaging. 2) Currently there is no consensus or guideline that mandates an EGD prior to EUS. In this case, this significant finding which changed the staging, treatment, and prognosis of the patient could have been missed with an oblique viewing EUS scope. At our center, we routinely perform EGD prior to EUS. Prospective studies are needed to confirm the utility of this practice.Figure 1.: a: EGD demonstrating 2cm submucosal, non-circumferential mass in the gastric fundus. b: EUS demonstrating a 2.1 cm intramural mass in the gastric fundus originating from the muscularis propria. c: EUS demonstrating 3.9-cm x 3.8-cm mass in the pancreatic body with invasion into the superior mesenteric vein, splenic vein, and splenoportal confluence with no noted arterial involvement.

Cytoreductive surgery for colorectal liver metastases: is it worthwhile?

To date, surgery of colorectal liver metastases is the only chance of long-term survival with the principle of resecting all the metastases to be potentially curative (R0-R1 resection). However, 10-20% of patients are initially resectable. Along with the increasing efficacy of chemotherapy, around 20% of initially unresectable patients could be switched to secondary resectability after tumor downsizing with real hope of long-term survival. However, still a majority of patients remain "curatively" unresectable while responding to chemotherapy, owing to the impossibility to resect all the initial tumoral disease. For such extensive cases, cytoreductive surgery might provide a survival benefit, provided an objective tumor response with chemotherapy and optimal cytoreduction with almost no macroscopic residual disease.

Training of youths for effective self-employment practices

PurposeCurrently, there is widespread consensus that training is helpful to the long-term success of business competitive advantages. However, youth continue to invest in various self-employment business options with low quality of short term trainings. The purpose of this study was to understand the competency level, training need and the role of training to business survival.Design/methodology/approachThis study examined the training needs of youth engaged in self-employment and validated its role in sustainable business performance using primary data. To determine training needs, data were analysed using effect size, and probit model was used to understand the predictive validity of training gap to business performance.FindingsThis study has strong evidence that youth engaged in self-employment career have low entrepreneurial competency. The findings of this study revealed that there was little effort to narrow skill and knowledge gaps of youth before entry into self-employment. Training deficiencies were reported in business planning, confidence, risk and time management, conflict management, and communications skills. In addition, self-employment business options were starting up their function with insufficient entrepreneurial knowledge and skills. This would have limited businesses' better chance of long-run survival. Training should be given to bridge the knowledge and skill gaps of youth to ensure the long-term survival of their business. Recommendations include: government should allocate budget for youth short term training, relevant stakeholders should also create access to training for youths before and after entry into self-employment.Practical implicationsSmall businesses, during start up with sufficient knowledge and skills, have a better chance of long-term survival. Therefore, this study calls for organized training that would be given to youth to bridge their knowledge and skill gaps on certain competency items and to ensure the long-term survival of micro and small enterprises. Relevant stakeholders should also deliberately create access to training for youth before and after entry into self-employment.Originality/valueTo the best of the authors' knowledge, this study is the first to provide empirical evidence of measurement of training gap and its effects of training on small business performance. Understanding role of training gap in business performance requires measurement of level of competency and training need in operating self-employment schemes. Validating consequence of level of training needs towards business performance of youth is essential to understand the contribution of skill training in the promotion of self-employment. The predictive validity of training need to business performance enhances our knowledge of the importance of training for small enterprise development. Previous studies focus on real training and its quality, however, fails to link youth self-employment initiatives. The finding of this study provides important insights on how strong skill training is important in supporting long term survival of youth self-employment.

MEDULLARY CARCINOMA OF THE BREAST-EPIDEMIOLOGY, THE PATTERN OF CARE, AND TREATMENT OUTCOME: EXPERIENCE FROM THE TERTIARY CANCER CARE CENTER

Objectives: Medullary breast carcinoma is a very rare subtype of invasive ductal carcinoma breast which accounts for about 1–7% of all breast carcinoma. The natural history of this uncommon histological subtype is unknown because of the lack of adequate reported data in the literature and the rare variety of this tumor. In our retrospective analysis, we have tried to identify demographic clinicopathological features and treatment outcomes of this rare subtype. Methods: Between January 2012 and December 2017, total of 1271 breast carcinoma cases were identified, and clinic pathological, demographic profile, and treatment received were recorded from the medical records file. American joint committee on Cancer tumor, node, and metastasis system was used for staging. Results: Out of 1271 breast carcinomas, 19 histologically confirmed medullary carcinoma cases were identified and constitute about 1.5% of the total case. About 78% of patients were with Stage II and Stage III disease at the time of diagnosis. Eleven patients were initially treated with MRM followed by adjuvant chemotherapy and radiotherapy. Eight patients received neoadjuvant chemotherapy followed by surgery and radiotherapy. In addition to cytotoxic chemotherapy, two patients received trastuzumab also. None of the patients received hormone therapy as all the patients were hormone receptor-negative. Conclusions: Out of all invasive carcinoma, approximately 1.5% of cases were medullary carcinoma. About 90% of cases were triple-negative. Triple-negative breast cancer is usually associated with poor outcomes but medullary carcinoma despite being triple-negative, patients with medullary carcinoma have a good chance of long-term survival.