Patients Received Neoadjuvant Chemotherapy Research Articles

PD-L1 Protein Expression Is Associated With Good Clinical Outcomes and Nomogram for Prediction of Disease Free Survival and Overall Survival in Breast Cancer Patients Received Neoadjuvant Chemotherapy.

ObjectiveThis study aims to investigate the potential prognostic significance of programmed death ligand-1 (PD-L1) protein expression in tumor cells of breast cancer patients received neoadjuvant chemotherapy (NACT).MethodsUsing semiquantitative immunohistochemistry, the PD-L1 protein expression in breast cancer tissues was analyzed. The correlations between PD-L1 protein expression and clinicopathologic characteristics were analyzed using Chi-square test or Fisher’s exact test. The survival curve was stemmed from Kaplan-Meier assay, and the log-rank test was used to compare survival distributions against individual index levels. Univariate and multivariate Cox proportional hazards regression models were accessed to analyze the associations between PD-L1 protein expression and survival outcomes. A predictive nomogram model was constructed in accordance with the results of multivariate Cox model. Calibration analyses and decision curve analyses (DCA) were performed for the calibration of the nomogram model, and subsequently adopted to assess the accuracy and benefits of the nomogram model.ResultsA total of 104 breast cancer patients received NACT were enrolled into this study. According to semiquantitative scoring for IHC, patients were divided into: low PD-L1 group (61 cases) and high PD-L1 group (43 cases). Patients with high PD-L1 protein expression were associated with longer disease free survival (DFS) (mean: 48.21 months vs. 31.16 months; P=0.011) and overall survival (OS) (mean: 83.18 months vs. 63.31 months; P=0.019) than those with low PD-L1 protein expression. Univariate and multivariate analyses indicated that PD-L1, duration of neoadjuvant therapy, E-Cadherin, targeted therapy were the independent prognostic factors for patients’ DFS and OS. Nomogram based on these independent prognostic factors was used to evaluate the DFS and OS time. The calibration plots shown PD-L1 based nomogram predictions were basically consistent with actual observations for assessments of 1-, 3-, and 5-year DFS and OS time. The DCA curves indicated the PD-L1 based nomogram had better predictive clinical applications regarding prognostic assessments of 3- and 5-year DFS and OS, respectively.ConclusionHigh PD-L1 protein expression was associated with significantly better prognoses and longer DFS and OS in breast cancer patients. Furthermore, PD-L1 protein expression was found to be a significant prognostic factor for patients who received NACT.

Not all small HER2 positive breast cancers have the same clinical outcome in the North-East of Scotland

HER2-positive breast cancers, representing up to 20% of all breast cancers, are more aggressive and have poorer outcomes. Systemic therapy has been proven to prevent disease recurrence and improve survival. Existing literature provides only limited evidence to support this in smaller HER2-positive tumors. The study aimed to evaluate HER-2 positive breast cancer management and treatment of all T1N0 tumors in the North of Scotland, diagnosed 2012–2019. Clinical-pathological details, comorbidities, treatments and clinical events were retrieved from the Scottish North Cancer Alliance audit database and analyzed using univariate and multivariate analysis including cox-regression and log-rank testing (SPSSv23).Overall, 299 patients (41% screen detected/ 56.9% symptomatic /2.1% other), median age 63 years and median tumor size 13 mm, were included. Most cancers were grade 2/3 (43.1%/ 55.5%). Most patients (59.5%) received treatment with trastuzumab (tT); 40.8% concurrent with chemotherapy and endocrine therapy. 7.7% of patients received neo adjuvant chemotherapy. Median follow-up time was 2.6 years, with recurrence on average occurring 2.9 years after diagnosis. Patients receiving trastuzumab were younger, had a higher grade and larger size tumor. 78.5% of patients in the untreated group (non-tT) were ER positive compared to 65.2% in the treated group (tT). Trastuzumab significantly lowered breast cancer recurrence (Tt=3.4% versus non-Tt=8.3%, p = 0.022 HR= 0.096, 95% CI 0.025–0.361). In conclusion, receiving anti-HER2 treatment significantly improved clinical outcome in this T1N0 patient group. Consideration, at the very least informed discussions with patients, should be undertaken to treat these early stage HER2-positive breast cancers.

Congenital Mesoblastic Nephroma: Our Experience in the Last 26 Years

Congenital mesoblastic nephroma (CMN) is the most common type of renal tumor in the neonatal period. It is rare in the general population and usually benign, and the treatment protocol is poorly defined. The aim of the present study is to present a retrospective analysis of the cases of mesoblastic nephroma treated at our centre during the last 26 years. A retrospective study was conducted of 11 patients diagnosed with congenital mesoblastic nephroma between 1st January 1990 and 30th September 2016 at our centre. A review of the patients’ clinical records was carried out, analysing the demographic, clinical, diagnostic, therapeutic, survival and follow-up variables. Nine (81.8%) were males; one patient was diagnosed prenatally, 9 patients in the first three months of life, and one patient when he was two years old. The most common presentation was a palpable abdominal mass in 10 patients, 2 had haematuria, 6 of them had arterial hypertension, and one had hypercalcaemia. The pathological findings were: 3 cases classic of classic CMN type, 4 mixed type and 4 cellular type. Regarding the tumor stage, 7 patients were at stage I, 3 were at stage II and 1 was at stage III. In all patients, the treatment of choice was radical nephrectomy, and 3 patients received neoadjuvant chemotherapy. Only one patient presented a local recurrence and all of the patients are still alive without any death related to the tumor. CMN is a rare renal tumor but it is considered the most frequent renal tumor in the neonatal period, generally of benign behaviour, but recurrence is possible, and its obstetric and perinatal complications can compromise life.

A Modified ypTNM Staging System-Development and External Validation of a Nomogram Predicting the Overall Survival of Gastric Cancer Patients Received Neoadjuvant Chemotherapy.

PurposeNeoadjuvant chemotherapy is now widely used in gastric cancer patients. However, the current 8th ypTNM staging system is developed based on patients with less extensive lymph node dissection and the predictive value is relatively limited. In this study, we aim to develop and validate a nomogram that predicts overall survival in gastric cancer patients received neoadjuvant chemotherapy.Patients and MethodsFrom January, 2007 to December, 2014, 471 patients receiving neoadjuvant chemotherapy at our center were enrolled in the study. Based on the Cox proportional hazard model, a nomogram was developed from them and then an external validation was conducted on a cohort of 239 patients from another cancer center.ResultsThe overall survival (OS) rates of 1 year and 3 years were 90.0% and 64.1%, respectively. Body mass index category, tumor location, T stage and N stage were independent prognostic factors for the survival outcome. The C-index of the model was 0.74 in the development cohort and 0.69 in the validation cohort. Our nomogram also showed good calibration in both cohorts.ConclusionWe developed and validated a nomogram to predict the 1- and 3-year OS of patients who received neoadjuvant chemotherapy and radical gastrectomy with D2 lymph node dissection. This nomogram predicts survival more accurately than the AJCC TNM staging system, which is the current golden standard.

Development and Validation of a Nomogram Predicting the Overall Survival of Gastric Cancer Patients Received Neoadjuvant Chemotherapy

Background: Neoadjuvant chemotherapy is now widely used in gastric cancer patients, while tools available to predict the prognosis are limited. In this study, we aim to develop and validate a nomogram that predicts overall survival in gastric cancer patients received neoadjuvant chemotherapy. Methods: From 01, 2007 to 12, 2014, 471 patients underwent neoadjuvant chemotherapy and received gastrectomy with D2 lymph nodes dissection at Peking University Cancer Hospital in Beijing, China. We developed a nomogram based on the Cox proportional hazard model and conducted external validation using a cohort of 239 patients at Sun Yat-sen University Cancer Center. Findings: The OS rate at 1 year and 3 years were 90.0% and 64.1%, respectively. Body Mass Index (BMI) category, tumor location, T stage and N stage were independent prognostic factors for the survival outcome. The C-index of the model was 0.74 in the development cohort and 0.69 in the validation cohort. Our nomogram also showed good calibration for both cohorts. Interpretation: We developed and validated a nomogram to predict the 1 and 3-year OS of patients who received neoadjuvant chemotherapy and radical gastrectomy with D2 lymph node dissection. This nomogram uses readily available clinicopathologic factors and predicts survival more accurately than the AJCC TNM staging system, which is the current golden standard. Funding Statement: This study was supported by Beijing Municipal Hospital Authority nos. ZYLX201701. Declaration of Interests: The authors state: None. Ethics Approval Statement: The Ethics Committee of Peking University Cancer Hospital approved this study. All procedures performed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or an appropriate substitute was obtained from all patients prior to inclusion in the study.

Prognosis of triple negative breast cancer patients who attain pathological complete response with neoadjuvant carboplatin/docetaxel and do not receive adjuvant anthracycline chemotherapy.

1015Background: Pathological complete response (pCR) in TNBC is associated with excellent long term survival. Recent studies demonstrate that addition of neoadjuvant (NA) carboplatin (Cb) to anthracycline/taxane chemotherapy improves pCR in TNBC. The prognostic value of pCR attained with anthracycline-free platinum/taxane chemotherapy in TNBC is not well known. Aims: To determine the long term outcomes in TNBC patients treated with NA Cb + Docetaxel (D). Methods: 443 patients with stage I (T>1cm), II, or III TNBC were enrolled in a prospective multisite registry between 2011-2015, out of which 76 patients received NA chemotherapy regimen of Cb(AUC 6) + D(75 mg/m2) q 21 days (4-6 cycles). pCR (no evidence of invasive tumor in the breast and axilla) and Residual Cancer Burden (RCB) was evaluated and patients were followed for recurrence and survival. Results: For the 76 eligible patients, median age: 52 yrs, African-American:16%, median tumor size: 3 cm, 33% LN positive and 25% with germline BRCA mutation. ...

Role of neo-adjuvant chemotherapy in locally advanced breast cancer.

Locally advanced breast cancer (LABC) is common in developing countries. The advancement of disease leads to decreased probability of radical cure and increase in treatment cost. The study evaluated neo adjuvant chemotherapy with MRM and MRM followed by adjuvant chemotherapy and also the effectiveness of neo-adjuvant chemotherapy in down staging advanced disease and offering radical cure. A rural hospital-based prospective comparative study. All histologically proven and investigated LABC (T3 N0, T3N1, Any T4, Any N2/N3, M0) were selected as subjects and divided into two groups. One group received neo adjuvant chemotherapy (5 fluorouracil, adriamycin and cyclophosphamide) followed by modified radical mastectomy and other group received adjuvant chemotherapy after modified radical mastectomy. Both groups were compared for disease free survival, overall survival and post-operative complications. Tumor response to chemotherapy in neo adjuvant group was also studied. All continuous variables were analyzed using student's' test and categorical variable by Fischer exact test. Thirty one patients were enrolled, of these 16 patients received neo adjuvant chemotherapy. Clinical complete response was observed in two patients (12.5%). Clinical partial response was found in 12 patients (75%) and no response was seen in two patients (12.5%). Disease free survival and overall survival was 82% in neo adjuvant group while in adjuvant group disease free survival was 75% and overall survival was 83%. Post operative complications were similar in both groups. Neo adjuvant chemotherapy helps in down staging LABC and offers opportunity in vivo to assess the effect of chemotherapy on individual basis. There was no significant difference in disease free survival, overall survival and post operative complication in between two groups.

Male breast cancer in Indian patients: Is it the same?

Cancer of the male breast accounts for about 1% of all malignancies in men and 1% of all breast cancers. Poor level of awareness often results in late presentation and delayed diagnosis in our environment. This study was done to analyse the demographic data, management and survival of male breast cancers in Indian subset of patients and compare it with that of western literature. A 10 year (2001-2010) retrospective study of all male breast cancers was done. Data regarding the incidence, presentation, histopathology, stage and grade of tumor, management and outcome of patients were analysed. 26 cases of male breast cancer were encountered. This comprised 0.4% of all breast cancers seen in our department during the 10 year period. The ages of patients ranged from 45-75 years with a mean age of 57 years. Family history was present in 4 patients. Clinically, symptoms included self-detected lump in 23 (88.5%) patients, nipple retraction in 12 (46.1%) and pain in 12 (46.1%). All cases were unilateral (16 on right, 10 on left). Disease most commonly involved central quadrant (9 patients). Grade 3 disease was found in 13 patients and Stage 3 disease was most commonly encountered (13 patients). None of our patients received neo adjuvant chemotherapy. 20 (76.9%) patients had modified radical mastectomy and 6 (23.1%) had radical mastectomy. Most of our patients were hormone receptor positive (21 patients). Bilateral orchidectomy, Adjuvant chemotherapy, Adjuvant radiotherapy and Tamoxifen were offered in 3 (11.5%), 16 (61.5%), 17 (65.4%) and 15 (57.7%) patients respectively. Follow up ranged from 1-59 months. Male breast cancer is rare in our centre. Late presentation with advanced disease is a common feature in our environment. Further multiinstitutional, prospective studies are needed for better understanding of management of male breast cancers in Indian subset of patients.