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SUMMARY OBJECTIVE: The aim of this study was to evaluate the impact of study methodology and evaluation type on the selection of studies during the presentation of scientific events. METHODS: A prospective, observational, transversal approach was applied to a cohort of studies that were submitted for presentation at the 2021 Brazilian Breast Cancer Symposium. Three forms of criteria (CR) were presented. CR1 was based on six criteria (method, ethics, design, originality, promotion, and social contribution); CR2 graded the studies from 0 to 10 for each study, and CR3 was based on five criteria (presentation, method, originality, scientific knowledge, and social contribution). To evaluate the item correlation, Cronbach’s alpha and factorial analysis were performed. For the evaluation of differences between the tests, we used the Kruskal-Wallis and post-hoc Dunn tests. To determine the differences in the study classifications, we used the Friedman test and Namenyi’s all-pairs comparisons. RESULTS: A total of 122 studies were evaluated. There was also a good correlation with the items concerning criterion 1 (α=0.730) and 3 (α=0.937). Evaluating CR1 methodology, study design and social contribution (p=0.741) represents the main factor and CR3 methodology, and the scientific contribution (p=0.994) represents the main factor. The Kruskal-Wallis test showed differences in the results (p

Objective: To evaluate the association between metabolic syndrome (MetS) and the immunohistochemical profile of breast cancer (BC) in postmenopausal women.Methods: This cross-sectional cohort study included 189 women, aged 45-75 years and amenorrhea > 12 months, with newly diagnosed BC and no previous cancer treatment. Clinical, anthropometric and biochemical (total cholesterol, HDL, LDL, triglycerides, and glucose) data were collected, as well as data on BC (histopathology, grade, tumor stage, lymph node metastasis hormone status (estrogen receptor, ER; progesterone receptor, PR; human epidermal growth factor receptor 2, HER-2), and epithelial proliferative activity (Ki-67). Tumors were divided into five subtypes: luminal A, luminal B HER-2 negative, luminal B HER-2 positive, non-luminal HER-2, and triple negative. Women with three or more of the following criteria were diagnosed with MetS: waist circumference ≥ 88 cm; triglycerides ≥ 150 mg/dL; HDL-cholesterol < 50 mg/dL; blood pressure ≥ 130/85 mmHg; glucose ≥ 100 mg/dL. The Student t-test, gamma distribution (asymmetric variables), chi-square test, and logistic regression (odds ratio, OR) were used for statistical analysis.Results: Sixty-three (33.3%) of the 189 patients had MetS at the time of diagnosis. The mean age, time since menopause and BMI were 59.0 ± 10.6 years, 11.4 ± 9.6 years and 28.5 ± 5.5 kg/m2, respectively, without difference between women with and without MetS (control). Women with MetS had a higher frequency of tumors ≤ 2 cm than women without MetS (49.2% vs 31.8%) (p=0.038). There were no differences in histological grade, staging, or axillary lymph node metastasis (p>0.05). The proportion of PR-positive (p=0.006), HER-2-negative (p=0.034), and luminal B HER-2-negative tumors was higher among patients with MetS (p=0.038) compared to women without MetS (79.4% vs 61.8%, 89.9% vs 78.6% and 44.5% vs 27.8%, respectively). Multivariate analysis adjusted for age, time at menopause and BMI showed a higher risk for luminal B HER-2-negative tumors among women with MetS (OR 2.00, 95% CI 1.03-3.89), obese patients (OR 2.03, 95% CI 1.06-3.90), and women with abdominal obesity (OR 1.96, 95% CI 1.01-4.03). The other BC subtypes were not associated with MetS or its components.Conclusion: In postmenopausal women with newly diagnosed BC, the presence of MetS was associated with a more favorable immunohistochemical profile of BC, such as a smaller tumor size, PR-positive and HER-2-negative status, and the luminal B tumor subtype. Citation Format: Andre Hideo Motoki, Daniel de AraujoBrito Buttros, Ana LuisaCamolezi Gaspar, Eduardo Carvalho Pessoa, Benedito de Sousa Almeida Filho, Jorge Nahas Neto, Heloisa de Luca Vespoli, Eliana AguiarPetri Nahas. Association between metabolic syndrome and immunohistochemical profile at breast cancer diagnosis in postmenopausal women [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-76.

Introduction: It is known that one of the most commonly used breast reduction surgeries is the inverted-T scar (Wise pattern). Numerous reports have established its efficacy in oncoplastic procedures and its aesthetically pleasing shape. However, it has some disadvantages and limitations, such as extensive scar pattern, risk of dehiscence, and its difficulty in reductions in larger and ptotic breasts (removal >800 g per side). As an alternative, the “No-Vertical-Scar” reduction mammoplasty has been proposed in plastic surgery for breasts in which a massive mass excision is required and where marked ptosis exists. Although this technique has not been frequently described and performed in oncoplastic surgeries, it has many advantages in breast cancer patients involving technique, feasibility, and convenience. Objective: The aim of this study was to describe the critical technical points, adjustments, and safety for oncoplastic surgery of the classic horizontal breast reduction, designated as modified “No-Vertical-Scar” reduction mammoplasty, allowing for the elimination of the vertical scar and axillary approach through the same incision. Methods: This is a single-center case-series study. We included patients with a breast cancer diagnosis who underwent surgical treatment between 2020 and 2021. Patients were selected for this technique if they had large and ptotic breasts (grade 2 or 3 according to Regnault classification) and a minimum distance of 27 cm between the mid-clavicle and the superior aspect of the areola. Clinical and anatomopathological data were collected. Results: A total of 25 patients underwent this modified oncoplastic mammoplasty. Preoperative skin markings were made with the patient in the standing position. The proposed new nipple position was determined based on a distance between 18 and 23 cm from the breast midline and the sternal notch. The lower edge of the “apron” flap was then marked at a distance of 5–6 cm below the inferior aspect of the new areola, and it needed to be located above the superior aspect of the original areola. An important step was to delineate the new lateral border of the breast, especially in wide-based breasts. This modified step is crucial to narrow the transverse base of the new breast and to provide a more natural silhouette. The areolated or nonareola pedicle was then selected and designed in accordance with the tumor location. In all patients, axillary surgery (sentinel lymph node biopsy or lymphadenectomy) was performed through the same breast incision. After flap development, lumpectomy, and axillary approach, the superior “apron” flap was then brought down over the remaining breast tissues and sutured in place. A free nipple complex graft or inferiorly pediculated nipple complex was then brought to the new areola site. The volume of removed tissue in each breast varied from 700 to 2,000 g. The complication rate was low (20%, 5 patients) and included minimal dehiscence that resolved in 2–3 weeks (2 patients), nipple epidermolysis (2 patients), and surgical site infection (1 patient). There were no cases of fat necrosis, nipple-areola complex necrosis, or other major complications. Patients were satisfied with the results in 96% of cases. Conclusion: The modified “No-Vertical-Scar” reduction mammoplasty has been shown to be a safe, easy, and cosmetic alternative in patients with very large and ptotic breasts. It has the advantage of eliminating the vertical scar present in both the inverted-T (Wise pattern) and vertical scar techniques, a low risk of complications and the ability to perform axillary staging through a single incision. It can also result in an “unoperated” look after surgery with good patient satisfaction. Once learned, it is fairly easy to perform, and the results are reproducible and free of major complications.

Objective: The purpose of this study was to evaluate the occurrence of the metabolic syndrome and obesity during the first year after the diagnosis of breast cancer in women undergoing interdisciplinary approach. Methods: In this prospective study, 81 women (age ≥45 years) with recent histological diagnosis of breast cancer, no established cardiovascular disease, who attended at a single specialized center with an interdisciplinary approach (medical, nutritionist, and psychological) were included. Results: Women with metabolic syndrome were considered to have three or more diagnostic criteria: waist circumference >88 cm, triglycerides 150 mg/dL, high-density lipoprotein 30 kg/m2 and abdominal obesity with waist circumference >88 cm. The evaluations were carried out at three time points: first cancer visit (T0m), 6 months (T6m), and 12 months (T12m). For statistical analysis, the McNemar test was used to compare these time points and the chi-square test was used for trends. The mean age of the patients was 58.410.7 years, and 83.3% of them were in the postmenopausal stage. There were no differences in the metabolic syndrome, body mass index, and waist circumference assessments at the indicated time points. When comparing the individual quantitative criteria for metabolic syndrome, there was a statistically significant difference in the values of triglycerides and blood glucose. At times T0m, T6m, and T12m, an increase in the mean triglyceride values was observed, 121, 139.4, and 148.46 mg/dL (p=0.003) and a reduction in the mean glucose values, 106.6, 100.46, and 98.96 mg/dL (p=0.004), respectively. Conclusion: Women with breast cancer subjected to interdisciplinary evaluation did not show an increase in the occurrence of metabolic syndrome and obesity during the first year following their cancer diagnosis.

Objective. We prospectively evaluated the association between vitamin D concentration at diagnosis and overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) in postmenopausal women treated for breast cancer. Methods. This study included 192 patients newly diagnosed with invasive breast cancer, aged ≥45 years, and serum 25-hydroxy vitamin D (25 (OH)D) concentration assessment at diagnosis. Patients were classified into groups according to 25 (OH)D concentrations: sufficient (≥30 ng/mL), insufficient (between 20 and 29 ng/mL), and deficient ( p < 0 .001 ). After adjustment for clinical and tumoral prognostic factors, patients with 25 (OH)D concentrations considered deficient at diagnosis had a significantly higher risk of global death (HR, 4.65; 95% CI, 1.65–13.12), higher risk of disease recurrence (HR, 6.87; 95% CI, 2.35–21.18), and higher risk of death from the disease (HR, 5.91; 95% CI, 1.98–17.60) than the group with sufficient 25(OH)D concentrations. Conclusion. In postmenopausal women treated for breast cancer, vitamin D deficiency and insufficiency at diagnosis were independently associated with lower OS, DFS, and CSS compared with patients with sufficient 25(OH)D concentrations.

To evaluate the relationship between the presence of BAC and coronary artery disease (CAD) by invasive coronary angiography (ICA) in postmenopausal women.In this cross-sectional study, postmenopausal women (age ≥ 45 years) with history of CAD, who underwent both ICA and digitized mammography, within six months of each other, were enrolled. Women who underwent prior percutaneous coronary intervention, or exhibited grade D breast density (BI-RADS®) or breast cancer upon mammography were excluded. Digital mammograms were identified in the electronic medical record system and reviewed for the presence of BAC, without knowledge of the ICA results by two experienced physicians. The ICA results were obtained from the electronic medical record, and categorized as follows: 1-single-vessel disease; 2-two-vessel disease; and 3-multivessel disease (≥3vessels). For statistical analysis Student t test, Gamma distribution, Chi-square test and logistic regression (odds ratio,OR) were used.Of the 183 postmenopausal women evaluated, 39 (21.3 %) had BAC. Women with BAC were older and had a longer time since menopause when compared to women without BAC (68.2 ± 9.6 × 59.6 ± 10.0 years of age and 19 ± 10.1 × 13.5 ± 8.2 years, respectively) (p 0.0.0001). Among the clinical and cardiovascular characteristics evaluated, only the incidence of smoking was higher in women with BAC (p = 0.007). There was no difference in the number of affected vessels upon ICA in women with or without BAC (p = 0.683). In multivariate analysis, after adjustment for age, time since menopause and smoking, the presence of BAC was not associated with a significant risk of observing a greater number of affected vessels upon ICA (OR1.07; 95 %CI 0.41-2.76, p = 0.609).The presence of BAC was not associated with the severity of CAD in postmenopausal women.

Com intuito de desenvolver um escore preditor da resposta quimioterápica neoadjuvante, propusemos a cintilografia de mamas com sestamibi-99mTc (CM), associada a fatores prognósticos como método preditor. Foram estudadas 65 pacientes com diagnóstico de carcinoma ductal submetidas à cintilografia de mamas pré-quimioterapia neoadjuvante (QT neo), painel imunohistoquímico e avaliação do espécime cirúrgico. Foram geradas áreas de interesse com contagens/pixels sobre a lesão e na mama contralateral e criados índices com a razão dessas contagens. Foi construído um modelo de regressão logística utilizando como variáveis, idade, índice, localização do tumor, painel imunohistoquímico e comprometimento axilar, obtendo-se valores preditos que em função da resposta patológica completa foi criada uma curva ROC, para que se obtivesse escore de maior sensibilidade e especificidade. A área da curva ROC foi significativa e o escore obtido foi de 0,728 com sensibilidade, especificidade e valores preditivos positivo e negativo de 81,6%, 81,25%, 93% e 59%, respectivamente. O escore preditor multifatorial é um método eficaz na predição da resposta quimioterápica neoadjuvante, uma vez, que reflete a biologia do tumor frente ao esquema quimioterápico, identificando precocemente as pacientes que não se beneficiariam deste tratamento.

Introduction Although pelvic floor muscle (PFM) weakness can be associated with pelvic floor dysfunctions, knowledge about the relationship with sexual dysfunction is limited. Aim The aim of this study was to evaluate the association between PFM strength and sexual function in postmenopausal women. Methods An analytical cross-sectional study was conducted on 226 sexually active heterosexual women aged 45−65 years with amenorrhea >12 months and without pelvic floor disorders. The Female Sexual Function Index (FSFI) was used for the evaluation of sexual function (total score ≤26.5 indicating sexual dysfunction). PFM strength was assessed by bidigital vaginal palpation using the modified Oxford scale (score 0−5) and was categorized into nonfunctional (scores 0−1, without contraction) and functional (scores 2−5, with contraction). Three-dimensional transperineal ultrasound was used to evaluate total urogenital hiatus area, transverse and anteroposterior diameters, and levator ani muscle thickness. Main Outcome Measure The main outcome measure was to determine the relationship between sexual dysfunction and PFM strength. Results The participants were classified as functional PFM (n = 143) and nonfunctional PFM (n = 83). There were no differences between groups in clinical and anthropometric parameters. A higher percentage of menopausal hormone therapy users was observed in the group with functional PFM (39.2%) compared to the nonfunctional group (24.1%; P = .043). Women classified as functional PFM exhibited greater levator ani muscle thickness than those classified as nonfunctional (P = .049). Women with nonfunctional PFM had poorer sexual function in the desire (P = .005), arousal (P = .001), and orgasm (P = 0.006) domains and in total FSFI score (P = .006) compared to the functional group. There was a weak positive correlation of PFM strength with the desire (r = 0.35; P = .0003), arousal (r = 0.21; P = .013), and orgasm (r = 0.23; P = .033) domains and with total FSFI score (r = 0.28; P = .004). Ultrasonographic levator ani muscle thickness showed a weak positive correlation with PFM strength (r = 0.21; P = .046) and with the arousal domain (r = 0.23; P = .044). Risk analysis adjusted for age, time since menopause, parity, and body mass index showed a lower risk of sexual dysfunction in menopausal hormone therapy users (odds ratio = 0.26; 95% CI 0.11−0.60; P = .002) and in women with greater levator ani muscle thickness (odds ratio = 0.85; 95% CI 0.73−0.98; P = .025). Clinical Implications The maintenance of PFM strength in the climacteric period is an important factor in postmenopausal women’s sexual function. Strength & Limitations The main strength of the study is that, to our knowledge, this is the first study that evaluated the correlation of PFM strength and 3D transperineal ultrasound with different domains of sexual function in postmenopausal women. The main limitation is the cross-sectional design does not permit to establish a cause-effect relationship. Conclusion Postmenopausal women with PFM dysfunction have poorer sexual function than women with functional PFM.

Made available in DSpace on 2019-10-06T16:13:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-03-04 Objective: Breast cancer (BC) therapies and the longevity that the women achieve imply a higher cardiovascular risk. The aim of the study was to evaluate the frequency of atherosclerotic disease and its association with cardiovascular risk factors in postmenopausal breast cancer survivors (BCS) compared to postmenopausal women without BC. Methods: In this study, 96 women with BC (case group) were compared to 192 women without BC (control group), age range 45–75 years. The case group included women with a histological diagnosis of BC, amenorrhea ≥ 12 months, and age ≥ 45 years, without metastatic disease or cardiovascular disease (CVD). The control group consisted of women with amenorrhea ≥ 12 months and age ≥ 45 years, without BC or CVD. Total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, and insulin were measured. Atherosclerotic disease was determined by increased intima-media thickness (thickness > 1.0 mm) of the carotid arteries and/or presence of atheromatous plaques evaluated by carotid duplex ultrasound. Results: The frequency of diabetes and metabolic syndrome were higher in BCS compared to controls (19.8% vs. 6.8% and 54.2% vs. 37.0%, respectively, p < 0.05). There was no difference in subclinical atherosclerosis between groups (BCS 26% vs. controls 18.7%, p = 0.062). However, atheromatous plaques were more frequent in BCS compared to controls (19.8% vs. 9.4%, p = 0.013). In the risk analysis, adjusted for age, time since menopause, and body mass index, BCS had a 2.4-fold higher risk of atheromatous plaques (odds ratio = 2.42; 95% confidence interval 1.18–4.93, p = 0.033) than women without BC. Conclusion: Postmenopausal BCS had a higher risk of developing atherosclerotic disease, associated with a higher frequency of cardiovascular risk factors such as metabolic syndrome and diabetes, when compared to women of the same age group without BC. Department of Gynecology and Obstetrics Sao Paulo State University–UNESP Department of Surgery Botucatu Medical School Sao Paulo State University–UNESP Department of Gynecology and Obstetrics Sao Paulo State University–UNESP Department of Surgery Botucatu Medical School Sao Paulo State University–UNESP

Introduction: Ultra young women (UYW) is defined as women aged up to 30 years. UYW with BC share some unfavorable biological tumor characteristics as larger size at diagnosis, higher loca-regional recurrence rate and lower survival, and have been merited specialized care. Objectives: We aimed to determine histopathological and molecular characteristics of BC in UYW. Methods: We carried out a multicentric, observational, retrospective study of consecutive UYW patients with BC. Only patients with infiltrating BC were included. Nine Mastology Centers located in the State of São Paulo took part in the research. The follow data were recorded: pathological tumor histology, number of positive lymph nodes multicentricity/multifocality, presence or absence of peritumoral vascular invasion (PVI), histologic grade (HG), pT category, estrogen receptor (ER), progesterone receptor (PR), HER2 and Ki67. We classified the neoplasias into five molecular subtypes by immunohistochemistry, based on modified recommendations of St. Gallen Consensus (2013): Luminal A-like, Luminal B-like HER2-, Luminal B-like HER2+, HER2 overexpressed (HER2+) non luminal and Triple-Negative. The frequency of the analysed parameters were calculated. The research protocol was approved by the Ethics Committee of all Collaborative Centers. Individual informed consent was waived. Results: Invasive carcinoma of no special type (NST) was observed in 243 patients (88%), and infiltrative lobular tumor was extremely rare, being found in 1.1%. The tumor size in surgical specimens was above 20 mm in 54% (in 10% there was no more evidence of tumor after neoadjuvant treatment). We found 52.6% of patients without invasion in lymph nodes (LN) whereas in 22.2% there was more than four LNs involved. Multifocality was seen in 12.4%. HG was 2 or 3 in 98.3%. In 67.5% the tumors expressed ER, 59.4% gR, and 25.1% were HER2+. In 61.5% Ki67 was higher than 20%. Tumor molecular subtypes were classified in 16.6% Luminal A-like, 35.9% Luminal B-like HER2-, 15.1% Luminal B-like HER2+, 9.3% HER2+ non-luminal and in 22.9% Basal-like. Conclusions: Our data from UYW with BC revealed unfavorable characteristics, with frequent adverse pathological and molecular prognostic factors.

Introduction: A substantial number of young women (YW) is affected by breast cancer (BC), an important cause of death in young age. The definition of a YW in a BC context varies in the literature. Considering specific characteristics, such as reproductive factors and hereditary risk, we defined ultra young women (UYW) as women aged 30 years or less. Despite the fact that specialized centers are increasingly providing assistance to UYW with BC, important aspects of the disease in this age remain controversial. Objective: Evaluate clinical and epidemiological characteristics of BC in UYW in the State of São Paulo. Methods: We conducted a multicentric, observational, retrospective study of consecutive BC in UYW patients in nine Services. Only patients with infiltrating BC aged 30 years or less were included. The following data were collected: age, body mass index, parity, hormonal contraception use, history of breast/ovarian cancer in the family, pathological tumor category and clinical staging. Frequency parameters were estimated. The research protocol was approved by the Ethics Committee of all collaborative centers. An informed consent was waived. Results: The study population included 293 patients. Age varied between 19 and 30 years (mean 27.3; median 28). Considering body weight, we found that 37.1% of the patients were overweight or obese. 58.6% were current or past HC users. Nulliparity was referred in 44.4%. 246 cases reported family history of BC which was verified in first degree relatives in 37.9%, while 66 patients referred BC in any member of the family. Only 33 patients went through a multigene testing panel: pathogenic inherited variants were detected in 37.5%. Remarkably, locally advanced tumors were diagnosed in 57.1%. Tumor sizes at diagnosis were: T1-11.8%, T2-33.8%, T3-31.6% T4-19.9% and T4d-2.9%. Clinical axillary lymph nodes evaluation revealed: N0-35%, N1-42.8%, N2-18.7%, and N3-3.5%. Systemic metastases at diagnosis were observed in 29 cases, that were classified as stage IV “de novo” (9.8%). The metastases sites were multiple in 31% and the clinical staging in the diagnosis are later. Conclusion: An unfavorable picture was observed in UYW with BC. We found a high rate of advanced neoplasias, with adverse clinical prognostic factors. To change the present-day scenario, we need to educate the population, enhancing BC awareness and self-body attention since adolescence, besides stimulating the adoption of a healthy lifestyle.

Introduction: Since the 90s, breast ultrasound (US) features that predict malignancy or benignity are well established, but recently Stravos and Taboul et al. brought new concepts that set out to understand lobar anatomy and its relationship with breast lesions. Nowadays we seek to understand the relationship between breast anatomy and imaging to differentiate malignant from benign lesions and to predict their biological behavior. Objectives: To correlate breast lesions morphology and tumor biology with BIRADS® ultrasound predictors. Methods: This study was performed from 2012 to 2017. A total of 1,070 breast lesions underwent US examination and anatomopathological study. Collected data included patients’ age, tumor size, presence or absence of echogenic halo and ultrasound predictors of BIRADS® 5th edition (shape, margin, surrounding tissue, presence of calcifications, echogenicity, posterior acoustic effect, lesion borders, orientation and doppler). Patients ≥18 years old with benign lesions and breast carcinomas were included. Results: When a lesion grows affronting lobar anatomy in a non-parallel manner, a malignant process is suspected. The risk of malignancy for this predictor was 7.92-times higher. Benign lesions do not infiltrate adjacent tissue, resulting in a circumscribed margin. Breast carcinomas grow infiltratively creating tissue reactions. Thus, when margins are infiltrative, there is a greater risk of malignancy – spiculated (61.4 times), angulated (24.4 times), microlobulated (9.4 times), indistinct (6.8 times). The presence of halo increased the risk by 25.3 times and thickening of the surrounding tissue by 6.7 times. In carcinomas, irregular shape is the most prevalent. But in fast growing lesions, round shape can also be found. We found a 6.27-fold increased risk in irregular tumors and 1.86-fold in round ones. Carcinomas with a large fibrous component generate posterior acoustic shadowing, a finding linked to cancer. We found a 2.56-fold increased risk. Acoustic enhancement was also observed in high cellularity tumors, such as triple negative. In our series, the risk of malignancy was 8.1 times higher. Ultrasound also contribute to the study of calcifications. Its presence within the nodule increased the risk by 3.55 times for malignancy. Heterogeneous lesions in this study showed a 5.1-fold risk. Angiogenesis is important in differentiating benign and malignant lesions, using doppler to assess this. Lesions with inner flow increased the risk by 5.39 times. Conclusions: Breast imaging, mainly with radiogenomics and radiomics development, is used to assess predictors of malignancy and benignity from a new perspective. It is important to understand the reason of a particular phenotype and its biological implications. In this context, the present study shows new data and brings a reflection on the reason for each finding, adapting the interpretation of US predictors to a new era of breast imaging.

Introduction: Since 2013, after the Saint Gallen International Breast Cancer Conference, breast cancer is classified by its morphological, biological and prognostic features into three subgroups according to the immunohistochemichal expression, which is similar to the genetic expression of the tumor. These groups, known as luminal, HER2 enriched and triple negative, are classified according to the positivity or negativity of nuclear receptors (estrogen [ER] and progesterone receptors [PR]) or membrane receptors (HER2). Triple negative tumors do not express positivity for any of these receptors. This group is composed of tumors with a more adverse biology and more aggressive behavior, affecting women in a younger age than other groups, and they also have higher rates of recurrence and lower overall survival. Objectives: This study aims to assess morphological and angiogenic features of these tumors by ultrasound exams. Methods: This is a prospective study, in which 129 lesions with an immunochemistry study compatible with triple negative tumors were selected from 1,180 breast carcinomas diagnosed by ultrasound and core biopsy from 2012 to 2017. Features assessed were shape, margin, posterior acoustic effect, reaction of the surrounding tissue, presence of calcifications within the lesion, presence of vascular flow with resistance index (RI), pulsatility index (PI), and maximum velocity of the vascular flow (Vmax). Results: Among the 129 tumors included, oval shape was the most prevalent with 72 cases (56%), 43 tumors (33%) had an irregular shape, and only 14 (11%) were round. As for their margin, the most prevalent was microlobulated, observed in 60 cases (46%), followed by circumscribed (35 cases, 27%), indistinct (19 cases, 15%), and the less frequent margins were angled and spiculated, with 10 (8%) and 5 cases (4%), respectively. The most prevalent posterior acoustic effect was enhancement (50 cases, 39%), followed by absence of posterior effect (38 cases, 27%), mixed effect (23 cases, 18%) and the least frequent was acoustic shadowing, accounting for only 18 cases (14%). The absolute majority of the tumors, 92% lesions in total, did not present calcifications within the lesion and 89% did not have a hyperechogenic halo in the surrounding tissue, presenting with abrupt lesion limits. From all cases, 110 (85%) had normal peritumoral tissue, causing no tissue thickening. In relation to the angiogenic study, most lesions had vascular flow (81 cases, 63%). The mean PI was 1.5, RI was 0.7 and the average Vmax was 19.7 cm/s. Conclusions: From an ultrasonographic point of view, some prevalent feautres are noted, which can help in their radiogenomic determination. Oval shape, abrupt interface, microlobulated margins, posterior acoustic enhancement, absence of internal microcalcifications and hyperechogenic halo prevailed.

Objectives: To estimate 5- and 10-year breast cancer–specific survival probabilities of patients admitted in the hospitalbased cancer registry (HBCR) of the Fundação Oncocentro de São Paulo (FOSP, in Portuguese) and to assess the prognostic factors for this neoplasm. Methods: Historical cohort study that included women with breast cancer included in HBCRFOSP and diagnosed between 2002 and 2012. The event of interest was breast cancer–specific mortality. Living cases at the end of follow-up (December 31, 2017), loss to follow-up, and death other than that due to breast cancer were considered censored on the date of the last contact or date of death. Descriptive analysis and survival analysis were performed using the Kaplan–Meyer method. Survival curves were compared using the log-rank test. HR and 95%CI were estimated using Cox proportional hazards model. This study was approved by the Human Research Ethics Committee of the Botucatu Medical School, São Paulo State University, Brazil. Results: The HBCR-FOSP registered 53,146 cases of invasive breast cancer between 2002 and 2012. The median age at diagnosis was 55.9 years. The 5- and 10-year breast cancer–specific survival for the entire cohort was 76.1% (95%CI 75.7–76.5) and 64.8% (95%CI 64.2–65.3), respectively. In the multivariate analysis, the factors clinical stage and educational level were with the greatest impact on survival. The other factors associated with prognosis were age at diagnosis, histological type, and year of diagnosis. Conclusion: The results show that patients in more advanced stages and with less level of education have a higher risk of death from breast cancer. Besides, these findings may contribute to the development of policies for the identification of breast tumors at earlier stages.

Introduction: Breast cancer (BC) centers are increasingly attending “ultra-young” women (UYW) patients (≤ 30 years), who usually present aggressive tumors and face specific problems. Objectives: We aimed to examine a multicentric casuistic view, addressing clinicopathological and molecular characteristics of BC, as well as therapeutic measures and oncological outcomes. Methods: A retrospective multicentric observational study of UYW with infiltrating BC was carried out. The patients were treated between the period from January 1991 to December 2019. Clinical, epidemiological, morphological, molecular, therapeutic and outcomes data were collected from the charts. Results: A total of 293 patients were followed for a average period of 34.5 months. Nulliparity was referred by 204 women (75.5%), of whom 81 (37.1%) were overweight or obese. Positive family history in first-degree relatives was verified in 25 patients (10.1%). Only 30 patients underwent genetic tests, which revealed inherited pathogenic mutations in 12 of them (37.5%). Thirty-two (32) cases were classified as T1 at diagnosis (10.9%), while “De novo” stage IV was found in 29 patients (9.8%). Mastectomy was performed in 175 women (70.2%), quadrantectomy in 46 women (18.4%), and mammary adenectomies in 28 women (11.2%), of which 149 cases were reported after neoadjuvant chemotherapy (56.0%). A total of 111 patients had at least one positive lymph node (47.4%). The rate of patients with estrogen receptor-negative was 32.7% and the rate of patients with Human Epidermal Growth Factor Receptor 2-positive (HER2-positive) was 25%. The frequency of Luminal A neoplasias was 16.6%, Luminal B/HER2- was 35.9%, Luminal B/HER2+ was 15.1%, HER2 overexpressed was 9.3%, and Basal was 22.9%. Taking into account the outcomes, 173 patients were alive without disease (65.7%); 23 patients were alive with any form of recurrence (8.7%); and 67 patients (25.4%) evolved to BC deaths. Conclusions: It was concluded that UYW with BC are commonly diagnosed at advanced stages, present adverse morphological and molecular parameters, and have unfavorable prognosis.

Introduction: Patients with breast cancer have a higher risk of gaining weight and of presenting with metabolic syndrome (MS), with worsening overall and specific survival. Intervention from an interdisciplinary team can influence the prognosis. Objective: To evaluate the occurrence of metabolic syndrome and its components in women during the first year after diagnosis of breast cancer. Methods: Prospective, single-centered clinical study that included women with a recent diagnosis of breast cancer, age ≥40 years, histological diagnosis of breast cancer, without metastatic disease and without established cardiovascular disease (CVD). Clinical and anthropometric data (blood pressure, body mass index [BMI] and waist circumference) were collected through interviews and physical examination. For biochemical analysis, HDL, triglycerides (TG) and glucose were requested. Women with MS were considered to have three or more diagnostic criteria: waist circumference (WC)>88 cm; TG³150 mg/dL; HDL88 cm) in the studied period, with mean BMI of 28.9 kg/m2 , 28.8kg/m2 and 28.8 kg/m2 and WC equal 97.2 cm, 97.2 cm and 96.7 cm, at T0, T6 and T12 moments, respectively (p>0.05). When comparing the individual MS criteria between the three assessment moments, there was only a statistical difference in the triglyceride and glycemia criteria. The analysis of glycemia showed a decrease in mean values, from 106.6 mg/dL in T0m, 100.4 mg/dL in T6m and 98.9 mg/dL in T12m (p=0.004). Regarding TG, an increase in mean values was observed, from 121 mg/dL in T0m, 139.4 mg/dL in T6m and 148.4 mg/dL in T12m (p=0.003). Conclusion: Women with breast cancer submitted to interdisciplinary evaluation did not show an increase in the occurrence of MS during the first year after cancer diagnosis. Among the components of MS, there was a reduction in blood glucose values and an increase in triglyceride values.

Objective: To evaluate the association between metabolic syndrome (MS), obesity, and central fat deposition with the immunohistochemical profile (IHC) of breast cancer (BC) in postmenopausal women. Methods: A comparative cross-sectional clinical study was carried out with 63 women with recent BC and MS, compared to 126 women with recent BC, without MS (control group). Inclusion criteria were: women aged 45-75 years, amenorrhea >12 months, without previous cancer treatment, attended at a University Hospital. The groups were matched for age, time since menopause, and body mass index (BMI), in the proportion of 1 case for 2 controls, according to the sample calculation of at least 186 women in their entirety. Clinical and anthropometric data were collected; tumor size and grade and the IHC profile (ER, PR, HER2, and Ki67). By IHC convention, tumors were grouped into five subtypes: Luminal A (ER+, PR+, HER-2 -, and Ki-67 88 cm; TG≥150 mg/dL; HDL cholesterol

Made available in DSpace on 2018-12-11T17:15:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-11-01 This study aimed to evaluate the association between pretreatment vitamin D (VD) deficiency with breast cancer prognostic features in Brazilian postmenopausal women. An analytical cross sectional study was conducted with 192 women, aged 45–75 years, attended at University Hospital. Women with recent diagnosis of breast cancer, in amenorrhea >12 months and age ≥45 years, without medication use or clinical conditions that interfere with VD values were included. Clinical and anthropometric data were collected. Serum level of 25 hydroxyvitamin D [25(OH)D] was measured in all patients until 20 days after breast cancer diagnosis, and was classified as normal (≥30 ng/mL), insufficiency (20–29 ng/mL) and deficiency (

Made available in DSpace on 2014-10-01T13:08:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-03-01Bitstream added on 2014-10-01T14:03:04Z : No. of bitstreams: 1 S0100-72032014000300118.pdf: 1156324 bytes, checksum: 369ef139a5c5eed3feae2fb25bae4f2d (MD5) OBJETIVO: Avaliar a viabilidade e acurácia diagnóstica da ultrassonografia pré-operatória combinada com biopsia por agulha fina (US-PAAF) e do exame clínico da axila em pacientes com câncer de mama.MÉTODOS: Neste estudo prospectivo 171 axilas de pacientes com câncer de mama foram avaliadas pelo exame clínico e ultrassonografia (US) com e sem biopsia por agulha fina (PAAF). Os linfonodos com espessura cortical maior que 2,3 mm na ultrassonografia foram considerados suspeitos e submetidos a US-PAAF.RESULTADOS: A análise de regressão logística não mostrou correlação estatisticamente significativa entre exame clínico e axilas positivas no exame patológico. Em relação à avaliação axilar com US, o risco de achados anatomopatológicos positivos aumentou 12,6 vezes, valor Kappa de Cohen foi de 0,12 para exame clínico, 0,48 para US e 0,80 para US-PAAF. A acurácia foi de 61,4% para o exame clínico, 73,1% para os US e 90,1% para US-PAAF. Análise Receiver Operating Chracteristics (ROC) mostrou que uma espessura de 2,75 mm cortical correspondeu à mais elevada sensibilidade e especificidade na predição metástase axilar (82,7 e 82,2%, respectivamente).CONCLUSÕES: A US combinada com aspiração por agulha fina é mais precisa que o exame clínico na avaliação do status axilar no pré-operatório em mulheres com câncer de mama. Aquelas que são US-PAAF positivo podem ser direcionadas para esvaziamento linfonodal axilar imediatamente, e somente aqueles que são US-PAAF negativos devem ser considerados para biópsia de linfonodo sentinela. PURPOSE: To assess the feasibility and diagnostic accuracy of preoperative ultrasound combined with ultrasound-guided fine-needle aspiration (US-FNA) cytology and clinical examination of axillary lymph node in patients with breast cancer.METHODS: In this prospective study, 171 axillae of patients with breast cancer were evaluated by clinical examination and ultrasonography (US) with and without fine needle aspiration (FNA). Lymph nodes with maximum ultrasonographic cortical thickness > 2.3 mm were considered suspicious and submitted to US-FNA.RESULTS: Logistic regression analysis showed no statistically significant correlation between clinical examination and pathologically positive axillae. However, in axillae considered suspicious by ultrasonography, the risk of positive anatomopathological findings increased 12.6-fold. Cohen's Kappa value was 0.12 for clinical examination, 0.48 for US, and 0.80 for US-FNA. Accuracy was 61.4% for clinical examination, 73.1% for US and 90.1% for US-FA. Receiver Operating Characteristics (ROC) analysis demonstrated that a cortical thickness of 2.75 mm corresponded to the highest sensitivity and specificity in predicting axillary metastasis (82.7 and 82.2%, respectively).CONCLUSIONS: Ultrasonography combined with fine-needle aspiration is more accurate than clinical examination in assessing preoperative axillary status in women with breast cancer. Those who are US-FNA positive can be directed towards axillary lymph node dissection straight away, and only those who are US-FNA negative should be considered for sentinel lymph node biopsy. Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Centro de Avaliação em Mastologia Professor Laurival Antonio De Luca Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Centro de Avaliação em Mastologia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Ginecologia Obstetrícia e Mastologia Universidade de Caxias do Sul Centro de Ciências da Saúde Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Centro de Avaliação em Mastologia Professor Laurival Antonio De Luca Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Centro de Avaliação em Mastologia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Ginecologia Obstetrícia e Mastologia

This study aims to evaluate the effects of soy isoflavones on breast tissue in postmenopausal women.In this randomized, double-blind, placebo-controlled study, 80 women (aged ≥ 45 y and with amenorrhea12 mo) with vasomotor symptoms were randomized to receive either 250 mg of standardized soy extract corresponding to isoflavone 100 mg/day (n = 40) or placebo (n = 40) for 10 months. Breasts were evaluated through mammographic density and breast parenchyma using ultrasound (US) at baseline and 10-month follow-up. Independent t test, analysis of variance, Mann-Whitney U test, and χ2 trend test were used in statistical analysis.Baseline clinical characteristics showed no significant differences between the isoflavone group and the placebo group, with mean (SD) age of 55.1 (6.0) and 56.2 (7.7) years, mean (SD) menopause duration of 6.6 (4.8) and 7.1 (4.2) years, and mean (SD) body mass index of 29.7 (5.0) and 28.5 (4.9) kg/m2, respectively (P0.05). The study was completed by 32 women on isoflavone and 34 women on placebo. The groups did not differ in mammographic density or breast parenchyma by US (P0.05). Within each group, the baseline and final moments did not differ in mammography or US parameters significantly (P0.05).The use of soy isoflavone extract for 10 months does not affect breast density, as assessed by mammography and US, in postmenopausal women.

To assess the feasibility and diagnostic accuracy of preoperative ultrasound combined with ultrasound-guided fine-needle aspiration (US-FNA) cytology and clinical examination of axillary lymph node in patients with breast cancer.In this prospective study, 171 axillae of patients with breast cancer were evaluated by clinical examination and ultrasonography (US) with and without fine needle aspiration (FNA). Lymph nodes with maximum ultrasonographic cortical thickness2.3 mm were considered suspicious and submitted to US-FNA.Logistic regression analysis showed no statistically significant correlation between clinical examination and pathologically positive axillae. However, in axillae considered suspicious by ultrasonography, the risk of positive anatomopathological findings increased 12.6-fold. Cohen's Kappa value was 0.12 for clinical examination, 0.48 for US, and 0.80 for US-FNA. Accuracy was 61.4% for clinical examination, 73.1% for US and 90.1% for US-FA. Receiver Operating Characteristics (ROC) analysis demonstrated that a cortical thickness of 2.75 mm corresponded to the highest sensitivity and specificity in predicting axillary metastasis (82.7 and 82.2%, respectively).Ultrasonography combined with fine-needle aspiration is more accurate than clinical examination in assessing preoperative axillary status in women with breast cancer. Those who are US-FNA positive can be directed towards axillary lymph node dissection straight away, and only those who are US-FNA negative should be considered for sentinel lymph node biopsy.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:50:33Z No. of bitstreams: 1 S0100-72032007001200005.pdf: 770263 bytes, checksum: 8ca1f437c9a22390d552e5f60bda17f9 (MD5) Made available in DSpace on 2013-08-22T18:50:33Z (GMT). No. of bitstreams: 1 S0100-72032007001200005.pdf: 770263 bytes, checksum: 8ca1f437c9a22390d552e5f60bda17f9 (MD5) Previous issue date: 2007-12-01 Made available in DSpace on 2013-09-30T18:28:57Z (GMT). No. of bitstreams: 2 S0100-72032007001200005.pdf: 770263 bytes, checksum: 8ca1f437c9a22390d552e5f60bda17f9 (MD5) S0100-72032007001200005.pdf.txt: 28747 bytes, checksum: 9e078ca83c3f1086f08adf93690a370a (MD5) Previous issue date: 2007-12-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:42:13Z No. of bitstreams: 2 S0100-72032007001200005.pdf: 770263 bytes, checksum: 8ca1f437c9a22390d552e5f60bda17f9 (MD5) S0100-72032007001200005.pdf.txt: 28747 bytes, checksum: 9e078ca83c3f1086f08adf93690a370a (MD5) Made available in DSpace on 2014-05-20T13:42:14Z (GMT). No. of bitstreams: 2 S0100-72032007001200005.pdf: 770263 bytes, checksum: 8ca1f437c9a22390d552e5f60bda17f9 (MD5) S0100-72032007001200005.pdf.txt: 28747 bytes, checksum: 9e078ca83c3f1086f08adf93690a370a (MD5) Previous issue date: 2007-12-01 OBJETIVO: analisar qual das características propostas pelo BIRADS-US tem maior impacto na diferenciação das lesões benignas das malignas. MÉTODOS: estudamos as características ultra-sonográficas do BIRADS em 384 nódulos submetidos à biópsia percutânea no período de fevereiro de 2003 a dezembro de 2006. Utilizou-se, para o exame, o aparelho Logic 5, com transdutor linear multifreqüencial de 7,5-12 MHz. A análise ultra-sonográfica do nódulo foi baseada no BIRADS-US levando em conta: forma, orientação, margem, limites da lesão, ecogenicidade, características acústicas posteriores, o tecido circunjacente e a presença de calcificações. Estes dados foram submetidos à análise estatística com modelo de regressão logística. Para o estudo de associação entre estas variáveis utilizamos o teste do c² e também calculamos a sensibilidade e a especificidade das variáveis tecido ao redor, calcificações, efeito posterior, limite da lesão e orientação. RESULTADOS: as lesões benignas representaram 42,4% e as malignas, 57,6%. A análise por regressão logística encontrou odds ratio (OR) aumentado para câncer de 7,7 vezes quando o tecido ao redor esteve alterado, de 6,2 vezes quando houve presença das microcalcificações no interior das lesões, de 1,9 quando o efeito acústico foi sombra, de 25,0 vezes quando houve o halo ecogênico e de 7,1 vezes quando a orientação foi não paralela. CONCLUSÕES: dentre as características estudadas, o limite da lesão, representado pela presença ou não do halo ecogênico, é o mais importante diferenciador das massas benignas das malignas. PURPOSE: to analyze which characteristics proposed by the BIRADS lexicon for ultrasound have the greatest impact on distinguishing between benign and malignant lesions. METHODS: ultrasonography features from the third edition of the BIRADS were studied in 384 nodes submitted to percutaneous biopsy from February 2003 to December 2006, at the Medical School of Botucatu. For the ultrasonography, the equipment Logic 5 with a 7.5-12 MHz multifrequential linear transducer was used. The ultrasonography analysis of the node considered the features proposed by the BIRADS lexicon for ultrasound. The data were submitted to statistical analysis by the logistic regression model. RESULTS: the benign lesions represented 42.4% and the malignant, 57.6%. The logistic regression analysis found an odds ratio (OR) for cancer of 7.69 times when the surrounding tissue was altered, of 6.25 times when there were microcalcifications in the lesions interior, of 1.95 when the acoustic effect is shadowing, of 25.0 times when there was the echogenic halo, and of 7.14 times when the orientation was non-parallel. CONCLUSIONS: among the features studied, the lesion limit, represented by the presence or not of the halogenic halo, is the most important differentiator of the benign from the malignant masses. Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Ginecologia, Obstetrícia e Mastologia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Radiologia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Centro de Avaliação em Mastologia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Ginecologia, Obstetrícia e Mastologia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Radiologia Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Centro de Avaliação em Mastologia

OBJETIVO: avaliar a resposta loco-regional à quimioterapia primária nas pacientes com câncer de mama nos estadios II e III. MÉTODOS: foi realizado um estudo clínico retrospectivo e analítico de 97 pacientes no estadios II e III, no período de janeiro de 1993 a dezembro de 2004, submetidas a três ou quatro ciclos de quimioterapia primária com 5-fluorouracil (500 mg/m²), epirrubicina (50 mg/m²) e ciclofosfamida (500 mg/m²) ou doxorrubicina (50 mg/m²) e ciclofosfamida (500 mg/m²) e posteriormente ao tratamento loco-regional cirúrgico conservador ou radical. Para estudo da associação entre as variáveis (idade, estado menopausal, volume tumoral pré-quimioterapia, estado axilar, estádio, esquema terapêutico e número de ciclos) foram utilizados os testes do chi2 e o exato de Fisher. Para as variáveis quantitativas (volume tumoral pelo estudo anátomo-patológico e volume tumoral clínico pós-quimioterapia) foi utilizado o coeficiente de correlação de Pearson. O nível de significância utilizado foi de 5%. RESULTADOS: a média de idade da população estudada foi de 52,2 anos. No estádio II, tivemos 56,8% dos casos e no estádio III, 43,2%. Aproximadamente metade das pacientes receberam FEC50 e 50%, AC. Obtivemos uma resposta clínica objetiva com o tratamento quimioterápico primário em 64,9% dos casos. A resposta clínica completa ocorreu em 12,3% das pacientes; já a resposta patológica completa aconteceu em 10,3% dos casos. Observamos uma correlação significante entre o número de ciclos e a resposta à quimioterapia primária. Também verificamos uma concordância significante entre a avaliação pelo exame clínico da resposta à quimioterapia primária e o achado anátomo-patológico. CONCLUSÕES: o número de ciclos foi importante para a resposta loco-regional, sendo que as pacientes que receberam maior número de ciclos obtiveram melhores respostas. Também foi possível avaliar a resposta tumoral pelo exame clínico, pois houve concordância com o anátomo-patológico. PURPOSE: to evaluate the loco-regional response to primary chemotherapy in patients with breast cancer at stages II and III. METHODS: a retrospective and analytical clinical study carried out in 97 patients with an average age of 52.2 years old, with breast cancer at stages II and III, attended from January 1993 to December 2004, and submitted to 3 to 4 cycles of primary chemotherapy with 5-fluorouracil - 500 mg/m2, epirubicin - 50 mg/m2 and cyclophosphamide - 500 mg/m2 or doxorubicin - 50 mg/m2 e cyclophosphamide - 500 mg/m2, and then to loco-regional surgical conservative or radical surgical treatment. Chi-square and Fisher’s exact tests were used to study the association among the variables (age, menopausal state, pre-chemotherapy tumoral volume, axillary condition, stage, therapeutic scheme and number of cycles), while Pearson’s correlation coefficient was used for the quantitative variables (tumoral volume according to the anatomo-pathological study and the post-chemotherapy clinical tumoral volume. The significance level was 5%. RESULTS: there were 56.8% of cases at stage II and 43.2% at stage III. Approximately 50% of the patients received FEC50 and 50% AC. Objective clinical response with primary chemotherapy was obtained in 64.9% of the cases. Full clinical response occurred in 12.3% of patients, while full pathological response occurred in 10.3% of the cases. CONCLUSIONS: there was a statistically significant correlation between the number of cycles and the response to primary chemotherapy. Patients who received 4 cycles had better response than those who received 3 cycles. There was also a statistically significant concordance between the evaluation through clinical examination of the response to primary chemotherapy and the pathological findings. No statistically significant correlation was observed concerning age, menopausal status, tumoral volume, and pretreatment of axillary damage.

Obesidade tem sido associada a um aumento de risco para desenvolvimento de câncer de mama, além de maior recorrência e mortalidade por esta neoplasia. Alguns biomarcadores séricos associados a inflamação sistêmica, por serem de baixo custo e fácil aquisição, têm sido estudados como fatores prognóstico em pacientes com câncer, entre eles a relação neutrófilo/linfócito (NLR) e a relação plaquetas/linfócitos (PLR). Este estudo tem como objetivo avaliar a associação entre o índice de massa corporal (IMC) e câncer de mama, e a influência do NLR e PLR no prognóstico dessas pacientes em uma coorte de mulheres brasileiras com longo tempo de seguimento. Trata-se de análise retrospectiva dos registros das pacientes atendidas e tratadas por câncer de mama no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (USP) no período entre 1999 e 2013. Foram utilizados os dados clínicos e patológicos coletados antes do primeiro tratamento. Para análise de sobrevida foram realizados modelos de regressão de Cox. Das 1.831 pacientes incluídas, 620 (33,8%) eram obesas na ocasião do diagnóstico (BMI≥30kg/m2). Obesas tinham tumores maiores comparadas as não-obesas (mediana 22mm versus 20mm, p=0.01). IMC acima de 30 foi associado a pior sobrevida livre de doença e maior mortalidade apenas em pacientes com doença inicial (estádio I), mas não em doença mais avançada. Valores elevados de NLR foram fator prognóstico independentes de maior recorrência e mortalidade. Um subgrupo de pacientes com alto NLR e alto IMC tiveram piores recorrência (p=0.046, logrank), sobrevida específica (p