Search

Purpose To evaluate the differences when performing the sentinel lymph node biopsy (SLNB) before or after neoadjuvant endocrine therapy (NET) in breast cancer patients, and the impact of its timing on prognosis. Methods A retrospective cohort study including 91 postmenopausal cases with clinically node-negative and hormone receptor-positive/HER2 negative (HR+/HER2-) breast cancer, treated with NET and SLNB at our institution. SLNB was performed pre-NET until 2014, and post-NET thereafter. Axillary lymph node dissection (ALND) was indicated only in SLNB-macrometastasis, although in selected elderly patients it was omitted. Kaplan-Meier survival curves were obtained in relation to the status of the axilla, and the differences assessed using the log-rank test. Results Between December 2006 and March 2022, SLNB was performed pre-NET in 14 cases and post-NET in 77. SLNB-positivity was similar regardless of whether SLNB was performed before or after NET (35.7% and 37%, respectively), with 2/14 SLN macrometastases in the pre-NET cohort and 17/77 in the post-NET cohort. Only three patients (18.7%) with SLN macrometastasis had > 3 positive nodes following axillary node dissection. The 5-year overall survival and distant disease-free survival were 92.4% and 94.8% respectively, with no significant differences according to SLNB status. Conclusion SLN positivity did not differ according to its timing (before or after NET). Therefore, NET has no effect on lymph node clearance. Furthermore, the prognosis is good regardless of the axillary involvement. Therefore, factors other than axillary involvement may affect the prognosis in these patients.

IntroductionThe clinical impact on fertility in carriers ofBRCA1andBRCA2mutations remains unclear. The aim of this study was to assess ovarian reserve as measured by anti-mullerian hormone levels inBRCA1orBRCA2mutation carriers, as well as to investigate the impact of anti-mullerian hormone levels on reproductive outcomes.MethodsThe study involved a cohort of women who tested positive forBRCA1andBRCA2screening or were tested for a BRCA1 or BRCA2 family mutation. Blood samples were collected for anti-mullerian hormone analysis and the reproductive outcomes were analyzed after a mean follow-up of 9 years. Participants were classified intoBRCAmutation-positive versusBRCAmutation-negative. Controls were healthy relatives who tested negative for the family mutation. All patients were contacted by telephone to collect data on reproductive outcomes. Linear regression was used to predict anti-mullerian hormone levels byBRCAstatus adjusted for a polynomial form of age.ResultsResults of anti-mullerian hormone analysis and reproductive outcomes were available for 135 women (BRCAmutation-negative, n=66;BRCA1mutation-positive, n=32;BRCA2mutation-positive, n=37). Anti-mullerian hormone curves according to BRCA status and adjusted by age showed thatBRCA2mutation-positive patients have lower levels of anti-mullerian hormone as compared withBRCA-negative and BRCA1 mutation-positive. Among the women who tried to conceive, infertility was observed in 18.7% ofBRCAmutation-negative women, in 22.2% ofBRCA1mutation-positive women, and in 30.8% ofBRCA2mutation-positive women (p=0.499). In the multivariable analysis, there were no factors independently associated with infertility.DiscussionBRCA2mutation-positive carriers showed more diminished anti-mullerian hormone levels thanBRCA1mutation-positive andBRCAmutation-negative women. However, these differences do not appear to have a negative impact on reproductive outcome. This is important to consider at the time of reproductive counseling in women withBRCA1orBRCA2mutations.

The clinical impact on fertility in carriers ofThe study involved a cohort of women who tested positive forResults of anti-mullerian hormone analysis and reproductive outcomes were available for 135 women (

Introduction/Background: The clinical impact on fertility in carriers of BRCA1 and BRCA2 mutations remains unclear. Our main objective was to assess the ovarian reserve as measured by circulating antimu00fcllerian hormone (AMH) levels in BRCA1 or BRCA2 mutation carriers, as well as to investigate the impact of AMH levels on reproductive outcomes.Methodology: Prospective observational cohort study carried out in Hospital Universitari de Bellvitge. The inclusion criteria were women aged between 18 and 45 years, proven carries of BRCA1 or BRCA2 gene mutations. Controls were healthy relatives that tested negative for the family mutation. Exclusion criteria were unilateral or bilateral adnexectomy, history of pelvic radiation therapy, cancer, chemotherapy, and refusal to participate in the study. AMH measurements were performed in frozen stored samples collected between January 2005 and November 2009. Between March and June 2018, all patients were contacted by telephone to collect data on reproductive outcomes and epidemiological variables.Results: A total of 135 women divided into three groups: BRCA negative (n = 66), BRCA1 positive (n = 32), and BRCA2 positive (n = 37). The mean age at AMH serum concentration measurement was 32 years in all groups. Local weighted regression (Loess) analysis showed lower AMH levels in BRCA2-positive women (figure 1). Epidemiological variables were assessed at a mean age of 41 years for each group (table 1). Statistically significant differences among groups in parity, infertility, or use of assisted reproductive treatments were not found (table 2). In the multivariable analysis to assess risk factors for infertility (excluding male factor), age at diagnosis of infertility was the only variable independently associated with infertility (OR 1.22, 95% CI 1.11 to 1.36, P < 0.001) (figure 2).Conclusions: BRCA2 mutation carriers showed decreased AMH levels, although it does not appear to have clinical impact as reproductive outcome was similar among groups.

Introduction/Background: The management of surgical stages in cervical cancer need to be redesign based on the recent literature. However, it is not less important to know about the own experience in that field in order to reconsider further changes in daily practice. We aimed to study our outcomes in women affected by early-stage cervical cancer.Methodology: This retrospective study analyzed data for all patients with early stage (IA1, IA2, IB1) cervical cancer treated by surgery between July 2000 and April 2017 at our institution. Clinical and pathological features, recurrences, disease free-survival (DFS) and disease specific survival rates were compared between patients who received Open Surgery (laparotomy), Minimally Invasive Surgery (MIS: laparoscopy or robotic) and Vaginal Surgery (Schauta assisted by laparoscopy for lymphadenectomy).Results. A total of 107 patients were included, of whom 24 (22.4%), 65 (60.7%) and 18 (16.8%) received open, MIS or vaginal surgery respectively. The three groups were similar with respect to age, histologic subtype, FIGO stage and ECOG. Higher rates of lymphovascular invasion and tumor grade 3 were observed in vaginal and open group respectively, and lower rates of none adjuvant treatment in open surgery were observed (Table 1). After a median follow-up of 99, 50 and 117 months, the DFS was 82.6%, 93.8% and 86.7% in Open, MIS and Vaginal respectively and Disease specific survival rate was 100%, 98.4% and 93.8% respectively (Table 2).Conclusion. In our experience, minimally invasive radical hysterectomy showed higher rates of DFS and similar disease specific survival rate than Open and Vaginal radical hysterectomy among women with early-stage cervical cancer. However, this results should be interpreted with caution considering that three groups were not homogeneus.