IntroductionIn locally and locally advanced triple-negative breast cancer (TNBC), neoadjuvant chemotherapy (NAC) only induces a pCR in 30–35% of patients. Clinical and pathological factors are not enough to distinguish the patients who have no chance of a pCR or not. The tumour microenvironment is critical for cancer and tumour-infiltrating lymphocytes (TIL). Moreover, the NAC scenario is the perfect setting to study possible changes in TIL levels.Material and methodsUsing our prospective maintained breast cancer (BC) database, we identified 164 TNBC patients treated with NAC between 1998 and 2015 with enough samples of diagnostic biopsy and after surgery. Evaluation of TILs before and after NAC followed a standardised methodology for visual assessment on haematoxylin–eosin sections and the amounts of TILs were quantitated in deciles. We categorised lymphocyte-predominant breast cancer cutoff according to a receiver operating characteristic (ROC) analysis. We categorised LPBC as involving > 40% lymphocytic infiltration tumour stroma. The primary end point was predictive value of TILs to NAC, and the secondary end point was disease-free survival (DFS). DFS was analysed using the Kaplan–Meier method and the groups were compared with a long-rank test. Univariate and multivariate Cox models were used to generate hazard ratios for determining associations between variables such as TIL after NAC and DFS.ResultsA total of 164 TNBC patients were treated with NAC and surgery. The main patients’ characteristics are listed in Table 1. We identify different pathological complete response to anthracycline and taxane-based NAC; LPBC subgroup 51 from 58 patients (88%) pCR versus non- lymphocyte-predominant breast cancer (LPBC) subgroup 10 from 106 (9%) pCR, p = 0.001. At a median follow-up of 78 months, LPBC was associated with better DFS; the three-year Kaplan–Meier estimates for DFS were 2% and 30 % for patients with LPBC and non-LPBC, respectively, p = 0.01. Univariate and multivariate analysis confirmed TIL to be an independent prognostic marker of DFS.ConclusionsTumour-infiltrating lymphocytes could be routinely used in locally advanced TNBC treated with anthracycline and taxane, such as biomarker, to be enabled the identification of different two subgroups: LPBC patients have a very high response to NAC pCR 88%, meanwhile non-LPBC patients only achieve 9%. Moreover, non-LPBC patients have a worse prognosis than LPBC patients. This data verified the predictive and prognostic value of TIL.
Mantle cell lymphoma (MCL) is an infrequent subtype of non-Hodgkin’s lymphoma (NHL) and represents between 4–8% of adult lymphomas. Recently an increase in its incidence to 1–2 cases/100,000 inhabitants/year has been observed. The first line of treatment is based on chemoimmunotherapy and depends on age and the initial stage at diagnosis. There are no second line or successive treatments. There are currently several drugs available that provide acceptable results.
Introduction: Triple-negative breast cancer (TNBC) is a heterogeneous disease with different biological behaviours and aggressiveness. Cancer immune edition has been revealed as a major hallmark in cancer. In patients treated with neoadjuvant chemotherapy (NAC) it is the perfect setting to study possible changes in tumour-infiltrating lymphocyte (TIL) levels since we have histological sample pre-treatment after NAC lacking pathological complete response (pCR). Several recent clinical studies have evaluated TILs in TNBC patients with different methodological approaches. Recently, the International TILs Working Group proposed that full sections are preferred over core biopsies. Material and methods: Using our prospective maintained BC database we identified 164 TNBC patients treated with NAC between 1998 and 2015 with enough samples of diagnostic biopsy and after surgery. Evaluation of TILs after NAC was following a standardized methodology for visual assessment on haematoxylin-eosin (HE) full sections and stromal TIL was measured as a continuous variable. The primary end point was prognostic value of TILs in residual disease. The secondary endpoint was influence of change in TIL score before and after NAC in disease free survival (DFS). DFS was analysed with Kaplan-Meier method and groups were compared with long-rank test. Univariate and multivariate Cox models were used to generate hazard ratios (HR) for determining associations between variables and DFS. Results: 103 TNBC patients had residual disease after NAC. At a median follow-up of 78 months, lymphocytepredominant breast cancer (LPBC) was associated with better DFS; the 6-year Kaplan-Meier estimates for DFS were 66.2% and 23% for patients with LPBC and non-LPBC, respectively (p = 0.001). About influence of change in TIL score before and after NAC in disease free survival (DFS); median DFS in non-changes-group was 40 months (95% CI 8.1-71 months), decrease TILs group 154 months (95% CI 9-371 months), and increase TILs group was not reached (p = 0.001). By univariate analysis, increase TILs levels between and after NAC vs. decrease or non-changes levels HR 4.01, (95% CI 1.69-9.59; p = 0.002). And by multivariate analysis TILs levels in residual disease HR 2.92 (95% CI 1.05-9.66; p = 0.040). Conclusions: TILs changes between pre and post-neoadjuvant treatment and in residual disease in triple negative breast cancer proportionate relevant prognostic in this study TNBC.
Results: Total number of cases who received palliative sedation is 212; (71%) 151 patients in the hospital and (29%) 61 patients at home. The median age was 61 years (range 19-91 years old) with 32% female and 68% male. 39 patients (18%) underwent treatment in the last 4 weeks of life and 17 patients (8%) in their last 2 weeks of life. Of these 39 patients, 54% of them are older than 65 years and 30% older than 70 years. Conclusions:The results in both groups (at home and in the hospital) were similar in sociodemographic and pathological patient profile and time from palliative sedation to death. The concept of aggressive chemotherapy or anti-target therapy in the group of patients analysed is similar to the literature review.
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