Introduction: The three different breast cancer subtypes (Luminal, HER2-positive, and triple negative (TNBCs) display different natural history and sensitivity to treatment, but little is known about whether residual axillary disease after neoadjuvant chemotherapy (NAC) carries a different prognostic value by BC subtype. Methods: We retrospectively evaluated the axillary involvement (0, 1 to 3 positive nodes, ≥4 positive nodes) on surgical specimens from a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012. We analyzed the association between nodal involvement (ypN) binned into three classes (0; 1 to 3; 4 or more), relapse-free survival (RFS) and overall survival (OS) among the global population, and according to BC subtypes. Results: 1197 patients were included in the analysis (luminal (n = 526, 43.9%), TNBCs (n = 376, 31.4%), HER2-positive BCs (n = 295, 24.6%)). After a median follow-up of 110.5 months, ypN was significantly associated with RFS, but this effect was different by BC subtype (Pinteraction = 0.004), and this effect was nonlinear. In the luminal subgroup, RFS was impaired in patients with 4 or more nodes involved (HR 2.8; 95% CI [1.93; 4.06], p < 0.001) when compared with ypN0, while it was not in patients with 1 to 3 nodes (HR = 1.24, 95% CI = [0.86; 1.79]). In patients with TNBC, both 1-3N+ and ≥4 N+ classes were associated with a decreased RFS (HR = 3.19, 95% CI = [2.05; 4.98] and HR = 4.83, 95% CI = [3.06; 7.63], respectively versus ypN0, p < 0.001). Similar decreased prognosis were observed among patients with HER2-positive BC (1-3N +: HR = 2.7, 95% CI = [1.64; 4.43] and ≥4 N +: HR = 2.69, 95% CI = [1.24; 5.8] respectively, p = 0.003). Conclusion: The prognostic value of residual axillary disease should be considered differently in the 3 BC subtypes to accurately stratify patients with a high risk of recurrence after NAC who should be offered second line therapies.

Introduction:The implementation of the first national lockdown during COVID-19 epidemic has forced primary care to adapt quickly. Aim: The main objective of this work was to evaluate the effect of the first lockdown imposed on the French population in 2020 on the number of admissions in gynecological emergencies in one center, in comparison with 2019. The secondary objectives were the study of diagnostics, analysis of the treatments and comparison of the complication rates between the two periods studied. Material and methods: A retrospective study was conducted in the gynecological EDs of Cochin Port Royal Hospital (Paris, France) regarding all admissions from 1 February to 30 April for 2019 and 2020. Results: A total of 4911 women were admitted to the gynecological EDs. The lockdown was associated with an average decrease of 20.3 patients per day, independently of the year and period. We noted a significant increase in the odds of deferred surgery (p = 0.02) and hospitalizations (p = 0.03), but this was not significant for immediate emergency surgery (p = 0.4). Moreover, there has been a significant increase in the odds of a new consultation with complication (p < 0.001). Conclusions: The COVID-19 lockdown reduced the admission rate to gynecological EDs in our center, but continues to test the capacity of health systems to manage emergencies.

IntroductionThe three different breast cancer subtypes (Luminal, HER2-positive and triple negative (TNBCs) display different natural history and sensitivity to treatment, but little is known about whether residual axillary disease after neoadjuvant chemotherapy (NAC) carries a different prognostic value by BC subtype.MethodsWe retrospectively evaluated axillary involvement (0, 1 to 3 positive nodes, ≥ 4 positive nodes) on surgical specimens from a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012. We analyzed the association between nodal involvement (ypN) binned into 3 classes (0; [1-3];4 or more), relapse-free survival (RFS) and overall survival (OS) among the global population, and according to BC subtypes.Results1197 patients were included in the analysis (luminal (n = 526, 43.9%), TNBCs (n = 376, 31.4%), HER2-positive BCs (n = 295, 24.6%)). After a median follow-up of 110.5 months, ypN was significantly associated with RFS, but this effect was different by BC subtype (Pinteraction= 0.004), and this effect was nonlinear. In the luminal subgroup, RFS was impaired in patients with 4 or more nodes involved (HR=2.8; 95% CI [1.93;4.06], p<0.001) when compared with ypN0, while it was not in patients with 1 to 3 nodes (HR=1.24, 95% CI = [0,86;1.79]). In patients with TNBC, both 1-3N+ and ≥ 4 N+ classes were associated with a decreased RFS (HR=3.19, 95%CI= [2.05; 4.98] and HR=4.83, 95%CI= [3.06; 7.63], respectively versus ypN0, p< 0.001). Similar decreased prognosis were observed among patients with HER2-positive BC (1-3N+: HR=2.7, 95%CI= [1.64; 4.43] and ≥ 4 N+: HR=2.69, 95%CI= [1.24; 5.8] respectively, p=0.003).ConclusionThe prognostic value of residual axillary disease should be considered differently in the 3 BC subtypes to accurately stratify patients with a high risk of recurrence after NAC who should be offered second line therapies.