BACKGROUND: There are a number of proven molecular and pathological markers important for the prognosis for OS of early luminal type breast cancer, but there are still some deficiencies mainly due to the non-linear relationship between the markers and the outcome of the disease. METHODS AND PATIENTS: In this retro-prospective study, clinical and pathological data were provided from 336 patients with breast cancer who underwent breast surgery and treatment between January 2010 and December 2013, and followed until December 2018. The aim of the study was an evaluation of ER, PR, and Ki-67 as independent prognostic factors for OS of early luminal breast cancer. RESULTS: Early luminal breast cancers were not predictive of ER expression status (p = 0.699, p = 0.356), whereas only early Luminal B was predictive for PR expression (>10%: 72.2%). Ki-67 in most of the cases of early Luminal B was with expression of >14–20% (p = 0.056). Patients with ER of 1–10% survived over 80 months (p = 0.0020) in early Luminal A, but ER expression status did not show prognostic significance for OS of early Luminal B (p = 0.775). PR status did not show prognostic significance for OS in early luminal types (p = 0.257, p = 0.622). ER >1%/PR >1% was protective in early Luminal B (p = 0.00043), but not in early Luminal A. CONCLUSION: Our results suggest ER, but not PR as independent prognostic factor for OS but only of early Luminal A. We did not prove Ki-67 as independent prognostic factor for OS of highly proliferative early breast cancer.

BACKGROUND: Primary stage IV breast cancer accounts about of 3–5% of newly diagnosed breast cancer cases. The management of this patient subset mostly comprises systemic therapy, with additional surgery or radiotherapy to control locoregional symptoms. Some of the retrospective studies showed the benefit of locoregional treatment as the first treatment of choice for overall survival (OS), but the efficacy of primary site surgery remains controversial for OS in prospective, controlled trials. AIM: We aimed to presents series of cases with primary metastatic breast cancer with diffuse bone metastasis. MATERIALS AND METHODS: This study was serial of cases with primary metastatic breast cancer with diffuse bone metastasis and a review of the literature. All of the cases were treated with upfront surgical resection of the primary in the breast. RESULTS: During the follow-up period of 36 months, all of our patients were still alive. CONCLUSION: Retrospective studies about resection of primary tumor as the first treatment of choice are with conflicting results, which may be related to randomization bias, including different biological types of breast cancer, different metastatic sites, and patients with different menopausal status. On the other hand, prospective studies did not show any powerful results that would lead the treatment in de novo stage IV breast cancer because of few limitations such a short follow-up period (between 23 and 40 months), younger patients, ER-positive/HER2 negative tumors, and type of chemotherapy given or not upfront. The effect of upfront surgery in newly metastatic breast cancer patients is still challenging, so there is a need to identify the exact cohort of patients who could benefit from surgery.

INTRODUCTION:Colorectal liver metastases have a poor prognosis, and only 2% have an average 5-year survival if left untreated. Despite radical resection, the average five-year survival is between 25% and 44%.AIM:To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the influence of the type and extensity of resection survival after radical surgical treatment of patients.METHODS:This is a retrospective study. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases.RESULTS:Radical resection of liver metastases has the impact of the patient survival, and the survival is the smallest in the patients with left hemihepatectomy and the longest in the patients with bisegmentectomy. But no specific technique and the number of resected segments influenced the survival of patients with colorectal liver metastases.CONCLUSION:In patients with colorectal liver metastases only resection has potentially curative character. The type and amount of liver resection has no influence of the survival.

BACKGROUND: The extent of the resection, whether clamped or non-clamping resection is factor that influences the operating time and intraoperative bleeding, the development of modern techniques for vascular control and resection, and determine of lesser blood loss, morbidity, and mortality. AIM: The aim of this study was to determine the experience of General and Hepatobiliary Surgery Clinic at Aleksandrovska Hospital Sofia, Republic of Bulgaria in the treatment of patients with colorectal metastases in the liver and to compare literature reports on the influence of the extent of resection and Pringle maneuver (IPM) on operating time and perioperative bleeding. MATERIALS AND METHODS: This retrospective study covers the time period from January 01, 2006, until December 31, 2015. A total of 239 patients were included, from which: 179 patients were treated with radical surgery, 5 with palliative intervention, and 55 were subjected on operability exploration. RESULTS: The use of the IPM for vascular control insignificantly influenced the prolonged operative time, while intraoperative blood loss was significantly lower in patients with Pringle <15 min. There was no association between IPM and resection type, while intraoperative blood loss and operating time were significantly greater in patients with major resection. CONCLUSION: Resection size is directly proportional to operating time and perioperative blood loss, but it does not significantly influence perioperative morbidity. The IPM does not influence operating time, while blood loss is significantly lower in the group of patients with Pringle <15 min.

BACKGROUND: Leptomeningeal metastases are diagnosed in 1% to 8% of patients with cancer. The most common histology is leukaemia, lymphoma, breast carcinoma, lung carcinoma and melanoma. The aim of this study is to show the appearance of leptomeningeal metastases in lung and breast cancer with specific biological features.