Fatores clínicos e anatomopatológicos que influenciam a sobrevida de pacientes com câncer de mama e derrame pleural neoplásico

Abstract

Objective: The objective of this study was to identify the clinical and pathological factors that can influence the prognosis of breast cancer patients with clinical symptoms of malignant pleural effusion. Methods: This was a clinical cohort study, in which we analyzed the medical charts of patients diagnosed with malignant pleural effusion between 2006 and 2010. By examining the charts, we identified the female patients with a history of breast cancer. For those patients, we collected pathology data related to the primary tumor and cytopathology data related to the pleural metastasis. Results: We evaluated 145 patients, 87 (60%) of whom had tested positive for malignant cells in the pleural fluid. Ductal histology was observed in 119 (82%). The triple-negative breast cancer phenotype was seen in 25 cases (17%). Those patients had the worst prognosis (with a sharp decline in the survival curve), and 20 of the 25 (80%) died during the follow-up period (through June of 2011). The mean survival after the identification of malignant pleural effusion was 6 months. Conclusions: In patients with triple-negative breast cancer who test positive for malignant cells in the pleural fluid, the prognosis is poor and survival is reduced.Keywords: Pleural effusion, malignant/mortality; Breast neoplasms/mortality; Breast neoplasms/genetics. ResumoObjetivo: O objetivo deste estudo foi identificar os fatores clínicos e anatomopatológicos que possam influenciar o prognóstico de pacientes com câncer de mama e sintomas clínicos de derrame pleural neoplásico. Métodos: Trata-se de um estudo clínico de coorte, no qual foram analisados os prontuários médicos de pacientes que receberam diagnóstico de derrame pleural neoplásico entre 2006 e 2010. Por meio da análise dos prontuários, identificamos as pacientes com história de câncer de mama. Para essas pacientes, coletamos dados anatomopatológicos relacionados ao tumor primário e dados citopatológicos relacionados à metástase pleural. Resultados: Das 145 pacientes avaliadas, 87 (60%) apresentaram, no exame citológico, resultado positivo para células neoplásicas no líquido pleural; além disso, 119 (82%) apresentaram tipo histológico ductal. O fenótipo triplo-negativo foi observado em 25 pacientes (17%), as quais apresentaram o pior prognóstico, com queda acentuada na curva de sobrevida. Das 25 pacientes, 20 (80%) evoluíram a óbito durante o período de seguimento (até junho de 2011). A sobrevida média após a identificação de derrame pleural neoplásico foi de 6 meses. Conclusões: Em pacientes com câncer de mama triplo-negativo e exame citológico com resultado positivo para células neoplásicas no líquido pleural, o prognóstico é ruim e a sobrevida é menor. cancer who develop pleural effusion. To that end, we evaluated factors related to the diagnosis, the histological type of the primary tumor, the identification of malignant cells in the pleural fluid, the expression of immunohistochemical markers of breast cancer, and outcomes. MethodsThis was a hospital-based, historical cohort study...

Impact of Cell Arrangement of Pleural Effusion in Survival of Patients with Breast Cancer

“…Nevertheless, in our study, survival improvement and its association with spheroids in pleural fluid could not be confirmed before a period of 30 months. Our patients with a triple-negative immunohistochemical phenotype (absence of expression of hormone receptors and HER-2) in the primary tumor had higher mortality (p < 0.05), in agreement with the literature [1,15,17,25]. …”

“…Identification of malignant cells in pleural fluid suggests primary disease spread and progression, which leads to a reduced life expectancy of cancer patients [17,18,19]. However, since there are differences on survival time between some groups of patients [20,21,22], identifying the characteristics of each organ-specific metastatic breast cancer may play a major role in understanding this malignancy [1,23,24].…”

Cancer Risk in Patients With Empyema

“…Malignant pleural effusion might be the first presentation of certain cancers, especially for lung, breast, and ovarian cancers. 19 – 21 However, malignant pleural effusion might be misclassified as empyema. Furthermore, patients with empyema might undergo more investigations such as imaging studies, which might lead to cancer being detected incidentally.…”

An Autoimmune Response Signature Associated with the Development of Triple-Negative Breast Cancer Reflects Disease Pathogenesis

“…Genetic variants of CDKN1A have been associated with breast cancer and TNBC cell proliferation (34). IL5 plays an important role in immune response by stimulating B cells and increasing immunoglobulin secretion (35) and has been shown to promote malignant pleural effusion formation, which in breast cancer is associated with poor prognosis and reduced survival (36). It is therefore likely that altered pathways in TNBC impact the immune response in the form of autoantibodies.…”