Biology, Thermal Requirements, and Fertility Life Table of Strains of Trichogramma foersteri (Hymenoptera: Trichogrammatidae) in Palpita forficifera (Lepidoptera: Crambidae)

Trichogramma foersteri Takahashi is a parasitoid recently identified in eggs of Palpita forficifera Munroe, considered the main pest of the olive tree in Brazil. The efficiency of a parasitoid is conditioned to several factors such as the temperature. The objective was to study the biology of the immature and adult phases at different constant temperatures (10, 15, 20, 25, and 30 °C), determine thermal requirements, and to elaborate a fertility life table for five strains (R1, R2, R3, R4, and R5) to T. foersteri. At 10 °C, there was no development of T. foersteri. The duration of the egg-adult period (days) was inversely related to temperature, ranging from 32 to 34 days (at 15 °C) to 6.5 to 7.5 days (at 30 °C). The thermal range evaluated did not influence parasitism (parasitism > 57%) and the sex ratio (sr > 0.74). The base temperature (Tt) was similar for all strains (approximately 12 °C), corresponding to a thermal constant (K) of 120.48 to 145.13 degree days. For the adult stage, T. foersteri had the highest rate of parasitism (> 48%) to 15 °C. The emergence rate ranged from 75 to 100%. The thermal range did not influence the sex ratio of the lines (sr > 0.70), but reduced the longevity from 50 days (at 15 °C) to 6 days (at 30 °C). Regarding the fertility life table, all strains of T. foersteri showed biological potential of development and growth in eggs of P. forficifera in the thermal range of 15 to 30 °C, important information for the establishment of biological control programs.

Resistance of Grapevine Genotypes (Vitis spp.) to Daktulosphaira vitifoliae (Hemiptera: Phylloxeridae) in Brazil: Implications for Pest Management

The phylloxera Daktulosphaira vitifoliae (Fitch) is considered the main pest in vine crops in the world. One of the alternatives for pest management is the use of resistant rootstocks. In the present study, 14 vine genotypes comprised of 6 canopy cultivars (Bordô, Isabel, BRS Lorena, Cabernet Sauvignon, Magnólia, and Chardonnay), 4 commercial rootstocks (Paulsen 1103, SO4, IAC 766, and IAC 572), and 4 promising rootstocks for pest management (1111-21, 548-44, 548-15, and IBCA-125) were evaluated for resistance to infestation the of root form of pest. For each genotype, the number of eggs, nymphs, and adults present in the roots were evaluated at 15, 20, 25, 30, and 35 d after egg infestation. In addition, the feeding place (lignified or nonlignified root), the presence or absence of tuberosities and nodosities, and the total fecundity of females were evaluated. The highest survival rates of nymphs and adults were observed in Cabernet Sauvignon, BRS Lorena, Chardonnay, and IBCA-25 in lignified roots, with the formation of tuberosities characterizing the materials as susceptible. In contrast, SO4, Paulsen 1103, IAC 572, IAC 766, 548-44, 548-15, Magnólia, and 1111-21 provided the least nymph and adult survival over time in nonlignified roots present in the nodosities, characterizing the materials as resistant. In addition, the lowest fecundity was observed in the roots of Magnólia (16 eggs). According to the results, it was verified that the cultivar Magnolia and the selections 548-15 and 1111-21 present reduced infestation and survival of nymphs of D. vitifoliae in the roots. This fact demonstrates the potential of the materials to be used as new resistant rootstocks or sources of insect resistance.

The IFMIF-DONES Project: Design Status and Main Achievements Within the EUROfusion FP8 Work Programme

International Fusion Materials Irradiation Facility-DEMO-Oriented NEutron Source (IFMIF-DONES) is a high-intensity neutron irradiation facility for qualification of fusion reactor materials, which is being designed as part of the European roadmap to fusion-generated electricity. Its main purpose is to study the behavior of materials properties under irradiation in a neutron flux able to simulate the same effects in terms of relevant nuclear responses as those expected in the first wall of the DEMO reactor which is envisaged to follow ITER. It is thus a key facility to support the design, licensing and safe operation of DEMO as well as of the fusion power plants that will be developed afterwards. The start of its construction is foreseen in the next few years. In this contribution, an overview of the IFMIF-DONES neutron source is presented together with a snapshot of the current engineering design status and of the relevant key results achieved within the EUROfusion Work Package Early Neutron Source (WPENS) as part of the 2014–2020 EURATOM Research and Training Programme, complementary to the EU Horizon 2020 Framework Programme (FP8). Moreover, some information on the future developments of the project are given.

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

BACKGROUND

The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.

METHODS

This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.

RESULTS

Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.

CONCLUSIONS

Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

Background

Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score.

Methods

This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally.

Results

Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification.

Conclusion

The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Occurrence of Sexual Reproduction of Daktulosphaira vitifoliae (Hemiptera: Phylloxeridae) in Southern Brazil and Biology and Fertility Life Table in Grapevine Cultivars

The grapevine phylloxera Daktulosphaira vitifoliae (Fitch) is the pest insect of greatest importance in grapevine. The objective of study was to evaluate the occurrence of overwintering eggs in seedlings of 'Paulsen 1103' (Vitis berlandieri × Vitis rupestris) and evaluate the biology and fertility life table of D. vitifoliae on five grape cultivars: 'Bordô' (Vitis labrusca), 'Cabernet Sauvignon' (Vitis vinifera), 'BRS Lorena' (Vitis vinifera × Seyval [Seibell 5656-Rayon d'Or]), 'Magnolia' (Vitis rotundifolia), and 'Paulsen 1103'. In the field, overwintering eggs were found to be present in 78% of 'Paulsen 1103' seedlings, on the trunk of the seedlings. In the laboratory, phylloxera was found to complete the biological cycle (egg to adult) in roots of 'BRS Lorena', 'Bordô', and 'Cabernet Sauvignon'. Nymphs did not complete development on roots of 'Paulsen 1103' and 'Magnolia', with 100% first instar mortality. Adult females feeding on 'Bordô' roots showed the lowest total fecundity (20.9 eggs per female), differing from insects feeding on 'Cabernet Sauvignon' roots (207.8 eggs per female). Based on the fertility life table, roots of 'Cabernet Sauvignon' provided the best reproduction rate (Ro = 219), intrinsic rate of increase (rm = 0.197 d) and time between generations (T = 21.5 d). The presence of overwintering eggs on the trunk of the rootstock 'Paulsen 1103' may promote the survival and dispersal of the insect. Lignified roots of the rootstock 'Paulsen 1103' and the cultivar 'Magnolia' do not allow the development of D. vitifoliae, with 'Cabernet Sauvignon' being the most suitable for the development of the insect.

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND

The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.

METHODS

Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups.

RESULTS

Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005).

CONCLUSION

Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.

Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study

BACKGROUND

No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer.

METHOD

This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).

RESULTS

Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC.

CONCLUSION

Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.

Comparison of short-term outcomes from the International Oesophago-Gastric Anastomosis Audit (OGAA), the Esophagectomy Complications Consensus Group (ECCG), and the Dutch Upper Gastrointestinal Cancer Audit (DUCA)

BACKGROUND

The Esophagectomy Complications Consensus Group (ECCG) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA) have set standards in reporting outcomes after oesophagectomy. Reporting outcomes from selected high-volume centres or centralized national cancer programmes may not, however, be reflective of the true global prevalence of complications. This study aimed to compare complication rates after oesophagectomy from these existing sources with those of an unselected international cohort from the Oesophago-Gastric Anastomosis Audit (OGAA).

METHODS

The OGAA was a prospective multicentre cohort study coordinated by the West Midlands Research Collaborative, and included patients undergoing oesophagectomy for oesophageal cancer between April and December 2018, with 90 days of follow-up.

RESULTS

The OGAA study included 2247 oesophagectomies across 137 hospitals in 41 countries. Comparisons with the ECCG and DUCA found differences in baseline demographics between the three cohorts, including age, ASA grade, and rates of chronic pulmonary disease. The OGAA had the lowest rates of neoadjuvant treatment (OGAA 75.1 per cent, ECCG 78.9 per cent, DUCA 93.5 per cent; P < 0.001). DUCA exhibited the highest rates of minimally invasive surgery (OGAA 57.2 per cent, ECCG 47.9 per cent, DUCA 85.8 per cent; P < 0.001). Overall complication rates were similar in the three cohorts (OGAA 63.6 per cent, ECCG 59.0 per cent, DUCA 62.2 per cent), with no statistically significant difference in Clavien-Dindo grades (P = 0.752). However, a significant difference in 30-day mortality was observed, with DUCA reporting the lowest rate (OGAA 3.2 per cent, ECCG 2.4 per cent, DUCA 1.7 per cent; P = 0.013).

CONCLUSION

Despite differences in rates of co-morbidities, oncological treatment strategies, and access to minimal-access surgery, overall complication rates were similar in the three cohorts.

Toxicities of acetogenin-based bioacaricides against two-spotted spider mite and selectivity to its phytoseiid predators

Tetranychus urticae is the main pest of strawberry crops and can cause up to 80% of productivity losses under high infestations. Aiming to search T. urticae management alternatives compatible with eco-friendly or organic-based food production systems, this study evaluated the lethal and sublethal toxicities of formulated derivatives from Annonaceae (rich in acetogenins) against this pest species. In addition, it also evaluated the selectivity of the most promising formulation to the predatory mites Neoseiulus californicus and Phytoseiulus macropilis, which are largely applied in biological control in Brazil. Among the derivatives tested, the emulsion from the ethanolic seed extract of Annona mucosa-ESEAm (major component: acetogenin bis-tetrahydrofuran rolliniastatin-1) caused pronounced mortality of T. urticae after 120 h of exposure (LC₅₀ = 465.5 mg L^-1), in a comparable or superior manner to an abamectin-based synthetic acaricide used as positive control (LC₅₀ = 1243.4 mg L^-1). Moreover, ESEAm exposure resulted in a significant decrease in the number of eggs laid by females and caused the most pronounced ovicidal action for T. urticae, with only 5% embryonic viability. However, ESEAm also showed high toxicity to the predatory mites tested, causing 100% mortality for both species after 120 h exposure, similar to abamectin. The interaction between these bioacaricides and biological control agents should be tested under field conditions to further assess the potential ecological selectivity of these derivatives.

Absence of interaction between rivaroxaban, tacrolimus and everolimus in renal transplant recipients with deep vein thrombosis or atrial fibrillation

No data are available on rivaroxaban use in renal transplant recipients and on its surmised interaction with immunosuppressants. The aim was to investigate potential interactions between rivaroxaban and immunosuppressants in this setting. Renal transplant recipients with a stable renal function treated with rivaroxaban and tacrolimus with or without everolimus were investigated. All drugs and creatinine concentrations were determined daily for 2 weeks after the start of anticoagulation. Blood samples were drawn at 8.00 am and 3-4 h later for trough and peak concentrations, respectively. Bleeding and thrombotic events were recorded during a minimum follow-up of 6 months. In 8 renal transplant patients, rivaroxaban levels showed a predictable pharmacokinetic trend, both at C_trough (30-61 μg/L) and at C_peak (143-449 μg/L), with limited variability in the 25th-75th percentile range. Tacrolimus (C_trough 3-13 μg/L; C_peak 3-16 μg/L), everolimus (C_trough 3-11 μg/L; C_peak 5-17 μg/L) and creatinine concentrations were stable as well. Immunosuppressors variability before and after rivaroxaban were 30% and 30% for tacrolimus, 27% and 29% for everolimus, respectively, as well as 14% and 3% for creatinine. For rivaroxaban monitoring, the reference change value better performed in identifying significant variations of its concentration. No patient had bleeding or thrombotic events, worsening of renal graft function, and signs of immunosuppressants toxicity during a mean follow-up of 23 (9-28) months. In conclusion, rivaroxaban does not seem to interact with tacrolimus and everolimus in renal transplant recipients. Both anticoagulant and immunosuppressive effects seem warranted, without major bleeding complications and effect on the graft function.

Acetogenin-Based Formulated Bioinsecticides on Anastrepha fraterculus: Toxicity and Potential Use in Insecticidal Toxic Baits

The present study evaluated the lethal toxicity and oviposition deterrence of ethanolic extracts of Annona mucosa Jacq., Annona muricata L., and Annona sylvatica A. St.-Hil on Anastrepha fraterculus (Wiedemann) (Diptera: Tephritidae) compared with those of a limonoid-based bioinsecticide (Azamax™ 1.2 EC-azadiractin +3-tigloyl-azadiractol) and a synthetic spinosyn-based insecticide (Delegate™ 250 WG-spinetoram). In addition, the efficacy of the selected toxic bait formulations was evaluated by mixing them with food attractants (Anamed™, 3% Biofruit and 7% sugarcane molasses). In the topical application and ingestion bioassays (2000 mg L^-1), the aqueous emulsion of the A. mucosa extract caused greater than 80% mortality of A. fraterculus adults in a similar manner to the spinosyn-based synthetic insecticide. Concentration-response curves were performed for the most promising treatments and showed an activity level dependent on the mode of contamination, exposure time, and applied concentration. In bioassays with and without choice, the A. mucosa (77%), A. muricata (51%), A. sylvatica (60%), Azamax™ (74%), and Delegate™ 250 WG (100%) significantly reduced the number of punctures and galleries in grape berries. In combination with the food attractants Anamed™, 3% Biofruit, and 7% sugarcane molasses, the emulsion of the A. mucosa extract had a residual effect similar to that of the spinetoram insecticide, with a mortality rate of over 80% of A. fraterculus adults up to 14 days after application (DAA) in the absence of rain. Thus, acetogenin-rich formulations, especially from A. mucosa seeds, are useful alternatives for the integrated management of A. fraterculus in agricultural orchards.

A Laboratory Bioassay Method to Assess the Use of Toxic Bait on Anastrepha fraterculus (Weidemann 1830)

The lack of standardization of bioassays for the evaluation of toxic bait toxicity on the South American fruit fly, Anastrepha fraterculus (Weidemann 1830), has led to erroneous interpretations of assay results. The objective of this study was to develop a methodology for the standardization and validation of toxicological tests on A. fraterculus toxic bait using the Success™ 0.02CB formulation (80 mg L^-1 of spinosad). Anastrepha fraterculus adults, obtained from larvae reared on an artificial diet, showed higher susceptibility (LT₅₀ = 48.96 h) than adults from larvae reared on cattley guava (LT₅₀ = 53.83 h) and mango fruit (LT₅₀ = 53.55 h). Anastrepha fraterculus adults at the age of five (LT₅₀ = 65.30 h), 15 (LT₅₀ = 59.01 h), and 30 (LT₅₀ = 55.53 h) days presented similar toxicity. The consumption of toxic bait (4.74 mg) increased at 15 days, a fact also observed with insects without food deprivation. In addition, the absence of a food source (artificial diet) with the toxic bait significantly reduced adult mortality time by 7 h (LT₅₀ = 57.42 h). In relation to exposure time, adults exposed to toxic bait for 1 h reduced consumption by 25%; however, they showed the same susceptibility as insects exposed to 2 (LT₅₀ = 55.72 h), 4 (LT₅₀ = 57.64 h), and 8 h (LT₅₀ = 57.76 h). However, with 24 h of food deprivation, they had a higher susceptibility (LT₅₀ = 46.48 h). Five-day-old A. fraterculus adults fed an artificial diet before being deprived of food for 12 or 24 h, then exposed to toxic bait for 4 h in the absence of a food source, are considered optimum conditions to evaluate the toxicity of toxic bait.

Effects of Extrinsic, Intraspecific Competition and Host Deprivation on the Biology of Trichopria anastrephae (Hymenoptera: Diapriidae) Reared on Drosophila suzukii (Diptera: Drosophilidae)

The pupal parasitoid Trichopria anastrephae Lima (Hymenoptera: Diapriidae) shows potential to control Drosophila suzukii (Matsumura) (Diptera: Drosophilidae), and understanding the behavior of this parasitoid in challenging environments is important to obtain a higher efficiency in mass rearing and in biological control programs. This study aimed to verify the effects of extrinsic intraspecific competition and the absence of host on the parasitism of T. anastrephae in D. suzukii pupae. Therefore, to evaluate the parasitism of T. anastrephae under intraspecific competition, groups of 20 pupae (24 h old) of D. suzukii were offered for different densities of parasitoids (1, 3, 5, or 10 couples) during a 7-day period. Whereas to evaluate the effects of host deprivation on parasitism of T. anastrephae, we tested different treatments: T1-no deprivation, T2-complete deprivation, T3-deprivation every other day, T4-deprivation for 3 days, and T5-deprivation for 7 days. The increase of density of parasitoids resulted in an increase of oviposition scars on pupae and a longer biological cycle, suggesting the occurrence of superparasitism. Increased density also resulted in a higher percentage of attacked pupae, but did not affect parasitoids emergence nor sex ratio. Host deprivation affected number of parasitized pupae, number and sex ratio of offspring, and the longevity of females. Based on our findings, competition among females do not impair offspring viability, and host deprivation for a period up to 7 days do not influence parasitism capacity, indicating that it can be used as a pre-release strategy.

Population Dynamics of Drosophila suzukii (Diptera: Drosophilidae) in Berry Crops in Southern Brazil

Drosophila suzukii (Matsumura) is an invasive species originating in Southeast Asia and considered a severe pest in berry crops in several countries of the Northern Hemisphere and Europe. In South America, the species was first detected in 2013. The objective of the study was to monitor the seasonal activity of D. suzukii in commercial crops of blackberry, strawberry guava, surinam cherry, blueberry, and strawberry during two consecutive harvests and in three properties in the Southern region of Brazil during the 2015/2016 and 2016/2017 harvests, with the aid of traps baited with apple cider vinegar. The highest population peaks were observed during late spring to mid-fall in all areas and plant species studied. It was verified that temperature is the factor that most influenced the seasonal activity of D. suzukii in the field, promoting low catches of the species during winter. However, even during periods of low temperatures (winter period), the presence of D. suzukii in the crops was verified, demonstrating the species' ability to stay in place from year to year, surviving in alternative hosts such as Eriobotrya japonica, a common species in the region. The information on the time of the highest occurrence of the pest in different hosts presented in this study provides the basis for decision-making in relation to the management of D. suzukii, to avoid further economic damage.

Bioassay Method for Toxicity Studies of Toxic Bait Formulations to Ceratitis capitata (Diptera: Tephritidae)

The development of appropriate methodologies for bioassays is of paramount importance to study the methodological factors that may interfere in the experimental design. Thus, laboratory bioassays have become increasingly important for the determination of data that are realistic and replicable. The objective of the study was to develop a bioassay methodology with the ready-to-use toxic bait Success™ 0.02CB, 96 mg L^-1 of spinosad, in adults of Ceratitis capitata (Wiedemann) as a study model. The insect origin (laboratory population, LT₅₀ = 11.16 h), time of toxic bait supply (4 h, LT₅₀ = 16.85 h), food deprivation (12 h, LT₅₀ = 15.55 h), and the adult age (5 days, LT₅₀ = 35.31 h) of C. capitata showed higher susceptibility and a shorter LT₅₀ lethal time to the Success™ 0.02CB toxic bait. However, the absence or presence of a food source (LT₅₀ ≈ 31.17 h) during the bioassay did not affect the susceptibility of C. capitata. Further, adults of C. capitata who were deprived and in the absence of a food source (artificial diet) had higher consumption of toxic baits (mg) during treatment exposure. The use of a 12-h deprivation period, toxic baits offered for 4 h, and absence of an artificial diet for adults of C. capitata at 5 days of age during the bioassay are considered adequate for evaluating formulations of toxic baits under laboratory conditions.

Impact of spleen-preserving total gastrectomy on postoperative infectious complications and 5-year overall survival: systematic review and meta-analysis of contemporary randomized clinical trials

Background

The role of splenectomy in proximal gastric cancer is still debated. The objective of the present meta-analysis was to provide more-robust evidence about the effect of spleen-preserving total gastrectomy on postoperative infectious complications, overall morbidity, and 5-year overall survival (os).

Methods

PubMed, embase, and the Web of Science were consulted. Pooled effect measures were calculated using an inverse-variance weighted or Mantel-Haenszel in random effects meta-analysis. Heterogeneity was evaluated using I ² index and Cochran Q-test.

Results

Three randomized controlled trials published between 2000 and 2018 were included. Overall, 451 patients (50.1%) underwent open total gastrectomy with spleen preservation and 448 (49.9%) underwent open total gastrectomy with splenectomy. The patients ranged in age from 24 to 78 years. No differences were found in the number of harvested lymph nodes (p = 0.317), the reoperation rate (p = 0.871), or hospital length of stay (p = 0.347). The estimated pooled risk ratios for infectious complications, overall morbidity, and mortality were 1.53 [95% confidence interval (ci): 1.09 to 2.14; p = 0.016], 1.51 (95% ci: 1.11 to 2.05; p = 0.008), and 1.23 (95% ci: 0.40 to 3.71; p = 0.719) respectively. The estimated pooled hazard ratio for 5-year os was 1.06 (95% ci: 0.78 to 1.45; p = 0.707).

Conclusions

Spleen-preserving total gastrectomy should be considered in patients with curable gastric cancer because it is significantly associated with decreased postoperative infectious complications and overall morbidity, with no difference in the 5-year os. Those observations appear worthwhile for establishing better evidence-based treatment for gastric cancer.

Drosophila suzukii in Southern Neotropical Region: Current Status and Future Perspectives

Non-native insect pests are often responsible for important damage to native and agricultural plant hosts. Since Drosophila suzukii Matsumura (Diptera: Drosophilidae) has become an important pest in North America and Europe (i.e., in 2008), the global production of soft thin-skinned fruits has faced severe production losses. In the southern Neotropical region, however, the first record of D. suzukii occurred in 2013 in the south of Brazil. It has also been recorded in Uruguay, Argentina, and Chile. Despite its recent occurrence in the southern Neotropical region, the fast dispersion of D. suzukii has inspired local research efforts in an attempt to mitigate the consequences of this insect pest invasion. In this forum, we explore the current status of D. suzukii in southern Neotropical regions, discussing its future perspectives. Additionally, we attempt to draft activities and a research agenda that may help to mitigate the losses caused by D. suzukii in native and commercial soft-skinned fruits produced in this region. Currently, D. suzukii appears to be well established in the south of Brazil, but considering the entire southern Neotropical region, the invasion panorama is still underinvestigated. The lack of studies and regulatory actions against D. suzukii has contributed to the invasion success of this species in this region. Considering several peculiarities of both the pest biology and the environmental of this region, the authors advocate for the need of intensive and integrative studies toward the development and implementation of area-wide integrated pest management programs against D. suzukii in the southern Neotropical region.

Biology and Thermal Requirements of Fopius arisanus (Sonan, 1932) (Hymenoptera: Braconidae) Reared on Ceratitis capitata Eggs (Wiedemann) (Diptera: Tephritidae)

Fopius arisanus (Sonan) is a solitary parasitoid of eggs and the first instar larvae of Tephritidae. Due to the occurrence of Ceratitis capitata (Wiedemann) in various regions and under several climatic conditions, this study aimed to evaluate the effect of different temperatures on the embryonic development (egg-adult) and determine thermal requirements and the number of annual generations F. arisanus on eggs of C. capitata. In the laboratory, eggs of C. capitata (24 h) were submitted to parasitism of F. arisanus during 6 h. Later, the eggs were placed in plastic containers (50 mL) (50 eggs/container) on a layer of artificial diet and packed in chambers at temperatures 15, 18, 20, 22, 25, 28, 30, and 32 ± 1°C, RH 70 ± 10%, and a photophase of 12 h. The largest number of offspring, emergence rate, and weight of adults of F. arisanus were observed at 25°C. The highest sex ratios (sr > 0.75) were recorded at 15 and 18°C, being statistically higher than the temperatures 20°C (0.65), 22°C (0.64), 25°C (0.65), 28°C (0.49), and 30°C (0.47). At 32°C, there was no embryonic development of F. arisanus. The egg-adult period was inversely proportional to temperature. Based on the development of the biological cycle (egg-adult), the temperature threshold (T _t) was 10.3°C and thermal constant (K) of 488.34 degree-days, being the number of generations/year directly proportional to the temperature increase. The data show the ability of F. arisanus to adapt to different thermal conditions, which is important for biological control programs of C. capitata.

Susceptibility, Oviposition Preference, and Biology of Grapholita molesta (Lepidoptera: Tortricidae) in Prunus Spp. Rootstock Genotypes

Studying the susceptibility of peach trees to Grapholita molesta (Busck) is one of the major steps in the development of pest-resistant peach varieties. This work evaluated the susceptibility of 55 genotypes of the "Prunus Rootstock Collection" ("Coleção Porta-enxerto de Prunus") of Embrapa Temperate Climate (Pelotas, Rio Grande do Sul, Brazil) to the natural infestation of G. molesta, assessed the oviposition preference of G. molesta in choice and no-choice bioassays, and estimated the biological parameters and the fertility life table on different Prunus spp. genotypes in the laboratory. Genotypes Prunus kansuensis (Rehder), I-67-52-9, and I-67-52-4 were the most susceptible to G. molesta infestation in the field (>60% of branches infested), while 'Sharpe' (Prunus angustifolia x Prunus spp.) and Prunus sellowii (Koehne) were the least infested (0% of branches infested). In choice and no-choice bioassays, G. molesta preferred to oviposit on P. kansuensis when compared with Sharpe. The Sharpe genotype also showed an antibiosis effect, resulting in negative effects on the fertility life table parameters when compared with the genotypes P. kansuensis and 'Capdeboscq.' The results found in the present study can provide information to initiate a long-term breeding program moving desired G. molesta resistance traits from the rootstock into the Prunus spp. cultivars.

Susceptibility and Interactions of Drosophila suzukii and Zaprionus indianus (Diptera: Drosophilidae) in Damaging Strawberry

Drosophila suzukii (Matsumura) has been recently detected causing damage to strawberries in Brazil. Infestation in strawberry culture has often been observed jointly with the presence of Zaprionus indianus Gupta. This study investigated the susceptibility of strawberries at three ripening stages to infestation of D. suzukii and Z. indianus and their interaction. In the laboratory, strawberries cv. Albion at different ripening stages (green, semi-ripe and ripe) were exposed to D. suzukii and Z. indianus for 24 h in choice and no-choice bioassays. Additionally, we evaluated the effects of mechanical damage incurred artificially or by D. suzukii oviposition on Z. indianus infestation. In no-choice bioassay, there were no significant differences in fruit susceptibility to D. suzukii infestation at different ripening stages. However, in choice bioassay, D. suzukii adults preferred to oviposit on R fruit. The presence of mechanical damage did not increase susceptibility of fruit to D. suzukii oviposition. For Z. indianus, there was greater susceptibility of R fruit in relation to SR and G fruit in both the choice and no-choice bioassays. There was a significant and positive interaction of mechanical damage and damage caused by D. suzukii to R fruit and infestation by Z. indianus, which was not observed in SR and G fruit. Although infestation of Z. indianus is related to attack damaged or decaying fruit, this work shows that this species has the ability to oviposit and develop in healthy strawberry fruit with and increased infestation level when the fruit has damage to its epidermis.

Biology of Fopius arisanus (Hymenoptera: Braconidae) in Two Species of Fruit Flies

Fopius arisanus (Sonan, 1932) (Hymenoptera: Braconidae) is an egg-larval parasitoid used in control programs of Bactrocera dorsalis (Hendel) and Ceratitis capitata (Wiedemann). In Brazil, C. capitata and Anastrepha fraterculus (Wiedemann) are considered the main tephritid pests of exotic and indigenous fruits. The objective of this study was to study the biology of F. arisanus in C. capitata and A. fraterculus Eggs of the two fruit fly species were used to determine the parasitism rate, number of offspring, emergence rate, sex ratio, adult weight and longevity of male and female F. arisanus These biological parameters were used to develop a fertility life table. We observed higher parasitism and emergence rates of adults, a shorter duration of the egg-adult period and a sex ratio biased to females when F. arisanus was reared in eggs of C. capitata than in those of A. fraterculus However, adults of F. arisanus from eggs of A. fraterculus were heavier and had greater longevity than those obtained from C. capitata eggs. The fertility life table showed better biological and reproductive performance for F. arisanus reared in eggs of C. capitata, although eggs of A. fraterculus also provided positive values for population increase.

Seasonal Life Cycle of Linepithema micans (Forel) (Hymenoptera: Formicidae) in Vineyards

Linepithema micans (Forel) is considered to be the main ant species responsible for the spread of Eurhizococcus brasiliensis (Wille), a soil scale that damages vine plants in southern Brazil. In this work, the seasonal life cycle of L. micans was evaluated in vineyards to define the most appropriate time for the application of toxic baits for control. Ant nests were transported to the laboratory in plastic bags, and individual ants were separated into groups of eggs, larvae, pupae, workers, males, and queens, recording the number of individuals per colony. The seasonal life cycle of L. micans in the vineyards began in spring with the deposition of eggs by queens. During the warm months of the year (spring and summer), it was possible to observe nests consisting primarily of eggs and pupae. During the autumn and winter months, the colonies were composed predominantly of larvae and a reduction in eggs was observed. Because the main control strategy targets the larval stage of the insect, the application of toxic baits for the control of L. micans must be performed during the winter.

Under-treatment of migrants with diabetes in a universalistic health care system: the ARNO Observatory

AIMS

To assess whereas prevalence, treatment and direct costs of drug-treated diabetes were similar in migrants and in people of Italian citizenship under the universalistic Italian health care system.

METHODS AND RESULTS

Drug-treated diabetic individuals were identified in the population-based multiregional ARNO Observatory on the basis of 2010 prescriptions. Migrants were identified by the country-of-birth code on the fiscal identification code. Diabetes prevalence was calculated for Italians (n = 7,328,383) and migrants (n = 527,965). To assess the odds of migrants of having diabetes compared to Italians, we individually matched all migrants to Italians for major confounders (age, sex and place of residence). Finally, all migrants with diabetes were individually matched for confounders to Italians with diabetes to compare prescriptions, hospitalization rates, services use and direct costs for the National Health System. We identified 368,797 subjects with diabetes among Italians and 10,336 among migrants, giving prevalence of 5.03% and 1.96%, respectively. Migrants with diabetes were younger than Italians (52 ± 13 years vs. 68 ± 14 years, P < 0.001); after matching, their risk of disease was higher (odds ratio, 1.55, 95% confidence interval, 1.50-1.60). The total cost was 27% lower in migrants, due to lower cost of drugs (-29%), hospital admission (-27%) and health services (-22%). The number of packages/treated person-year of all glucose-lowering drugs was also lower in migrants (-15%) (P < 0.001).

CONCLUSIONS

Compared to subjects of Italian ancestry, migrants to Italy show a higher risk of diabetes but less intense treatment. Inequalities in health care use are likely and are maintained also in a universalistic system.

Aphid Species and Population Dynamics Associated with Strawberry

Aphids are among the major pests associated with strawberries in Southern Brasil. In this study, we identified the main species that occur in strawberry fields in the states of Paraná and Rio Grande do Sul, Brasil. We also compared the effectiveness of different sampling methods and studied the population dynamics of aphid species during two strawberry crop cycles in the municipality of Pinhais, state of Paraná, Brasil. Chaetosiphon fragaefolii (Cockerell) and Aphis forbesi Weed were the main species associated with strawberry. The method of hit plant and the Möericke trap showed equal effectiveness to capture wingless and winged insects. The peak population of aphids in the state of Paraná occurred from September to November. This information can help producers to implement strategies to monitor and control the major aphid species that occur in strawberry culture.

Application of breast tomosynthesis in screening: incremental effect on mammography acquisition and reading time

OBJECTIVE

The aim of this study was to supplement the paucity of information available on logistical aspects of the application of three-dimensional (3D) mammography in breast screening.

METHODS

We prospectively examined the effect on radiographers' and radiologists' workload of implementing 3D mammography in screening by comparing image acquisition time and screen-reading time for two-dimensional (2D) mammography with that of combined 2D+3D mammography. Radiologists' accuracy was also calculated.

RESULTS

Average acquisition time (measured from start of first-view breast positioning to compression release at completion of last view) for seven radiographers, based on 20 screening examinations, was longer for 2D+3D (4 min 3 s; range 3 min 53 s-4 min 18 s) than 2D mammography (3 min 13 s; range 3 min 0 s-3 min 26 s; p<0.01). Average radiologists' reading time per screening examination (three radiologists reading case-mix of 100 screens: 10 cancers, 90 controls) was longer for 2D+3D (77 s; range 60-90 s) than for 2D mammography (33 s; range 25-46 s; p<0.01). 2D+3D screen-reading was associated with detection of more cancers and with substantially fewer recalls than 2D mammography alone.

CONCLUSION

Relative to standard 2D mammography, combined 2D+3D mammography prolongs image acquisition time and screen-reading time (at initial implementation), and appears to be associated with improved screening accuracy.

ADVANCES IN KNOWLEDGE

These findings provide relevant information to guide larger trials of integrated 3D mammography (2D+3D) and its potential implementation into screening practice.

Frequency of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from Trentino, North East Italy

OBJECTIVE

Triple negative breast carcinomas (TNT) are infiltrating breast carcinomas (BC) with negative oestrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER-2) expression, and are associated with frequent BRCA1/BRCA2 mutations. The aim of the present study is to analyze the frequency and distribution of TNT in our population where a breast cancer screening program for women aged between 50 and 69 years is effective since 2001 with 85% accrual.

METHODS

We investigated the records of 2112 consecutive BC and 153 interval BC (i.e. BC detected in the screened negative women in the interval between screening rounds). Tumours with complete negative expression of ER, PgR and Her2 were considered TNT; tumours with negative ER and PgR status and faint Her2 expression (score 1) were considered as possible TNT (pTNT).

RESULTS

We identified 82 (3.8%) TNT and 20 (0.9%) pTNT in the series of 2112 consecutive BC and 7 TNT and 1 pTNT (5.2%) in the series of 153 interval BC. In the consecutive series, TNT/ pTNT were observed in 6.5% patients below 50 years and in 4.3% of patients above 50 years. A high proliferation rate (Ki-67 labelling > 36%) was observed in 87.8% of TNT (median labelling 56.3%) and in 60% of pTNT (median labelling 48.4%).

CONCLUSIONS

Since TNT/pTNT occurring in women < 50 years is a criterion for selecting patients whom genetic counselling and BRCA1 testing should be offered, our study is of help in foreseeing the workload of the Unit of Medical Genetics and the Laboratory of Molecular Pathology.

Interobserver agreement in breast radiological density attribution according to BI-RADS quantitative classification

PURPOSE

The authors sought to assess interobserver agreement in classifying mammography density according to quantitative Breast Imaging Reporting and Data System (BI-RADS) criteria.

MATERIALS AND METHODS

Six expert mammography readers were tested on a set of 100 mammograms. Interobserver agreement was determined according to the kappa statistic, adjusting for chance agreement, on a four-category (D1 vs. D2 vs. D3 vs. D4) or two-category (D1-2 vs. D3-4) basis. Agreement with a panel of 12 readers who had been tested on the same set in a previous study was also assessed.

RESULTS

The six readers showed good agreement when compared in pairs [agreement on a four-category basis was substantial (kappa=0.60-0.80) for 13 pairs and almost perfect (kappa>0.80) for two pairs); agreement on a two-category basis was substantial for 12 pairs and almost perfect for three pairs) or compared with the panel (on a four-category basis, agreement was substantial for five of six readers and almost perfect for one; on a two-category basis, agreement was substantial for all readers).

CONCLUSIONS

In agreement with previous studies, visual classification of mammography density according to BI-RADS quantitative criteria was highly reproducible among readers; nevertheless, attribution to the "dense breast" (BI-RADS D3-4) category, which might be adopted as a determinant of different screening protocols (such as adjunct ultrasonography or yearly interval) varied among readers (range 6-15%). Controlled studies should be performed comparing visual with computer-density category attribution, the latter possibly being a better alternative due to its absolute reproducibility.

Proportional incidence and radiological review of large (T2+) breast cancers as surrogate indicators of screening programme performance

OBJECTIVES

Surrogate measures of screening performance [e.g. interval cancer (IC) proportional incidence] allow timely monitoring of sensitivity and quality. This study explored measures using large (T2+) breast cancers as potential indicators of screening performance.

METHODS

The proportional incidence of T2+ cancers (observed/expected cases) in a population-based screening programme (Trento, 2001-2009) was estimated. A parallel review of 'negative' preceding mammograms for screen-detected T2+ and for all ICs, using 'blinded' independent readings and case-mixes (54 T2+, 50 ICs, 170 controls) was also performed.

RESULTS

T2+ cancers were observed in 168 screening participants: 48 at first screen, 67 at repeat screening and 53 ICs. The T2+ estimated proportional incidence was 68% (observed/expected = 168/247), corresponding to an estimated 32% reduction in the rate of T2+ cancers in screening participants relative to that expected without screening. Majority review classified 27.8% (15/54) of T2+ and 28% (14/50) of ICs as screening error (P = 0.84), with variable recall rates amongst radiologists (8.8-15.2%).

CONCLUSIONS

T2+ review could be integrated as part of quality monitoring and potentially prove more feasible than IC review for some screening services.

KEY POINTS

• Interval breast cancers, assumed as screening failures, are monitored to estimate screening performance • Large (T2+) cancers at screening may also represent failed prior screening detection • Analysis of T2+ lesions may be more feasible than assessing interval cancers • Analysis of T2+ cancers is a potential further measure of screening performance.

Prognostic Value of mib-1 in Patients with Early Invasive Breast Cancer and Its Correlation with Other Biologic Parameters in a Monoinstitutional Series

INTRODUCTION: Mib-1 is a proliferation biomarker and a prognostic factor for breast cancer as reported in several studies.PURPOSE: The aim of the present study was to examine interactions between mib-1 and other clinical-pathological markers and their impact on outcomes in early invasive breast cancer.PATIENTS AND METHODS: Mib-1 was identified by immunohistochemical staining in 2660 EIBC patients treated in our institution from 2000 to 2008. Mib-1 was dichotomized at the value of 20%. Correlation between mib-1 (&gt; or ≤10620%) and age, tumour size (T), nodal status (N), ER, PR, HER-2, grading (G) was performed by χ2 test. Log-rank test and Cox regression model were performed to test mib-1 as prognostic factor for overall survival (OS) and Disease Free Survival (DFS) and evaluate its correlation with other known prognostic factors.RESULTS: Mib-1 was &gt; 20% in 1276 and ≤106 20% in 1384. Mib-1&gt; 20% was significantly (p=.000) associated with younger age, greater size, positive lymph nodes, poor grading, absent or low ER and/or PR expression level, HER-2 over-expression or amplification with or without co-expression of ER and/or PR, triple negative subtypes. Mib-1 was a significant predictor of worse DFS and OS (p=.000). At a median follow up of 32 months the DFS and OS were 97.4 and 99.2% respectively in Mib-1 ≤20% group and 92.4 and 97.2% respectively in Mib-1 &gt; 20%. There were 195 relapses (7,3%): 139 (5.2%) in Mib-1 &gt; 20% and 56 (2.1%) in Mib-1 ≤ 20%. Breast cancer related deaths were 74 (2.8%) with 58 (2.2%) in mib-1 &gt; 20% group and 16 (0.6%) in mib-1 ≤ 20%.Mib1 &gt;20% was predictive of poorer prognosis in &gt; 40 years patients, small tumors (T1), lower grading (G1 and G2), positive ER and/or PR group with high or intermediate expression, negative HER-2 tumors. However, in Cox multivariate analysis mib-1 didn't maintain independent prognostic value.CONCLUSIONS: In our experience, Mib-1 confirms to be a significant prognostic biomarker for DFS and OS in early breast cancer. It could provide additional information beside other clinico-pathological parameters to perform the risk stratification of early breast cancer patients.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6054.