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Gentile D, Gatzemeier W, Sagona A, Barbieri E, Testori A, Errico V, Bottini A, Di Maria Grimaldi S, Caraceni G, Boni L, Bruzzi P, Fernandes B, Franceschini D, Spoto R, Torrisi R, Zambelli A, Scorsetti M, Santoro A, Canavese G, Tinterri C. The current status and future perspectives of the multicenter randomized clinical trial SINODAR-ONE. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Caraceni G, Barbieri E, Gentile D, Gatzemeier W, Sagona A, Testori A, Errico V, Bottini A, Di Maria Grimaldi S, Canavese G, Tinterri C. A rare case of duodenal metastasis from lobular breast cancer. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Tinterri C, Gentile D, Gatzemeier W, Sagona A, Barbieri E, Testori A, Errico V, Bottini A, Marrazzo E, Dani C, Dozin B, Boni L, Bruzzi P, Fernandes B, Franceschini D, Spoto R, Torrisi R, Scorsetti M, Santoro A, Canavese G, Custodero O, Troilo VL, Taffurelli M, Cucchi MC, Galluzzo V, Cabula C, Cabula R, Lazzaretti MG, Caruso F, Castiglione G, Grossi S, Tavoletta MS, Rossi C, Curcio A, Friedman D, Fregatti P, Magni C, Tazzioli G, Papi S, Giovanazzi R, Chifu C, Bettini R, Pezzella M, Michieletto S, Saibene T, Roncella M, Ghilli M, Sibilio A, Cariello A, Coiro S, Falco G, Meli EZ, Fortunato L, Ciuffreda L, Murgo R, Battaglia C, Rubino L, Biglia N, Bounous V, Rovera FA, Chiappa C, Pollini G, Mirandola S, Meneghini G, Di Bartolo F. ASO Visual Abstract: Preservation of Axillary Lymph Nodes Compared with Complete Dissection in T1-2 Breast Cancer Patients Presenting 1-2 Metastatic Sentinel Lymph Nodes: The Multicenter Randomized Clinical Trial SINODAR-ONE. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-022-11908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tinterri C, Gentile D, Gatzemeier W, Sagona A, Barbieri E, Testori A, Errico V, Bottini A, Marrazzo E, Dani C, Dozin B, Boni L, Bruzzi P, Fernandes B, Franceschini D, Spoto R, Torrisi R, Scorsetti M, Santoro A, Canavese G. Preservation of Axillary Lymph Nodes Compared with Complete Dissection in T1-2 Breast Cancer Patients Presenting One or Two Metastatic Sentinel Lymph Nodes: The SINODAR-ONE Multicenter Randomized Clinical Trial. Ann Surg Oncol 2022; 29:5732-5744. [PMID: 35552930 DOI: 10.1245/s10434-022-11866-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The SINODAR-ONE trial is a prospective noninferiority multicenter randomized study aimed at assessing the role of axillary lymph node dissection (ALND) in patients undergoing either breast-conserving surgery or mastectomy for T1-2 breast cancer (BC) and presenting one or two macrometastatic sentinel lymph nodes (SLNs). The endpoints were to evaluate whether SLN biopsy (SLNB) only was associated with worsening of the prognosis compared with ALND in terms of overall survival (OS) and relapse. METHODS Patients were randomly assigned (1:1 ratio) to either removal of ≥ 10 axillary level I/II non-SLNs followed by adjuvant therapy (standard arm) or no further axillary treatment (experimental arm). RESULTS The trial started in April 2015 and ceased in April 2020, involving 889 patients. Median follow-up was 34.0 months. There were eight deaths (ALND, 4; SNLB only, 4), with 5-year cumulative mortality of 5.8% and 2.1% in the standard and experimental arm, respectively (p = 0.984). There were 26 recurrences (ALND 11; SNLB only, 15), with 5-year cumulative incidence of recurrence of 6.9% and 3.3% in the standard and experimental arm, respectively (p = 0.444). Only one axillary lymph node recurrence was observed in each arm. The 5-year OS rates were 98.9% and 98.8%, in the ALND and SNLB-only arm, respectively (p = 0.936). CONCLUSIONS The 3-year survival and relapse rates of T1-2 BC patients with one or two macrometastatic SLNs treated with SLNB only, and adjuvant therapy, were not inferior to those of patients treated with ALND. These results do not support the use of routine ALND.
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Affiliation(s)
- Corrado Tinterri
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Damiano Gentile
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | | | - Andrea Sagona
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Erika Barbieri
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alberto Testori
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valentina Errico
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alberto Bottini
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Carla Dani
- Department of Epidemiology, Biostatistics and Clinical Trials, IRCCS S. Martino, IST, Genoa, Italy
| | - Beatrice Dozin
- Department of Epidemiology, Biostatistics and Clinical Trials, IRCCS S. Martino, IST, Genoa, Italy
| | - Luca Boni
- Department of Epidemiology, Biostatistics and Clinical Trials, IRCCS S. Martino, IST, Genoa, Italy
| | - Paolo Bruzzi
- Department of Epidemiology, Biostatistics and Clinical Trials, IRCCS S. Martino, IST, Genoa, Italy
| | - Bethania Fernandes
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ruggero Spoto
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Rosalba Torrisi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Canavese
- Breast Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Gentile D, Gatzemeier W, Barbieri E, Sagona A, Bottini A, Errico V, Testori A, Scorsetti M, Canavese G, Tinterri C. Abstract GS4-05: Preservation of axillary lymph nodes compared to complete dissection in T1-T2 breast cancer patients presenting 1-2 metastatic sentinel lymph nodes. A multicenter randomized clinical trial. Sinodar One. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs4-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Sentinel lymph node (SLN) staging is currently used to avoid complete axillary lymph node dissection (ALND) in breast cancer (BC) patients. The SLN is the only site of axillary metastasis (MTS) in ≥60% of cases. Recently, a randomized controlled trial (Z0011) comparing SLN biopsy (SLNB) alone with SLNB followed by ALND in patients with 1-2 SLNs+ demonstrated no significant statistical difference in relapse and overall survival (OS) rates among the two different groups. However, this study had some limitations: small tumor size (≤2cm in 70% of cases), frequent presence of only microMTS in SLN (40%), prevalent use of “whole breast” adjuvant radiotherapy (>90%). Given these considerations, the SINODAR-ONE study started in April 2015. Objectives: The aims are to assess whether ALND omission in BC patients with 1-2 SLNs+ is associated with worse survival and/or increased rate of regional/distant relapse. Thus evaluating whether SLNB is or is not inferior to ALND. Primary endpoint is OS. Secondary endpoints are disease-free survival (DFS) referring to distant MTS and loco-regional recurrence. Methods: Patients received either mastectomy or conservative surgery plus radiotherapy. They all underwent SLNB and were randomly divided into two arms of treatment: standard (SLNB plus ALND) or experimental treatment (only SLNB). According to multidisciplinary evaluation, patients could undergo additional adjuvant radiotherapy, chemo- and/or hormonal therapy, or no further therapy. Eligibility criteria: age 40-75 years; primary invasive T1-T2 tumor; axillary nodes cN0; no more than 2 macro-metastatic SLNs; no distant MTS; no neo-adjuvant therapy; no previous invasive BC. Exclusion criteria: in situ, inflammatory, contralateral BC; micro-metastatic SLNs; pregnancy or breast feeding; comorbidity impeding adjuvant therapy. All analyses were performed both on all patients according to the Intention-To-Treat principle and excluding those patients who did not receive the axillary treatment randomly assigned. Statistical analysis: OS and DFS were calculated using the Kaplan-Meier Product Limit Estimator and differences between arms were assessed with the log-rank test. Results: The enrollment of patients ended in April 2020 with a total of 889 cases (443: standard arm; 446: experimental arm). In April 2021, we conducted a preliminary analysis on 889 patients. We found the two groups homogeneous for epidemiologic characteristics (age and menopausal status), tumor characteristics (tumor size, pTNM, immunohistochemistry, histology, grading, vascular and lymphatic invasion), and adjuvant therapies. The majority of patients (77.2%) received breast conserving surgery, while 22.8% of patients underwent mastectomy. A median of 2 SLNs were removed in both arms. Overall, only 3 micro-metastatic SNLs were found (1 in the standard arm and 2 in the experimental arm). Conclusion: In sum, OS rate is 99.1% and 99.3% in the standard and experimental arm, respectively; DFS rate is 96.8% and 95.9% in the standard and experimental arm, respectively. After a median follow-up of 36 months, there has been only one axillary recurrence in the experimental arm. Additionally, we found seven distant relapses in both arms; four and three deaths in the standard and experimental arm, respectively.
Citation Format: Damiano Gentile, Wolfgang Gatzemeier, Erika Barbieri, Andrea Sagona, Alberto Bottini, Valentina Errico, Alberto Testori, Marta Scorsetti, Giuseppe Canavese, Corrado Tinterri. Preservation of axillary lymph nodes compared to complete dissection in T1-T2 breast cancer patients presenting 1-2 metastatic sentinel lymph nodes. A multicenter randomized clinical trial. Sinodar One [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS4-05.
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Errico V, Perroni G, Milana F, Lisa AVE, Marrazzo E, Klinger M, Tinterri C, Testori A. Internal mammary lymph node siliconoma in absence of prosthesis rupture: a case series that raises concern for potential risk of overdiagnosis. Gland Surg 2021; 10:2123-2129. [PMID: 34422583 DOI: 10.21037/gs-20-860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 05/11/2021] [Indexed: 11/06/2022]
Abstract
Background Silicon migration after rupture is an adverse event of breast implant, whose risk increases with the aging of prosthesis. The exact prevalence of this complication remains unclear and reported data are inconsistent. In addition, microscopic diffusion of silicone gel through intact implant, known as gel bleeding, might verify thus complicating diagnosis. Although high cohesive gel has reduced the occurrence of gel bleeding, this phenomenon is still possible and its occurrence rate remains underestimated. If silicon droplets migrate in locoregional lymph node, a swelling that mimics recurrence can arise. Therefore, a risk of overdiagnosis is possible when clinicians rely only on imaging techniques. The aim of this study is to evaluate the actual prevalence of metastasis in internal mammary lymph node (IMLN) in presence of PET positive uptake and no prosthesis rupture. Methods We retrospectively evaluated our patient's records and selected those with intact breast implants and suspected relapse in IMLN that underwent biopsy, either surgical or imaging guided. All patients performed PET/CT scan showing pathological uptake in IMLNs. A breast magnetic resonance (MRI) or ultrasound (US) imaging confirmed a suspicious adenopathy and excluded prosthesis rupture. From 2015 to 2019 a total of nine patients underwent biopsy of the IMLN and only six of them met inclusion criteria. Results Four biopsies were CT-guided, two were surgical. Three patients (50%) were diagnosed with breast cancer relapse while two (33.3%) were found with siliconoma and one (16.7%) was inflammatory. Conclusions Siliconoma can occur even without evidence of capsule rupture, challenging the clinicians and leading to a risk of relapse over diagnosis. Echographic, MRI and nuclear medicine imaging criteria may be not sufficient in differential diagnosis. To overcome the issue, we suggest introducing into the clinical practice the biopsy of suspicious enlarged IMLN with minimally invasive technique.
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Affiliation(s)
- Valentina Errico
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianluca Perroni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Flavio Milana
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Emilia Marrazzo
- Breast Unit Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Klinger
- Plastic Surgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine Biometra, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Milan, Italy
| | - Corrado Tinterri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Breast Unit Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Gentile D, Sagona A, Anghelone C, Barbieri E, Marrazzo E, Gatzemeier W, Canavese G, Errico V, Testori A, Tinterri C. Ipsilateral breast cancer recurrence: characteristics, treatment, and long-term oncological results at a high volume center. Breast 2021. [DOI: 10.1016/s0960-9776(21)00104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tinterri C, Marrazzo E, Anghelone C, Barbieri E, Sagona A, Bottini A, Rubino A, Gentile D, Gatzemeier W, Errico V, Testori A, Canavese G. Abstract PD4-01: Preservation of axillary lymph nodes compared to complete dissection in T1-T2 breast cancer patients presenting 1-2 metastatic sentinel lymph nodes : A multicenter randomized clinical trial. Sinodar One. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd4-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Sentinel lymph node (SLN) staging is currently used to avoid complete axillary lymph node dissection (ALND) in breast cancer (BC) patients. The SLN is the only site of axillary metastasis (MTS) in ≤60% of cases. Recently, a randomized controlled trial (Z0011) comparing SLN biopsy (SLNB) alone with SLNB followed by ALND in patients with 1-2 SLNs+ demonstrated no significant statistical difference in relapse and overall survival rates among the two different groups. However, this study had some limitations: small tumor size (≤2cm in 70% of cases), frequent presence of only microMTS in SLN (40%), prevalent use of “whole breast” adjuvant radiotherapy (>90%). Given these considerations, the SINODAR-ONE study started in April 2015.Objectives: The aims are to assess whether ALND omission in BC patients with 1-2 SLNs+ is associated with worse survival and/or increased rate of regional/distant relapse. Thus evaluating whether SLNB is or is not inferior to ALND. Primary endpoint is overall survival (OS). Secondary endpoints are disease-free survival (DFS) referring to distant MTS and loco-regional recurrence. Methods: Patients receive either mastectomy or conservative surgery plus radiotherapy. They all undergo SLNB and are randomly divided into two arms of treatment: standard (SLNB plus ALND) or experimental treatment (only SLNB). According to multidisciplinary evaluation, patients may undergo additional adjuvant radiotherapy, chemo- and/or hormonal therapy , or no further therapy. Eligibility criteria: age 40-75 years; primary invasive T1-T2 tumor; axillary nodes clinically N0; no more than 2 macro-metastatic SLNs; no distant MTS; no neo-adjuvant therapy; no previous invasive BC; signed informed consent. Exclusion criteria: in situ, inflammatory, contralateral BC; micro-metastic SLNs; pregnancy or breast feeding; comorbidity impeding adjuvant therapy. All analyses are performed both on all patients according to the Intention-To-Treat principle and excluding those patients who did not receive the axillary treatment randomly assigned. Statistical analysis: OS and DFS are calculated using the Kaplan-Meier Product Limit Estimator and differences between arms are assessed with the log-rank test. Results: The enrollment of patients ended in April 2020 with a total of 889 cases (443: standard arm; 446: experimental arm). In June 2020, we conducted an ad interim analysis on 889 patients. We found the two groups homogeneous for epidemiologic characteristics (age and menopausal status), tumor characteristics (tumor size, pTNM, immunohistochemistry, histology, grading, vascular and lymphatic invasion), adjuvant therapies and surgery on T. In particular we have performed a 23,1% of mastectomies in the standard arm and 20,1% in the experimental arm. We found a median of 2 sentinel lymph nodes removed in both arms and 1 non-sentinel positive lymph node in the experimental arm, and only 3 micro-metastases (1 in the standard arm and 2 in the experimental arm). Conclusion: In sum, with a median follow-up of 30 months, there have been no axillary recurrence in both arms. In the standard arm we found 8 total events (2 deaths and 6 distant relapses) and in in the experimental arm 6 events (1 death and 5 distant relapses), with a projected 5-years cumulative incidence of 6,5% in standard arm and 4,85% in the experimental arm.
Citation Format: Corrado Tinterri, Emilia Marrazzo, Chiara Anghelone, Erika Barbieri, Andrea Sagona, Alberto Bottini, Arianna Rubino, Damiano Gentile, Wolfgang Gatzemeier, Valentina Errico, Alberto Testori, Giuseppe Canavese. Preservation of axillary lymph nodes compared to complete dissection in T1-T2 breast cancer patients presenting 1-2 metastatic sentinel lymph nodes : A multicenter randomized clinical trial. Sinodar One. [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD4-01.
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Affiliation(s)
| | | | | | | | - Andrea Sagona
- Humanitas Clinical and Research Center, Milano, Italy
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Gentile D, Sagona A, Anghelone CAP, Barbieri E, Marrazzo E, Gatzemeier W, Canavese G, Errico V, Testori A, Tinterri C. Abstract PS1-16: Ipsilateral breast cancer recurrence: Treatment and long-term oncological results at a high volume center. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps1-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background A small proportion of patients with primary breast cancer who receive breast conserving surgery (BCS) will develop an ipsilateral breast cancer recurrence (IBCR). In these patients, mastectomy is still considered the treatment of first choice, even if a second conservative surgical approach is technically feasible. The aims of our study are to analyze the characteristics of patients with IBCR after BCS, evaluate and compare the different treatment modalities (repeat BCS vs. mastectomy) in terms of patients and tumor characteristics, disease-free interval (DFI), disease-free survival (DFS), and overall survival (OS).MethodsOur prospectively maintained institutional database was queried, and 309 patients with IBCR after BCS who underwent either repeat BCS or mastectomy, between January 2008 and December 2018, were identified. Ipsilateral breast cancer recurrence was defined as a local tumor reappearance in the same breast or in the surgical scar. Exclusion criteria were: age <18 years, primary cancer treated with mastectomy, residual disease, controlateral recurrence, recurrent benign disease, only distant or axillary recurrence, IBCR not treated surgically, follow-up <24 months, and DFI <6 months.ResultsThe mean age of patients at primary breast cancer was 55.3 years. The majority of primary tumors were ductal (87.4%), luminal A-B (81.2%) breast cancers. After BCS, 222 (71.8%) patients underwent radiotherapy. Out of 309 patients with IBCR after BCS, 143 underwent repeat BCS and 166 underwent mastectomy. At multivariable analysis, young age, <65 years (59.6% vs. 37.1% if age ≥65 years, odds ratio (OR)=2.374, 95% confidence interval (95%CI)=0.02-0.24, p= 0.018) and short DFI <24 months (15.7% vs. 10.5% if DFI ≥24 months, OR=2.705, 95%CI=0.02-0.17, p= 0.007) were found to significantly increase the probability to receive mastectomy for IBCR after BCS. After IBCR, DFS rate at 3-, 5-, and 10-years was 79.2%, 68.2%, 36.9%, and 77.2%, 65.9%, 55.3%, in patients receiving repeat BCS or mastectomy, respectively (p = 0.842). Overall-survival rate at 3-, 5-, and 10-years was 95.4%, 91.4%, 68.5%, and 87.3%, 69.3%, 57.9%, in patients receiving repeat BCS or mastectomy, respectively (p = 0.018).ConclusionsThe best candidates for repeat BCS in the treatment of IBCR are patients ≥65 years with a DFI ≥24 months. Young patients (<65 years) with early onset of recurrence (DFI <24 months) have a high probability to receive mastectomy for the treatment of IBCR. Mastectomy does not improve survival in patients with IBCS after BCS. The information about the risk of poor long-term prognosis after mastectomy should be shared with the patient and a repeat BCS could be proposed.
Citation Format: Damiano Gentile, Andrea Sagona, Chiara Annunziata Pasqualina Anghelone, Erika Barbieri, Emilia Marrazzo, Wolfgang Gatzemeier, Giuseppe Canavese, Valentina Errico, Alberto Testori, Corrado Tinterri. Ipsilateral breast cancer recurrence: Treatment and long-term oncological results at a high volume center [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-16.
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Affiliation(s)
- Damiano Gentile
- Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Andrea Sagona
- Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | - Erika Barbieri
- Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Emilia Marrazzo
- Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | | | | | - Alberto Testori
- Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Losurdo A, De Sanctis R, Fernandes B, Torrisi R, Masci G, Agostinetto E, Gatzemeier W, Errico V, Testori A, Tinterri C, Roncalli M, Santoro A. Insights for the application of TILs and AR in the treatment of TNBC in routine clinical practice. Sci Rep 2020; 10:20100. [PMID: 33208857 PMCID: PMC7674426 DOI: 10.1038/s41598-020-77043-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/27/2020] [Indexed: 12/20/2022] Open
Abstract
Triple negative breast cancer (TNBC), usually presenting with a very aggressive phenotype, is a heterogeneous entity. We aim to discuss new biomarkers, suitable for prognostic and predictive purposes. We retrospectively collected clinical variables and immunohistochemical characteristics of early TNBCs, specifically focusing on the prognostic and predictive significance of tumor infiltrating lymphocytes (TILs) and androgen receptor (AR) expression, assessing their correlation with clinical variables. Among 159 patients, TILs were significantly higher in younger patients and with lower BMI, and in tumors with higher ki-67 and greater nodal involvement; conversely, AR was significantly higher in older patients and in tumors with lower ki-67. Interestingly and in line with literature, both TILs level and ARs expression were lower within metastatic sites, in patients who developed distant metastases, compared to those found in the primary site. Small (pT1) and node negative tumors were highly represented and no correlation of either TILs or AR with prognosis could be observed. Our findings support the use of stromal TILs to identify a more aggressive, but chemo-sensitive phenotype, mostly represented in younger women, while AR may identify a less aggressive, slow-growing luminal TNBC subtype, more common among older patients. TILs and AR are worth implementing in routine clinical practice to refine prognosis even if, in our case series, we couldn't identify a significant correlation of the two variables with either disease-free and overall survival.
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Affiliation(s)
- Agnese Losurdo
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Rita De Sanctis
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Bethania Fernandes
- Department of Pathology, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Rosalba Torrisi
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giovanna Masci
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Elisa Agostinetto
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Wolfgang Gatzemeier
- Department of Breast Surgery, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Valentina Errico
- Department of Breast Surgery, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Alberto Testori
- Department of Breast Surgery, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Corrado Tinterri
- Department of Breast Surgery, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Massimo Roncalli
- Department of Pathology, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Armando Santoro
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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Testori A, Alloisio M, Errico V, Perroni G, Gatzemeier W, Tinterri C. Extraordinary emergency measures set up by a Breast Unit to prevent COVID-19: Report of our experience. Breast J 2020; 26:1611-1612. [PMID: 32588479 PMCID: PMC7362057 DOI: 10.1111/tbj.13920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Alberto Testori
- Breast Unit Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Marco Alloisio
- Breast Unit Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Valentina Errico
- Breast Unit Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Gianluca Perroni
- Thoracic Surgery Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Wolfgang Gatzemeier
- Breast Unit Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Corrado Tinterri
- Breast Unit Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
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Losurdo A, Scirgolea C, Mazza E, Errico V, Fernandes B, Tommaso LD, Sagona A, Pilipow K, Torrisi R, Masci G, De Sanctis R, Agostinetto E, Testori A, Tinterri C, Roncalli M, Santoro A, Lugli E. Abstract P5-04-07: Defining T cell dysfunctionality in breast cancer by single cell analysis: Implications for immunotherapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-04-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Despite the well-known association between extensive lymphocytic infiltration in breast cancer (BC), good prognosis, and high response rates to neoadjuvant chemotherapy (CT), pathologic evaluation of tumor infiltrating lymphocytes (TILs) is currently not routine and a deep understanding of the properties of TILs, remain largely unfilled. So far, only in triple-negative (TN), PD-L1 positive BCs it has been possible to demonstrate a survival benefit with immunotherapy plus CT, thereby making the definition of possible immunotherapeutic targets across all biological subtypes a fundamental requirement. Material and methods Single-cell RNA-sequencing (scRNAseq) data from 8 BCs were downloaded from Gene Expression Omnibus dataset (GSE114725), obtaining CD45+ single cells only from the tumoral compartment. scRNAseq-guided high-dimensional profiling by 27-parameter FACS was then applied to a large cohort (n=54, including luminal-like, TN and HER2+ BCs) of early BC patients surgically treated at our Institution. We simultaneously profiled the peripheral blood, the normal and tumoral tissue from each patient and acquired using FACS Symphony A5 flow cytometer (BD Biosciences). Flow Cytometry Standard (FCS) 3.0 files were imported into FlowJo software v9, and analyzed by standard gating to remove aggregates and dead cells, and subsequently imported in FlowJo v10, biexponentially transformed, and exported for further analysis in R by a custom-made script, using an ad-hoc pipeline. Data were analyzed using the Phenograph unbiased algorithm coded in the cytofkit package. Data were further analyzed in FlowJo to determine the frequency of positive cells for each marker and the corresponding median fluorescence intensity (MFI). These values were multiplied to derive the integrated MFI; hierarchical metaclustering of all samples, based on the frequency of Phenograph clusters, was performed in R based on the Euclidean distance and Ward-linkage. Pearson correlation analysis was used to investigate the relationship between CD8+ and CD4+ clusters. Results Our scRNA-guided informative 27-colors flow cytometry panel included antibodies to define not only different lymphocyte subpopulations, but also different stages of T lymphocytes: differentiation and memory maturation (CCR7, CD45RA), activation status (HLA-DR), cytotoxicity (GZMK, GZMB), exhaustion (PD-1, TIGIT) and tissue residency (CD69, CD103). Focusing on CD8+ T cells, we observed, as expected, bona fide naïve T cells to be virtually absent at the tumor site and enriched in peripheral blood, while cytotoxic and effector memory cells were enriched in the tumor compartment. Of note, we identified a population of tissue resident memory T cells (Trm) CD69+ CD103+, CD39+, specifically enriched in the tumor, that could be further subdivided into a HLA-DR+ CD127- and a HLA-DR- CD127+ subpopulation. Interestingly, the HLA-DR+ subset exhibited more exhaustion markers (PD-1hi, TIGIT+, NKG2A+) and was significantly positively correlated with CD4+ regulatory T cells. We speculated, and deeply investigated by bulk RNA-seq, that these two subsets of Trm might represent different maturation states and that they could be reinvigorated targeting highly expressed inhibitory molecules using approved (e.g., PD-1) together with newly identified (e.g., NKG2A) immunotherapeutics. Moreover, as no difference was observed in the relative distribution of Phenograph clusters, our data may be applied to revert acquired immune escape mechanisms in all different BC biological subtypes. Conclusions We identified, among Trm CD69+ CD103+, tumor-specific CD39+, PD1+ exhausted population, novel dysfunctional NKG2A+ T cells previously not characterized in BC. This population is of extreme interest to characterize a novel potential immunotherapeutic target.
Citation Format: Agnese Losurdo, Caterina Scirgolea, Emilia Mazza, Valentina Errico, Bethania Fernandes, Luca Di Tommaso, Andrea Sagona, Karolina Pilipow, Rosalba Torrisi, Giovanna Masci, Rita De Sanctis, Elisa Agostinetto, Alberto Testori, Corrado Tinterri, Massimo Roncalli, Armando Santoro, Enrico Lugli. Defining T cell dysfunctionality in breast cancer by single cell analysis: Implications for immunotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-04-07.
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Affiliation(s)
- Agnese Losurdo
- 1Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Caterina Scirgolea
- 2Laboratory of Translational Immunology, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Emilia Mazza
- 2Laboratory of Translational Immunology, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Valentina Errico
- 3Breast Surgery Unit, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Bethania Fernandes
- 4Department of Pathology, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Luca Di Tommaso
- 4Department of Pathology, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Andrea Sagona
- 3Breast Surgery Unit, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Karolina Pilipow
- 2Laboratory of Translational Immunology, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Rosalba Torrisi
- 1Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giovanna Masci
- 1Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Rita De Sanctis
- 1Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Elisa Agostinetto
- 1Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Alberto Testori
- 3Breast Surgery Unit, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Corrado Tinterri
- 3Breast Surgery Unit, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Massimo Roncalli
- 4Department of Pathology, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Armando Santoro
- 1Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
| | - Enrico Lugli
- 2Laboratory of Translational Immunology, Humanitas Cancer Center, Humanitas Research Hospital, Rozzano (MI), Italy
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Tinterri C, Marrazzo E, Gatzemeier W, Barbieri E, Sagona A, Bottini A, Testori A, Errico V, Canavese G. Abstract OT3-01-03: Neonod Study: Conservation of axillary lymph nodes in the presence of micrometastases in the sentinel lymph node if cN- After neoadjuvant chemotherapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-ot3-01-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In the last 20 years it was observed a clear trend to develop and perform less and less demolitive axillary surgery in breast cancer patients. The development of identification, dissection and intraoperative analysis of sentinel lymph node (SLNB, Sentinel Lymph Node Biopsy) contributed to give all informations on the need to proceed or not to axillary lymph node dissection (ALND), while neoadjuvant chemotherapy (NAC) permitted to enable surgical treatment in initially non-operable cancers or to reduce tumor size in order to perform a less demolitive surgery. In Patients with residual axillary disease after NAC, it is not completely clear if the prognosis worsens according to the entity of residual disease (isolated tumor cells or ITC, micrometastases, macrometastases). In particular, IBCSG 23-01 study demonstrated that, in patients with ypN1mi early breast cancer, axillary lymph node dissection (ALND) could be avoided without worsening the prognosis. Assuming that patients cN+ before, but ypN1mi after NAC are clinically equivalent to patients in IBSCG study, complete ALND would be useless even if in patients subjected to NAC for that subgroup. Still it is to demonstrate if axillary micrometastases after NAC could have a prognostic value similar to micrometastasis in patients subjected to adjuvant treatment. To overcome these limitations, we propose this non-controlled clinical study to verify the effect of avoiding ALND on relapse and survival rate in cN+ patients, turned ycN0 (clinically) and ypN1mi (pathologically) after NAC.
Materials and methods: This is a non-controlled clinical study designed as a non-inferiority study to verify if the avoidance of ALND in ypN1mi patients after NAC does not involve a significant worsening of survival or locoregional or distant relapse risk compared to ypN0 patients, in which the avoidance of ALND actually represents the standard treatment. Patients with macrometastatic SLN (ypN≥1) after NAC subjected to ALND as a standard procedure represents an internal control group for the demonstrated worse prognosis compared to ypN0 and ypN1mi patients. This study includes patients with cN+ lymph nodes assessed in the initial diagnosis, resulted negative (with clinical and instrumental studies) after NAC. On the base of histopathologic definitive evaluation on harvested sentinel lymph nodes, patients will be allocated in one of the two groups (standard or experimental). Group 1 (experimental) will include patients with micrometastatic SLN or micrometastatic parasentinel lymph node (ypN1mi), in which ALND will not be performed. Group 2 (standard) will include patients with negative SLN or SLN with ITC in it (ypN0/ypN0(i+)). ALND will not be performed in these patients. Patients with macrometastatic SLN or another macrometastatic lymph node (ypN≥1) will be included in a third internal control group (group 3) not utilized in statistical comparison with the other two groups, but finalized to the evaluation of the case study’s appropriateness. In these patients, standard ALND will be performed. Patients enrolling in the study protocol will last 3 years. Patients should be studied for at least 5 years with clinical and instrumental follow-up periodic controls, prevised from actual standard guidelines.
Endpoints: The primary endpoint of the study is the disease free survival rate (DFS) and will be evaluated from the entry date in the study to the date of the last contact, the date of the distant or locoregional relapse, or the date of death for any cause. Secondary endpoints are overall survival (OS), locoregional disease-free survival (LRDFS) and distant disease-free survival (DDFS)
Citation Format: Corrado Tinterri, Emilia Marrazzo, Wolfgang Gatzemeier, Erika Barbieri, Andrea Sagona, Alberto Bottini, Alberto Testori, Valentina Errico, Giuseppe Canavese. Neonod Study: Conservation of axillary lymph nodes in the presence of micrometastases in the sentinel lymph node if cN- After neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT3-01-03.
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Tinterri C, Marrazzo E, Frusone F, Gatzemeier W, Barbieri E, Sagona A, Bottini A, Errico V, Testori A, Canavese G. Abstract OT3-01-02: Preservation of axillary lymph nodes compared to complete dissection in T1-T2 breast cancer patients presenting 1-2 metastatic sentinel lymph nodes: A multicenter randomized clinical trial. Sinodar One Study. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-ot3-01-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction Sentinel lymph node (SLN) staging is currently used to avoid complete axillary lymph node dissection (ALND) in breast cancer (BC) patients with negative SLNs without jeopardizing survival or regional control. International guidelines keep recommending ALND in the presence of positive (+) SLNs. However SLN is the only site of axillary metastasis (MTS) in many cases (60%). Retrospective studies have also shown a low risk of locoregional relapse in patients with SLNs+ not receiving ALND.This latter finding was recently confirmed in a randomized trial comparing SLN biopsy (SLNB) alone with SLNB followed by ALND in patients with 1-2 SLNs+. However the observation of both similar relapse rate and survival in the 2 arms and the conclusion of a non-inferiority of SLNB compared to ALND require cautiousness because of some study limitations: premature enrollment cessation due to death rate lower than expected, short follow-up (6 years), small tumor size (≤2cm in 70% of cases), frequent presence of only microMTS in SLN (40%), prevalent use of “whole breast” adjuvant radiotherapy (>90%) which irradiates the breast but also the I° axillary level, thereby contributing to the low rate of regional relapse in the SLNB arm due to lymph node sterilization. Consequently further randomized trials with more precise selection criteria based on homogeneous clinico-pathological features and with longer follow-up are needed to confirm that performing only SLNB does not affect survival or relapse risk in patients with 1-2 SLNs+. Materials and Methods Primary and secondary aims of the present 2-arm randomized trial are to assess whether ALND omission in BC patients with 1-2 SLNs+ is associated with worse survival and/or increased rate of regional/distant relapse, respectively, thus evaluating whether SLNB is or is not inferior to ALND. Patients receive either conservative surgery or mastectomy and radiotherapy. They all undergo intraoperative SLNB and SLN evaluation, and are randomly assigned to either further dissection of level I-II axillary lymph nodes (standard ALND arm) or absence of any axillary surgery (experimental SLNB arm). According to International Guidelines post-surgery treatments. Eligibility criteria are: age 40-75 years; primary invasive T1-T2 tumor; axillary nodes clinically N0; no more than 2 SLNs presenting macroMTS at intraoperative or definitive histological evaluation; no distant MTS; no neoadjuvant therapy; no previous invasive BC, signed informed consent. Exclusion criteria are: in situ, inflammatory, contralateral BC; presence of only microMTS in the SLN+; pregnancy or breast feeding; comorbidity impeding adjuvant therapy. Follow-up controls foresee: clinical examination every 6 months for 5 years and yearly thereafter; annual mammography and breast echography; annual axillary echography for patients in the SLNB arm; additional laboratory and instrumental surveys in case of suspected onset of distant MTS. The primary endpoint is overall survival (OS). Secondary endpoints are disease-free survival (DFS) referring to distant MTS and to locoregional (ipsilateral breast or axillary, internal mammary or sopraclaveolar lymph nodes) disease recurrence. All analyses are performed both on all patients according to the Intention-To-Treat principle and excluding those patients who did not receive the axillary treatment randomly assigned.
Citation Format: Corrado Tinterri, Emilia Marrazzo, Federico Frusone, Wolfgang Gatzemeier, Erika Barbieri, Andrea Sagona, Alberto Bottini, Valentina Errico, Alberto Testori, Giuseppe Canavese. Preservation of axillary lymph nodes compared to complete dissection in T1-T2 breast cancer patients presenting 1-2 metastatic sentinel lymph nodes: A multicenter randomized clinical trial. Sinodar One Study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT3-01-02.
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Affiliation(s)
| | | | - Federico Frusone
- 2Dipartimento di Scienze Chirurgiche. Università Sapienza, Roma, Italy
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Marrazzo E, Frusone F, Milana F, Sagona A, Gatzemeier W, Barbieri E, Bottini A, Canavese G, Rubino AO, Eboli MG, Rossetti CM, Testori A, Errico V, De Luca A, Tinterri C. Mucinous breast cancer: A narrative review of the literature and a retrospective tertiary single-centre analysis. Breast 2019; 49:87-92. [PMID: 31783314 PMCID: PMC7375663 DOI: 10.1016/j.breast.2019.11.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/14/2019] [Accepted: 11/01/2019] [Indexed: 12/15/2022] Open
Abstract
Mucinous carcinoma (MC) is a rare breast cancer characterized by the presence of large extracellular mucin amount. Two main subtypes can be distinguished: pure (PMC) and mixed (MMC). We conducted a retrospective MC analysis in our prospective maintained database, calculating disease-free survival (DFS) and 5-year overall survival (OS). We found a global 92.1% OS (higher in MMC group and statistically significative) and a DFS of 95.3% (higher in MMC group but not statistically significative).
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Affiliation(s)
- Emilia Marrazzo
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
| | - Federico Frusone
- Sapienza University of Rome, Department of Surgical Sciences, Rome, Italy.
| | - Flavio Milana
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
| | - Andrea Sagona
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
| | - Wolfgang Gatzemeier
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
| | - Erika Barbieri
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
| | - Alberto Bottini
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
| | - Giuseppe Canavese
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
| | - Arianna Olga Rubino
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
| | - Marco Gaetano Eboli
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
| | - Carlo Marco Rossetti
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
| | - Alberto Testori
- Humanitas Research Hospital and Cancer Center, Thoracic Surgery Dept, Milan, Rozzano, Italy
| | - Valentina Errico
- Humanitas Research Hospital and Cancer Center, Thoracic Surgery Dept, Milan, Rozzano, Italy
| | - Alessandro De Luca
- Sapienza University of Rome, Department of Surgical Sciences, Rome, Italy
| | - Corrado Tinterri
- Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy
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Losurdo A, De Sanctis R, Fernandes B, Errico V, Sagona A, Masci G, Zuradelli M, Agostinetto E, Torrisi R, Gatzemeier W, Testori A, Roncalli M, Alloisio M, Tinterri C, Santoro A. TNBC universe: A monocentric retrospective analyses of TILs and AR as prognostic markers. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Sanctis R, D'Antonio F, Agostinetto E, Marinello A, Masci G, Zuradelli M, Losurdo A, Guiducci D, Tinterri C, Testori A, Gatzemeier W, Errico V, Torrisi R, Santoro A. Real-life data on the cardiac toxicity of adjuvant fixed-dose subcutaneous trastuzumab in HER2-positive breast cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Losurdo A, De Sanctis R, Fernandes B, Errico V, Sagona A, Masci G, Zuradelli M, Agostinetto E, Torrisi R, Gatzemeier W, Testori A, Roncalli M, Alloisio M, Tinterri C, Santoro A. A monocentric retrospective analysis of TILs and AR as hints for prognosis definition in TNBC. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Agnese Losurdo
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Rozzano (Milano), Italy
| | - Rita De Sanctis
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Rozzano (Milano), Italy
| | - Bethania Fernandes
- Department of Pathology, Humanitas Cancer Center, Rozzano (Milano), Italy
| | | | - Andrea Sagona
- Breast Center, Humanitas Cancer Center, Rozzano (Milano), Italy
| | - Giovanna Masci
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Rozzano (Milano), Italy
| | - Monica Zuradelli
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Rozzano (Milano), Italy
| | - Elisa Agostinetto
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Rozzano (Milano), Italy
| | - Rosalba Torrisi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Rozzano (Milano), Italy
| | | | - Alberto Testori
- Breast Center, Humanitas Cancer Center, Rozzano (Milano), Italy
| | - Massimo Roncalli
- Department of Pathology, Humanitas Cancer Center, Rozzano (Milano), Italy
| | - Marco Alloisio
- Thoracic Surgery Department, Humanitas Cancer Center, Rozzano (Milano), Italy
| | | | - Armando Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Rozzano (Milano), Italy
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Testori A, Voulaz E, Alloisio M, Errico V, Cariboni U, De Simone M, Cioffi U. Multicentric castleman's disease resembling metastatic lung carcinoma. A case report. Clin Case Rep 2018. [PMID: 29531720 PMCID: PMC5838266 DOI: 10.1002/ccr3.1381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 67‐year‐old patient presented for persistent cough. Computed tomography showed right lower lung opacity associated with mediastinal adenopathy. On suspicion of metastatic pulmonary neoplasm, the patient was submitted to right lower lobectomy with lymphadenectomy. Postoperative histopathology led to the diagnosis of multicentric Castleman's disease.
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Affiliation(s)
- Alberto Testori
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Emanuele Voulaz
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Marco Alloisio
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Valentina Errico
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | - Umberto Cariboni
- Deparment of General and Thoracic Surgery Humanitas Research Hospital Rozzano Milan Italy
| | | | - Ugo Cioffi
- Deparment of Surgery University of Milan Milan Italy
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Testori A, Alloisio M, Errico V, Bottoni E, Voulaz E, Fernandez B, Meroni S, De Simone M, Cioffi U. Pseudoangiomatous stromal hyperplasia - a benign and rare tumor of the breast in an adolescent: a case report. J Med Case Rep 2017; 11:284. [PMID: 28978330 PMCID: PMC5628468 DOI: 10.1186/s13256-017-1426-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/16/2017] [Indexed: 11/15/2022] Open
Abstract
Background Pseudoangiomatous stromal hyperplasia is an uncommon mesenchymal breast neoplasm. Case presentation Here we present a case of an 11-year old hispanic girl affected by bilateral mammary nodular pseudoangiomatous stromal hyperplasia, an uncommon breast disease, with a review of the literature related to diagnostic workup, differential diagnosis, and management. A rapidly growing mass in the breast may be stressful for both parents and child as the suspicion of malignancy arises. Multiple wide excisions of both breasts were performed. Conclusions The purpose of this case report is to draw attention to the fact that most emerging lesions of the breast in girls during puberty are benign diseases.
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Affiliation(s)
- Alberto Testori
- Division of General and Thoracic Surgery, Humanitas Research Hospital, Via Manzoni, 56, 20089, Rozzano, Milan, Italy.
| | - Marco Alloisio
- Division of General and Thoracic Surgery, Humanitas Research Hospital, Via Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Valentina Errico
- Division of General and Thoracic Surgery, Humanitas Research Hospital, Via Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Edoardo Bottoni
- Division of General and Thoracic Surgery, Humanitas Research Hospital, Via Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Emanuele Voulaz
- Division of General and Thoracic Surgery, Humanitas Research Hospital, Via Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Bethania Fernandez
- Division of Anatomopathology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Meroni
- Division of Breast Imaging, European Institute of Oncology, Milan, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
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Solinas M, Novellis P, Bottoni E, Errico V, Voulaz E, Alloisio M, Veronesi G. Robotic approach in case of thymoma involving the left anonymous vein: a case report. AME Case Rep 2017; 1:3. [PMID: 30263990 DOI: 10.21037/acr.2017.09.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/14/2017] [Indexed: 11/06/2022]
Abstract
The robotic system has several technical advantages over the manual video thoracoscopic approach. It offers a high definition three-dimensional view and robotic arms are more comfortable to use, because they allow more precise, flexible, and intuitive movements. This case report describes a locally advanced thymoma in a 75-year-old male patient, excised through a robotic-assisted thymectomy with atypical resection of the infiltrated left upper lobe, the preservation of the left phrenic nerve and partial resection of the left anonymous vein involved, without necessity of reconstruction. Clinical staging was thymoma T3 B1-2, while the postoperative histological classification and radiation was thymoma T3, B3, Masaoka-Koga stage IIB. The postoperative course was uneventful and the patient was discharged in second postoperative day. This case remarks that robotic devices are of great help in the intraoperative recognition and precise management of infiltrated structure, like important vessels and nerves, avoiding conversion to an open approach, which until now was the main surgical indication in these situations.
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Affiliation(s)
- Michela Solinas
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
| | - Edoardo Bottoni
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
| | - Valentina Errico
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
| | - Emanuele Voulaz
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy.,Humanitas University, Biomedical Science Department, Rozzano 20089, Milan, Italy
| | - Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
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22
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Masci G, Santarpia L, Bottai G, Giordano L, Zuradelli M, Torrisi R, Di Tommaso L, Sagona A, Errico V, Gatzemeier W, Testori A, Navarria P, Bello L, Tinterri C, Scorsetti M, Santoro A. HER2 positive breast cancer with central nervous system metastases: Pathological features and clinical outcome. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Infante M, Morenghi E, Bottoni E, Zucali P, Rahal D, Morlacchi A, Ascolese AM, De Rose F, Navarria P, Crepaldi A, Testori A, Voulaz E, Errico V, Perrino M, Scorsetti M, Chiti A, Santoro A, Alloisio M. Comorbidity, postoperative morbidity and survival in patients undergoing radical surgery for malignant pleural mesothelioma. Eur J Cardiothorac Surg 2016; 50:1077-1082. [PMID: 27330149 DOI: 10.1093/ejcts/ezw215] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES We examined a series of malignant pleural mesothelioma (MPM) patients who underwent radical surgery to explore relationships among comorbidity, postoperative morbidity and survival. METHODS A retrospective analysis was carried out of all MPM patients operated on in a single centre from 2000 to 2015. The Charlson Comorbidity Index (CCI) was used to classify patients according to their underlying condition. Postoperative complications were scored according to WHO-derived criteria. Survival comparisons were performed by Cox analysis. RESULTS Ninety-one patients underwent extrapleural pneumonectomy (EPP), 47 underwent pleurectomy decortication (PD) and 25 underwent palliative pleurectomy. The mean CCI of PD patients was significantly higher compared with that of EPP patients (P= 0.044). The frequency of grade 3+ complications was similar between EPP and PD (27 vs 26%). However, EPP patients had a 6-fold higher frequency of pleural sepsis (24 vs 4%, P= 0.002) occurring up to 695 days postoperatively. Median overall survival was 19 months (95% CI 13-25) after EPP, 30 months (95% CI 20-35) after PD and 13 months (95% CI 5-32) after palliative pleurectomy. At multivariate analysis, CCI (P< 0.001), histology (P= 0.014) and pleural sepsis (P= 0.001), but not complete resection, were significantly associated with survival. There was a trend in favour of PD over palliative resection after adjusting for histology and CCI. CONCLUSIONS The CCI is an independent predictor of survival in MPM patients undergoing radical surgery. Owing to its significant frequency and adverse impact, pleural sepsis may contribute to a reduced life expectancy after EPP. Surgical treatment of MPM remains debatable.
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Affiliation(s)
- Maurizio Infante
- Department of Thoracic Surgery, University Hospital Borgo Trento, Verona, Italy
| | - Emanuela Morenghi
- Clinical Research Unit, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Edoardo Bottoni
- Department of Thoracic Surgery, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Paolo Zucali
- Oncology and Hematology, Humanitas Clinical and Research Center, Humanitas University, Rozzano (Milan), Italy
| | - Daoud Rahal
- Department of Pathology, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Andrea Morlacchi
- Department of Thoracic Surgery, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Anna Maria Ascolese
- Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Fiorenza De Rose
- Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Alessandro Crepaldi
- Department of Thoracic Surgery, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Alberto Testori
- Department of Thoracic Surgery, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Emanuele Voulaz
- Department of Thoracic Surgery, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Valentina Errico
- Department of Thoracic Surgery, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Matteo Perrino
- Oncology and Hematology, Humanitas Clinical and Research Center, Humanitas University, Rozzano (Milan), Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Arturo Chiti
- Nuclear Medicine, Humanitas Clinical and Research Center, Humanitas University, Rozzano (Milan), Italy
| | - Armando Santoro
- Oncology and Hematology, Humanitas Clinical and Research Center, Humanitas University, Rozzano (Milan), Italy
| | - Marco Alloisio
- Department of Thoracic Surgery, Humanitas Research Hospital, Rozzano (Milan), Italy
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24
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Paladini L, Bottai G, Raschioni C, Sagona A, Errico V, Torrisi R, Canavese G, Gatzmeier W, Barbieri E, Rubino A, Rossetti C, Eboli M, Malerba P, Scorsetti M, Antunovic L, Alloisio M, Santoro A, Testori A, Tinterri C, Santarpia L. A circulating miRNA signature to implement diagnostic imaging analysis in young early-stage breast cancer patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.11562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Laura Paladini
- Oncology Experimental Therapeutics Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Giulia Bottai
- Oncology Experimental Therapeutics Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Carlotta Raschioni
- Oncology Experimental Therapeutics Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Andrea Sagona
- Senology Unit, Humanitas Cancer Center, Rozzano, Italy
| | - Valentina Errico
- Thoracic Surgery Department, Humanitas Cancer Center, Rozzano, Italy
| | | | | | | | | | | | | | - Marco Eboli
- Senology Unit, Humanitas Cancer Center, Rozzano, Italy
| | - Paolo Malerba
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | - Marco Alloisio
- Thoracic Surgery Department, Humanitas Cancer Center, Rozzano, Italy
| | - Armando Santoro
- Humanitas Cancer Center, Humanitas University, Rozzano (MI), Italy
| | - Alberto Testori
- Thoracic Surgery Department, Humanitas Cancer Center, Rozzano, Italy
| | | | - Libero Santarpia
- Oncology Experimental Therapeutics Unit, Humanitas Clinical and Research Center, Basiglio - Milano, Italy
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25
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Infante M, Allavena P, Garlanda C, Nebuloni M, Morenghi E, Rahal D, Roncalli M, Cavuto S, Pesce S, Monari M, Valaperta S, Montanelli A, Solomon D, Bottoni E, Errico V, Voulaz E, Bossi M, Chiesa G, Passera E, Mantovani A, Alloisio M. Prognostic and diagnostic potential of local and circulating levels of pentraxin 3 in lung cancer patients. Int J Cancer 2015; 138:983-91. [PMID: 26348770 DOI: 10.1002/ijc.29822] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/06/2015] [Accepted: 08/14/2015] [Indexed: 12/19/2022]
Abstract
There is a well-established link between inflammation and cancer of various organs, but little data are available on inflammation-associated markers of diagnostic and prognostic clinical utility in pulmonary malignancy. Blood samples were prospectively collected from 75 resectable lung cancer patients before surgery and in a cohort of 1,358 high-risk subjects. Serum levels of long pentraxin 3 (PTX3) were determined by high-sensitivity ELISA. PTX3 immunostaining was evaluated by immunohistochemistry in cancer tissue. Serum PTX3 levels in the high-risk population were not predictive of developing subsequent lung cancer or any other malignancy; however, serum PTX3 values in patients with lung cancer were significantly higher compared with cancer-free heavy smokers. With a cutoff of 4.5 ng/ml, specificity was 0.80, sensitivity 0.69, positive predictive value 0.15 and negative predictive value 0.98. The receiver operating curve (ROC) for serum PTX3 had an area under the curve (AUC) of 83.52%. Preoperative serum PTX3 levels in lung cancer patients did not correlate with patient outcome, but high interstitial expression of PTX3 in resected tumor specimens was a significant independent prognostic factor associated with shorter survival (p < 0.001). These results support the potential of serum PTX3 as a lung cancer biomarker in high-risk subjects. Furthermore, PTX3 immunohistochemistry findings support the role of local inflammatory mechanisms in determining clinical outcome and suggest that local expression of PTX3 may be of prognostic utility in lung cancer patients.
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Affiliation(s)
- Maurizio Infante
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milano, Italy
| | | | | | - Manuela Nebuloni
- Department of Pathology, University of Milan, L. Sacco Hospital, Milano, Italy
| | - Emanuela Morenghi
- Biostatistical Unit, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Daoud Rahal
- Department of Pathology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Massimo Roncalli
- Department of Pathology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Silvio Cavuto
- Department of Infrastructure Research and Statistics, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | - Marta Monari
- Humanitas Research Center, Rozzano, Milano, Italy
| | - Serenella Valaperta
- Clinical Investigation Laboratory, Fondazione IRCCS Policlinico San Matteo Hospital, Pavia, Italy
| | | | - Daniel Solomon
- Department of General Surgery, Rabin Medical Center, Petah Tiqva, Israel
| | - Edoardo Bottoni
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Valentina Errico
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Emanuele Voulaz
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Manuela Bossi
- Service de Chirurgie Digestive et Metabolique, Hôpital Jean Verdier, Bondy, France
| | - Giuseppe Chiesa
- Thoracic Surgery Department, Humanitas-Gavazzeni Hospital, Bergamo, Italy
| | - Eliseo Passera
- Thoracic Surgery Department, Humanitas-Gavazzeni Hospital, Bergamo, Italy
| | - Alberto Mantovani
- Humanitas Research Center, Rozzano, Milano, Italy.,Humanitas University, Rozzano, Milano, Italy
| | - Marco Alloisio
- Thoracic Surgery Department, Humanitas Research Hospital, Rozzano, Milano, Italy
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26
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Infante M, Cavuto S, Lutman FR, Passera E, Chiarenza M, Chiesa G, Brambilla G, Angeli E, Aranzulla G, Chiti A, Scorsetti M, Navarria P, Cavina R, Ciccarelli M, Roncalli M, Destro A, Bottoni E, Voulaz E, Errico V, Ferraroli G, Finocchiaro G, Toschi L, Santoro A, Alloisio M. Long-Term Follow-up Results of the DANTE Trial, a Randomized Study of Lung Cancer Screening with Spiral Computed Tomography. Am J Respir Crit Care Med 2015; 191:1166-75. [PMID: 25760561 DOI: 10.1164/rccm.201408-1475oc] [Citation(s) in RCA: 248] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Screening for lung cancer with low-dose spiral computed tomography (LDCT) has been shown to reduce lung cancer mortality by 20% compared with screening with chest X-ray (CXR) in the National Lung Screening Trial, but uncertainty remains concerning the efficacy of LDCT screening in a community setting. OBJECTIVES To explore the effect of LDCT screening on lung cancer mortality compared with no screening. Secondary endpoints included incidence, stage, and resectability rates. METHODS Male smokers of 20+ pack-years, aged 60 to 74 years, underwent a baseline CXR and sputum cytology examination and received five screening rounds with LDCT or a yearly clinical review only in a randomized fashion. MEASUREMENTS AND MAIN RESULTS A total of 1,264 subjects were enrolled in the LDCT arm and 1,186 in the control arm. Their median age was 64.0 years (interquartile range, 5), and median smoking exposure was 45.0 pack-years. The median follow-up was 8.35 years. One hundred four patients (8.23%) were diagnosed with lung cancer in the screening arm (66 by CT), 47 of whom (3.71%) had stage I disease; 72 control patients (6.07%) were diagnosed with lung cancer, with 16 (1.35%) being stage I cases. Lung cancer mortality was 543 per 100,000 person-years (95% confidence interval, 413-700) in the LDCT arm versus 544 per 100,000 person-years (95% CI, 410-709) in the control arm (hazard ratio, 0.993; 95% confidence interval, 0.688-1.433). CONCLUSIONS Because of its limited statistical power, the results of the DANTE (Detection And screening of early lung cancer with Novel imaging TEchnology) trial do not allow us to make a definitive statement about the efficacy of LDCT screening. However, they underline the importance of obtaining additional data from randomized trials with intervention-free reference arms before the implementation of population screening.
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27
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Testori A, Meroni S, Errico V, Travaglini R, Voulaz E, Alloisio M. Huge malignant phyllodes breast tumor: a real entity in a new era of early breast cancer. World J Surg Oncol 2015; 13:81. [PMID: 25880837 PMCID: PMC4350953 DOI: 10.1186/s12957-015-0508-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/09/2015] [Indexed: 11/10/2022] Open
Abstract
Phyllodes tumor is an extremely rare tumor of the breast. It occurs in females in the third and fourth decades. The difficulty in distinguishing between phyllodes tumors and benign fibroadenoma may lead to misdiagnosis. Lymph node involvement is rarely described in phyllodes tumors; for this reason, sentinel node biopsy may be warranted. We present a case of a 33-year-old woman affected by huge tumor of the right breast with ulceration in the skin with a rapid tumor growth and with omolateral axillary metastasis.
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Affiliation(s)
- Alberto Testori
- Department of Thoracic and General Surgery, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy.
| | - Stefano Meroni
- Division of Breast Radiology, European Institute of Oncology, Via Ripamonti, 435, Milan, Italy.
| | - Valentina Errico
- Department of Thoracic and General Surgery, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy.
| | - Roberto Travaglini
- Department of Thoracic and General Surgery, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy.
| | - Emanuele Voulaz
- Department of Thoracic and General Surgery, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy.
| | - Marco Alloisio
- Department of Thoracic and General Surgery, Humanitas Research Hospital, Via Manzoni, 56, Rozzano, Milan, Italy.
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28
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Infante MV, Voulaz E, Passera E, Bottoni E, Crepaldi A, Errico V, Andresi M, Alloisio M. 084 * SURGICAL MANAGEMENT OF THYMOMA AND THYMIC CARCINOMA: RESULTS IN 158 PATIENTS. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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29
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Infante MV, Bottoni E, Morlacchi A, Morenghi E, Testori A, Voulaz E, Errico V, Alloisio M. 198 * SURGICAL MANAGEMENT OF MALIGNANT PLEURAL MESOTHELIOMA BY EXTRAPLEURAL PNEUMONECTOMY: A SINGLE-INSTITUTION EXPERIENCE. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Testori A, Meroni S, Cariboni U, Errico V, Voulaz E, Infante VM, Alloisio M. A very elderly lung cancer patient: case report of a long disease free survival. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:470-3. [PMID: 23801173 DOI: 10.5761/atcs.cr.12.02127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite the fact that non-small-cell lung cancer (NSCLC) is very common in the older population, these patients are frequently underrepresented in clinical and surgical trials and thus it is difficult to reach evidence-based recommendations for this special population. We present a case of a surgical treatment of asymptomatic lung cancer in a very elderly patient. The patient had no recurrence for 4 years after a complete resection.
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Affiliation(s)
- Alberto Testori
- Unità Operativa di Chirurgia Toracica e Generale, Istituto Clinico Humanitas, Milano, Italy
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31
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Infante M, Cavuto S, Lutman FR, Brambilla G, Chiesa G, Ceresoli G, Passera E, Angeli E, Chiarenza M, Aranzulla G, Cariboni U, Errico V, Inzirillo F, Bottoni E, Voulaz E, Alloisio M, Destro A, Roncalli M, Santoro A, Ravasi G. A randomized study of lung cancer screening with spiral computed tomography: three-year results from the DANTE trial. Am J Respir Crit Care Med 2009; 180:445-53. [PMID: 19520905 DOI: 10.1164/rccm.200901-0076oc] [Citation(s) in RCA: 300] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Screening for lung cancer with modern imaging technology may decrease lung cancer mortality, but encouraging results have only been obtained in uncontrolled studies. OBJECTIVES To explore the effect of screening with low-dose spiral computed tomography (LDCT) on lung cancer mortality. Secondary endpoints are incidence, stage at diagnosis, and resectability. METHODS Male subjects, aged 60 to 75 years, smokers of 20 or more pack-years, were randomized to screening with LDCT or control groups. All participants underwent a baseline, once-only chest X-ray and sputum cytology examination. Screening-arm subjects had LDCT upon accrual to be repeated every year for 4 years, whereas controls had a yearly medical examination only. MEASUREMENTS AND MAIN RESULTS A total of 2,811 subjects were randomized and 2,472 were enrolled (LDCT, 1,276; control, 1,196). After a median follow-up of 33 months, lung cancer was detected in 60 (4.7%) patients receiving LDCT and 34 (2.8%) control subjects (P = 0.016). Resectability rates were similar in both groups. More patients with stage I disease were detected by LDCT (54 vs. 34%; P = 0.06) and fewer cases were detected in the screening arm due to intercurrent symptoms. However, the number of advanced lung cancer cases was the same as in the control arm. Twenty patients in the LDCT group (1.6%) and 20 controls (1.7%) died of lung cancer, whereas 26 and 25 died of other causes, respectively. CONCLUSIONS The mortality benefit from lung cancer screening by LDCT might be far smaller than anticipated.
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Affiliation(s)
- Maurizio Infante
- Thoracic Surgery Department, Istituto Clinico Humanitas, Milan, Italy.
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32
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Infante M, Lutman RF, Imparato S, Di Rocco M, Ceresoli GL, Torri V, Morenghi E, Minuti F, Cavuto S, Bottoni E, Inzirillo F, Cariboni U, Errico V, Incarbone MA, Ferraroli G, Brambilla G, Alloisio M, Ravasi G. Differential diagnosis and management of focal ground-glass opacities. Eur Respir J 2008; 33:821-7. [PMID: 19047318 DOI: 10.1183/09031936.00047908] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Focal pulmonary ground-glass opacities (GGOs) can be associated with bronchioloalveolar carcinoma. The present retrospective study aimed to test the validity of a multistep approach to discriminate malignant from benign localised (focal) GGOs, identifies useful diagnostic features on computed tomography (CT), and suggests appropriate management guidelines. A stepwise approach, including oral antibiotics, follow-up high-resolution CT (HRCT) 40-60 days later and CT-guided core biopsy, was used. All cases with localised GGOs detected since 2001 were reviewed. CT features were described according to a structured scheme. In total, 40 patients were evaluated. Of these, 11 patients were diagnosed with benign GGOs, 19 patients had lung cancer and 10 were undetermined. Nonpolygonal shape, apparent radial growth and clear-cut margins were associated with a malignant histology. The specificity of CT findings was low. Diagnostic accuracy increased after oral antibiotics, follow-up HRCT and percutaneous core biopsy. Overall, 18 patients underwent surgery for lung cancer. In conclusion, malignant ground-glass opacities have a fairly typical appearance, but some benign lesions closely mimic their malignant counterparts. The stepwise approach adopted in the present study increased the diagnostic specificity and reduced time to definitive diagnosis. Segmentectomy might be the ideal resection volume for such tumours.
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Affiliation(s)
- M Infante
- Dept of Thoracic Surgery, IRCCS Istituto Clinico Humanitas, Milan, Italy.
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Incarbone M, Alloisio M, Luzzati S, Testori A, Cariboni U, Infante M, Errico V, Canevini M, Ravasi G. [Chest wall and vertebral en-bloc resection for sarcoma: ten-year experience]. MINERVA CHIR 2005; 60:273-8. [PMID: 16166926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIM We reviewed our ten-year experience with surgical en-bloc chest wall and vertebral resection for sarcoma invading the spine, and verified five-year survival and feasibility of this aggressive surgery. METHODS From 1994 to 1999, 13 patients underwent surgical en-bloc resection for primary sarcoma of the chest wall involving the spine. Concurrent pulmonary resection was performed in 12 cases. A single hemi-vertebrectomy was performed in 2 patients, a triple hemi-vertebrectomy in 2, a complete vertebrectomy in 4, a triple complete vertebrectomy in 5. RESULTS Significative morbidity occurred in 1 patient who had lower limbs paralysis (9%). Perioperative mortality occurred in 2 patients (15.4%): 1 operative death for bleeding and 1 patients for a adult respiratory distress syndrome (ARDS). The overall five-year survival was 30.8%, excluding the 2 perioperative deaths the five-year survival resulted 36.4%. CONCLUSIONS In spite of the limited number of patients, the morbidity and mortality outcome and the five-year survival leads us to think that surgery is the main therapy for primary chest wall sarcomas involving the spine. En-bloc chest wall and vertebral resection is a safe and effective treatment.
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Affiliation(s)
- M Incarbone
- Unità Operativa di Chirurgia Toracica e Generale, Istituto Clinico Humanitas, Rozzano, Milan.
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