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Faur IF, Dobrescu A, Clim IA, Pasca P, Prodan-Barbulescu C, Tarta C, Neamtu AA, Brebu D, Neamtu C, Rosu M, Duta C, Clim A, Lazar G, Totolici B. The Predictive Role of Serum Lipid Levels, p53 and ki-67, According to Molecular Subtypes in Breast Cancer: A Randomized Clinical Study. Int J Mol Sci 2024; 25:3911. [PMID: 38612725 PMCID: PMC11012133 DOI: 10.3390/ijms25073911] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Dyslipidemia is a component of metabolic syndrome, having an important role in the carcinogenesis of different tumor types, such as prostate, ovarian, or renal cancer. The number of studies on the predictive potential of the different components of the lipid profile with a predictive potential in breast cancer is quite low. The evaluation of the lipid profile was carried out for the 142 patients who benefited from neoadjuvant therapy (NAC) in order to identify a potential predictive biomarker. The serological sample collection was performed sequentially according to a standardized protocol, pre-NAC, post-NAC and 6 months post-NAC after a 6-h pre-collection fast. We also investigated in the general group the presence or absence of the p53 mutation (TP53) and of the mitotic index ki-67, respectively, in relation to the molecular subtypes. The menopausal status, tumor size, family history, grading, Ki-67, p53 and LN metastases have a predictive nature regarding overall survival (OS) (p < 0.05), while for disease free survival (DFS), only tumor size, tumor grading, Ki-67 > 14, and p53+ are of predictive nature. The genetic and molecular analysis carried out in our group indicates that 71.67% have a Ki-67 score higher than 14%, and 39% of the patients have the positive P53 mutation. The multivariate analysis in the case of patients included in the TNBC subtype showed that the increased tumor volume (p = 0.002) and increased level of HDL (p = 0.004) represent predictive factors for the tumor response rate to NAC. High HDL-C levels before NAC and increased LDL-C levels after NAC were associated with the better treatment response in ER-positive and HER2+ breast cancer patients. Increased HDL-C values and tumor volume represent predictive factors as to the response rate to NAC in the case of patients included in the TNBC subtype. Regarding the ER+ and HER2+ subtypes, increased levels of HDL-C pre-NAC and increased levels of LDL-C post-NAC were associated with a better therapeutic response rate. Tumor grading, Ki-67, p53, and LN metastases have a predictive nature for OS, while tumor size, tumor grading, and Ki-67 > 14, and p53+ are predictive for DFS.
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Affiliation(s)
- Ionut Flaviu Faur
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.T.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Multidisciplinary Doctoral School, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania
| | - Amadeus Dobrescu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.T.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Ioana Adelina Clim
- IInd Obstetrics and Gynecology Clinic “Dominic Stanca”, 400124 Cluj-Napoca, Romania;
| | - Paul Pasca
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.T.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Catalin Prodan-Barbulescu
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Department I-Discipline of Anatomy and Embryology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Cristi Tarta
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.T.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Andreea-Adriana Neamtu
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Sq., Nr. 2, 300041 Timișoara, Romania;
- Pathology Department, Clinical County Emergency Hospital of Arad, Andrenyi Karoly Str, Nr. 2-4, 310037 Arad, Romania
| | - Dan Brebu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.T.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Carmen Neamtu
- Ist Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania; (C.N.); (M.R.); (B.T.)
- Department of General Surgery, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania
| | - Mihai Rosu
- Ist Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania; (C.N.); (M.R.); (B.T.)
- Department of General Surgery, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania
| | - Ciprian Duta
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (P.P.); (C.T.); (D.B.); (C.D.)
- X Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Andreea Clim
- Department of Morpho-Functional Sciences II, Discipline of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Gabriel Lazar
- Department of Oncology Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
- Ist Clinic of Oncological Surgery, Oncological Institute “Prof. Dr. I Chiricuta”, 400015 Cluj-Napoca, Romania
| | - Bogdan Totolici
- Ist Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania; (C.N.); (M.R.); (B.T.)
- Department of General Surgery, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania
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Faur FI, Clim IA, Dobrescu A, Isaic A, Prodan C, Florea S, Tarta C, Totolici B, Duţă C, Pasca P, Lazar G. The Use of Wound Infiltration for Postoperative Pain Management after Breast Cancer Surgery: A Randomized Clinical Study. Biomedicines 2023; 11:biomedicines11041195. [PMID: 37189812 DOI: 10.3390/biomedicines11041195] [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: 02/15/2023] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: The present study aims to evaluate the reduction of postoperative pain in breast surgery using a series of local analgesics, which were infiltrated into the wound; (2) Methods: Envelopes containing allocation were prepared prior to the study. The patients involved were randomly assigned to the groups of local anesthesia infiltration (Group A) or normal pain management with intravenous analgesics (Group B). The random allocation sequence was generated using computer-generated random numbers. The normally distributed continuous data were expressed as the means (SD) and were assessed using the analysis of variance (ANOVA), independent-sample t-test, or paired t-test; (3) Results: The development of the postoperative pain stages was recorded using the VAS score. Therefore, for Group A, the following results were obtained: the VAS at 6 h postoperatively showed an average value of 0.63 and a maximum value of 3. The results for Group B were the following: the VAS score at 6 h postoperatively showed an average value of 4.92, a maximum of 8, and a minimum of 2; (4) Conclusions: We can confirm that there are favorable statistical indicators regarding the postoperative pain management process during the first 24-38 h after a surgical intervention for breast cancer using local infiltration of anesthetics.
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Affiliation(s)
- Flaviu Ionut Faur
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Ioana Adelina Clim
- IInd Obstetric and Gynecology Clinic "Dominic Stanca", 400124 Cluj-Napoca, Romania
| | - Amadeus Dobrescu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Alexandru Isaic
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Catalin Prodan
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Sabrina Florea
- Central Military Emergency University Hospital "Dr. Carol Davila", 010825 Bucharest, Romania
| | - Cristi Tarta
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Bogdan Totolici
- Ist Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania
- Department of General Surgery, Faculty of Medicine, "Vasile Goldiș" Western University of Arad, 310025 Arad, Romania
| | - Ciprian Duţă
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
- Department X of General Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Paul Pasca
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timișoara, Romania
| | - Gabriel Lazar
- Department of Oncology Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- Ist Clinic of Oncological Surgery, Oncological Institute "Prof Dr I Chiricuta" Cluj-Napoca, 400015 Cluj-Napoca, Romania
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Faur FI, Clim IA, Pasca P, Prodan C, Nati I, Dobrescu A, Florea S, Rosu M, Totolici B, Duta C, Lazar G. Low-Cost and Reproductible Method to Obtain Mapping of Lymphatic Drainage in Patient with Early Endometrial Cancer. Chirurgia (Bucur) 2023; 118:153-160. [PMID: 37146192 DOI: 10.21614/chirurgia.2837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 05/07/2023]
Abstract
Introduction: Endometrial cancer is the most common form of gynecological cancer in developed countries. Current recommended therapeutic management takes into account a number of factors such as: TNM stage, justification for primary surgery, desire to preserve fertility. For primary operable cases, surgical staging has become an extremely important pillar, in which the status of the pelvic lymph nodes needs to be known (1-3). Material and Method: Between August 2015 and June 2021, a multicenter prospective observational study was performed in the "Prof. Dr. I. Chiricuta" Oncological Institute Cluj Napoca, 2nd Department of Surgery of "Pius Brinzeu" County Hospital Timisoara, 1st Department of General Surgery of Arad County Hospital, 2nd Department of Obstetrics and Gynecology "Dominic Stanca" Cluj Napoca and "Dr. Carol Davila" Central Military Emergency University Hospital Bucharest, Romania with the main aim of examining the sentinel lymph node detection rate using methylene blue as a tracer. Surgeries were performed by the team of surgeons of the mentioned clinics, and patients were informed about this study and signed an informed consent form for enrollment. Results: A total of 116 cases met the inclusion criteria for this prospective study. The mean age of the included patients was 62.3 years (minimum - 38, maximum - 83). The mean body mass index was 31.8 (minimum - 19.9, maximum - 48.2). In terms of histological type of the endometrial cancer, the majority of cases were endometrioid cancer, amounting to 72.5% of the total (n=84). A considerable number of cases were of mixed type, either with clear cell carcinoma (8.6%, n=10) or mixed carcinosarcoma (17.2%, n=20). The preferred approach for surgery was laparoscopic surgery rather than traditional surgery (72% vs 28%). Another element investigated from a histological point of view is the tumour grading, the degree of differentiation of cells with anarchic development, we note that 50% (n=58) were G2. Of the 116 cases of endometrial carcinoma included in the study, in 83% of cases (n=96) methylene blue tracer injection was successful and sentinel node was identified. The SLN technique continues to be of great interest and use in surgical centers around the world. The method of detecting sentinel lymph nodes varies depending on the individual. According to literature studies, indocyanine (ICG- Indocyanine green) is the gold standard for lymph node mapping, with superior detection rates when compared to other existing versions. Another key factor to consider when selecting a sentinel node identification method is cost-effectiveness. The use of methyl blue as a marker tracer is the most cost-effective option with equivalent detection rate outcomes. Conclusions: Based on the results of our study and other studies in the literature, lymphatic mapping using methylene blue as a tracer in endometrial cancer is a cost-effective method with a favourable detection rate. With this low-cost procedure we can achieve a correct tumor staging, avoiding overtreatment. There are multiple ways to identify the sentinel node using different tracers with higher accuracy, but the objective of the study was not to make a comparison between different tracers, but to present the feasibility of lymph node mapping using methylene blue as a low cost tracer with good reproducibility, short learning curve and optimal detection rate.
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