The Effect of Clinical (Anatomical) and Prognostic Stage Groups on Survival in Patients Diagnosed with Breast Cancer: MULTI-Center Study Results, TROD Breast Cancer Study Group

PURPOSE/OBJECTIVE(S)

The American Joint Committee on Cancer (AJCC) anatomic stage groups have arguably been the most powerful method in predicting breast cancer outcomes. In the present study, we aimed to determine the differences between anatomical stage and clinical prognostic stage groups, which were obtained by adding biological markers such as histologic tumor grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 status to patients diagnosed with breast cancer, the rate of change in stage, and the effect of stage change on survival.

MATERIALS/METHODS

The study protocol was sent to all radiation oncology centers in Türkiye. Four centers enrolled their patients to the study. A total of 1470 stage I-III breast cancer patients with complete information on biological markers (histologic tumor grade, hormone receptor, and c-erb B2 receptor status), haven't been treated with neoadjuvant therapy were included to the study and evaluated retrospectively. The 8th edition of AJCC consolidated biological markers in to clinical prognostic stage groups. Kaplan-Meier curves were used to estimate survival. The log-rank test was used to compare the difference between groups. The Cox proportional-hazards regression model was used to determine the association between anatomic-prognostic stage, disease-free survival (DFS), and overall survival (OS).

RESULTS

The median follow-up time was 82 (6-237) months. Median age of the patients was 52 years (20-88) and 865 cases (58.8%) were in the postmenopausal period. The axillary lymph node status was negative (N0) in 765 patients (52.1%). Tumor grade was grade I in 200 patients (13.6%), grade II in 812 patients (55.2%) and grade III in 452 patients (30.7%). Estrogen receptor status was positive in 1247 patients (84.8%), PR status was positive in 1178 patients and Her2-neu status was positive in 207 patients (14.1%). A stage change has been identified in a total of 777 patients (52.9%). Compared with the anatomic stage groups, application of the clinical prognostic stage groups assigned 46.4% cases lower and 6.5% cases higher stage. Five- and ten-year OS and DFS rates of the patients are 73.7%, 44.3% and 91.9%, 86.3% respectively. Age (p<0.001), tumor grade (p<0.001), ER status (p<0.001), PR status (p<0.001), cerbB2 receptor status (p = 0.025) were found to be statistically significant variables in multivariable analysis for OS. For DFS, multivariable analysis showed that age (p = 0.027), tumor grade (p = 0.005), anatomical stage (p<0.001) and assigned to higher stage (p = .001) were statistically significant variables.

CONCLUSION

Hormone receptors and c-erb B2 receptor status are independent variables which impact OS and DFS in our patient group which is mostly consisted of early-stage cases according to anatomical stage. In prognostic staging, upstaging stands out as an independent prognostic factor for DFS. The 8th edition of AJCC prognostic stage groups determines the prognosis much better in our patient cohort.

Assessment of Palliative Care in Lung Cancer in Turkey

OBJECTIVE

To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms.

SUBJECTS AND METHODS

This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis.

RESULTS

The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled.

CONCLUSION

In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults

The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9-9.1%), 13.5% (95% CI 12.8-14.2%), 17.5% (95% CI 16.7-18.2%) and 10.8% (95% CI 10.2-11.4%), respectively; and in females were: 11.2% (95% CI 10.9-11.8%), 14.7% (95% CI 14.3-15.1%), 21.2% (95% CI 20.4-22.0%) and 13.1% (95% CI 12.4-13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8-6.6%), 10.8% (95% CI 10.3-11.3%), 11.7% (95% CI 11.4-12.0%) and 6.6% (95% CI 6.2-7.0%), respectively; and in females were: 7.5 % (95% CI 7.9-7.1%), 12.0% (95% CI 11.7-12.3%), 17.0% (95% CI 16.4-17.6%) and 7.3% (95% CI 6.9-7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country- and population-based environmental factors may contribute to increased prevalence rates of allergic diseases.

Peak expiratory flow monitoring to screen for asthma in patients with allergic rhinitis

AIM

To investigate the benefit of using peak expiratory flow (PEF) monitoring to screen for asthma in allergic rhinitis patients.

METHODS

Eighty-nine consecutive patients with allergic rhinitis but never assessed for asthma were included in this prospective study. Their allergic status was determined by skin prick tests. All of the subjects filled in a questionnaire on asthma-like symptoms. If they reported such symptoms, pulmonary function tests were carried out. Then, PEF was checked twice daily for 3 weeks.

RESULTS

Thirty-six percent of our study group were male and 64% were female patients with a mean (SD) age of 36.3 (14.0) years. Skin prick tests were positive to grass mixture in 71 (79.8%) patients, to tree mixture in 51 (57.3%), to mite in 46 (51.7%), and to epidermal mix in 26 (29.2%) patients. Thirty-six patients (41%) reported 3 or more asthma symptoms. Lung function test results for these 36 patients showed obstruction for 11.1% (4 patients); the remaining patients (88.9%) had normal function parameters. The subjects who reported 3 or more asthma symptoms but had normal lung function monitored their PEF for 3 weeks. Sixteen (50%) patients from this group and the 4 patients with demonstrated airway obstruction had more than 20% diurnal variation in PEF. These 20 patients' asthma symptoms disappeared after they received 3 months of low-dose inhaled corticosteroid therapy.

CONCLUSION

It is necessary to look for asthma in patients suffering from allergic rhinitis. PEF monitoring is a low-cost, objective approach to asthma diagnosis that can be performed by a patient with allergic rhinitis even if spirometry is normal. Knowledge of this technique is of utmost importance because delay in diagnosis will result in the unsatisfactory treatment of the disease.

Impact of obstructive sleep apnoea on left ventricular mass and global function

Obstructive sleep apnoea syndrome (OSAS) might be a cause of heart failure. The present study aimed to assess left ventricular mass and myocardial performance index (MPI) in OSAS patients. A total of 67 subjects without any cardiac or pulmonary disease, referred for evaluation of OSAS, had overnight polysomnography and echocardiography. According to apnoea-hypopnoea index (AHI), subjects were classified into three groups: mild OSAS (AHI: 5-14; n = 16), moderate OSAS (AHI: 15-29; n = 18), and severe OSAS (AHI: > or = 30; n = 33). Thickness of interventricular septum (IVS) and posterior wall (LVPW) were measured by M-mode, along with left ventricular mass (LVM) and LVM index (LVMI). Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Döppler echocardiography. There were no differences in age or body mass index among the groups, but blood pressures were higher in severe OSAS compared with moderate and mild OSAS. In severe OSAS, thickness of IVS (11.2+/-1.1 mm), LVPW (11.4+/-0.9 mm), LVM (298.8+/-83.1 g) and LVMI (144.7+/-39.8 g x m(-2)) were higher than in moderate OSAS (10.9+/-1.3 mm; 10.8+/-0.9 mm; 287.3+/-74.6 g; 126.5+/-41.2 g x m(-2), respectively) and mild OSAS (9.9+/-0.9 mm; 9.8+/-0.8 mm; 225.6+/-84.3 g; 100.5+/-42.3 g x m(-2), respectively). In severe OSAS, MPI (0.64+/-0.14) was significantly higher than in mild OSAS (0.50+/-0.09), but not significantly higher than moderate OSAS (0.60+/-0.10). In conclusion, severe and moderate obstructive sleep apnoea syndrome patients had higher left ventricular mass and left ventricular mass index, and also left ventricular global dysfunction.

QT interval dispersion in obstructive sleep apnoea syndrome patients without hypertension

QT interval dispersion (QT(d)) reflects inhomogeneity of repolarisation. Delayed cardiac repolarisation leading to the prolongation of the QT interval is a well-characterised precursor of arrhythmias. Obstructive sleep apnoea syndrome (OSAS) can cause cardiovascular complications, such as arrhythmias, myocardial infarction, and systemic and pulmonary hypertension. The aim of this study was to assess QT(d) in OSAS patients without hypertension. A total of 49 subjects without hypertension, diabetes mellitus, any cardiac or pulmonary diseases, or any hormonal, hepatic, renal or electrolyte disorders were referred for evaluation of OSAS. An overnight polysomnography and a standard 12-lead ECG were performed in each subject. According to the apnoea-hypopnoea index (AHI), subjects were divided into control subjects (AHI <5, n = 20) and moderate-severe OSAS patients (AHI > or =15, n = 29). QT(d) (defined as the difference between the maximum and minimum QT interval) and QT-corrected interval dispersion (QT(cd)) were calculated using Bazzet's formula. In conclusion, the QT(cd) was significantly higher in OSAS patients (56.1+/-9.3 ms) than in controls (36.3+/-4.5 ms). A strong positive correlation was shown between QT(cd) and AHI. In addition, a significantly positive correlation was shown between QT(cd) and the desaturation index (DI). The AHI and DI were significantly related to QT(cd) as an independent variable using stepwise regression analysis. The QT-corrected interval dispersion is increased in obstructive sleep apnoea syndrome patients without hypertension, and it may reflect obstructive sleep apnoea syndrome severity.

Does Rigid Bronchoscopy Induce Bacterial Translocation?

BACKGROUND

Although some reports suggest that bronchoscopy induces bacterial translocation (BT), the mechanisms of BT remain unclear.

OBJECTIVE

We aimed to assess whether bronchoscopy or hypoxemia during bronchoscopy is responsible for BT.

METHODS

We evaluated 24 rats divided into three subgroups: the control group (group 1, n = 8); the rigid bronchoscopy group (group 2, n = 8), and the group receiving bronchoscopy + mechanical ventilation (group 3, n = 8). Oxygen saturation (SaO(2)) was measured during the bronchoscopic procedure. Blood and tissue cultures from mesenteric lymph nodes (MLNs), liver, spleen and cecal contents were obtained 24 h following bronchoscopy.

RESULTS

In group 2, SaO(2) was significantly lower than in groups 1 and 3 (p < 0.01). In group 2, BT significantly increased (6/8, 75%; p < 0.01 vs. group 1, and p < 0.05 vs. group 3). The main site of translocation was MLNs (6/8, 75%) in group 2, while BT was detected in only 1 rat in group 3 (1/8, 12.5%).

CONCLUSION

Hypoxemia during rigid bronchoscopy resulted in intestinal mucosal damage in a rat model. Hypoxemia may have been the trigger for BT from the intestine following bronchoscopy.

Prevalence of byssinosis and respiratory symptoms among cotton mill workers

BACKGROUND

While the prevalence of byssinosis is decreasing in industrialized countries and persists at high levels in developing countries, this prevalence is remaining constant in Turkey.

OBJECTIVE

In order to determine the effects of past cotton dust exposure on the respiratory tract, a total of 223 persons working in a cotton mill were included in this study.

METHODS

A questionnaire was used to inquire about respiratory symptoms. Participants underwent several spirometric measurements, which were performed on the 1st, 3rd and 5th day of the working week. Cotton dust measurements were performed in different divisions of the factory.

RESULTS

The most common respiratory symptom was chest tightness (20.3%). The prevalence of byssinosis was 14.2% in cotton-processing workers. Among these cases, 28.6% had symptoms on the 1st day of the week, and 71.4% had symptoms on all days of the week. An acute effect was seen in 53.6% of the workers with byssinosis. Mean respirable dust levels were between 0.095 and 0.413 mg/m(3).

CONCLUSIONS

In spite of technological improvements, respirable dust concentrations are still above the permissible limits, and thus the risk of byssinosis remains. Workers in the cotton industry where obsolete technology is used and standardized protection measures are not applied should be followed for byssinosis.

Involvement of central dopamine in the hyperthermia in rats produced by d-amphetamine

The effect of amphetamine on the body temperature was studied in 6-hydroxydopamine and pimozide pretreated rats. Amphetamine alone (1, 2.5 and 5 mg/kg) produced a fairly dose-dependent increase in body temperature. The effect was almost totally antagonized by pimozide, and also reduced after pretreatment with 6-hydroxydopamine. These results are discussed with regard to the possible role of central dopamine in mediating amphetamine-induced hyperthermia in rats.