Lymphovascular invasion has a significant prognostic impact in patients with early breast cancer, results from a large, national, multicenter, retrospective cohort study

Background

We determined the prognostic impact of lymphovascular invasion (LVI) in a large, national, multicenter, retrospective cohort of patients with early breast cancer (BC) according to numerous factors.

Patients and methods

We collected data on 17 322 early BC patients treated in 13 French cancer centers from 1991 to 2013. Survival functions were calculated using the Kaplan–Meier method and multivariate survival analyses were carried out using the Cox proportional hazards regression model adjusted for significant variables associated with LVI or not. Two propensity score-based matching approaches were used to balance differences in known prognostic variables associated with LVI status and to assess the impact of adjuvant chemotherapy (AC) in LVI-positive luminal A-like patients.

Results

LVI was present in 24.3% (4205) of patients. LVI was significantly and independently associated with all clinical and pathological characteristics analyzed in the entire population and according to endocrine receptor (ER) status except for the time period in binary logistic regression. According to multivariate analyses including ER status, AC, grade, and tumor subtypes, the presence of LVI was significantly associated with a negative prognostic impact on overall (OS), disease-free (DFS), and metastasis-free survival (MFS) in all patients [hazard ratio (HR) = 1.345, HR = 1.312, and HR = 1.415, respectively; P < 0.0001], which was also observed in the propensity score-based analysis in addition to the association of AC with a significant increase in both OS and DFS in LVI-positive luminal A-like patients. LVI did not have a significant impact in either patients with ER-positive grade 3 tumors or those with AC-treated luminal A-like tumors.

Conclusion

The presence of LVI has an independent negative prognostic impact on OS, DFS, and MFS in early BC patients, except in ER-positive grade 3 tumors and in those with luminal A-like tumors treated with AC. Therefore, LVI may indicate the existence of a subset of luminal A-like patients who may still benefit from adjuvant therapy.

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In a study of 17 322 early BC patients, LVI had a significant independent negative prognostic impact on survival.

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LVI negatively impacted survival in almost every patient category and cancer subtype, with and without AC.

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LVI did not have a negative survival impact in patients with ER+ grade 3 or with luminal A-like tumors with chemotherapy.

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Results suggest a possible benefit of AC in LVI-positive luminal A-like patients.

Laparoscopic restaging of borderline ovarian tumours (BLOT): a retrospective study of 142 cases

OBJECTIVES

PRIMARY OBJECTIVE

To analyse the impact of restaging, on recurrences and survival, in BLOT.

SECONDARY OBJECTIVE

To cluster patients who could be exempted from restaging.

STUDY DESIGN

This retrospective study, included patients operated for a BLOT, between January 1990, and December 2007, in gynaecological surgery units of the University Hospital of Clermont-Ferrand. Two groups were evaluated: patients with and without optimal restaging.

RESULTS

One hundred and forty-two patients were included. Optimal initial staging rate was 38.7% (n=55). Among the eighty-seven women not initially staged, two groups were compared: restaged (n=45) and non-restaged patients (n=42). Mean follow-up was 80.5 months. Overall survival was 93.7%. Relapse rate was 7.7% (n=11). Disease free survival (DFS) was 88% after a mean follow-up of 80.5 months. One death was noted. Optimal restaging rate was 31.7% (n=45, 43 by laparoscopy). Mean follow-up was of 87.1 months among restaged patients, 84.5 months among non-restaged patients (p=0.93). Relapse incidence was significantly higher in non restaged, than in restaged patients (p=0.008). DFS was significantly longer among restaged than non-restaged patients, (p=0.072). Younger age (p=0.04), conservative treatment (p<10(-4)) or non-diploidy (p=0.04) increased the incidence of relapse.

CONCLUSIONS

When initial staging is missing, restaging improves the patients outcome in comparison to non-restaged groups. Laparoscopy is a valuable surgical option. This study suggests that a selected group of patients, older than 30 years old, submitted to a radical treatment, presenting a diploid, non micropapillar, mucinous BLOT, without visible implants during careful peritoneal inspection, could be exempted from restaging. They represented 11.6% of our population.

[A policy of selective episiotomy in a ward: an example of medical professional assessment]

OBJECTIVES

To reduce the episiotomy rates, according to the Clinical Practice Guidelines, of 2005, from the French College of Obstetricians and Gynaecologists.

PATIENTS AND METHODS

A cross sectional study was conducted, in the university hospital maternities (Maternity 1 and 2) with a retrospective record from medical files. Patients who had delivered in those maternities, by vaginal route, after 22 weeks amenorrhea were eligible. The global rate of episiotomy was analysed from 2006 to 2008. A descriptive clinical study was performed with a retrospective analysis (from July to December 2005 on 100 medical files and from July to December 2007 on 85 files). Besides, a study of episiotomy rate was conducted from 2006 to 2008. Improvement actions were developed between the two phases of assessment of the audit: sharing and comparing the results to standardized episiotomy rates, and elaborating an informatized regional perinatality file with episiotomy related items and national recommendations.

RESULTS

Episiotomy rate decreased during the study, from 22.35% in 2005 to 19.34% in 2008, in the Ward 1 (p<0.0001) and from 33.62% in 2005 to 17.93% en 2008 (p<0.0001) in the Ward 2. An improvement was observed between the two periods of audits, for each item of the chart but without statistical signification.

DISCUSSION AND CONCLUSION

Theses procedures have led to a positive impact on practices thanks to the work group and because of the politics of the perinatal network in favour of an episiotomy reduction. We hope these results could be improved in the future.