Consensus on complementary feeding from the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition: COCO 2023

Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.

Abstract PO-154: Clinical and prognostic significance of tumor infiltrating lymphocytes of triple negative breast cancer in Colombian women

Background: Triple negative breast cancer (TNBC) is the most aggressive breast cancer subtype, represents 10%-20% of all breast cancers and occurs more frequently in young Non- Hispanic Black and Latina women. TNBC is highly immunogenic due to the relatively high levels of tumor infiltrating lymphocytes (TILs) which in turn has been associated with long term survival as well as a risk reduction of death and recurrence. Little is known about TILs and its prognostic value in TNBCs from Latinas such as Colombian women. The goal of this study was to evaluate the differences in the clinic-pathological variables according to TILs levels. Also, to evaluate if TILs are an independent prognostic factor in TNBC from Colombian patients. Methods: We included 130 TNBC patients diagnosed between 2008-2016 at the Colombian National Cancer Institute. Analysis of TILs was performed on a single full-face hematoxylin and eosin (H&E) stained pre-treatment sections. TILs score was estimated as a proportion of intratumoral TILs (iTILs) and stromal TILs (sTILs) on tumoral area and was classified using a cut-off of 10% for sTILs and 1% for iTILs. Additionally, immunohistochemistry for PD-L1 (n=92), CD4 (n=40) and CD8 (n=40) was evaluated on three different fields of vision. Chi-squared test and ANOVA were used to test differences in clinic-pathological variables and Kaplan Meier analysis and long-rank test was used to explore differences in survival according to TILs. Results: High sTILs (≥10%) was observed in 36.4% of the patients. We observed that patients in the high sTILs group were usually diagnosed at early stages and with smaller tumors (<2cm) compared to patients with low sTILs (48.9% vs 23.2%, p<0.01 and 27.3% vs. 5.3%, p<0.01). Regarding treatment, a lower number of patients with high sTILs received neoadjuvant chemotherapy (46.8% vs. 74.4%, p<0.01 and mastectomy (53.2% vs. 74.4%, p=0.02) but had clinical complete response (cCR) (30% vs. 6.2%, p=0.053) compared to patients with low sTILs. Similar results were found for cCR in the iTILs positive group compared to iTILs negative group (13.8% vs. 0%, p<0.01). Differences in overall survival was observed according to sTILs (p<0.01). Cox regression analysis in a model adjusted by AJCC stage found low sTILs (<10%) as a prognostic factor associated with higher risk of death (HR: 1.65, 95% CI 0.99 – 2.77, p=0.05). Stromal and intratumoral CD4 and CD8 were evaluated, and patients were categorized according to the median of expression. For low iCD4 we observed a higher percentage of patients with node involvement (88.9% vs. 52.6%, p=0.04) and for the low iCD8 group we observed larger tumors (>5cm) (47.4% vs. 31.2%, p=0.03). Finally, PD-L1 expression was positive in 21.7% of the patients and was associated with high level of sTILs (p=0.02). Conclusions: Our results suggests that higher levels of sTILs in the TNBC are associated with a better prognosis. Further work is needed to explore the level of CD4, CD8 and PD-L1 expression in our patients to assess its clinical impact.

Citation Format: Carlos A. Huertas, Mayra A. Ramirez, Henry J. Gonzalez, Juan C. Mejía, Laura Fejerman, Jovanny Zabaleta, María C. Sanabria, Silvia J. Serrano. Clinical and prognostic significance of tumor infiltrating lymphocytes of triple negative breast cancer in Colombian women [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-154.

Abstract P1-08-09: Increased prevalence of luminal B subtype in Colombian women with breast cancer

Background: Breast cancer is the most frequent malignancy in women worldwide. Distinct intrinsic subtypes of breast cancer have different prognoses, and their relative prevalence varies significantly among ethnic groups. Hispanic/Latino (H/L) populations are a genetically admixed and heterogeneous group, with variable levels of European, Native American and African ancestries. Breast cancer in H/L patients is understudied from a molecular standpoint, and most studies reported so far include limited numbers of H/L patients and assign ethnicity based on self-reported data rather than ancestry. This is the first study to explore the prevalence of breast cancer intrinsic subtypes in Colombia and their association with clinicopathological data and genetic ancestry.

Methods: Immunohistochemistry surrogates from the 2013 St. Gallen International Expert Consensus were applied to classify breast cancer into intrinsic subtypes in 301 patients diagnosed between 2008 and 2012 at the Colombian National Cancer Institute. We analyzed the distribution of subtypes by age, histologic type, node status, margins at surgery, AJCC stage, tumor size, Bloom-Richardson grade, histologic features, administration and response to neoadjuvant therapy, adjuvant therapy and recurrence. Genetic ancestry was estimated from a panel of 80 ancestry-informative markers (AIM).

Results: Luminal B breast cancer subtype was the most prevalent in our population (47.5%), followed by luminal A (23.9%), non-basal triple negative (9.3%), basal-like (8.6%), HER2-enriched (8%), and unknown (2.6%). The average of age at diagnosis was 55 and the average tumor size was 4.08 cm. We found statistical significant differences in age at diagnosis, Bloom-Richardson grade, histologic features, adjuvant chemotherapy and recurrence according to intrinsic subtype. Consistent with North American and European observations, basal-like and non-basal triple negative were poorly differentiated tumors and more likely to be diagnosed at younger ages compared to luminal tumors. Patients diagnosed with HER2-enriched, basal and non-basal triple negative breast cancer had the highest African ancestry.

Conclusions: Luminal B tumors, a high risk subset of ER-positive breast cancer, occur with remarkably higher prevalence in Colombian women with breast cancer compared to North American and European populations. Triple-negative subtypes and HER2-enriched tumors appeared to be more frequent among patients with African ancestry, as observed in North American cohorts. Future studies analyzing the molecular profiles of breast cancer in Colombian women will help us understand the molecular basis of this subtype distribution and compare the molecular characteristics of the different intrinsic subtypes in Colombian Hispanic/Latina patients.

Citation Format: Serrano-Gomez SJ, Sanabria MC, Hernández-Suarez GA, Garcia O, Silva C, Romero A, Mejía JC, Fejerman L, Antonia T, Miele L, Zabaleta J. Increased prevalence of luminal B subtype in Colombian women with breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-08-09.

Urinary N-acetyl-beta-glucosaminidase in the prediction of preeclampsia

The urinary excretion of N-acetyl-beta-glucosaminidase (NAG), a lysosomal enzyme of the renal tubular cells was analyzed in 177 women divided into nonpregnant healthy controls (n = 46), normal pregnant women in their third trimester (n = 49), pregnant women with transient hypertension (n = 43), and women with preeclampsia (n = 39). Urinary activity of NAG was increased in normal pregnant women and in patients with transient hypertension in pregnancy compared to nonpregnant healthy controls. In preeclamptic women, this increase was found to be much higher than that corresponding to their gestational age; this fact is due to the tissue ischemia that precedes glomerular endotheliosis, but also tubular lesions caused by arteriolar vasoconstriction may have an important role.