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Dembinski R, Prasath V, Bohnak C, Siotos C, Sebai ME, Psoter K, Gani F, Canner J, Camp MS, Azizi A, Jacobs L, Habibi M. Estrogen Receptor Positive and Progesterone Receptor Negative Breast Cancer: the Role of Hormone Therapy. Discov Oncol 2020; 11:148-154. [PMID: 32519274 DOI: 10.1007/s12672-020-00387-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
ER+/PR- (estrogen receptor positive and progesterone receptor negative) tumors constitute only a small portion of the breast cancer population. Patients with ER+/PR- tumors, however, are characterized by worse survival compared to patients with ER+/PR+ (estrogen receptor positive and progesterone receptor positive) tumors. Controversy exists regarding the efficacy of hormone blocking therapy for patients with ER+/PR- tumors. The NCDB was queried between 2004 and 2015, and patients with invasive ER+/PR- tumors were identified. We employed univariate Cox proportional hazards to compare outcomes among patients that did or did not receive hormone blocking therapy. We identified 138,398 patients with invasive ER+/PR- tumors, 32,044 (23%) of whom did not receive hormone blocking therapy. The reasons for not receiving hormone blocking therapy included contraindications to treatment, death, patient refusal, and unknown. There were no significant differences in race, income quartile, or education quartile between patients who did and did not receive hormone blocking therapy. Patients who did not receive hormone blocking therapy underwent surgical assessment of the axilla more frequently than those who did receive hormone therapy. Our analysis demonstrated that hormone blocking therapy administration was associated with increased overall survival for up to 10 years of follow up (HR: 0.58; 95% CI: 0.56-0.59, p < 0.001). Hormone blocking therapy may be associated with increased survival for breast cancer patients with ER+/PR- tumors. Although this benefit may last for years after completion of the course, up to 25% of patients do not receive this treatment. Strategies to increase the utilization and adherence to hormone blocking therapy regimens may improve patient survival outcomes.
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Affiliation(s)
- Robert Dembinski
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Vishnu Prasath
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Carisa Bohnak
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Charalampos Siotos
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Mohamad E Sebai
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Kevin Psoter
- Department of Pediatrics, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Faiz Gani
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Joe Canner
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Melissa S Camp
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Armina Azizi
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Lisa Jacobs
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Bayview Campus, Building A, 5th Floor, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
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Kumar M, Sebai ME, Appleford C, Dekhne N. Myxoma in the axilla of a patient with a history of inflammatory breast cancer. Breast J 2020; 26:1400-1401. [PMID: 31898362 DOI: 10.1111/tbj.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Mohineesh Kumar
- Breast Cancer Center, Department of Surgery, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Mohamad E Sebai
- Breast Cancer Center, Department of Surgery, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Colin Appleford
- Department of Pathology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Nayana Dekhne
- Breast Cancer Center, Department of Surgery, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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Siotos C, McColl M, Psoter K, Gilmore RC, Sebai ME, Broderick KP, Jacobs LK, Irwin S, Rosson GD, Habibi M. Tumor Site and Breast Cancer Prognosis. Clin Breast Cancer 2018; 18:e1045-e1052. [DOI: 10.1016/j.clbc.2018.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022]
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Lynch JM, Sebai ME, Rodriguez-Unda NA, Seal S, Rosson GD, Manahan MA. Breast Pocket Irrigation with Antibiotic Solution at Implant Insertion: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2018; 42:1179-1186. [PMID: 29948092 DOI: 10.1007/s00266-018-1166-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Antibiotic irrigation is routinely used during implant insertion in augmentation mammoplasty procedures. However, the evidence for whether this reduces the incidence of infection or capsular contracture is unclear. METHODS AND MATERIALS Five databases were used to search for all randomized control trials, retrospective cohort and prospective cohort studies containing original data related to the primary outcomes being investigated in this study. The primary outcomes were the effects of antibiotic breast pocket irrigation on clinical infection and capsular contracture. The literature search was designed to combine three concepts: implant or tissue expander-based breast surgery, antibiotic irrigation and clinical infection or capsular contracture. Studies found were screened using specific eligibility criteria. Risk ratios (RR) and 95% confidence interval (CI) were calculated using pooled acquired data from all included studies. RESULTS The search identified 1256 citations. Three independent screeners identified seven studies that met the inclusion criteria with a pooled population of 4725. This included one prospective and six retrospective studies. A meta-analysis of pooled study data showed significant reductions in clinical infection (RR 0.52, 95% CI 0.33-0.81) and capsular contracture (RR 0.36, 95% CI 0.16-0.83) as a result of antibiotic irrigation. CONCLUSION The meta-analyses support the use of antibiotic irrigation of the breast pocket. However, the results of this study are limited by the large proportion of retrospective studies, the small number of studies included, the lack of randomized controlled trials and the heterogeneity of the antibiotic and control regimes used. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Abstract
Oncoplastic surgery of the tissue defect from partial mastectomy should be considered for all patients. It can result in in significant asymmetries from scar contraction, skin tethering, and alterations in the nipple areolar complex location. Indications, risks, and benefits are discussed. Optimal procedures are described, considering resected specimen volume, primary tumor location, tumor to breast size ratio, and the impact on the nipple areolar complex. Indications for plastic surgery consultation and joint surgery are discussed. Surgical management includes incision planning, preservation of the nipple areolar complex pedicle and position, patient positioning, incision location, and recovery.
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Affiliation(s)
- Mehran Habibi
- Department of Surgery, Johns Hopkins University, 4940 Eastern Avenue, Room A-562, Baltimore, MD 21224, USA
| | - Kristen P Broderick
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, 4940 Eastern Avenue, Suite A 520, Baltimore, MD 21224, USA
| | - Mohamad E Sebai
- Department of Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Building A 5th Floor-Room 562, Baltimore, MD 21224, USA
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University, Blalock 607, Baltimore, MD 21287, USA.
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Siotos C, Sebai ME, Wan EL, Bello RJ, Habibi M, Cooney DS, Manahan MA, Cooney CM, Seal SM, Rosson GD. Breast reconstruction and risk of arm lymphedema development: A meta-analysis. J Plast Reconstr Aesthet Surg 2018; 71:807-818. [DOI: 10.1016/j.bjps.2018.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/13/2017] [Accepted: 01/21/2018] [Indexed: 11/15/2022]
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Sebai ME, Cui D, Bello RJ, Lee J, Siotos C, Manahan MA, MSacks J, Habibi M, Rosson GD, Cooney CM. A Cross-Sectional Comparison of Quality of Life Outcomes in 348 Older and Younger Adults after Breast Reconstruction. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.023] [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: 10/18/2022]
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Sebai ME. Artist's Statement: Rosalyne. Acad Med 2017; 92:1405. [PMID: 28952996 DOI: 10.1097/acm.0000000000001898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Mohamad E Sebai
- M.E. Sebai is a postdoctoral fellow, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; e-mail:
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Sebai ME, Psoter KJ, Siotos C, Gilmore RC, Irwin S, Grauer MJ, Broderick KP, Jacobs LK, Habibi M. Delayed Surgical Treatment in Breast Cancer Patients: Single-Institution Study on Survival Outcomes and Delaying Factors. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.026] [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: 11/28/2022]
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Sebai ME, Bello RJ, Devulapalli C, Cooney CM, Rosson GD. Impact of Tissue Expander to Final Breast Reconstruction Time Interval on Postoperative Quality of Life: A Cohort Study of 144 Breast Reconstruction Patients using Breast-Q. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.053] [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: 10/20/2022]
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Sebai ME, Lynch JM, Rodriguez-Unda N, Rosson GD, Manahan MA. Breast Pocket Irrigation with Antibiotic Solution at Implant or Tissue Expander Insertion: A Systematic Review and Meta-Analysis. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.202] [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: 10/20/2022]
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Sebai ME, Bello RJ, Clarke-Pearson E, Redett RJ, Wan EL, Manahan MA, Sacks JM, Cooney D, Cooney CM, Rosson GD. Severe Deficiency of Reconstructive Surgery for the Hidden Victims of the Syrian Crisis: Challenges and Urgent Call for Solutions for Non-Fatal Injury Victims. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.320] [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: 11/24/2022]
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Bello RJ, Devulapalli C, Ohkuma R, Baltodano-Fallas P, Rodriguez-Unda NA, Sebai ME, Manahan MA, Sacks J, Cooney CM, Rosson GD. Health-related quality of life throughout the breast reconstruction process. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10106] [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
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Xiang L, Hester RL, Fuller WL, Sebai ME, Mittwede PN, Jones EK, Aneja A, Russell GV. Orthopedic trauma-induced pulmonary injury in the obese Zucker rat. Microcirculation 2011; 17:650-9. [PMID: 21044219 DOI: 10.1111/j.1549-8719.2010.00061.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Obese subjects with orthopedic trauma exhibit increased inflammation and an increased risk of pulmonary edema. Prostaglandin E(2) (PGE(2) ) production is elevated during inflammation and associated with increased vascular permeability. We hypothesize that pulmonary edema in obesity following orthopedic trauma is due to elevated PGE(2) and resultant increases in pulmonary permeability. METHODS Orthopedic trauma was induced in both hindlimbs in lean (LZ) and obese Zucker rats (OZ). On the following day, plasma interleukin-6 (IL-6) and PGE(2) levels, pulmonary edema, and pulmonary gas exchange capability were compared between groups: LZ, OZ, LZ with trauma (LZT), and OZ with trauma (OZT). Vascular permeability in isolated lungs was measured in LZ and OZ before and after application of PGE(2) . RESULTS As compared with the other groups, the OZT exhibited elevated plasma IL-6 and PGE(2) levels, increased lung wet/dry weight ratio and bronchoalveolar protein concentration, and an impaired pulmonary gas exchange. Indomethacin treatment normalized plasma PGE(2) levels and pulmonary edema. Basal pulmonary permeability in isolated lungs was higher in OZ than LZ, with a further increase in permeability following treatment with PGE(2) . CONCLUSIONS These results suggest that pulmonary edema in OZ following orthopedic trauma is due to an elevated PGE(2) and resultant increases in pulmonary permeability.
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Affiliation(s)
- Lusha Xiang
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA.
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