Patients with triple-negative breast cancer (TNBC) who achieve pathologic complete response (pCR) to neoadjuvant systemic therapy have favorable survival, while those with residual disease have high recurrence risk. Stromal tumor infiltrating lymphocytes (sTILs) and TNBC-DX both predict pCR in TNBC. Whether these 2 biomarkers provide complementary information has not been tested. We evaluated sTILs and TNBC-DX in TNBC patients treated with docetaxel-carboplatin (TCb) on the MMJ-CAR-2014-01 study (NCT01560663) or TCb plus pembrolizumab (TCb+Pem) on the NeoPACT trial (NCT03639948). sTILs and TNBC-DX independently predicted pCR in patients treated with TCb+Pem. Patients with sTILs ≥ 30% and a TNBC-DX pCR-high genomic score achieved a pCR rate of 91.3% with TCb+Pem. An integrated classification incorporating sTILs and TNBC-DX identified approximately 40% of the NeoPACT cohort with a pCR rate exceeding 85%. The integrated classification was prognostic for event-free survival in patients treated with TCb+Pem. Integrating sTILs and TNBC-DX may facilitate chemoimmunotherapy escalation and de-escalation trials.
BACKGROUND:The Suppression of Ovarian Function Trial (SOFT) found adding ovarian function suppression (OFS) to tamoxifen (T) reduced breast cancer recurrence, and exemestane (E)+OFS further reduced recurrence. A combined analysis of SOFT and TEXT showed a significant reduction in distant recurrence with E+OFS versus T+OFS. We now report final 15-year outcomes. PATIENTS AND METHODS:Premenopausal women with hormone receptor-positive early breast cancer were enrolled, with 3047 in SOFT and 2660 in TEXT intention-to-treat populations. SOFT randomized to 5 years of T versus T+OFS versus E+OFS. TEXT randomized to 5 years of T+OFS versus E+OFS. Chemotherapy was optional, before SOFT entry with subsequent premenopausal oestradiol or concurrent with OFS in TEXT. Endpoints included disease-free survival, breast cancer-free interval (BCFI), distant recurrence-free interval (DRFI), and overall survival (OS). Additionally, 15-year Kaplan-Meier estimates, hazard ratios (HRs), and 95% confidence intervals (CIs) are reported. RESULTS:In SOFT, escalating endocrine therapy (ET) continued to reduce recurrence with 15-year BCFI of 78.6% for E+OFS, 75.7% for T+OFS, and 72.1% for T (T+OFS versus T: HR 0.82, 95% CI, 0.69-0.98, P = 0.03). In the SOFT no-chemotherapy cohort, OFS reduced breast cancer events at 15 years, while DRFI and OS remained high regardless of ET assignment. After prior chemotherapy for HER2-negative tumors (n = 1257), the 15-year OS rate in SOFT was 81.0% with E+OFS, 77.1% with T+OFS and 76.8% with tamoxifen alone. In women under age 35 years with HER2-negative tumors (n = 241), the 15-year OS rate was 82.5% with E+OFS, 77.9% with T+OFS, and 68.1% with tamoxifen. In combined SOFT and TEXT analysis, among those with HER2-negative tumors (n = 4035), E+OFS versus T+OFS reduced distant recurrence (HR 0.75, 95% CI 0.63-0.90), with a smaller reduction in deaths (HR 0.89, 95% CI 0.74-1.06), with absolute survival benefits largest with high-risk features, particularly young age or high-grade tumors. CONCLUSION:Meaningful OS benefit in hormone receptor-positive, HER2-negative breast cancer from adjuvant exemestane and/or OFS compared with tamoxifen alone is limited to high-risk premenopausal subgroups. Tamoxifen-based ET may not result in optimal outcomes in premenopausal high-grade HER2-negative tumors.
BACKGROUND/PURPOSE:Chyle leakage (CL) after pancreaticoduodenectomy (PD) remains an underestimated complication with a consistent incidence. This expert survey analyzed its occurrence from anatomical and surgical perspectives. METHODS:A structured survey was distributed to 57 surgeons from 10 countries, with extensive experience in open and minimally-invasive pancreatectomy. RESULTS:Most experts reported CL incidence as: open ≥ laparoscopic, open > robotic, and laparoscopic = robotic. They identified three major anatomical pitfalls: (i) the transverse mesocolon on the ventral side of the superior mesenteric artery and vein (SMA/SMV), (ii) the meso-jejunum on the dorsal side of the SMA/SMV, and (iii) the fusion fascia of Treitz on the ventral side of the inferior vena cava (IVC). For lymphatic dissection and control, energy devices were favored across all approaches, whereas ligation was more common in open PD and clipping more frequent in robotic PD. Opinions on the optimal dissection plane at the fusion fascia of Treitz varied: along the pancreatic surface (21%), within the fascia (31%), or exposing the IVC (38%). CONCLUSIONS:Expert opinions suggest that the incidence of CL after PD does not differ significantly between open and minimally invasive approaches. Consensus emerged regarding common anatomical pitfalls, which may inform strategies for prevention.
ABSTRACT Background Multidomain health indicators, including chronic disease indicators, risk behaviors, health habits, depressive symptomatology, disability indicators, and healthcare‐access indicators, may be interconnected through complex patterns of conditional association. Network analysis provides an exploratory framework for estimating such interdependencies without implying causality or clinically confirmed comorbidity patterns. Objective To estimate the network structure of conditional associations among selected ENDES health‐related indicators in an analytic sample of Peruvian adults from 2021 to 2023, and to descriptively explore sex‐specific patterns. Methods A secondary analysis was conducted using ENDES 2021–2023 data. A total of 92,101 respondents aged 18 years or older who completed the Health Questionnaire module and had complete data for the selected variables were included. Twenty‐one indicators selected a priori from five domains—chronic disease indicators, behavioral risks, health habits, disability/depressive symptomatology, and healthcare‐access/anthropometric context—were modeled using a mixed graphical model. Bootstrapped edge‐weight accuracy and Expected Influence stability diagnostics were added. Sex‐specific networks were examined descriptively, without a formal Network Comparison Test. Results The overall network showed positive conditional associations among smoking indicators and alcohol consumption, among disability indicators, and between age and hypertension, diabetes, visual disability, and motor disability. Negative conditional associations were observed between daily smoking and both health insurance coverage and fruit consumption, as well as between depressive symptomatology and fruit‐based indicators. In sex‐specific networks, men showed a descriptively denser disability‐related clustering than women, but these visual differences were not inferentially tested. Conclusions Selected multidomain ENDES health‐related indicators were conditionally interconnected in the analytic sample. Findings should be interpreted as exploratory and hypothesis‐generating and do not imply causality, directionality, nationally weighted network estimates, statistically confirmed sex differences, or clinically confirmed comorbidity patterns.
Abstract Background National Institute of Neoplastic Diseases (INEN) is a reference center for diagnosis and specialized treatment of cancer in Peru. The number of cases treated each year is increasing, with hematological neoplasms accounting for a significant proportion of patients evaluated at Hematology Lab. Automated blood counts are currently used alongside morphological analysis for the initial detection of abnormal cell populations. Blastic plasmacytoid dendritic cells neoplasm (BDPCN) is a rare entity characterized by proliferation of blast cells derived from plasmacytoid dendritic cell precursors. It can present with bone marrow involvement and a leukemic phase, clinically mimicking acute leukemia. Due to its morphological overlap with other myeloid neoplasms, its timely recognition requires the integration of CBC and smear findings together with immunophenotyping. Accurate identification allows for an appropriate differential diagnosis to be established in relation to acute myeloid leukemias. Methods A 24-year-old male with Down syndrome referred from another institution with presumptive diagnosis of acute myeloid leukemia. Upon admission, he presented with marked pallor and conjunctival bleeding. A CBC was performed using Mindray BC-6800Plus hematology analyzer, and cell population data (CPD) and two-dimensional scattergrams in leukocyte differential channel (DIFF) were evaluated. Al smear microscopic review was performed with differential counting, and automated findings were correlated with the observed cell morphology. Results CBC showed RBC 2.82 ×10¹²/L; HGB 101 g/L; HCT 30.5%; VCM 108.2 fL; HCM 35.8 pg; CHCM 331 g/L; PLT 117 ×10?/L; WBC 6.60 ×10?/L. Leukocyte scattergram (DIFF channel) showed an abnormal cluster displaced between lymphocyte and monocyte regions, and above them towards areas of high fluorescence intensity. Neutrophils showed variable internal complexity, which did not correspond to typical distribution. The graph was suggestive of an immature/ malignant suspected. Cells with blast morphology were found in smears. The immunophenotype study identified an immature population that was positive for CD45+, CD4+, CD123+, HLA-DR+ and negative for other myeloid and lymphoid markers, consistent with BDPCN. Conclusion This case highlights the diagnostic value of CPD and scattergram interpretation to trigger early smear review and flow cytometry referral, particularly in rare hematologic neoplasms. Mindray BC-6800Plus hematology analyzer identified an atypical cell population with very specific fluorescence characteristics and an unusual distribution. Integration of quantitative data and graphical interpretation was key to early suspicion of blast proliferation and subsequent diagnosis by flow cytometry. Comprehensive analysis of hematological parameters, cell population data (CPD), and triggered prompt smear review are essential for hematological neoplasms diagnosis. In rare entities, timely identification through a suggestive graph from the analyzer contributed to better guidance in medical decision-making.
