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- Andersson, Yvette, et al.
(författare)
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Breast Cancer Survival in Relation to the Metastatic Tumor Burden in Axillary Lymph Nodes
- 2010
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Ingår i: Journal of Clinical Oncology. - 0732-183X .- 1527-7755. ; 28:17, s. 2868-2873
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this study was to determine the prognostic significance of lymph node micrometastases in patients with breast cancer. Patients and Methods Between September 2000 and January 2004, 3,369 patients with breast cancer were included in a prospective cohort. According to their lymph node status, they were classified in the following four groups: 2,383 were node negative, 107 had isolated tumor cells, 123 had micrometastases, and 756 had macrometastases. Median follow-up time was 52 months. Kaplan-Meier estimates and the multivariate Cox proportional hazard regression model were used to analyze survival. Results Five-year cause-specific and event-free survival rates were lower for patients with micrometastases (pN1mi) than for node-negative (pN0) patients (94.1% v 96.9% and 79.6% v 87.1%, respectively; P = .020 and P = .032, respectively). There was no significant survival difference between node-negative patients and those with isolated tumor cells. The overall survival of pN1mi and pN0 patients did not differ. Conclusion This study demonstrates a worse prognosis for patients with micrometastases than for node-negative patients.
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| 2. |
- Andersson, Yvette, 1972-
(författare)
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Sentinel Node in Clinical Practice : Implications for Breast Cancer Treatment and Prognosis
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The introduction of sentinel lymph node biopsy (SLNB) has conveyed several new issues, such as the risk of false negativity, long-term consequences, the prognostic significance of micrometastases and whether ALND can be omitted in sentinel lymph node- (SLN) positive patients.Archived SLN specimens from 50 false negative patients and 107 true negative controls were serially sectioned and stained with immunohistochemistry. The detection rate of previously unknown metastases did not differ between the false and the true negative patients. The risk of false negativity was higher in patients with multifocal or hormone receptor-negative tumours, or if only one SLN was found.In a Swedish multicentre cohort, 2216 SLN-negative patients in whom ALND was omitted were followed up for a median of 65 months. The isolated axillary recurrence rate was only 1.0%, and the overall survival was high (93%).The survival of 3369 breast cancer patients (2383 node-negative (pN0), 107 isolated tumour cells (pN0(i+), 123 micrometastases (pN1mi) and 756 macrometastases (pN1)) was analysed. The 5-year cause-specific and event-free survival was worse for pN1mi and pN1 patients than for pN0 patients. There was no difference in survival between pN0(i+) and pN0 patients.Tumour and SLN characteristics in 869 SLN-positive patients were compared between those with and without non-SLN metastases, and the Tenon score was calculated. The risk of non-SLN metastases was higher in case of SLN macrometastases (compared with micrometastases), a high positive/total SLN ratio and Elston grade 3 tumours, and increased with increasing tumour size. The area under the curve (AUC) for the Tenon score was 0.65, and the test thus performed inadequately in this population.In conclusion, despite the risk of false negativity, SLNB with omission of ALND in SLN-negative patients appears to be safe even in the long term. The presence of micrometastases is of prognostic importance and should entail adjuvant treatment. The need for ALND in patients with SLN micro- and even macrometastases has been questioned, but the occurrence of non-SLN metastases is hard to predict, and strong evidence for the safe omission of ALND is lacking.
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| 3. |
- Lundberg, Jonas, et al.
(författare)
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When Is the Deep Inferior Epigastric Artery Flap Indicated for Breast Reconstruction in Patients not Treated With Radiotherapy?
- 2014
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Ingår i: Annals of Plastic Surgery. - 1536-3708. ; 73:1, s. 105-113
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: It is controversial whether breast reconstruction with a microvascular free flap should be done without restrictions in patients who have not had radiotherapy. Many regard it as too expensive, but some consider it better and more economically advantageous than an implant reconstruction. METHODS: Databases of publications were searched to find out under what conditions is it suitable to offer a deep inferior epigastric perforator (DIEP) or a transverse rectus abdominis myocutaneous flap to normalize the body's appearance in a woman whose breast(s) had been removed for cancer or to prevent the development of breast cancer. The effect of breast reconstruction with DIEP flaps was analyzed, taking account of the following factors: general satisfaction (quality of life), aesthetic satisfaction (cosmesis), and morbidity. To find out which factors were of potential importance, we recorded age, hypertension, whether scars from previous abdominal surgery were present, microcirculation, whether the patient was overweight or obese, and costs of the procedure. RESULTS: Patients planning to have DIEP flaps should be willing to stop smoking at least 4 weeks before and after the procedure and have a body mass index of less than 30 kg/m to avoid a higher risk of complications. Because of the paucity of papers, it is difficult to recommend one approach over the other when considering general satisfaction, aesthetic satisfaction, and health economics. However, economical long-term outcome is highly dependent on the initial costs of each procedure and the cumulative costs of complications for each reconstruction method. CONCLUSIONS: The scientific foundation of assessment of methods of techniques of breast reconstruction is weak. Therefore, it is important that future studies should present more comparable series, highlight the long-term effects in high-quality studies, to provide the patients with optimal results without undue risks and to avoid financial burdens on society.
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| 4. |
- Nordensten, Christina, et al.
(författare)
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Hanteringen av de omfattande naturkatastroferna i Queensland 2011 : Observatörsrapport
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- En myndighetsgemensam observatörsresa genomfördes våren 2012 för att lära av erfarenheterna av den omfattande naturkatastrofen 2011 i Queensland, Australien. Observatörsresan organiserades av avdelningen för utvärdering och lärande vid Myndigheten för samhällsskydd och beredskap, MSB. Planerade möten hos myndigheter och organisationer ägde rum dels på federal nivå i Canberra, dels i delstaten Queensland med studiebesök i Brisbane och andra orter.Syftet med denna observatörsinsats var sålunda att:–– lära från de erfarenheter Australien gjort med anledning avde stora översvämningar, orsakade av extrema regn och cyklonenYasi, som drabbade delstaten Queensland under periodendecember 2010 - januari 2011.–– studera det australiensiska civila samhällets samlade förmågaatt hantera och återhämta sig efter dessa extrema händelseroch påfrestningar.Observatörsinsatsen initierades via MSB:s samverkansområden. En begäran och önskan riktades till MSB att organisera en observatörsinsats, i enlighet med MSB:s uppdrag att samordna och samverka inom området observatörsverksamhet
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