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102P LUNG METASTASECTOMY IN CRC PATIENTS: A PORTUGUESE SINGLE-INSTITUTION EXPERIENCE
METASTASES TO THE LUNG
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Table 1 (abstract 100P). Relative risk, Odds ratio and Fisher’s exact test p-value of readmission according to sex, smoking habit, indication to resection, number of parenchymal resection and malignant histology
Sex (male vs. female) Smoking habit (yes vs. no) Indication to resection (nodular vs. non nodular) Left upper lobe localization (yes vs. no) No. of parenchymal resection (one vs. two-wedge) Neoplasia (yes vs. no) a
p-valuea
Readmission due to complication Relative Risk 95% confidence (RR) interval
Odds Ratio
95% confidence interval
0.8696 1.176 1.111 4.000 1.00 1.429
0.60 1.52 0.89 10.00 1.00 2.286
0.04 0.12 0.03 0.75 0.08 0.18
0.38 0.49 0.98 1.29 0.43 0.58
1.98 2.77 1.25 12.41 2.31 3.46
7 18.77 21.12 132.8 12.41 28.01
1.00 1.00 1.00 1.00 1.00 0.60
Fisher’s exact test.
November 2010 to August 2012. All procedures were performed under general anaesthesia with double-lumen-endotracheal-tube. Three port sites were used and one or two stapled wedge resections were performed without any suture-reinforcement. A chest-drain in continuous aspiration ( 20 cm/H2 O) was positioned as needed. Chest tubes were removed when no air leak (0 ml/min) or bleeding (<200 ml) were detected by digital device one hour after surgery. The distribution of study subjects according to sex, smoking habit, indication to resection, number of wedge, histological findings and the readmission or not readmission into hospital was compared by the Exact Fisher’s test. A logistic-regression was fitted to estimate the odds ratio for readmission in hospital. The significance limit was set at p < 0.05. Results: Thirty-seven patients with mean age of 59 (±11.88) underwent outpatient-thoracoscopy during the study period. The thoracoscopic-outpatient-wedge-resections were performed in 33 cases (3 interstitial and 30 nodular disease). In 11 of these (33.3%) two parenchymal resections were performed. The overall readmission rate was 9.1% (3/33). When air-flow detected before drainage removal was 0 ml/min the presence of two pulmonary resections, malignant histology, interstitial disease or smoke history seem to not imply a significant readmissions rate (Table 1). Conclusion: When air-flow detected by digital device before drainage removal is 0 ml/min the thoracoscopic outpatient-wedge resections seems to be a safe and effective procedure. Disclosure: All authors have declared no conflicts of interest.
study was to evaluate the usefulness of preoperative cefazolin prophylaxis in preventing SSI in patients with LC undergoing VATS or open surgery. Patients and Methods: We prospectively considered 149 patients (median age 63, range 49 68 years) with LC selected for surgery. Patients were randomly assigned to receive either preoperative prophylactic antibiotic regimen cefazolin (2 g I.V., N = 71, Group A) or none antimicrobial prophylaxis (N = 78, Group B). Seventy (47.0%) patients underwent VATS wedge resection, while 79 (53.0%) underwent open lobectomy via thoracotomy. VATS approach was done using three standard ports located on the chest wall in relation to the lesion, while in open procedures a posterolateral thoracotomy was used. Chi-square test and Fisher’s exact test were used to analyze results. Results: Age and gender distribution did not differ between Groups (p = NS). Overall, 5 (3.3%) patients developed SSI within 30 days after surgery. All SSIs were observed among Group B (p = 0.03). Open lobectomy vs. VATS was a weak risk factor for SSI developing (RR = 1.18, 95% CI 0.87 1.60, p = 0.26). There was a trend towards longer stay after open surgery (7.1±2.3 days) compared to VATS (5.6±2.7 days, p < 0.01). Conclusions: Our study confirms that the SSI rate is low, especially after minimally invasive VATS procedures, showing that cefazolin prophylaxis represents a useful and cost-effective way to reduce the risk of SSI in patients with LC undergoing surgery. Disclosure: All authors have declared no conflicts of interest.
101P PREOPERATIVE CEFAZOLIN PROPHYLAXIS PREVENTS SURGICAL SITE INFECTIONS IN PATIENTS UNDERGOING OPEN AND THORACOSCOPIC METASTASECTOMY FOR LUNG METASTASES. A CASE CONTROL STUDY
102P LUNG METASTASECTOMY IN CRC PATIENTS: A PORTUGUESE SINGLE-INSTITUTION EXPERIENCE
F. Lumachi1 , F. Mazza2 , A. Camporese3 , A. Del Conte4 , G.B. Chiara5 , S.M.M. Basso5 1 Department of Surgery, Oncology & Gastroenterology (DISCOG), University of Padua, School of Medicine, Padova, Italy, 2 Pneumology, S. Maria degli Angeli Hospital, Pordenone, Italy, 3 Microbiology and Virology, S. Maria degli Angeli Hospital, Pordenone, Italy, 4 Oncology, S. Maria degli Angeli Hospital, Pordenone, Italy, 5 Chirurgia 1, S. Maria degli Angeli Hospital, Pordenone, Italy Background: Wedge resection and lobectomy by means of videoassisted thoracoscopic surgery (VATS) and open surgery are the treatment of choice in patients with early stage lung cancer (LC). The advantages of VATS include less postoperative pain, shorter hospital stay and quicker return to preoperative activity. There is also evidence that VATS is less immunosuppressive and morbid than open lobectomy, eliciting a milder inflammatory response. Postoperative infections are not infrequent in thoracic surgery, but surgical site infection (SSI) are unusual. It is unclear which antibiotic regimen provides the best prophylaxis against SSI. The aim of this
I. Miguel, T. Marques, J. Freire Servi¸co de Oncologia M´ edica, Instituto Portugu` es de Oncologia de Lisboa Francisco Gentil, E.P.E. (IPOLFG EPE), Lisboa, Portugal Introduction: The lung is a frequent metastatic site in patients (pts) with colorectal carcinoma (CRC). Several studies have shown the benefit of lung metastases (LM) resection in CRC pts, with 5-year survival ranging from 45.2% to 74%. The presence of hepatic metastases (HM) can affect survival in these pts. Objective: To report our experience in LM resection in pts with primary CRC who were referred to a Portuguese Oncological Center between 2005 and 2008. Methods: Single-centre retrospective review of clinical charts of pts with CRC who underwent LM resection in our Center. The primary endpoint was survival after resection of LM. Values of P < 0.05 were considered statistically significant. Results: Twenty pts were included (65% male; mean age: 64±8.9 years, age range: 41 82). Primary tumor site: rectum-18 and colon-2. Stages: IIA-3, IIIB-9, IIIC-2, IV-6. Sixteen pts received neoadjuvant chemotherapy (mainly 5-FU+radiotherapy) and 7 adjuvant chemotherapy (de Gramont regimen). LM were metachronic in 16 pts (disease-free interval: 30.7±19.6 months). Metastasectomy
S44 was performed in 12 pts and lobectomy in 8; 60% on the left lung. Postoperative chemotherapy was instituted in 12 pts (FOLFIRI was mainly used). Ten had HM (2 previous, 2 after and 6 synchronous to LM) and six had hepatic metastasectomy (5 previous to LM resection). Mean survival after resection was 29.8±11.4 months. The overall 2-year survival following LM resection was 65% (n = 20) and 62.5% (n = 16) at 3-years. Metachronous and synchronous LM presented equal mean survival (29.5 vs 31.2 months; p = 0.799). Survival in our pts was not affected by HM or previous HM resection. Conclusion: Lung metastases of CRC are more associated with rectal cancer (7.5 11%) than to colon cancer (3.5%) and time to diagnosis is normally longer than to HM. Resection of LM with curative intent is infrequent and some authors have found better results in metachronous than in synchronous metastases, not observed in our results. Longer follow-up and larger studies are needed to asses overall survival at 3 and 5 years after resection but data obtained matches the experience of other authors. Disclosure: All authors have declared no conflicts of interest. 103P SERUM MARKERS OF BONE METABOLISM MEASUREMENT IN PATIENTS WITH BREAST CANCER AND LUNG METASTASIS F. Lumachi1 , F. Marino2 , G.B. Chiara3 , S.M.M. Basso3 Department of Surgery, Oncology & Gastroenterology (DISCOG), University of Padua, School of Medicine, Padova, Italy, 2 Department of Pathology, University of Padua, School of Medicine, Padova, Italy, 3 Chirurgia 1, S. Maria degli Angeli Hospital, Pordenone, Italy
1
Background: Breast cancer (BC) is the most common cancer in women. In patients with metastatic disease (stage IV) the major sites of involvement are bone, lung, brain and liver. Bone lysis induced by cancer cells invading the bone usually promotes degradation of mineral matrix, altering several urinary and serum markers of bone metabolism (SMs). The aim of this study was to evaluate the usefulness of SMs in detecting the onset of bone metastases (BMs) in patients with advanced (stage II) BC with confirmed lung metastases. Patients and Methods: We measured 6 putative SMs, including, bone alkaline phosphatase (BAP), deoxypyridinoline crosslinks (DPD), cross-linked aminoterminal telopeptide of type I collagen (ICTP), amino-terminal telopeptide of type I collagen (NTx), tartrateresistant acid phosphatase type 5b (TRAP), and osteocalcin in seven women (median age 62, range 45 70 years) with stage IV BC and lung metastases (cases), who developed BMs during follow-up. Controls were 10 age- and stage-matched patients without BMs. 18F-FDGFPET/CT was uses for staging all patients. The following cut-offs were considered: 50 U/L (BAP), 52 mg/g creatinine (DPD), 6 mg/L (ICTP), 30 nM BCE (NTx), 7 U/L (TRAP), and 45 ng/mL (osteocalcin). Relative risk (RR) estimates, and the associate 95% confidence interval (95%CI) were obtained. Fisher’s exact test was used to calculate the statistical significance. Results: Serum elevation of BAP (RR = 1.14, 95%CI 0.47 2.79, p = 0.58), DPT (RR = 1.07, 95%CI 0.34 3.36, p = 0.64), ICTP (RR = 1.43, 95%CI 0.40 5.12, p = 0.48), NTx (RR = 1.43, 95%CI 0.52 3.86, p = 0.42), and osteocalcin (RR = 1.43, 95%CI 0.40 5.12, p = 0.48) was not a significant risk factor of BMs. Elevation of serum TRAP (RR = 2.39, 95%CI 0.83 6.85, p = 0.11) was e weak nonsignificant risk factor. The combination of all SMs does not increased sensitivity significantly. Conclusions: In patients with stage IV BC and lung metastasis the measurement of bone metabolism SMs is not useful in detecting the onset of BMs early. Disclosure: All authors have declared no conflicts of interest.
METASTASES TO THE LUNG 104P RISK FACTORS OF LUNG METASTASES FROM ADVANCED INVASIVE DUCTAL CARCINOMA OF THE BREAST F. Lumachi1 , F. Marino2 , G.B. Chiara3 , S.M.M. Basso3 Department of Surgery, Oncology & Gastroenterology (DISCOG), University of Padua, School of Medicine, Padova, Italy, 2 Department of Pathology, University of Padua, School of Medicine, Padova, Italy, 3 Chirurgia 1, S. Maria degli Angeli Hospital, Pordenone, Italy
1
Background: The causal mechanisms underlying breast cancer (BC) have yet to be completely elucidated, and the majority of cases of BC appear to occur sporadically in the absence of any known risk factor (RF) or genetic mutation. Metastasis is a crucial event in the progression of the disease and a leading cause of cancer morbidity and mortality. Because BC is a heterogeneous disease, RFs affecting the onset of metastases remain unclear, and more needs to be learned about mechanisms that control this process. The aim of this study was to evaluate the weight of RFs such as age <50 years, estrogen receptor (ER) negativity, human epidermal growth factor 2 (HER2) positivity, high histological nuclear grading (G2 3), and preoperative carbohydrate tumorrelated antigen serum levels >50 U/mL (CA 15-3 >50), in a small group of patients with advanced BC who underwent curative surgery and adjuvant postoperative therapy, and developed lung metastases (LMs). Patients and Methods: Eight women (median age 61, range 45 73 years) with stage II III BC (cases) and no evidence of distant metastasis (M0) at the time of diagnosis underwent curative surgery (lumpectomy or mastectomy plus sentinel lymph node biopsy or axillary node dissection) followed by adjuvant chemotherapy, and/or endocrine therapy (selective estrogen receptor modulators or aromatase inhibitors) or targeted immunotherapy (trastuzumab). All patients developed LMs during follow-up. Controls were 15 age- and stage-matched M0 women with BC. 18F-FDG-PET/CT was used for staging all patients. Odds ratio (OR) estimates and the associated 95% confidence interval (CI) were calculated. The significance level, using Fisher exact test, was set at p < 0.05. Results: Age <50 years (OR = 1.09, 95%CI 0.15 7.8, p = 0.66) and ER negativity (OR = 1.65, 95%CI 0.26 10.31, p = 0.46) were statistically nonsignificant RFs, while the presence of bone metastasis (OR = 2.75, 95%CI 0.45 16.50, p = 0.25), CA15-3 >50 U/mL (OR = 3.33, 95%CI 0.55 19.94, p = 0.18), and G2 3 (OR = 4.00, 95%CI 0.61 26.12, p = 1.15) were weak RFs. HER2 positivity was the only statistically significant (OR = 10.83, 95%CI 1.37 85.44, p = 0.02) RF of LMs from BC. Conclusions: Patients with stage II III HER2+ BC have a significantly (p < 0.05) increased (>10-fold) risk of developing LMs during followup. Disclosure: All authors have declared no conflicts of interest. 105P A UNIQUE CASE OF SALIVARY PLEOMORPHIC ADENOMA CHANGING INTO HYALINIZING CLEAR CELL CARCINOMA WITH PULMONARY METASTASIS F. Raveglia1 , A. Rizzi1 , A. Luciani2 , F. Biglioli3 , A. Baisi1 Thoracic Surgery, A.O. San Paolo Universit` a degli Studi Milano, a degli Studi Milano, Italy, 2 Oncology, A.O. San Paolo Universit` di Milano, Milano, Italy, 3 Maxillofacial Surgery, A.O. San Paolo Universit` a degli Studi di Milano, Milano, Italy 1
Introduction: Hyalinizing clear cell carcinoma (HCCC) is a rare tumor arising from salivary glands. It was described by Milchgrub in 1994; since then 55 cases have been reported. Its behavior and treatment are still uncertain. Therefore, additional cases need to be collected. Material and Method: A 45-years woman underwent left salivary gland excision in 1980 and local recurrence removal in 1990 for pleomorphic adenoma. In 2012 a further submandibular recurrence
S43
Table 1 (abstract 100P). Relative risk, Odds ratio and Fisher’s exact test p-value of readmission according to sex, smoking habit, indication to resection, number of parenchymal resection and malignant histology
Sex (male vs. female) Smoking habit (yes vs. no) Indication to resection (nodular vs. non nodular) Left upper lobe localization (yes vs. no) No. of parenchymal resection (one vs. two-wedge) Neoplasia (yes vs. no) a
p-valuea
Readmission due to complication Relative Risk 95% confidence (RR) interval
Odds Ratio
95% confidence interval
0.8696 1.176 1.111 4.000 1.00 1.429
0.60 1.52 0.89 10.00 1.00 2.286
0.04 0.12 0.03 0.75 0.08 0.18
0.38 0.49 0.98 1.29 0.43 0.58
1.98 2.77 1.25 12.41 2.31 3.46
7 18.77 21.12 132.8 12.41 28.01
1.00 1.00 1.00 1.00 1.00 0.60
Fisher’s exact test.
November 2010 to August 2012. All procedures were performed under general anaesthesia with double-lumen-endotracheal-tube. Three port sites were used and one or two stapled wedge resections were performed without any suture-reinforcement. A chest-drain in continuous aspiration ( 20 cm/H2 O) was positioned as needed. Chest tubes were removed when no air leak (0 ml/min) or bleeding (<200 ml) were detected by digital device one hour after surgery. The distribution of study subjects according to sex, smoking habit, indication to resection, number of wedge, histological findings and the readmission or not readmission into hospital was compared by the Exact Fisher’s test. A logistic-regression was fitted to estimate the odds ratio for readmission in hospital. The significance limit was set at p < 0.05. Results: Thirty-seven patients with mean age of 59 (±11.88) underwent outpatient-thoracoscopy during the study period. The thoracoscopic-outpatient-wedge-resections were performed in 33 cases (3 interstitial and 30 nodular disease). In 11 of these (33.3%) two parenchymal resections were performed. The overall readmission rate was 9.1% (3/33). When air-flow detected before drainage removal was 0 ml/min the presence of two pulmonary resections, malignant histology, interstitial disease or smoke history seem to not imply a significant readmissions rate (Table 1). Conclusion: When air-flow detected by digital device before drainage removal is 0 ml/min the thoracoscopic outpatient-wedge resections seems to be a safe and effective procedure. Disclosure: All authors have declared no conflicts of interest.
study was to evaluate the usefulness of preoperative cefazolin prophylaxis in preventing SSI in patients with LC undergoing VATS or open surgery. Patients and Methods: We prospectively considered 149 patients (median age 63, range 49 68 years) with LC selected for surgery. Patients were randomly assigned to receive either preoperative prophylactic antibiotic regimen cefazolin (2 g I.V., N = 71, Group A) or none antimicrobial prophylaxis (N = 78, Group B). Seventy (47.0%) patients underwent VATS wedge resection, while 79 (53.0%) underwent open lobectomy via thoracotomy. VATS approach was done using three standard ports located on the chest wall in relation to the lesion, while in open procedures a posterolateral thoracotomy was used. Chi-square test and Fisher’s exact test were used to analyze results. Results: Age and gender distribution did not differ between Groups (p = NS). Overall, 5 (3.3%) patients developed SSI within 30 days after surgery. All SSIs were observed among Group B (p = 0.03). Open lobectomy vs. VATS was a weak risk factor for SSI developing (RR = 1.18, 95% CI 0.87 1.60, p = 0.26). There was a trend towards longer stay after open surgery (7.1±2.3 days) compared to VATS (5.6±2.7 days, p < 0.01). Conclusions: Our study confirms that the SSI rate is low, especially after minimally invasive VATS procedures, showing that cefazolin prophylaxis represents a useful and cost-effective way to reduce the risk of SSI in patients with LC undergoing surgery. Disclosure: All authors have declared no conflicts of interest.
101P PREOPERATIVE CEFAZOLIN PROPHYLAXIS PREVENTS SURGICAL SITE INFECTIONS IN PATIENTS UNDERGOING OPEN AND THORACOSCOPIC METASTASECTOMY FOR LUNG METASTASES. A CASE CONTROL STUDY
102P LUNG METASTASECTOMY IN CRC PATIENTS: A PORTUGUESE SINGLE-INSTITUTION EXPERIENCE
F. Lumachi1 , F. Mazza2 , A. Camporese3 , A. Del Conte4 , G.B. Chiara5 , S.M.M. Basso5 1 Department of Surgery, Oncology & Gastroenterology (DISCOG), University of Padua, School of Medicine, Padova, Italy, 2 Pneumology, S. Maria degli Angeli Hospital, Pordenone, Italy, 3 Microbiology and Virology, S. Maria degli Angeli Hospital, Pordenone, Italy, 4 Oncology, S. Maria degli Angeli Hospital, Pordenone, Italy, 5 Chirurgia 1, S. Maria degli Angeli Hospital, Pordenone, Italy Background: Wedge resection and lobectomy by means of videoassisted thoracoscopic surgery (VATS) and open surgery are the treatment of choice in patients with early stage lung cancer (LC). The advantages of VATS include less postoperative pain, shorter hospital stay and quicker return to preoperative activity. There is also evidence that VATS is less immunosuppressive and morbid than open lobectomy, eliciting a milder inflammatory response. Postoperative infections are not infrequent in thoracic surgery, but surgical site infection (SSI) are unusual. It is unclear which antibiotic regimen provides the best prophylaxis against SSI. The aim of this
I. Miguel, T. Marques, J. Freire Servi¸co de Oncologia M´ edica, Instituto Portugu` es de Oncologia de Lisboa Francisco Gentil, E.P.E. (IPOLFG EPE), Lisboa, Portugal Introduction: The lung is a frequent metastatic site in patients (pts) with colorectal carcinoma (CRC). Several studies have shown the benefit of lung metastases (LM) resection in CRC pts, with 5-year survival ranging from 45.2% to 74%. The presence of hepatic metastases (HM) can affect survival in these pts. Objective: To report our experience in LM resection in pts with primary CRC who were referred to a Portuguese Oncological Center between 2005 and 2008. Methods: Single-centre retrospective review of clinical charts of pts with CRC who underwent LM resection in our Center. The primary endpoint was survival after resection of LM. Values of P < 0.05 were considered statistically significant. Results: Twenty pts were included (65% male; mean age: 64±8.9 years, age range: 41 82). Primary tumor site: rectum-18 and colon-2. Stages: IIA-3, IIIB-9, IIIC-2, IV-6. Sixteen pts received neoadjuvant chemotherapy (mainly 5-FU+radiotherapy) and 7 adjuvant chemotherapy (de Gramont regimen). LM were metachronic in 16 pts (disease-free interval: 30.7±19.6 months). Metastasectomy
S44 was performed in 12 pts and lobectomy in 8; 60% on the left lung. Postoperative chemotherapy was instituted in 12 pts (FOLFIRI was mainly used). Ten had HM (2 previous, 2 after and 6 synchronous to LM) and six had hepatic metastasectomy (5 previous to LM resection). Mean survival after resection was 29.8±11.4 months. The overall 2-year survival following LM resection was 65% (n = 20) and 62.5% (n = 16) at 3-years. Metachronous and synchronous LM presented equal mean survival (29.5 vs 31.2 months; p = 0.799). Survival in our pts was not affected by HM or previous HM resection. Conclusion: Lung metastases of CRC are more associated with rectal cancer (7.5 11%) than to colon cancer (3.5%) and time to diagnosis is normally longer than to HM. Resection of LM with curative intent is infrequent and some authors have found better results in metachronous than in synchronous metastases, not observed in our results. Longer follow-up and larger studies are needed to asses overall survival at 3 and 5 years after resection but data obtained matches the experience of other authors. Disclosure: All authors have declared no conflicts of interest. 103P SERUM MARKERS OF BONE METABOLISM MEASUREMENT IN PATIENTS WITH BREAST CANCER AND LUNG METASTASIS F. Lumachi1 , F. Marino2 , G.B. Chiara3 , S.M.M. Basso3 Department of Surgery, Oncology & Gastroenterology (DISCOG), University of Padua, School of Medicine, Padova, Italy, 2 Department of Pathology, University of Padua, School of Medicine, Padova, Italy, 3 Chirurgia 1, S. Maria degli Angeli Hospital, Pordenone, Italy
1
Background: Breast cancer (BC) is the most common cancer in women. In patients with metastatic disease (stage IV) the major sites of involvement are bone, lung, brain and liver. Bone lysis induced by cancer cells invading the bone usually promotes degradation of mineral matrix, altering several urinary and serum markers of bone metabolism (SMs). The aim of this study was to evaluate the usefulness of SMs in detecting the onset of bone metastases (BMs) in patients with advanced (stage II) BC with confirmed lung metastases. Patients and Methods: We measured 6 putative SMs, including, bone alkaline phosphatase (BAP), deoxypyridinoline crosslinks (DPD), cross-linked aminoterminal telopeptide of type I collagen (ICTP), amino-terminal telopeptide of type I collagen (NTx), tartrateresistant acid phosphatase type 5b (TRAP), and osteocalcin in seven women (median age 62, range 45 70 years) with stage IV BC and lung metastases (cases), who developed BMs during follow-up. Controls were 10 age- and stage-matched patients without BMs. 18F-FDGFPET/CT was uses for staging all patients. The following cut-offs were considered: 50 U/L (BAP), 52 mg/g creatinine (DPD), 6 mg/L (ICTP), 30 nM BCE (NTx), 7 U/L (TRAP), and 45 ng/mL (osteocalcin). Relative risk (RR) estimates, and the associate 95% confidence interval (95%CI) were obtained. Fisher’s exact test was used to calculate the statistical significance. Results: Serum elevation of BAP (RR = 1.14, 95%CI 0.47 2.79, p = 0.58), DPT (RR = 1.07, 95%CI 0.34 3.36, p = 0.64), ICTP (RR = 1.43, 95%CI 0.40 5.12, p = 0.48), NTx (RR = 1.43, 95%CI 0.52 3.86, p = 0.42), and osteocalcin (RR = 1.43, 95%CI 0.40 5.12, p = 0.48) was not a significant risk factor of BMs. Elevation of serum TRAP (RR = 2.39, 95%CI 0.83 6.85, p = 0.11) was e weak nonsignificant risk factor. The combination of all SMs does not increased sensitivity significantly. Conclusions: In patients with stage IV BC and lung metastasis the measurement of bone metabolism SMs is not useful in detecting the onset of BMs early. Disclosure: All authors have declared no conflicts of interest.
METASTASES TO THE LUNG 104P RISK FACTORS OF LUNG METASTASES FROM ADVANCED INVASIVE DUCTAL CARCINOMA OF THE BREAST F. Lumachi1 , F. Marino2 , G.B. Chiara3 , S.M.M. Basso3 Department of Surgery, Oncology & Gastroenterology (DISCOG), University of Padua, School of Medicine, Padova, Italy, 2 Department of Pathology, University of Padua, School of Medicine, Padova, Italy, 3 Chirurgia 1, S. Maria degli Angeli Hospital, Pordenone, Italy
1
Background: The causal mechanisms underlying breast cancer (BC) have yet to be completely elucidated, and the majority of cases of BC appear to occur sporadically in the absence of any known risk factor (RF) or genetic mutation. Metastasis is a crucial event in the progression of the disease and a leading cause of cancer morbidity and mortality. Because BC is a heterogeneous disease, RFs affecting the onset of metastases remain unclear, and more needs to be learned about mechanisms that control this process. The aim of this study was to evaluate the weight of RFs such as age <50 years, estrogen receptor (ER) negativity, human epidermal growth factor 2 (HER2) positivity, high histological nuclear grading (G2 3), and preoperative carbohydrate tumorrelated antigen serum levels >50 U/mL (CA 15-3 >50), in a small group of patients with advanced BC who underwent curative surgery and adjuvant postoperative therapy, and developed lung metastases (LMs). Patients and Methods: Eight women (median age 61, range 45 73 years) with stage II III BC (cases) and no evidence of distant metastasis (M0) at the time of diagnosis underwent curative surgery (lumpectomy or mastectomy plus sentinel lymph node biopsy or axillary node dissection) followed by adjuvant chemotherapy, and/or endocrine therapy (selective estrogen receptor modulators or aromatase inhibitors) or targeted immunotherapy (trastuzumab). All patients developed LMs during follow-up. Controls were 15 age- and stage-matched M0 women with BC. 18F-FDG-PET/CT was used for staging all patients. Odds ratio (OR) estimates and the associated 95% confidence interval (CI) were calculated. The significance level, using Fisher exact test, was set at p < 0.05. Results: Age <50 years (OR = 1.09, 95%CI 0.15 7.8, p = 0.66) and ER negativity (OR = 1.65, 95%CI 0.26 10.31, p = 0.46) were statistically nonsignificant RFs, while the presence of bone metastasis (OR = 2.75, 95%CI 0.45 16.50, p = 0.25), CA15-3 >50 U/mL (OR = 3.33, 95%CI 0.55 19.94, p = 0.18), and G2 3 (OR = 4.00, 95%CI 0.61 26.12, p = 1.15) were weak RFs. HER2 positivity was the only statistically significant (OR = 10.83, 95%CI 1.37 85.44, p = 0.02) RF of LMs from BC. Conclusions: Patients with stage II III HER2+ BC have a significantly (p < 0.05) increased (>10-fold) risk of developing LMs during followup. Disclosure: All authors have declared no conflicts of interest. 105P A UNIQUE CASE OF SALIVARY PLEOMORPHIC ADENOMA CHANGING INTO HYALINIZING CLEAR CELL CARCINOMA WITH PULMONARY METASTASIS F. Raveglia1 , A. Rizzi1 , A. Luciani2 , F. Biglioli3 , A. Baisi1 Thoracic Surgery, A.O. San Paolo Universit` a degli Studi Milano, a degli Studi Milano, Italy, 2 Oncology, A.O. San Paolo Universit` di Milano, Milano, Italy, 3 Maxillofacial Surgery, A.O. San Paolo Universit` a degli Studi di Milano, Milano, Italy 1
Introduction: Hyalinizing clear cell carcinoma (HCCC) is a rare tumor arising from salivary glands. It was described by Milchgrub in 1994; since then 55 cases have been reported. Its behavior and treatment are still uncertain. Therefore, additional cases need to be collected. Material and Method: A 45-years woman underwent left salivary gland excision in 1980 and local recurrence removal in 1990 for pleomorphic adenoma. In 2012 a further submandibular recurrence