Obesity is a known risk factor for postmenopausal breast cancer, and is associated with worse disease prognosis in pre- and postmenopausal women. Adjuvant hormonal therapies improve disease prognosis in obese women, but many still recur. Given that obesity induces inflammation and increases levels of cyclooxygenase-2 (COX-2) enzyme, resulting in tumor proliferation, this retrospective study investigated if women on anti-inflammatory drugs would have improved disease outcomes by reduced production of prostaglandins by COX-2 pathway. Four hundred and forty women treated for invasive breast cancer in San Antonio clinics were included. Cases were classified as NSAID users if notes included daily use of aspirin, ibuprofen, celecoxib or another COX-2 inhibitor; patients were categorized as NSAID nonusers if they were not taking any NSAIDs, or if they used COX-2 drugs for pain as needed rather than daily. Patients on NSAIDs were more likely to be older, be slightly more obese and postmenopausal. NSAID and NSAID nonusers did not statistically significantly differ in regards to BMI categories, tumor stage, hormone receptor status, type of invasive tumor, ethnicity/race and type of surgery. NSAID users had significantly less recurrence rates compared to nonusers (p=0.05). Further, time to disease progression was delayed by almost 28 months in patients who were NSAIDs users. Although this trend was non-significant statistically due to low number of total recurrences, it is promising in the clinical setting. In a logistic regression model using NSAID use, BMI categories and hormonal therapy drug as independent variables to predict recurrence, use of NSAID was only statistically significant in the univariate model. Overweight women were more likely to develop recurrence than normal weight when holding NSAID use and endocrine therapy constant. Obese women had increase recurrence risk, but the trend was not statistically significant. Females using aromatase inhibitors were less likely to recur than those on tamoxifen. The results of this exploratory study had limited power to determine multiple modulating factors, but because they suggest a major clinical benefit, further analyses in a larger sample size are needed to confirm these findings. / text

No description available.

Introdução: O câncer de mama é a neoplasia maligna mais prevalente em mulheres. Em decorrência do diagnóstico tardio, a mastectomia radical modificada (MRM) permanece como tratamento cirúrgico de escolha para a maioria das pacientes portadoras da doença. Em pacientes mastectomizadas, a reconstrução mamária com retalhos miocutâneos é a técnica que apresenta melhor resultado a longo prazo. Material e métodos: O estudo compara as taxas de recorrência local e sistêmica e a sobrevida livre de doença em pacientes submetidas à MRM, associada ou não à reconstrução mamária imediata com retalho miocutâneo transverso do reto abdominal (TRAM). Resultados: O grupo submetido à TRAM apresentou recorrência local de 11,8% e sistêmica de 35,7%, e o grupo da MRM, 4,4 e 26,1%, respectivamente. A sobrevida livre de doença (tempo decorrido entre a cirurgia e a primeira recorrência) foi, em média, de 105,4 meses (IC95% 97,0-113,72) no grupo MRM e de 95,4 meses (IC95% 80,7-110,0) no grupo TRAM, não havendo diferença estatisticamente significativa entre os grupos (P = 0,147). Conclusões: Em pacientes portadoras de câncer de mama, a reconstrução mamária imediata com retalho miocutâneo transverso do reto abdominal não influencia o prognóstico da doença, devendo ser oferecida às pacientes que não apresentam contraindicação clínica ao procedimento. / Introduction: Breast cancer is the most prevalent malignant neoplasia among women. In cases of late diagnoses, modified radical mastectomy (MRM) remains the surgical treatment of choice for most women with this disease, and breast reconstruction with myocutaneous flaps is the technique with the best long-term results. Material and methods: Local and systemic recurrence rates were compared, as well as diseasefree survival of patients who underwent MRM with or without immediate breast reconstruction using transverse rectus abdominis myocutaneous flap (TRAM). Results: The TRAM group had a local recurrence rate of 11.8% and a systemic recurrence rate of 35.7%; for the MRM group, these rates were 4.4 and 26.1%, respectively. Disease-free survival time (from surgery to first recurrence) was 95.4 months (95%CI 80.7-110.0) in the TRAM group and 105.4 (95%CI 97.0-113.72) in the MRM group, but the difference was not statistically significant (P = 0.147). In patients with breast cancer, immediate breast reconstruction with TRAM did not affect disease prognosis, and may be indicated to all patients who undergo MRM, except those with any clinical contraindications to the procedure.

Introdução: O câncer de mama é a neoplasia maligna mais prevalente em mulheres. Em decorrência do diagnóstico tardio, a mastectomia radical modificada (MRM) permanece como tratamento cirúrgico de escolha para a maioria das pacientes portadoras da doença. Em pacientes mastectomizadas, a reconstrução mamária com retalhos miocutâneos é a técnica que apresenta melhor resultado a longo prazo. Material e métodos: O estudo compara as taxas de recorrência local e sistêmica e a sobrevida livre de doença em pacientes submetidas à MRM, associada ou não à reconstrução mamária imediata com retalho miocutâneo transverso do reto abdominal (TRAM). Resultados: O grupo submetido à TRAM apresentou recorrência local de 11,8% e sistêmica de 35,7%, e o grupo da MRM, 4,4 e 26,1%, respectivamente. A sobrevida livre de doença (tempo decorrido entre a cirurgia e a primeira recorrência) foi, em média, de 105,4 meses (IC95% 97,0-113,72) no grupo MRM e de 95,4 meses (IC95% 80,7-110,0) no grupo TRAM, não havendo diferença estatisticamente significativa entre os grupos (P = 0,147). Conclusões: Em pacientes portadoras de câncer de mama, a reconstrução mamária imediata com retalho miocutâneo transverso do reto abdominal não influencia o prognóstico da doença, devendo ser oferecida às pacientes que não apresentam contraindicação clínica ao procedimento. / Introduction: Breast cancer is the most prevalent malignant neoplasia among women. In cases of late diagnoses, modified radical mastectomy (MRM) remains the surgical treatment of choice for most women with this disease, and breast reconstruction with myocutaneous flaps is the technique with the best long-term results. Material and methods: Local and systemic recurrence rates were compared, as well as diseasefree survival of patients who underwent MRM with or without immediate breast reconstruction using transverse rectus abdominis myocutaneous flap (TRAM). Results: The TRAM group had a local recurrence rate of 11.8% and a systemic recurrence rate of 35.7%; for the MRM group, these rates were 4.4 and 26.1%, respectively. Disease-free survival time (from surgery to first recurrence) was 95.4 months (95%CI 80.7-110.0) in the TRAM group and 105.4 (95%CI 97.0-113.72) in the MRM group, but the difference was not statistically significant (P = 0.147). In patients with breast cancer, immediate breast reconstruction with TRAM did not affect disease prognosis, and may be indicated to all patients who undergo MRM, except those with any clinical contraindications to the procedure.

Introdução: O câncer de mama é a neoplasia maligna mais prevalente em mulheres. Em decorrência do diagnóstico tardio, a mastectomia radical modificada (MRM) permanece como tratamento cirúrgico de escolha para a maioria das pacientes portadoras da doença. Em pacientes mastectomizadas, a reconstrução mamária com retalhos miocutâneos é a técnica que apresenta melhor resultado a longo prazo. Material e métodos: O estudo compara as taxas de recorrência local e sistêmica e a sobrevida livre de doença em pacientes submetidas à MRM, associada ou não à reconstrução mamária imediata com retalho miocutâneo transverso do reto abdominal (TRAM). Resultados: O grupo submetido à TRAM apresentou recorrência local de 11,8% e sistêmica de 35,7%, e o grupo da MRM, 4,4 e 26,1%, respectivamente. A sobrevida livre de doença (tempo decorrido entre a cirurgia e a primeira recorrência) foi, em média, de 105,4 meses (IC95% 97,0-113,72) no grupo MRM e de 95,4 meses (IC95% 80,7-110,0) no grupo TRAM, não havendo diferença estatisticamente significativa entre os grupos (P = 0,147). Conclusões: Em pacientes portadoras de câncer de mama, a reconstrução mamária imediata com retalho miocutâneo transverso do reto abdominal não influencia o prognóstico da doença, devendo ser oferecida às pacientes que não apresentam contraindicação clínica ao procedimento. / Introduction: Breast cancer is the most prevalent malignant neoplasia among women. In cases of late diagnoses, modified radical mastectomy (MRM) remains the surgical treatment of choice for most women with this disease, and breast reconstruction with myocutaneous flaps is the technique with the best long-term results. Material and methods: Local and systemic recurrence rates were compared, as well as diseasefree survival of patients who underwent MRM with or without immediate breast reconstruction using transverse rectus abdominis myocutaneous flap (TRAM). Results: The TRAM group had a local recurrence rate of 11.8% and a systemic recurrence rate of 35.7%; for the MRM group, these rates were 4.4 and 26.1%, respectively. Disease-free survival time (from surgery to first recurrence) was 95.4 months (95%CI 80.7-110.0) in the TRAM group and 105.4 (95%CI 97.0-113.72) in the MRM group, but the difference was not statistically significant (P = 0.147). In patients with breast cancer, immediate breast reconstruction with TRAM did not affect disease prognosis, and may be indicated to all patients who undergo MRM, except those with any clinical contraindications to the procedure.