JOSE ROBERTO FILASSI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
15 resultados
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- The circulating 70 kDa heat shock protein (HSPA1A) level is a potential biomarker for breast carcinoma and its progression(2022) FREITAS, Gabriela Boufelli de; PENTEADO, Laura; MIRANDA, Mila Meneguelli; FILASSI, Jose Roberto; BARACAT, Edmund Chada; LINHARES, Iara MorenoThe early diagnosis of breast cancer can improve treatment and prognosis. We sought to evaluate whether the serum concentration of the 70 kDa heat shock protein (HSPA1A) was elevated in Brazilian women with breast cancer, and if levels correlated with tumor characteristics. This was a cross-sectional, analytical, case-control exploratory study performed at The University of Sao Paulo School of Medicine. From September 2017 to December 2018, 68 women with breast cancer and 59 controls were recruited. The HSPA1A concentration in serum samples was determined by ELISA by individuals blinded to the clinical data. The mean ages in the study and control groups were 54.9 and 52.0 years, respectively. The median serum levels of HSPA1A were elevated in women with breast cancer (1037 pg/ml) compared with controls (300 pg/ml) (p < 0.001). Elevated HSPA1A levels were associated with advanced histological tumor grade (p < 0.001) and with the cell proliferation index (KI67) (p = 0.0418). The HSPA1A concentration was similar in women with different histological subtypes, nuclear grade, hormone receptor expression, HER2 status and the presence or absence of angiolymphatic invasion. Elevated serum HSPA1A in Brazilian women with advanced histological grade and proliferation index breast cancer supports the potential value of additional investigation on larger and more varied populations to verify the value of HSPA1A detection as a component of breast cancer diagnosis and progression.
- Outcome Analysis of Immediate and Delayed Conservative Breast Surgery Reconstruction With Mastopexy and Reduction Mammaplasty Techniques(2011) MUNHOZ, Alexandre Mendonca; ALDRIGHI, Claudia Maria; MONTAG, Eduardo; ARRUDA, Eduardo; BRASIL, Jose Augusto; FILASSI, Jose Roberto; ALDRIGHI, Jose Mendes; GEMPERLI, Rolf; FERREIRA, Marcus CastroBackground: Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction. Method: Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed. Results: There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval - 1.01-7.00; P = 0.049). Conclusions: On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.
- Underestimation Rate in the Percutaneous Diagnosis of Radial Scar/Complex Sclerosing Lesion of the Breast: Systematic Review(2022) ZANON, Ana Beatrice Bonganha; MAESAKA, Jonathan Yugo; CHEQUIN, Bruna Bello; SANTOS, Ana Gabriela de Siqueira; BARACAT, Edmund Chada; FILASSI, Jose RobertoObjective To evaluate the underestimation rate in breast surgical biopsy after the diagnosis of radial scar/complex sclerosing lesion through percutaneous biopsy. Data Sources A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The Pub M ed, SciELO, Cochrane, and Embase databases were consulted, with searches conducted through November 2020, using specific keywords ( radial scar OR complex sclerosing lesion , breast cancer , anatomopathological percutaneous biopsy AND/OR surgical biopsy ). Data collection Study selection was conducted by two researchers experienced in preparing systematic reviews. The eight selected articles were fully read, and a comparative analysis was performed. Study selection A total of 584 studies was extracted, 8 of which were selected. One of them included women who had undergone a percutaneous biopsy with a histological diagnosis of radial scar/complex sclerosing lesion and subsequently underwent surgical excision; the results were used to assess the underestimation rate of atypical and malignant lesions. Data synthesis The overall underestimation rate in the 8 studies ranged from 1.3 to 40% and the invasive lesion underestimation rate varied from 0 to 10.5%. Conclusion The histopathological diagnosis of a radial scar/complex sclerosing lesion on the breast is not definitive, and it may underestimate atypical and malignant lesions, which require a different treatment, making surgical excision an important step in diagnostic evaluation.
- What a difference a clip makes! Analysis of boost volume definition in radiation therapy for conservative breast surgery(2018) FREITAS, Thiago Brasileiro de; LIMA, Kennya Medeiros Lopes de Barros; CARVALHO, Heloisa de Andrade; MARQUES, Patricia de Azevedo; MATTOS, Fabio Teixeira Belfort; FONSECA, Alexandre Siqueira Franco; MUNHOZ, Alexandre Mendonca; FILASSI, Jose Roberto; STUART, Silvia R.; MARTA, Gustavo NaderPurpose/objective(s): To evaluate the role of surgical clips placement in the definition of boost treatment volume. Materials/methods: Clinical Target Volumes (CTV) were defined as: CTV Breast, CTV Quadrant (based on physical exam and pre-surgical images), CTV Boost, defined by clip plus margin (1 cm for 2 or more clips and 2 cm for 1 clip only) plus radiological changes, CTV NT (normal tissue), defined by CTV Quadrant minus CTV Boost and CTV MISS (CTV that would be outside the treatment volume), defined by cry Boost minus CTV Quadrant. Results: A total of 247 patients were included. Upper lateral quadrant was the most common clinical location (47.3%). The median number of clips used was three. The mean volumes were: CTV Breast:982.52 cc, CTV Boost:36.59 cc, CTV Quadrant:285.07 cc, Cry NT:210.1 cc and CTV MISS:13.57 cc. Only 50.6% (125) of the patients presented the CTV Boost completely inside the Cry Quadrant and in 473% (117), partially inside. Among patients with any CFV MISS, 803% (98) had 10% or more of CTV Boost outside the treatment volume. Regarding CTV MISS, there were no statistically significant differences between the groups with 1 clip versus 2 or more clips, nor between patients with or without reconstructive surgery. In average, the CTV Boost was 87% smaller than the CFV Quadrant. The whole quadrant irradiation would lead to unnecessary irradiation of 26% of normal breast tissue. Conclusion: Surgical bed clipping is up most important in the definition of the boost volume irradiation to ensure precision minimizing geographical miss and optimizing surrounding normal tissue sparing.
- Can Breast Nipple Fluid Collected with Automated Aspiration and Preserved in Based-Liquid Solution Improve the Cytological Samples?(2013) FILASSI, Jose Roberto; ZONTA, Marco Antonio; TRINCONI, Angela; CALVAGNO, Daniele; OLIVEIRA, Fernada Velame de; RICCI, Marcos Desiderio; BARACAT, Edmund; LONGATTO-FILHO, AdhemarObjective: Samples from breast nipples collected with the automated HALO (TM) Mamo Cito Test were studied in order to evaluate the cellularity for the diagnosis of breast cancer. Study Design: One hundred and fifty-nine asymptomatic women were prospectively examined. Women younger than 18 years, pregnant or lactating women, and women with a history of breast cancer, with previous radio- or chemotherapy and with nipple piercing were excluded from the study. Nipple samples from both breasts were collected. Results: In 107 (34.96%) of the 306 samples of nipple discharge analyzed by optical microscopy, adequate cellularity was observed after the HALO procedure. Cytological findings, previously categorized according to the National Health Service Breast Screening Program (NHSBSP), were grouped as unsatisfactory, benign, suspected for malignancy, and malignant. Of the cellular breast samples, 97.19% (104/107) were classified as benign, and 2.81% (3/107) were classified as suspicious for malignancy. In 199 cases there were samples without cells (65.03%). Most of the cells observed were easily recognized as well-preserved and adequately stained macrophages. None of the women reported discomfort with the nipple aspiration procedure. Conclusions: The results discussed here encouraged us to use samples collected automatically in routine procedures.
- Papillomas of the breast: factors associated with underestimation(2018) BOUFELLI, Gabriela; GIANNOTTI, Marcelo A.; RUIZ, Carlos A.; BARROS, Nestor de; CHALA, Luciano E.; MAESAKA, Jonathan Y.; GONCALVES, Rodrigo; BRESCIANI, Barbara H.; VIANNA, Paula; SOARES JR., Jose. M.; BARACAT, Edmund C.; FILASSI, Jose. R.The distinction between benign and malignant papilloma of the breast through percutaneous needle biopsy can be difficult because of limited samples; the underestimation rate can be up to 25%. The aim of this study is to identify clinical and histological factors associated with underestimation, invasive ductal carcinoma, or ductal in-situ carcinoma (DCIS) of the breast found in surgical specimens from papillary lesions. This may contribute toward selection of patients for a follow-up strategy without the need for surgical excision. From a database of 3563 patients, we identified 85 with intraductal papilloma between 2007 and 2013 who had undergone breast-imaging studies, percutaneous needle biopsy, and surgical resection of the lesion. Central papillomas normally present with a palpable mass, whereas peripheral papillomas generally do not have clinical manifestations (microcalcifications); both central and peripheral papillomas were related to atypical lesions, 13.5 and 15.4%, respectively. Among the 59 cases of central papillomas, there were four cases of underestimation, three DCIS and one invasive ductal carcinoma (6.8%). Among the 26 cases of peripheral papillomas, there was one case of DCIS (3.8%), with a total underestimation rate of 5.8%; all underestimated lesions measured more than 1cm. The median size was 11mm at mammography and 19mm at ultrasound. Our data suggest that lesions less than 1cm in size, without atypia and concordant imaging and clinical findings, may not require surgical resection.
- Predictive factors for positive surgical margins in the treatment of breast ductal carcinoma in situ(2016) HASSAN, Rafael A. M.; MAESAKA, Jonathan Y.; RICCI, Marcos D.; SOARES JR., Jose M.; DORIA, Maira Teixeira; BARACAT, Edmund C.; FILASSI, Jose R.Context: Surgery is the main form of treatment for ductal carcinoma in situ (DCIS) of the breast. Among other factors, treatment success requires that the surgical margins are free of disease, to reduce the risk of recurrence. Aims: The purpose of this study was to analyze factors that might be associated with positive margins in patients diagnosed with DCIS. Settings and Design: A retrospective analysis was performed of hospital databases from the year 2006 to 2014, to identify patients with an initial diagnosis of DCIS made by percutaneous biopsy. Subjects and Methods: Age, the presence of disease symptoms, lesion size on mammogram, and the presence of estrogen receptors, and their relationship to the surgical margins were evaluated in 249 patients. Statistical Analysis Used: Shapiro and WilcoxonuMannuWhitney tests were used to verify that the data were normally distributed. Chi-squared test was used to verify the independence of the variables. Results: Lesions measuring 1.55 cm or greater had a relative risk of positive margins after conservative surgery of 1.39 (95% confidence interval [95% CI]: 1.02u1.90). The presence of symptoms had a relative risk of positive margins after conservative surgery of 1.54 (95% CI: 1.17u2.02). Conclusion: Lesions measuring 1.55 cm or greater and the presence of symptoms are risk factors for positive margins in the treatment of ductal carcinoma in situ. Therefore, these patients need a better surgical planning in order to reduce the risk of positive margins. There is a clear need for large prospective studies to validate our findings and define other factors that might contribute to the success of surgical resection for ductal carcinoma in situ.
- Immediate conservative breast surgery reconstruction with perforator flaps: New challenges in the era of partial mastectomy reconstruction?(2011) MUNHOZ, Alexandre Mendonca; MONTAG, Eduardo; ARRUDA, Eduardo; BRASIL, Jose Augusto; ALDRIGHI, Jose Mendes; GEMPERLI, Rolf; FILASSI, Jose Roberto; FERREIRA, Marcus CastroIntroduction: Although the use of local flaps in conservative breast surgery (CBS) reconstruction is a reliable technique, little information has been available regarding outcome following the use of perforator flaps. The purpose of this study is to analyze the feasibility, surgical planning and outcome following CBS reconstruction with intercostal artery perforator (ICAP) flap. Patients/methods: Thirteen patients underwent CBS reconstructions with an ICAP flap. These flaps were raised from adjacent tissue located on the lateral and thoracic region and based on perforators originating from the costal and muscular segment of the intercostal vessels. The technique was indicated in patients with small/moderate volume breasts. Results: Mean time of follow-up was 32 months. Flap complications were evaluated and information on patient satisfaction were collected. 61.5 percent had tumors located in the lower-outer quadrants and 69.2 percent had tumors measuring 2 cm or less (T1). Complications occurred in 3 patients (23%), including wound dehiscence in 2 patients and fat necrosis in one. All cases were treated by conservative approach with a good result. No flap loss or wound infection were reported. 90 percent were either satisfied or very satisfied with their result. Conclusion: The ICAP flap is a reliable technique for immediate CBS reconstruction. The technique is advantageous because it does not require the use of muscle transfer, with minimum donor site morbidity. Success depends on patient selection, coordinated planning with the oncological surgeon and careful intra-operative management.
- Validation of the Residual Cancer Burden Index as a prognostic tool in women with locally advanced breast cancer treated with neoadjuvant chemotherapy(2023) CUNHA, Juliana Pierobon Gomes da; GONCALVES, Rodrigo; SILVA, Fernando; AGUIAR, Fernando Nalesso; MOTA, Bruna Salani; CHEQUIM, Bruna Bello; SOARES, Jose Maria; BARACAT, Edmund C.; FILASSI, Jose RobertoAims To correlate the 'Residual Cancer Burden' (RCB) index with overall survival (OS) and disease-free survival (DFS) in women undergoing neoadjuvant chemotherapy at the Cancer Institute of the State of Sao Paulo. Methods We analysed the medical records of patients with breast cancer who underwent neoadjuvant chemotherapy and breast surgery, from 2011 to December 2017. Variables analysed were age, clinical and pathological staging, molecular subtype, number of recurrences or metastases, number of deaths, value and class of the RCB index. We used the Kaplan-Meier and the log-rank statistics to evaluate the possible association between RCB and OS and DFS. A regression model was used to determine the independent association of the RCB with the outcomes controlling for confounding factors. Results 347 patients were included in the analysis with a mean age of 49.39 years. Initial clinical staging was T3 in 57.9% of patients and 43.8% of patients had N1 axillary status. Survival analysis showed a statistically significant better prognosis for the RCB 0 (pCR) subgroup compared with RCB 1, 2 and 3 (log rank p=0.01). In a multivariate analysis, only the RCB classification showed a statistically significant correlation with DFS (RCB 1, HR 6.9, CI 1.9 to 25.4, p=0.004; RCB 2, HR 4.2, CI 1.6 to 10.8, p=0.03; and RCB 3, HR 7.6, CI 2.76 to 20.8, p=0.00). Conclusion We demonstrated a positive and significant relationship between the RCB index and the risk of relapse and death.
- Multidisciplinary international survey of post-operative radiation therapy practices after nipple-sparing or skin-sparing mastectomy(2017) MARTA, Gustavo Nader; POORTMANS, Philip; BARROS, Alfredo C. de; FILASSI, Jose Roberto; FREITAS JUNIOR, Ruffo; AUDISIO, Riccardo A.; MANO, Max Senna; METERISSIAN, Sarkis; DESNYDER, Sarah M.; BUCHHOLZ, Thomas A.; HIJAL, TarekPurpose/Objective(s): Skin sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) have entered routine surgical practice for breast cancer, though their oncologic safety has not been established in randomized controlled trials. The aim of this study was to evaluate and compare radiation oncologists' and breast surgeons' opinions concerning the indications of post-operative radiation therapy (PORT) after SSM and NSM. Materials/Methods: Radiation oncologists and breast surgeons from North America, South America and Europe were invited to contribute in this study. A 22-question survey was used to evaluate their opinions. Results: A total of 550 physicians (298 radiation oncologists and 252 breast surgeons) answered the survey. The majority of responders affirmed that PORT should be performed in early-stage (stages I and II) breast cancer for patients who present with risk factors for relapse after SSM and NSM. They considered age, lymph node involvement, tumor size, extracapsular extension, involved surgical margins, lymphovascular invasion, triple negative receptor status and multicentric presentation as major risk factors. Considering that after SSM and NSM, residual breast tissue can be left behind, the residual tissue considered as acceptable in the context of an oncologic surgery were 1-5 mm for breast surgeons. There is no consensus for the necessity of evaluating residual breast tissue through breast imaging. Conclusion: Although the indications of PORT after SSM and NSM vary among practitioners, standard risk factors for relapse are considered as important by radiation oncologists and breast surgeons.