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1.  Metaplastic sarcomatoid carcinoma of the breast appears more aggressive than other triple receptor-negative breast cancers 
Breast cancer research and treatment  2011;131(1):10.1007/s10549-011-1393-6.
Metaplastic sarcomatoid carcinoma (MSC) of the breast is usually triple receptor (ER, PR, and HER2) negative and is not currently recognized as being more aggressive than other triple receptor-negative breast cancers. We reviewed archival tissue sections from surgical resection specimens of 47 patients with MSC of the breast and evaluated the association between various clinicopathologic features and patient survival. We also evaluated the clinical outcome of MSC patients compared to a control group of patients with triple receptor-negative invasive breast carcinoma matched for patient age, clinical stage, tumor grade, treatment with chemotherapy, and treatment with radiation therapy. Factors independently associated with decreased disease-free survival among patients with stage I–III MSC of the breast were patient age >50 years (P = 0.029) and the presence of nodal macrometastases (P = 0.003). In early-stage (stage I–II) MSC, decreased disease-free survival was observed for patients with a sarcomatoid component comprising ≥95% of the tumor (P = 0.032), but tumor size was the only independent adverse prognostic factor in early-stage patients (P = 0.043). Compared to a control group of triple receptor-negative patients, patients with stage I–III MSC had decreased disease-free survival (two-sided log rank, P= 0.018). Five-year disease-free survival was 44 ± % versus 74 ± 7% for patients with MSC versus triple receptor-negative breast cancer, respectively. We conclude that MSC of the breast appears more aggressive than other triple receptor-negative breast cancers.
doi:10.1007/s10549-011-1393-6
PMCID: PMC3867807  PMID: 21331622
Breast cancer; Metaplastic carcinoma; Sarcomatoid; Triple-negative; Survival
2.  A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: physiological capacity compared with the ASA physical status classification system 
BJA: British Journal of Anaesthesia  2010;104(4):465-471.
Background
This pilot study compared the risk predictive value of preoperative physiological capacity (PC: defined by gas exchange measured during cardiopulmonary exercise testing) with the ASA physical status classification in the same patients (n=32) undergoing major abdominal cancer surgery.
Methods
Uni- and multivariate logistic regression models were fitted to measurements of PC and ASA rank data determining their predictive value for postoperative morbidity. Receiver operating characteristic (ROC) curves were used to discriminate between the predictive abilities, exploring trade-offs between sensitivity and specificity.
Results
Individual statistically significant predictors of postoperative morbidity included the ASA rank [P=0.038, area under the curve (AUC)=0.688, sensitivity=0.630, specificity=0.750] and three newly identified measures of PC: PAT (% predicted anaerobic threshold achieved, <75% vs ≥75%), ΔHR1 (heart rate response from rest to the anaerobic threshold), and HR3 (heart rate at the anaerobic threshold). A two-variable model of PC measurements (ΔHR1+PAT) was also shown to be statistically significant in the prediction of postoperative morbidity (P=0.023, AUC=0.826, sensitivity=0.813, specificity=0.688).
Conclusions
Three newly identified PC measures and the ASA rank were significantly associated with postoperative morbidity; none showed a statistically greater association compared with the others. PC appeared to improve predictive sensitivity. The potential for new unidentified measures of PC to predict postoperative outcomes remains unexplored.
doi:10.1093/bja/aeq034
PMCID: PMC2837548  PMID: 20190255
assessment, preanaesthetic; complications, morbidity; measurement techniques, gas exchange metabolic; metabolism, oxygen consumption; oxygen uptake; risk; surgery, postoperative

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