Introduction: One of the most important regulators of immune response is the programmed death receptor 1 (PD-1) and its interaction with its ligand (PD-L1), which negatively influences the immune response. Objectives: This study aims to clarify PD-L1 expression levels and the associated tumor infiltrating lymphocytes (TILs) in patients with metastatic breast cancer, and to assess their influence on the prognosis of these patients and the association with clinico-pathologic criteria. Patients and Methods: PD-L1 expression was analyzed using immunohistochemistry (IHC) while TILs count was assessed by histopathological examination of the hematoxylin and eosin (H & E) stained full tumor sections from 50 patients diagnosed with stage IV breast cancer at Ain Shams University hospital, Cairo, Egypt. Results: PD-L1 expression was demonstrated on TILs in 21 of 50 specimens, and on tumor cells in 13 of 50 specimens. Triple negative breast cancer (TNBC) and ER-/Her2+ subtypes were significantly associated with TIL infiltration and PD-L1 expression (on TILs and tumor cells). High TIL infiltration was significantly associated with worse overall survival (OS) and progression free survival (PFS) (P=0.0238 [HR 4.7, 95% CI: 1.22-18.11] and P=0.0262 [HR 3.1, 95% CI: 1.14-8.59] respectively). No correlation was found between PD-L1 expression (on tumor or TILs) and the survival of the patients (OS nor PFS). Conclusion: High TIL count infiltrating the breast tumor is associated with worse OS and PFS in patients with metastatic breast cancer. High PD-L1 expression correlated with high counts of TIL levels around the tumor. These findings have major clinical implications in using immune-checkpoint inhibitors in treating breast cancer patients.

Background: Breast cancer is a disease which have a variety of important features whose different phenotype only partially summarize the underlying biological complexity. Treatment choices in routine management principally rely on the clinical and pathological characteristics of the disease, although molecular classification currently offers information alongside that provided by clinical and pathological examination. The decision to offer adjuvant chemotherapy to patients is not easy and the knowledge of prognostic factors is mandatory. Ki 67 plays an important role in this context, especially in patients who do not have access to genetic signatures. Aim of the work: This study aims to evaluate the value of Ki67 as a prognostic factor in relation to disease free survival and other clinico-pathological factors in Egyptian females with early stage breast cancer. Patients and Methods: Type of study: This is a retrospective cohort study. Study population: It consisted of 124 patients diagnosed with early stage breast cancer. Study Period: They were diagnosed between January 2011 and December 2015. Study setting: The patients were following up in Ain Shams University Hospital clinical oncology department. Information were manually retrieved from the records of the clinical oncology department at Ain Shams university hospitals. Clinical and pathological tumor characteristics were collected using patient charts and pathology reports. Results: Our study showed a significant relation between Ki67 index and estrogen receptors, progesterone receptors and Her2 neu status. Ki67 was found to be statistically significantly correlated to intrinsic subtypes. Our study was unable to find out the effect of Ki67 on disease free survival. Cox regression analysis revealed a statistical significant influence of estrogen receptors status on disease free survival. It also revealed statistical prognostic effect of progesterone receptors and Her2 status on disease free survival. Covariate analysis of results in our study showed that tumor with T4 stage has a significant prognostic effect on disease free survival. Conclusion: ki67 index may have a prognostic role in management of early stage breast cancer in relation to other prognostic markers like hormone receptor status and HER2neu expression. Moreover, immunohisto-chemistry-based subtyping is extremely important to classify breast carcinoma into molecular subtypes that vary in clinic-pathological features and would lead to different prognosis. Thus, molecular subtyping is essential for breast carcinoma management.

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Background Pancreatic cancer is considered the seventh cause of cancer-related death worldwide, and has low resection rate and a poor prognosis. Surgical resection to achieve R0 followed by adjuvant chemotherapy is the treatment of choice. Borderline resectable pancreatic cancer (BRPC) is technically difficult tumor with high risk of non-radical resection R1 and early postoperative recurrence. A neoadjuvant chemotherapy in BRPC instead of upfront surgical resection has advantages of increase R0 resection rate, treatment of undetected micro metastases and decrease postoperative pancreatic fistula. Objective Comparing the short-term outcome between upfront surgery and neoadjuvant chemotherapy for borderline resectable pancreatic carcinoma for venous encasement only as regards the ability to do R0 resection, early surgical complications and the progression rate of the disease Design Prospective cohort. Patients and methods Patients age between 20–70, with only venous encasement (no arterial encasement) with encasement>180 degrees and a segment of venous encasement not more than 2 cm were included. Patients with an arterial encasement, distant metastasis, and not fit for chemotherapy were excluded. Results The upfront surgery group has higher resection rate (75%) with portal/SMV reconstruction needed in one-third of the cases (33.3%) while the neoadjuvant chemotherapy group has higher progression rate (55%) and low resection rate (only 20%). No significant difference between the groups as regards the complication rate (morbidity and mortality), R1 resection(margin invasion), blood loss or time of surgery. Conclusion Upfront surgery can be done in selected patients with BR-PDAC to avoid the progression of the disease with no statistically significant difference as regards the short-term complications in comparison to the neoadjuvant group.