Hospital São Paulo

Obesity is an independent driver of cardiovascular disease (CVD), mediated through adverse haemodynamic loading, insulin resistance, systemic inflammation, endothelial dysfunction and prothrombotic pathways. Contemporary obesity therapies show cardiovascular (CV) benefits beyond improvements in traditional risk factors. Across large CV outcome trials, glucagon-like peptide 1 receptor agonists consistently reduce three-point major adverse CV events (MACE) in patients with overweight, obesity and established CVD with and without diabetes. In obesity-related heart failure of preserved ejection fraction, semaglutide and tirzepatide improve symptoms and functional capacity and reduce worsening heart failure events, while effects on CV mortality remain uncertain. In contrast, evidence for metabolic bariatric surgery is dominated by large observational cohorts and meta-analyses, which are associated with durable weight loss and lower observed rates of MACE, heart failure and all-cause mortality compared with non-surgical care, though causal inference is constrained by residual confounding. Data support that sustained weight loss of at least 10% is more likely to translate into CVD event reduction, alongside other organ specific mechanisms that impact CV health independent from weight reduction. Obesity treatments offer a safe and effective method to lose weight with varying CV benefits, with current evidence still in early stages to establish robust clinical recommendations.

Abstract Introduction: Breast cancer is the leading cause of cancer-related morbidity among women globally and represents a significant burden on health systems, particularly in low- and middle-income countries (LMICs) such as Brazil. Surgical biopsy (SB) and vacuum-assisted biopsy (VAB) are both widely employed for the evaluation of suspicious breast lesions. While SB remains the more established and broadly implemented modality in public settings due to its lower acquisition cost and infrastructure requirements, VAB has gained attention for its enhanced diagnostic performance—enabling larger tissue sampling, improved lesion targeting, and reduced rates of diagnostic underestimation and repeat procedures. The economic implications of adopting VAB over SB remain insufficiently studied in LMICs, where healthcare budgets are constrained and decision-makers must balance cost containment with the pursuit of higher-value care. Objective: The objective of the study was to assess whether VAB or SB would provide better resource allocation in Brazil. Methods: Considering the Brazilian Public Health System (SUS), Hospital and Societal perspectives, a decision tree was modelled using retrospective data of women with breast cancer from 1,833 procedures performed at Pérola Byington Hospital (PBH), which included data on pathological outcomes and the proportion of patients requiring a subsequent lumpectomy. The costs were retrieved from SIGTAP platform, PBH and the societal perspective included costs from official sources of national average salary. Results: VAB kit costs was $382, while SB was considerably lower, ranging from $ 86 to $196 (HPB and Societal perspectives). Through modelling, the total average cost per patient was $268 for VAB and $492 for SB, considering the PBH perspective, resulting in average savings of $223 per patient. Considering the SUS perspective, the average cost was $208 for VAB and $62 for SB, representing a cost increase of $146. From the societal perspective, VAB led to savings of $353 per patient, largely due to fewer workdays lost compared to SB. Conclusion: VAB minimizes the costs against SB, considering the perspectives from PBH and society. While the SUS perspective shows a slight increase in cost, the overall findings support the economic benefit of using VAB, particularly in settings focused on efficiency and patient recovery. Citation Format: A. Amorim, M. Mattar, M. Antonini, M. Teixeira, M. Ramos, R. Lopes, L. Damous, L. Gebrim. A COST-MINIMIZATION ANALYSIS OF VACUUM-ASSISTED BIOPSY (VAB) VERSUS SURGICAL BIOPSY (SB) IN WOMEN ELIGIBLE FOR BREAST CANCER SCREENING: BRAZILIAN PUBLIC HEALTH SYSTEM, HOSPITAL’S AND SOCIETAL PERSPECTIVES [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-06-19.

Abstract Background: Neoadjuvant chemotherapy (NAC) may alter tumor biology, leading to immunohistochemical (IHC) subtype conversions between diagnosis and residual disease. The prognostic impact of such changes remains unclear. This systematic review and meta-analysis evaluated the effect of NAC-induced IHC subtype conversion on overall survival (OS) and disease-free survival (DFS) in patients with residual disease (non-pCR). Methods: This study was registered in PROSPERO (CRD42024558811). PubMed, EMBASE, and Cochrane Library were searched through 2025 for studies reporting IHC subtype conversions after NAC and associated survival outcomes in non-pCR patients. Eligible studies included randomized trials and observational cohorts of adult women with primary breast cancer. Two reviewers independently selected studies and extracted data. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane tool. Pooled risk ratios (RRs) were calculated using random-effects models. Heterogeneity was quantified with I2, and publication bias was assessed by Egger’s test. Results: Twenty-five retrospective studies (n=5,263 non-pCR patients) were included. Mean patient age ranged from 46-54 years, and tumors were predominantly T2-T3. IHC subtype conversion occurred in 20% [95% CI: 0.17-0.24], with high heterogeneity (I2=89.8%). Common conversions included luminal-to-TNBC (35%), luminal-to-HER2+ (25%), HER2+-to-luminal (20%), and TNBC-to-luminal (20%).Patients without subtype conversion had significantly better OS (RR=1.13 [95% CI: 1.01-1.26], p=0.03; I2=62%). Luminal tumors showed the greatest OS benefit without conversion (RR=1.19 [1.01-1.41], p=0.04), while HER2+ (RR=1.11 [0.95-1.31], p=0.19) and TNBC (RR=0.98 [0.84-1.16], p=0.85) showed no significant OS impact. DFS was not significantly affected by conversion overall (RR=0.95 [0.80-1.14], p=0.58; I2=79%). Sensitivity analysis confirmed OS findings. Egger’s test revealed no publication bias for OS (p=0.33) but suggested bias for luminal DFS (p=0.044). Conclusion: IHC subtype conversion after NAC occurs in 1 in 5 patients with residual disease and is associated with worse OS—particularly in luminal breast cancer. Routine post-NAC IHC reassessment should be considered to improve prognostication and guide adjuvant treatment. Prospective studies with standardized reporting are needed to validate these findings and refine treatment algorithms. Citation Format: M. Antonini, A. Mattar, F. P. Cavalcante, F. Zerwes, E. C. Millen, F. P. Brenelli, L. A. Frasson, L. X. Félix, J. C. Vieira, R. C. Campos, M. Teixeira, M. Figueiredo, M. Madeira, H. C. Lima, G. Facina, R. Arakelian, A. D. Lima, L. R. Soares, R. J. Freitas, G. N. Garcia, F. Bagnoli, G. T. Tosello, L. H. Gebrim. Immunohistochemical Subtype Conversion After Neoadjuvant Chemotherapy and Its Impact on Breast Cancer Survival: A Systematic Review and Meta-analysis [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PD2-01.

Reference values for cardiac chamber quantification are essential for clinical decision-making. Brazil is a continental country with marked racial diversity and substantial regional socioeconomic and anthropometric variability, which may not be adequately represented in international echocardiographic standards. To establish reference echocardiographic measurements for healthy Brazilian adults and to investigate geographic and sex-related differences across Brazil's major regions. In this prospective, multicenter study, transthoracic echocardiograms were performed in 496 healthy volunteers (mean age 41 ± 15 years; 55% women) from five Brazilian regions. Left ventricular (LV) and left atrial (LA) dimensions, volumes, mass, ejection fraction, and global longitudinal strain (GLS) were analyzed in accordance with current guidelines. Comparisons were conducted by sex (Student's t test or Mann-Whitney U test) and by region (analysis of variance). Cardiac chamber dimensions and LV mass were greater in men, even after indexing for body surface area. LA volumes were also higher in men, although these differences were attenuated after indexing. Absolute LVGLS and right ventricle (RV) GLS (RVGLS) values were higher in women, whereas LA strain reservoir (LASr) was similar between sexes. Regionally, the Center-West exhibited significantly smaller LV volumes, a difference primarily driven by women, along with lower LVGLS and RVGLS (p < 0.001). In contrast, LA volumes were smaller in the Northeast region. No significant associations were observed between self-reported race and echocardiographic parameters, except for RVGLS and LASr, which were lower in White participants. This study establishes echocardiographic reference values in a nationally representative Brazilian cohort, confirms expected sex-related differences, and identifies previously unrecognized regional variations in cardiac chamber dimensions. These findings underscore the need for population-specific standards to ensure accurate cardiac quantification.