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Neoadjuvant therapy has been continuously improved the outcomes of early breast cancer patients, and more patients with positive axillary lymph node achieve complete pathological responds. The timing of sentinel lymph node biopsy for patients receiving neoadjuvant therapy has also had a new strategy, especially for the patients with clinical positive axillary lymph node before treatment and become clinical negative after neoadjuvant therapy, sentinel lymph node biopsy after neoadjuvant therapy has gradually become a standard axillary surgery procedure. However, there are still many differences in clinical practice domestic in China and abroad. This article discussed the timing of sentinel lymph node biopsy in patients with early breast cancer undergoing neoadjuvant therapy, in order to draw the attention of domestic surgical colleagues to this issue and promote standardized surgery and multidisciplinary cooperation.
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BACKGROUND@#: Breast cancer with low-positive human epidermal growth factor receptor 2 (HER2) expression has triggered further refinement of evaluation criteria for HER2 expression. We studied the clinicopathological features of early-stage breast cancer with low-positive HER2 expression in China and analyzed prognostic factors.@*METHODS@#: Clinical and pathological data and prognostic information of patients with early-stage breast cancer with low-positive HER2 expression treated by the member units of the Chinese Society of Breast Surgery and Chinese Society of Surgery of Chinese Medical Association, from January 2015 to December 2016 were collected. The prognostic factors of these patients were analyzed.@*RESULTS@#: Twenty-nine hospitals provided valid cases. From 2015 to 2016, a total of 25,096 cases of early-stage breast cancer were treated, 7642 (30.5%) of which had low-positive HER2 expression and were included in the study. After ineligible cases were excluded, 6486 patients were included in the study. The median follow-up time was 57 months (4-76 months). The disease-free survival rate was 92.1% at 5 years, and the overall survival rate was 97.4% at 5 years. At the follow-up, 506 (7.8%) cases of metastasis and 167 (2.6%) deaths were noted. Multivariate Cox regression analysis showed that tumor stage, lymphvascular invasion, and the Ki67 index were related to recurrence and metastasis (P < 0.05). The recurrence risk prediction model was established using a machine learning model and showed that the area under the receiving operator characteristic curve was 0.815 (95% confidence interval: 0.750-0.880).@*CONCLUSIONS@#: Early-stage breast cancer patients with low-positive HER2 expression account for 30.5% of all patients. Tumor stage, lymphvascular invasion, and the Ki67 index are factors affecting prognosis. The recurrence prediction model for breast cancer with low-positive HER2 expression based on a machine learning model had a good clinical reference value for predicting the recurrence risk at 5 years.@*TRIAL REGISTRATION@#: ChiCTR.org.cn, ChiCTR2100046766.
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Female , Humans , Breast Neoplasms/metabolism , Ki-67 Antigen , Mastectomy , Receptor, ErbB-2/metabolismABSTRACT
The improvement of comprehensive therapy of breast cancer,not only improve the prognosis of patients,but also affect the strategy of surgical treatment,especially the widespread development of preoperative neoadjuvant chemotherapy.The timing of sentinel lymph node biopsy and the incision margin of breast-conserving surgery in patients treated with neoadjuvant chemotherapy are hot topics for surgeons.And for patients who cannot accept total breast resection,stage Ⅰ reconstruction after mastectomy is the best surgical method to preserve the cosmetic breast shape.Methods and materials of reconstruction are another hot topic of surgical treatment.This article reviews the hot issues of surgical treatment of breast cancer in 2019,with a view to arousing the thinking of surgical colleagues on standardized treatment of breast cancer and strengthening multidisciplinary collaboration.
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The improvement of comprehensive therapy of breast cancer, not only improve the prognosis of patients, but also affect the strategy of surgical treatment, especially the widespread development of preoperative neoadjuvant chemotherapy. The timing of sentinel lymph node biopsy and the incision margin of breast-conserving surgery in patients treated with neoadjuvant chemotherapy are hot topics for surgeons. And for patients who cannot accept total breast resection, stage I reconstruction after mastectomy is the best surgical method to preserve the cosmetic breast shape. Methods and materials of reconstruction are another hot topic of surgical treatment. This article reviews the hot issues of surgical treatment of breast cancer in 2019, with a view to arousing the thinking of surgical colleagues on standardized treatment of breast cancer and strengthening multidisciplinary collaboration.
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In recent years, with the improvement of screening and early diagnosis, the overall prognosis of breast cancer patients has been greatly improved in China. Breast reconstruction is an option to improve cosmetic outcomes and quality of life for the patients received mastectomy, this procedure has attracted a lot of attention. The breast reconstruction surgery is recommended by the 2018 NCCN Clinical Practice Guidelines in Oncology for Breast Cancer in patients with appropriate indications. Despite the high proportion of breast reconstruction after mastectomy in western countries, Chinese breast surgeon should objectively understand the differences in breast structure and cultural backgrounds between Chinese and foreign women, and conduct rigorous clinical practice on the basis of calm thinking. In particular, it should be clearly recognized that we have more local advanced and high-risk cases in newly diagnosed breast cancer patients. Making efforts to improve the overall survival for patients with breast cancer must be the top priority for our surgeon. Breast reconstruction for all patients without identifying the distinction of personal characters and indications should be avoided, and the pursuing of high proportion of clinical data with no consideration of the realities of clinical practice in China should also be avoided. The indication of breast reconstruction for breast cancer patients received mastectomy must be strictly determined by the surgeon.
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Objective@#To investigate the clinical relevance of prognostic staging according to the AJCC Breast Cancer Staging System, Eighth Edition for evaluation of the prognosis of triple-negative breast cancer.@*Methods@#The clinical data of 293 patients with triple-negative breast cancer who were treated at the Breast Disease Center, Peking University First Hospital, between January 2008 and December 2014, were retrospectively analyzed. All patients were female, with age of 53(16) years (M(QR)). The patients were staged according to the AJCC Breast Cancer Staging System, Eighth Edition. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The role of clinical staging and prognostic staging in prognostic evaluation was investigated.@*Results@#In all, 293 patients with triple-negative invasive breast cancer with complete clinical data and follow-up data were treated over a 7-year period. The follow-up time was 64.5(32.8) months, the 5-year overall survival (OS) rate was 83.9%, and the 5-year disease-free survival (DFS) rate was 84.1%. The results showed that clinical staging and prognostic staging were correlated with the DFS rate and OS rate of patients with triple-negative breast cancer (χ2 were 15.395 to 50.084,P=0.00). However, these two staging systems yielded different results. The prognostic stage of 91.8%(269/293) patients was higher than that of the original anatomical stage. There were significant differences in disease-free survival rate (χ2=22.357,P=0.00) and overall survival rate (χ2=50.084, P=0.00) among patients with different clinical stages. There were significant differences in disease-free survival rate (χ2=15.395,P=0.00) and overall survival rate (χ2=29.187,P=0.00)among patients with different prognostic stages.@*Conclusions@#The prognostic stage according to the AJCC Breast Cancer Staging System, Eighth Edition complements the clinical stage. It has a good predictive value for the prognosis of triple-negative breast cancer.
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Objective@#To study the clinicopathological characteristics and the prognostic determinants of the invasive lobular carcinoma breast cancer.@*Methods@#This was a retrospective single-center study of invasive lobular breast cancer cases diagnosed from January 2008 to December 2014 at Peking University First Hospital Breast Disease Center. The study enrolled 68 invasive lobular breast cancer patients, which represented 3.64% (68/1 870) of total invasive breast cancer. The median age of all selected patients was 46 years ranging from 36 to 83 years. All patients were restaged based on the 8th edition of AJCC cancer staging system and follow-up data including disease-free survival (DFS) and overall survival (OS) were analyzed to explore the prognostic determinants. The 5-year OS and DFS were calculated using Kaplan-Meier method; the significance of correlations between clinicopathological features and prognostic factors was estimated using log-rank test.@*Results@#There were significant differences in OS between patients with different anatomic stage, prognostic stage, lymph node metastasis, progesterone receptor (PR) expression, lymphvascular invasion and perineural invasion (χ2: 4.318 to 32.394, all P<0.05); significant differences in DFS were also observed between patients with different anatomic stage, prognostic stage, lymph node metastasis, PR expression, human epidermal growth factor receptor-2 expression, Ki-67 level, histological grade and lymphvascular invasion (χ2: 4.347 to 27.369, all P<0.05). Prognostic stages of 52.9% patients changed compared with anatomic stage, among which Luminal subtype mainly downstaged (22/30), however, triple negative subtype mainly upstaged (6/6).@*Conclusions@#Anatomic stage, prognostic stage, lymph node metastasis, PR expression, lymphvascular invasion are the prognostic factors of invasive lobular breast cancer. Regard to invasive lobular breast cancer patients, clinicians should pay close attention to the differences between prognostic stage and anatomic stage.
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Liquid biopsy is a diagnostic approach by analyzing body fluid samples. Peripheral blood is the most common sample. Urine, saliva, pleural effusion and ascites are also used. Now liquid biopsy is mainly used in the area of neoplasm diagnosis and treatment. Compared with traditional tissue biopsy, liquid biopsy is minimally invasive, convenient to sample and easy to repeat. Liquid biopsy mainly includes circulating tumor cells and circulating tumor DNA (ctDNA) detection. Detection of ctDNA requires sensitive and accurate methods. The progression of next-generation sequencing (NGS) and digital PCR promote the process of studies in ctDNA. In 2016, Nature published the result of whole-genome sequencing study of breast cancer. The study found 1 628 mutations of 93 protein-coding genes which may be driver mutations of breast cancer. The result of this study provided a new platform for breast cancer ctDNA studies. In recent years, there were many studies using ctDNA detection to monitor therapeutic effect and guide treatment. NGS is a promising technique in accessing genetic information and guiding targeted therapy. It must be emphasized that ctDNA detection using NGS is still at research stage. It is important to standardize ctDNA detection technique and perform prospective clinical researches. The time is not ripe for using ctDNA detection to guide large-scale breast cancer clinical practice at present.
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Objective To investigate the difference of the expression of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein between primary lesions of breast cancer and its synchronous ipsilateral lymph node metastasis,as well as its clinical implications.Methods Retrospectively analyze invasive breast cancer patients treated in Peking University First Hospital from January 2012 to May 2016.The IHC expressions of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein in both the primary and lymph node metastatic lesions are compared and analyzed statistically.The count data were represented as n(％),and comparsion between groups were evaluated using the McNemar test.Results One hundred and fifty-six patients were included,of which on 2 cases (1.3％),estrogen receptor status of primary lesions is different from that of lymph node metastases(P =0.500);on 10 cases (6.4％),progesterone receptor status of primary lesions is different from that of lymph node metastases (P =0.344);on 28 cases (18.0％),Ki-67 protein status of primary lesions is different from that of lymph node metastases (P =0.000 18);on 3 cases (1.9％),human epidermal growth factor receptor 2 status of primary lesions is different from that of lymph node metastases (P =1.000).Conclusion There may be difference between primary lesions and lymph node metastases in the expression of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein,which can provide a reference for individualized treatment of breast cancer patients.
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<p><b>OBJECTIVES</b>To explore the clinical and pathological characteristics of stage IV breast cancer and to analyze their relationship with the morbidity and prognosis.</p><p><b>METHODS</b>The records of 66 patients presenting from January 2008 to December 2014 with stage IV breast cancer were reviewed. All of the patients were women and the median age was 57.5 (31 to 80) years, accounted for 3.01% (66/2 189) among the breast cancer patients treated in the same period. Statistical methods were used to analyze the correlation between clinical and pathological characteristics such as T-stage, N-stage, immuno-histo-chemistry and the morbidity and prognosis of stage IV breast cancer. The influence of patients characteristics to metastasis were compared by χ(2) test. Kaplan-Meier curves were reported for overall survival (OS), and the Log-rank test was used to compare the difference in groups. Cox proportional models were fitted for multivariate analysis.</p><p><b>RESULTS</b>The median survival time of stage IV breast cancer was 56.0 months and the 5-year survival rate was 40%. To metastasis, the effects of age, subtypes, histological grade, hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2)had no significant statistics differences. It was concluded that the expression of HER2 (P=0.003) and HR (P=0.001) as well as single metastasis (P=0.029) were the influencing factors of the survival by multivariate Cox regression analysis. Primary tumor R0 surgery group and no surgery group had no significant statistics differences of overall survival and the 5-year survival rate (P=0.102).</p><p><b>CONCLUSIONS</b>Clinical and pathological characteristics have no effect on metastasis. The expression of HER2 and HR as well as single metastasis play important roles in survival.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Breast Neoplasms , Multivariate Analysis , Neoplasm Staging , Prognosis , Proportional Hazards Models , Receptor, ErbB-2 , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To explored the relationship of clinicopathological classification and clinical and pathological characteristics of breast cancer and analyze the value in treatment.</p><p><b>METHODS</b>The patients with invasive breast carcinoma had been treated between January 2011 and December 2012. The breast cancer have been divided into luminal A, luminal B, HER2-positive and triple-negative subtypes according to criteria of St. Gallen International Expert Consensus report 2011. The Mann-Whitney test and Kruskal-Wallis test were used to analyze the relationships between four subtypes and TNM staging, histopathological grading.</p><p><b>RESULTS</b>The 530 cases of invasive breast cancer patients were included in this study. The luminal A was 94 cases (17.7%), the luminal B was of 285 cases (53.8%), the HER2-positive was 59 cases (11.1%), and the triple-negative subtype was 92 cases (17.4%). In luminal B subtype, the HER2-positive was 56 (19.6%) and negative was 229 (80.4%). Most of luminal B was later in grade (71.7% of cases were more than II grade) and stage (66.7% were more than stage II).</p><p><b>CONCLUSIONS</b>Clinical pathological classification is important in the individualized treatments of breast cancer, and the Luminal types (A+B) are more than 71.5% of all breast cancer patients, and they should be paid more attention to the endocrine therapy; Luminal B type accounted for 53.8% of all breast cancer and it needs further study to improve the precision of the diagnosis and treatment.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Young Adult , Breast Neoplasms , Classification , Pathology , Neoplasm Staging , PrognosisABSTRACT
Objective To assess the value of initial MRI measurements of breast tumor diameter and pathological responses for predicting response to neoadjuvant chemotherapy (NAC). Methods Fortynine patients who underwent neoadjuvant chemotherapy were included in this study. The longest diameter of each tumor was measured on MRI before and after two cycles of NAC and just before operation. Pathological responses were evaluated by Miller and Payne grading system criteria by comparing post-operation breast tissue with large core biopsy tissue. Changes of diameter after two cycles of NAC and before operation were compared and pathological responses were evaluated. ROC and spearman correlation analysis was used.Results The sensitivity and specificity of initial diameter for predicting response to NAC were 96. 7% (29/30) and 84.2% (16/19). There was a moderate correlation between pathological responses and diameter measured pre-operation ( r = 0. 613, P = 0. 000 ). Conclusion The initial diameter changes of breast tumor could predict response to neoadjuvant chemotherapy, pathological response have moderate correlation with changes of tumor diameter.