Effects of different treatments on prognosis of triple-negative breast cancer / 国际肿瘤学杂志

Objective:To analyze the clinical features and the effects of different treatments on 5-year overall survival (OS) rate and 5-year disease free survival (DFS) rate of stage 0-Ⅲ triple-negative breast cancer (TNBC).Methods:The data of 209 patients diagnosed as stage 0-Ⅲ TNBC in Ward 2 of Department of General Surgery of the Fifth Medical Center of PLA General Hospital from January 2004 to December 2013 were selected. The relationships between the clinical features, treatments and 5-year OS rate, 5-year DFS rate were retrospectively analyzed. Kaplan-Meier method was used to draw survival curves, and Cox proportional risk model was used for multivariate analysis.Results:Univariate analysis found that clinical stage and methods of surgery were associated with 5-year OS rate ( χ2=52.615, P<0.001; χ2=17.329, P=0.001) and 5-year DFS rate ( χ2=55.112, P<0.001; χ2=18.816, P<0.001). Multivariate analysis showed that clinical stage was an independent prognostic factor of DFS ( HR=3.637, 95% CI: 2.146-6.164, P<0.001) and OS ( HR=3.545, 95% CI: 2.091-6.009, P<0.001). For the TNBC patients without axillary lymph node metastasis ( n=118), the 5-year OS rates of patients with breast conservation surgery + sentinel lymph node biopsy, total breast resection + sentinel lymph node biopsy, modified radical mastectomy and breast conserving surgery + axillary lymph node dissection were 97.6%, 97.7%, 91.4%, 100% respectively, the 5-year DFS rates were 97.3%, 94.3%, 85.8%, 100% respectively, and there were no significant differences among the four groups ( χ2=3.369, P=0.338; χ2=3.868, P=0.276). The 5-year OS rate (74.5% vs. 91.1%) and 5-year DFS rate (73.6% vs. 86.8%) were significantly different in patients receiving neoadjuvant chemotherapy ( n=106) compared with those receiving adjuvant chemotherapy ( n=80) ( χ2=4.504, P=0.034; χ2=4.683, P=0.030). The patients receiving neoadjuvant chemotherapy had later clinical stages than those receiving adjuvant chemotherapy ( χ2=35.314, P<0.001). There were no significant differences in 5-year OS rate and 5-year DFS rate between the patients receiving neoadjuvant chemotherapy and adjuvant chemotherapy with the same clinical stage (all P>0.05). The 5-year OS rates of patients with pathologic complete response (pCR), partial response (PR) and stable disease (SD) obtained by neoadjuvant chemotherapy were 100%, 75.8% and 57.1% respectively, and the 5-year DFS rates were 100%, 74.5% and 55.7% respectively, with statistically significant differences ( χ2=10.086, P=0.006; χ2=10.399, P=0.006). Between the pCR group and the PR group, the 5-year OS rate ( χ2=4.238, P=0.040) and 5-year DFS rate ( χ2=4.525, P=0.033) were significantly different. Between the pCR group and the SD group, the 5-year OS rate ( χ2=8.163, P=0.004) and 5-year DFS rate ( χ2=8.509, P=0.004) were significantly different. Between the PR group and the SD group, the 5-year OS rate ( χ2=3.931, P=0.047) and 5-year DFS rate ( χ2=3.896, P=0.048) were significantly different. Conclusion:For the patients with stage 0-Ⅲ TNBC, clinical stage is an independent prognostic factor. For the TNBC patients without axillary lymph node metastasis, breast conservation surgery + sentinel lymph node biopsy, total breast resection + sentinel lymph node biopsy, modified radical mastectomy and breast conserving surgery + axillary lymph node dissection have similar outcomes. There is no significant difference between neoadjuvant chemotherapy and adjuvant chemotherapy in the prognosis of patients with the same clinical stage, but patients with pCR or PR obtained by neoadjuvant chemotherapy can achieve better survival.

BRCA1 and BRCA2 pathogenic mutations in 74 patients with early-onset breast cancer / 军事医学

Objective To investigate the pathogenic mutations of BRCA1 and BRCA2 in patients with early-onset breast cancer(≤35 years) and explore the relationships between BRCA1/2 mutations and clinical features.Methods Seventy-four patients with early-onset breast cancer were enrolled,who were treated in Hospital 307 between September 2014 and June 2016.High-throughput sequencing was used to test the 49 exon sequences and adjacent sequences of BRCA1 and BRCA2.χ2 test was used to analyze the distribution of BRCA1/2 pathogenic mutations in each group that was set up according to clinical features.Results Fifteen mutations(20.27%) were identified,including 5(6.76%) in BRCA1 and 10(13.51%) in BRCA2.Eleven new pathogenic mutations were discovered,and BRCA1:c.5470_5477delTGCCCAAT was found in one patient.The frequency of BRCA1/2 mutations in the group with a family history of breast cancer or ovarian cancer was higher than in the group without a family history (40.91% vs 11.54%) (χ2=6.534,P=0.011).Conclusion BRCA1/2 pathogenic mutation is significant for early-onset breast cancer,especially for those with a family history of breast or ovarian cancer.The new mutations may be specific to Chinese people.BRCA1:c.5470_5477delTGCCCAAT may be the ancestor mutation among the Chinese.

Core needle biopsy for molecular classification of breast cancer / 中华普通外科杂志

Objective To evaluate core needle biopsy (CNB) in detecting estrogen receptor (ER) and progesterone receptor (PR) of HER2,Ki67,and molecular classification of breast cancer.Methods Clinical data of 188 breast cancer patients admitted from Nov 2012 to Jun 2015,were retrospectively analyzed.All patients received both CNB and open excision biopsy (OEB).Immunohistochemistry (IHC) was used to evaluate the expression of ER,PR,HER2 and Ki67.All cases were categorized into four molecular subtypes:Luminal A,Luminal B,triple negative breast canccr and HER2 over-expression breast cancer.Kappa test was used to evaluate the consistency of CNB and OEB.Results Concordance rate of ER,PR,HER2 receptor status and Ki67 value were 94.68％,93.62％,94.68％ and 73.40％.There was no difference between CNB and OEB for non-Luminal tumors (P =0.774).Ki67 expression in OEB samples was higher than in CNB samples (25.90％ vs.21.65％,P ＜ 0.001).Concordance rate between CNB and OEB for molecular subtypes was 72.34％ (K =0.606 4).Conclusions CNB is accurate in evaluating ER,PR,HER2 and Ki67 in breast cancer.CNB is accurate in diagnosing non-Luminal molecular subtypes of breast cancer.

Correlation between expression of Ki-67 and Her-2 and clinical features in breast invasive ductal carcinoma / 军事医学

Objective To analyze the correlation between the expression of Ki-67 and Her-2 and clinical features in breast invasive ductal carcinoma .Methods Clinical and pathological data of 202 female breast invasive ductal carcinoma patients were collected between January 2012 and September 2014 .The correlation between the expression of Ki-67 and Her-2 and clinical features was analyzed .Results The positive rate of Ki-67 was 73.3%(148/202) and that of Her-2 was 19.3(39/202).The expression of Ki-67 was related to histological grading , ER and PR status(P0.05).The expression of Her-2 was related to ER and PR status (P0.05).Moreover, the low expression Ki-67 and negative expression of Her-2 were positvely corelated with the positive expression of hormone receptor [estrogen receptor(ER),pro-gestin receptor(PR)](P<0.05).Conclusion High expression of Ki-67 suggested that the differential grade of tumor was lower , malignant grade was higher , infiltration was stronger and metastasis was easier .High expression of Ki-67 and positive Her-2 suggests lower sensitivity to endocrine therapy and treatment .Detection of Ki-67 and Her-2 expression in breast inva-sive ductal carcinoma is of guiding significance for understanding the degree of malignancy and for evaluating prognosis .