Clinical observation of the immediate breast reconstruction following breast-conserving surgery for centrally located breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical efficacy of the immediate breast reconstruction following breast-conserving surgery for centrally located breast cancer.</p><p><b>METHODS</b>From January of 2006 through December of 2011, 30 women with centrally located breast cancer of stage I or II was treated by breast-conserving surgery removing or not removing the nipple-areola complex. All the patients received immediate breast reconstruction with adjacent gland tissue flap or latissimus dorsi myocutaneous flap. The breast shape and complication were observed. All the patients were followed up.</p><p><b>RESULTS</b>The thirty women underwent the breast-conserving surgery successfully, in which 12 cases received immediate breast reconstruction with adjacent gland tissue flap and 18 cases received immediate breast reconstruction with latissimus dorsi myocutaneous flap. The superior rate of the aesthetic effect was 90% (27/30) according to JCRT in one week or six months after surgery. No recurrence and metastasis were observed after a median follow-up of 38 months ( range 4-72 months).</p><p><b>CONCLUSION</b>The immediate breast reconstruction following breast-conserving surgery for centrally located breast cancer at early stage is satisfactory for the aesthetic result and clinical efficacy, and deserves further clinical application.</p>

Risk factors related to female breast cancer in regions of Northeast China: a 1:3 matched case-control population-based study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There has been an increase in the incidence of breast cancer in China, but no definite risk and protective factors for breast cancer have been identified in Chinese females. This study was designed to identify the risk factors for female breast cancer in North and East China.</p><p><b>METHODS</b>A 1:3 matched, case-control study was conducted. All of the subjects in the case and control groups were selected from a previous epidemiological survey of 122 058 females aged 25 to 70 years. Single and multiple Logistic regression analyses were used to study potential factors in the development of breast cancer.</p><p><b>RESULTS</b>Significant differences at the level of α=0.20 between case and control groups were observed for the following factors: economic status, social status, family annual income, bean product consumption, body mass index (BMI), family history of breast cancer in the first or second degree, number of miscarriages, menstrual pattern, benign breast disease history, nipple leakage, inverted nipple, history of diabetes mellitus, history of hypertension, history of ovarian cyst, physical exercise, current and global quality of life satisfaction, healthy behavior and prevention, and scores of breast cancer-related knowledge. After Cox-regression model analysis (α=0.10), six factors were found to be significantly related to breast cancer, of which the ORs and 95%CIs were: BMI, 1.696 (1.169-2.460, P=0.005); benign breast disease history, 2.672 (0.848-8.416, P=0.093); family history of breast cancer, 7.080 (1.758-28.551, P=0.006); number of miscarriages, 1.738 (1.014-2.978, P=0.044); global quality of life satisfaction, 3.044 (1.804-5.136, P=0.000); healthy behavior and prevention, 3.294 (1.692-6.412, P=0.000).</p><p><b>CONCLUSIONS</b>A comprehensive range of factors related to breast cancer was identified. Women should be educated about a healthy lifestyle, especially those with a family history of breast cancer or a personal history of benign breast disease.</p>

MTHFR polymorphisms, dietary folate intake and risks to breast cancer / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the relationship between dietary folate intake and genetic polymorphisms of 5, 10-methylenetetrahydrofolate reductase (MTHFR) with reference to breast cancer risk.</p><p><b>METHODS</b>A case-control study was conducted with 669 cases and 682 population-based controls in Jiangsu province of China. MTHFR C677T and A1298C genotypes were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. Dietary folate intake was assessed by using an 83-item food frequency questionnaire. Odds ratios (OR) were estimated with an unconditional logistic model.</p><p><b>RESULTS</b>The frequencies of MTHFR C677T C/C, C/T and T/T genotypes were 32.37% (202/624), 48.88% (305/624) and 18.75% (117/624) in cases and 37.66% (235/624), 48.24% (301/624) and 14. 10% (88/624) in controls, respectively. The difference in distribution was significant (chi2 = 6.616, P = 0.037), the T/T genotype being associated with an elevated OR for breast cancer (1.62, 95% CI: 1.14 -2.30). The frequencies of MTHFR A1298C A/A, A/C and C/C were 71.47% (446/624), 27.08% (169/624) and 1.44% (9/624) in cases and 68.11%(425/624), 30.13% (188/624) and 1.76% (11/624)in controls,with no significant differences found (chi2 = 1.716, P= 0.424). Folate intake of cases [(263.00 +/- 137.38) microg/d] was significantly lower than that of controls [(285.12 +/- 149.61) microg/d] (t = -2. 830, P =0.005). Compared with the lowest tertile (< or = 199.08 microg/d) of folate intake, the adjusted OR for breast cancer in the top tertile (> or = 315.11 microg/d) was 0.70 (95% CI: 0.53 -0.92). Among individuals with the MTHFR A1298C A/A genotype,adjusted OR for breast cancer were 0.89 (95% CI: 0.62 - 1.27) and 1.69 (95% CI: 1.20 - 2.36) for the second to the third tertile of folate intake compared with the highest folate intake group (X2trend = 11.372, P = 0.001).</p><p><b>CONCLUSION</b>The findings of the present study suggest that MTHFR genetic polymorphisms,and dietary intake of folate may modify susceptibility to breast cancer.</p>

Lesion localization and surgical resection for non-palpable breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the methods of lesion localization and surgical treatment for non-palpable breast cancer, presented with only small calcification lesion on the images.</p><p><b>METHODS</b>From November 2003 to August 2007, 61 patients with non-palpable lesion were finally pathologically diagnosed as early breast cancer (T1-2N0M0), based on the small calcification lesions shown by full field digital mammography (FFDM) through molybdenum target, and the rich blood supply shown by type-B ultrasonic examination. Accurate lesion-localization prior to surgical resection was conducted, and sample re-examination by FFDM was done after resection. Patients with single lesion underwent breast-conserving surgery, precise excision with the aid of image-guided wire localization, and stage I breast reconstruction was performed simultaneously using wide-based gland-tissue flap. Patients with multiple lesions received modified radical mastectomy.</p><p><b>RESULTS</b>Among the 50 patients treated with breast-conserving surgery, the accuracy of localization for lesions was 100% (50/50), and all lesions were excised completely with a negative margin proven by FFDM re-examination and pathological examination. The superior rate of mammaplasty was 86.0% (43/50) according to JCRT criteria, with a compliance difference of 1.5 cm. Modified radical mastectomy was performed in 11 patients. The follow-up period in this series was from 6 to 58 months with a mean follow-up time of 39 months. Distant metastases were detected in only one patient and local recurrence was not observed yet.</p><p><b>CONCLUSION</b>Lesion localization by FFDM in patients with non-palpable breast cancer is accurate and practical. In patients with single lesion, breast-conserving resection followed by synchronous stage I breast reconstruction with wide-based gland-tissue flap is appropriate.</p>

Establishment of a multiplex ligation-dependent SNP genotyping method and its application in the detection of genes related to chemotherapeutic drugs in breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To establish a method for SNP genotyping of multi-genes by allele-specific oligonucleotide probe ligation mediated by a thermostable ligase, and to explore the genetic polymorphisms of drug-metabolizing enzymes in breast cancer patients and their association with chemotherapeutic responses.</p><p><b>METHODS</b>10 SNP loci of enzyme genes related to chemotherapeutic drugs such as taxanes, anthracyclines and cyclophosphamide were selected, and were genotyped for blood samples from 126 breast cancer patients by the established method. Their correlations with therapeutic responses were retrospectively evaluated.</p><p><b>RESULTS</b>The lower detection limit of genomic DNA by this developed method was 6.25 ng. The fluorescent peak locations of ligation products on ABI PRISM 377 DNA sequencer were accurate and consistent with prospective sizes in bases (Bias range 0.08 - 0.69 bp, x(-) = 0.31 bp, s = 0.18 bp). Same genotyping results were obtained for repeat tests of 8 random samples, which were further confirmed by sequencing analysis. The 10 SNP loci were polymorphic of different frequency in the breast cancer patients. The combinations with GSTP1 genotypes and GSTM1 genotypes were related to anthracycline-based chemotherapy efficacy (P = 0.037), and the low GSTs activity group (GSTP1 variant allele + GSTM1 null) showed the best effects (85.7%). GSTM1 genotypes and their combinations with GSTP1 and/or CYP3A5*3 genotypes were related to taxane-based therapy efficacy (P < 0.05 for all), and both the low GSTs activity group and the drug slow-metabolising group (low GSTs activity group + CYP3A5*3 wild allele) showed better effects (100%).</p><p><b>CONCLUSION</b>The established method is reliable and applicable in multiplex SNPs genotyping of multi-genes. SNPs combination may have a better clinical application value for prediction of chemotherapeutic responses.</p>

Effects of chemotherapy on circulating angiogenic factor levels in patients with breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the changes in circulating VEGF and endostatin (ES) levels during chemotherapy for patients with breast cancer, and their correlation with efficacy of chemotherapy.</p><p><b>METHODS</b>40 breast cancer patients with metastases were included in this study. They received TAC/TEC, CAF/CEF, NP, CAP, CMF, TFP, TA or TC regime chemotherapy, respectively. Totally 120 serum samples were collected from the patients at three time points: before chemotherapy, the end of 1 and 5-6 chemotherapy cycles, and analyzed for VEGF and ES levels using ELISA. Tumor agiogenesis activity was evaluated by serum soluble vascular cell adhesion molecule (VCAM - 1) measured by ELISA as a surrogate marker.</p><p><b>RESULTS</b>(1) Before chemotherapy, the median level of VEGF in patients with breast cancer was 496.6 pg/ml, 4.7 times higher than that of healthy controls (P <0.001). The median level of ES was 95.5 ng/ml, 18.3% lower than that of healthy controls (P = 0.183). VCAM-1 was 1077.1 ng/ml and higher than that of controls (P <0.001). The serum VEGF levels correlated with VCAM-1 levels, tumor staging and metastatic sites (P <0.05). (2) At the end of 1 cycle of chemotherapy, the serum VEGF level (median 524.8 pg/ml) was higher than the pretreatment values (P = 0.047), whereas the levels of ES and VCAM-1 were not significantly altered (110.5 ng/ml, P = 0.055; and 975.6 ng/ml, P = 0.27). (3) At the end of 5-6 cycles, the changes in VEGF correlated with the response to chemotherapy. Serum VEGF levels in 27 patients with chemotherapy-responsive and stable disease showed a significant decrease (median 287.4 pg/ml) , but not observed in 13 patients with progressive disease. VCAM-1 also showed a treatment-related change like VEGF. However, chemotherapy might only have a minor effect on ES, because there was no significant difference in the ES levels among 5-6 cycle patients, 1 cycle patients and healthy controls, and neither between therapy-responsive patients.</p><p><b>CONCLUSION</b>Intensive chemotherapy for breast cancer results in a significant decrease of serum VEGF level, which might be an indicator of the controlled disease status, and following the treatment-induced response or stabilization, the tumor angiogenesis seems to change into an anti-angiogenesis direction.</p>