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Objective:To analyze the clinicopathological features, survival and related prognostic factors of encapsulated papillary carcinoma (EPC) of breast.Methods:Data on EPC and invasive ductal carcinoma (IDC) of the breast from January 2010 to December 2015 were searched and screened using the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to adjust for baseline confounding between the EPC and IDC groups. The Kaplan-Meier method was used to calculate cumulative survival curves for overall survival (OS) and breast cancer-specific survival (BCSS). Prognostic value of these factors were assessed by univariate Log-rank test and multivariate Cox regression analysis.Results:In this study, 184 524 patients with IDC and 175 patients with EPC were included. Compared with patients with IDC, patients with EPC over 60 years old had a higher proportion, a lower rate of lymph node metastasis, and a higher proportion of estrogen receptor positive, progesterone receptor positive and human epidermal growth factor receptor 2 negative ( P<0.05). After PSM adjustment, OS of patients with EPC was worse than that of IDC, and BCSS was better than that of IDC ( P<0.05). Univariate and multivariate analysis showed that age, surgical approach and N stage were associated with poorer OS, while surgery approach, T stage, N stage and molecular typing were associated with worse BCSS ( P<0.05). Conclusions:Compared with IDC, EPC of breast has better BCSS and lower lymph node metastasis rate. There is a certain correlation between tumor stage and molecular type and prognosis of EPC.
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BACKGROUND@#Pathological complete response (pCR) of axillary lymph nodes (ALNs) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC), and ALN status is an important prognostic factor for breast cancer patients. This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.@*METHODS@#This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR. A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients. The adjusted area under the receiver operating characteristic curve (AUC) was calculated to quantify the ability to rank patients by risk. Internal validation was performed using the 50/50 hold-out validation method. The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.@*RESULTS@#In this retrospective study, 115 (24.6%) patients achieved ALN pCR after NAC. Multivariate analysis showed that clinical tumor stage (Odds ratio [OR]: 0.321, 95% confidence interval [CI]: 0.121-0.856; P = 0.023); primary tumor response (OR: 0.189; 95% CI: 0.123-0.292; P < 0.001), and estrogen receptor status (OR: 0.530, 95% CI: 0.304-0.925; P = 0.025) were independent predictors of ALN pCR. The nomogram was constructed based on the result of multivariate analysis. In the internal validation of performance of nomogram, the AUCs for the training and test sets were 0.719 and 0.753, respectively. The nomogram was validated in external cohorts with AUCs of 0.720, which demonstrated good discriminatory power in these data sets.@*CONCLUSION@#We developed a nomogram to predict the likelihood of axillary pCR in node-positive breast cancer patients after NAC. The predictive model performed well in multicenter prospective external validation. This practical tool could provide information to surgeons regarding whether to perform additional ALN dissection after NAC.@*TRIAL REGISTRATION@#ChiCTR.org.cn, ChiCTR1800014968.
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Female , Humans , Breast Neoplasms/drug therapy , Lymph Nodes , Lymphatic Metastasis , Neoadjuvant Therapy , Nomograms , Prospective Studies , Retrospective StudiesABSTRACT
Objective To investigate the effect of breast conserving surgery on neurotensin (NTS) and its receptor 1(NTR1) in patients with breast cancer.Methods From May 2012 to May 2015,200 patients with breast cancer,aged 44.7 years(range,32-56 years),were treated at Tiantan Hospital,Capital Medical University.All patients were divided into control group (n =100) and observation group (n =100).The patients in the control group were treated with radical operation and the patients in the observation group were treated with breastconserving surgery.The positive rate of NTS and NTR1 before and 1 week after operation,WHOQOL-100 (It includes four aspects:physiological state,psychological state,environmental condition and social function) 1 d before surgery,3 months and 6 months after surgery,and the incidence of postoperative complications 1 week after surgery were compared between the two groups.Measurement data with normal distribution were described as mean± standard deviation (Mean ± SD) and analyzed by the t test.Count data were analyzed by chi-square test.Results The positive rate of NTS (17.00％) in the observation group was significantly lower than that in the control group (36.00％) (t =9.267,P =0.002),The positive rate of NTR1 (19.00％) was significantly lower than that in the control group (33.00％) (t =5.094,P =0.024).The physiological status,psychological state,environmental condition and social function of 3 months after surgery of the observation group were (62.57 ± 5.73),(63.48 ±5.91),(68.73 ±6.32),(64.06 ±5.94) scores,respectively,and the control group were (53.47 ±5.38),(55.62 ±5.54),(60.38 ±6.14),(55.86 ±5.66) scores,respectively,showing statistically significant differences between the two groups (P ＜ 0.05).The physiological status,psychological state,environmental condition and social function of 6 months after surgery were (73.74 ±t 6.19),(76.27 ± 6.32),(78.85 ±6.77),(73.53 ±6.58) scores in the observation group,and (64.18 ±5.67),(67.38 ±6.02),(69.64 ± 6.43),(63.28 ± 6.17) scores in the control group,showing statistically significant differences between the two groups (P ＜ 0.05).The incidence of postoperative complications in the observation group (6.00％) was significantly lower than that in the control group (18.00％) (P ＜ 0.05).Conclusion Breast conserving surgery can reduce the expression level of NTS and NTR1 in breast cancer patients,It is related to reducing the incidence of postoperative complications and improving the quality of life of patients.
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Objective To study on the impact of medical environment on the life meaning of med-ical students. Methods A stratified sampling method was used to investigate 220 medical students in September 2013. The content of the survey includes the evaluation of the doctor-patient relationship, the evaluation of the medical ethics of medical personnel, and the influencing factors of the life meaning of medical students. SPSS 19.0 was used to make the chi-square test and multiple linear regression analysis of the data. Results For the evaluation of the current social present situation and doctor-patient relationship, there is statistical difference (P<0.05) between the students of different sex, the student cadres and the non-student cadres. For the medical ethics present situation evaluation, there is statistically significant difference of evaluation (P<0.05) between student cadres and non-student cadres and students with different professional interests. Average score of life meaning is 85.8 points, and whether students like the profession, the current view of the doctor-patient relationship, and the current study and work conditions are the main impact factors affecting the medical students' sense of meaning of life in. Conclusions To enhance medical students' sense of life, we need to attach importance to clinical practice, strengthen professional ideological education, guide students to learn actively, and make objective and rational evaluation of medical status.
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Objective To investigate the conditions of family function of rehabilitative breast cancer patients and its related factors. Methods Self-administrated questionnaire and the family APGAR (adaptation, partnership, growth, affection, resolve) index questionnaire were used in 245 breast cancer patients to investigate their general and illness information, and their family APGAR index. The factors relat-ed with the family function of breast cancer patients were analyzed. Results The APGAR score of the participants was (7.51±1.17), and the condition of family was graded from good (73.5%), moderate impairment (21.2%) to severs impairment (5.3%). The multiple regression analysis found that the stage of the disease (β=-9.671), the condition of marriage (β=8.29) and their social activities (β=7.402) related with the APGAR index in rehabilitative breast cancer patients. Conclusion The family function needs attention, especially the metastasis ones in breast cancer patients. A healthy marriage and beneficial socialization contribute to keep good family function.
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Objective To explore the effect of large group psychological intervention mode on coping style of patients with breast can-cer. Methods 420 patients with breast cancer participated in the Rukang Salon, a large group psychological intervention, were investigated with the Simplified Coping Style Questionnaire and self-administrated questionnaire before and after intervention, respectively. Results The score of coping style of the patients significantly improved after the intervention (P<0.01). Conclusion It is effective in the large group psy-chological intervention on coping style of patients with breast cancer, more often in positive coping style and less in negative coping style.
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@#Objective To investigate the life satisfaction and its related factors in primary caregivers of breast cancer patients. Methods The Life Satisfactory Index A (LSIA) and self-administrated questionnaire were used. The life satisfaction between breast cancer patients'primary caregivers and breast benign patients' primary caregivers were compared. The factors of the life satisfaction in primary caregivers of breast cancer patients were analyzed. Results The life satisfaction was poorer in the breast cancer patients' primary caregivers than in the breast benign patients' primary caregivers (P<0.01). The life satisfaction in the breast cancer patients' primary caregivers was correlated with the stage of breast cancer, course of disease, primary caregivers' age and family monthly income (P<0.05). Conclusion The life satisfaction in breast cancer patients' primary caregivers is worse and is related with stage of breast cancer, course of disease, primary caregivers' age and family monthly income.
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@#The effects of different methods of psychological treatment in psychological rehabilitation of breast cancer patients were reviewed. Group psychotherapy is the best choice of breast cancer patients for psychological rehabilitation.
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With the development of systemic therapy for the treatment of breast cancer, the incidence of brain metastases from breast cancer is gradually increasing. Treatment with surgery,stereotactic radiosurgery, and wholebrain radiotherapy (WBRT) are still the first-line therapies for the majority of patients with brain metastases. Recently, chemotherapy, hormone therapy and targeted therapy have been widely used for breast cancer. This review summarizes the efficiency of those strategies for the breast cancer patients with brain metastases.