Construction of a Prognostic Prediction Model of Patients with Pathologic N0 in Resected Invasive Mucinous Adenocarcinoma of the Lung / 中国肺癌杂志

BACKGROUND@#Invasive mucinous adenocarcinoma (IMA) was a rare and specific type of lung adenocarcinoma, which was often characterized by fewer lymphatic metastases. Therefore, it was difficult to evaluate the prognosis of these tumors based on the existing tumor-node-metastasis (TNM) staging. So, this study aimed to develop Nomograms to predict outcomes of patients with pathologic N0 in resected IMA.@*METHODS@#According to the inclusion criteria and exclusion criteria, IMA patients with pathologic N0 in The Affiliated Lihuili Hospital of Ningbo University (training cohort, n=78) and Ningbo No.2 Hospital (validation cohort, n=66) were reviewed between July 2012 and May 2017. The prognostic value of the clinicopathological features in the training cohort was analyzed and prognostic prediction models were established, and the performances of models were evaluated. Finally, the validation cohort data was put in for external validation.@*RESULTS@#Univariate analysis showed that pneumonic type, larger tumor size, mixed mucinous/non-mucinous component, and higher overall stage were significant influence factors of 5-year progression-free survival (PFS) and overall survival (OS). Multivariate analysis further indicated that type of imaging, tumor size, mucinous component were the independent prognostic factors for poor 5-year PFS and OS. Moreover, the 5-year PFS and OS rates were 62.82% and 75.64%, respectively. In subgroups, the survival analysis also showed that the pneumonic type and mixed mucinous/non-mucinous patients had significantly poorer 5-year PFS and OS compared with solitary type and pure mucinous patients, respectively. The C-index of Nomograms with 5-year PFS and OS were 0.815 (95%CI: 0.741-0.889) and 0.767 (95%CI: 0.669-0.865). The calibration curve and decision curve analysis (DCA) of both models showed good predictive performances in both cohorts.@*CONCLUSIONS@#The Nomograms based on clinicopathological characteristics in a certain extent, can be used as an effective prognostic tool for patients with pathologic N0 after IMA resection.

Clinicopathological characteristics of 83 lymph node- negative rectal neuroendocrine tumors / 中国肿瘤临床

Objective: To explore the clinicopathological characteristics of lymph node-negative rectal neuroendocrine neoplasms (R-NENs). Methods: We retrospectively analyzed and regularly followed up the clinical and pathological data of 83 patients with lymph node-negative rectal NENs treated at China-Japan Friendship Hospital between December 2012 to December 2019. Results: Among the 83 patients, 49 (59%) were male and 34 (41%) were female with an average age of (43.3±11.4) years. Of the patients, 61 (75.5%) were mainly treated for nonspecific symptoms, 75 (90.4%) had a single tumor with an average size of (0.8±0.7) cm, 80 (96.4%) showed tumor infiltration into the mucosal and submucosal layers, and 65 (78.3%) predominantly had tumors of pathological grade G1. The average Ki-67 index was (2.1±1.7) %, with 78 (94%) patients having stage I tumors. Twenty-nine (34.9%) patients showed CgA positivity on immunohistochemical analysis. As for treatment, 67 (80.7%) patients underwent endoscopic resection, and 16 (19.3%) patients underwent surgery. The median follow-up time was 24 (3-90) months, with a 100% 5-year survival rate and relapse in 2 (2.4%) patients. Tumor recurrence was significantly correlated with the Ki-67 positive index (P=0.025), and tumor infiltration depth was correlated with the tumor diameter (P=0.03). Kaplan-Meier analysis showed that different treatment mode and tumor grade on prognosis and recurrence was statistically significant (Log-rank P=0.031, 0.001). Conclusions: Lymph node-negative rectal neuroendocrine neoplasms with a diameter >1 cm infiltrate the muscularis propria relatively easily and those ≤1 cm may also infiltrate the muscularis propria. It is recommended that all patients undergo ultrasound enteroscope (EUS) to determine the treatment choice. Endoscopic resection is the main treatment for lymph node-negative rectal neuroendocrine neoplasms. Patients with a high Ki-67 index are relatively prone to relapse after treatment.

Correlation between CT Texture Analysis and Synchronous Distant Metastasis in Patients with Lymph Node-negative Colorectal Cancer / 中国医学科学院学报

Objective To investigate the correlation between CT texture analysis and synchronous distant metastasis in patients with lymph node-negative colorectal cancer. Methods The preoperative CT images of 82 patients with lymph node-negative colorectal cancer were analyzed retrospectively.There were 12 patients with simultaneous distant metastasis and 70 patients without simultaneous distant metastasis.The maximum plane of the lesion on plain scan and portal CT images was analyzed by TexRAD software.When the spatial scaling factor(SSF)was 0 and 2-6,six texture parameters were obtained,and the differences of texture parameters between the two groups were compared.The counting data were analyzed by chi-square test and the measurement data by Mann-Whitney test. Results There was a significant difference in the skewness of SSF=3 between the simultaneous distant metastasis group and the non-synchronous metastasis group on plain CT scan(

Detection of micrometastasis in axillary lymph nodes of breast carcinoma patients and its association with clinical outcome

Context: There is heterogeneity in the clinical behavior of breast carcinoma patients with node negativity. Studies have analyzed different factors influencing the outcome in such patients. It is suggested that the presence of nodal micrometastasis can act as a tool in predicting the aggressiveness of these tumors. Aims: The aim of this study is to assess the yield of micrometastasis/isolated tumor cell (ITC) by ultrastaging the morphologically negative axillary nodes and staining them with immunohistochemistry for epithelial membrane antigen. The association of such metastasis with the clinical outcome is determined. Settings and Design: This was a retrospective analytical study. One hundred cases of node-negative breast carcinoma patients who underwent surgery along with axillary lymph node dissection were selected. Materials and Methods: The largest node from the axillary dissection was selected and subjected to ultrastaging and immunohistochemical staining (as sentinel node dissection was not a routine practice at that time), to look for occult metastasis in the form of micrometastasis or ITCs. Statistical Analysis: Occurrence of events in the form of recurrence or death was noted. Association of the parameters was analyzed using Fisher's exact test. Results: Among the 100 cases, 79 patients were followed up for a minimum period of 5 years. Two cases had micromets in one node each. These two patients were among the eight, who developed events subsequently (25%). Hence, a statistically significant association was found between the presence of micromets with events. Conclusions: There is a statistically significant association between the presence of micromets and disease recurrence. Hence, we suggest that ultrastaging of the negative axillary node (now sentinel node, as it is being routinely done) might prove effective in predicting the events/prognosis in clinically and morphologically node-negative breast carcinoma patients

Clinical value of central lymph node dissection and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma / 上海交通大学学报（医学版）

Objective: To evaluate central lymph node dissection (CLND) and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma (PTMC). Methods: Clinical data and neck lymph node metastasis of 187 PTMC patients treated by the same surgeon from October 2012 to November 2015 in Department of Endocrine Breast Surgery, First Affiliated Hospital of Chongqing Medical University were analyzed retrospectively. Results: Postoperative pathology inspection confirmed that 94 of the 187 patients were accompanied with lymph node metastasis in central region, and the metastasis rate was 50.2%. Furthermore, lymph node metastasis rate in central region was not associated with gender and age (P>0.05), but the metastasis rates of the patients with multifocal lesion, tumor diameter greater than 5 mm, capsular invasion, or tumor location in the lower third of thyroid lobe were higher (P<0.05). Twenty-two cases of the 69 patients who underwent CLND were confirmed to have lymph node metastasis in this region. When the number of lymph node metastases in the central region was greater than or equal to 2, the cases were accompanied by increased risk of lymph node metastasis in the cervical region (P<0.05). The diagnosis level of lymph node metastasis in central region by intraoperative frozen-section examination was relatively higher than current cervical lymph node-negative (cN0) standard (P<0.05), which had lower false negative rate (20.2%) than current cN0 standard (88.8%) and was highly consistent with the postoperative pathology in central lymph node metastasis diagnosis (K=0.765, P=0.000). Conclusion: PTMC has high lymph node metastasis rate in the central region. Regular CLND is recommended. Intraoperative frozen-section examination can accurately evaluate cervical lymph node metastasis to help guide operation scope of thyroid and cervical lymph nodes.

Clinical value of central lymph node dissection and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma / 上海交通大学学报（医学版）

Objective·To evaluate central lymph node dissection (CLND) and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma (PTMC).Methods· Clinical data and neck lymph node metastasis of 187 PTMC patients treated by the same surgeon from October 2012 to November 2015 in Department of Endocrine Breast Surgery,First Affiliated Hospital of Chongqing Medical University were analyzed retrospectively.Results · Postoperative pathology inspection confirmed that 94 of the 187 patients were accompanied with lymph node metastasis in central region,and the metastasis rate was 50.2％.Furthermore,lymph node metastasis rate in central region was not associated with gender and age (P＞0.05),but the metastasis rates of the patients with multifocal lesion,tumor diameter greater than 5 mm,capsular invasion,or tumor location in the lower third of thyroid lobe were higher (P＜0.05).Twenty-two cases of the 69 patients who underwent CLND were confirmed to have lymph node metastasis in this region.When the number of lymph node metastases in the central region was greater than or equal to 2,the cases were accompanied by increased risk of lymph node metastasis in the cervical region (P＜0.05).The diagnosis level of lymph node metastasis in central region by intraoperative frozen-section examination was relatively higher than current cervical lymph node-negative (cN0) standard (P＜0.05),which had lower false negative rate (20.2％) than current cN0 standard (88.8％) and was highly consistent with the postoperative pathology in central lymph node metastasis diagnosis (K=0.765,P=0.000).Conclusion· PTMC has high lymph node metastasis rate in the central region.Regular CLND is recommended.Intraoperative frozen-section examination can accurately evaluate cervical lymph node metastasis to help guide operation scope of thyroid and cervical lymph nodes.

Value of bilateral central neck dissection in patients with clinically node-negative papillary thyroid microcarcinoma / 中华内分泌外科杂志

Objective To study the risk factors of lymph node metastasis in the central neck compartment of thyroid carcinoma,and to explore the reasonable range of lymph node dissection in central neck dissection for clinically node-negative papillary thyroid microcarcinoma patients.Methods From Dec.2015 to Dec.2016,a total of 200 patients with CN0 papillary thyroid carcinoma were randomly divided into two groups according to the registration number:unilateral central neck dissection group and bilateral central neck dissection group in Department of Thyroid Surgery,Fujian Medical University Union Hospital.The risk factors of lymph node metastasis and value of bilateral central neck dissection were analyzed.Results The risk factors of lymph node metastasis in the central papillary thyroid carcinoma were ≥0.7 cm in diameter and older than 45 years in age and gender in male.Further analysis found that contralateral central lymph node metastasis occurred in patients with tumor diameter ≥0.5 cm.The positive rate was 22％.The number of lymph nodes detected in the unilateral and bilateral central areas was 9.53±6.04 and 12.19±7.18,P=0.035,respectively.The positive numbers of lymph nodes were 1.17±1.47 and 2.11±2.75,P=0,022 respectively.Conclusion In patients with tumor diameter ≥0.5 cm,bilateral central neck dissection is conducive to improving the thoroughness of tumor dissection and does not increase the risk of complications.

Risk factors of lymph node metastasis in cN0 papillary thyroid carcinoma / 中国癌症杂志

Background and purpose:Pathological lymph node metastasis (LNM) is not rare in clinical lymph node negative (cN0) papillary thyroid carcinoma (PTC). The aim of this study was to investigate the risk factors of LNM, especially of high volume LNM (more than 5 metastatic lymph nodes) and contralateral central compartment LNM, in cN0 PTC.Methods:Medical records of 350 PTC patients (265 female, 85 male, 212 patients with solitary lesion in unilateral lobe) were reviewed. All operations of these patients were performed by one surgical team. The clinical pathological data were collected, and univariate and multivariate analysis was performed.Results:LNM was conifrmed in 138 patients (39.4%) and 20 patients had high volume LNM. In 169 patients with solitary lesion in unilateral lobe with total thyroidectomy and bilateral central neck dissection, 24 patients had contralateral metastasis (14.2%). In univariate analysis, tumor size (58.5% in >1 cmvs 33.6% in≤1 cm) and tumor with calcification in preoperational ultrasonography (43.7% withvs 31.7% without) showed signiifcant difference in prevelance of LNM. In multivariate analysis, tumor size >1 cm (OR=2.792) was the independent risk factor of LNM. Gender (3.8% in male vs 11.8% in female), age (10.7% 1 cmvs 3.4% in≤1 cm) and tumor with low echo in preoperational ultrasonography (13.9% withvs 4.8% without) showed signiifcant difference in univariate analysis of high volume LNM. Male (OR=5.152), tumor size >1 cm (OR=5.712) and age 1 cm (OR=3.863) were also demonstrated as independent risk factors of contralateral LNM in patients with solitary lesion in unilateral lobe, the prevalence of LNM were 26.5% in male and 26.1% in tumor size >1 cm, respectively.Conclusion:LNM was not “rare” in cN0 PTC patients. Prophylactic central neck dissection should be performed in cN0 patients with tumor size >1 cm. For cN0 microcarcinoma, more active surgical treatment may be considered in male and young patients.

Analysis of clinicopathological factors for node-negative colon cancer patients with synchronous liver metastases / 中国肿瘤临床

Objective:To explore the clinicopathological factors in node-negative colon cancer patients with synchronous liver metasta-ses and to improve the efficiency of follow-up and rate of early diagnosis for high-risk patients. Methods:Clinical data of 140 colon cancer patients who underwent operation from January 2008 to December 2012 in Beijing Cancer Hospital were analyzed. The high-risk variables associated with synchronous liver metastases were subjected to univariate and multivariate analyses. Results:Synchro-nous liver metastases developed in 13 out of the 140 node-negative colon cancer patients. Eight out of those 13 patients (61.5%) ex-hibited complications with incomplete colon obstruction, and 6 cases underwent surgical treatment for both primary tumor and liver metastases. Both univariate and multivariate analyses revealed that preoperative abnormal serum carcinoembryonic antigen levels (≥5 ng/mL) and vascular invasion were significant independent risk factors for synchronous liver metastases. Conclusion:The risk of syn-chronous liver metastases for colon cancer patients with negative lymph node is slightly high. Vascular invasion and abnormal preoper-ative CEA levels are significant independent risk factors for synchronous liver metastases. Specific examination of livers is necessary for the special cohort at the time of diagnosis or after operation to avoid misdiagnosis.

Research progress on recurrence and metastasis factors for node negative breast cancer and its impact on treatment decisions / 实用肿瘤学杂志

Node negative breast cancer is a prevalent form of breast cancer .With the improvement of breast cancer screening and disease awareness ,the rates of node negative breast cancer are gradually increasing . Although node negative breast cancer patients have much lower recurrence rates as compared with node positive patients,node-negative breast cancer is unequal to a low risk disease .Thus,it is important for oncologist to esti-mate the risk factors of node negative disease ,to carry out risk assessment and to guide the best regimen for these patients.In current review ,we discuss the value of traditional prognostic factors and new prognostic factors ,such as the urokinase -type plasminogen activator/plasminogen activator inhibitor 1,oncotype DX,MammaPrint and tumor associated macrophages ,on the predictive and treatment decisions in node negative breast cancer .

Application of central region cervical lymph nodes dissection in papillary thyroid microcarcinoma with clinically node-negative sides of neck stage / 中国医师进修杂志

Objective To analyze the application value of central region cervical lymph nodes dissection in papillary thyroid microcarcinoma (PTMC) with clinically node-negative sides of neck stage.Methods Clinical data of 72 PTMC patients with clinically node-negative sides of neck stage were collected,and they were underwent total thyroidectomy,isthmic portion excision and contralateral lobus glandularis excision and neck dissection.A long term follow-up was made.Results Twenty-four patients were found central region cervical lymph nodes metastasis while other 48 patients were not found central region cervical lymph nodes metastasis.Followed up for 1.5-4.5 (3.4 ± 1.1) years,4 patients were found recurrent laryngeal nerve paralysis and recovered within 4 months.Four patients were found central region cervical lymph nodes metastasis after operation the 3rd years.Conclusions There is a tendency for PTMC patients with clinically node-negative sides of neck stage to occur central region cervical lymph nodes metastasis,it's necessary to perform prophylactic central region dissection.It can decrease the complications and improve the prognosis.

Effect of tumor length on clinicopathologied and prognosis of node-negative esophageal carcinoma patients / 中国癌症杂志

Background and purpose:At present, the relationship between tumor length and prognosis of esophageal carcinoma patients has been a controversial topic, and there have been few studies describing the effect of tumor length on clinicopathology and prognosis of node-negative esophageal carcinoma patients. The purpose of this study was to investigate the effect of the tumor length on clinicopathology and prognosis of node-negative esophageal carcinoma patients.Methods:The clinicopathological characteristics and survival time of 686 node-negative esophageal carcinoma patients, conifrmed by surgical pathology specimens in the First Afifliated Hospital of Nanjing Medical University from Jan. 2008 to Dec. 2010, were retrospectively analyzed. The optimal cut-off value was determined by decision tree model. Univariate and multivariate methods were used to analyze the prognostic factors of node-negative esophageal carcinoma patients.Results:In decision tree analysis, esophageal tumor length was correlated with an increasing hazard ratio for death with a cut-off value at 3 cm. No signiifcant differences were found in gender, onset age, lesion site and pathological type between 2 groups which were patients with tumor length≤3 cm and tumor length >3 cm (P>0.05). The only 1 difference between 2 groups was T stage (P3 cm were 95.7%, 84.4%, 76.1% and 88.3%, 57.8%, 46.5% respectively, and the difference was statistically signiifcant (P3 cm as T3. Tumor length is an important prognostic factor for esophageal carcinoma patients without lymphatic metastasis.

An unusual case of invasive papillary carcinoma of the breast.

Invasive papillary carcinoma is a rare variant of breast cancer. We report an unusual case of invasive papillary carcinoma of the breast with high nuclear grade, brisk mitosis, necrosis, extensive apocrine differentiation, and intense lymphoplasmacytic infiltrate; additionally triple-negativity for estrogen and progesterone receptors and Her2 neu. The patient underwent modified radical mastectomy and adjuvant chemotherapy. But, it was a node negative breast carcinoma. Increasing the awareness of this clinicopathologic entity would be helpful in avoiding overtreatment of patients with this cancer even if the tumor has negative morphological and immunohistochemical prognosticators.

Prognostic Factors on Overall Survival in Lymph Node Negative Gastric Cancer Patients Who Underwent Curative Resection

PURPOSE: To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. MATERIALS AND METHODS: Among 1,874 gastric cancer patients who received curative resection, 967 patients were lymph node-negative. Independent prognostic factors for overall survival in lymph node-negative gastric cancer patients grouped by tumor invasion depth (early gastric cancer versus advanced gastric cancer) were explored with univariate and multivariate analyses. RESULTS: There was a significant difference in the distribution of recurrence pattern between lymph node-negative and lymph node-positive group. In the lymph node-negative group, the recurrence pattern differed by the depth of tumor invasion. In univariate analysis for overall survival of the early gastric cancer group, age, macroscopic appearance, histologic type, venous invasion, lymphatic invasion, and carcinoembryonic antigen level were significant prognostic factors. Multivariate analysis for these factors showed that venous invasion (hazard ratio, 6.695), age (> or =59, hazard ratio, 2.882), and carcinoembryonic antigen level (> or =5 ng/dl, hazard ratio, 3.938) were significant prognostic factors. Multivariate analysis of advanced gastric cancer group showed that depth of tumor invasion (T2 versus T3, hazard ratio, 2.809), and age (hazard ratio, 2.319) were prognostic factors on overall survival. CONCLUSIONS: Based on our results, independent prognostic factors such as venous permeation, carcinoembryonic antigen level, and age, depth of tumor invasion on overall survival were different between early gastric cancer and advanced gastric cancer group in lymph node-negative gastric cancer patients. Therefore, we are confident that our results will contribute to planning follow-up strategies.

Prognostic Factors on Overall Survival in Lymph Node Negative Gastric Cancer Patients Who Underwent Curative Resection

PURPOSE: To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. MATERIALS AND METHODS: Among 1,874 gastric cancer patients who received curative resection, 967 patients were lymph node-negative. Independent prognostic factors for overall survival in lymph node-negative gastric cancer patients grouped by tumor invasion depth (early gastric cancer versus advanced gastric cancer) were explored with univariate and multivariate analyses. RESULTS: There was a significant difference in the distribution of recurrence pattern between lymph node-negative and lymph node-positive group. In the lymph node-negative group, the recurrence pattern differed by the depth of tumor invasion. In univariate analysis for overall survival of the early gastric cancer group, age, macroscopic appearance, histologic type, venous invasion, lymphatic invasion, and carcinoembryonic antigen level were significant prognostic factors. Multivariate analysis for these factors showed that venous invasion (hazard ratio, 6.695), age (> or =59, hazard ratio, 2.882), and carcinoembryonic antigen level (> or =5 ng/dl, hazard ratio, 3.938) were significant prognostic factors. Multivariate analysis of advanced gastric cancer group showed that depth of tumor invasion (T2 versus T3, hazard ratio, 2.809), and age (hazard ratio, 2.319) were prognostic factors on overall survival. CONCLUSIONS: Based on our results, independent prognostic factors such as venous permeation, carcinoembryonic antigen level, and age, depth of tumor invasion on overall survival were different between early gastric cancer and advanced gastric cancer group in lymph node-negative gastric cancer patients. Therefore, we are confident that our results will contribute to planning follow-up strategies.

Prognostic Factors Influence on the Systemic Recurrence in Axillary Lymph Node Negative Breast Cancer

PURPOSE: Axillary lymph node metastasis is one of the most important prognostic factors in breast cancer. Previous reports show differences that clinicopathologic factors influence the systemic recurrence and survival in axillary lymph node negative breast cancer. Thus, we have attempted to determine the prognostic factors influence on the systemic recurrence and survival in axillary lymph node negative breast cancer. METHODS: We retrospectively reviewed the data of 1,351 node negative breast cancer patients who underwent curative surgery to determine the prognostic factors such as age, sex, body mass index (BMI), family history, bilateral breast cancer, operation method, tumor size, stage, histologic grade, number of resected lymph nodes, hormone receptor status, overexpression of p53 and c-erbB2, and adjuvant therapy that influence the systemic recurrence and 10-year-distant relapse-free survival. RESULTS: Systemic recurrence occurred in 58 patients (4.3%) during 53.3 months median follow up period. The tumor size (P=0.001), stage (P=0.005), histologic grade (P=0.049). ER (P=0.028), PR (P=0.002), overexpression of p53 (P=0.001) and bilateral breast cancer (P=0.043) were statistically significant factors that influenced the systemic recurrence. In multivariate analysis, only tumor size was associated with the systemic recurrence (P=0.003). Tumor size (P=0.004), histologic grade (P=0.035), ER (P=0.046), PR (P=0.001) and bilateral cancer (P=0.003) were statistically significant factors that influenced 10-year-distant relapse-free survival. CONCLUSION: The larger tumor size was determined to be an independent prognostic value in axillary lymph node negative breast cancer.

Prognostic Factors of Advanced Gastric Cancer Patients without Lymph Node Metastasis

PURPOSE: This study was conducted to identify prognostic factors in gastric cancer without lymph node metastasis and to specifiy which prognostic factors can be available in detail according to the depth of invasion. MATERIALS AND METHODS: This retrospective study was based on the medial records of 268 gastric cancer patients who received resectional therapy from 1990 to 1999. The patients who revealed pT2NOMO, pT3NOMO, pT4NOMO on postoperative pathologic reports were enrolled. The survival rate was analyzed according to clinicopathologic and therapeutic factors. RESULTS: According to the depth of invasion, the number of patients with pT2a, pT2b, pT3 and pT4 were 86 (32.1%), 56 (20.9%), 108 (40.3%), and 18 (6.7%) respectively. Age, depth of invasion, histological type, Borrmann type, and Lauren classification were statistically significant in the univariate analysis, and the age, the depth of invasion, and Lauren classification were independent prognostic factors identified by multivariate analysis. On multivariate analysis of subgroups according to the depth of invasion, the independent prognostic factors were age, Borrmann type, and Lauren classification in pT2, and age, Lauren classification , and vascular invasion in pT3. The prognostic factors of pT4 patients could not be analyzed due to limited sample size. CONCLUSION: In advanced gastric cancer patients without lymph node metastasis, age, the depth of invasion, and Lauren classification should be checked to predict prognosis. In patients with pT2 lesion among the above patients, the Borrmann type should be added in check-list.

Usefulness of Ki-67 as a prognostic factor in lymph node-negative breast cancer / 한국유방암학회지

PURPOSE: To evaluate the independent prognostic value of Ki-67 in lymph node-negative breast cancer and the usefulness of Ki-67 when it combined with St. Gallen classification as a guidance of adjuvant chemotherapy for node-negative cancer. METHODS: We retrospectively reviewed the data of 534 patients with lymph node-negative breast cancer who underwent curative surgery between 1998 and 2001 at our institution. Patients were classified according to the guideline of risk groups of St. Gallen consensus and the level of Ki-67 expression. Distant metastasis-free survival (DFS) rates were compared between groups. RESULTS: With a median follow-up of 55 months, the overall 5-year DFS rate was 91.5%. The 5-year DFS rates for patients with high and low Ki-67 tumors (cut-off value: > or = 10%) were 84.6% and 93.7%, respectively (p < 0.001). In a Cox regression model involving potential prognostic factors, high Ki-67 expression could independently predict the risk of distant recurrence (odds ratio = 2.0 [95% confidence interval, 1.03-3.93]). The 5-year DFS rates for patients with average and minimal risk group of St. Gallen classification were 89.3% and 97.5%, respectively. The average risk group was further divided into two subgroups with significantly different prognosis according to the Ki-67 expression (DFS rate: 84.2% vs. 91.5%; p = 0.007). CONCLUSIONS: Ki-67 was an independent prognostic factor in lymph node-negative breast cancer and the combination of Ki-67 expression and the St. Gallen classification could provide a more useful therapeutic guideline for lymph node-negative breast cancer patients.

Usefulness of Ki-67 as a prognostic factor in lymph node-negative breast cancer / 한국유방암학회지

PURPOSE: To evaluate the independent prognostic value of Ki-67 in lymph node-negative breast cancer and the usefulness of Ki-67 when it combined with St. Gallen classification as a guidance of adjuvant chemotherapy for node-negative cancer. METHODS: We retrospectively reviewed the data of 534 patients with lymph node-negative breast cancer who underwent curative surgery between 1998 and 2001 at our institution. Patients were classified according to the guideline of risk groups of St. Gallen consensus and the level of Ki-67 expression. Distant metastasis-free survival (DFS) rates were compared between groups. RESULTS: With a median follow-up of 55 months, the overall 5-year DFS rate was 91.5%. The 5-year DFS rates for patients with high and low Ki-67 tumors (cut-off value: > or = 10%) were 84.6% and 93.7%, respectively (p < 0.001). In a Cox regression model involving potential prognostic factors, high Ki-67 expression could independently predict the risk of distant recurrence (odds ratio = 2.0 [95% confidence interval, 1.03-3.93]). The 5-year DFS rates for patients with average and minimal risk group of St. Gallen classification were 89.3% and 97.5%, respectively. The average risk group was further divided into two subgroups with significantly different prognosis according to the Ki-67 expression (DFS rate: 84.2% vs. 91.5%; p = 0.007). CONCLUSIONS: Ki-67 was an independent prognostic factor in lymph node-negative breast cancer and the combination of Ki-67 expression and the St. Gallen classification could provide a more useful therapeutic guideline for lymph node-negative breast cancer patients.

Significance of Akt Expression in Node-negative Breast Cancer

BACKGROUND: Patients with lymph node-negative breast cancer show a 10-year recurrence rate of approximately 20%. In node-negative breast cancer, the prognostic factors are age, menopause, tumor size, hormone receptors, p53, DNA ploidy, Ki-67 index (Ki-67) and c-erbB2. Of these, ErbB2 (the protein of the c-erbB2 gene) is a member of the receptor tyrosine kinase family. Overexpression of ErbB2 is known to regulate cell proliferation, differentiation, growth and apoptosis via the ErbB2/Phosphoinositol 3-Kinase (PI 3-K)/Akt signaling pathway. Therefore, it is important to identify high- risk patients that would benefit from adjuvant therapies related with ErB2. For this purpose, the prognostic relevance of the ErbB2/PI 3-K/Akt pathway was examined in node-negative breast cancer. METHODS: A retrospective analysis was performed on the hospital records of all 72 patients diagnosed with breast cancer, and who underwent surgical treatment between January 1996 and December 2003. Clinicopathological data were compared with the results of immunohistochemical staining using the phospho-specific antibody for the expression of Akt. RESULTS: The mean age of the patient's was 48.6 years. Phospho-Akt (pAkt) was expressed in 24 cases (33.3%), but there was no statistical relationship between pAkt expression and the known prognostic factors of breast cancer. There was no statistical significance in the survival rates between the pAkt positive and negative expression groups (P=0.123). In the ErbB2 positive patients, the expression of pAkt was associated with a shorter disease-free survival (P=0.045), and the disease-free survival was shorter in patients whose tumors expressed pAkt and had a high level of Ki-67 (P=0.040). CONCLUSION: The co-expression of ErbB2 and pAkt positivity implied a poor prognosis in node-negative breast cancer patients, and the co-expression of high Ki-67 and pAkt positivity also revealed a poor prognosis in these patients. These results show that the expression of pAkt could be considered a prognostic marker of node-negative breast cancer with ErbB2 positive expression and high levels of Ki-67.