Efficacy analysis of THP-containing regimens as neoadjuvant and adjuvant chemotherapy for primary breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the effect of anthracycline pirarubicin-based regimen in association with different ways of fluorouracil (5-Fu) as neoadjuvant and adjuvant chemotherapy for primary breast cancer.</p><p><b>METHODS</b>Two hundred and eighty-nine primary breast cancer patients who were to be operated, two to eight cycles of pirarubicin in association with cyclophosphamide and 5-Fu (CTF or CTFci regimen) were given before operation. The pathological response rate, effect and its relation with the infusion routes of 5-Fu were analyzed.</p><p><b>RESULTS</b>The overall pathological complete remission (pCR) rate was 28.4%. The median follow-up period was 39 months. The 5-year DFS was 87.6% (95% CI:82.1% to 92.7%), 5-year DDFS was 89.9% (95% CI:84.0% to 95.8%), and overall survival was 99.6%. CTFci (5-Fu, continuous infusion) regimen was superior to CTF regimen in pCR rates (32.3% vs. 20.2%, P = 0.037), and 5-year DDFS were 92.9% and 80.1%, respectively (P = 0.015). The pCR group was superior to non-pCR group in 5-year DDFS (92.4% vs. 85.6%, P = 0. 033). The pCR rate of patients with ER/PR-positive tumor was significantly lower than those of ER/PR-negative (P = 0.004). The 5-year DDFS rates of HER-2 (+) and HER-2(-) groups were 75.0% and 91.9%, respectively (P = 0.043). In the ER/PR-positve group, the 5-year DDFS of CTFci regimen was superior to those of CTF regimen, 91.4% vs. 81.4% (P = 0.047).</p><p><b>CONCLUSIONS</b>CTF/CTFci regimen as neoadjuvant and adjuvant chemotherapy is effective for primary breast cancer. CTFci regimen is superior to CTF regimen in pathological complete response rate and 5-year DDFS. CTFci regimen may do better to ER/PR (+) patients' benefits compared with CTF regimen.</p>

Different influence of Her-2 expression on the prognosis in node-positive and node-negative breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the prognostic significance of Her-2 expression in node-positive and node-negative breast cancer in Chinese women.</p><p><b>METHODS</b>The Her-2 expression in breast cancers from 981 patients was detected by immunohistochemistry with anti-Her-2 (CB11) monoclonal antibody. The survival curves were analyzed by Kaplan-Meier method, and Cox regression model was applied to determine whether this factor is an independent predictor of survival in multivariate analysis.</p><p><b>RESULTS</b>Nineteen point seven percent of the patients showed positive Her-2 expression in their tumors. Patients with Her-2-positive tumors tended to be younger. The high level Her-2 expression was significantly associated with negative estrogen receptor and progesterone receptor status in their tumors (P < 0.05). Among 387 patients with node-positive disease, the 5-year disease-free survival (DFS) rate and 5-year overall survival (OS) rate were significantly lower in patients with Her-2-positive tumors than in patients with Her-2-negative tumors (DFS: 48.8% vs. 66.9%, P = 0.009; OS: 55.2% vs. 76.4%, P = 0.001), and Her-2 expression was an independent unfavorable prognostic factor for OS, but not for DFS in patients with node-positive disease. Among 591 patients with node-negative disease, Her-2 expression was not significantly associated with DFS and OS (P > 0.05).</p><p><b>CONCLUSION</b>Her-2 expression is an important prognostic factor in patients with node-positive disease, but not for patients with node-negative disease in Chinese women.</p>

The clinical research of local recurrence after breast-conserving therapy for breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To compare and analyze the data of breast cancer recurrence after breast-conserving therapy (BCT), and to find high risk factors that can affect local recurrence.</p><p><b>METHODS</b>A total of 1034 patients in the data base between January 2000 and June 2008 were analyzed retrospectively. The patients aged 23 to 94 years when diagnosed (median age, 48 years). The data was investigated to compare of two different groups in local recurrence rate and survival rate. The high risk factors of recurrence after BCT [estrogen receptor (ER)/progesterone receptor (PR), human epidermal growth factor receptor (HER-2), age, lymph node involvement, tumor diameter, neoadjuvant chemotherapy, pathological status] were studied.</p><p><b>RESULTS</b>The patients were followed-up to June 2010, and the median period was 42 months (range, 3-126 months). During the period, 35 patients developed ipsilateral breast tumor recurrence (3.3%), 47 patients had metastasis to distant organs (4.5%). The 5-year disease-free survival was 87.7%, 5-year distant disease-free survival was 94.0%. The lymph node status, HER-2 status and age were significant risk factors for ipsilateral breast tumor recurrence on univariate analysis. One peak recurrence period was from the 2nd to 3rd year, and the other was from the 5th to 6th year after the operation. The HER-2 status was independent factors of ipsilateral breast tumor recurrence on multivariate analysis.</p><p><b>CONCLUSIONS</b>The recurrence happens primarily in the 2nd to 3rd and the 5th to 6th year after the breast-conserving therapy. HER-2 status is an independent factor of ipsilateral breast tumor recurrence. The patients with high risk factors of recurrence should be treated more aggressively.</p>

Prognostic role of apoptosis-related gene Fas-1377 and -670 polymorphisms in breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the correlations between Fas-1377 and -670 polymorphisms and survival in Chinese women with breast cancer.</p><p><b>METHODS</b>Polymerase chain reaction-restriction fragment length polymorphism assay (PCR-RFLP) was used to detect the polymorphism of Fas gene in 310 breast cancer patients with a long-term follow-up (median 10.5 years, range 0.2 - 16.1 years). Survival curves were analyzed by Kaplan-Meier method.</p><p><b>RESULTS</b>The polymorphism of neither Fas-1377 nor Fas-670 was significantly correlated with the overall survival in this series of 310 cases (P > 0.05). However, among 146 patients without lymph node metastasis, the 5-year overall survival (OS) rate was significantly lower in the patients with Fas-1377 AA genotype than that in the patients with Fas-1377 GA or GG genotype (OS: 66.7% vs. 95.4%, P = 0.03). Among 117 patients with lymph node metastasis, both the Fas-1377 and Fas-670 polymorphisms were not significantly correlated with OS (P = 0.42).</p><p><b>CONCLUSION</b>Among breast cancer patients without lymph node metastasis, patients with Fas-1377 AA genotype may have a worse survival, while patients with Fas-1377 GA or GG genotype may not be so.</p>

Correlation of BRCA1 and APC aberrant methylation with the response to anthracycline-based neoadjuvant chemotherapy in primary breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the correlation of hypermethylation of BRCA1 and APC gene promoters with the response to anthracycline-based neoadjuvant chemotherapy in primary breast cancer.</p><p><b>METHODS</b>One hundred and forty patients with primary breast cancer received anthracycline-based neoadjuvant chemotherapy, and pretreatment hypermethylation status of BRCA1 and APC genes promoters was detected by methylation-specific PCR.</p><p><b>RESULTS</b>Of the 140 patients, 30 (21.4%) achieved pathological complete response (pCR), and methylation rates of BRCA1 and APC gene promoters were 21.4% (30/140) and 18.3% (24/131), respectively. Among the 110 patients with unmethylated BRCA1 gene, 28 (25.5%) achieved pCR, while in the 30 patients with methylated BRCA1 gene, only 2 (6.7%) had a pCR, with a significant difference between the two groups (chi(2) = 4.94, P = 0.026). However, no statistically significant correlation was found between the methylation of APC gene and pCR to neoadjuvant chemotherapy in this cohort of patients (P > 0.05).</p><p><b>CONCLUSION</b>Primary breast cancer with an unmethylated BRCA1 gene is prone to achieve a pathological complete response to anthracycline-based neoadjuvant chemotherapy than those with a methylated BRCA1 gene. BRCA1 methylation status may be a useful predictor for anthracycline-based neoadjuvant chemotherapy in primary breast cancer patients.</p>

Ultrasound-guided core needle biopsy in the diagnosis of breast lesions / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy and utility of ultrasound-guided core needle biopsy (CNB) in the diagnoses of breast lesions.</p><p><b>METHODS</b>The clinical data of 2152 consecutive breast lesions examined by CNB were reviewed. The histological agreement between core pathology and subsequent excision pathology was studied. The benign diseases without repeat biopsy were followed up.</p><p><b>RESULTS</b>There were 1461 cancers in final diagnosis among 2152 breast lesions, 1339 cancers were diagnosed by CNB. The false-negative rate of CNB was 3.5% (51/1461), and the underestimation rate was 4.9% (71/1461). In the repeat biopsy, carcinoma was found in 17 (50.0%) of 34 atypical ductal hyperplasia lesions and 25 (46.3%) of 54 papillary lesions. In 1461 cancers, the false-negative rate of ultrasound-guided CNB (2.1%, 22/1068) was significantly lower than that of free-hand-guided CNB (7.4%, 29/393) (P < 0.05). The false-negative rate of two special doctors for CNB (1.2%, 8/681) was significantly lower than that of other doctors (5.5%, 43/780) (P < 0.05). In 738 of benign lesions, 417 cases were excised and 50 malignant lesions were found, 205 cases were followed up by 2 - 29 months (median, 10.2 months), and one malignant lesion was found.</p><p><b>CONCLUSIONS</b>Ultrasound-guided core needle biopsy with histopathological assessment is an accurate method in diagnosis of breast lesions. Excisional biopsy is required to the high-risk lesions in CNB.</p>

Preliminary study of new imaging agent, 99mTc-Rituximab, for sentinel lymph node biopsy of primary breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To study the feasibility and effects of new imaging agent, 99mTc-Rituximab, for sentinel lymph nodes biopsy (SLNB) of primary breast cancer.</p><p><b>METHODS</b>SLNB were performed in eighty-five primary breast cancer patients using 99mTc-Rituximab combined with patent blue. Metastases in sentinel lymph nodes were detected with routine pathologic and immunohistochemistry method.</p><p><b>RESULTS</b>The successful rate of SLNB using combining method of 99mTc-Rituximab and patent blue was 96% (82/85). Thirty cases of SLN (37%, 30/82) were metastasis positive, including twenty-four positive cases by HE staining and six by immunohistochemistry method. SLN was the only metastasis lymph nodes in 18/30 cases. One case has false negative SLN metastasis. The sensitivity and accuracy of SLNB were 97% (30/31) and 99% (81/82). The specificity was 100% (51/51). The false negative rate was 3% (1/30) and the negative predictive value was 98% (51/52). The positive predictive value was 100% (31/31). Internal mammary sentinel lymph node lymphoscintigraphy was positive in eleven cases but all of them were confirmed metastases negative by pathologic examination.</p><p><b>CONCLUSIONS</b>99mTc-Rituximab, as a new imaging agent, can keep SLN imaging durable and can make SLNB more convenient. Through primary clinical manifestation, higher sensitivity and accuracy could obtained by combining method of 99mTc-Rituximab and patent blue for SLNB of primary breast cancer.</p>

Breast-conserving therapy for centrally located primary breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The goal of the study is to investigate the feasibility of breast-conserving therapy for early primary breast carcinoma centrally located in the breast.</p><p><b>METHODS</b>157 patients with stage I or II primary breast cancer located in the central part of the breast were operated with extended local excision and axillary lymph node dissection. Nipple-areola complex was excised in 18 patients. Ninety-three patients received two to six cycles neo-adjuvant chemotherapy. Radiotherapy was given postoperatively to the whole remaining breast.</p><p><b>RESULTS</b>The clinical response rate was 87.1% (81/93) and pathologic complete remission rate was 15.1% (14/93) after neo-adjuvant chemotherapy. Breast conservation surgery was performed successfully for all the patients in this series. After a median follow-up of 23 months (range 6-53 months), there was no recurrence in the ipsilateral breast. The aesthetic effect of the conserved breast was satisfactory including excellent for 88 patients and good for 48 patients representing of 86.6% of all cases.</p><p><b>CONCLUSION</b>Breast conserving surgery is suitable for the early centrally located primary breast carcinoma. Though the short-term results are satisfactory, the long-term follow-up is still needed for the final outcome.</p>

The application of conservative surgery for local advanced and bigger primary breast carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the application of conservative surgery for local advanced and bigger primary breast carcinoma (> 4 cm in diameter).</p><p><b>METHODS</b>Thirty-three primary breast cancer patients with tumor diameter more than four centimeters were treated with wide local excision and axillary lymph node dissection. Before operation, neoadjuvant chemotherapy with anthracyclines based combined regimen was done in thirty-one patients.</p><p><b>RESULTS</b>Thirty-one patients received one to eight cycles of neoadjuvant chemotherapy (mean 3.7 cycles). The response rate was 100%, including clinical complete remission in 19 cases, clinical partial remission in 12 cases and pathological complete remission in 9 cases. The final margin negative rate was 100% in thirty-three patients and first margin negative rate was 75.8% during operation. After a median follow-up of 27 months (range 2-39 months), up to date yet, no relapse case was found. The relapse-free survival was 100%.</p><p><b>CONCLUSIONS</b>Combining with neoadjuvant chemotherapy, breast-conserving therapy can be done successfully for most primary breast cancer patients with local advanced and bigger tumor. The curative effect was the same as the patient with smaller tumor in a short term follow-up.</p>

Clinical study of percutaneous ultrasound-guided or freehand core needle biopsy of primary breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate ultrasound-guided or freehand percutaneous core needle biopsy in histopathological assessment of primary breast cancer lesions and its utility in primary breast cancer treatment.</p><p><b>METHODS</b>Retrospectively analysis of the clinical data of 697 primary breast cancer examined by mean of core needle biopsy.</p><p><b>RESULTS</b>The diagnostic accuracy, false negative rate and insufficiency rate was 90.5%, 8.9% and 0.6%, respectively. Diagnostic accuracy was significantly higher in ultrasound guiding comparing to palpable guiding (92.7% vs. 88.2%, P < 0.05). There was a nonsignificant trend toward increased false negative rate in palpable guiding (10.9% vs. 7.1%, P > 0.05).</p><p><b>CONCLUSION</b>Percutaneous core needle biopsy is reliable in histopathological assessment of primary breast cancer lesions. Ultrasound guiding was superior to palpable guiding in term of diagnostic accuracy in this study.</p>

Exploration of the extent of axillary dissection for patients with node positive primary breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the frequency of the involvement of level III and interpectoral lymph nodes in patients with node-positive breast cancer, and discuss the necessity of completely axillary dissection in this subgroup of patients.</p><p><b>METHODS</b>Consecutive 291 cases underwent completely axillary dissections (level I/II/III and interpectoral node) according to identical procedure. Level I/II, Level III and interpectoral lymph nodes were sent separately for routine pathological examination.</p><p><b>RESULTS</b>Eighty-seven cases (29.9%) were proved to be node-positive. Among them, metastases were detected at level III lymph nodes in 18 cases (20.7%) and at interpectoral lymph nodes in 16 cases (18.3%), respectively. Twenty-five cases involved in level III and/or interpectoral lymph nodes. In a subgroup of 52 cases with primary tumor smaller than 5 cm and involved Level I/II lymph nodes less than 4, 6 cases (11.5%) were found metastases at level III and/or interpectoral lymph nodes.</p><p><b>CONCLUSIONS</b>It is reasonable to perform completely axillary nodes dissection including level III and interpectoral lymph nodes for patients with node-positive breast cancer.</p>

Neoadjuvant chemotherapy for primary breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and effect of fluorouracil (5-Fu) in association with anthracycline-based regimen as neoadjuvant chemotherapy for primary breast cancer.</p><p><b>METHODS</b>For one hundred and eleven primary breast cancer patients with 114 lesions who were to be operated, two to six cycles of 5-Fu (continuous infusion) in association with epirubicin or pirarubicin and cyclophosphamide (CEFci or CTFci regimen) were given before operation. The response rate, side effect and its relation with tumor characteristics were studied.</p><p><b>RESULTS</b>The overall response rate was 87.7%, of which the complete clinical response was 39.5%, pathological complete response was 23.7%, only one patient (0.9%) showed progressive disease. The regimen containing pirarubicin was superior to epirubicin regimen in pathological complete response rate (P < 0.05). Alopecia was mild in pirarubicin regimen as compared with epirubicin regimen but neutropenia was more severe in pirarubicin regimen than that in epirubicin regimen. Hormonal receptor expressions were significantly related to treatment response, the pathological complete response rate was 33.3% in oestrogen or progestin receptor negative tumors, but it was 7.5% in the positive tumors (P < 0.005). No correlation was observed between treatment response and tumor size, as well as HER-2 expression.</p><p><b>CONCLUSION</b>CTFci/CEFci regimen as neoadjuvant chemotherapy is effective and safe for primary breast cancer. CTFci regimen is superior to CEFci regimen in response rate. The patients with negative hormonal receptor are more sensitive to the neoadjuvant chemotherapy.</p>

The early results of breast-conserving therapy in ninety-five patients of primary breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the effects of breast-conserving therapy in Chinese women with early primary breast carcinoma.</p><p><b>METHODS</b>Ninety-five patients with stage I to II primary breast cancer were operated with wide local excision and axillary lymph node dissection. After operation, the radiation therapy was done on the whole breast.</p><p><b>RESULTS</b>Breast conservation surgery was taken successfully in ninety-five patients. Six months after operation, the approval rate for their breast was 100% by themselves. Ninety-two per cent of them were very satisfactory. After a median follow-up of 17 months (range 2 - 51 months), only one patient suffered from ipsilateral breast tumor relapse. The two years local relapse rate was 1.4%. There were no cases of distant relapse and death.</p><p><b>CONCLUSIONS</b>The early results of breast-conserving therapy are satisfactory for stage I to II primary breast cancer. The long-term follow-up is needed for the final outcome.</p>