Study on predictors of long term results for neo-adjuvant chemotherapy in locally advanced breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To identify predictive markers of the long-term outcome for neo-adjuvant chemotherapy (NC) in locally advanced breast cancer (LABC) treated with intravenous vinorelbine (V) and epirubicin (E) combination regimen.</p><p><b>METHODS</b>One hundred and nineteen patients with LABC were treated from September 2001 to May 2006. All patients were diagnosed as invasive breast cancer by 14G core needle biopsy and treated with three cycles of VE regimen before the operation. The patients were subjected to surgery and subsequently were given other three cycles of VE or cyclophosphamide+epirubicin+fluorouracil (CEF) regimen according to the clinical responses. Local-regional radiotherapy was applied to all patients after the chemotherapy and followed by hormone-therapy according to hormone receptor status. The impact of clinical, pathological, and immunohistochemical features on disease free survival (DFS) and overall survival (OS) was evaluated.</p><p><b>RESULTS</b>All patients were evaluable for responses: clinical complete response was documented in 27 patients (22.7%), 78 patients (65.5%) obtained partial clinical response. The pathological complete response was found in 22 cases (18.5%). Of the patients, 115 cases (96.6%) were followed-up for a median time of 63.4 months (range, 9-76 months), the 5-year DFS rate and OS rate was 58.7% and 71.3%, respectively. On multivariate analysis, high pre-Ki-67 (P=0.012) and post-Ki-67 expression (P=0.045), no pathological complete response after NC (P=0.034) were associated with the higher risk of disease relapse; high pre-Ki-67 (P=0.017) and post-Ki-67 expression (P=0.001), negative pre-ER (P=0.002) and no pathological complete response after NC (P=0.034) were associated with a shorter survival.</p><p><b>CONCLUSION</b>Pathological response in primary tumor, pre-Ki-67 and post-Ki-67 expression, pre-ER expression are important predictors of long-term outcome for LABC patients with three cycles of VE regimen before operation.</p>

A study on the relationship between breast cancer molecular classification and prognosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between breast cancer molecular classification and prognosis.</p><p><b>METHODS</b>From January 2002 to December 2003, 708 female primary breast cancer patients with a mean age of 53 years old were retrospectively analyzed. The classification of breast cancer was according to the immunohistochemical results of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER2) status. Molecular classification definitions included highly endocrine responsive, incompletely endocrine responsive, triple negative, and HER2 positive. The prognosis among different molecular classifications of breast cancer was investigated. The survival rates of different classifications were compared by Log-rank test.</p><p><b>RESULTS</b>The proportion of highly endocrine responsive, incompletely endocrine responsive, HER2 positive and triple-negative breast cancer was 33.2% (235/708), 23.6% (167/708), 21.3% (151/708) and 21.9% (155/708). The follow-up period were from 3 to 68 months with a median of 40.2 months. A total of 100 cases were identified to had disease recurrence or death. Factors affecting the prognosis were tumor size, axillary lymph node status, molecular classification, adjuvant radiotherapy and adjuvant endocrine therapy by univariate analysis. Multivariate analysis revealed that the molecular classification and lymph node status were the independent prognostic factors with the hazard ratio 1.205 (P = 0.047) and 4.512 (P = 0.000), respectively. Survival analysis showed that highly endocrine responsive breast cancer was with superior prognosis versus others.</p><p><b>CONCLUSIONS</b>Molecular classification of breast cancer is an independent predictor of prognosis. Breast cancer patients classified as highly endocrine responsive subtype have the best outcome.</p>

A study of the combination of vinorelbine and epirubicin as neoadjuvant chemotherapy regimen in the treatment of locally advanced breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy and toxicity of vinorelbine (N) and epirubicin (E) as the neoadjuvant chemotherapy regimen in the treatment of locally advanced breast cancer (LABC).</p><p><b>METHODS</b>From September 2001 to December 2004, 158 patients with LABC were treated with NE chemotherapy before operation. Neoadjuvant chemotherapy containing vinorelbine (N), 25 mg/m(2) (days 1 and 8) and epirubicin (E), 60 mg/m(2) (days 1) was administered every 3 weeks for three cycles before local treatment.</p><p><b>RESULTS</b>Response in the breast: the clinical objective response was 81.6% [23.4% (37/158) cCR and 58.2% (92/158) PR], 16.5% (26/158) SD and 1.9% (3/158) PD. Pathological complete response was found in 29 cases (18.3%). Eighteen cases (26.5%) who have positive FNA result in the axillary lymphnode before chemotherapy showed negative result in the surgery specimen. The most common toxicities were neutropenia, alopecia and nausea/vomiting. Neutropenia grade 3 - 4 was reported in 111 patients (70.3%) and there was no toxic deaths.</p><p><b>CONCLUSIONS</b>The combination of vinorelbine and epirubicin is a very active and well-tolerated regimen as neoadjuvant chemotherapy for the LABC.</p>

Stereotactic biopsy for non-palpable breast lesions: evaluation and choice of minimal invasive and excisional biopsy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate three biopsy methods which are currently used in stereotactic breast biopsy.</p><p><b>METHODS</b>A total of 361 cases of stereotactic breast biopsies were carried out since 2000, including 73 cases of true cut core needle biopsies (ST-CNB), 74 cases of vacuum assisted biopsies (ST-VAB) and 214 cases of excisional biopsies. After medium follow-up time of 18 months (6 to 66 months), the accuracy as well as the clinical benefits of the three stereotactic biopsy procedures were analyzed retrospectively.</p><p><b>RESULTS</b>The cancer miss rate of stereotactic wire localized excisional biopsy, ST-CNB and ST-VAB is 0, 2.7% and 0 respectively. Under-estimate rate of minimal invasive biopsy was 33% in atypical ductal hyperplasia (ADH) and 53% in ductal carcinoma in situ (DCIS). The minimal invasive procedure is superior to surgical procedure in terms of operation time, breast cosmetic outcome and complications, etc. Furthermore, 69% of the surgeries for suspicious lesion were waived.</p><p><b>CONCLUSIONS</b>Stereotactic minimal invasive breast biopsy, especially ST-VAB, is an accurate, safty and convenient diagnosis technique and could be considered as the first line choice for mammographic moderate suspicious breast lesions (BIRADS-4). However, further excisional biopsy is recommended for atypical hyperplasia. Stereotactic excisional biopsy could be directly used for diagnosis of mammographic highly suspicious breast lesions (BIRADS-5).</p>