Analysis of intraoperative molecular assessment of sentinel lymph nodes in breast carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the reliability and application of GeneSearch(TM) breast lymph node assay (Genesearch), a real-time fluorescence quatitative PCR method, in intraoperative assay of metastasis in sentinel lymph nodes (SLNs) from breast cancer patients.</p><p><b>METHODS</b>Totally 140 SLNs from 80 patients with breast carcinoma were prospectively studied from May 2010 to August 2010. The 80 patients included 78 women and 2 men who ranged in age from 29 to 85 years, and the median age is 49 years. The expression of CK19 and mammaglobulin in all 140 SLNs were detected by Genesearch, and the results were compared with that of histological evaluation of both frozen and paraffin-embedded sections.</p><p><b>RESULTS</b>Among SLNs, by histological analyses, there were 121 without metastasis, 17 with macrometastasis, 2 with micrometastasis, and none of isolated tumor cell. By Genesearch, there were 119 without metastasis and 21 with metastasis. Genesearch showed sensitivity of 89.4%, positive predictive value of 81.0%, negative predictive value of 98.3% and specificity of 96.7% by comparing to histological analyses. The concordance between Genesearch and histological analysis was 95.7%. The sensitivity of Genesearch was 15/17 for macrometastasis and 2/2 for micrometastasis.</p><p><b>CONCLUSIONS</b>Genesearch detection presents high sensitivity and specificity in evaluating metastasis of sentinel lymph nodes in breast cancer, but strict performance technically is necessary to avoid false positive and false negative results. Inability of further subtyping for the positive cases might be the key limitations for wide application of this method.</p>

Analysis of the factors affecting pathologic complete response to neoadjuvant chemotherapy in breast cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the factors affecting pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer patients.</p><p><b>METHODS</b>A retrospective cohort study was carried out to analyze the clinical data of 141 breast cancer patients treated with neoadjuvant chemotherapy. The factors affecting pCR and the changes of tumor receptor status before and after treatment were analyzed.</p><p><b>RESULTS</b>Among all the 141 patients, 21 patients (14.9%) achieved pCR. The rate of pCR achieved by regimens of anthracycline combined with taxane was higher (16.8%, 19/113) than that by anthracycline-containing regimens (7.1%, 1/14). The dose intensity of anthracycline had a significant correlation with pCR rate (P < 0.05). The pCR rate in the relative dose intensity of taxane ≥ 0.85 arm was higher than that of < 0.85 arm (P = 0.02). Eighty patients (56.7%) had completed more than 4 cycles of chemotherapy and the median time to achieve pCR was 6 (3 to 10) cycles. The pCR rate had a significant difference between patients < 6 and ≥ 6 cycles (7.1% vs. 22.5%,P = 0.01). Multivariate analysis showed that tumor size measured by palpation ≤ 5 cm and ≥ 6 chemotherapy cycles were significantly related with pCR rate (P < 0.05). In all the 21 pCR patients, the pre-treatment ER(-), PR(-), HER-2(-) statuses were in 14, 14 and 17 patients, respectively. The status of ER, PR, HER-2 of most patients (74.2%, 69.7% and 87.7%, respectively) was not changed after treatment. Among the patients with changes in receptor status, ER changed from negative to positive was in the majority (37.1%, 13/35 vs. 12.9%, 4/31, P < 0.05), and the percentage of changes in PR and HER-2 status had no significant differences.</p><p><b>CONCLUSIONS</b>The regimens of anthracycline combined with taxane can achieve a higher pCR rate. The lymph node and receptor status before therapy have no significant correlation with pCR. Patients who have primary tumor size ≤ 5 cm, ≥ 6 chemotherapy cycles and enough dose intensity are easier to achieve pCR. The receptor status before and after therapy should be determined, and according to any positive results, physicians can chose HER-2 targeted therapy and/or endocrine therapy after surgery to benefit the patients.</p>

Multicenter cross-sectional study of anemia in patients with gastric and colorectal cancer before and after the operation / 中华外科杂志

<p><b>OBJECTIVES</b>To determine the prevalence of cancer-related anemia and iron deficiency anemia (IDA) in patients with gastric and colorectal cancer in North of China.</p><p><b>METHODS</b>A cross-sectional study of 262 inpatients diagnosed with gastric or colorectal cancer admitted to eight general hospitals in Beijing from August 2009 to December 2009 was performed. The blood samples were took on the day after admission and the seventh day after operation for the tests of hemoglobin, serum iron and ferritin. The morbidity of cancer-related anemia and IDA before and after the surgery was also compared respectively.</p><p><b>RESULTS</b>The preoperative morbidity of cancer-related anemia was 36.6% in 131 patients with gastric cancer, and the morbidity of IDA was 52.1%. The mean age of the anemic patients was higher than that in cases without anemia [(62 ± 11) yrs vs. (57 ± 12) yrs, P < 0.05]; the postoperative morbidity of IDA increased to 72.6% (P < 0.05). In the 131 cases with colorectal cancer, the preoperative incidence of cancer-related anemia and IDA was 37.4% and 61.2%, respectively. About 45% of the cases with anemia had a tumor in the right colon. Postoperative incidence of IDA was significantly higher than that before the surgery (76.7%, P < 0.05). Only 10.3% of the anemic patients were treated with chalybeate therapy before surgical procedures, and the proportion was 22.7% after the operation. More than 50% of anemic patient received blood transfusion.</p><p><b>CONCLUSIONS</b>Cancer-related anemia is a common clinical manifestation in patients with gastrointestinal cancer, and anemia occurs more frequently in elder and patients with right colon tumor. The treatment to cancer-related anemia is insufficient and a systematic therapy is needed to be established.</p>

Comparison of response evaluation methods of neoadjuvant chemotherapy in breast cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the efficiency of response evaluation by clinical examination, ultrasonograghy and mammography in neoadjuvant chemotherapy (NAC) for breast cancer.</p><p><b>METHODS</b>A retrospective cohort study was conducted to analyze the data of 141 patients treated with neoadjuvant chemotherapy. Response evaluation was performed by clinical palpation, ultrasound and mammography.</p><p><b>RESULTS</b>Only 12 (8.5%) among the 141 patients presented with a stage I tumor. The tumor size determined by palpation was often larger than that by ultrasound before therapy (P < 0.01). Among patients with suspicions axillary nodes checked by ultrasound, 88.3% (53/60) of them had positive nodes by pathology before NAC, and 34.5% (10/29) of patients with negative nodes determined by ultrasound had positive nodes by pathology. In all the 141 patients, 21(14.9%) showed pathological complete remission in both the primary tumor and lymph node. For response evaluation, the false complete remission rate judged by clinical examination was 46.8% (22/47), and the false tumor residual rate by ultrasound was 84.0% (21/25). In 53.5% (23/43) of patients the response could not be assessed by mammography due to that the tumors were undistinguishable in size. The range of microcalcification was not reduced in 5 patients with a partial response of the tumor. 25 patients experienced needle puncture during therapy. Among them, in the 9 pathologically negative patients, only 3 achieved pCR, and the other 16 positive patients didn't achieve pCR.</p><p><b>CONCLUSION</b>Using the puncture or sentinel lymph node biopsy, clinicians should pay enough emphasis on the pathological determination of the node status before chemotherapy. Clinicians will make a quite of false judgment of the tumor by clinical examination, ultrasound or mammography. They may use needle puncture during therapy to evaluate the response of neoadjuvant chemotherapy, and the result should be analyzed synthetically.</p>

Differentiation of bone marrow derived Thy-1+ beta2M- cells into liver cells in AA induced liver injury micro-environment / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the differentiation of bone marrow derived Thy-1+ beta2M- cells (BDTCs) into liver cells in allyl alcohol (AA) induced liver injury micro-environment.</p><p><b>METHODS</b>BDTCs of male F344 rats were isolated by two-step magnetic separation system (MACS) technique, and infused intraportally into female recipients after labeling with PKH26. Thirty recipients were divided randomly into 3 groups: (1) AA-injured liver + BDTCs infusion, (2) normal liver + BDTCs infusion and (3) AA-injured liver + NS infusion (control). Blood biochemical examination, fluorescence labeled cellular localization, Y-chromosome sry gene in-situ hybridization and immunohistochemistry were carried out to evaluate BDTCs distribution, differentiation and proliferation in recipients's livers after different intervals.</p><p><b>RESULTS</b>Fluoromicroscopy and in situ hybridization suggested that BDTCs of donors were interspersed in pieces and cords among the necro-periportals induced by AA; immunohistochemistry indicated that those implanted cells expressed OV-6, AFP, CK19 and albumin successively, while positive cells were hardly seen in the normal liver + BDTCs infusion group. Compared with the controls, the blood biochemical restitution was more rapid in group (1), (9.8 d +/- 3.1 d vs. 13.7 d +/- 4.2 d).</p><p><b>CONCLUSION</b>The injury micro-environment induced by AA facilitates BDTCs integration with hepatic cell plates and differentiation into mature liver cells. BDTCs differentiation into liver cells might accelerate endogenous liver cell regeneration and reparation.</p>