Clinical Diagnosis and Treatment of Male Breast Cancer:Analysis of 24 Cases / 中国医学科学院学报

Objective To summarize our experiences in the clinical diagnosis and treatment of male breast cancer(MBC).Methods The clinical date of 24 MBC patients treated in our hospital from January 2006 to December 2012 were retrospective analyzed.Results The average age of these 24 patients was(55.7±2.1) years.All the patients received surgical treatment,and the surgical procedures were simple excision of breast lesion in 6 patients,breast resection alone in 5 patients,and modified radical mastectomy in 13 patients(bilateral in 1 case).The pathological diagnoses included invasive ductal carcinoma in 18 cases,papillary carcinoma in 4 cases,mucinous adenocarcinoma in 1 case,and malignant solitary fibrous tumor in 1 case.Twenty patients received chemotherapy,7 received radiotherapy,and 15 received endocrine therapy after operation.The 5-year survival rate was 54.2%.Conclusions The incidence of MBC is low.This malignancy is mainly seen in elderly individuals,with relatively long disease course,poor prognosis,and high risk of metastasis.MBC is mainly treated by surgery,and adjuvant chemotherapy,radiotherapy,and endocrine therapy may be applied,if appropriate,after the operation.

Correlation of Stress Hyperglycemia after Ischemic Stroke with Early Vascular Cognitive Impairment / 中国医学科学院学报

Objective To investigate the influence and forecast value of stress hyperglycemia on the early vascular cognitive impairment (VCI) in stroke patients.Methods Totally 422 patients with acute non-diabetic stroke were divided into three groups according to the fasting plasma glucose level:the euglycemia group (<6.1 mmol/L),the mild stress hyperglycemia group (6.1-7.0 mmol/L),and the severe stress hyperglycemia group (≥7.0 mmol/L).Mini-mental state examination,Alzheimer's disease rating scale cognitive subscale,and clinical dementia rating scale were used to evaluate early cognition in post-stroke patients,and patients were divided into three groups accordingly:normal cognitive function group,mild VCI group,and vascular dementia group.Correlation analysis was carried out on the level of stress hyperglycemia and the degree of VCI.Results Of these 422 patients,stress hyperglycemia was identified in 62 cases (14.7%).The risk of stress hyperglycemia was higher in patients with a high degree of education [(8.39±3.85)years vs.(6.62±4.39)years,P=0.037)] or a history of cardiovascular disease (45.2% vs.18.3%,P=0.001).VCI was detected in 270 patients (64.0%).Age,sex,smoking,National Institute of Health Stroke Scale score,Hamilton Depression Rating Scale score,stress hyperglycemia,and history of cardiovascular disease were related with early VCI after non-diabetic ischemic stroke (P<0.05).Multivariate Logistic regression analysis showed that stress hyperglycemia was an independent risk factor for VCI in patients with non-diabetic ischemic stroke (OR=3.086,95% CI=1.065-8.929).The risks of cognitive impairment in the mild stress hyperglycemia group and the severe stress hyperglycemia group were higher than that of the euglycemia group,while it was also higher in the severe stress hyperglycemia group than in the mild stress hyperglycemia group (61.11% vs.75.00% vs.90.91%).Stress hyperglycemia was positively correlated with the high risk of early cognitive impairment in stroke patients (r=0.185,P=0.007).Conclusion There is a significant correlation between stress hyperglycemia and early VCI after ischemic stroke.

Expressions of Estrogen Receptor,Progestogen Receptor,Cerb-B2,and Ki67 Index in the Simple Mucinous Carcinoma of the Breast / 中国医学科学院学报

<p><b>OBJECTIVE</b>To approach the expressions of estrogen receptor (ER),progestogen receptor (PR),Cerb-B2,and Ki67 index in simple mucinous carcinoma of the breast and their clinical significance.</p><p><b>METHODS</b>The clinicopathological data of 72 patients with simple mucinous carcinoma of the breast who were treated in our hospital from 1997 to 2012 were retrospectively studied. Expressions of ER,PR,Cerb-B2,and Ki67 index and their relationship with clinical characteristics were analyzed.</p><p><b>RESULTS</b>Nine patients had lymph node metastasis. Expressions of ER,PR,and Cerb-B2 were 77.8%,69.4%,and 3.1%,respectively. The expressions of ER,PR,and Cerb-B2 showed no correlation with age,menstrual status,and axillary lymph node metastasis (P>0.05). The expression of ER was correlated with tumor diameter (P=0.008) while the expression of PR and Cerb-B2 showed no such correlation.</p><p><b>CONCLUSIONS</b>High ER or PR expression and low Cerb-B2 expression predict good prognosis in patients with simple mucinous carcinoma of the breast. Combined detection of ER,PR,Cerb-B2,and Ki67 index may help to improve the multidisciplinary management of simple mucinous carcinoma of the breast.</p>

Analysis of prognostic factors related to triple-negative breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors related to triple-negative breast cancer (TNBC) by analyzing clinicopathologic characteristics, treatment and prognosis.</p><p><b>METHODS</b>Three hundred and five TNBC patients treated between January 2004 and December 2011 were enrolled and retrospectively reviewed with Kaplan-Meier and Cox proportional hazards models. All patients were females and the age onset were 24-82 years old (the median were 50 years old).</p><p><b>RESULTS</b>The follow-up period was 1 to 114 months, with median 38 months. The 5-year disease free survival (DFS) rate was 68% and overall survival (OS) rate 75%. The peak risk of recurrence occurs within the first 2-3 years after initial treatment of the disease, but distant relapse after this time is much less common. Survival analysis showed that surgery type (χ(2) = 4.030, P = 0.045), tumor grade (χ(2) = 8.000, P = 0.046), lymph-vascular invasion (χ(2) = 10.386, P = 0.001) and lymph node stage (χ(2) = 119.36, P = 0.000), TNM stage (χ(2) = 65.961, P = 0.000) and treatment plan (χ(2) = 28.371, 21.874, 32.163, all P = 0.000) were statistically related to DFS; while age (χ(2) = 10.226, P = 0.006), lymph-vascular invasion (χ(2) = 18.881, P = 0.000), lymph node stage (χ(2) = 98.958, P = 0.000), TNM stage (χ(2) = 65.342, P = 0.000) and type of treatment (χ(2) = 17.862, 18.708, 31.921, all P = 0.000) were related to OS. The lymph nodes stage was prognostic factor related to both DFS and OS.</p><p><b>CONCLUSIONS</b>TNBC was characterized by poor prognosis and rapid progression. The lymph nodes metastatic status was the most important prognostic factor of TNBC.</p>

Comparative analysis of early diagnostic tools for breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Mammography is the principle imaging modality used for early diagnosis of breast cancer in Western countries. It has not been well-established whether this Western diagnostic modality is adoptable for Chinese women. The aim of this study was to evaluate the respective accuracy of the common diagnostic tools for breast cancer including history-taking, physical examination, ultrasound and mammography.</p><p><b>METHODS</b>Clinical presentation and investigations for consecutive patients undergoing history-taking, physical examination, ultrasound, mammography and pathological assessment at Peking Union Medical College Hospital were prospectively recorded between April 2010 and September 2011. Breast cancer high-risk factors acquired by history-taking were input into the risk assessment model established previously by Eleventh Five Year Key Programs for Science and Technology Development of China (Grant No. 2006BAI02A09) and classified into low-, medium-, high- and extremely high-risk groups. The low- and medium-risk groups were defined as test negative, while the high- and extremely high-risk groups were defined as test positive. Each mammogram and ultrasound was reported prospectively using a five-point reporting scale of the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS). Clinical data were compared with pathological findings. Sensitivity, specificity, positive predictive value (PRV), negative predictive value (NPV) and accuracy of respective diagnostic methods were calculated and compared. The patients were divided into two groups, above and below 50 years of age for subgroup analysis.</p><p><b>RESULTS</b>A total of 1468 patients (1475 breast lesions) constituted the study population. The median age was 44 (range 13 - 92) years. Five hundred and fifty-one patients were diagnosed as breast cancer. The median age at diagnosis was 51 years and breast cancer peaked in the age group of 40 - 60 years. The sensitivity of risk assessment model, physical examination, ultrasound and mammogram was 47.5%, 86.2%, 89.8% and 79.3%, respectively; specificity was 68.8%, 83.3%, 81.0% and 88.7%, respectively; PRV was 47.6%, 75.5%, 73.8% and 80.8%, respectively; NPV was 68.8%, 91.0%, 93.0% and 87.8%, respectively; and accuracy was 60.9%, 84.4%, 84.3% and 85.2%, respectively. Further subgroup analysis demonstrated that age is an important factor influencing the sensitivity and specificity of physical examination, ultrasound and mammography.</p><p><b>CONCLUSIONS</b>Ultrasound is more sensitive than mammography for early diagnosis of breast cancer in Chinese women and should be routinely used as a first-line diagnostic tool. Only a single diagnostic method is not enough sometimes and combined examination is needed for some high-risk populations.</p>

Pure mucinous carcinoma of the breast: a clinicopathologic analysis with 56 patients / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To assess recent trends and prognostic features in the treatment of pure mucinous carcinoma (PMC) of the breast.</p><p><b>METHODS</b>Fifty-six patients diagnosed with PMC of the breast in our hospital from December 1982 to June 2008 were included. We evaluated the general information and tumor characteristics of the patients, examined the relationship between these factors and prognosis. Fisher's exact test was applied to analyze tumor characteristics.</p><p><b>RESULTS</b>The mean age of the patients was 53.7 years. The majority of the patients presented with early stage disease. Tumor size was found not a significant prognostic factor in this study. Mean follow-up period was 39 months and no breast cancer-related deaths were identified in the patient cohort.</p><p><b>CONCLUSIONS</b>PMC of the breast has a favorable prognosis. Tumor size does not appear to significantly impact survival.</p>

Diagnosis and treatment of occult breast cancer: report of 23 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the presenting clinical features, management approach and treatment outcomes for occult breast cancer.</p><p><b>METHODS</b>Twenty-three patients with occult breast cancer presenting with axillary nodal metastases treated in our department between 1986 and 2007 were included in this study. The clinicopathological, imaging and follow-up data of the 23 cases were retrospectively analyzed.</p><p><b>RESULTS</b>All patients were female. The mean age of diagnosis was 57.7 years with a range of 27 - 73 years. The mean follow-up was 15.70 months (range 1 - 62 months). Eight cases in 17 patients were positive by breast ultrasound, three cases in 9 patients were positive by mammography, one case in 2 patients was positive by breast MRI. 20 patients underwent modified radical mastectomy and three patients did not receive the mastectomy treatment. 16 patients had chemotherapy, four patients had radiotherapy, two patients had both chemotherapy and radiotherapy. Two patients had pulmonary metastasis, one patient had recurrence of axillary nodes, pulmonary metastasis and bone metastasis during follow-up.</p><p><b>CONCLUSIONS</b>A normal check before operation to exclude a cancer of other origin can help to diagnose occult breast cancer. The breast must be treated. Axillary nodal dissection and mastectomy, or breast conservation with radiation therapy alone can be considered as a management option.</p>

Dose dense chemotherapy in the postoperative adjuvant treatment for breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the safety and feasibility of dose dense chemotherapy in the postoperative adjuvant treatment for breast cancer.</p><p><b>METHODS</b>The data of 114 breast cancer patients treated with adjuvant dose dense chemotherapy was retrospectively analyzed.</p><p><b>RESULTS</b>114 breast cancer patients received postoperative adjuvant dose dense chemotherapy from Jan. 2004 to March 2005. The patients were treated with different regimens according to their recurrence risk: 43 with paclitaxel + epirubicin (PE), 8 with taxotere + epirubicin (TE), 36 with cyclophosphamide + epirubicin + 5-Fu ( CEF) and 27 with epirubicin +5-Fu (EC). Totally, 111 patients except 3 completed the dose dense chemotherapy smoothly. Major toxicities severer than grade III included: neutropenia in 6.3% of the patients, nausea and vomit in 11.7%, peripheral neuropathy in 3.6%.</p><p><b>CONCLUSION</b>Postoperative adjuvant dose dense chemotherapy for breast cancer patient is feasible and safe, but the long-term outcome still needs further observation.</p>

Treatment of premenopausal patients with advanced or recurrent breast cancer by chemical ablation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy and safety of luteinizing hormone releasing hormone (LH-RH) analog in premenopausal patients with advanced or recurrent breast cancer.</p><p><b>METHODS</b>LH-RH analog (enantone 3.75 mg/2 ml) were administered to 28 premenopausal patients with advanced recurrent breast cancer and its efficacy and side effect were observed.</p><p><b>RESULTS</b>The response rate (complete response and partial response) was 42.9%, and after 8 weeks of treatment, the plasma estrogen in all patients decreased to the level of postmenopause. No major adverse events were observed.</p><p><b>CONCLUSIONS</b>LH-RH analog is effective and safe for premenopausal breast cancer with low adverse reaction and its administration method is easy.</p>

Diagnosis and treatment of Paget's disease of the breast: report of 33 cases / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the clinical features and histologic criteria of Paget's disease of breast, and evaluate the potential prognostic factors for better appropriate treatment strategies.</p><p><b>METHODS</b>Thirty-three patients treated for Paget's disease of breast were reviewed retrospectively.</p><p><b>RESULTS</b>The median age of diagnosis was 57 years. Twenty-nine patients were treated by modified radical mastectomy, 4 cases by mastectomy. Twenty-three (69.7%) patients had underlying carcinoma. Twenty-six (78.8%) patients did not have a palpable breast mass, 10 of them was simple Paget's disease, eight had ductal carcinoma in situ, eight had invasive ductal carcinoma. Seven patients had a palpable breast mass, and none of them was simple Paget's disease, except one of them had ductal carcinoma in situ, six had invasive ductal carcinoma.</p><p><b>CONCLUSIONS</b>Most patients with Paget's disease had associated breast carcinoma. Paget's disease of the breast with a palpable breast mass is more likely to be accompanied by an invasive ductal carcinoma and had a poor prognosis. Patients with any nipple complaints deserve a serious investigation.</p>