Survival outcomes of patients with lobular carcinoma in situ who underwent bilateral mastectomy or partial mastectomy.

AIM: To compare the survival outcomes between patients treated with bilateral mastectomy and partial mastectomy alone as the initial surgical management for primary lobular carcinoma in situ (LCIS). PATIENTS AND METHODS: Patients with histologically confirmed LCIS underwent partial mastectomy alone or bilateral mastectomy were identified by the SEER*Stat database (version 8.3.2) released in 2016. The primary outcome measure was all-cause mortality and the secondary outcome measure was breast cancer-specific mortality. RESULTS: Of the 5964 cases included in the analysis, 208 cases underwent bilateral mastectomy and 5756 cases underwent partial mastectomy alone. The 1-, 5- and 10-year estimated overall survival rates were 99.7%, 96.7% and 91.7%, respectively. Univariate and multivariate proportional hazards regression (Cox) analyses showed no significant difference between the risk of all-cause mortality in the bilateral mastectomy group compared with the partial mastectomy group (HR = 1.106, 95% confidence interval [CI] 0.350-3.500, P = 0.86). In propensity score-matched model, bilateral mastectomy still did not show benefit to overall mortality (HR = 2.248, 95% CI 0.451-11.200). Patients older than 60 years of age showed a higher risk of all-cause mortality (HR = 7.593, 95% CI 5.357-10.764, P < 0.0001). No risk factors, including surgery type, were identified for breast cancer-specific survival. CONCLUSIONS: Survival outcomes of patients with LCIS who underwent partial mastectomy without radiotherapy were not inferior to patients who underwent bilateral prophylactic mastectomy. Breast cancer-specific mortality in patients with LCIS was extremely low; aggressive prophylactic surgery like bilateral prophylactic mastectomy should not be advocated for most patients with LCIS.

Erratum to: Low expression of ULK1 is associated with operable breast cancer progression and is an adverse prognostic marker of survival for patients.

Erratum to: Breast Cancer Res Treat (2012),134:549­560,DOI 10.1007/s10549-012-2080-y. In the original publication of the article, Fig. 5c was published incorrectly. The authors apologize for this error and the correct Fig. 5c is given below.

Low expression of ULK1 is associated with operable breast cancer progression and is an adverse prognostic marker of survival for patients.

ULK1 plays an important role in autophagy which is widely involved in the development of breast cancer. However, the function and expression of ULK1 in human breast cancer is still scarcely explored. In this study, we showed that the mRNA and protein levels of ULK1 decreased in 10 of 14 (71.4 %) breast cancer tissues, compared with matched normal tissues. Furthermore, immunohistochemical staining of ULK1 was performed on the tissue microarray containing 298 non-metastatic invasive breast primary cancer tissues and 73 matched adjacent noncancerous tissues. 70.1 % breast cancer specimens displayed none to weak staining of ULK1, however, 78.1 % adjacent noncancerous specimens showed moderate to strong staining of ULK1. Statistical analysis revealed that ULK1 expression was negatively correlated with tumor size (r = -0.176, P = 0.002), lymph node status (r = -0.115, P = 0.048), and pathological stage (r = -0.177, P = 0.002). The log-rank test showed that patients with lower level of ULK1 had a significant shorter distant metastasis-free survival time (P = 0.008) and cancer-related survival time (P = 0.008). Multivariate Cox regression analysis found that ULK1 expression was recognized as an independent prognostic factor (P = 0.034). In addition, a significant positive correlation between expression of ULK1 and LC3A (r = 0.401, P < 0.001), and a significant negative correlation between expression of ULK1 and p62 (r = -0.226, P < 0.001) were observed in our breast cancer cohort. These findings suggest that decreased expression of ULK1 is associated with breast cancer progression, together with closely related to decreased autophagic capacity. ULK1 also may be used as a novel prognostic biomarker for breast cancer patients.

Comparison of Clinical Features and Treatment Outcome of Breast Cancers in Young and Elderly Chinese Patients.

BACKGROUND: This study aimed to investigate the clinicopathological features and prognosis of operable breast cancers in young and elderly Chinese women. PATIENTS AND METHODS: This study included 209 patients aged ≤35 years and 213 patients aged ≥60 but <70 years, who received treatment between January 2000 and December 2004. The clinicopathological features, molecular subtypes, therapeutic strategies, and prognosis were evaluated. RESULTS: Tumor size was of significant difference between the 2 groups (p = 0.018), with more T2 and T3 tumors in the young group and more lymph node involvement in young patients with stage T1 tumors (p = 0.033). There were more triple-negative and less luminal A tumors in the young group (p = 0.018). 47.1% of tumors were not detected by mammography in the young group as compared to 5.5% in the elderly group (p < 0.001). More patients received chemotherapy in the young group (p < 0.001) and preferred breast-conserving surgery (p = 0.031). The 6-year disease-free survival (DFS) was 80 and 66% in the elderly and the young group, respectively (p = 0.001), but no difference was seen in overall survival. CONCLUSIONS: Compared with elderly women, young breast cancer patients have different clinicopathological features and molecular subtypes, and poorer DFS. Furthermore, the insidious onset of breast cancer in young women suggests that clinicians should pay more attention to young women with breast abnormalities.

Radiocolloid in combination with methylene dye localization, rather than wire localization, is a preferred procedure for excisional biopsy of nonpalpable breast lesions.

BACKGROUND: Wire localization (WL) is traditionally performed before excisional biopsy for patients with nonpalpable breast lesions, but it has several disadvantages. Our current study examines whether the method of radiocolloid combined with methylene dye localization (RCML) has an advantage over WL. MATERIALS AND METHODS: From August 2006 to May 2009, 157 patients with nonpalpable breast lesions classified as BI-RADS category 5 were enrolled in our study. Of the 157 patients, 78 were assigned to WL and 79 to RCML. The status of surgical margins, weight of specimens, length of incisions, and duration of operation were compared between these two groups. RESULTS: All patients were diagnosed after first excisional biopsy. The patients with malignancy accounted for 55.1% in WL group, and 53.2% in RCML group. For malignant lesions, fewer patients undergoing RCML had close or involved surgical margins than did those who had WL (19.0% vs. 39.5%, P = .038). The mean weight of specimen was 45.2 g in WL group and 39.0 g in RCML group (P < .001). The mean length of incision was 44.8 mm in WL group and 36.3 mm in RCML group (P < .001). The mean time of operation was 16.3 min for WL and 14.7 min for RCML (P = .001). CONCLUSIONS: RCML provides precise identification of the site of the nonpalpable lesion and a visible marker to the lesion for surgeons and allows rapid, easy, and accurate excision of nonpalpable breast lesions. Therefore, RCML is a promising alternative to WL.

[Risk factor analysis of mediastinal lymph node metastasis in non-small cell lung cancer patients and the strategy of mediastinoscopy prior to surgery].

OBJECTIVE: To discuss the strategy of mediastinoscopy for the evaluation of mediastinal lymph node status (metastasis or not) of non-small cell lung cancer (NSCLC) prior to surgery. METHODS: From October 2000 to June 2007, 152 consecutive NSCLC cases pathologically proven and clinically staged I-III were enrolled in the study. Of the 152 cases, there were 118 males and 34 females. Age ranged 24-79 years old and the median age was 58. All cases underwent CT and mediastinoscopy for the evaluation of mediastinal lymph node status prior to surgery. Compared with the results of final pathology, the positive rate of mediastinoscopy and the prevalence of mediastinal lymph node metastasis were calculated in the NSCLC patients with negative mediastinal or hilar lymph nodes on CT scan (the shortest axis of mediastinal or hilar lymph nodes <1 cm). Clinical characteristics used as predictive factor including sex, age, cancer location, type of pathology, T status, cancer type (central or peripheral), size of mediastinal lymph nodes (the shortest axis <1 cm or >1 cm) on CT scan and serum CEA level were analyzed by univariate and multivariate analysis with Binary logistic regression model to identify risk factors of mediastinal metastasis. RESULTS: The positive rate of mediastinoscopy was 11.6% (8/69) and the prevalence of mediastinal metastasis was 20.1% (14/69) in NSCLC with negative mediastinal or hilar lymph nodes on CT scan respectively. In clinical stage I (cT1-2N0M0) NSCLC the positive rate of mediastinoscopy was 11.3% (7/62), N2 accounting for 6.5% (4/62) and N3 4.8% (3/62), respectively; and the prevalence of mediastinal lymph node metastasis was 19.4% (12/62), N2 ccounting for 14.6% (9/62) and N3 4.8% (3/62), respectively. In the whole group both univariate and multivariate analysis showed that adenocarcinoma or mediastinal lymph nodes > or =1 cm in the shortest axis on CT scan was an independent risk factor to predict mediastinal lymph node metastasis. In NSCLC with negative mediastinal or hilar lymph nodes on CT scan both univariate and multivariate analysis showed that adenocarcinoma was a predictor of mediastinal lymph node metastasis. Conclusion We recommend the policy of routine mediastinoscopy in NSCLC prior to surgery if the mediastinal staging was only based on CT scan. Mediastinal lymph nodes > or =1 cm in the shortest axis on CT scan mandates preoperative mediastinoscopy. Adenocarcinoma also indicates mandatory mediastinoscopy even with negative mediastinal or hilar lymph nodes on CT scan.

[Postmastectomy locoregional recurrence and survival in early stage breast cancer patients with one to three axillary lymph node metastases].

BACKGROUND AND OBJECTIVE: For early stage breast cancer with less than four metastatic axillary lymph nodes (ALN), indications for adjuvant radiotherapy are not well defined. This study was to investigate the risk factors for postmastectomy locoregional recurrence and survival in those patients. METHODS: In total 217 patients undergoing mastectomy in Sun Yat-sen University Cancer Center between March 1998 and March 2002 were retrospectively reviewed. Seventy-one patients were at pT1 stage, and 146 cases at pT2 stage. Two hundred and two patients received adjuvant chemotherapy, 51 received radiotherapy (RT), and 116 received endocrine therapy whose estrogen receptors (ER) or progesterone receptors (PR) were positive. RESULTS: The median follow-up time for these patients was 69 months. The 5-year actuarial locoregional recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were 85.2%, 81.8%, and 90.2%, respectively. Treatment failure was found in 44 patients, among whom 21 cases were diagnosed as locoregional recurrence. The 5-year actuarial OS was significantly lowered in patients with locoregional recurrence than in those without (61.9% vs. 93.6%, P<0.0001). Age younger than 35 years, pT2 tumor, and the rate of metastatic ALN>or=30% were risk factors for poor LRFS, DFS, and OS. When a scoring system was established consisting of these three prognostic factors, the 5-year actuarial LRFS in patients with varied scores were significantly different (P=0.0072). In the subgroup of 159 patients who received adjuvant chemotherapy of not less than five cycles, 35 patients who received adjuvant RT achieved significantly better survival rates than those who did not. CONCLUSION: Age younger than 35 years, pT2 tumor, and the rate of metastatic ALN>or=30% are risk factors for locoregional recurrence and survival in patients with early stage breast cancer who have one to three positive ALN. Adjuvant RT is recommended for those patients.

[Roles of Aurora-A in tumorigenesis and prognosis of breast cancer].

Aurora kinases play key roles in the transition of G2/M phase by regulating functions of centrosomes and microtubules. Overexpression of Aurora-A, a new oncogene, can induce centrosome amplification, aneuploidy and tumor formation. Aurora kinases are closely associated with breast cancer. In this article, we reviewed the mechanisms of Aurora kinases inducing tumorigenesis of breast cancer via interacting with p53 gene, BRCA1 gene, PTEN/PI3K/AKT pathway, gene polymorphism, estrogen, and so on, analyzed the expression of Aurora kinases in breast cancer and its relationship with prognosis.

[Prospective comparison of CT versus mediastinoscopy in preoperative evaluation of mediastinal lymph node status in patients with non-small cell lung cancer].

OBJECTIVE: To compare the value of CT and mediastinoscopy in assessment of mediastinal lymph node status in potentially operable non-small cell lung cancer (NSCLC). METHODS: From Oct. 2000 to Jun. 2007, 152 consecutive patients with pathologically proven and stage I to approximately III NSCLC were enrolled into the study. Of the 152 cases, there were 118 males and 34 females, with a median age of 58 years (range, 24 to approximately 79 years). Compared with the final pathology, the sensitivity, specificity, positive and negative predictive values and accuracy of CT and mediastinoscopy for preoperative evaluation of mediastinal lymph node status were calculated, respectively. The accuracy and diagnostic efficacy of CT and mediastinoscopy was compared by Pearson chi(2) test and ROC curve, respectively. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of detection of mediastinal metastasis was 73.8%, 70.1%, 64.9%, 78.2% and 71.7% by CT, respectively, versus 83.1%, 100.0%, 100.0%, 88.8% and 92.8% by mediastinoscopy, respectively. Both the accuracy and diagnostic efficacy of mediastinoscopy were superior to CT (Pearson chi(2) test, P < 0.001; Z test of the areas under the ROC curve, P < 0.001). The complication rate of mediastinoscopy was 4.6%, and the false negative rate was 7.2%. CONCLUSION: Mediastinoscopy is safe and effective in preoperative assessment of mediastinal lymph node status in potentially operable NSCLC, while CT alone is inadequate.

Significance of methylene blue dye for localization biopsy of nonpalpable breast lesions.

BACKGROUND AND OBJECTIVE: With advances in mammographic equipment and techniques, more and more nonpalpable breast lesions have been detected. This study was to investigate the application of methylene blue dye for localized biopsy to diagnose nonpalpable breast lesions. METHODS: In total 138 patients with suspicious malignant, nonpalpable breast lesions between August 2002 and October 2006 were enrolled. A small dose of methylene blue was injected into the lesion under mammographic guidance. The dyed tissues were excised completely via an optimal incision, and radiographys was obtained to confirm the removal of the nonpalpable lesion. The specimen weight and incision length were measured. RESULTS: Suspicious lesions in all 138 patients were accurately excised. Eighty-four (60.9%) patients were confirmed as breast cancer, and 54 (39.1) were diagnosed with benign lesions. The mean length of the incision was 4.6 cm (range 3.2-5.3 cm), and the mean weight of the resected specimen was 42 g (range18-86 g). All patients achieved stage I healing. CONCLUSIONS: Excisional biopsy is recommended for nonpalpable breast lesions which are highly suggestive of malignancy by imaging examination. Methylene blue guided localization and excisional biopsy is a safe, relatively simply procedure with high diagnostic accuracy.

[Sustained-hypoxemia: a significant risk factor for anastomotic cicatricial stenosis after esophagectomy].

OBJECTIVE: To analyze retrospectively the roles of different factors, especially the factors in the anastomotic cicatricial, stenosis after esophagectomy. METHODS: The clinical data of 1111 patients, undergone esophagectomy with immediate reconstruction for cancer in the Sun Yat-sen Cancer Center from December 1997 to December 2003, were analyzed retrospectively. Up to 19 factors were evaluated by univariate and multivariate Logistic regression analysis with SPSS 11.5 for windows. Spearman rank correlation was used to evaluate the factors that were statistically significant in Logistic regression analysis. RESULTS: The overall incidence of anastomotic cicatricial stenosis was 6.84%. By using univariate Logistic regression, sustained-hypoxemia (P=0.003), chest complications (P=0.000), anastomotic leakage (P=0.000), a history of diabetes (P=0.019), a history of chronic obstructive pulmonary disease (P=0.046) and cardiovascular complications (P=0.015) came out to be significantly related to anastomotic stenosis. Multivariate Logistic regression showed that sustained-hypoxemia (P=0.044), chest complications (P=0.009), anastomotic leakage (P=0.001) and a history of diabetes (P=0.036) were statistically significant. Spearman rank correlation estimation revealed that sustained-hypoxemia was positively correlated with chest complications (r=0.105) and anastomotic leakage,(r=0.106), and chest complications were positively correlated with anastomotic leakage (r=0.228). CONCLUSION: Sustained-hypoxemia is one of the significant factors for anastomotic cicatricial stenosis after esophagectomy.

[Advancement in endocrine therapy for breast cancer].

Endocrine therapy with certain effect is an important part of combined therapy for hormone receptor-positive breast cancer. The endocrine therapy for breast cancer has made progress with the development of new endocrine drugs. Now, tamoxifen is still the standard endocrine therapeutic drug for the premenopausal patients, but aromatase inhibitors can bring more benefit for the postmenopausal patients. Several large-scale clinical trials about aromatase inhibitors and medical ovarian ablation are ongoing and attract attention widely. This review overviewed the endocrine therapy for breast cancer, and mainly introduced its recent advancement.

[Expression and clinical significance of adhesive molecule CD44v6 in breast invasive ductal carcinoma].

BACKGROUND & OBJECTIVE: Many researches suggest that CD44v6 is associated with the occurrence, invasion, and metastasis of breast cancer. However the reports about the relationship between CD44v6 expression and the prognosis of breast cancer are conflicting. This study was to investigate the expression of CD44v6 and its correlation to clinicopathologic characteristics and prognosis of breast cancer. METHODS: CD44v6 expression in 84 specimens of breast cancer and 20 specimens of para-tumor breast tissues was detected by SP immunohistochemistry. COX proportional hazards model was used to analyze the prognosis. RESULTS: The positive rate of CD44v6 in the epithelial cells of breast cancer was significantly higher than that in para-tumor breast tissues (78.6% vs. 5.0%, P<0.05). The expression of CD44v6 was closely correlated to TNM stage, tumor size, and lymph node metastasis (P<0.05). The median follow-up period was 60 months. The overall survival rate was significantly higher in CD44v6-negative group than in CD44v6-positive group (P<0.05). The survival curve had a tendency to decline with the stronger expression of CD44v6. Cox model revealed that ER, TNM stage, and CD44v6 were independent prognostic factors of breast cancer. CONCLUSIONS: CD44v6 is highly expressed in breast cancer, and positively correlated to TNM stage, tumor size, and lymph node metastasis. CD44v6 is an independent prognostic factor of breast cancer.

[Surgical treatment efficacy of bronchioloalveolar carcinoma: a retrospective analysis of 130 patients].

BACKGROUND & OBJECTIVE: Bronchioloalveolar carcinoma (BAC) is a well-differentiated lung adenocarcinoma occurring in the periphery of the lung and growing along an intact interstitial framework. There are controversies about the surgical treatment efficacy of BAC. This study was to explore the surgical treatment efficacy of BAC. METHODS: Data were collected from 130 patients with BAC, hospitalized in the department of Thoracic Surgery, Cancer Center of Sun Yat-sen University, diagnosed by postoperative pathology from 1985 to 2000. Clinical and histological features, approaches and outcomes of surgical treatment according to different TNM stages and clinical patterns were studied retrospectively. RESULTS: Of the 130 patients, 56.1% were men, 42.9% were women. The ratio of smoker to non-smoker was 1:1.55. Ninety-eight patients underwent complete resection and 32 underwent incomplete resection. Patients in stage I (n=54), stage II (n=15), stage III B (2/11), and stage IV (1/19) underwent complete resection, of whom the 5-year survival rates were 60.7%, 33.3%, 13.6%, and 14.0%, respectively. Patients of unifocal (96/113), multifocal (1/12), and pneumonic (1/19) patterns underwent complete resection, of whom the median survival time was 46.3, 20.6, and 5 months. The 1-, 3-, and 5-year survival rates were 96.4%, 58.6%, and 41.2% for the unifocal pattern, 91.2%, 41.7%, and 33.3% for the multifocal pattern, 20%, 0, and 0 for the pneumonic pattern. CONCLUSION: Complete surgical resection can achieve favorable survival rates for BAC in stage I/II and multifocal BAC in stage III/IV, whereas relatively poorer prognosis for pneumonic BAC.

[Expression and significance of C-kit and platelet-derived growth factor receptor-beta (PDGFRbeta) in esophageal carcinoma].

BACKGROUND & OBJECTIVE: Some researches have showed that STI-571 could inhibit tyrosine kinase of Bcr-Abl, C-kit, and platelet-derived growth factor receptor-beta (PDGFRbeta), therefore, inhibit cell differentiation and proliferation and accelerate cell apoptosis. This study was to examine the expression of tyrosine kinase receptor C-kit and PDGFRbeta, which is correlated to STI-571, in esophageal carcinoma. METHODS: The expression of C-kit and PDGFRbeta in tumor tissue, para-tumor tissue, and normal tissue of 50 specimens of esophageal carcinoma was examined by immunohistochemistry. RESULTS: The strong expression rate of C-kit was low in tumor, para-tumor, and normal tissues (4%, 4%, and 12%, respectively), with no significant difference (P=0.220). The strong expression rate of PDGFRbeta was significantly higher in tumor tissues than in para-tumor and normal tissues (68% vs. 28% and 28%, P=0.001). Logistic regression analysis revealed that the strong expression rate of C-kit and PDGFRbeta had no correlation to sex, age, differentiation degree, infiltrative depth, position, lymph node metastasis, and stage of esophageal carcinoma. CONCLUSIONS: The strong expression rate of PDGFRbeta is significantly higher in tumor tissues than in para-tumor and normal tissues. The strong expression rate of C-kit in normal esophageal tissues is low, and it is lower in para-tumor and tumor tissues.

[Clinical significance of hMAM mRNA detection in bone marrow of breast carcinoma patient].

OBJECTIVE: To investigate the expression of the human mammoglobin (hMAM) mRNA in bone marrow and its clinical significance in the breast cancer patient. METHODS: Expression of hMAM mRNA was detected using nested reverse transcription polymerase chain reaction (RT-PCR) in the bone marrow aspiration sample from 75 breast cancer patients, 15 patients with benign breast lesions and 8 healthy volunteers as control. The possible correlation of hMAM mRNA expression with clinico-pathological parameters and related molecular markers such as Ki67, p53 and VEGF were analyzed. RESULTS: The sensitivity of RT-PCR in this series reached 10(-6). The hMAM mRNA was found to be positively expressed by RT-PCR in 21 of 75 breast cancer patients with a positive rate of 28.0%. However, hMAM mRNA expression was not detected in the bone marrow aspiration samples from patients with benign breast lesions and healthy volunteers. The hMAM mRNA expression was positively correlated with axillary nodal involvement and progesterone receptor (PR) status (P < 0.05) as well as Ki67 expression in breast cancer tissue (chi2 = 4.936, P = 0.026), but not with age, tumor size, clinical stage, or estrogen receptor (ER) status (P > 0.05). CONCLUSION: RT-PCR is quite sensitive and has a high specificity in detecting the presence of hMAM mRNA in the bone marrow from breast cancer patients. Thereupon, hMAM mRNA may be useful as a molecular biomarker in detecting disseminated tumor cells (DTC) in the bone marrow of breast cancer patients. Positive hMAM mRNA expression result may have an impact upon therapeutic recommendations and patients' prognostic judgement.

[Detection of sentinel lymph node in patients with early stage breast cancer].

BACKGROUND & OBJECTIVE: Axillary lymph node dissection (ALND) is routinely performed during surgery for breast cancer, but whether ALND could increase survival rate of early stage breast cancer patients remains controversial. Recently, replacing ALND with sentinel lymph node (SLN) biopsy has became a hotspot in breast cancer research. This study aimed to evaluate the reliability and accuracy of SLN biopsy for early stage breast cancer, and to discover the significance of multiple step section level cytokeratin immunohistochemistry in identifying micrometastatic disease. METHODS: SLN biopsy was performed on 121 patients with T1 or T2 breast cancer: methylene blue-labeling was used in 38 patients (methylene blue group), double-labeling of (99m)Tc sulfur colloid and methylene blue was used in 83 patients (combination group). Lymphoscintigraphy and hand-hold gamma detector were used to localize SLNs before operation. All SLNs and ALND lymph nodes were pathologically examined. The tumor-negative SLNs were cut at three levels, and detected by immunohistochemistry. RESULTS: Success rates were 81.6% in methylene blue group, and 95.2% in combination group; accurate detection rates of axillary lymph nodes were 93.5% in methylene blue group, and 97.5% in combination group. SLNs were found in 19 patients (23%) by lymphoscintigraphy, and 76 patients (92%) by hand-hold gamma detector, respectively (P=0.04). A total of 194 negative SLNs, detected by routine pathologic examination, were re-examined by multiple step section level cytokeratin immunohistochemistry; micrometastatic diseases were identified in 21 SLNs of 13 patients. The accuracy rate of combined examinations was 98.7%, and the false-negative rate was 3.2%. CONCLUSIONS: The axillary node status can be predicted by SLN biopsy; double-staining is better than methylene blue-labeling. The role of lymphoscintigraphy in SLN biopsy needs further explore. Multiple step section level cytokeratin immunohistochemistry can improve detection rate of micrometastatic diseases.

[Expression and clinical significance of cytokeratin 19 in bone marrow of patients with breast cancer].

BACKGROUND & OBJECTIVE: Breast cancer may undergo metastasis in early phase. Distant metastasis, especially bone metastasis, may influence prognosis of breast cancer patients. Bone marrow micrometastasis (BMM) is difficult to detect with routine methods. This study was designed to evaluate expression and clinical significance of cytokeratin 19 (CK19) in bone marrow of patients with breast cancer. METHODS: Expression of CK19 mRNA in bone marrows of 65 breast cancer patients, 15 benign breast disease patients, and 8 healthy volunteers was detected by reverse transcription-polymerase chain reaction (RT-PCR). Correlation of CK19 mRNA expression to clinicopathologic features of the 65 breast cancer patients was analyzed. RESULTS: Positive rate of CK19 mRNA was 33.8% in the 65 breast cancer patients, and 0 in both benign breast disease patients and healthy volunteers. Expression of CK19 mRNA was positively correlated with tumor size and clinical stage (P < 0.05), but was not related to age and lymph node status (P > 0.05). In addition, positive rate of CK19 mRNA was positively correlated with carcinoembryonic antigen (CEA) in peripheral blood (r=0.372, P=0.002). CONCLUSIONS: CK19 mRNA may be used as a molecular marker to detect bone marrow micrometastasis in patients with breast cancer. The detection may help to select proper therapy and predict prognosis of breast cancer patients.

[Neoadjuvant chemotherapy with docetaxel plus epirubicin for locally advanced breast cancer: a multi-center phase II study].

OBJECTIVE: To investigate the clinical response, pathological complete response (pCR), tumor resection rate and safety of neoadjuvant chemotherapy with docetaxel and epirubicin (ET) for locally advanced breast cancer (LABC). METHODS: From March to December 2001, 40 women with LABC, aged from 28-67 (medium 48) years were alloted. Twenty patients had clinical stage IIIa disease, 15 had stage IIIb disease and 5 stage IV patients who had ipsilateral sura-clavicular metastasis. The dose was: epirubicin (E) 60 mg/m2, docetaxel (T) 75 mg/m2 every 3 weeks, with G-CSF given preventively. After 2 cycles of ET, a pilot clinical response evaluation was performed by investigators for each patient to decide if she should receive another 1-2 cycles of ET before surgery or radiation therapy. RESULTS: Thirty-eight patients received 2-3 cycles of ET regimen. The pCR, clinical complete response (cCR) and clinical partial response (cPR) rates were 15.0%, 20.0% and 52.5%, respectively. Tumor resection rate in this group was 92.5%. Incidence of III/IV Grade neutropenia was 8.4%/14.0% of cycles, and 3 patients suffered from neutropenia with fever. Non-hematological adverse events were alopecia, nausea, vomiting, fluid retention, myalgia, arthralgia and nail disorders, which were mild to moderate. CONCLUSION: Neo-adjuvant chemotherapy with a combination of docetaxel and epirubicin is effective and well tolerated by women with locally advanced breast cancer.

[Clinical analysis of resectable breast cancer: a report of 6 263 cases].

BACKGROUND & OBJECTIVE: In Europe and America, breast cancer commonly occurs in women of middle and old age, the median age of patients is about 57 years old. Modified radical mastectomy has taken the place of traditional radical mastectomy, and is called standard radical mastectomy. Patients with breast cancer of early stage commonly receive breast conservative therapy. TNM stage (especially the lymph node status) affects the prognosis, and adjuvant therapy can improve the survival. In China, just a few clinical researches of large amounts of breast cancer patients have been reported. This study was to analyze clinical feature, surgical patterns, treatment outcome of resectable breast cancer, and explore prognostic factors and the effect of adjuvant therapy, for the sake of improving the levels of diagnosis and treatment. METHODS: Records of 6 263 patients with resectable breast cancer, admitted in our hospital from Jun. 1963 to Jun. 2003, were analyzed retrospectively. RESULTS: Of the 6 263 patients, 98.8% were women. Breast cancer occurred most frequently in patients of 40-49 years old (41.0%), especially in patients of 45-49 years old (25.2%). Breast lump was the main clinical manifestation, and occurred in 96.2% of the patients. The 5-, and 10-year survival rates of all patients were 75.2%, and 40.4%. Of the patients in TNM stages 0-I,II, and III, the 5-year survival rates were 96.8%, 73.7%, and 46.4%, respectively the 10-year survival rates were 78.7%, 64.6%, and 33.5%, respectively. The 5-, and 10-year survival rates were higher in lymph node negative group than in lymph node positive group (80.3% vs. 55.6%, and 59.2% vs. 31.9%, P<0.01). There was no significant difference in survival rates of patients received radical mastectomy and modified radical mastectomy since 1980's (P>0.05). Of the 73 patients received breast conservative therapy, no local recurrence or metastasis occurred, with the maximal follow-up of 17 years. Of the patients in stage T2 -T4, the 5-, and 10-year survival rates were significantly higher in adjuvant chemotherapy group than in non-chemotherapy group (78.2% vs. 60.1%, and 48.9% vs. 30.7%, P<0.01). CONCLUSIONS: According to our data, breast cancer most frequently occurred in patients of 45-49 years old. TNM stage (especially the axillary lymph node status)relates to prognosis of breast cancer. The prognosis was worse in the patients with positive lymph node than in the patients with negative Lymph node. The efficacy of modified radical mastectomy equals to that of radical mastectomy, breast conservative therapy can be applied to patients in early stage. Adjuvant chemotherapy and endocrine therapy can improve the survival of resectable breast cancer patients.