Survival outcomes after breast-conserving surgery plus radiotherapy compared with mastectomy in breast ductal carcinoma in situ with microinvasion.

Ductal carcinoma in situ with microinvasion (DCIS-MI) is a subtype of breast cancer with a good prognosis, for which both breast conserving surgery plus radiotherapy (BCS + RT) and mastectomy are feasible surgical methods, but no clear conclusion has been made on the choice of these treatments. We used the Surveillance, Epidemiology and End Results database to extract 5432 DCIS-MI patients. Participants were divided into the BCS + RT group and the mastectomy group. We compared the overall survival (OS) and breast cancer-specific survival (BCSS) of the two groups using the Kaplan-Meier method and Cox regressions before and after propensity score matching (PSM). Before PSM, both univariate and multivariate analyses showed that BCS + RT group had significantly higher OS and BCSS compared with patients in the mastectomy group (P < 0.001). After PSM, the multivariate analysis showed that compared with mastectomy, the BCS + RT showed significantly higher OS and BCSS (HR = 0.676, 95% CI = 0.540-0.847, P < 0.001; HR = 0.565,95% CI = 0.354-0.903, P = 0.017). In addition, the subgroup analysis showed that BCS + RT is at least equivalent to mastectomy with respect to OS and BCSS in any subgroup. For patients with DCIS-MI, the prognosis of BCS + RT was superior to mastectomy.

Effect of postmastectomy radiotherapy on T1-2N1M0 triple-negative breast cancer.

BACKGROUND: The effect of postmastectomy radiotherapy (PMRT) on T1-2N1M0 triple-negative breast cancers (TNBC) remains unclear. The population-based study aimed to investigate the survival outcomes of T1-2N1M0 TNBC patients who underwent PMRT or not. METHODS: We selected 1743 patients with T1-2N1M0 TNBC who underwent mastectomy between 2010 and 2015 through the Surveillance, Epidemiology and End Results (SEER) database. After propensity score matching (PSM), the PMRT and no-PMRT groups consisted of 586 matched patients, respectively. The Kaplan-Meier method was applied to calculate breast cancer-specific survival (BCSS) and cox proportional hazard model was used to determine the prognostic factors of T1-2N1M0 TNBC. RESULTS: The 5-year BCSS for the PMRT and no-PMRT groups was 79.1% and 74.7%, respectively. Analysis showed that in patients with three nodes positive, radiotherapy could significantly improve BCSS (HR = 0.396, 95% CI = 0.175-0.900, P = 0.027), but it brought no significant advantage in BCSS in patients with one or two nodes positive (HR = 1.061, 95% CI = 0.725-1.552, P = 0.761; HR = 0.657, 95% CI = 0.405-1.065, P = 0.088). In addition, PMRT improves the BCSS in TNBC patients with T2 tumor concomitant with three positive lymph nodes (HR = 0.343, 95% CI = 0.132-0.890, P = 0.028). CONCLUSION: TNBC patients with T2 tumor concomitant with three positive lymph nodes can benefit from PMRT.

The different outcomes between breast-conserving surgery plus radiotherapy and mastectomy in metaplastic breast cancer: A population-based study.

BACKGROUND: Metaplastic breast cancer (MBC) are rare. The survival outcomes of MBC patients after breast conserving surgery plus radiotherapy (BCS+RT) or mastectomy have not been established. The study aimed to compare survival outcomes of MBC patients subjected to BCS+RT or mastectomy therapeutic options. METHODS: Patients who were subjected to BCS+RT or mastectomy between 2004 and 2014 were enrolled in this study through the Surveillance, Epidemiology and End Results (SEER) database. Breast cancer-specific survival (BCSS) and the overall survival (OS) of the participants were determined. Cox proportional hazard model and the Kaplan Meier method were used to determine the correlation between the two surgical methods and survival outcomes. RESULTS: A total of 1197 patients were enrolled in this study. Among them, 439 patients were subjected to BCS+RT, while 758 patients were subjected to mastectomy. After propensity score matching (PSM), the BCS+RT and mastectomy groups consisted of 321 patients, respectively. The univariate and multivariate analysis with a 6-month landmark all indicate that patients receiving BCS+RT has higher OS than patients receiving mastectomy (HR = 0.701,95% CI = 0.496-0.990, P = 0.044; HR = 0.684,95% CI = 0.479-0.977, P = 0.037) while the BCSS was no difference between the two groups (HR = 0.739,95% CI = 0.474-1.153, P = 0.183; HR = 0.741,95% CI = 0.468-1.173, P = 0.200). CONCLUSION: The BCS+RT therapeutic option exhibits a higher OS in MBC patients compared to the mastectomy approach.

Efficacy and Safety of Radiofrequency Ablation for Breast Cancer Smaller Than 2 cm: A Systematic Review and Meta-Analysis.

BACKGROUND: To evaluate the efficacy and safety of radiofrequency ablation (RFA) of breast cancer smaller than 2 cm. METHODS: A systematic search was conducted in the PubMed and EMBASE databases to identify published studies investigating the efficacy and safety of RFA for breast cancer smaller than 2 cm. The main outcomes were technical success rate of the ablation, complete ablation rate, complications and local recurrence. Secondary considerations were mode of anesthesia, pain tolerance, mean ablation time and surgical excision after ablation. RESULTS: Seventeen studies involving 399 patients and 401 lesions met the inclusion criteria. Nearly 99%(95%CI=0.98-1.00) of lesions achieved good technical success rate.Notably, 83.88% of the patients received RFA under general anesthesia (333/397) whereas 15.87% received RFA under local anesthesia (63/397). Of the 63, 98.41% tolerated the pain associated with the procedure. Majority of patients (65.74%, 261/397) underwent surgical excision of the tumor after ablation whereas in a few patients (34.26%, 136/397), the tumor tissue was retained in the breast after ablation. Complete ablation was achieved in 96% of patients for a mean time of 15.8 minutes (95%CI=0.93-0.99). Overall, only 2% (95%CI=0.01-0.04) of the individuals developed complications. Skin burns (2.02%, 8/397) were the most common complications. There was no local recurrence after a median follow-up of 27.29 months, whether or not they underwent surgical resection following RFA. CONCLUSION: The results show that RFA for breast cancer smaller than 2 cm is safe and effective. However, prospective studies are needed to validate this conclusion.

Survival outcomes of neoadjuvant versus adjuvant chemotherapy in triple-negative breast cancer: a meta-analysis of 36,480 cases.

BACKGROUND: The survival outcomes of neoadjuvant chemotherapy (NACT) versus adjuvant chemotherapy (ACT) for patients with triple-negative breast cancer (TNBC) remain unclear. Therefore, in this study, a meta-analysis was conducted to analyze current evidence on the survival outcomes of NACT versus ACT in TNBC. METHODS: A systematic search was performed on the PubMed and Embase databases to identify relevant articles investigating the survival outcomes of NACT versus ACT in TNBC. RESULTS: A total of nine studies involving 36,480 patients met the selection criteria. Among them, 10,728 (29.41%) received NACT, and 25,752 (70.59%) received ACT. The pathological complete response (pCR) rate was 35% (95% CI = 0.23-0.48). Compared with ACT, the overall survival (OS) of NACT was poor (HR = 1.59; 95% CI = 1.25-2.02; P = 0.0001), and there was no significant difference in disease-free survival (DFS) between the two treatments (HR = 0.85; 95% CI = 0.54-1.34; P = 0.49). NACT with pCR significantly improved the OS (HR = 0.53; 95% CI = 0.29-0.98; P = 0.04) and DFS (HR = 0.52; 95% CI = 0.29-0.94; P = 0.03), while the OS (HR = 1.18; 95% CI = 1.09-1.28; P < 0.0001) and DFS (HR = 2.36; 95% CI = 1.42-3.89; P = 0.0008) of patients with residual disease (RD) following NACT were worse compared to those receiving ACT. CONCLUSION: These findings suggest that, for TNBC, NACT with pCR is superior to ACT in improving OS and DFS, and it turns to be opposite when patients are receiving NACT with RD.

[Experimental study of targeting therapy of breast cancer with 131I-labeled epidermal growth factor].

OBJECTIVE: To investigate the effectiveness of (131)I-epidermal growth factor (EGF) on the proliferation of a heterologous graft in nude mice bearing human breast infiltrating duct carcinoma. METHODS: EGF/HAS was labeled with (131)I by chloramines-T method. Human breast cancer xenografts with positive EGFR expression were established in nude mice. The nude mice were injected with normal saline, Epirubicin Hydrochloride, (131)I-EGF, (131)I-HAS, (131)I intravenously and (131)I-EGF intratumoral administration respectively. The tumor growth inhibition rate was determined by measurement of tumor volume. Different examinations were carried out. RESULTS: There was remarkable significant difference of tumor volumes at 26th day among (131)I-EGF trial groups, (131)I, (131)I-HAS, and the negative control group. The tumor growth inhibition rate of (131)I-EGF trial groups was 82.0%, 80.7% respectively. Compared with the negative control group, the (131)I-EGF trial groups remarkably suppressed the growth of tumor (P < 0.05). Irreversible destruction of tissues in (131)I-EGF groups was observed under light and electron microscope. There was no evidence of hepatotoxicity, renal toxicity and myelotoxicity in nude mice bearing human breast cancer given (131)I-EGF over a 4-wk observation period. CONCLUSION: (131)I-EGF has obvious antitumor effects on a heterologous graft in nude mice bearing human breast infiltrating duct carcinoma, with little obvious side effects.

131I-recombinant human EGF has antitumor effects against MCF-7 human breast cancer xenografts with low levels of EGFR.

This study investigated the inhibitory action of (131)I-recombinant human EGF ((131)I-rhEGF) on MCF-7 human breast cancer tumor development in nude mice. The activity and tumor uptake of (131)I-rhEGF was measured by tissue distribution assay, and its effect on tumor growth was measured by monitoring tumor size after treatment with (131)I-rhEGF. Changes in tumor cell ultrastructure were observed by transmission electron microscopy (TEM), and pathological changes in tumor tissue were observed by light microscopy. The tissue distribution assay revealed that (131)I-rhEGF was markedly absorbed by the tumor and reached its maximal uptake rate (16.73%ID. g(-1)) at 120 hours at which point the drug concentration in the tumor was 11.1-fold, 8.1-fold, and 6.6-fold higher than that in blood, liver, and kidneys, respectively. Tumor size measurements showed that tumor development was significantly inhibited by intravenously and intratumorally injected (131)I-rhEGF. Tumor inhibition rates (82.0% and 80.7%, respectively) were significantly higher than those of tumors treated with (131)I (7.49%) and (131)I-HSA (6.91%; P < 0.05). TEM and light microscopy revealed that intravenous and intratumoral injection of (131)I-rhEGF could significantly damage and ultimately kill tumor cells. Our results suggest that (131)I-rhEGF suppresses development of xenografted breast cancer cells in nude mice, providing a novel candidate for receptor-mediated targeted radiotherapy.

[Quantitative pathologic technique in prognostic identification of breast carcinoma with negative lymph node].

OBJECTIVE: To study the prognostic identification of lymph node negative breast carcinoma by quantitative pathologic technique. METHODS: Several morphometrical parameters, DNA content of cell nuclei were detected by means of a quantitative pathologic technique on 102 patients with lymph node negative invasive breast duct carcinoma. The effects of potential prognostic factors of lymph node negative breast cancer patients were assessed by Cox's proportional hazards regression model. RESULTS: DNA index, minimal diameter of nuclei, area of nuclei, maximal diameter of nuclei, and the perimeter of nuclei are important factors to influence the prognosis. CONCLUSION: Quantitative pathologic technique combined with valid statistical methods, as an objective means of assessing prognosis, may reliably improve the outcome in lymph node negative breast cancer.