Objective
To analyze the clinicopathologic features and prognosis of low-age young breast cancer patients (age ≤30 years old).
Methods
138 low-age young patients pathologically confirmed as breast cancer who received radical surgery in our hospital from January 1992 to December 2005 were selected, 206 middle and old age breast cancer patients (age >35 years old) during the same period were randomly selected as control. The clinicopathologic characteristics were compared between the two groups. The Kaplan-Meier method was used to analyze the survival of breast cancer patients in different age groups.
Results
Compared with the control group, large lump and positive lymph node metastasis were more common in the low-age young group, with statistically significant differences (P<0.05). The 5 year survival rates of low-age young group and the control group were 66.7% and 78.7%, the 10 year survival rates were 47.1% and 56.0%. Kalpan-Meleir survival analysis showed that the overall survival of the two groups were significantly different.
Conclusion
The low-age young patients with breast cancer are with inferior biological behavior, such as larger lump, higher lymph node metastasis, and poor prognosis. Therefore, early diagnosis and early treatment should be advocated in clinical practice, and more attention should be paid to very young patients to improve the prognosis.
Key words:
Young breast cancer; Clinicopathologic characteristics; Prognosis
To explore the clinical application of the pedicled omentum flap in breast reconstruction of breast cancer patients.Between May 2013 and October 2017, 205 patients with breast cancer received modified mastectomy. The pedicled omentum flap was used to reconstruct breast at the same time. All patients were female with an average age of 34.9 years (mean, 26-58 years). The tumor located at left breast in 127 cases and right side in 78 cases. The diameter of the tumor was 2-5 cm (mean, 2.9 cm). The 120 cases of breast cancer were at stage Ⅰ and 85 cases were at stage Ⅱ; and 126 cases were invasive ductal carcinoma and 79 cases were invasive lobular carcinoma. The course of disease ranged from 10 to 92 days (mean, 38.5 days). The size of defect after tumor ablation ranged from 9 cm× 6 cm to 18 cm×12 cm; the size of pedicled omentum flap ranged from 18 cm×10 cm to 22 cm×16 cm.According to the anatomical basis, the omentum was divided into 4 types, including thin type (42 cases, 20.5%), medium type (133 cases, 64.9%), hypertrophy type (24 cases, 11.7%), and absence type (6 cases, 2.9%). All omentum flaps survived successfully and the incisions healed by first intention. All patients were followed up 6-74 months (mean, 24.5 months); 83 cases were followed up more than 5 years. The shape, texture, and elasticity of the reconstructed breast were good and no flap contracture deformation happened. Only linear scar left at the donor sites, and the function of abdomen was not affected. No local recurrence happened.The pedicled omentum flap can be harvested safely and reliable, which is the one of ideal option for breast reconstruction in breast cancer patients.探讨带蒂大网膜瓣在乳腺癌术后乳房再造中的临床应用。.2013 年 5 月—2017 年 10 月，对 205 例乳腺癌患者行改良根治术联合带蒂大网膜瓣移植再造乳房。患者均为女性；年龄 26～58 岁，平均 34.9 岁。左侧 127 例、右侧 78 例；肿瘤直径 2～5 cm，平均 2.9 cm。乳腺癌分期：Ⅰ期 120 例，Ⅱ期 85 例。病理诊断：浸润性导管癌 126 例，浸润性小叶癌 79 例。病程 10～92 d，平均 38.5 d。肿物切除后遗留缺损范围为 9 cm×6 cm～18 cm×12 cm。带蒂大网膜瓣切取范围为 18 cm×10 cm～22 cm×16 cm。.根据术中观察的组织特点，将大网膜分为 4 种类型，稀薄型（42 例，20.5%）、中间型（133 例，64.9%）、肥厚型（24 例，11.7%）、缺如型（6 例，2.9%）。术后带蒂大网膜瓣均成活，切口Ⅰ期愈合。患者均获随访，随访时间 6～74 个月，平均 24.5 个月；其中 83 例随访达 5 年以上。再造乳房外形可、弹性好，无挛缩变形。供区仅遗留线性瘢痕，腹部功能无影响。随访期间无乳腺癌复发。.带蒂大网膜瓣切取安全可靠、质地优良，是乳腺癌术后乳房再造的理想方法之一。.
Objective To investigate clinical application of intraoperative intraperitoneal hyperthermic chemotherapy using sustained-release fluorouracil in radical gastrectomy for advanced gastric cancer.Methods The clinical data of 280 advanced gastric cancer patients admitted from September,2002 to September,2010 were analyzed retrospectively.They were divided into three groups randomly and followed up.The postoperative morbidity,the mortality and the overall survival rates were evaluated.Results There were no significant differences in these three groups with respect to postoperative morbidity ( P ＞ 0.05 ).The incidence of recurrence in intraperitoneal chemotherapy using sustained-release fluorouracil ( treatment group) was significantly lower than those of intraperitoneal chemotherapy and operative treatment( 16.18％,37.61％ and 41.28％,P ＜0.05).The 1,3- and 5-year overall survival rates of treatment group were 85.51％,61.28％ and 53.67％,respectively,and the 1-,3- and 5-year overall survival rates were 84.11％,39.98％ and 28.12％,and 81.28％,29.88％ and 25.21％ respectively in intrapeitoneal chemotherapy group and operative group.1-year overall survival rate had no significant differences among three groups with respect to ( P＞0.05).3-and 5-year overall survival rates in treatment group were higher signfficantly than those of intraperitoneal chemotherapy and operative treatment( P＜0.05).Conclusions Intraoperative intrapeitoneal hyperthermic chemotherapy using sustained-release fluorouracil is a kind of convenient,safe,and highly effective comprehensive treatment method,and it can kill isolated intraperitoneal cancer cells.It may reduce postoperative recurrence and improve survival rates.
Key words:
Stomach neoplasms/surgery/drug therapy; Antineoplastic combined chemotherapy protocols/therapeutic use; Hyperthermia,induced; Injections,intraperitoneal; Fluorouracil/administration & dosage
Pertuzumab plus trastuzumab combined with chemotherapy has become a standard neoadjuvant therapy option for patients with high-risk human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). There is still not enough evidence for the efficacy and safety of neoadjuvant pertuzumab and trastuzumab plus chemotherapy in HER2-positive BC patients in China, both in clinical trials and real-world settings. This study aimed to assess the efficacy and safety of neoadjuvant pertuzumab plus trastuzumab in combination with chemotherapy in Chinese patients with HER2-positive BC in real-world clinical application.We retrospectively collected the data from the electronic medical records of HER2-positive patients treated with neoadjuvant trastuzumab and pertuzumab plus chemotherapy from December 2018 to May 2021 at 21 hospitals located in Hunan Province, China, including age, American Joint Committee on Cancer (AJCC) stage, clinical tumor size, clinical lymph node status, pathological characteristics (before neoadjuvant systemic therapy), treatment approach, adverse events to neoadjuvant therapy, and achievement of pathological complete response (pCR). The primary endpoint was the total rate of pCR, and the secondary endpoints were the rate of pCR of each subgroup and the safety of dual anti-HER2 therapy.A total of 188 patients met the inclusion criteria and were included in the analysis. Of the 188 patients, 119 (63.3%) were diagnosed at stage II and 64 (34.0%) at stage III; 163 (86.7%) were cT2-3; 149 patients (79.3%) were ≥ cN1; 84 patients (44.7%) were hormone receptor (HR)-positive. pCR was observed in 88 of 188 patients (46.8%). The pCR rate of HR-negative patients (54.8%) was higher (P=0.014) than that of HR-positive patients (36.9%). Patients with Ki-67 <15% achieved a higher (P=0.033) pCR rate (68.2%) than those with Ki-67 ≥15% (44.0%). Anemia was the most common adverse event (63.4%), and the most common grade 3-4 adverse event was nausea and vomiting (8.5%).Our study confirmed the benefit of neoadjuvant pertuzumab plus trastuzumab in combination with chemotherapy on pCR with a tolerable safety profile in routine clinical practice in Chinese patients with HER2-positive BC. HR-negativity and Ki-67 <15% were associated with pCR in these patients.
Abstract Background The laparoscopically harvested omental flap (LHOF) has been used in partial or total breast reconstruction, but most studies on LHOF were case reports or small case series. However, the clinical feasibility and oncological safety of LHOF in oncoplastic breast surgery remains controversial. This study reported our experience applying LHOF for immediate breast reconstruction. Methods Between June 2018 and March 2022, 300 patients underwent oncoplastic breast surgery using LHOF at our institution. Their clinicopathological data, complications, cosmetic outcomes, and oncologic outcomes were evaluated. Results All patients underwent total breast reconstruction using LHOF after nipple-sparing mastectomy. The median operation time was 230 min (ranging from 155 to 375 min). The median operation time for harvesting the omental flap was 55 min (ranging from 40 to 105 min). The success rate of the laparoscopically harvested pedicled omental flap was over 99.0%. Median blood loss was 70 ml, ranging from 40 to 150 ml. The volume of the flap was insufficient in 102 patients (34.0%). The overall complication rate was 12.3%. Subcutaneous fluid in the breast area (7%) was the most common reconstruction-associated complication, but most cases were relieved spontaneously. The incidence rate of omental flap necrosis was 3.3%. LHOF-associated complications occurred in two cases, including one case of incisional hernia and one case of vascular injury. Cosmetic outcomes were satisfactory in 95.1% of patients on a four-point scale by three-panel assessment and 97.2% using the BCCT.core software. Two local and one systemic recurrence were observed during a median follow-up period of 32 months. Conclusions The LHOF for immediate breast reconstruction is a safe and feasible method that involves minimal donor-site morbidity, satisfactory cosmetic outcomes, and promising oncologic safety.
The administration of doxorubicin (DOX) is one of the first‐line treatments of breast cancer. However, acquisition of resistance remains the major obstacle restricting the clinical application of DOX. MicroRNAs (miRNAs) are small, noncoding RNAs which play crucial role in epigenetic regulation. Recent studies have shown that miRNAs are associated with tumor chemoresistance. Here we aim to explore the role of miRNA‐192‐5p in resistance to DOX in breast cancer cells. Normal human breast epithelial cell line MCF‐10A, breast cancer cell line Michigan Cancer Foundation‐7 (MCF‐7), and DOX‐resistant breast cancer cell line MCF‐7/ADR were used here. The expression of miR‐192‐5p was examined by qPCR, and the expression of peptidylprolyl isomerase A (PPIA) was examined by qPCR and Western blot. The effects of miR‐192‐5p overexpression on the sensitivity to DOX were confirmed by Methylthiazolyldiphenyl‐tetrazolium bromide (MTT) and Annexin‐V/PI assay. Downstream molecular mechanisms, including PPIA, BAD, CASP9, Bcl‐2, and c‐Jun N‐terminal kinase (JNK) activation, were detected by Western blot and qPCR. Luciferase reporter assay was used to validate the association between miR‐192‐5p and PPIA. miR‐192‐5p was downregulated while PPIA was upregulated in MCF‐7/ADR cells. Functionally, miR‐192‐5p overexpression increased sensitivity to DOX by promoting cell apoptosis. Mechanistically, miR‐192‐5p overexpression performed its function by activating JNK, augmenting BAD and caspase9 expression, and suppressing Bcl‐2 and PPIA expression. Luciferase assay validated that PPIA was a direct target of miR‐192‐5p. miR‐192‐5p sensitizes breast cancer cells to DOX by targeting PPIA, suggesting that miR‐192‐5p might serve as a novel target for reversing DOX resistance and controlling breast tumor growth.
Objective
To discuss the feasibility and effect of immediate breast reconstruction with pedicled greater omentum and gel prosthesis following nipple and areola complex sparing mastectomy.
Methods
From August 2013 to September 2015, after mastectomy with conservation of nipple and areola, twenty-three patients with stage 0, Ⅰ, Ⅱ breast cancer accepted immediate breast reconstruction with pedicled greater omentum and gel prosthesis.
Results
All the pedicled greater omentum was successfully inserted, and no prosthesis migration and rupture occurred 3 to 25 months after operations. The reconstructed breast was good in shape and with soft feeling. Nipple ischemia occurred in two patients with ductal carcinoma in situ, while skin necrosis was not found within 3 months. There was no recurrence of breast cancer during follow-up period.
Conclusion
Immediate breast reconstruction with pedicled greater omentum and gel prosthesis after mastectomy with conservation of nipple and areola is an effective and safe procedure.
Key words:
Breast neoplasms; Mastectomy; Bioprosthesis; Reconstructive surgical procedures
Modern biopsychosocial medical model embodies the organic combination of medical scientism and humanism. It emphasizes the necessity of humanistic care in medical practice. This kind of humanistic care includes not only caring for people, but also caring for technology. Because of humanistic care, it is necessary to realize the improvement of technology. Patients get benefits from the progress for humanistic care. PICC, one of intravenous infusion system, can provide the protective effect to peripheral vein, but is still visible. Venous access port can be completely hidden in the body of patients, maximize the protection of the privacy of the patient. At the same time, the interference of daily life is greatly reduced, the complication rate is reduced, the quality of life of patients increases significantly. Therefore, by using the venous access port in patients with breast cancer, its humanities spirit is revealed from the design concept and the actual use of the process and effect.
Key words:
Venous access port; Humanistic care; Breast cancer
Cisplatin resistance presents a major challenge in the successful treatment of breast cancer, and its mechanism has not been documented well. In this study, to determine the relationship between chemotherapy resistance and microRNA (miRNA) expression during the development of cisplatin resistance in breast cancer, we used microRNA microarrays analysis successfully identified 19 miRNAs that were either overexpressed or underexpressed (8 upregulated and 11 downregulated) in the MCF-7 cell line and its cisplatin-resistant variant MCF-7/DDP. Among them, the miR-218 was most downregulated in cisplatin-resistant cell lines and identified that breast cancer 1 (BRCA1) was the cellular targets of miR-218. In vivo assay also demonstrated that restoring miR-218 expression in MCF-7/DDP cell line could sensitize cells against cisplatin, thereby increasing cisplatin-mediated tumor cell apoptosis and reducing DNA repair. Kaplan-Meier survival analysis indicated that patients with breast cancer display high levels of miR-218 and low levels of BRCA1 expression; these patients may gain the greatest benefits in terms of increased survival when treated with cisplatin. All of these results indicated that miR-218 has a significant function in the development of cisplatin resistance in breast cancer. Restoring miR-218 expression may constitute a novel therapeutic approach by which to increase cisplatin sensitivity in breast cancer.
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