Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with...Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with primary breast cancer treated with BCT or MRM in a single Chinese institute between January 2000 and February 2009 were analyzed retrospectively to compare their outcomes with respect to the incidence of local recurrence （LR）, distant metastasis, and survival. The patients were matched with regard to age at diagnosis, spreading to axillary lymph nodes, hormone receptor status, the use of neoadjuvant chemotherapy and maximal tumor diameter. The match ratio was 1：1, and each arm included 873 patients. Results： The median follow-up period was 71 months. The 6-year disease-free survival （DFS） and 6-year distant disease-free survival （DDFS） rates differed significantly between two groups. The 6-year local recurrence-free survival （LRFS） rates were 98.2% [95% confidence interval （CI）： 0.973-0.989] in the BCT group and 98.7% （95% CI： 0.980-0.994） in the MRM group （P=0.182）, respectively. DFS rates in BCT and MRM groups were 91.3% （95% CI： 0.894-0.932） and 86.3% （95% CI： 0.840-0.886） （P〈0.001）, respectively, whereas the DDFS rates in BCT and MRM groups were 93.6% （95% CI： 0.922-0.950） and 87.7% （95% CI： 0.854-0.900） （P〈0.001）, respectively. Conclusions： BCT in eligible patients is as effective as MRM with respect to local tumor control, DFS and DDFS, and may result in a better outcome than MRM in Chinese primary breast cancer patients.展开更多
BACKGROUND As the most common cancer in women,breast cancer is the leading cause of death.Most patients are initially diagnosed as stage I-III.Among those without distant metastases,64%are local tumors and 27%are regi...BACKGROUND As the most common cancer in women,breast cancer is the leading cause of death.Most patients are initially diagnosed as stage I-III.Among those without distant metastases,64%are local tumors and 27%are regional tumors.Patients in stage IIA-IIIC and those who meet the breast-conserving criterion with the exception of tumor size can consider neoadjuvant chemotherapy(NACT).It is worth noting that the status of tumor cell biomarkers is not consistently static.Endocrine-related estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor 2(HER2)encoded by erythroblastic leukemia viral oncogene homolog 2 gene can all alter from positive to negative or vice versa,especially in luminal B subtype after NACT.In addition,determination of HER2 status currently mainly relies on immunohistochemistry(IHC)and fluorescence in situ hybridization(FISH),but FISH is commonly used when the result of IHC is uncertain.HER2 is regarded as negative when the IHC result is 0/1+without the addition of FISH.To the best of our knowledge,this is the first report of a case harboring HER2 status transformation and IHC1+with positive amplification by FISH after NACT.CASE SUMMARY A 49-year-old woman discovered a mass in her right breast and underwent diagnostic workup.Biopsies of the right breast lesion and axillary lymph nodes were obtained.The results pointed to invasive ductal carcinoma with the IHC result for ER(80%),PR(60%),Ki-67(20%)and ambiguous expression of HER2(IHC 2+)with negative amplification by FISH(HER2/CEP17 ratio of 1.13).She underwent surgery after NACT.The pathological findings of the surgically resected sample supported invasive ductal carcinoma with the tumor measuring 1.1 cm×0.8 cm×0.5 cm and had spread to one of fifteen dissected lymph nodes.Retesting of the specimen showed that the tumor was positive for ER(2+,85%)and PR(2+,10%)but negative for HER2 by IHC(1+).Also Ki-67 had dropped to 2%.The patient was regularly monitored every 3 mo without evidence of recurrence.CONCLUSION Biomarker status should be reassessed after NACT especially in luminal subtypes.展开更多
Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. Aft...Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.展开更多
Objective： Being antigen-presenting cells, dendritic cells （DCs） transport captured antigen from peripheral tissues to T cell zone of lymph nodes via lymphatic vessels. This migration is essential for the presentat...Objective： Being antigen-presenting cells, dendritic cells （DCs） transport captured antigen from peripheral tissues to T cell zone of lymph nodes via lymphatic vessels. This migration is essential for the presentation of antigen that leads to priming of effector T cell responses. In this study, we tried to promote the migratory ability of mouse bone marrow-derived dendritic cells （BMDCs） loaded with antigen of breast cancer, and its immunological effect in vivo. Methods： After being loaded with breast carcinoma antigen, BMDCs were cultured with medium containing PGE2, LTC4, or Bryo-1 respectively. Phenotypic changes, CCR7 expression, chemotaxis assay, mixed lymphocyte response, specific T lymphocyte cytotoxicity assay and anti-tumor immune efficacy of BMDCs were observed. Results ： PGF2 and LTC4 promoted maturation, CCR7 expression and migratory ability of BMDCs compared with control group in vitro. In vivo PGE2 and LTC4 group vaccines were more efficient on suppressing growth of mouse breast cancer than other groups. However Bryo-1 only enhanced BMDCs maturation. Conclusion： Because the effect of specific CTL in vitro had no difference, we suggested that migration of dendritic cells to lymph nodes maybe answered for the better anti-tumor immunological response induced by PGE2 or LTC4 in vivo.展开更多
Primary systemic treatment is a fundamental part of breast cancer therapy, and it is applied to non-surgical and locally advanced tumours as well as surgical tumours to increase the likelihood of conservative treatmen...Primary systemic treatment is a fundamental part of breast cancer therapy, and it is applied to non-surgical and locally advanced tumours as well as surgical tumours to increase the likelihood of conservative treatment. Its aim is to achieve the best possible survival with better cosmetic results and with the lowest number of treatment-related secondary effects. Before treatment is started, it is necessary to attain the best knowledge of the biological features and locoregional extension of the tumour. To do so, it is necessary to obtain a biopsy of the lesion with a wide bore needle,as well as good radiological knowledge of the disease.Therefore, currently, the use of a dynamic magnetic resonance imaging(MRI) of the breast should be included in all cases. In addition, before it is started,especially in those tumours in which conservative treatment is considered, one or several radiopaque markers should be put into place to make it possible to locate the area to be treated if there is a considerable or complete response. Systemic treatment is mainly based on combined chemotherapy with anthracyclins and taxanes, in addition to some biological agents with demonstrated efficiency for increasing the likelihood of complete disease response(trastuzumab in patients with Her-2/neu overexpression). However, there is room for neoadjuvant hormone treatment, in patients with hormone receptor overexpression, especially in those cases in which chemotherapy is contraindicated as well as in elderly patients with a relatively short life expectancy. The assessment of preoperative treatment should be based on adequate radiological tests, and nowad these should include MRI before taking decisions about adequate surgical treatment. The objective of primary treatment is to be able to increase survival and improve the chances of local treatment in the case of locally advanced treatment, achieving results that are at least equal to those of adjuvant treatment in the case of surgical tumours, but with greater chances of conservative surgery. Although the objective is survival, achieving complete pathological response seems to be a reasonable related objective, although these are more closely linked in some tumour subtypes.展开更多
Primary neuroendocrine breast carcinoma （NEBC） is a very rare type of breast cancer. Two characteristic biomarkers, namely, CgA and Syn, should be immunohistochemically detected to diagnose NEBC. In this study, a 43...Primary neuroendocrine breast carcinoma （NEBC） is a very rare type of breast cancer. Two characteristic biomarkers, namely, CgA and Syn, should be immunohistochemically detected to diagnose NEBC. In this study, a 43-year-old woman with a large mass of 8.3 cm × 2.9 cm in her right breast was reported. The patient was pathologically diagnosed with NEBC after specific markers, including CgA and Syn, as well as few differential markers, such as CK7, ER, PR, C-erbB-2, NSE, and E-cadherin, were immunohistochemically detected. The patient showed a remarkable response to four cycles of neo-adjuvant chemotherapy （partial response based on RECIST criteria） and sequentially underwent modified radical mastectomy. Moreover, the diagnosis and treatment of NEBC based on this case and available related literature were discussed.展开更多
目的:分析乳腺化生性癌(metaplastic breast carcinoma,MBC)患者的临床病理特征及其影响预后的因素。方法:收集2005年1月至2015年1月55例天津医科大学肿瘤医院诊治MBC患者完整的临床病理资料。回顾性分析MBC患者的临床病理特征、复发及...目的:分析乳腺化生性癌(metaplastic breast carcinoma,MBC)患者的临床病理特征及其影响预后的因素。方法:收集2005年1月至2015年1月55例天津医科大学肿瘤医院诊治MBC患者完整的临床病理资料。回顾性分析MBC患者的临床病理特征、复发及生存情况。MBC患者根据淋巴结是否转移分为淋巴结阳性组(13例)及淋巴结阴性组(39例);根据术后是否接受化疗、放疗及内分泌治疗,将其分为化疗组(40例)和非化疗组(15例)、放疗组(12例)及非放疗组(43例)和内分泌治疗组(5例)及非内分泌治疗组(50例)。并且每例MBC患者与3例同期年龄及临床TNM分期情况基本类似,均接受手术治疗的三阴性乳腺癌(TNBC)患者170例匹配。结果:MBC患者5年无疾病生存率(disease-free survival,DFS)和总生存率(overall survival,OS)分别为45.0%及48.2%,显著低于TNBC患者5年DFS 74.7%及OS 83.5%,且两者之间比较5年OS和DFS差异具有统计学意义(均P<0.001)。肿瘤大小、淋巴结是否转移及接受化疗与否是影响患者生存预后的重要因素。化疗组5年OS和DFS明显高于非化疗组的OS(P=0.008)和DFS(P=0.033)。淋巴结阳性组的MBC患者接受放疗可明显提高其5年OS(P=0.030)。结论:MBC是一种侵袭性强的罕见的乳腺癌特殊类型,预后较TNBC差,化疗使其5年OS及DFS获益,且以铂类为基础的化疗方案可使患者获益更大,对淋巴结阳性患者应行术后放疗。展开更多
目的：观察反义热休克蛋白70（heat shock protein 70,HSP70）RNA对人乳腺癌细胞的生物学特性的影响，探讨其抗肿瘤作用。方法：将逆转录病毒真核表达载体介导的反义HSP70重组质粒pX-AHSP70和空载体pLXSN-neo转染至MCF7/Adr人乳腺癌细...目的：观察反义热休克蛋白70（heat shock protein 70,HSP70）RNA对人乳腺癌细胞的生物学特性的影响，探讨其抗肿瘤作用。方法：将逆转录病毒真核表达载体介导的反义HSP70重组质粒pX-AHSP70和空载体pLXSN-neo转染至MCF7/Adr人乳腺癌细胞，通过细胞生长曲线和软琼脂集落实验以及裸鼠移植瘤实验观察转染反义HSP70重组质粒细胞的体内外抑瘤作用。结果：建立了稳定表达反义HSP70 RNA的MAp70细胞，与空载体细胞相比，HSP70蛋白的表达下降了48％。细胞群体生长速度明显减慢，软琼脂集落形成率和抑制率分别为6.08％和62.14％，裸鼠皮下接种的平均出瘤时间为15天，最终平均瘤重为108 mg，以上参数与空载体细胞相比，均有显著差异。结论：反义HSP70 RNA能够有效地抑制HSP70表达，进而抑制乳腺癌细胞的体外增殖和体内移植瘤的形成与发展。展开更多
文摘Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with primary breast cancer treated with BCT or MRM in a single Chinese institute between January 2000 and February 2009 were analyzed retrospectively to compare their outcomes with respect to the incidence of local recurrence （LR）, distant metastasis, and survival. The patients were matched with regard to age at diagnosis, spreading to axillary lymph nodes, hormone receptor status, the use of neoadjuvant chemotherapy and maximal tumor diameter. The match ratio was 1：1, and each arm included 873 patients. Results： The median follow-up period was 71 months. The 6-year disease-free survival （DFS） and 6-year distant disease-free survival （DDFS） rates differed significantly between two groups. The 6-year local recurrence-free survival （LRFS） rates were 98.2% [95% confidence interval （CI）： 0.973-0.989] in the BCT group and 98.7% （95% CI： 0.980-0.994） in the MRM group （P=0.182）, respectively. DFS rates in BCT and MRM groups were 91.3% （95% CI： 0.894-0.932） and 86.3% （95% CI： 0.840-0.886） （P〈0.001）, respectively, whereas the DDFS rates in BCT and MRM groups were 93.6% （95% CI： 0.922-0.950） and 87.7% （95% CI： 0.854-0.900） （P〈0.001）, respectively. Conclusions： BCT in eligible patients is as effective as MRM with respect to local tumor control, DFS and DDFS, and may result in a better outcome than MRM in Chinese primary breast cancer patients.
文摘BACKGROUND As the most common cancer in women,breast cancer is the leading cause of death.Most patients are initially diagnosed as stage I-III.Among those without distant metastases,64%are local tumors and 27%are regional tumors.Patients in stage IIA-IIIC and those who meet the breast-conserving criterion with the exception of tumor size can consider neoadjuvant chemotherapy(NACT).It is worth noting that the status of tumor cell biomarkers is not consistently static.Endocrine-related estrogen receptor(ER),progesterone receptor(PR)and human epidermal growth factor receptor 2(HER2)encoded by erythroblastic leukemia viral oncogene homolog 2 gene can all alter from positive to negative or vice versa,especially in luminal B subtype after NACT.In addition,determination of HER2 status currently mainly relies on immunohistochemistry(IHC)and fluorescence in situ hybridization(FISH),but FISH is commonly used when the result of IHC is uncertain.HER2 is regarded as negative when the IHC result is 0/1+without the addition of FISH.To the best of our knowledge,this is the first report of a case harboring HER2 status transformation and IHC1+with positive amplification by FISH after NACT.CASE SUMMARY A 49-year-old woman discovered a mass in her right breast and underwent diagnostic workup.Biopsies of the right breast lesion and axillary lymph nodes were obtained.The results pointed to invasive ductal carcinoma with the IHC result for ER(80%),PR(60%),Ki-67(20%)and ambiguous expression of HER2(IHC 2+)with negative amplification by FISH(HER2/CEP17 ratio of 1.13).She underwent surgery after NACT.The pathological findings of the surgically resected sample supported invasive ductal carcinoma with the tumor measuring 1.1 cm×0.8 cm×0.5 cm and had spread to one of fifteen dissected lymph nodes.Retesting of the specimen showed that the tumor was positive for ER(2+,85%)and PR(2+,10%)but negative for HER2 by IHC(1+).Also Ki-67 had dropped to 2%.The patient was regularly monitored every 3 mo without evidence of recurrence.CONCLUSION Biomarker status should be reassessed after NACT especially in luminal subtypes.
文摘Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.
文摘Objective： Being antigen-presenting cells, dendritic cells （DCs） transport captured antigen from peripheral tissues to T cell zone of lymph nodes via lymphatic vessels. This migration is essential for the presentation of antigen that leads to priming of effector T cell responses. In this study, we tried to promote the migratory ability of mouse bone marrow-derived dendritic cells （BMDCs） loaded with antigen of breast cancer, and its immunological effect in vivo. Methods： After being loaded with breast carcinoma antigen, BMDCs were cultured with medium containing PGE2, LTC4, or Bryo-1 respectively. Phenotypic changes, CCR7 expression, chemotaxis assay, mixed lymphocyte response, specific T lymphocyte cytotoxicity assay and anti-tumor immune efficacy of BMDCs were observed. Results ： PGF2 and LTC4 promoted maturation, CCR7 expression and migratory ability of BMDCs compared with control group in vitro. In vivo PGE2 and LTC4 group vaccines were more efficient on suppressing growth of mouse breast cancer than other groups. However Bryo-1 only enhanced BMDCs maturation. Conclusion： Because the effect of specific CTL in vitro had no difference, we suggested that migration of dendritic cells to lymph nodes maybe answered for the better anti-tumor immunological response induced by PGE2 or LTC4 in vivo.
文摘Primary systemic treatment is a fundamental part of breast cancer therapy, and it is applied to non-surgical and locally advanced tumours as well as surgical tumours to increase the likelihood of conservative treatment. Its aim is to achieve the best possible survival with better cosmetic results and with the lowest number of treatment-related secondary effects. Before treatment is started, it is necessary to attain the best knowledge of the biological features and locoregional extension of the tumour. To do so, it is necessary to obtain a biopsy of the lesion with a wide bore needle,as well as good radiological knowledge of the disease.Therefore, currently, the use of a dynamic magnetic resonance imaging(MRI) of the breast should be included in all cases. In addition, before it is started,especially in those tumours in which conservative treatment is considered, one or several radiopaque markers should be put into place to make it possible to locate the area to be treated if there is a considerable or complete response. Systemic treatment is mainly based on combined chemotherapy with anthracyclins and taxanes, in addition to some biological agents with demonstrated efficiency for increasing the likelihood of complete disease response(trastuzumab in patients with Her-2/neu overexpression). However, there is room for neoadjuvant hormone treatment, in patients with hormone receptor overexpression, especially in those cases in which chemotherapy is contraindicated as well as in elderly patients with a relatively short life expectancy. The assessment of preoperative treatment should be based on adequate radiological tests, and nowad these should include MRI before taking decisions about adequate surgical treatment. The objective of primary treatment is to be able to increase survival and improve the chances of local treatment in the case of locally advanced treatment, achieving results that are at least equal to those of adjuvant treatment in the case of surgical tumours, but with greater chances of conservative surgery. Although the objective is survival, achieving complete pathological response seems to be a reasonable related objective, although these are more closely linked in some tumour subtypes.
基金This study is partly supported by the National Basic Research Program of China （973 Program, Grant No. 2011CB707705）, the National Natural Science Foundation of China （Grant Nos. 31271068 and 81302331）, and Guangdong Provincial Key Laboratory on Breast Cancer Diagnosis and Treatment Research.
文摘Primary neuroendocrine breast carcinoma （NEBC） is a very rare type of breast cancer. Two characteristic biomarkers, namely, CgA and Syn, should be immunohistochemically detected to diagnose NEBC. In this study, a 43-year-old woman with a large mass of 8.3 cm × 2.9 cm in her right breast was reported. The patient was pathologically diagnosed with NEBC after specific markers, including CgA and Syn, as well as few differential markers, such as CK7, ER, PR, C-erbB-2, NSE, and E-cadherin, were immunohistochemically detected. The patient showed a remarkable response to four cycles of neo-adjuvant chemotherapy （partial response based on RECIST criteria） and sequentially underwent modified radical mastectomy. Moreover, the diagnosis and treatment of NEBC based on this case and available related literature were discussed.
