BACKGROUND Occult breast cancer(OBC)has traditionally been considered to be a carcinoma of unknown primary origin with a favorable prognosis and can be treated as stage II-III breast cancer.Due to the small number of ...BACKGROUND Occult breast cancer(OBC)has traditionally been considered to be a carcinoma of unknown primary origin with a favorable prognosis and can be treated as stage II-III breast cancer.Due to the small number of cases and limited clinical experience,treatments vary greatly around the world and no standardized treatment has yet been established.AIM To investigate the clinicopathological features,psychological status and prognostic features of patients with OBC.METHODS The clinicopathological data of 33 OBC patients diagnosed and treated in the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital from November 2015 to November 2022 were retrospectively analyzed.The psychological status of OBC patients was evaluated by the Self-rating Anxiety Scale and Self-rating Depression Scale.Patients’emotions,stress perception and psychological resilience were evaluated by the Positive and Negative Affect Schedule,the Chinese Perceived Stress Scale,and the Connor-Davidson Resilience Scale(CD-RISC),respectively.Patient survival was calculated using the Kaplan-Meier method,and survival curves were plotted for analysis with the log-rank test.Univariate and multivariate survival analyses were performed using the Cox regression model.RESULTS The 33 OBC patients included 32 females and 1 male.Of the 33 patients,30(91%)had axillary tumors,3(9%)had a neck mass as the primary symptom;18(54.5%)had estrogen receptor-positive tumors,17(51.5%)had progesterone receptor-positive tumors,and 18(54.5%)had Her-2-positive tumors;24(72.7%)received surgical treatment,including 18 patients who underwent modified radical mastectomy,1 patient who underwent breast-conserving surgery plus axillary lymph node dissection(ALND),and 5 patients who underwent ALND alone;12 patients received preoperative neoadjuvant therapy.All 30 patients developed anxiety and depression,with low positive affect scores and high negative affect scores,accompanied by a high stress level and poor psychological resilience.There were no differences in the psychological status of patients according to age,body mass index,or menopausal status.The overall survival and disease-free survival(DFS)of all the patients were 83.3%and 55.7%,respectively.Univariate analysis demonstrated that the initial tumor site(P=0.021)and node stage(P=0.020)were factors that may affect patient prognosis.The 5-year DFS rate of OBC patients who received radiotherapy was greater(P<0.001),while the use of different surgical methods(P=0.687)had no statistically significant effect on patient outcomes.Multivariate analysis revealed that radiotherapy(P=0.031)was an independent prognostic factor.Receiving radiotherapy had a significant effect on the CD-RISC score(P=0.02).CONCLUSION OBC is a rare breast disease whose diagnosis and treatment are currently controversial.There was no significant difference in the efficacy of other less invasive surgical procedures compared to those of modified radical mastectomy.In addition,radiotherapy can significantly improve patient outcomes.We should pay attention to the psychological state of patients while they receive antitumor therapy.展开更多
BACKGROUND Occult breast cancer(OBC)is a special type of breast cancer presenting as axillary lymph node metastasis with undetectable primary lesions in the breast.Due to its low incidence and unique clinical manifest...BACKGROUND Occult breast cancer(OBC)is a special type of breast cancer presenting as axillary lymph node metastasis with undetectable primary lesions in the breast.Due to its low incidence and unique clinical manifestations,there is a lack of consensus on the diagnosis and treatment of OBC.We report a case of OBC treated with neoadjuvant chemotherapy combined with anlotinib.The treatment was well tolerated,and the patient achieved a pathologic complete response.CASE SUMMARY A 53-year-old woman presented with a lump in her right axillary area with no primary lesions in the breast.Pathological biopsy confirmed right axillary metastatic carcinoma.Immunohistochemical staining results were positive for progesterone receptor,cytokeratin 7,specific breast markers GATA3 and gross cystic disease fluid protein-15.Tumor cells were negative for estrogen receptor,human epidermal growth factor receptor-2,cytokeratin 5/6,cytokeratin 20,and villin.The patient was diagnosed with OBC,and she underwent neoadjuvant chemotherapy combined with anlotinib.Mastectomy plus axillary lymph node dissection was performed.The patient achieved pathologic complete response with no residual invasive tumor cells in the breast or axillary lymph nodes.Postoperatively,she received adjuvant radiotherapy and endocrine therapy.CONCLUSION Neoadjuvant chemotherapy and anlotinib had good efficacy and safety in the treatment of OBC and may be a new therapeutic option.展开更多
Background: Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parame?trectomy(RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our ...Background: Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parame?trectomy(RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early?stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avoid RP.Methods: A total of 13 patients with occult cervical cancer who had undergone RP with an upper vaginectomy and pelvic lymphadenectomy were included in this retrospective study. Data on the clinicopathologic characteristics of the cases were collected. The published literature was also reviewed, and low risk factors for parametrial involvement in early?stage cervical cancer were analyzed.Results: Of the 13 patients, 9 had a stage IB1 lesion, and 4 had a stage IA2 lesion. There were four patients with grade 1 disease, seven with grade 2 disease, and two with grade 3 disease. The median age of the entire patients was 41 years. The most common indication for extrafascial hysterectomy was cervical intraepithelial neoplasia 3. Three patients had visible lesions measuring 10–30 mm, in diameter and ten patients had cervical stromal invasions with depths ranging from 4 to 9 mm; only one patient had more than 50% stromal invasion, and four patients had lymph?vascular space invasion(LVSI). Perioperative complications included intraoperative bowel injury, blood transfusion, vesico?vaginal istula, and ileus(1 case for each). Postoperative pathologic examination results did not show residual disease or parametrial involvement. One patient with positive lymph nodes received concurrent radiation therapy. Only one patient experienced recurrence.Conclusions: Perioperative complications following RP were common, whereas the incidence of parametrial involve?ment was very low among selected early?stage cervical cancer patients. Based on these results, we thought that patients with very low?risk parametrial involvement(tumor size ≤2 cm, no LVSI, less than 50% stromal invasion, nega?tive lymph nodes) may beneit from omitting RP. Further prospective data are warranted.展开更多
AIM: To evaluate the sensitivity and specificity of transfesrrin dipstick test (Tf) in colorectal cancer (CRC) screening and precancerous lesions screening. METHODS: Eight hundreds and sixty-one individuals at high-ri...AIM: To evaluate the sensitivity and specificity of transfesrrin dipstick test (Tf) in colorectal cancer (CRC) screening and precancerous lesions screening. METHODS: Eight hundreds and sixty-one individuals at high-risk for CRC were recruited. Six hundreds and eleven subsequently received the three fecal occult blood tests and colonoscopy with biopsy performed as needed. Fecal samples were obtained on the day before colonoscopy. Tf, immuno fecal occult blood test (IFOBT) and guaiac fecal occult blood test (g-FOBT) were performed simultaneously on the same stool. To minimize false-negative cases, all subjects with negative samples were asked to provide an additional stool specimen for a second test even a third test. If the results were all negative after testing three repeated samples, the subject was considered a true negative. The performance characteristics of Tf for detecting CRC and precancerous lesions were examined and compared to those of IFOBT and the combination of Tf, IFOBT and g-FOBT. RESULTS: A total of six hundreds and eleven subjects met the study criteria including 25 with CRC and 60 with precancerous lesions. Sensitivity for detecting CRC was 92% for Tf and 96% for IFOBT, specificities of Tf and IFOBT were both 72.0% (95% CI: 68.2%-75.5%; χ2 = 0.4, P > 0.05); positive likelihood ratios of those were 3.3 (95% CI: 2.8-3.9) and 3.4 (95% CI: 2.9-4.0), respectively. In precancerous lesions, sensitivities for Tf and IFOBT were 50% and 58%, respectively (χ 2 = 0.8, P > 0.05); specificities of Tf and IFOBT were 71.5% (95% CI: 67.6%-75.1%) and 72.2% (95% CI: 68.4%-75.8%); positive likelihood ratios of those were 1.8 (95% CI: 1.3-2.3) and 2.1 (95% CI: 1.6-2.7), respectively; compared to IFOBT, g-FOBT+ Tf+ IFOBT had a significantly higher positive rate for precancerous lesions (83% vs 58%, respectively; χ 2 = 9.1, P < 0.05). In patients with CRC and precancerous lesions, the sensitivities of Tf and IFOBT were 62% and 69% (χ 2 = 0.9, P > 0.05); specificities of those were 74.5% (95% CI: 70.6%-78.1%) and 75.5% (95% CI: 71.6%-79.0%); positive likelihood ratios of those were 2.5 (95% CI: 2.0-3.1) and 2.8 (95% CI: 2.3-3.5). Compared to IF-OBT alone, combining g-FOBT, IFOBT and Tf led to significantly increased sensitivity for detecting CRC and cancerous lesions (69% vs 88%, respectively; χ 2 = 9.0, P < 0.05). CONCLUSION: Tf dipstick test might be used as an ad- ditional tool for CRC and precancerous lesions screening in a high-risk cohort.展开更多
Background:Because of the rarity of occult breast cancer(OBC)and limited experience in OBC treatment,the optimal treatment strategy is unknown.This study aimed to compare the efficacy of axillary lymph node dissection...Background:Because of the rarity of occult breast cancer(OBC)and limited experience in OBC treatment,the optimal treatment strategy is unknown.This study aimed to compare the efficacy of axillary lymph node dissection(ALND)plus radiotherapy with that of mastectomy plus ALND in patients with OBC.Methods:Relevant clinical data between January 2004 and December 2015 were retrospectively collected from the Surveillance,Epidemiology,and End Results database.The clinical characteristics and prognoses of patients who underwent ALND plus radiotherapy or mastectomy plus ALND were compared before and after propensity score matching.Results:Overall,569 eligible patients with OBC were included in this study.Of these,247 patients underwent ALND plus radiotherapy and 322 underwent mastectomy plus ALND.The 5-year overall survival(OS)rates in the ALND plus radiotherapy group and the mastectomy plus ALND group were 89.2%and 80.6%,respectively;and the corresponding 5-year breast cancer-specific survival(BCSS)rates were 95.2%and 93.0%,respectively.After propensity score matching,the OS in the ALND plus radiotherapy group was significantly better than that in the mastectomy plus ALND group.In addition,further subgroup analyses revealed that ALND plus radiotherapy prolonged OS in the pN3 subgroup.Among patients receiving adjuvant chemotherapy,those who underwent ALND plus radiotherapy had better BCSS and OS than those who underwent mastectomy plus ALND.Conclusions:ALND plus radiotherapy could improve the OS of patients with OBC,especially those with pN3 disease and those receiving chemotherapy.ALND combined with radiotherapy is the optimal treatment strategy for patients with imaging-negative OBC.展开更多
There is a lack of investigation into the biological characteristics and preoperative systemic therapy （PST） for occult breast cancer （OBC）. For this study, departmental records in Breast Disease Center of Peking ...There is a lack of investigation into the biological characteristics and preoperative systemic therapy （PST） for occult breast cancer （OBC）. For this study, departmental records in Breast Disease Center of Peking University First Hospital from January 2008 to December 2015 were retrospectively reviewed to identify cases of OBC. Eleven cases were included, and all patients were female, with a median age of 56 （range： 29-75） years. The sensitivity of magnetic resonance imaging （MRD was I00%, and the false positive rate was 33.3%. Based on histologic analysis of the axillary node, 9 （81.8%） cases were grade 3, and 2 （18.2%） cases were grade 2; 4 （36.4%） cases were 〉10% estrogen receptor （ER） positive and 6 （54.5%） human epidermal growth receptor 2 （HER2） positive. Nine cases （81.8%） exhibited over 30% Ki67 expression. PST was performed in 5 of the 11 cases. The lymph node response rate was 100% （5/5）, but no complete remission was achieved. In conclusion, aggressive subtypes were predominant among the included cases, and PST should be considered for OBC treatment options.展开更多
AIM:To present a critical discussion of the efficacy of the faecal pyruvate kinase isoenzyme type M2(faecal M2-PK) test for colorectal cancer(CRC) screening based on the currently available studies.METHODS:A literatur...AIM:To present a critical discussion of the efficacy of the faecal pyruvate kinase isoenzyme type M2(faecal M2-PK) test for colorectal cancer(CRC) screening based on the currently available studies.METHODS:A literature search in PubMed and Embase was conducted using the following search terms:fecal Tumor M2-PK,faecal Tumour M2-PK,fecal M2-PK,faecal M2-PK,fecal pyruvate kinase,faecal pyruvate kinase,pyruvate kinase stool and M2-PK stool.RESULTS:Stool samples from 704 patients with CRC and from 11 412 healthy subjects have been investigated for faecal M2-PK concentrations in seventeen independent studies.The mean faecal M2-PK sensitivity was 80.3%;the specificity was 95.2%.Four studies compared faecal M2-PK head-to-head with guaiacbased faecal occult blood test(gFOBT).Faecal M2PK demonstrated a sensitivity of 81.1%,whereas the gFOBT detected only 36.9% of the CRCs.Eight independent studies investigated the sensitivity of faecal M2-PK for adenoma(n = 554),with the following sensitivities:adenoma < 1 cm in diameter:25%;adenoma > 1 cm:44%;adenoma of unspecified diameter:51%.In a direct comparison with gFOBT of adenoma > 1 cm in diameter,47% tested positive with the faecal M2-PK test,whereas the gFOBT detected only 27%.CONCLUSION:We recommend faecal M2-PK as a routine test for CRC screening.Faecal M2-PK closes a gap in clinical practice because it detects bleeding and nonbleeding tumors and adenoma with high sensitivity and specificity.展开更多
AIM:To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program.METHODS:Colorectal cancer(CRC) was the second leading cause of ...AIM:To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program.METHODS:Colorectal cancer(CRC) was the second leading cause of cancer mortality in men(n = 1063,49.77/100 000),as well as women(n = 803,34.89/100 000) in Croatia in 2009.The Croatian National CRC Screening Program was established by the Ministry of Health and Social Welfare,and its implementation started in September,2007.The coordinators were recruited in each county institute of public health with an obligation to provide fecal occult blood testing(FOBT) to the participants,followed by colonoscopy in all positive cases.The FOBT was performed by hypersensitive guaiac-based Hemognost card test(Biognost,Zagreb).The test and short questionnaire were delivered to the home addresses of all citizens aged 50-74 years consecutively during a 3-year period.Each participant was required to complete the questionnaire and send it together with the stool specimen on three test cards back to the institute for further analysis.About 4% FOBT positive cases are expected in normal risk populations.A descriptive analysis was performed.RESULTS:A total of 1 056 694 individuals(born between 1933-1945 and 1952-1957) were invited to screening by the end of September 2011.In total,210 239(19.9%) persons returned the envelope with a completed questionnaire,and 181 102 of them returned it with a correctly placed stool specimen on FOBT cards.Until now,12 477(6.9%),FOBT-positive patients have been found,which is at the upper limit of the expected values in European Guidelines for Quality Assurance in CRC Screening and Diagnosis [European Union(EU) Guidelines].Colonoscopy was performed in 8541 cases(uptake 66%).Screening has identified CRC in 472 patients(5.5% of colonoscopied,3.8% of FOBT-positive,and 0.26% of all screened individuals).This is also in the expected range according to EU Guidelines.Polyps were found and removed in 3329(39% of colonoscopied) patients.The largest number of polyps were found in the left half of the colon:64%(19%,37% and 8% in the rectum,sigma,and descendens,respectively).The other 36% were detected in the proximal part(17% in the transverse colon and 19% in ceco-ascending colon).Small polyps in the rectum(5-10 mm in diameter),sigmoid and descending colon were histologically found to be tubular adenomas in 60% of cases,with a low degree of dysplasia,and 40% were classified as hyperplastic.Polyps of this size in the transverse or ceco-ascending colon in almost 20% had a histologically villous component,but still had a low degree of dysplasia.Polyps sized 10-20 mm in diameter were in 43% cases tubulovillous,and among them,32% had areas with a high degree of dysplasia,especially those polyps in the cecoascending or transverse part.The characteristics of the Croatian CRC Screening National Program in the first 3 years were as follows:relatively low percentage of returned FOBT,higher number of FOBT-positive persons but still in the range for population-based programs,and higher number of pathologic findings(polyps and cancers).CONCLUSION:These results suggest a need for intervention strategies that include organizational changes and educational activities to improve awareness of CRC screening usefulness and increase participation rates.展开更多
In the study, 739 regional lymph nodes from 94 patients with stage I non- small cell lung carcinoma (NSCLC) were studied by immunohistochemical techniques. These lymph nodes contained no metastatic tumor as assessed b...In the study, 739 regional lymph nodes from 94 patients with stage I non- small cell lung carcinoma (NSCLC) were studied by immunohistochemical techniques. These lymph nodes contained no metastatic tumor as assessed by conventional histopatholgy were recut. A series of consecutive sections from the original blocks were immunostained with poly-and monoclonal antibodies to cytokeratins, carcinoembryonic antigen (CEA), and human milk fat globulin membrane antigen (HMFG-2). Single tumor cells or small clusters of tumor cells, not visible on routine examination, were readily detected. The actual number of lymph nodes that contained occult tumor cells was 123 (16.6%) from 53 patients (56.4%). The majority of 102 immunostalned positive nodes were distributed in the hllar (29% ) and peribronchlal (25%) regions. Our data indicate that (1) a series of consecutive sections and immunohistochemistry may greatly Increase the diagnostic yield of occult micrometastases in lymph nodes; (2) the high incidence of occult metastases in NSCLC may be of Importance in relation to their rapid dissemination and high death rates; (3) the high frequencyof occult nodal metastases in NSCLC raises questions in regard to our presently used criteria for staging, prognosis and treatment of ostensibly stage I disease; and (4) perhaps dissections of hllar and peribronchlal nodes will have an Importantly clinical significance in prevention of wide dissemination of tumor cells.展开更多
Colorectal cancer (CRC) is still one of the leading causes of cancer-related death in Western countries, despite major improvements in its treatment. The dramatically high social and economic impact of CRC on human he...Colorectal cancer (CRC) is still one of the leading causes of cancer-related death in Western countries, despite major improvements in its treatment. The dramatically high social and economic impact of CRC on human health makes the identification of a reliable screening tool of paramount importance. Current screening methods, such as the fecal occult blood test and colonoscopy do not adequately meet the ideal requisites of a screening test because, even if they are effective, they are limited first by too low specificity and sensitivity, or second by high invasiveness, costs and risk. Nowadays extended efforts are made by researchers to look for more reliable and effective screening tests based on a systems biology approach, using biological samples easily available, such as urine, breath, serum and feces. The effectiveness and reliability of several new attempts to screen these patients by non-invasive analysis of their biological samples using genomic (genetic and epigenetic alteration), transcriptomic (miRNA), proteomic (cancer-related antigens, new antibodies against tumor-associated antigens, mutated proteins) and metabolomic (volatile organic metabolites) methods are discussed in this review. Among the most interesting new screening tools, fecal fluorescent long-DNA, fecal miRNA and metabolomic evaluation in breath and/ or serum seem to be most promising.展开更多
Colorectal cancer(CRC) is the third leading cause of death worldwide and represents a clinical challenge.Family members of patients affected by CRC have an increased risk of CRC development.In these individuals,screen...Colorectal cancer(CRC) is the third leading cause of death worldwide and represents a clinical challenge.Family members of patients affected by CRC have an increased risk of CRC development.In these individuals,screening is strongly recommended and should be started earlier than in the population with average risk,in order to detect neoplastic precursors,such as adenoma,advanced adenoma,and nonpolypoid adenomatous lesions of the colon.Fecal occult blood test(FOBT) is a non invasive,widespread screening method that can reduce CRC-related mortality.Sigmoidoscopy,alone or in addition to FOBT,represents another screening strategy that reduces CRC mortality.Colonoscopy is the best choice for screening highrisk populations,as it allows simultaneous detection and removal of preneoplastic lesions.The choice of test depends on local health policy and varies among countries.展开更多
Objective: Despite the high prevalence of CRC and the proven benefits of faecal sampling tests, participation rates in CRC screening are suboptimal. Literature has identified a number of barriers to participation, inc...Objective: Despite the high prevalence of CRC and the proven benefits of faecal sampling tests, participation rates in CRC screening are suboptimal. Literature has identified a number of barriers to participation, including faecal aversion. Emerging test technologies suggest blood-based molecular markers might provide an alternative, more acceptable option, for CRC screening tests. We aim to determine preference for blood compared to faeces as the sample for the screening test. Methods: A survey was mailed to 956 South Australians aged 50 to 74 years. Data were collected on sample preference, demographic variables, and ratings of screening test convenience and comfort. Results: The survey yielded a 43% response rate. The majority of participants preferred to provide a blood sample (78% v 22%, p < 0.001). Women were more likely to prefer blood than men (82% vs 74%, p = 0.05). Sample experience influenced preferences, with a significantly higher preference for faeces among participants with experience in faecal sampling (27% vs 17% with no experience, p < 0.05). Participants who preferred to provide a faecal sample rated it significantly more convenient (p < 0.001), more comfortable (p < 0.001), and more acceptable (p < 0.001) than those who preferred blood sampling. Conclusions: Survey participants overwhelmingly indicate a preference for the idea of a blood sample over a faecal sample for CRC screening. Preference was influenced by gender, experience with sampling method and the individual’s perception of sampling convenience, sampling comfort and sample acceptability. Our results suggest population participation rates are likely to improve with blood-based screening tests.展开更多
Axillary presentation from occult breast cancer is uncommon and continues to be a diagnostic and therapeutic challenge to physicians. Once the diagnosis of adenocarcinoma metastatic to an axillary lymph node has been ...Axillary presentation from occult breast cancer is uncommon and continues to be a diagnostic and therapeutic challenge to physicians. Once the diagnosis of adenocarcinoma metastatic to an axillary lymph node has been confi rmed, a preoperative workup should be done. The current experience is based on several relatively small retrospective reviews and case reports. It is diffi cult to determine the best management of occult breast cancer. However, treatment of axillary lymph node dissection is recommended for local control and complete staging information. Treatment of breast should be a choice between breast conservation with whole-breast radiotherapy and mastectomy. Adjuvant systemic treatment should be offered.展开更多
基金Supported by Jiangsu Provincial Health Commission’s 2020 High-Level Health Talents“Six Ones Project”Top-Notch Talent Research Project,No.LGY20200062021 Youth Medical Science Innovation Project of Xuzhou Health Commission,No.XWKYHT20210580.
文摘BACKGROUND Occult breast cancer(OBC)has traditionally been considered to be a carcinoma of unknown primary origin with a favorable prognosis and can be treated as stage II-III breast cancer.Due to the small number of cases and limited clinical experience,treatments vary greatly around the world and no standardized treatment has yet been established.AIM To investigate the clinicopathological features,psychological status and prognostic features of patients with OBC.METHODS The clinicopathological data of 33 OBC patients diagnosed and treated in the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital from November 2015 to November 2022 were retrospectively analyzed.The psychological status of OBC patients was evaluated by the Self-rating Anxiety Scale and Self-rating Depression Scale.Patients’emotions,stress perception and psychological resilience were evaluated by the Positive and Negative Affect Schedule,the Chinese Perceived Stress Scale,and the Connor-Davidson Resilience Scale(CD-RISC),respectively.Patient survival was calculated using the Kaplan-Meier method,and survival curves were plotted for analysis with the log-rank test.Univariate and multivariate survival analyses were performed using the Cox regression model.RESULTS The 33 OBC patients included 32 females and 1 male.Of the 33 patients,30(91%)had axillary tumors,3(9%)had a neck mass as the primary symptom;18(54.5%)had estrogen receptor-positive tumors,17(51.5%)had progesterone receptor-positive tumors,and 18(54.5%)had Her-2-positive tumors;24(72.7%)received surgical treatment,including 18 patients who underwent modified radical mastectomy,1 patient who underwent breast-conserving surgery plus axillary lymph node dissection(ALND),and 5 patients who underwent ALND alone;12 patients received preoperative neoadjuvant therapy.All 30 patients developed anxiety and depression,with low positive affect scores and high negative affect scores,accompanied by a high stress level and poor psychological resilience.There were no differences in the psychological status of patients according to age,body mass index,or menopausal status.The overall survival and disease-free survival(DFS)of all the patients were 83.3%and 55.7%,respectively.Univariate analysis demonstrated that the initial tumor site(P=0.021)and node stage(P=0.020)were factors that may affect patient prognosis.The 5-year DFS rate of OBC patients who received radiotherapy was greater(P<0.001),while the use of different surgical methods(P=0.687)had no statistically significant effect on patient outcomes.Multivariate analysis revealed that radiotherapy(P=0.031)was an independent prognostic factor.Receiving radiotherapy had a significant effect on the CD-RISC score(P=0.02).CONCLUSION OBC is a rare breast disease whose diagnosis and treatment are currently controversial.There was no significant difference in the efficacy of other less invasive surgical procedures compared to those of modified radical mastectomy.In addition,radiotherapy can significantly improve patient outcomes.We should pay attention to the psychological state of patients while they receive antitumor therapy.
基金Supported by Health Specific Program of Jilin Province,China,No.2018SCZWSZX-035Scientific and Technological Development Program of Jilin Province,China,No.20190701041GH.
文摘BACKGROUND Occult breast cancer(OBC)is a special type of breast cancer presenting as axillary lymph node metastasis with undetectable primary lesions in the breast.Due to its low incidence and unique clinical manifestations,there is a lack of consensus on the diagnosis and treatment of OBC.We report a case of OBC treated with neoadjuvant chemotherapy combined with anlotinib.The treatment was well tolerated,and the patient achieved a pathologic complete response.CASE SUMMARY A 53-year-old woman presented with a lump in her right axillary area with no primary lesions in the breast.Pathological biopsy confirmed right axillary metastatic carcinoma.Immunohistochemical staining results were positive for progesterone receptor,cytokeratin 7,specific breast markers GATA3 and gross cystic disease fluid protein-15.Tumor cells were negative for estrogen receptor,human epidermal growth factor receptor-2,cytokeratin 5/6,cytokeratin 20,and villin.The patient was diagnosed with OBC,and she underwent neoadjuvant chemotherapy combined with anlotinib.Mastectomy plus axillary lymph node dissection was performed.The patient achieved pathologic complete response with no residual invasive tumor cells in the breast or axillary lymph nodes.Postoperatively,she received adjuvant radiotherapy and endocrine therapy.CONCLUSION Neoadjuvant chemotherapy and anlotinib had good efficacy and safety in the treatment of OBC and may be a new therapeutic option.
文摘Background: Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parame?trectomy(RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early?stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avoid RP.Methods: A total of 13 patients with occult cervical cancer who had undergone RP with an upper vaginectomy and pelvic lymphadenectomy were included in this retrospective study. Data on the clinicopathologic characteristics of the cases were collected. The published literature was also reviewed, and low risk factors for parametrial involvement in early?stage cervical cancer were analyzed.Results: Of the 13 patients, 9 had a stage IB1 lesion, and 4 had a stage IA2 lesion. There were four patients with grade 1 disease, seven with grade 2 disease, and two with grade 3 disease. The median age of the entire patients was 41 years. The most common indication for extrafascial hysterectomy was cervical intraepithelial neoplasia 3. Three patients had visible lesions measuring 10–30 mm, in diameter and ten patients had cervical stromal invasions with depths ranging from 4 to 9 mm; only one patient had more than 50% stromal invasion, and four patients had lymph?vascular space invasion(LVSI). Perioperative complications included intraoperative bowel injury, blood transfusion, vesico?vaginal istula, and ileus(1 case for each). Postoperative pathologic examination results did not show residual disease or parametrial involvement. One patient with positive lymph nodes received concurrent radiation therapy. Only one patient experienced recurrence.Conclusions: Perioperative complications following RP were common, whereas the incidence of parametrial involve?ment was very low among selected early?stage cervical cancer patients. Based on these results, we thought that patients with very low?risk parametrial involvement(tumor size ≤2 cm, no LVSI, less than 50% stromal invasion, nega?tive lymph nodes) may beneit from omitting RP. Further prospective data are warranted.
基金Supported by National Natural Science Foundation of China,No. 81071832the Key Scientific Research Project of the Health Bureau of Hubei Province, No. JX5A01
文摘AIM: To evaluate the sensitivity and specificity of transfesrrin dipstick test (Tf) in colorectal cancer (CRC) screening and precancerous lesions screening. METHODS: Eight hundreds and sixty-one individuals at high-risk for CRC were recruited. Six hundreds and eleven subsequently received the three fecal occult blood tests and colonoscopy with biopsy performed as needed. Fecal samples were obtained on the day before colonoscopy. Tf, immuno fecal occult blood test (IFOBT) and guaiac fecal occult blood test (g-FOBT) were performed simultaneously on the same stool. To minimize false-negative cases, all subjects with negative samples were asked to provide an additional stool specimen for a second test even a third test. If the results were all negative after testing three repeated samples, the subject was considered a true negative. The performance characteristics of Tf for detecting CRC and precancerous lesions were examined and compared to those of IFOBT and the combination of Tf, IFOBT and g-FOBT. RESULTS: A total of six hundreds and eleven subjects met the study criteria including 25 with CRC and 60 with precancerous lesions. Sensitivity for detecting CRC was 92% for Tf and 96% for IFOBT, specificities of Tf and IFOBT were both 72.0% (95% CI: 68.2%-75.5%; χ2 = 0.4, P > 0.05); positive likelihood ratios of those were 3.3 (95% CI: 2.8-3.9) and 3.4 (95% CI: 2.9-4.0), respectively. In precancerous lesions, sensitivities for Tf and IFOBT were 50% and 58%, respectively (χ 2 = 0.8, P > 0.05); specificities of Tf and IFOBT were 71.5% (95% CI: 67.6%-75.1%) and 72.2% (95% CI: 68.4%-75.8%); positive likelihood ratios of those were 1.8 (95% CI: 1.3-2.3) and 2.1 (95% CI: 1.6-2.7), respectively; compared to IFOBT, g-FOBT+ Tf+ IFOBT had a significantly higher positive rate for precancerous lesions (83% vs 58%, respectively; χ 2 = 9.1, P < 0.05). In patients with CRC and precancerous lesions, the sensitivities of Tf and IFOBT were 62% and 69% (χ 2 = 0.9, P > 0.05); specificities of those were 74.5% (95% CI: 70.6%-78.1%) and 75.5% (95% CI: 71.6%-79.0%); positive likelihood ratios of those were 2.5 (95% CI: 2.0-3.1) and 2.8 (95% CI: 2.3-3.5). Compared to IF-OBT alone, combining g-FOBT, IFOBT and Tf led to significantly increased sensitivity for detecting CRC and cancerous lesions (69% vs 88%, respectively; χ 2 = 9.0, P < 0.05). CONCLUSION: Tf dipstick test might be used as an ad- ditional tool for CRC and precancerous lesions screening in a high-risk cohort.
文摘Background:Because of the rarity of occult breast cancer(OBC)and limited experience in OBC treatment,the optimal treatment strategy is unknown.This study aimed to compare the efficacy of axillary lymph node dissection(ALND)plus radiotherapy with that of mastectomy plus ALND in patients with OBC.Methods:Relevant clinical data between January 2004 and December 2015 were retrospectively collected from the Surveillance,Epidemiology,and End Results database.The clinical characteristics and prognoses of patients who underwent ALND plus radiotherapy or mastectomy plus ALND were compared before and after propensity score matching.Results:Overall,569 eligible patients with OBC were included in this study.Of these,247 patients underwent ALND plus radiotherapy and 322 underwent mastectomy plus ALND.The 5-year overall survival(OS)rates in the ALND plus radiotherapy group and the mastectomy plus ALND group were 89.2%and 80.6%,respectively;and the corresponding 5-year breast cancer-specific survival(BCSS)rates were 95.2%and 93.0%,respectively.After propensity score matching,the OS in the ALND plus radiotherapy group was significantly better than that in the mastectomy plus ALND group.In addition,further subgroup analyses revealed that ALND plus radiotherapy prolonged OS in the pN3 subgroup.Among patients receiving adjuvant chemotherapy,those who underwent ALND plus radiotherapy had better BCSS and OS than those who underwent mastectomy plus ALND.Conclusions:ALND plus radiotherapy could improve the OS of patients with OBC,especially those with pN3 disease and those receiving chemotherapy.ALND combined with radiotherapy is the optimal treatment strategy for patients with imaging-negative OBC.
基金supported by grants of the Precision Medicine Special Project of National Key Research and Development Program of China(2016YFC0901302)
文摘There is a lack of investigation into the biological characteristics and preoperative systemic therapy （PST） for occult breast cancer （OBC）. For this study, departmental records in Breast Disease Center of Peking University First Hospital from January 2008 to December 2015 were retrospectively reviewed to identify cases of OBC. Eleven cases were included, and all patients were female, with a median age of 56 （range： 29-75） years. The sensitivity of magnetic resonance imaging （MRD was I00%, and the false positive rate was 33.3%. Based on histologic analysis of the axillary node, 9 （81.8%） cases were grade 3, and 2 （18.2%） cases were grade 2; 4 （36.4%） cases were 〉10% estrogen receptor （ER） positive and 6 （54.5%） human epidermal growth receptor 2 （HER2） positive. Nine cases （81.8%） exhibited over 30% Ki67 expression. PST was performed in 5 of the 11 cases. The lymph node response rate was 100% （5/5）, but no complete remission was achieved. In conclusion, aggressive subtypes were predominant among the included cases, and PST should be considered for OBC treatment options.
文摘AIM:To present a critical discussion of the efficacy of the faecal pyruvate kinase isoenzyme type M2(faecal M2-PK) test for colorectal cancer(CRC) screening based on the currently available studies.METHODS:A literature search in PubMed and Embase was conducted using the following search terms:fecal Tumor M2-PK,faecal Tumour M2-PK,fecal M2-PK,faecal M2-PK,fecal pyruvate kinase,faecal pyruvate kinase,pyruvate kinase stool and M2-PK stool.RESULTS:Stool samples from 704 patients with CRC and from 11 412 healthy subjects have been investigated for faecal M2-PK concentrations in seventeen independent studies.The mean faecal M2-PK sensitivity was 80.3%;the specificity was 95.2%.Four studies compared faecal M2-PK head-to-head with guaiacbased faecal occult blood test(gFOBT).Faecal M2PK demonstrated a sensitivity of 81.1%,whereas the gFOBT detected only 36.9% of the CRCs.Eight independent studies investigated the sensitivity of faecal M2-PK for adenoma(n = 554),with the following sensitivities:adenoma < 1 cm in diameter:25%;adenoma > 1 cm:44%;adenoma of unspecified diameter:51%.In a direct comparison with gFOBT of adenoma > 1 cm in diameter,47% tested positive with the faecal M2-PK test,whereas the gFOBT detected only 27%.CONCLUSION:We recommend faecal M2-PK as a routine test for CRC screening.Faecal M2-PK closes a gap in clinical practice because it detects bleeding and nonbleeding tumors and adenoma with high sensitivity and specificity.
文摘AIM:To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program.METHODS:Colorectal cancer(CRC) was the second leading cause of cancer mortality in men(n = 1063,49.77/100 000),as well as women(n = 803,34.89/100 000) in Croatia in 2009.The Croatian National CRC Screening Program was established by the Ministry of Health and Social Welfare,and its implementation started in September,2007.The coordinators were recruited in each county institute of public health with an obligation to provide fecal occult blood testing(FOBT) to the participants,followed by colonoscopy in all positive cases.The FOBT was performed by hypersensitive guaiac-based Hemognost card test(Biognost,Zagreb).The test and short questionnaire were delivered to the home addresses of all citizens aged 50-74 years consecutively during a 3-year period.Each participant was required to complete the questionnaire and send it together with the stool specimen on three test cards back to the institute for further analysis.About 4% FOBT positive cases are expected in normal risk populations.A descriptive analysis was performed.RESULTS:A total of 1 056 694 individuals(born between 1933-1945 and 1952-1957) were invited to screening by the end of September 2011.In total,210 239(19.9%) persons returned the envelope with a completed questionnaire,and 181 102 of them returned it with a correctly placed stool specimen on FOBT cards.Until now,12 477(6.9%),FOBT-positive patients have been found,which is at the upper limit of the expected values in European Guidelines for Quality Assurance in CRC Screening and Diagnosis [European Union(EU) Guidelines].Colonoscopy was performed in 8541 cases(uptake 66%).Screening has identified CRC in 472 patients(5.5% of colonoscopied,3.8% of FOBT-positive,and 0.26% of all screened individuals).This is also in the expected range according to EU Guidelines.Polyps were found and removed in 3329(39% of colonoscopied) patients.The largest number of polyps were found in the left half of the colon:64%(19%,37% and 8% in the rectum,sigma,and descendens,respectively).The other 36% were detected in the proximal part(17% in the transverse colon and 19% in ceco-ascending colon).Small polyps in the rectum(5-10 mm in diameter),sigmoid and descending colon were histologically found to be tubular adenomas in 60% of cases,with a low degree of dysplasia,and 40% were classified as hyperplastic.Polyps of this size in the transverse or ceco-ascending colon in almost 20% had a histologically villous component,but still had a low degree of dysplasia.Polyps sized 10-20 mm in diameter were in 43% cases tubulovillous,and among them,32% had areas with a high degree of dysplasia,especially those polyps in the cecoascending or transverse part.The characteristics of the Croatian CRC Screening National Program in the first 3 years were as follows:relatively low percentage of returned FOBT,higher number of FOBT-positive persons but still in the range for population-based programs,and higher number of pathologic findings(polyps and cancers).CONCLUSION:These results suggest a need for intervention strategies that include organizational changes and educational activities to improve awareness of CRC screening usefulness and increase participation rates.
文摘In the study, 739 regional lymph nodes from 94 patients with stage I non- small cell lung carcinoma (NSCLC) were studied by immunohistochemical techniques. These lymph nodes contained no metastatic tumor as assessed by conventional histopatholgy were recut. A series of consecutive sections from the original blocks were immunostained with poly-and monoclonal antibodies to cytokeratins, carcinoembryonic antigen (CEA), and human milk fat globulin membrane antigen (HMFG-2). Single tumor cells or small clusters of tumor cells, not visible on routine examination, were readily detected. The actual number of lymph nodes that contained occult tumor cells was 123 (16.6%) from 53 patients (56.4%). The majority of 102 immunostalned positive nodes were distributed in the hllar (29% ) and peribronchlal (25%) regions. Our data indicate that (1) a series of consecutive sections and immunohistochemistry may greatly Increase the diagnostic yield of occult micrometastases in lymph nodes; (2) the high incidence of occult metastases in NSCLC may be of Importance in relation to their rapid dissemination and high death rates; (3) the high frequencyof occult nodal metastases in NSCLC raises questions in regard to our presently used criteria for staging, prognosis and treatment of ostensibly stage I disease; and (4) perhaps dissections of hllar and peribronchlal nodes will have an Importantly clinical significance in prevention of wide dissemination of tumor cells.
文摘Colorectal cancer (CRC) is still one of the leading causes of cancer-related death in Western countries, despite major improvements in its treatment. The dramatically high social and economic impact of CRC on human health makes the identification of a reliable screening tool of paramount importance. Current screening methods, such as the fecal occult blood test and colonoscopy do not adequately meet the ideal requisites of a screening test because, even if they are effective, they are limited first by too low specificity and sensitivity, or second by high invasiveness, costs and risk. Nowadays extended efforts are made by researchers to look for more reliable and effective screening tests based on a systems biology approach, using biological samples easily available, such as urine, breath, serum and feces. The effectiveness and reliability of several new attempts to screen these patients by non-invasive analysis of their biological samples using genomic (genetic and epigenetic alteration), transcriptomic (miRNA), proteomic (cancer-related antigens, new antibodies against tumor-associated antigens, mutated proteins) and metabolomic (volatile organic metabolites) methods are discussed in this review. Among the most interesting new screening tools, fecal fluorescent long-DNA, fecal miRNA and metabolomic evaluation in breath and/ or serum seem to be most promising.
文摘Colorectal cancer(CRC) is the third leading cause of death worldwide and represents a clinical challenge.Family members of patients affected by CRC have an increased risk of CRC development.In these individuals,screening is strongly recommended and should be started earlier than in the population with average risk,in order to detect neoplastic precursors,such as adenoma,advanced adenoma,and nonpolypoid adenomatous lesions of the colon.Fecal occult blood test(FOBT) is a non invasive,widespread screening method that can reduce CRC-related mortality.Sigmoidoscopy,alone or in addition to FOBT,represents another screening strategy that reduces CRC mortality.Colonoscopy is the best choice for screening highrisk populations,as it allows simultaneous detection and removal of preneoplastic lesions.The choice of test depends on local health policy and varies among countries.
文摘Objective: Despite the high prevalence of CRC and the proven benefits of faecal sampling tests, participation rates in CRC screening are suboptimal. Literature has identified a number of barriers to participation, including faecal aversion. Emerging test technologies suggest blood-based molecular markers might provide an alternative, more acceptable option, for CRC screening tests. We aim to determine preference for blood compared to faeces as the sample for the screening test. Methods: A survey was mailed to 956 South Australians aged 50 to 74 years. Data were collected on sample preference, demographic variables, and ratings of screening test convenience and comfort. Results: The survey yielded a 43% response rate. The majority of participants preferred to provide a blood sample (78% v 22%, p < 0.001). Women were more likely to prefer blood than men (82% vs 74%, p = 0.05). Sample experience influenced preferences, with a significantly higher preference for faeces among participants with experience in faecal sampling (27% vs 17% with no experience, p < 0.05). Participants who preferred to provide a faecal sample rated it significantly more convenient (p < 0.001), more comfortable (p < 0.001), and more acceptable (p < 0.001) than those who preferred blood sampling. Conclusions: Survey participants overwhelmingly indicate a preference for the idea of a blood sample over a faecal sample for CRC screening. Preference was influenced by gender, experience with sampling method and the individual’s perception of sampling convenience, sampling comfort and sample acceptability. Our results suggest population participation rates are likely to improve with blood-based screening tests.
文摘Axillary presentation from occult breast cancer is uncommon and continues to be a diagnostic and therapeutic challenge to physicians. Once the diagnosis of adenocarcinoma metastatic to an axillary lymph node has been confi rmed, a preoperative workup should be done. The current experience is based on several relatively small retrospective reviews and case reports. It is diffi cult to determine the best management of occult breast cancer. However, treatment of axillary lymph node dissection is recommended for local control and complete staging information. Treatment of breast should be a choice between breast conservation with whole-breast radiotherapy and mastectomy. Adjuvant systemic treatment should be offered.
