Isolation and identification of adipose-derived stromal/stem cells from breast cancer patients after exposure neoadjuvant chemotherapy

BACKGROUND With recent research advances,adipose-derived stromal/stem cells(ASCs)have been demonstrated to facilitate the survival of fat grafts and thus are increasingly used for reconstructive procedures following surgery for breast cancer.Unfortunately,in patients,following radiation and chemotherapy for breast cancer suggest that these cancer treatment therapies may limit stem cell cellular functions important for soft tissue wound healing.For clinical translation to patients that have undergone cancer treatment,it is necessary to understand the effects of these therapies on the ASC's ability to improve fat graft survival in clinical practice.AIM To investigate whether the impact on ASCs function capacity and recovery in cancer patients may be due to the chemotherapy.METHODS ASCs were isolated from the cancerous side and noncancerous side of the breast from the same patients with receiving neoadjuvant chemotherapy(NAC)or notreceiving NAC.ASCs were in vitro treated with 5-fluorouracil(5-FU),doxorubicin(DXR),and cyclophosphamide(Cytoxan)at various concentrations.The stem cells yield,cell viability,and proliferation rates were measured by growth curves and MTT assays.Differentiation capacity for adipogenesis was determined by qPCR analysis of the specific gene markers and histological staining.RESULTS No significant differences were observed between the yield of ASCs in patients receiving NAC treatment and not-receiving NAC.ASCs yield from the cancerous side of the breast showed lower than the noncancerous side of the breast in both patients receiving NAC and not-receiving NAC.The proliferation rates of ASCs from patients didn’t differ much before and after NAC upon in vitro culture,and these cells appeared to retain the capacity to acquire adipocyte traits simile to the ASCs from patients not-receiving NAC.After cessation and washout of the drugs for another a week of culturing,ASCs showed a slow recovery of cell growth capacity in 5-FU-treated groups but was not observed in ASCs treated with DXR groups.CONCLUSION Neoadjuvant therapies do not affect the functioning capacity of ASCs.ASCs may hold great potential to serve as a cell source for fat grafting and reconstruction in patients undergoing chemotherapy.

Effect of laparoscopic surgery combined with neoadjuvant chemotherapy on serum CEA, VEGF, CA724, CA242, LEP and T lymphocyte subsets in patients with low rectal cancer

Objective: To study the effect of laparoscopic surgery combined with neoadjuvant chemotherapy on serum CEA, VEGF, CA724, CA242, LEP and T lymphocyte subsets in patients with low rectal cancer. Methods A total of 80 patients with low rectal cancer in our hospital from June 2014 to June 2017 were enrolled in this study. The subjects were divided into the control group (n=40) and the treatment group (n=40) randomly. The control group were treated with laparoscopic surgery, the treatment group were treated with laparoscopic surgery combined with neoadjuvant chemotherapy, and both the two groups were treated for 6 periods with neoadjuvant chemotherapy after surgery. The serum CEA, VEGF, CA724, CA242, LEP levels and peripheral blood CD3+, CD4+, CD8+, NK cells of the two groups before and after treatment were compared. Results: There were no significantly differences of the serum CEA, VEGF, CA724, CA242, LEP levels and peripheral blood CD3+, CD4+, CD8+, NK cells of the two groups before treatment. The serum CEA, VEGF, CA724, CA242 and LEP levels of the two groups after treatment were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group.The peripheral blood CD3+, CD4+, CD8+, NK cells of the two groups of the two groups after treatment were significantly lower than before treatment, and that of the treatment group were significantly higher than the control group. Conclusion: Laparoscopic surgery combined with neoadjuvant chemotherapy can significantly reduce the serum CEA, VEGF, CA724, CA242, LEP levels, improve the immunologic function, and it was worthy clinical application.

Predictive factors of histological response of colorectal liver metastases after neoadjuvant chemotherapy

BACKGROUND Colorectal cancer is the third most common cancer in men and the second most common in women worldwide. Almost a third of the patients has or will develop liver metastases. Neoadjuvant chemotherapy(NAC) has recently become nearly systematic prior to surgery of colorectal livers metastases(CRLMs). The response to NAC is evaluated by radiological imaging according to morphological criteria.More recently, the response to NAC has been evaluated based on histological criteria of the resected specimen. The most often used score is the tumor regression grade(TRG), which considers the necrosis, fibrosis, and number of viable tumor cells.AIM To analyze the predictive factors of the histological response, according to the TRG, on CRLM surgery performed after NAC.METHODSFrom January 2006 to December 2013, 150 patients who had underwent surgery for CRLMs after NAC were included. The patients were separated into two groups based on their histological response, according to Rubbia-Brandt TRG.Based on their TRG, each patient was either assigned to the responder(R) group(TRG 1, 2, and 3) or to the non-responder(NR) group(TRG 4 and 5). All of the histology slides were re-evaluated in a blind manner by the same specialized pathologist. Univariate and multivariate analyses were performed.RESULTS Seventy-four patients were classified as responders and 76 as non-responders.The postoperative mortality rate was 0.7%, with a complication rate of 38%.Multivariate analysis identified five predictive factors of histological response.Three were predictive of non-response: More than seven NAC sessions, the absence of a radiological response after NAC, and a repeat hepatectomy(P <0.005). Two were predictive of a good response: A rectal origin of the primary tumor and a liver-first strategy(P < 0.005). The overall survival was 57% at 3 yr and 36% at 5 yr. The disease-free survival rates were 14% at 3 yr and 11% at 5 yr.The factors contributing to a poor prognosis for disease-free survival were: No histological response after NAC, largest metastasis > 3 cm, more than three preoperative metastases, R1 resection, and the use of a targeted therapy with NAC(P < 0.005).CONCLUSION A non-radiological response and a number of NAC sessions > 7 are the two most pertinent predictive factors of non-histological response(TRG 4 or 5).

Cost-Effectiveness Analysis of Neoadjuvant Chemotherapy with Zoledronic Acid for HER2-Negative Breast Cancer in Japan: The JONIE1 Study

Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.

A retrospective clinical study of neoadjuvant chemotherapy for advanced epithelial ovarian cancer

Objective The aim of this study was to investigate the clinical efficacy of neoadjuvant chemotherapy(NACT) and the prognostic factors for advanced epithelial ovarian cancer(EOC).Methods We enrolled 241 patients with stage III and IV EOC who were diagnosed at the Yunnan Cancer Hospital between October 2006 and December 2015.The observation(NACT-IDS) group(n = 119) received 1–3 courses of platinum-based NACT,followed by interval debulking surgery(IDS) and 6–8 courses of postoperative chemotherapy.The control group underwent primary debulking surgery(PDS)(n = 122) followed by 6–8 courses of postoperative chemotherapy.We analyzed the general conditions of the operations and the survival of both groups.Results Operating time,intraoperative blood loss and postoperative hospitalization were significantly lower in the NACT-IDS group(P < 0.05).The rate of optimal cytoreductive surgery was significantly higher in the NACT-IDS group(P < 0.05).A visible residual lesion was observed in 49(41.18%) and 48(40%) cases in the NACT-IDS and PDS groups,respectively,which were not significantly different(P > 0.05).The percentage of International Federation of Gynecology and Obstetrics(FIGO) stage IV tumors and the recurrence rates were significantly higher in the NACT-IDS group(P < 0.05).The mortality rates were 45.19%(47/104) and 35.19%(38/108) in the NACT-IDS and PDS groups,respectively(P > 0.05).Progression-free survival was 23.75 ± 9.98 and 23.57 ± 12.25 months in the NACT-IDS and PDS groups,respectively(P > 0.05).Overall survival(OS) was 31.11 ± 15.66 and 29.63 ± 18.00 months in the NACTIDS and PDS groups,respectively(P > 0.05).Optimal cytoreductive surgery with or without residual lesion was an independent influencing factor for advanced EOC in multivariate analysis.OS of patients treated with ≥8 courses of chemotherapy was significantly longer than those treated with < 8 courses.Conclusion NACT could improve the intra-and postoperative conditions in advanced EOC patients.Although the percentage of FIGO stage IV cancer was significantly higher in the NACT-IDS group,the prognosis was similar in both the NACT-IDS and PDS groups,suggesting that NACT improves the clinical outcome of advanced EOC.Optimal cytoreductive surgery with no residual lesion is a long-term protective factor in advanced EOC.At least 8 courses of chemotherapy overall or ≥ 6 courses postoperatively improves the OS.

Clinicopathological predictors of long-term benefit in breast cancer treated with neoadjuvant chemotherapy

AIM To investigate the survival impact of clinicopathological factors, including pathological complete response(p CR) and tumor-infiltrating lymphocytes(s TIL) levels according to subtypes, in breast cancer(BC) patients who received neo-adjuvant chemotherapy(NAC).METHODS We evaluated 435 BC patients who presented and received NAC at the Instituto Nacional de Enfermedades Neoplasicas from 2003 to 2014. s TIL was analyzed as the proportion of tumor stroma occupied by lymphocytes, and was prospectively evaluated on hematoxylin and eosin-stained sections of the preN AC core biopsy. p CR was considered in the absence of infiltrating cancer cells in primary tumor and axillary lymph nodes. Analysis of statistical association between clinical pathological features, s TIL, p CR and survival were carried out using SPSSvs19.RESULTS Median age was 49 years(range 24-84 years) and the most frequent clinical stage was ⅢB(58.3%). Luminal A, Luminal B, HER2-enriched and(triple-negative) TN phenotype was found in 24.6%, 37.9%, 17.7% and 19.8%, respectively. p CR was observed in 11% and median percentage of s TIL was 40%(2%-95%) in the whole population. p CR was associated to Ct1-2(P = 0.045) and to high s TIL(P = 0.029) in the whole population. There was a slight trend towards significance for s TIL(P = 0.054) in Luminal A. s TIL was associated with grade Ⅲ(P < 0.001), no-Luminal A subtype(P < 0.001), RE-negative(P < 0.001), PgR-negative(P < 0.001), HER2-positive(P = 0.002) and p CR(P = 0.029) in the whole population. Longer disease-free survival was associated with grade Ⅰ-Ⅱ(P = 0.006), cN 0(P < 0.001), clinical stage Ⅱ(P = 0.004), ER-positive(P < 0.001), Pg R-positive(P < 0.001), luminal A(P < 0.001) and p CR(P = 0.002). Longer disease-free survival was associated with grade Ⅰ-Ⅱ in Luminal A(P < 0.001), N0-1 in Luminal A(P = 0.045) and TNBC(P = 0.01), clinical stage Ⅱ in Luminal A(P = 0.003) and TNBC(P = 0.038), and pC R in TNBC(P < 0.001). Longer overall survival was associated with grade Ⅰ-Ⅱ(P < 0.001), ER-positive(P < 0.001), PgR-positive(P < 0.001), Luminal A(P < 0.001), cN 0(P = 0.002) and p CR(P = 0.002) in the whole population. Overall survival was associated with clinical stage Ⅱ(P = 0.017) in Luminal A, older age(P = 0.042) in Luminal B, and pC R in TNBC(P = 0.005).CONCLUSION Predictive and prognostic values of clinicopathological features, like p CR and s TIL, differ depending on the evaluated molecular subtype.

Decrease in the Ki67 index during neoadjuvant chemotherapy predicts favorable relapse-free survival in patients with locally advanced breast cancer

Objective: The purpose of this study was to explore the optimal cutoffs of the three parameters of Ki67 during NAC for predicting patient prognosis and investigate whether the optimal cutoffs of the Ki67 values were associated with relapse-free survival(RFS) or breast cancer-specific survival(BCSS).Methods: A total of 92 patients with locally advanced breast cancer(LABC), who had residual disease after NAC were retrospectively investigated.The optimal cutoff values of the Ki67 parameters were assessed by the online algorithm Cutoff Finder.Kaplan-Meier analysis, the log-rank test and Cox regression analysis were carried out to analyze survival.Results: The optimal cutoff values for the postsurgical Ki67 level and the decrease in the Ki67 level during NAC were defined as 25% and 12.5%, respectively.According to the univariate survival analysis, a higher Ki67 level in residual disease was associated with poor RFS(P = 0.004) and BCSS(P = 0.014).In addition, a Ki67 expression decrease > 12.5% during NAC was related to favorable RFS(P = 0.007), but was not related to BCSS(P = 0.452).Cox regression analysis showed that the Ki67 expression decrease(> 12.5% vs.≤ 12.5%) and histological grade(grade 3 vs.grade 1-2) were the independent factors associated with RFS(P =0.020 and P = 0.023, respectively), with HR values of 0.353(95% CI: 0.147-0.850) and 3.422(95% CI: 1.188-9.858), respectively.Conclusions: The Ki67 decrease was one of the independent factors associated with RFS in LABC patients with residual disease after receiving NAC.

Unnecessity of lymph node regression evaluation for predicting gastric adenocarcinoma outcome after neoadjuvant chemotherapy

BACKGROUND Neoadjuvant chemotherapy has been applied worldwide to improve the survival of patients with gastric adenocarcinoma(GAC). The evaluation of histological regression in primary tumors is valuable for predicting prognosis. However, the prognostic effect of regression change in lymph nodes(LNs) remains unclear.AIM To confirm whether the evaluation of regression change in LNs could predict the prognosis of GAC patients who received neoadjuvant chemotherapy followed by surgery.METHODS In this study, we evaluated the histological regression of resected LNs from 192 GAC patients(including those with esophagogastric junction adenocarcinoma)treated with neoadjuvant chemotherapy. We classified regression change and residual tumor in LNs into four groups:(A) true negative LNs with no evidence of a preoperative therapy effect,(B) no residual metastasis but the presence of regression change in LNs,(C) residual metastasis with regression change in LNs,and(D) metastasis with minimal or no regression change in LNs. Correlations between regression change and residual tumor groups in LNs and regression change in the primary tumor, as well as correlations between regression change in LNs and clinicopathological characteristics, were analyzed. The prognostic effect of regression change and residual tumor groups in LNs was also analyzed.RESULTS We found that regression change and residual tumor groups in LNs were significantly correlated with regression change in the primary tumor, tumor differentiation, ypT stage, ypN stage, ypTNM stage, lymph-vascular invasion,perineural invasion and R0 resection status. Regression change and residual tumor groups in LNs were statistically significant using univariate Cox proportional hazards analysis, but were not independent predictors. For patients who had no residual tumor in LNs, the 5-year overall survival(OS) rates were 67.5% in Group A and 67.4% in Group B. For the patients who had residual tumors in LNs, the 5-year OS rates were 28.2% in Group C and 39.5% in Group D.The patients in Groups A+B had a significantly better outcome than the patients in Groups C+D(P < 0.01). No significant differences in survival were found between Groups A and B, or between Groups C and D.CONCLUSION The existence of residual tumor in LNs, rather than regression change in LNs, is useful for predicting the prognosis after neoadjuvant chemotherapy in GAC patients. In practice, it may not be necessary to report regression change in LNs.

Effects of neoadjuvant chemotherapy on respiratory function in patients with breast cancer

Objective: To evaluate changes in chest X-rays, pulmonary function tests(PFTs) and quality of life in female breast cancer patients who had been treated with four cycles of neoadjuvant chemotherapy consisting of a regimen of cyclophosphamide, epirubicin and 5-fluorouracil(CEF regimen), and to determine the correlation between pulmonary function parameters and declined quality of life.Methods: Twenty-nine eligible female patients diagnosed with breast cancer at the first visit who were 20-60 years old, were classified as the American Society of Anesthesiologists(ASA) Ⅰ-Ⅱ and patients whose body mass index(BMI) <30 kg/m^2 were recruited and subjected to chest X-ray examinations, PFTs and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30(EORTC QLQ-C30)questionnaire before and after receiving 4 cycles of the CEF regimen.Results: In this study, chest X-rays showed no abnormal changes after chemotherapy, but significant decreases in carbon monoxide diffusing capacity(DLCO) and percentage of the DLCO predicted value(DLCO%)(P<0.001). A significant increase in maximal ventilatory volume(MVV)(P=0.004) was observed, and most patients experienced dyspnea(P=0.031) and fatigue(P<0.001). However, there was no significant correlation between the changes in these PFTs parameters and the results of the EORTC QLQ-C30(P>0.05).Conclusions: Neoadjuvant chemotherapy can reduce lung diffusion function and quality of life in females with breast cancer.

Clinical Application Effect of Paclitaxel Combined with Cisplatin Neoadjuvant Chemotherapy in Treatment of Early and Mid Stage Cervical Cancer

Objective:To study the application effect and value of paclitaxel combined with cisplatin neoadjuvant chemotherapy in treatment of early and mid stage cervical cancer.Methods:A total of 92 patients with early and mid stage cervical cancer admitted to our department from 2016 to 2018 were enrolled in the study.The patients were divided into two groups according to random number table.Reference group(n=46)was treated with cervical cancer radical resection combined with postoperative chemotherapy.On the same basis,experimental group(n=46)was given neoadjuvant chemotherapy regimen of paclitaxel combined with cisplatin.Total effective rate,adverse reaction and score of life quality of the two groups were compared.Results:Total effective rate of experimental group was 76.09%which was higher than reference group,41.30%.Score of life quality of the experimental group was higher than that of reference group,the comparison between two groups showed P<0.05.There was no difference in incidence of adverse reaction between the two groups,P>0.05.Conclusion:Application of neoadjuvant chemotherapy of paclitaxel combined with cisplatin had ideal tumor controlling effect for early and mid stage cervical cancer with lesser adverse reaction.Postoperative quality of life was high.It should be promoted in clinics.

Effect of Zhenwu decoction combined with paclitaxel neoadjuvant chemotherapy on the malignant degree of cervical cancer

Objective:To study the effect of Zhenwu decoction combined with paclitaxel neoadjuvant chemotherapy on the malignant degree of cervical cancer.Methods: Patients with cervical cancer who accepted neoadjuvant chemotherapy in Nanchong Central Hospital and Suining Central Hospital between March 2015 and June 2017 were selected and randomly divided into two groups, the observation group received neoadjuvant chemotherapy combined with Zhenwu decoction therapy, and the control group received neoadjuvant chemotherapy. Before chemotherapy and after 2 courses of chemotherapy, the serum was collected to detect the contents of tumor markers;after chemotherapy, the surgically removed cervical cancer lesion was collected to detect the mRNA expression of proliferation genes, tumor suppressor genes and invasion genes.Results: After 2 course of chemotherapy, CA12-5, bFGF and SCC-Ag levels in serum of both groups were lower than those before treatment, and CA12-5, bFGF and SCC-Ag levels in serum as well as Ki-67, TK-1, SOX-2, CyclinD1, S100A6, N-cadherin, Gal-3, CatL and CatD mRNA expression in cervical cancer lesion of observation group were lower than those of control group whereas p53, p16, FHIT, NF2-1 and LATS1 mRNA expression in cervical cancer lesions were higher than those of control group.Conclusion:Zhenwu decoction combined with paclitaxel neoadjuvant chemotherapy can be more effective than neoadjuvant chemotherapy alone to kill cervical cancer cells and reduce the malignancy of cervical cancer.

Effect of Herceptin combined with paclitaxel neoadjuvant chemotherapy on the proliferation viability of HER-2 positive breast cancer cell

Objective: To study the effect of Herceptin combined with paclitaxel neoadjuvant chemotherapy on the proliferation viability of HER-2 positive breast cancer cell. Methods:The patients who were diagnosed with breast cancer and received neoadjuvant chemotherapy in Ziyang First People's Hospital between February 2015 and October 2017 were selected and randomly divided into the experimental group who received Herceptin combined with docetaxel chemotherapy and the control group who received epirubicin combined with docetaxel chemotherapy. After chemotherapy ended, serum levels of tumor markers were measured;after surgical resection, the breast cancer lesions were collected to measure the mRNA expression of proliferation genes and tumor suppressor genes. Results: The differences in tumor marker levels as well as proliferation gene and tumor suppressor gene expression were statistically significant between the two groups;CA15-3, IGF-1, TSGF and TPS levels in serum as well as CyclinD1, PCNA, Bcl-2, Survivin and VEGF mRNA expression in breast cancer lesions of experimental group were lower than those of control group whereas PTEN, Bax, ARID1A, FasL and Caspase-3 mRNA expression in breast cancer lesions were higher than those of control group. Conclusion: Herceptin combined with paclitaxel neoadjuvant chemotherapy can more effectively inhibit the proliferation activity of HER-2 positive breast cancer cells than epirubicin combined with paclitaxel chemotherapy.

Effect of brucea javanica oil injection combined with neoadjuvant chemotherapy on malignant molecule expression and antitumor immune response in patients with gastric cancer

Objective:To study the effect of brucea javanica oil injection combined with neoadjuvant chemotherapy on malignant molecule expression and antitumor immune response in patients with gastric cancer.Methods: A total of 78 patients with gastric cancer undergoing preoperative neoadjuvant chemotherapy in our hospital between May 2013 and July 2016 were selected and randomly divided into two groups, intervention group received brucea javanica oil injection combined with neoadjuvant chemotherapy, and the control group accepted neoadjuvant chemotherapy. Serum tumor marker levels and peripheral blood regulatory molecule expression were determined before and after treatment, and the malignant molecule expression levels in gastric cancer lesions were determined after the operation.Results:2 cycles and 4 cycles after treatment, serum CEA, DKK1, exosc2 and ANXA2 levels of both groups of patients were significantly lower than those before treatment, PD-1, TIM-3 and Foxp3 mRNA expression in peripheral blood mononuclear cells of control group were significantly higher than those before treatment, PD-1, TIM-3 and Foxp3 mRNA expression in peripheral blood mononuclear cells of intervention group were significantly lower than those before treatment, serum CEA, DKK1, exosc2 and ANXA2 levels as well as PD-1, TIM-3 and Foxp3 mRNA expression in peripheral blood mononuclear cells of intervention group were significantly lower than those of control group, and the GKN1 and GKN2 mRNA expression in gastric cancer lesions were significantly higher than those of control group while GOLPH3 and PTP1B mRNA expression were significantly lower than those of control group.Conclusion:Brucea javanica oil injection combined with neoadjuvant chemotherapy can more effectively kill the gastric cancer cells and improve the antitumor immune response.

Accuracy of Sentinel Lymph Node Biopsy after Neoadjuvant Chemotherapy in Breast Cancer Patients;Single Center Experience

Purpose: Most important factor affecting prognosis of breast cancer is axillary nodal involvement. Several studies evaluated the accuracy of Sentinel lymph node biopsy in breast cancer patients post neoadjuvant chemotherapy. In this study, we will examine accuracy and feasibility of using Sentinel lymph node biopsy in predicting axillary lymph node status in breast cancer patients after neoadjuvant chemotherapy. Methods: 45 female patients with resectable, nonmetastatic breast carcinoma cases who received neoadjuvant chemotherapy were enrolled in this study according to the routine Mansoura Oncology Center—guidelines of management of breast cancer. Methylene blue dye used for detection of Sentinel lymph node. Results: Successful Sentinel lymph node detection was 82.2%. Skin involvement (T4 disease) were linked to a low identification (P = 0.005). False negative rate equals 11/27 = (40.7%).With advancement of the stage of the tumor, the incidence of false negative results increases significantly (p = 0.012) with 95% confidence interval;1.2 - 5.4. Conclusion: Sentinel lymph node should be adopted to be the standard method for axillary staging with T1-3 tumors after receiving neoadjuvant chemotherapy, in T4 patients, it is associated with low detection rate & high false negative rate making it doubtful technique for axillary staging.

Oncoplastic Breast Surgery after Neoadjuvant Chemotherapy Replacing Mastectomy in Locally Advanced Breast Cancer (LABC): Single Institute Experience

Background: Integration of neoadjuvant chemotherapy (NCT) in early 70s resulted that many LABC tumors become resectable but with total mastectomy especially those with partial response, oncoplastic techniques give better oncological outcome with better cosmetic results. Objective: We evaluate the oncological safety of oncoplastic breast surgery (OS) in LABC showing partial response to NCT. Methods: We prospectively analyzed the data of 32 out of 58 patients with LABC who showed partial response to NCT and could have conservative surgery with advanced oncoplastic techniques rather than total mastectomy. Results: Out of 58 patients with LABC, received neoadjuvant chemotherapy, complete response was observed in 8 patients (13%), partial response reported in 32 (55.1%) cases, 12 patients (20%) had stable disease and 6 patients (10%) showed progressive disease. Data of 32 cases were studied (mean age 44.84 ± 9.10 years;range 26 - 59 years). Inferior pedicle was performed in 9 cases, mini LD flap in 3 patients, 5 had Grissotti technique, 6 with superomedial pedicle, 4 had V mammoplasty and 3 with J mammoplasty and 2 had vertical mammoplasty. Margins were positive in 5 cases (15.6%) with mean margin width 9.63 ± 5.72 (range 0 - 22 mm), and the local recurrence was reported in 2 cases (6.2%). Complications were reported in 3 cases (9.3%). The follow up was 1.67 ± 1.03 (range 0 - 3.3 years). Conclusions: Integration of neoadjuvant chemotherapy together with advanced oncoplastic techniques opens a new way for management of LABC especially those showing partial response with avoidance of total mastectomy, and comparable oncological safety in addition to better aesthetic and psychological outcome.

Primary Debulking Surgery for Stage III Epithelial Ovarian Cancer Has a Better Outcome Than Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery

Background:?Ovarian cancer (OC) is the most lethal gynecologic malignancy. About 70% of ovarian cancer patients have advanced disease and often not totally resectable. Previous studies of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) versus primary debulking surgery (PDS) give inconsistent results. The aim of this retrospective study is to evaluate the outcome of the neoadjuvant chemotherapy followed by IDS versus PDS followed by adjuvant chemotherapy for the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer.?Methods:?This study was performed on eligible patients with ovarian cancer admitted in Surgical Oncology and Medical Oncology departments at South Egypt Cancer Institute-Assiut University in the period from January 2010 to December 2015. Patients were divided into two groups, the first group included those who have NACT and underwent IDS plus adjuvant chemotherapy, and the second group included those who underwent PDS followed by adjuvant chemotherapy.?Results:?This study included 380 cases. One hundred and fifty-four patients (40.53%) had IDS. The remaining two hundred and twenty-six patients (59.47%) underwent PDS. In this study, treatment modality was significant for both disease-free survival (DFS) and overall survival (OS). DFS was significantly reduced after IDS when compared to PDS (median DFS: 33.00 months vs. 45.00 months, respectively;p??0.001). Also, OS was significantly reduced after IDS when compared to PDS. (Median OS: 43 months vs. 46 months, respectively;p = 0.047). Moreover, this drop of the survivals mainly occurred in specific subgroups such as the elderly patients, patients with bad performance status, suboptimal cytoreduction, as well as high-grade tumors. Conclusion:?This study showed that PDS resulted in a better disease-free survival and overall survival than IDS. Moreover, OS and DFS have significantly dropped in specific patients’ subgroups. Therefore, patients selection should be considered.

Sentinel Lymph Node Biopsy Prior to Neoadjuvant Chemotherapy: A Series of 89 Patients

Purpose: There are still un-responded questions concerning the type of and the timing of axillary procedures that has to be performed in association with neoadjuvant chemotherapy. Methods: We led a prospective, multicentric, non-randomized study to evaluate the feasibility and accuracy of sentinel lymph node biopsy before neoadjuvant chemotherapy. The clinical and radiological response to chemotherapy was evaluated after 4 treatment cycles and at the end of chemotherapy. Axillary lymph node dissection was performed 3 to 4 weeks after chemotherapy. Histological analysis of sentinel lymph node biopsies and axillary lymph node dissections were studied for each patient. Results: Eighty nine patients had sentinel lymph node biopsy. The identification rate for sentinel lymph nodes was 98.9%. The sentinel lymph node biopsies were metastatic in 44 of 88 patients. Axillary lymph nodes were metastatic in 12 cases. The negative predictive value was 91.1% [95%CI: 85.1% - 97.1%]. Conclusion: Identification rate and negative predictive value of sentinel lymph node biopsy prior to neoadjuvant chemotherapy confirm that the procedure is suitable with its use in standard practice. This approach comprises two surgical procedures, but allows a better nodal status evaluation.

Magnetic resonance imaging apparent diffusion coefficient before and after neoadjuvant chemotherapy in patients with breast cancer and its correlation with tumor load

Objective:To study the magnetic resonance imaging apparent diffusion coefficient (ADC) before and after neoadjuvant chemotherapy in patients with breast cancer and its correlation with tumor load.Methods: Patients with stage II-III breast cancer who intended to receive radical operation for breast cancer in our hospital between May 2015 and February 2018 were selected and divided into the experimental group who accepted neoadjuvant chemotherapy and the control group who received surgery directly according to the adoption of preoperative neoadjuvant chemotherapy or not in the history data. Experimental group underwent magnetic resonance imaging before and after neoadjuvant chemotherapy to measure the ADC, and control group underwent magnetic resonance imaging before surgery to measure the ADC;the tumor tissues surgically removed from the two groups of patients were collected to measure the expression of oncogenes and invasion genes.Results:ADC value of experimental group after neoadjuvant chemotherapy was higher than that before neoadjuvant chemotherapy, ADC value of experimental group before neoadjuvant chemotherapy was not significantly different from that of control group whereas ADC value after neoadjuvant chemotherapy was significantly higher than that of control group;MCM3, CyclinD1, TC-1,β-catenin, YAP and MMP2 mRNA expression levels in surgically removed tumor tissues of experimental group were significantly lower than those of control group whereas CCN5, ARID1A and PDCD4 mRNA expression levels were significantly higher than those of control group;MCM3, CyclinD1, TC-1,β-catenin, YAP and MMP2 mRNA expression levels in tumor tissues with high ADC value were significantly lower than those in tumor tissues with low ADC value whereas CCN5, ARID1A and PDCD4 mRNA expression levels were significantly higher than those in tumor tissues with low ADC value.Conclusion:The increase of ADC after breast cancer neoadjuvant chemotherapy is related to the activity of cancer cell proliferation and invasion, and can be used to evaluate the changes of tumor load before and after chemotherapy.

Effects of preoperative neoadjuvant chemotherapy on malignant biological characteristics in the lesions of patients with ⅠB-ⅡB cervical cancer

Objective: To investigate the effects of preoperative neoadjuvant chemotherapy on malignant biological characteristics in the lesions of patients with ⅠB-ⅡB cervical cancer. Methods:Patients who were diagnosed with ⅠB-ⅡB cervical cancer and underwent surgical treatment in Navy General Hospital of PLA between February 2015 and May 2017 were selected as the research subjects and randomly divided into the neoadjuvant chemotherapy group who underwent preoperative neoadjuvant chemotherapy and the control group who underwent routine preoperative preparation. After surgical resection, the mRNA expression of tumor suppressor genes, proliferation genes as well as migration and invasion genes in cervical cancer tissue were determined by fluorescence quantitative PCR. Results: After surgical resection, tumor suppressor genes THBS2, PTEN, LAST1 and eIF4E3 mRNA expression in cervical cancer tissue of adjuvant chemotherapy group were significantly higher than those of routine surgery group whereas proliferation genes RUNX2, CyclinD1, ALEX1, ALDH1 and ABCG2 as well as migration and invasion genes CXCL12, CXCR4, MMP9, S100A6 and N-cadherin mRNA expression were significantly lower than those of routine surgery group. Conclusion:Preoperative neoadjuvant chemotherapy can inhibit the proliferation, migration and invasion of cancer cells within the lesions of patients with ⅠB-ⅡB cervical cancer.

Effect of zhenwu decoction combined with neoadjuvant chemotherapy on malignant characteristics of cancer cells in ovarian cancer

Objective:To explore the effect of zhenwu decoction combined with neoadjuvant chemotherapy on malignant characteristics of cancer cells in ovarian cancer.Methods:A total of 80 patients with ovarian cancer who underwent surgical treatment in this hospital between March 2015 and January 2017 were divided into the control group (n=42) who received preoperative neoadjuvant chemotherapy and the zhenwu decoction group (n=38) who received preoperative zhenwu decoction combined with neoadjuvant chemotherapy. Intraoperative ovarian cancer tissue was kept to detect the expression of proliferation genes, invasion genes and autophagy genes through fluorescence quantitative PCR method.Results:Proliferation genes AKT, LSD1, SIRT1 and NOB1 mRNA expression in ovarian lesion tissue of zhenwu decoction group were lower than those of control group;invasion gene DACT1 mRNA expression was higher than that of control group whereas MTA1 and GRP78 mRNA expression were lower than those of control group;autophagy gene Beclin1 mRNA expression was higher than that of control group whereas LC3-Ⅱ and Atg5 mRNA expression were lower than those of control group.Conclusion:Preoperative zhenwu decoction combined with neoadjuvant chemotherapy can effectively inhibit the proliferation and invasion activity of tumor cells and regulate their autophagy function in patients with ovarian cancer.