中药CY-1号对外源性雌激素致乳腺癌危险因素的阻断作用

目的:探讨中药 CY-1号对外源性雌激素所致乳腺癌危险因素的阻断作用及其机制。方法:雌性 Wistar 大鼠随机分为:A 组(饲己烯雌酚);B 组(饲己烯雌酚加三苯氧胺);C 组(饲己烯雌酚加中药 CY-1号),持续3个月后进行血清雌二醇(E_2)和孕酮(P)检测,乳腺的病理形态和超微结构观察,乳腺上皮细胞 Ag-NOR 计数和 DNA 定量测定。结果:A 组和 C 组血清 E_2(分别为11.7 ng/L,12.36 ng/L)均明显低于 B 组(16.37 ng/L,P<0.05);B 组和 C 组血清 P(分别为22.17μg/L,17.42μg/L)明显高于 A 组(12.7μg/L,P<0.05);C 组乳腺组织增生率(33.33%)、增生程度、DNA 含量(71.35)和 AgNOR 计数(1.87)显著低于 A 组(分别为80%、120.11、7.6,P<0.05),但与 B 组(分别为26.67%、67.26、1.86)比较差异无显著性(P>0.05)。结论:中药 CY-1号可增加血清 P 水平,抑制己烯雌酚所致的 DNA 和 AgNOR 量变,并阻断乳腺上皮细胞异常增殖。但与三苯氧胺在内分泌调节和细胞超微结构改变中的作用并非相同。

广东佛山地区乳腺癌危险因素的调查分析

目的调查广东佛山地区妇女罹患乳腺癌的危险因素,为确定当地乳腺癌高危人群及防治提供科学依据。方法对2010年1月至2011年8月在广东佛山南海区人民医院住院治疗并确诊为乳腺癌且均在南海区居住10年以上的168例患者实施问卷式调查,并按1∶1配比选择同期住院、年龄相差±2岁、同性别且在南海区居住10年以上其他非肿瘤、乳腺、内分秘疾病病例作为对照组,应用非条件Logistic回归模型对调查内容进行分析。结果多因素Logistic回归分析显示,初次活产年龄大、初潮年龄小、乳腺良性肿瘤、乳腺癌家族史、常染发涂指甲油为乳腺癌的主要危险因子;而哺乳时间长、常吃蔬菜水果及有饮茶习惯则有保护作用。结论对有乳腺癌家族史及乳腺良性疾病史的妇女应定期进行普查普治;提倡合理饮食,多吃蔬菜水果等富含维生素的食品,少染发及涂指甲油,提倡母乳喂养。

2型糖尿病合并甲状腺癌发生率及预后相关性研究

目的探讨2型糖尿病合并甲状腺癌的发生率及预后相关性。方法回顾性分析300例2型糖尿病患者的临床资料,此外选取同期健康体检者290例作为对照组。对比分析两组血糖水平及血清游离三碘甲状腺原氨酸FT3、甲状腺激素、TSH及甲状腺癌发病率。单因素和logistic多因素分析甲状腺癌预后的相关因素。结果研究组患者血糖水平与对照组比较具有显著差异。研究组血清游离三碘甲状腺原氨酸FT3、甲状腺激素、TSH及甲状腺癌发病率明显高于对照组,差异具有统计学意义(P<0.05)。随访5年,研究组甲状腺癌7例,总患病率2.33%,随年龄的增加而逐渐升高,女性患病比例明显高于男性。女性甲状腺癌发病率高于男性,约是男性的3倍,甲状腺癌的发病年龄相对年轻,发病率随年龄的增长而上升。甲状腺滤泡状癌2例,嗜酸细胞甲状腺癌1例,甲状腺髓样癌2例,低分化甲状腺癌1例,甲状腺原发性鳞状细胞癌1例。单因素分析显示,手术方式、病理分型、淋巴结转移、肿瘤大小以及术后用药为甲状腺癌预后的相关因素。多因素分析显示,病理分型、淋巴结转移、肿瘤大小以及术后用药为甲状腺癌预后的相关因素。结论 2型糖尿病患者血糖与甲状腺癌发病率存在密切相关性,病理分型、淋巴结转移、肿瘤大小以及术后用药为甲状腺癌预后的相关因素。

Re-searching nasopharyngeal carcinoma

Nasopharyngeal carcinoma(NPC)has been a focus of medical research for more than 100 years,with significant interest emerging over the last 58 years following the identification of the link between the disease and Epstein-Barr virus(EBV)infection.NPC possesses several distinctive characteristics among human cancers,notably its well-documented global epidemiology,which reveals localized high-incidence regions primarily in Southeast Asia,particularly in the Southern provinces of China near the Pearl river,as well as in Greenland and North Africa.Epidemiological data indicate a marked male predominance,early disease onset,and a nearly 100%prevalence of latent EBV infection in the tumors.Due to lack of consistent pattern of cancer-related mutations in NPC genomes and excessive DNA-methylation in the tumor cells,NPC can be considered"an epigenetic cancer".Despite extensive researches,convincing biological explanations for these unique characteristics remain elusive.Recently,suggestive evidence has been published that specific local variants of EBV may represent major high risk factors.In spite of tumor and virus specific immunity,it has not been possible to use this for improved treatment.Ongoing studies on the role of the local microflora and tumor microenvironment are essential for a comprehensive understanding of host-EBV-tumor interactions.Ultimately,this knowledge aims to enhance diagnosis,disease fractionation,treatment strategies,and potentially prevention of NPC.

Interactions between CagA and smoking in gastric cancer

AIM: To examine the interactions between cytotoxinassociated gene (CagA) positive Helicobacter pylori infection and smoking in non-cardiac gastric cancer.METHODS: A case-control study (257 cases and 514 frequency-matched controls) was conducted from September 2008 to July 2010 in Xi’an,China.Cases were newly diagnosed,histologically confirmed non-cardiac cancer.Controls were randomly selected from similar communities to the cases and were further matched by sex and age (± 5 years).A face-to-face interview was performed by the investigators for each participant.Data were obtained using a standardized questionnaire that included questions regarding known or suspected lifestyle and environmental risk factors of gastric cancer.A 5 mL sample of fasting venous blood was taken.CagA infection was serologically detected by enzymelinked immunosorbent assays.RESULTS: Smoking and CagA infection were statistically significant risk factors of non-cardiac cancer.CagA was categorized in tertiles,and the odds ratio (OR) was 12.4 (95% CI: 6.1-20.3,P = 0.003) for CagA after being adjusted for confounding factors when the highexposure category was compared with the low-exposure category.Smokers had an OR of 5.4 compared with subjects who never smoked (95% CI: 2.3-9.0,P = 0.002).The OR of non-cardiac cancer was 3.5 (95% CI: 1.8-5.3) for non-smokers with CagA infection,3.5 (95% CI: 1.9-5.1) for smokers without CagA infection,and 8.7 (95% CI: 5.1-11.9) for smokers with CagA infection compared with subjects without these risk factors.After adjusting for confounding factors,the corresponding ORs of non-cardiac cancer were 3.2 (95% CI: 1.5-6.8),2.7 (95% CI: 1.3-4.9) and 19.5 (95% CI: 10.3-42.2),respectively.There was a multiplicative interaction between smoking and CagA,with a synergistic factor of 2.257 (Z = 2.315,P = 0.021).CONCLUSION: These findings support a meaningful interaction between CagA and smoking for the risk of gastric cancer which may have implications for its early detection.

Gastric dysplasia may be an independent risk factor of an advanced colorectal neoplasm

AIM: To evaluate the relationship between gastric dysplasia and Helicobacter pylori (H pylori) and the occurrence of colorectal adenoma, and to defi ne the necessity for colonoscopy in patients with gastric dysplasia or H pylori infection.METHODS: From May 2005 to February 2008, 133 patients with established gastric dysplasia by gastroduo-denoscopy (EGD) were additionally investigated by colonoscopy. The authors compared results with those of 213 subjects who underwent both EGD and colonoscopy during the same period at the author’s Health Promotion Center as a control group. H pylori infection was evaluated in both the gastric dysplasia and control groups.RESULTS: The mean age of all 346 study subjects was 54.1 ± 10.5 years, and there were 258 (73%) men and 87 (27%) women. No signif icant difference was found between the H pylori positive and negative subjects in terms of the prevalence of colorectal adenoma and advanced colorectal adenoma (P = 0.261). Patients with gastric dysplasia showed no elevated risk of colorectal adenoma (OR = 0.910, 95% CI: 0.587-1.411, P = 0.738), but had a signif icantly higher risk of having advanced colorectal adenoma (OR = 3.382, 95% CI: 1.700-6.342, P = 0.000).CONCLUSION: The study emphasizes the need for colon surveillance in patients with gastric dysplasia, regardless of H pylori infection.

Risk factors for sporadic colorectal cancer in southern Chinese

AIM:To investigate the role of smoking, alcohol drinking, family history of cancer, and body mass index(BMI) in sporadic colorectal cancer in southern Chinese.METHODS:A hospital-based case-control study was conducted from July 2002 to December 2008.There were 706 cases and 723 controls with their sex and age(within 5 years) matched.An unconditional logistic regression model was used to analyze the association between smoking, alcohol drinking, family history of cancer, BMI and sporadic colorectal cancer.RESULTS:No positive association was observed between smoking status and sporadic colorectal cancer risk.Compared with the non alcohol drinkers, the current and former alcohol drinkers had an increased risk of developing sporadic colorectal cancer(CRC)(adjusted OR = 8.61 and 95% CI = 6.15-12.05;adjusted OR = 2.30, 95% CI = 1.27-4.17).Moreover, the increased risk of developing sporadic CRC was significant in those with a positive family history of cancer(adjusted OR = 1.62, 95% CI = 1.12-3.34) and in those with their BMI ≥ 24.0 kg/m2(adjusted OR = 1.39, 95% CI = 1.10-1.75).Stratification analysis showed that the risk of developing both colon and rectal cancers was increased in current alcohol drinkers(adjusted OR = 7.60 and 95% CI = 5.13-11.25;adjusted OR = 7.52 and 95% CI = 5.13-11.01) and in those with their BMI ≥ 24.0 kg/m2(adjusted OR = 1.38 and 95% CI = 1.04-1.83;adjusted OR = 1.35 and 95% CI = 1.02-1.79).The risk of developing colon cancer, but not rectal cancer, was found in former alcohol drinkers and in those with a positive family history of cancer(adjusted OR = 2.51 and 95% CI = 1.24-5.07;adjusted OR = 1.82 and 95% CI = 1.17-2.82).CONCLUSION:Alcohol drinking, high BMI(≥ 24.0 kg/m2) and positive family history of cancer are the independent risk factors for colorectal cancer in southern Chinese.

Diabetes but not insulin is associated with higher colon cancer mortality

AIM： To evaluate whether diabetic patients had a higher risk of colon cancer mortality and its associated risk factors. METHODS： The sex-specific crude and age-standard- ized （to the 2000 World Health Organization popula- tion） mortality rates of colon cancer in the Taiwan Residents general population were first calculated from 1995 to 2006. The trends were evaluated by linear regression. A total of 113 347 diabetic men and 131 573 diabetic women aged ~〉 25 years at recruitment from 1995 to 1998 were followed up until the end of 2006. Age/sex- specific colon cancer mortality rate ratios were cal- culated comparing the mortality rates of the diabetic patients with the average mortality rates of the general population within 12 years （1995-2006）. A sub-cohort of diabetic patients （42 260 men and 49 405 women） was interviewed using a baseline questionnaire and Cox＇s regression was used to evaluate the risk factors for colon cancer mortality in these diabetic patients.RESULTS： The crude and age-standardized trends of colon cancer mortality from 1995 to 2006 increased significantly for both sexes in the general population. A total of 641 diabetic men and 573 diabetic women died of colon cancer, with a mortality rate of 74.4 and 54.3 per 100 000 person-years, respectively. Mortality rate ratios [95% confidence intervals （CIs）] showed a significantly higher risk of mortality from colon can- cer for the diabetic patients compared to the general population, with the magnitude increasing with de- creasing age： 1.65 （1.40-1.95）, 2.01 （1.78-2.27）, 2.75 （2.36-3.21） and 5.69 （4.65-6.96） for /〉 75, 65-74, 55-64 and 25-54 years old, respectively, for men; and 1.46 （1.24-1.72）, 2.09 （1.84-2.38）, 2.67 （2.27-3.14） and 3.05 （2.29-4.06）, respectively, for women. Among the sub-cohort of diabetic patients who had been in- terviewed with the baseline questionnaire, including information on age, sex, diabetes duration, diabe- tes type, body mass index, smoking, insulin use and area of residence, age and smoking were significantly predictive for colon cancer mortality, with respec- tive adjusted hazard ratios （HRs） （95% CIs） of 1.077 （1.066-1.088） and 1.384 （1.068-1.792）. Diabetes dura- tion became a significant factor when those who died of colon cancer within 5 years of diabetes diagnosis were excluded to minimize the possible contamination of diabetes caused by incipient colon cancer, with an adjusted hazard ratio of 1.021 （1.007-1.034）. Sex, dia- betes type, insulin use, body mass index and area of residence were not significant predictors for colon can- cer mortality in the diabetic patients. Although insulin use was categorized into subgroups of duration of use （non-users and users 〈 5 years, 5-9 years and i〉 10 years）, none of the HRs for colon cancer mortality was significant with regards to different durations of insulin use. CONCLUSION： Colon cancer mortality is increasing in Taiwan. A higher risk is observed in diabetic patients. Smoking, but not insulin use, is a modifiable risk factor.

Extracapsular invasion as a risk factor for disease recurrence in colorectal cancer

AIM: To evaluate the presence of extracapsular invasion (ECI) in positive nodes as a predictor of disease recurrence disease in colorectal cancer. METHODS: Two hundred and twenty-eight consecutive patients who underwent colorectal resection were identified for inclusion in this study, of which 46 had positive lymph nodes. Among 46 cases with stage Ⅲcolorectal cancer, 16 had ECI at positive nodes and 8 had disease recurrence. The clinical and pathological features of these cases were reviewed. RESULTS: In the univariate analysis, the number of positive lymph nodes and depth of tumor invasion were significantly associated with the presence of ECI at positive nodes. Multivariate analysis demonstrated that only ECI was a predictor of recurrence. The recurrence-free interval differed significantly among patients with ECI at positive nodes.CONCLUSION: Our results suggest that ECI at metastatic nodes can identify which cases are at high risk of short-term disease recurrence in colorectal cancer.

Estrogen,male dominance and esophageal adenocarcinoma:Is there a link?

Esophageal adenocarcinoma is a cancer with poor prognosis, and its incidence has risen sharply over recent decades. Obesity is a major risk factor for developing this cancer and there is a clear male gender bias in the incidence that cannot be fully explained by known risk factors. It is possible that a difference in the expression of estrogen, or its signaling axes, may contribute to this gender bias. We undertook a com- prehensive literature search and analyzed the available data regarding estrogen and estrogen receptor expres- sion, and the possible sex-specific links with esopha- geal adenocarcinoma development. Potentially relevant associations between visceral vs subcutaneous fat deposition and estrogen expression, and the effect of crosstalk between estrogen and leptin signaling were identified. We also found limited studies suggesting a role for estrogen receptor 13 expression in esophageal adenocarcinoma development. The current literature supports speculation on an etiological role for estrogen in the male gender bias in esophageal adenocarcino- ma, but further studies are required.

Influence of obesity and bariatric surgery on gastric cancer

Esophageal and gastric cancer(GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery.

Chemotherapy of ovarian cancer in elderly patients

Epithelial ovarian cancer is primarily a disease of older women. Advanced age is risk factor for decreased survival. Optimal surgery and the safe and effective administration of chemotherapy are essential for prolonged progression-free and overall survival(OS). In this article, the available regimens in both the primary treatment and relapsed setting are reviewed.

Anterior resection for rectal carcinoma-risk factors for anastomotic leaks and strictures

AIM:To determine the incidence and factors responsible for anastomotic leaks and stricture following anterior resection(AR)and its subsequent management.METHODS:Retrospective analysis of data from 108 patients with rectal carcinoma who underwent AR or low anterior resection(LAR)to identify the various preoperative,operative,and post operative factors that might have influence on anastomotic leaks and strictures.RESULTS:There were 68 males and 40 females with an average of 47 years(range 21-75 years).The median distance of the tumor from the anal verge was 8 cm(range 3-15 cm).Sixty(55.6%)patients underwent handsewn anastomosis and 48(44.4%)were stapled.The median operating time was 3.5 h(range2.0-7.5 h).Sixteen(14.6%)patients had an anastomotic leak.Among these,11 patients required reexploration and five were managed expectantly.The anastomotic leak rate was similar in patients with and without diverting stoma(8/60,13.4%with stoma and 8/48;16.7%without stoma).In 15(13.9%)patients,resection margins were positive for malignancy.Ninteen(17.6%)patients developed anastomotic strictures at a median duration of 8 mo(range 3-20 mo).Among these,15 patients were successfully managed with per-anal dilatation.On multivariate analysis,advance age(>60 years)was the only risk factor for anastomotic leak(P=0.004).On the other hand,anastomotic leak(P=0.00),mucin positive tumor(P =0.021),and lower rectal growth(P=0.011)were found as risk factors for the development of an anastomotic stricture.CONCLUSION:Advance age is a risk factor for an anastomotic leak.An anastomotic leak,a mucin-secreting tumor,and lower rectal growth predispose patients to develop anastomotic strictures.

Pre-diagnostic levels of adiponectin and soluble vascular cell adhesion molecule-1 are associated with colorectal cancer risk

AIM： To examine the relationships between pre-diag- nostic biomarkers and colorectal cancer risk and assess their relevance in predictive models.METHODS： A nested case-control study was designed to include all first primary incident colorectal cancer cases diagnosed between inclusion in the SUpplemen- tation en VItamines et Min^raux AntioXydants cohort in 1994 and the end of follow-up in 2007. Cases （n = 50） were matched with two randomly selected con- trols （n = 100）. Conditional logistic regression models were used to investigate the associations between pre- diagnostic levels of hs-CRP, adiponectin, leptin, soluble vascular cell adhesion molecule-1 （sVCAM-1）, soluble intercellular adhesion molecule-I, E-selectin, monocyte chemoattractant protein-1 and colorectal cancer risk. Area under the receiver operating curves （AUC） and relative integrated discrimination improvement （RIDI） statistics were used to assess the discriminatory poten- tial of the models. RESULTS： Plasma adiponectin level was associated with decreased colorectal cancer risk （P for linear trend -- 0.03）. Quartiles of sVCAM-1 were associated with increased colorectal cancer risk （P for linear trend = 0.02）. No association was observed with any of the other biomarkers. Compared to standard models with known risk factors, those including both adiponectin and sVCAM-1 had substantially improved performance for colorectal cancer risk prediction （P for AUC improve- ment = 0.01, RIDI = 26.5%）. CONCLUSION： These results suggest that pre-diag- nostic plasma adiponectin and sVCAM-1 levels are as- sociated with decreased and increased colorectal cancer risk, respectively. These relationships must be confirmed in large validation studies.

Is diabetes a causal agent for colorectal cancer? Pathophysiological and molecular mechanisms

The possible relationship between diabetes mellitus (DM) and colorectal cancer (CRC), concerning pathophysiological and molecular mechanisms is highlighted in this review. The most recent and complete articles and developments in this particular field were thoroughly reviewed. Common risk factors, such as obesity, sedentary lifestyle, and Western diet between DM and CRC, led to the theory that DM might be a causal agent for CRC development. Various studies have connected type 2 DM and CRC, either proximal or distal, in both sexes. Additionally, chronic insulin treatment has been linked with increased colorectal tumor risk among type 2 diabetic patients. Interestingly, elevated hemoglobin A1c has been proven to be an independent predictor of aggressive clinical behavior in CRC patients. These mechanisms include the insulin-like growth factor-hyperinsulinemia theory and the participation of oncogenic intracellular signaling pathways. Furthermore, it has been proposed that Cox-2 inhibitors might have a role in decreasing the incidence of CRC. Finally, the use of statins to reduce the risk for colon cancer in patients with diabetes has remained controversial. Diabetic patients over 50 should receive counseling regarding their elevated risk for CRC, and screening colonoscopy should be recommended before initiating insulin therapy. However, there are no current guidelines, and this strategy is not yet applicable to some countries, as the corresponding risk would not allow screening colonoscopy to be adopted. There is strong evidence to indicate that DM is a causal agent for CRC development. This conclusion provides new impetus for re-evaluating CRC screening worldwide.

Evaluation of SNPs in miR-196-a2, miR-27a and miR-146a as risk factors of colorectal cancer

AIM: To investigate whether selected single nucleotide polymorphisms (SNPs) in miR-196a2, miR-27a and miR146a genes are associated with sporadic colorectal cancer (CRC).METHODS: In order to investigate the effect of these SNPs in CRC, we performed a case-control study of 197 cases of sporadic CRC and 212 cancer-free controls originating from the Central-European Caucasian population using TaqMan Real-Time polymerase chain reaction and allelic discrimination analysis. RESULTS: The genotype and allele frequencies of SNPs were compared between the cases and the controls. None of the performed analysis showed any statistically significant results. CONCLUSION: Our data suggest a lack of association between rs11614913, rs895819 and rs2910164 and colorectal cancer risk in the Central-European Caucasian population, a population with an extremely high incidence of sporadic colorectal cancer.

Surgical treatment of intrahepatic cholangiocarcinoma: a retrospective study of 104 cases

Objective: To explore the clinicopathological features, surgical treatment techniques, and prognostic risk factors of intrahepatic cholangiocarcinoma(ICC).Methods: A total of 104 ICC cases were collected from January 2008 to December 2013 at Tianjin Medical University Cancer Institute and Hospital and divided into the hepatic hilum lymphadenectomy(HLL, 21 cases), extended hepatic hilum lymphadenectomy(EHLL, 12 cases), and non-lymphadenectomy(NL, 71 cases) groups. The clinical data of the patients were retrospectively analyzed, and the prognostic differences were compared among different groups.Results: The 1-, 2-, and 3-year overall survival(OS) rates of all cases were 72.1%, 56.1%, and 43.7%, respectively. The median survival duration was 34 months. The 1-, 2-, and 3-year OS rates of the HLL group(42.9%, 28.6%, and 28.6%, respectively) were significantly lower than those of the NL group(78.9%, 62.5%, and 47.8%, respectively). Meanwhile, the 1-, 2-, and 3-year OS rates of the EHLL group(75.0%, 56.1%, and 33.3%, respectively) were not significantly different from those of the other two groups.Univariate analysis showed that age, gender, American Joint Committee on Cancer(AJCC) stage, differentiation, ferritin(Fer),carbohydrate antigen19-9(CA19-9) and carcinoembryonicantigen(CEA) levels, lymph node metastasis(LNM), and lymph node dissection(LND) were prognostic factors for the long-term survival of ICC. Meanwhile, multivariate analysis revealed that age,AJCC stage, differentiation, Fer levels, and LNM were independent risk factors for survival.Conclusions: ICC patients will not benefit from lymphadenectomy in the absence of LNM. However, systematic lymphadenectomy may improve ICC outcomes if the location of lymphatic metastasis is known. Age, AJCC stage, differentiation,Fer level, and LNM are independent risk factors for survival in ICC.

Risk factors for residual tumor after resection of hepatocellular carcinoma

AIM:To identify the clinicopathological risk factors correlated with residual tumor in hepatocellular carcinoma (HCC) patients after resection. METHODS:From January 2001 to April 2007,766 HCC patients who had undergone resection were included in this research. Lipiodol angiography was performed within 2 mo after surgery and followed by post-Lipiodol computed tomography (CT) 4 wk later for all 766 patients to monitor tumor in the remnant liver. Tumor detected within the first 3-mo postoperative period was defined as residual tumor. Patients were divided into 2 groups:disease or disease-free within the first 3 mo after surgery. Risk factors for residual tumor were investigated among various clinicopathological variables. RESULTS:A total of 63 (8.22%) patients were found to have residual tumor after surgery. Three independent factors associated with residual tumor were identified by multivariate analysis:preoperative serum α-fetoprotein (AFP) level [odds ratio (OR) = 1.68 (95% confidence interval (CI):1.20-2.36)],tumor size [OR = 1.73 (95% CI:1.29-2.31)] and microvascular invasion [OR = 1.91 (95% CI:1.12-3.24)]. CONCLUSION:Residual tumor is related to AFP level,tumor size and microvascular invasion. Patients at high risk should undergo closer follow-up and could be candidates for multimodality therapy.

Is adjuvant chemotherapy necessary for patients with microinvasive breast cancer after surgery？

Objective: Survival and treatment of patients with microinvasive breast cancer(MIBC) remain controversial. In this paper, we evaluated whether adjuvant chemotherapy is necessary for patients with MIBC to identify risk factors influencing its prognosis and decide the indication for adjuvant chemotherapy.Methods: In this retrospective study, 108 patients with MIBC were recruited according to seventh edition of the staging manual of the American Joint Committee on Cancer(AJCC). The subjects were divided into chemotherapy and non-chemotherapy groups.We compared the 5-year disease-free survival(DFS) and overall survival(OS) rates between groups. Furthermore, we analyzed the factors related to prognosis for patients with MIBC using univariate and multivariate analyses. We also evaluated the impact of adjuvant chemotherapy on the prognostic factors by subgroup analysis after median follow-up time of 33 months(13-104months).Results: The 5-year DFS and OS rates for the chemotherapy group were 93.7% and 97.5%, whereas those for the nonchemotherapy group were 89.7% and 100%. Results indicate that 5-year DFS was superior, but OS was inferior, in the former group compared with the latter group. However, no statistical significance was observed in the 5-year DFS(P=0.223) or OS(P=0.530) rate of the two groups. Most relevant poor-prognostic factors were Ki-67 overexpression and negative hormonal receptors. Cumulative survival was 98.2% vs. 86.5% between low Ki-67(≤20%) and high Ki-67(>20%). The hazard ratio of patients with high Ki-67 was 16.585 [95% confidence interval(CI), 1.969-139.724; P=0.010]. Meanwhile, ER(-)/PR(-) patients with MIBC had cumulative survival of 79.3% compared with 97.5% for ER(+) or PR(+) patients with MIBC. The hazard ratio for ER(-)/PR(-) patients with MIBC was 19.149(95% CI, 3.702-99.057; P<0.001). Subgroup analysis showed that chemotherapy could improve the outcomes of ER(-)/PR(-) patients(P=0.014), but not those who overexpress Ki-67(P=0.105).Conclusions: Patients with MIBC who overexpress Ki-67 and with negative hormonal receptors have relatively substantial risk of relapse within the first five years after surgery. However, adjuvant chemotherapy can only improve the outcomes of ER(-)/PR(-)patients, but not those who overexpress Ki-67. Further studies with prolonged follow-up of large cohorts are recommended to assess the prognostic significance and treatment of this lesion.

Effects of postmastectomy radiotherapy on prognosis in different tumor stages of breast cancer patients with positive axillary lymph nodes

Objective: To explore the effects of postmastectomy radiotherapy(PMRT) on the locoregional failure-free survival(LRFFS) and overall survival(OS) of breast cancer patients under different tumor stages and with one to three positive axillary lymph nodes(ALNs). Methods: We conducted a retrospective review of 527 patients with one to three positive lymph nodes who underwent modified radical or partial mastectomy and axillary dissection from January 2000 to December 2002. The patients were divided into the T1-T2 N1 and T3-T4 N1 groups. The effects of PMRT on the LRFFS and OS of these two patient groups were analyzed using SPSS 19.0, Pearson's χ2-test, Kaplan-Meier method, and Cox proportional hazard model. Results: For T1-T2 N1 patients, no statistical significance was observed in the effects of PMRT on LRFFS [hazard ratio(HR)=0.726; 95% confidence interval(CI): 0.233-2.265; P=0.582] and OS(HR=0.914; 95% CI: 0.478-1.745; P=0.784) of the general patients. Extracapsular extension(ECE) and high histological grade were the risk factors for LRFFS and OS with statistical significance in multivariate analysis. Stratification analysis showed that PMRT statistically improved the clinical outcomes in high-risk patients [ECE(+), LRFFS: P=0.026, OS: P=0.007; histological grade III, LRFFS: P<0.001, OS: P=0.007] but not in low-risk patients [ECE(–), LRFFS: P=0.987, OS: P=0.502; histological grade I-II, LRFFS: P=0.816, OS: P=0.296]. For T3-T4 N1 patients, PMRT effectively improved the local control(HR=0.089; 95% CI: 0.210-0.378; P=0.001) of the general patients, whereas no statistical effect was observed on OS(HR=1.251; 95% CI: 0.597-2.622; P=0.552). Absence of estrogen receptors and progesterone receptors(ER/PR)(–) was an independent risk factor. Further stratification analysis indicated a statistical difference in LRFFS and OS between the high-risk patients with ER/PR(–) receiving PMRT and not receiving PMRT [ER/PR(–), LRFFS: P=0.046, OS: P=0.039]. However, PMRT had a beneficial effect on the reduction of locoregional recurrence(LRR) but not in total mortality [ER/PR(+), LRFFS: P<0.001, OS: P= 0.695] in T3-T4 N1 patients with ER/PR(+) who received endocrine therapy. Conclusion: PMRT could reduce ECE(+), histological grade III-related LRR, and total mortality of T1-T2 N1 patients. T3-T4 N1 patients with ER/PR(–) could benefit from PMRT by improving LRFFS and OS. However, PMRT could only reduce LRR but failed to improve OS for T3-T4 N1 patients with ER/PR(+) who received endocrine therapy.