591 Background: Premenopausal patients with locally advanced hormone receptor–positive, HER2-negative (HR+/HER2−) breast cancer are routinely recommended neoadjuvant chemotherapy (NAC) despite heterogeneous and often limited response. In advanced disease, endocrine therapy (ET) plus CDK4/6 inhibition has replaced chemotherapy as first-line treatment. Whether patients with poor early response to NAC may benefit from chemotherapy-sparing strategies remains unclear. We conducted a prospective response-adapted study integrating early chemosensitivity assessment with exploratory genomic profiling to guide neoadjuvant treatment selection. Methods: A total of 116 premenopausal patients with stage II-III HR+/HER2− breast cancer received two initial cycles of TAC chemotherapy (docetaxel, doxorubicin, and cyclophosphamide). Radiologic response was assessed after two cycles. Patients achieving partial response (PR) continued TAC. Patients with stable disease (SD) were randomized to either continue TAC (NAC) or switch to 16 weeks of ET consisting of dalpiciclib (CDK4/6 inhibitor), exemestane, and goserelin (NET). Whole-exome sequencing was performed in an exploratory subset. The primary endpoint was objective response rate (ORR). Results: After two cycles of TAC, 30 patients achieved PR, while 86 exhibited SD and were subsequently randomized. Among evaluable patients, the ORR was 68.3% in the NET group (41 evaluable patients) compared with 48.7% in the continued NAC group (39 evaluable patients), indicating a higher response rate with NET in tumors demonstrating poor early chemosensitivity. Exploratory genomic analyses further showed that NET-sensitive tumors were predominantly TP53 wild-type and lacked PIK3CA or AKT alterations, consistent with a highly endocrine-dependent biology. In contrast, nonresponders to NET frequently harbored TP53 mutations, often in combination with PIK3CA/AKT pathway alterations, whereas patients who responded to continued chemotherapy commonly exhibited TP53 or TTN mutations, suggesting a chemotherapy-responsive but endocrine-refractory phenotype. Conclusions: Taken together, our findings indicate that in premenopausal patients with stage II-III HR+/HER2− breast cancer who demonstrate suboptimal early response to intensive neoadjuvant chemotherapy, continued cytotoxic treatment may not be optimal for all patients. A response-adapted strategy integrating early functional assessment with genomic features, particularly TP53 and PI3K/AKT pathway status, distinguishes endocrine-sensitive from chemotherapy-sensitive disease. These results provide a biologically informed framework for neoadjuvant treatment selection and support biomarker-enriched randomized trials evaluating chemotherapy-sparing strategies in selected patients. Clinical trial information: NCT06009627 .

BACKGROUND:To assess the efficacy and safety of tucidinostat plus exemestane as a neoadjuvant strategy in early-stage breast cancer. METHODS:This prospective, open-label, single-arm phase II trial enrolled patients with stage II-III breast cancer with hormone receptor-positive and human epidermal growth factor receptor 2 (HER2)-negative. Eligible patients received tucidinostat plus exemestane, and then breast-conserving surgery (BCS) or modified radical mastectomy. RESULTS:Among 20 enrolled patients, 3 of them achieved preoperative endocrine prognostic index (PEPI) score of 0. Additionally, complete cell cycle arrest was observed in 7, radiologic objective response rate in 10, and disease control rate in 20 patients, pathological complete response in 1 patient, and 5 patients performed BCS. Ki67 suppression from baseline to surgery was observed in 17 of patients, with the Ki67 change ratio of -73.5%. Treatment-emergent adverse event included neutropenia, leukopenia, thrombocytopenia, lymphopenia, hypoalbuminemia, aspartate aminotransferase elevation, glutamyl transpeptidase elevation, anemia, and alanine aminotransferase elevation. CONCLUSIONS:Despite the rate of PEPI score 0 was not high, tucidinostat plus exemestane as a neoadjuvant therapy might be well tolerated and showed promising clinical responses in patients with early hormone receptor-positive, HER2-negative breast cancer. To clarify the safety and efficacy of this strategy, further investigation is warranted. CLINICAL TRIAL REGISTRATION:ChiCTR2100046678.

Background: Growing evidence suggests that the KLHL family may be involved in the occurrence and development of cancer. KLHL38, a member of the KLHL protein family, contains BTB/POZ, BACK domains, and five to six Kelch motifs. However, no pan-cancer analyses have been conducted on KLHL38. In this study, we aimed to explore the potential biological functions of KLHL38 that may provide potential tumor-related therapeutic targets. Methods: The potential roles of KLHL38 in different tumor types were explored based on The Cancer Genome Atlas (TCGA), Genotype-tissue expression (GTEx), Tumor Immune Estimation Resource (TIMER), and Gene Set Enrichment Analysis (GSEA) datasets. Several factors related to KLHL38 were analyzed, including expression differences, survival, pathological stage, DNA methylation, tumor mutation burden (TMB), tumor microenvironment (TME), stemness score, and immune cell infiltration. Results: There were significant differences in KLHL38 expression among different cancer types and between cancer tissue and normal tissue, which was closely correlated with survival prognosis. Furthermore, KLHL38 expression was found to be correlated with DNA methylation, tumor mutations, and stemness scores in major cancer types, suggesting its involvement in cancer development. To some extent, KLHL38 expression levels were significantly correlated with immune cell infiltration, immune checkpoint genes, and immune regulatory genes. These results indicated that KLHL38 can be used as a tumor prognostic indicator. Conclusion: In our study, we analyzed the role of KLHL38 role in tumor development and immunotherapy, which may provide a potential new target for tumor treatment.

Abstract Background: Breast cancer (BC) has become the most common type of cancer and the second most common cause of cancer-related death. In comparison with other subtypes of breast cancer, triple-negative breast cancer (TNBC) is highly aggressive, more likely to metastasize, and has a shorter survival time. MiRNAs play an inhibitory or promoting role in cancer, and are involved in several cell signaling pathways, including growth, proliferation, differentiation, and survival. Vasculogenic mimicry (VM) is associated with invasive disease, tumor spread, metastasis, and poor prognosis. Additional research is needed to determine the mechanisms governing VM formation in TNBC. Methods: We measured RNA and protein expression using quantitative real-time PCR (RT-qPCR) and western blotting. Assays assessing cell proliferation were conducted with CCK-8, cell cycle, and colony formation. Cell migration and invasion were evaluated using transwells, scratch tests, and high-intensity imaging. Luciferase reporter assays were used to confirm miR-651-3p and CAV1 target relationships. Results: In TNBC, miR-651-3p was significantly overexpressed, implicating it as an oncogene. By inhibiting CAV1 transcriptional synthesis, miR-651-3p can enhance the activity of EGFR pathways, leading to promotion of TNBC proliferation, VM formation, and migration. Conclusion: It was determined that miR-651-3p/CAV1/EGFR axis could be a therapeutic target for TNBC in this study.

PurposeWith an increasing demand for postoperative cosmetic effects in breast diseases, the single port by trans-axillary incision and air-inflation system, which provided better space and spared the assistant the effort of retraction, is widely used in clinic surgical treatment for multiple breast diseases.MethodsAccording to inclusion and exclusion criteria, patients who underwent trans-axillary single-incision surgery at Tianjin Medical University Cancer Hospital between December 2020 and July 2022 were included in the study. We collected and analyzed data on age, fertility history, ultrasound grade, clinical stage, pathological results, oncological prognosis, patient-centered cosmetic outcome, etc.ResultsA total of 115 cases were included, of which 33 patients with benign disease underwent mass resection, 68 patients with malignant tumors underwent mastectomy. 10 patients had a special type of breast lesion. A mastectomy was performed in 4 patients with male mammary gland development. Of the 115 cases, the maximum mass diameter was 3.00 ± 1.644 (0.6–8.5) cm. Blood loss during surgery was 85.77 ± 50.342 (10-200) ml. The surgery took 131.84 ± 59.332 (30-280) minutes to complete. The patient spent a total of 5.05 ± 2.305 (2-18) days in the hospital. And the length of surgical incision in all patients was 3.83 ± 0.884 (3-8) cm. All patients were very satisfied with the appearance of their breasts after dressing. 94.78% of patients were satisfied with the position of the incision.ConclusionThrough this study, we believe that in benign breast diseases and malignant breast tumors, trans-axillary single port insufflation technique-assisted endoscopic surgery has oncological safety and an aesthetic effect for most people with breast diseases.

ObjectiveTo investigate the effect of endoscopic breast reconstruction surgery under CO2 gas chamber on the perioperative blood gas parameters of patients with benign and malignant breast tumors and to ensure its safety. MethodsA total of 35 patients with benign and malignant breast tumors who underwent breast endoscopic surgery at Tianjin Medical University Cancer Institute & Hospital between March 2022 and September 2022 were selected. Blood was collected from the patients’ radial artery preoperatively (before CO2 aeration), during surgery (60 min after CO2 aeration), and postoperatively (30 min after anesthesia recovery). The changes in blood gas indices, including pH, arterial partial pressure of carbon dioxide (pCO2), residual alkali (±BE), and bicarbonate ion (HCO3-) and the correlations among them were analyzed statistically. ResultsThe intraoperative levels of pCO2 increased compared to the preoperative levels, while the postoperative levels of pCO2 reduced to the preoperative levels. Results from the t-test showed that the measurements of intraoperative pCO2 and HCO3− significantly increased compared with those postoperatively (t =−7.196, t =−4.709, all P<0.05). The pH value significantly decreased (t=7.069, P<0.05), and the positive BE value increased (t=−1.924, P>0.05). No significant changes in the preoperative measurements of pCO2, pH, and HCO3− relative to those postoperatively were observed (t=0.141, t=1.170, t=1.622, all P>0.05), while the negative BE value increased (t=1.830, P>0.05). Results from the Pearson correlation showed that the changes in pCO2 during surgery were correlated with the changes in pH and HCO3− (r=0.423, r=0.769, all P<0.05), while BE was correlated with HCO3− (r=0.678, P<0.05). ConclusionsEndoscopic breast reconstruction surgery under CO2 gas chamber impacted the patients’ perioperative blood gas analysis indices; however, the measurements returned to preoperative levels after recovery from anesthesia. Our findings suggest that endoscopic breast surgery under CO2 gas chamber reconstruction is safe and reliable, and thus, should be promoted.

Luminal A型乳腺癌是恶性程度相对较低、预后相对良好的分型，其治疗方式和获益程度成为临床医师关注的重点问题。系统性辅助治疗是目前应用广泛的癌症治疗手段，能够提高进行根治性手术的机会和改善远期预后。针对Luminal A型乳腺癌，系统性辅助治疗的方案正在逐渐完善，临床应用最多且最有效的是内分泌治疗，其次是细胞毒化疗。本文主要对Luminal A型乳腺癌的内分泌治疗以及细胞毒化疗的研究进展、临床指南和现存问题进行了总结，期望能够为解决辅助治疗中的耐药及过度治疗问题提供一些新的研究思路，在分子生物学水平上寻找到改进治疗方案的方式，为Luminal A型的乳腺癌患者提供低成本、高收益的治疗选择。

目的:探讨采用经腋窝单孔充气法乳腺腔镜手术在乳腺疾病中的可行性、安全性及临床应用价值.方法:回顾性分析2020年12月至2022年3月于天津医科大学肿瘤医院收治经腋窝单孔充气法乳腺腔镜手术的84例乳腺疾病患者的临床资料,包括患者基线临床特征、术中及术后恢复情况、术后满意度评分及随访情况.结果:84例患者均顺利完成手术,无中途转为开放手术病例.术后满意度评分为(8.25±1.21)分,手术效果佳.术后无切口感染、切缘坏死等重大并发症发生.随访8～23个月,未发现肿瘤局部复发及转移.结论:经腋窝单孔充气法乳腺腔镜手术安全高效、并发症少、患者满意度高,临床应用上具有推广前景.

乳腺癌是目前全球女性发病率最高的恶性肿瘤，全球每年新发1 800万乳腺癌患者，早期乳腺癌患者多经手术治疗，而术后乳房缺失会严重影响患者的生活质量，因此乳房重建尤为重要，乳房重建手术大致可分为两类，假体植入及自体组织移植乳房重建，这两种手术根据手术时机不同均可以分为Ⅰ期及Ⅱ期重建。脱细胞真皮基质(acellular dermal matrix, ADM)目前已广泛应用于乳房再造，它不仅可扩展乳房皮肤组织，纠正假体皱褶和移位，还可以减少自体组织的应用，减少传统重建手术相关并发症。本文将主要阐述ADM与各期假体植入乳房重建及放化疗的关系。

To investigate the clinical and prognostic significance of circulated tumor cells (CTC) marked by cytokeratin 19 coding gene KRT19 mRNA and carcinoembryonic antigen coding gene CEACAM5 mRNA in preoperative peripheral blood of breast cancer patients and provide molecular markers for breast cancer metastasis risk.

Objective: To investigate the effect of axillary lymph node status in evaluating the prognosis of patients with local recurrence after breast-conserving surgery. Methods: The clinical data of 72 patients with local-regional recurrence who had undergone breast-conserving therapy in Tianjin Cancer Hospital from February 2001 to December 2009 were collected and retrospectively analyzed. These patients were divided into axillary lymph node positive group (23 cases) and negative group (49 cases), according to their axillary lymph node status. Results: Among 72 patients, 21 cases were local recurrence, 35 cases were regional recurrence, and 16 cases were local-regional recurrence. In the axillary lymph node positive group, 7 cases were local recurrence, 10 cases were regional recurrence, 6 cases were local-regional recurrence. In the axillary lymph node negative group, 14 cases were local recurrence, 25 cases were regional recurrence, 10 cases were local-regional recurrence. There was no significant difference between these two groups (P=0.807). Moreover, no significant differences of the age, recurrent site, estrogen receptor (ER) and/or progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER-2) status, disease-free period, local and systemic therapeutic effect, non-distant metastasis survival between these two groups were observed (P>0.05). However, the overall survival of axillary lymph node positive group after recurrence was significantly lower than that of negative group (P=0.014). Cox multivariate analysis showed that recurrent site is an independent prognostic factor of disease-free survival of patients with regional recurrence after breast-conserving surgery (OR=2.050, P=0.002). The axillary lymph node status and recurrent site were independent prognostic factors of overall survival of these patients (OR=3.469, P=0.003; OR=3.676, P<0.001). Conclusions: Axillary lymph node status is an independent factor of overall survival of patients with regional recurrence after breast-conserving surgery, but it is marginally related with their non-distant metastasis survival.

Objective: To explore the oncological safety of immediate breast reconstruction after nipple-areola complex(NAC) sparing mastectomy(NSM+ IBR) in patients with early stage breast cancer, and to analyze the prognostic factors of NSM+ IBR. Methods: From January 2004 to December 2015, the clinical data of 118 cases of stage Ⅰ-ⅡA breast cancer who had undergone NSM+ IBR in Tianjin Tumor Hospital were collected, comparing with 75 cases of Ⅰ-ⅡA breast cancer patients who had undergone immediate breast reconstruction after modified radical mastectomy (MRM+ IBR) at the same period. In addition to the prognosis of these two groups, the prognostic factors were also retrospectively analyzed. Results: The median follow-up were 53 months in the NSM+ IBR group and 51 months in the MRM+ IBR group, respectively. In the NSM+ IBR group, local recurrence, distant metastasis, death and NAC necrosis occurred in 4, 6, 9 and 4 cases during 3 years after operation, respectively. The local recurrence rate (LRR) was 3.4%, 3-year disease-free survival (DFS) rate was 91.5%, and the overall survival (OS) rate was 92.4%. In the MRM+ IBR group, local recurrence, distant metastasis, and death occurred in 1, 4, and 3 cases during 3 years after operation, respectively. The LRR was 1.3%, 3-year DFS was 93.3%, whereas the OS rate was 96.0%. No statistical difference was noted between the two groups (all P>0.05). That HER-2 positive and molecular type correlated with the 3-year DFS (P<0.05) independently and molecular type correlated with OS (P<0.05) independently in the NSM+ IBR group. Conclusions: NSM does not impair patients' prognosis and could ensure oncological safety of patients with early stage breast cancer. IBR could improve female patients' figure and ensure the quality of life. HER-2 status and molecular type are the independent prognostic factors of the 3-year DFS. Molecular type is the independent prognosis factor of OS.

OBJECTIVE The treatment of LABC patients who didn''t get pCR from NCT is a tough clinical problem in the world and hampering to improve the overall prognosis of breast cancer patients.The aim of this study was to evaluate the impact of different radical surgery on these patients with stage Ⅲ disease.METHODS During January 1,2011 to December 31,2013,the clinical data of 186 patients suffering from LABC with stage Ⅲ disease were collected from Tianjin Medical University Cancer Institute and Hospital,of whom 120 patients received modified radical mastectomy (MRM) and 66 patients received Halsted radical mastectomy (HRM),and data of all the patients'' type of surgery were analyzed.The relationship between these data and 3-year loco-regional recurrence-free survival(LRRFS),3-year distant metastasis-free survival (DMFS) were studied.RESULTS At Kaplan-Meier analysis,the 3-year LRRFS in MRM group and HRM group was 86.8% and 93.8%,χ2=2.296,P=0.130;and 3-year DMFS was 80.0% and 87.9%,χ2=0.774,P=0.379.However,for patients with stage ⅢB/ⅢC disease,the 3-year LRRFS in MRM group and HRM group was 80.5% and 95.2%,χ2=4.792,P=0.029;and 3-year DMFS was 76.2% and 85.7%,χ2=0.298,P=0.585.The same result can be seen in patients with N3 disease but not T>5 cm disease.Single factor analysis showed that menopausal status (χ2=4.317,P=0.038),tumor size(χ2=4.200,P=0.040),lymph node stage(χ2=4.635,P=0.031)were also interrelated to 3-year LRRFS of LABC patients with stage ⅢB/ⅢC disease.Cox analysis showed that type of surgery(HR=0.211,P=0.047),lymph node stage(HR=4.725,P=0.020)were independent prognostic factors of LRR risk for LABC patients with stage ⅢB/ⅢC disease.CONCLUSION Receiving HRM can enhance the stage ⅢB/ⅢC patients'' 3-year LRRFS,reduce the patients'' relapse rate and improve prognosis.

Objective To observe the growth of primary breast cancer cells cultured in Matrigel three-dimensional cell culture method and its sensitivity to adriamycin.Methods The primary breast cancer cells were cultured by two-dimensional monolayer culture and Matrigel three-dimensional cell culture methods.On the 1st, 3rd, 5th and 7th day of culture, Olympus IX70 inverted microscope was used to observe the morphology of primary breast cancer cells under the condition of two-dimensional monolayer culture and three-dimensional culture.CellTiter-Glo(R) Luminescent Cell Viability Assay was applied to observe the cell proliferation and its sensitivity to adriamycin.Primary breast cancer cell growth curve and drug sensitivity curve were drawn based on the observation results.Results The primary breast cancer cells with two-dimensional monolayer culture were in adherent growth, and the cancer cells gathered like a nest, with a variety of forms.The primary breast cancer cells with three-dimensional cell culture gathered into close multi-tumor cell microspheres.The proliferation of primary breast cancer cells cultured by two-dimensional monolayer culture on the 1st, 3rd, 5th and 7th day was 1.00±0.00, 1.39±0.29, 2.08±0.25 and 3.26±0.41.The proliferation of primary breast cancer cells cultured by Matrigel three-dimensional cell culture was 1.00±0.00, 1.25±0.08, 1.79±0.10 and 1.58±0.02.With the increase of adriamycin concentration, the inhibition rate of proliferation of primary breast cancer cells increased under two-dimensional monolayer culture and three-dimensional culture.But the proliferation inhibition rate of primary breast cancer cells with three-dimensional cell culture was lower than that with two-dimensional cell culture.Conclusion The primary breast cancer cells with Matrigel three-dimensional cell culture can gather into close spheres, the cell proliferation rate slows down, and the sensitivity of adriamycin decreases.Matrigel three-dimensional cell culture is better for culturing primary breast cancer cells.

The impact of calcification in patients with breast carcinoma treated with breast-conserving surgery (BCS) is unclear. The present study aimed to determine the outcome of breast cancer patients with calcification treated with BCS. The records of 409 patients with breast carcinoma treated with BCS from January 2005 to December 2008 were reviewed. Patients were categorized as those with calcification (on mammography or ultrasonography), or those without calcification (neither on mammography nor ultrasonography). The local relapse free survival time (LRFS), disease free survival time (DFS) and overall survival time (OS) were compared, and subgroup analysis was performed based on morphological types and distribution patterns of mammographic calcification. Survival analysis demonstrated that patients with calcification had a significantly increased risk of local recurrence, distant metastasis and mortality compared with those without calcification [relative risk (RR) and 95% confidence interval (CI): local recurrence, 2.46 and 1.11-5.44; distant metastasis, 2.24 and 1.19-4.24; mortality, 2.50 and 1.06-5.86]. Subgroup analysis revealed that the distribution patterns (rather than morphological types of calcification) accounted for the increased risk of recurrence following BCS. Patients with mammographic calcification of liner/segmental distribution had significantly decreased LRFS (RR=6.20; 95% CI, 2.26-16.98), DFS (RR=6.81; 95% CI, 2.86-16.20) and OS (RR=9.14; 95% CI, 2.53-33.00), while patients with mammographic calcification of clustered distribution did not have significantly decreased LRFS, DFS and OS (P>0.05), compared with those without calcification. In addition, the mammographic calcification spreading along the ducts was more likely to be accompanied by an extensive intraductal component (P<0.001). Finally, the outcome of patients with calcification on breast ultrasound was as good as those without calcification. Patients with mammographic calcification, particularly those with calcification spreading along the ducts, have a higher risk of recurrence following BCS, which has a negative impact on long-term survival. Calcification identified on breast ultrasonography does not affect the survival of patients treated with BCS.

Abstract Purpose: To evaluate the effect of neck dissection in breast cancer patients who present with ipsilateral supraclavicular lymphnode metastasis (ISLM) without distant metastasis and to reveal the outcomes of neck dissection in different molecular subtypes. Methods: A total of 90 patients with synchronous ISLM and 36 patients with metachronous ISLM without distant metastasis between 2000 and 2009 were retrospectively analyzed. Combined-modality treatments were performed, and patients were respectively divided into two parts according to whether they received neck dissection or not. Results: In the synchronous ISLM group, there was no significant difference between the neck dissection and non-dissection group with respect to age, menstrual status, tumour size, and histological type, PR and HER2 status. Patients with negative ER status and a higher number of positive axillary nodes were more common in the neck dissection group. The five-year locoregional relapse free survival (LRFS) was 63.6% in the neck dissection group VS. 48.9% in the non-dissection group, respectively (P=0.359). The 5-year distant metastasis free survival (DMFS) was 37.3% in the neck dissection group VS. 38.5% in the non-dissection group, respectively (P=0.882). Further analyses were performed by the site of metastases. Results showed that the incidence of bone metastasis was lower in neck dissection patients (14.7% vs. 28.6%, P=0.132). Due to the limited amount of patients, subgroup analysis was just performed in the subtypes with negative ER status, negative PR status and negative HER2 status, respectively. The five-year LRFS of patients receiving neck dissection in the subtypes with negative ER status, negative PR status and negative HER2 status was 63.7%, 59.8%and 61.2%, which was much better than their matched non-dissection group, respectively. However, the difference was not statistically significant. The 5-year overall survival (OS) was similar between the neck dissection and non-dissection group in the subtypes of negative ER status and negative PR status, respectively. However, the 5-year OS of HER2 negative subtype significantly decreased in the neck dissection group (37.2% vs. 65.4%, P=0.032). Besides, it's worth mentioning that in the HER2 positive subtype, the mean time to relapse, metastasis and death was shorter in the neck dissection subgroup compared with the non-dissection subgroup. In the metachronous ISLM group, a trend of better regional control, with similar PFS and OS, was achieved in the neck dissection group. Discussion: Neck dissection is an effective approach to improve the regional control for the patients with ISLM, especially for the subtypes with negative ER status, negative PR status and probably positive HER2 status in the synchronous ISLM. But, it might not be comfortable for the patients with negative HER2 status, because of the unfavorable effect on its overall survival. In addition, neck dissection, with better regional control, might be helpful for the control of bone metastasis, which is beneficial for long term survival. Citation Format: Xiao C, Qi X, Chen A, Zhang W, Zhang P, Cao X. The role of neck dissection in breast cancer patients with synchronous and metachronous ipsilateral supraclavicular lymph node metastasis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-15.

目的：探究老年乳腺叶状肿瘤患者的生存状况。方法回顾性分析96例乳腺叶状肿瘤老年患者的临床资料，采用单因素分析和多因素COX回归分析乳腺叶状肿瘤老年患者无病生存的危险因素。结果96例患者的无病生存时间为（39．27±11．34）个月，1年、3年和5年无病生存率分别为95．60％、85．56％和66．67％。多因素COX回归分析结果病理类型为恶性、初治手术方式为局部切除、有同侧或对侧纤维腺瘤病史均为乳腺叶状肿瘤老年患者无病生存的危险因素（ P＜0．05）。结论临床上应加强对病理类型为恶性、初治手术方式为局部切除、有同侧或对侧纤维腺瘤病史乳腺叶状肿瘤老年患者的监测，提高其术后生存率。

Objective: In this study, we evaluated the effect of supraclavicular lymph node dissection in breast cancer patients who presented with ipsilateral supraclavicular lymph node metastasis (ISLM) without distant metastasis. Methods: A total of 90 patients with synchronous ISLM without distant metastasis between 2000 and 2009 were retrospectively analyzed. Patients were retrospectively divided into two groups, namely supraclavicular lymph node dissection group(34 patients) and non-dissection group(56 patients), according to whether they underwentsupraclavicular lymph node dissection or not.The Kaplan-Meier method was applied to analyze the locoregional relapse free survival (LRFS) and overall survival(OS). Results: Median follow-upwas 85 months(range, 6 to 11 months). Local recurrence in 32 cases, 47 cases of distant metastasis, of which 25 patients were accompanied by both locoregional relapse and distant metastasis. Of the 32 patients with locoregional relapse, 11 patients were in the lymph node dissection group and 21 patients in the control group. Of the 47 patients with distant metastases, 17 were treated with lymph node dissection, 30 in the control group. Thirty-two patients died in the whole group and 16 patients underwentlymph node dissection and 16 patients didn't. There was no significant difference between the rate of 5-year LRFS and 5-year OS (P=0.359, P=0.246). For patients of ER negative, the 5-year loco-regional relapse free survival rates were 63.7% and 43.3% in supraclavicular lymph node dissection group and control group, respectively. The 5-year overall survival rates were 52.1% and 52.3%, respectively, and there were no statistically significant differences (P=0.118, P=0.951). For patients of PR negative, the 5-yearloco-regional relapse free rates were 59.8% and 46.2%, respectively, and the 5-year overall survival rates were 50.6% and 43.2%, respectively, and there was no significant difference between the two groups (P=0.317, P=0.973). The 5-year recurrence-free survival rates of human epidermal growth factor receptor 2 (HER2)-positive patients were 61.2% and 48.0%(P=0.634), respectively, and the 5-year overall survival rates were 37.2% and 65.4%(P=0.032). Forty-seven patients suffered distant metastases and the 5-year metastases free survival rates were 37.3% and 38.5% in supraclavicular lymph node dissection group and control group, respectively. Conclusion: Supraclavicular lymph node dissection maybe an effective approach to improve the loco-regional control for the patients with ISLM, especially for ER negative and PR negative subtypes, but it might has adverseeffects for the patients with negative HER2 status.

Objective To assess the impact of radiation on superior epigastric vessel pedicled transverse rectus abdominal myocutaneous (TRAM) for breast reconstruction.Methods Female breast cancer patients were divided into 4 groups:group A (immediate breast reconstruction + radiation therapy,123 cases),group B (immediate breast reconstruction,262 cases),group C (radiation therapy + delayed breast reconstruction,34 cases),group D (delayed breast reconstruction,53 cases) from June 2009 to June 2012 at Department of Breast Oncology,Tianjin Medical University.Patient demographics,operative details,radiation therapy details,postoperative complications,patient-centered evaluation of aesthetic and psychological outcomes were assessed.Results The average follow-up duration was 24.98 ± 6.99 months.2.5％ patients developed delayed wound healing postoperatively.Fat necrosis and flap contracture were seen in 7.0％ and 3.6％ of all patients,respectively.Irradiated patients had a significant statistical difference in cancer staging,involved lymph nodes,tissue invasion and neoadjuvant chemotherapy (P ＜ 0.05).No significant statistical differences were observed in post-operative early complications,but in advanced stage complications.There was no significantly statistical difference in breast aesthetic outcome before and after radiation therapy within four groups.Conclusions For breast reconstruction patients,those without postoperative radiotherapy were suggested immediate breast reconstruction,and those with postoperative radiotherapy were proposed to accomplish breast reconstruction after postoperative radiotherapy.