Background The association of radiotherapy with breast cancer survival in patients who underwent a mastectomy and had micrometastases in the sentinel lymph node is unclear. Material/Methods The survival benefit of radiotherapy was examined in patients with T0/1-T2N1mi breast cancer undergoing mastectomy plus sentinel lymph node biopsy (SLNB). Kaplan-Meier curves were employed for survival analysis and competing risk analysis, and a propensity score matching (PSM) cohort was enrolled to investigate whether such patients benefit from radiotherapy. Results We identified 2864 patients in the SEER database from 2004 to 2015. All eligible patients were divided into the radiotherapy and the no-radiotherapy cohorts. With the median follow-up of 53 months, 5-year breast cancer-specific survival (BCSS) was 94.4% vs 95.2% (P=0.135), and 5-year overall survival (OS) was 91.2% vs 90.1% (P=0.466) in the radiotherapy cohorts and no-radiotherapy cohorts, respectively. The results of the competing risk analysis showed a comparable 5-year cumulative incidence of breast cancer-specific death (BCSD) in the radiotherapy and no-radiotherapy groups (5.5% vs 4.7%, P=0.107) but a higher 5-year cumulative incidence of other causes of death (OCD) in the no-radiotherapy cohort (3.3% vs 5.3%, P=0.011). No significant difference was observed for BCSS or OS in the PSM cohort. Conclusions Radiotherapy has no benefit for patients with T0/1-T2 breast cancer undergoing mastectomy with N1mi disease on SLNB. This analysis provides evidence that radiotherapy may safely be omitted in this group of patients.

乳腺癌在我国发病率为7％～10％,呈上升趋势,尤其是在东部沿海和经济发达地区,位于恶性肿瘤发生率第2位,成为仅次于子宫癌威胁女性生命安全的疾病[1-2].研究表明,我国乳腺癌患者发病呈年轻化趋势,每年发病率超出世界平均水平1.0％～2.0％,已成为一个重要的公共卫生问题[3-4].乳腺癌的发生、发展涉及多阶段、多因素,如与乳腺增生、心理状态、遗传因素、孕产次数、饮食和生活习惯、年龄、烟酒史等有密不可分的关系[5-6].中医将该病归为"乳岩"等疾病范畴,多归于外为六淫内侵,内因禀赋不足,后天失养,肝脾气郁,冲任失调,脏腑虚弱,以致气滞血瘀、痰凝、邪毒结于乳络而成.未病先防、已病防传、既病防变、瘥后防复的中医"治未病"思想在乳腺癌的防治过程中起到了独特优势.本研究基于中医"治未病"思想,选取457例乳腺癌住院患者为研究对象,从电子病例系统中调取患者一般资料、病理类型、中医证型等信息,回顾性分析乳腺癌患者中医证型与病理类型之间的相关性,为今后中医辨治乳腺癌提供可借鉴的经验.

Purpose: Chemotherapy is the clinically recommended treatment for patients with operable metaplastic breast carcinoma (MBC); however, its impact remains controversial. This study investigated the possible role of chemotherapy in the treatment of MBC. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify the operable MBC patients. The competing risk analysis along with the propensity score matching (PSM) method was performed to evaluate the effect of chemotherapy. Moreover, a competing risk nomogram was built to identify prognosis in patients with MBC. Results: Of the 1137 patients with MBC, 775 received chemotherapy and 362 did not receive chemotherapy. The 5-year cumulative incidence of breast cancer-specific death (BCSD) showed similar outcomes in both the Chemo and No-Chemo groups (21.1 vs. 24.3%, p = 0.57). Chemotherapy showed no apparent association with BCSD (HR, 1.07; 95% CI, 0.72–1.60; p = 0.72), even after subgroup analysis or PSM. Race, tumor size, lymph node status, and radiation were identified as the significant factors for MBC after a penalized variable selection process. In addition, a competing risk nomogram showed relatively good accuracy of prediction with a C-index of 0.766 (95% CI, 0.700–0.824). Conclusion: Our findings demonstrated that chemotherapy did not improve BCSD for operable MBC patients. Thus, it may indicate the need to reduce exposure to the current chemotherapy strategies for patients with resectable MBC. Additionally, some novel treatment strategies are required urgently to identify and target the potential biomarkers.

目的 分析乳腺导管内癌(DCIS)患者发生微浸润(DCISM)的危险因素.方法 回顾性分析2008年1月至2016年12月221例DCIS和DCISM患者的临床资料.采用Logistic回归筛选出可能预测DCISM的临床、影像学和组织病理学的危险因素,根据独立危险因素建立预测导管内癌发生微浸润的列线图模型.结果 多因素Logistic回归分析显示,DCIS病灶(肿瘤直径≥2 cm)、可触及肿块、乳房钼靶X线提示钙化和/或肿块、高级别核分级与DCISM显著相关.利用这些因素绘制列线图显示良好的预测性能(受试者工作特征曲线下面积0.811,95％CI 0.752～0.870).在校准图形中标准曲线与预测校准曲线拟合良好,表明模型一致性较好.结论 基于四个危险因素的列线图能准确预测导管内癌微浸润,该模型对导管内癌患者临床治疗选择有指导意义.

目的 探讨乳腺囊内乳头状癌(IPC)的临床生物学特性及预后.方法 选取2007年至2017年经手术病理确诊的15例IPC患者(IPC组),随机按1:3比例选择同期浸润性导管癌45例患者(IDC组),比较两组患者的临床病理指标,包括年龄、性别、肿瘤大小、超声表现、钼靶表现、淋巴结转移状况、分子分型、无复发生存等.结果 IPC组与IDC组在发病年龄、性别、超声表现、腋窝淋巴结转移均差异有统计学意义(P<0.05),在肿瘤大小、钼靶表现、分子分型等方面差异无统计学意义(P>0.05).所有患者中位随访63个月(20～96个月),IPC组和IDC组无复发生存率(RFS)分别为93.3％和82.2％,差异无统计学意义(P>0.05).结论 与IDC相比,IPC好发于老年患者,特别是绝经后女性,男性发病较IDC占比更高,超声表现为囊实混合的界清肿块更多见,淋巴结转移更少见;IPC总预后好,对于IPC合并浸润性癌,建议行前哨淋巴结活检评估腋窝.

Rationale: Primary breast angiosarcoma (PBA) is a rare and overly aggressive entity and account for less than 1% of all breast cancer cases. PBA had a high rate of delayed preoperative diagnosis due to absent distinctive radiographic characteristics. Patient concerns: We report a case of a 47-year-old female patient who had a previous history of luminal cancer in the right breast with mastectomy; the patient complained of asymmetrically diffuse enlarged, accompanying with a painless mass in the left breast 12 years after the mastectomy of her right breast. Diagnoses: The tumor mimicked idiopathic granulomatous mastitis on magnetic resonance imaging (MRI) at the first presentation. Contrast-enhanced ultrasound (CEUS) was performed for further lesion characterization and showed heterogeneous rapid hyper enhanced. An ultrasound-guided core needle biopsy was performed, and the pathology report indicated a breast angiosarcoma. Interventions: The patient underwent a nipple-sparing simple mastectomy with immediate reconstruction of the left breast. Outcomes: After 8 months later, the tumor recurred, CEUS and MRI examination suggested PBA recurrence, then re-excision with implant removal was performed, the patient had a lung metastasis 4 months later eventually died 22 months after diagnosis. Lessons: It is not easy to diagnose PBA with the radiographic examination. This case's importance is by combining CEUS and MRI to reflect enhanced morphology and hemodynamic characteristics of PBA and help diagnose breast angiosarcomas.

Rationale: Intracystic papillary breast carcinoma is extremely rare in males with a favorable prognosis. Clinical and mammographic manifestations of IPC are not specific, and no consensus has been reached on its management. Patient concerns: Three cases of IPC of the breast in male patients who underwent surgery are presented. In each patient, clinical manifestations, radiological appearance, surgical procedures, pathological diagnosis, and prognosis were investigated. Diagnosis: Ultrasonography showed a complex mass with cystic and nodular solid components in 2 patients and a solid hypoechoic mass in the other 1. Contrast-enhanced ultrasonography(CEUS) was performed for 1 patient demonstrated a solid component of the characteristic enhancement patterns. The final diagnosis of IPC was made after an excisional biopsy. Interventions: A mastectomy with sentinel lymph node mapping was carried out in 2 patients, and it was negative for metastatic disease. The third patient received a mastectomy without an investigation of the axillary lymph node status. Outcomes: All the patients are disease-free during a median follow-up of 67 months (range, 13-120) months. Lessons: It is difficult to diagnose IPC of the male breast before surgery, excisional biopsy is necessary. CEUS can be useful to diagnose IPC in male patients in the preoperative evaluation. Sentinel node biopsy may be considered in patients with IPC associated with DCIS or invasive carcinoma.

The objective of the present study was to implement Kaplan-Meier analysis, competing risk analysis, and propensity score matching to evaluate whether the patients with T1bN0M0 triple-negative breast (TNBC) could benefit from adjuvant chemotherapy. A total of 1849 patients were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. All eligible patients were divided into two cohorts, the chemotherapy (1155 patients) and the no-chemotherapy (694 patients) cohorts. Similar 5-year breast cancer-specific survival (BCSS) was observed in the chemotherapy and no-chemotherapy cohorts (96.1% vs. 96.0%, p=0.820). The results of the competing risk analysis showed a comparable 5-year breast cancer-specific death (BCSD) in both groups (chemotherapy 3.6% vs. no-chemotherapy 3.4%, p=0.778). Also, a higher 5-year other causes death (OCD) was observed in the no-chemotherapy cohort (0.7% vs. 5.4%, p<0.001). Multivariable competing risks regression models showed no association between chemotherapy and BCSS (HR, 1.21; 95%CI, 0.64-2.31; p=0.560). After 1:1 PSM, no significant difference was also observed for BCSD and OCD between two cohorts. The value of adjuvant chemotherapy in patients with T1bN0M0 TNBC is less than the present guidelines recommend, suggesting that de-escalated treatment could be a potentially beneficial strategy in appropriately selected patients.

Aim:The purpose of this study was to assess the role of marital status in esophageal adenocarcinoma (EAC).Methods:We identified 8341 EAC patients based on the Surveillance, Epidemiology and End Results database during 2007-2015, of whom 7275 were male and 1066 were female. Temporal trends, competing risk analysis and propensity score matching were performed.Results:There was an upward trend for the rate of unmarried patients in both male and female populations (p < 0.05). Unmarried status represented an independent risk factor for higher cancer-specific death (CSD) in males (hazard ratio: 1.11; 95% CI: 1.04-1.18; p = 0.001) but not in females (hazard ratio: 0.96; 95% CI: 0.81-1.13; p = 0.610). Married EAC patients experienced lower CSD compared with their unmarried counterparts in the male cohort.

Background: The effects of marital status on infiltrating ductal carcinoma of breast cancer (IDC) have not been studied in detail. This study investigated the impact of marital status on IDC patients. Material/Methods: SEER databases were searched from 2010 to 2015 for subjects who were married, divorced, single, and wid- owed. The influence of marital status on breast cancer-specific survival (BCSS) and overall survival (OS) of IDC patients was investigated through multivariate Cox regression analysis and Kaplan-Meier analysis. To prevent bias, propensity score matching (PSM) analysis was performed. Results: The 5-year OS was 89.6%in married patients, 84.9% in divorced patients, 83.5% in single patients, and 71.3% in widowed patients (p<0.001). The 5-year BCSS were 92.9%, 90.2%, 87.6%, and 86.4%, respectively (p<0.001). Multivariate Cox regression analysis revealed that marriage was a protective factor for patients with IDC in terms of OS (divorced: HR, 1.27; 95% CI, 1.21-1.32; p<0.001; single: HR, 1.36; 95% CI, 1.31-1.42; p<0.001; widowed: HR, 1.42; 95% CI, 1.36-1.48; p<0.001) and BCSS (divorced: HR, 1.15; 95% CI, 1.09-1.21; p<0.001; single: HR, 1.27; 95% CI, 1.21-1.33; p<0.001; widowed: HR, 1.32; 95% CI, 1.25-1.40; p<0.001). Following subgroup and PSM analysis, married patients were shown to have better OS and BCSS as opposed to divorced, single, or widowed patients. Conclusions: We identify marital status as a predictor of survival in those with IDC. Widowed patients showed the highest mortality risk.

BACKGROUND:The microRNAs (miRNAs) have been validated as prognostic markers in many cancers. Here, we aimed at developing a miRNA-based signature for predicting the prognosis of esophagus adenocarcinoma (EAC).METHODS:The RNA-sequencing data set of EAC was downloaded from The Cancer Genome Atlas (TCGA). Eighty-four patients with EAC were classified into a training set and a test set randomly. Using univariate Cox regression analysis and the least absolute shrinkage and selection operator (LASSO), we identified prognostic factors and constructed a prognostic miRNA signature. The accuracy of the signature was evaluated by the receiver operating characteristic (ROC) curve.RESULT:In general, in the training set, six miRNAs (hsa-mir-425, hsa-let-7b, hsa-mir-23a, hsa-mir-3074, hsa-mir-424 and hsa-mir-505) displayed good prognostic power as markers of overall survival for EAC patients. Relative to patients in the low-risk group, those assigned to the high-risk group according to their risk scores of the designed miRNA model displayed reduced overall survival. This 6-miRNA model was validated in test and entire set. The area under curve (AUC) for ROC at 3 years was 0.959, 0.840, and 0.868 in training, test, and entire set, respectively. Molecular functional analysis and pathway enrichment analysis indicated that the target messenger RNAs associated with 6-miRNA signature were closely related to several pathways involved in carcinogenesis, especially cell cycle.CONCLUSION:In summary, a novel 6-miRNA expression-based prognostic signature derived from the EAC data of TCGA was constructed and validated for predicting the prognosis of EAC.

Objective To explore the effect of Cucurbitacin E(CuE) or CuE combined with autophagy inhibitor,Chloroquine (CQ) on the proliferation of human breast cancer cells Bcap-37 and its possible mechanism.Methods MTT assay was used to measure the effect of CuE or CuE combined with CQ on Bcap-37 proliferation.The apoptosis was measured by flow cytometry.Western blot was used to detect LC3-Ⅰ / Ⅱ and P62 protein expression.The autolysosome was observed by electronic microscopy.Results CuE significantly inhibited the in vitro growth of human breast cancer cells by inducing the apoptosis.After treated with CuE,the expression of autophagy-related protein LC3-Ⅱ was increased,while LC3-Ⅰ,P62 expression were decreased.In addition,CuE also induced the formation of autolysosomes,indicating the activation of autophagy.Conclusion CuE could induc the apoptosis of human breast cancer cells and cytoprotective autophagy.The inhibition of autophagy could significantly enhance the cytotoxicity of CuE to Bcap-37.

Objective To compare the diagnostic value of automated breast volume scanner (ABVS) and hand-held ultrasound (HHUS) as second-look ultrasound examinations for high-risk breast lesions on MRI.Methods One hundred and sixteen patients with 132 high-risk lesions on breast MRI were enrolled in the study.The patients underwent HHUS and ABVS examinations as second-look ultrasound modalities.Based on pathologic findings,the value of ABVS and HHUS in differential diagnosis of benign and malignant breast lesions was compared;and the detection rates of two modalities for lesions with different characteristics on MRI were analyzed.Results The detection rate of ABVS for high-risk lesions was higher than that of HHUS (76.5％ vs.69.7％,P＜0.05),but there was no significant difference in differential diagnosis of benign and malignant breast lesions.The detection rate of two ultrasound methods was no statistically different for lesions with different size,internal enhancement patterns and TIC curves on MRI (P ＞0.05),but there was significant difference in detection of lesions with different enhancement types on MRI between two methods.The detection rate of non-mass lesions was lower than that of mass-type lesions by both methods.Conclusion ABVS is more effective than HHUS in detection of high-risk lesions as the second-look ultrasound examination.However,both techniques have limitations in detecting non-mass enhancement.

藏红花(Crocus sativus)是一种鸢尾科番红花属的草本植物,广泛分布于地中海沿岸、印度、西藏等,其花朵包含多种化学成分,作为中药具有较高的药用价值[1].藏红花素(Crocin)是藏红花的主要成分,具有保护心肌、抗肿瘤、抗抑郁焦虑、提高性欲等作用[2].

Objective To explore the apply of breast aesthetics to immediate breast reconstruction with implants in the early stage of breast cancer in order to get favorable appearance. Methods The immediately reconstructive breast surgery with implants were carried out with the emphasis on the combination of reconstructive repair and aesthetic analysis.Preoperative design based on the principles of breast aesthetics and In consideration of the safety of the tumor,selected the appropriate prosthesis.The full separation to make the prosthesis could be placed in place,and the details of the operation must be accurate and effective. Immediate assessment of aesthetic effects should be done intraoperative. Results This immediately reconstructive breast surgery was completed in 67 breast cancer patients.Appearance evaluation:excellent in 53 cases,good in 11 cases,general in 2 cases,poor in 1 case. The excellent and good rate was 95.5%. Conclusion The best aesthetic effects can be achieved from the aesthetic point of view and the details of the control during the immediately reconstruction surgery with implants .

Objective To explore the relationship between serum reproductive hormone levels and vasomotor dysfunction manifested as hot flashes after endocrinotherapy in premenopausal patients with Luminal subtype breast cancer. Methods Reproductive hormone levels were measured in 139 premenopausal patients with Luminal subtype breast cancer administrated in our hospital from Mar 2013 to Dec 2014 and the relation between the level of serum reproductive hormones and dysfunction of vasomotoricity manifested as hot flashes before and after endocrinotherapy was also analyzed. Results The serum levels of progesterone (P), luteinizing hormone (LH), testosterone (T), follicle-stimulating hormone (FSH) and prolactin (PRL) were marked higher in 139 premenopausal patients with Luminal subtype breast cancer than those in controlled healthy premenopausal woman (P<0.05) and there was no significant difference between patients and controlled healthy premenopausal woman on the serum levels of estradiol (E2) (P<0.05). The serum levels of P, E2, LH and PRL tested in 139 premenopausal patients with Luminal subtype breast cancer were higher and serum level of T was lower significantly after endocrinotherapy than those in same patients before endocrinotherapy ( P<0.05). There was no significant difference before and after endocrinotherapy on serum FSH (P>0.05). The main clinical symptom of vasomotor dysfunction manifested as hot flashes in 139 premenopausal patients with Luminal subtype breast cancer were hot flashes in afternoon (53.1%) and hot flashes in first half of midnight (34.4%), the occurrence of hot flashes presented in other time was only 12.5%. The percentage of hot flashes after endocrinotherapy was markedly increased (P<0.05= and meanwhile, the ratio of hot flashes presented in afternoon and first half of midnight were significantly lower than that suffered at administration and before endocrinotherapy (P<0.05). The percentage of hot flashes presented in other time before and after endocrinotherapy was significant higher than that at administration (P<0.01). The serum levels of P and T were correlated to hot flashes presented in other time statistical significantly (P=0.006, 0.0001). Conclusion Vasomotor dysfunction manifested as hot flashes after endocrinotherapy in premenopausal patients with Luminal subtype breast cancer may correlate with the dynamic serum hormone levels of ascending progesterone and descending testosterone. The dynamic levels of reproductive hormone can serve as an important index for determining the suitability of dialectic and classification of hot flashes in patients for treatment with traditional Chinese medicine.

医学影像技术及定位技术的飞速发展，一些临床触诊阴性的乳腺癌被发现。文献报道，约20%的乳腺癌为触诊阴性[1]。本文通过这些触诊阴性的乳腺癌病例，从临床角度分析此类乳腺癌的影像特点、与病理的关系以及乳腺X线、超声在诊断中的作用，报道如下。

ObjectiveThe explore the safety and complications of the nipple-sparing mastectomy with immediate Implant breast reconstructive for early breast cancer .Methods Retrospective analysis were carried out on 51 cases of patients with early stage breast cancer undergoing nipple-sparing mastectomy(NSM)and immediate breast reconstruction(IBR)at our hospital from October 2007 to October 2012.Results All patients were followed-up once every 3 months to 6 months before 2 years and 6 months to 1 year follow-up 2 years later,follow-up time was 36-96 months, median follow-up time was 70 months. 2 cases(3.9%)had local recurrence and distant metastases,no recurrence of the nipple areola area. 3 cases (5.9%)occurred wholly or partly nipple necrosis,and 1(2%)had local skin necrosis(3cm×2cm)prosthesis exposure by dressing 3 months later surgical removal of the prosthesis again,12 cases(23.5%)delayed healing incision by dressing 1-2 months wound healing,7 cases(13.7%) peripheral and subcutaneous implants effusion,2 cases(3.9%)was infected and was improved after anti-infection treatment. Encapsulation contracture and implantrupture did not occur,the excellent rate of appearance of the subjective evaluation of breast was 86.3%.Conclusions The nipple-sparing mastectomy with immediate Implant breast reconstructive for early breast cancer is safe,with a rapid recovery,fewer complications,without increasing the risk of local recurrence,and has the advantages of patients’ high satisfaction with the postoperative appearance.

Objective] To analyse the clinical and pathological feature of breast nonpalpable breast lesion located by different methods. [Method] Total 1278 lesions in 1012 patients were collected and divided into 3 groups:mammography group, ultrasound group, nipple discharge group(located by staining), their positive predictive value, clinical and pathological feature were analyzed, the correlation analysis based on multi-parameters was also analyzed by SPSS. [Result] 38, 36, and 23 malignant NPBLs are found in mammography group, ultrasound group, nipple discharge group respectively. Breast carcinoma in situ was detected in the malignant lesions of these groups, mammography group 65.8%(25/38), ultrasound group 38.9%(14/36), nipple discharge group 73.9%(17/23). PPV of mammography group(BI-RADS score≥4) is 24.0%( 37/154); PPV of ultrasound group(BI-RADS score≥4) is 8.2%( 30/368); PPV of nipple discharge group(blood discharge) is 25.0%( 18/72) . In the mammography group, benign NPBL is mostly characteristic of calcification;its pathology is breast adenosis. In ultrasound group, benign NPBL is mostly characteristic of nodule, its pathology is adenoma. In discharge group, pathology of most lesions is intraductal papilloma. Besides the strong positive relationship between the performance of ultrasound/nipple discharge and pathological feature, correlation analysis indicate that BI-RADS score of mammography has a positive relationship associated with the patient age. [Conclusion] Ultrasound is the most sensitive method to detect NPBL, but mammography and nipple blood discharge are more valuable in the diagnosis of malignant NPBL.

目的 探讨二至丸合桂枝汤对绝经前Luminal型乳腺癌治疗后潮热患者生殖激素、改良Kupperman评分和ki67表达的影响.方法 选取2014年1月～2016年6月在杭州市中医院接受他莫西芬治疗出现潮热症状的绝经前Luminal型乳腺癌患者138例,按随机数字表法将其分为研究组和对照组,各69例.对照组采用谷维素治疗,研究组采用二至丸合桂枝汤治疗,治疗时间均8周.观察两组治疗前后生殖激素水平、改良Kupperman评分、潮热症状评分;研究组随机抽取30例患者检测治疗前后乳腺组织ki67表达水平;观察两组治疗期间药物相关性不良反应.结果 研究组治疗后孕酮(P)、促黄体生成素(LH)、泌乳素(PRL)水平均较治疗前显著降低(均P＜0.05),睾酮(T)较治疗前显著升高(P＜0.05),雌二醇(E2)、卵泡刺激素(FSH)与治疗前比较差异均无统计学意义(P＞ 0.05).对照组治疗后E2、P、LH、FSH、T、PRL水平与治疗前比较差异均无统计学意义(均P＞0.05).研究组治疗后潮热症状评分和改良Kupperman评分均较治疗前显著降低(均P＜0.05),对照组治疗后潮热症状评分和改良Kupperman评分与治疗前比较差异均无统计学意义(均P＞0.05).研究组治疗前后乳腺组织ki67表达差异无统计学意义(P＞ 0.05).两组均未见治疗相关不良反应.结论 二至丸合桂枝汤对绝经前Luminal型乳腺癌治疗后潮热具有明显疗效,值得临床推广.