Objective To analyze the efficacy of breast-conserving surgery with adjuvant radiation therapy (BCS+RT) vs. mastectomy (MAST) for early breast cancer among young Chinese patients. Methods Young female breast cancer patients (≤40 years old) treated at West China Hospital of Sichuan University between January 1st, 2008, and December 31st, 2019 were analyzed for clinical staging, molecular subtypes, surgical techniques, and prognostic assessments using follow-up data. Results Of 974 eligible patients in this study, 211 underwent BCS+RT and 763 underwent MAST. The Kaplan-Meier analyses indicated that there was no significant difference in the 5-year locoregional recurrence-free survival rate (99.1% vs. 99.4%, P=0.299), distant metastasis-free survival rate (97.9% vs. 96.4%, P=0.309), breast cancer-specific survival rate (100.0% vs. 97.0%, P=0.209), or overall survival rate (99.4% vs. 96.8%, P=0.342) between patients who underwent BCS+RT and those who underwent MAST. The multiple Cox proportional hazards regression analyses revealed that the treatment approach (BCS+RT or MAST) did not significantly predict locoregional recurrence-free survival (P=0.427), distant metastasis-free survival (P=0.154), breast cancer-specific survival (P=0.155), or overall survival (P=0.263). Subgroup analyses showed that there was no statistically significant difference in survival outcomes between BCS+RT and MAST in different clinical stages or molecular subtypes. Clinical stage and molecular subtype should also not be regarded as independent factors in deciding the treatment approach. Conclusions Receiving BCS+RT or MAST treatment does not affect the survival outcomes of young early-stage breast cancer patients, showing similar efficacy across various clinical stages and molecular subtypes. Choosing BCS+RT is considered safe for early-stage young female breast cancer patients eligible for breast conservation.
ObjectiveTo investigate the anatomy and function of pectoralis fascia in breast cancer operation, and the choice of resection and preservation of pectoralis fascia in different operation methods.MethodWe searched the articles related to pectoralis fascia and breast cancer through PubMed, Web of Science, EBSCO, WanFang Medical Network, SinoMed, and other databases, and then selected the Chinese and foreign articles that met the objective of this paper, and made an review after reading the articles.ResultsIn the immediate breast reconstruction of breast prosthesis after breast cancer operation, the preservation of pectoralis fascia was beneficial to the complete coverage of breast prosthesis and improved the cosmetic effect after operation. The purpose of preserving pectoralis fascia adipose tissue in breast-conserving surgery was to reduce the loss of breast volume and to pursue the cosmetic effect after operation. At present, there had been reports on the safety of pectoralis fascia oncology, but there was no final conclusion on the safe distance between tumor and pectoralis fascia, and the current research could not provide sufficient evidence for the preservation of pectoralis fascia.ConclusionsThe question of whether the pectoralis fascia needs to be removed in breast cancer surgery is still controversial. The preservation of pectoralis fascia is more for better immediate breast reconstruction after operation. However, the current evidence of evidence-based medicine is not sufficient. Clinicians need to conduct multicenter, randomized controlled clinical trials to improve the evidence.
To study the effect of the proliferation and apoptosis of Survivin-T34A mutant on breast cancer MCF-7 cell, we adopted the method of cell culture in vitro to observe the proliferation and apoptosis of the cell. In the experiment, MCF-7 cells were randomly divided into three groups and transfected with normal saline, PORF-9-null and Survivin-T34A, respectively. Breast cancer nude mouse models were established to study anti-tumor effect of Survivin-T34A in vivo. The activity of the cells in the Survivin-T34A-transfected group was lower than that in PORF-9-null group. The increase of cell apoptosis was observed under electron microscopy, meanwhile the apoptotic rate was obviously higher than that in PORF-9-null control by flow cytometry. Tumor inhibition effects of the mouse which received the injection of Survivin-T34A intratumoral injection were apparent, and the inhibition ratio was as high as 47.1%. In conclusion, Survivin-T34A mutant has anti-tumor effect through efficiently inhibiting the growth of breast cancer MCF-7 cell and actively promoting apoptosis of cancer cells.
Objective To compare the efficacy and safety of different cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) combined with endocrine therapy (ET) for the treatment of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) advanced or metastatic breast cancer. Methods Randomized controlled trials (RCTs) on CDK4/6i for the treatment of HR+/HER2− metastatic or advanced breast cancer were retrieved from databases including PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP, and SinoMed, with the search period ranging from database inception to August 2023. Bayesian network meta-analysis was conducted using R 4.2.0 software. Results A total of 18 RCTs from 25 articles, involving 8 031 patients and 11 treatment regimens, were included. There was no significant difference in progression-free survival (PFS) or overall survival (OS) among different CDK4/6i+ET combinations. The highest cumulative probability for PFS was observed with dalpiciclib (DAL)+fulvestrant (FUL), while ribociclib (RIB)+FUL ranked first for OS. In terms of efficacy, abemaciclib (ABE)+aromatase inhibitors (AI) and ABE+FUL ranked first in objective response rate and clinical benefit rate, respectively. Regarding safety, statistically significant difference in grade 3-4 adverse events was observed among certain types of CDK4/6i (P<0.05). Conclusion Current evidence suggests that CDK4/6i+ET is superior to ET alone for the treatment of HR+/HER2− advanced/metastatic breast cancer. Different CDK4/6i+ET combinations demonstrate comparable or similar efficacy; however, the incidence of adverse reactions is higher with combination therapy. Treatment regimens should be selected based on individual conditions.
ObjectiveTo investigate the effects of phenethyl isothiocyanate (PEITC) on apoptosis and proliferation of breast cancer SK-BR-3 cells. MethodsSK-BR-3 cells were treated with different concentrations (0, 10, 30, 50 μmol/L) of PEITC respectively. The proliferation capacity of SK-BR-3 cells was detected by MTT and BrdU staining methods. The cell apoptosis was detected by TUNEL and flow cytometry methods. The protein and mRNA expressions levels of indexes related apoptosis such as Bcl-2, Bax, and MCL-1 and indexes related endoplasmic reticulum stress (ERS) such as PERK, eIF2α, CHOP, IRE1α, ATF6α were detected by Western blot and quantitative real-time PCR (qRT-PCR), respectively. ResultsCompared with the control group (0 μmol/L PEITC treatment group), the results of MTT and BrdU staining methods showed that the proliferations of SK-BR-3 cells in the 10, 30 and 50 μmol/L PEITC treatment group were decreased in turn with the increase of concentration. The results of TUNEL and flow cytometry methods showed that the apoptosis rates of SK-BR-3 cells in the 10, 30 and 50 μmol/L PEITC treatment group were increased in turn with the increase of concentration. The results of Western blot and qRT-PCR methods showed that the protein and mRNA expression levels of anti-apoptotic indexes (Bcl-2, MCL-1) were decreased with the increase of concentration, while the expression levels of protein and mRNA of the pro-apoptotic index (Bax) and ERS-related indexes (PERK, eIF2α, CHOP, IRE1α, ATF6α) increased with the increase of concentration. ConclusionFrom the preliminary results of this study, PEITC can promote the apoptosis of breast cancer SK-BR-3 cells and inhibit cell proliferation, which might be achieved by regulating the expression levels of indexes related apoptosis and ERS.
Objective To review the application progress, mechanism, application points, limitations, and oncological safety of external volume expansion (EVE) assisted autologous fat grafting for breast reconstruction and provide a reference for optimizing the design of EVE. Methods Based on the latest relevant articles, the basic experiments and clinical applications of EVE were summarized. ResultsEVE can reduce interstitial fluid pressure, increase blood supply, and promote adipogenic differentiation, thereby benefiting the survival of transplanted fat. EVE assisted autologous fat grafting in clinical practice can improve the retention rate of breast volume and the outcome of breast reconstruction, meanwhile it doesn’t increase the risk of local recurrence. But there is no standard parameters for application, and there are many complications and limitations. ConclusionEVE improves the survival of transplanted fat, but its complications and poor compliance are obvious, so it is urgent to further investigate customized products for breast reconstruction after breast cancer and establish relevant application guidelines.
ObjectiveTo detect protein expression of androgen receptor (AR) in patients with estrogen receptor (ER)-positive primary breast cancer and investigate its significances on prognosis.MethodsThe clinicopathologic data of female patients with ER-positive primary breast cancer in the Affiliated Hospital of Southwest Medical University from January 2012 to December 2012 were retrospectively analyzed. The AR protein expression in the breast cancer tissue was detected by the immunohistochemistry. The relationship between the AR protein expression and the clinicopathologic characteristics such as the age, tumor diameter, invasive biological behavior, molecular typing or the survival after the operation was analyzed.ResultsThe positive rate of AR protein expression was 58.5% (76/130) in the patients with ER-positive primary breast cancer. The positive rates of AR protein expression in the patients with the low differentiation, clinical stage Ⅲ+Ⅳ, p53 positive, neurovascular invasion, and lymph node metastasis were significantly lower than those in the patients with the moderate and high differentiations, clinical stage Ⅰ +Ⅱ, p53 negative, without neurovascular invasion, and without lymph node metastasis (P<0.050). The positive rate of AR protein expression was not correlated with the age, menstrual status, tumor diameter, progesterone receptor and Her-2 statuses, Ki-67, or molecular typing (P>0.050). The 3-year and 5-year overall survival and tumor-free survival of the AR-positive patients were significantly higher than those of the AR-negative patients (P<0.050). The 5-year cumulative total survival and tumor-free survival of the AR-positive patients were significantly better than those of the AR-negative patients (χ2=8.134, P=0.004; χ2=9.150, P=0.002).ConclusionsPatient with AR protein positive expression in ER-positive breast cancer has a better differentiation, lower clinical stage, and weaker invasiveness. Long-term survival of patient with AR protein positive expression after standardized treatment is also better than that of patient with AR protein negative expression. It might provide an important additional information on prognosis and become a promising object for targeted therapy.
ObjectiveTo detect the expressions of signal peptide-CUB-EGF-like domain containing protein 3 (SCUBE3) and specificity protein 1 (SP1) in breast cancer tissues, and explore relations between their protein expressions and clinicopathologic features or prognosis.MethodsFrom February 2013 to October 2015, the breast cancer tissues and the corresponding adjacent normal breast tissues of 80 women patients with breast cancer in the Mianyang Central Hospital were selected, and the expressions of SCUBE3 and SP1 proteins in the tissues were detected by immunohistochemistry. The relations between the expressions of SCUBE3 and SP1 and clinicopathologic parameters of breast cancer were analyzed, the correlation between the SCUBE3 and SP1 was analyzed by Spearman rank correlation analysis. Kaplan-Meier method was used to analyze the survival of patients with breast cancer; and Cox proportional hazards regression model was used to analyze the risk factors of overall survival of patients with breast cancer.ResultsThe positive rates of SCUBE3 and SP1 proteins expressions in the breast cancer tissues were higher than those in the corresponding adjacent normal breast tissues (P<0.05). The positive rates of SCUBE3 and SP1 protein expressions were higher in the breast cancer tissues with lymph node metastasis and molecular subtypes of Luminal A or B (P<0.05), and the positive rates of SCUBE3 protein expression were higher in the breast cancer tissues with TNM stage Ⅱ–Ⅳ and high Ki67 (P<0.05). The retsult of Spearman rank correlation analysis showed that the positive rates of SCUBE3 and SP1 proteins expressions in the breast cancer tissues was positive correlation (χ2=7.979, rs=0.316, P=0.005). Kaplan-Meier curve showed that the overall survival of the patients with positive expression of SCUBE3 or SP1 protein was worse than that of the patients with negative expression (χ2=4.042, P=0.044; χ2=10.676, P=0.001). The Cox proportional hazards regression model multivariate analysis showed that the positive SCUBE3 (HR=6.020, P=0.016), positive SP1 (HR=4.077, P=0.018), lymph node metastasis (HR=3.518, P=0.017), and higher Ki67 expression (HR=7.989, P<0.001) were the independent risk factors of overall survival for the patients with breast cancer.ConclusionPositive rates of SCUBE3 and SP1 proteins expressions in breast cancer tissues are higher and there is a positive correlation between them, which are closely related to clinicopathologic parameters such as lymph node metastasis and molecular subtypes and prognosis of patients with breast cancer.
ObjectiveTo understand the current research status of conservative mastectomy with breast reconstruction for breast cancer, so as to provide a reference for surgeons and patients with breast cancer to choose surgical method. MethodThe recently domestic and foreign literature on the research of conservative mastectomy with breast reconstruction for breast cancer was reviewed and summarized. ResultsAt present, conservative mastectomy mainly included nipple sparing mastectomy, skin sparing mastectomy, and skin reduction mastectomy. All three surgical methods were safe and effective in the treatment of breast cancer, and the complications could be controlled. When combined with breast reconstruction, the better cosmetic effect could be obtained, and the postoperative satisfaction and quality of life of patients were markedly improved. ConclusionsAfter comprehensively preoperative evaluation for patients with breast cancer, conservative mastectomy provides a treatment choice for them. After conservative mastectomy, individualized reconstruction scheme is formulated according to size and sagging degree of breast, as well as individual expectations of patients, which can obtain a higher quality of life while treating diseases for patients with breast cancer.
ObjectiveBy comparing the epidemiological characteristics of the incidence and death of female breast cancer in China and the United States, the differences in prevention and screening strategies between China and the United States were analyzed to explore the prevention and control measures of female breast cancer in China. MethodsBased on the relevant data released by the Global Burden of Disease in 2020, the National Cancer Center of China, and the China Health Statistical Yearbook, the new cases and deaths of breast cancer in Chinese and American women in 2023 were estimated respectively, and the incidence, mortality and time trend of breast cancer in Chinese and American women were analyzed. ResultsIn China, 376 789 new cases of female breast cancer and 116 791 deaths were expected in 2023. In the United States, approximately 297 790 women were expected to be newly diagnosed with breast cancer in 2023, representing approximately 15.2% of new cancer cases. About 43 170 women died from breast cancer, accounting for about 7.1% of all cancer deaths. The incidence of breast cancer in women in the United States during the period 1975–2020 gradually increased and then stabilized; In contrast, the incidence of breast cancer among Chinese women increased year by year during the period 1990–2020. In recent years, the incidence and mortality rates of breast cancer in Chinese women had increased more than those in the United States, and there was a large difference between urban and rural areas in China. ConclusionsBoth China and the United States face a large burden of female breast cancer, and the characteristics of female breast cancer in China are similar to those in the United States. To reduce the burden of breast cancer in Chinese women, further efforts should be made in various aspects, such as strengthening breast cancer education, raising public health awareness, improving diet structure, cultivating healthy lifestyle, increasing screening efforts, and improving medical level.