ObjectiveTo analyze the factors influencing axillary pathological complete response (pCR) after neoadjuvant therapy (NAT) and to provide the possibility of exempting axillary surgery for patients with better pathological efficacy of primary breast lesions after NAT. MethodsAccording to the inclusion and exclusion criteria, the patients with breast cancer admitted to the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from January 1, 2020 to June 30, 2022 were retrospectively analyzed. All patients were diagnosed with ipsilateral axillary lymph node metastasis of breast cancer and the NAT cycle was completed according to standards. All patients underwent axillary lymph node dissection (ALND) after NAT. The therapeutic effect of primary breast lesions was evaluated by Miller-Payne (MP) grading system. The axillary pCR was judged according to whether there was residual positive axillary lymph nodes after ALND. The unvariate and multivariate logistic regressions were used to analyze the risk factors affecting the axillary pCR. At the same time, the possibility of exempting axillary surgery after NAT in the MP grade 5 or in whom without ductal carcinoma in situ (DCIS) was evaluated. The ALND was considered to exempt when the negative predictive value was 90% or more and false negative <10% or almost same. ResultsA total of 111 eligible patients with breast cancer were gathered in the study, 64 of whom with axillary pCR. There were 43 patients of MP grade 5 without DCIS after NAT, 41 of whom were axillary pCR. The univariate analysis results showed that the estrogen receptor and progesterone receptor statuses, molecular type, NAT regimen, and MP grade were associated with the axillary pCR after NAT, then the logistic regression multivariate analysis results showed that the MP grade ≤3 and MP grade 4 decreased the probability of axillary pCR as compared with the MP grade 5 [OR=0.105, 95%CI (0.028, 0.391), P=0.001; OR=0.045, 95%CI (0.012, 0.172), P<0.001]. There were 51 patients of MP grade 5 after NAT, 46 of whom were axillary pCR. The negative predictive value and the false negative rate of MP grade 5 on predicting the postoperative residual axillary lymph nodes were 90.2% [95%CI (81.7%, 98.6%)] and 10.6% [95%CI (1.5%, 19.8%)], respectively, which of MP grade 5 without DCIS were 95.3% [95%CI (88.8%, 101.9%)] and 4.3% [95%CI (–1.7%, 10.2%)] , respectively. ConclusionsThe probability of axillary pCR for the patient with higher MP grade of breast primary after NAT is higher. It is probable of exempting axillary surgery when MP grade is 5 after NAT.
Objective To systematically evaluate the related factors that lead to the underestimation of puncture pathology of ductal carcinoma in situ (DCIS), and to reduce the underestimation rate of puncture pathology of DCIS by controlling related factors. Methods A computer search of PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, and Wanfang databases were conducted to retrieve clinical studies that led to underestimation of puncture pathology for DCIS between the establishment of the database and April 1, 2021. After two researchers independently screened the literatures, extracted the data, and evaluated the risk of bias in the included studies, RevMan 5.4 software was used for meta analysis. Results A total of 24 studies including 8 810 patients were included. Results of meta analysis showed that puncture pathology underestimation rate in patients ≥50 years old was lower than that <50 years old [OR=0.82, 95%CI (0.70, 0.96), P=0.020]. Breast imaging reporting and data system (BI-RADS) of DCIS ≤4A class patients had a lower puncture pathology underestimation rate [OR=0.38, 95%CI (0.21, 0.68), P=0.001]. Human epidermal growth factorreceptor 2 (HER2) negative [OR=1.69, 95%CI (1.12, 2.55), P=0.010], no calcification in the mass [OR=1.55, 95%CI (1.10, 2.18), P=0.010], estrogen receptor (ER) positive [OR=0.73, 95%CI (0.60, 0.89), P=0.001], progesterone receptor (PR) positive [OR=0.62, 95%CI (0.44, 0.86), P=0.004], tumor diameter ≤2 cm [OR=2.98, 95%CI (2.18, 4.09), P<0.001], DCIS patients with low/intermediate nuclear grading [OR=0.58, 95%CI (0.50, 0.68), P<0.001], and untouchable masses [OR=0.48, 95%CI (0.28, 0.82), P=0.008] had lower puncture pathology underestimation rate. Conclusions In patients with DCIS, age≥50 years, BI-RADS≤4A class, mass diameter ≤2 cm, non-palpable mass, low nuclear grade (low grade/medium grade DCIS), ER positive, PR positive, HER2 negative, and no calcification can reduce the underestimation rate of puncture pathology. Due to the limitation of the number and quality of included studies, the above conclusions need to be confirmed by the results of high quality cohort studies with large samples.
ObjectiveTo investigate the effect and predictive value of systemic inflammatory markers on pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) for locally advanced breast cancer (LABC). MethodsThe clinicopathologic data of female patients with LABC who received NACT and radical surgical resection in the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from February 2019 to February 2022 were retrospectively analyzed. The factors affecting pCR after NACT were analyzed by the multivariate logistic regression and the prediction model was established. The efficiency of the prediction model was evaluated by receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). ResultsA total of 98 patients were gathered, of which 29 obtained pCR, with a pCR rate of 29.6%. The multivariate analysis of binary logistic regression showed that the patients with non-menopausal status, negative estrogen receptor (ER), chemotherapy+targeted therapy, and systemic immune-inflammation index (SII) <532.70 (optimal critical value) were more likely to obtain pCR after NACT (P<0.05). The prediction model was established according to logistic regression analysis: Logit (P)=0.697–2.974×(menopausal status)–1.932×(ER status)+3.277×(chemotherapy regimen)–2.652×(SII). The AUC (95%CI) of the prediction model was 0.914 (0.840, 0.961), P<0.001. ConclusionsIt is not found that other inflammatory indicators such as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio are associated with pCR after NACT. But SII is an important predictor of pCR after NACT for LABC and has a good predictive efficiency.
Objective To observe the biocompatibil ity of self-assembled FGL peptide nano-fibers scaffold with neural stem cells (NSCs). Methods FGL peptide-amphiphile (FGL-PA) was synthesized by sol id-phase peptide synthesistechnique and thereafter It was analyzed and determined by high-performance l iquid chromatography (HPLC) and massspectrometry (MS). The diluted hydrochloric acid was added into FGL-PA solution to reduce the pH value and accordinglyinduce self-assembly. The morphological features of the assembled material were studied by transmission electron microscope (TEM). NSCs were cultured and different concentrations of FGL-PA assembled material were added with the terminal concentrations of 0, 50, 100, 200, 400 mg/L, respectively. CCK-8 kit was used to test the effect of FGL assembled material on prol iferation of NSCs. NSCs were added into differentiation mediums (control group: DMEM/F12 medium containing 2% B27 supplement and 10% FBS; experimental group: DMEM/F12 medium containing 2% B27 supplement, 10% FBS and 100 mg/L FGL-PA, respectively). Immunofluorescence was appl ied to test the effect of FGL-PA assembled material on differentiation of NSCs. Results FGL-PA could be self-assembled to form a gel. TEM showed the self-assembled gel was nano-fibers with diameter of 10-20 nm and length of hundreds nanometers. After NSCs were incubated for 48 hours with different concentrations of FGL-PA assembled material, the result of CCK-8 assay showed that FGL-PA with concentrations of 50, 100 or 200 mg/L could promote the prol iferation of NSCs and absorbance of them was increased (P lt; 0.05). Immunofluorescence analysis notified that the differentiation ratio of neurons from NSCs in control group and experimental group were 46.35% ± 1.27% and 72.85% ± 1.35%, respectively, when NSCs were induced to differentiation for 14 days, showing significant difference between 2 groups (P lt; 0.05). Conclusion FGL-PA can self-assemble to nano-fiber gel, which has good biocompatibil ity and neural bioactivity.
ObjectiveTo design an interventional cardiology simulation system based on unity 3d virtual reality technology to simulate the multi-sensory feedback in the operation of heart disease. MethodsWe used 3Dmax and Unity3D engine to build a three-dimensional cardiovascular model, and use Falcon Novint and Rift Oculus software and hardware system to build a virtual reality environment to simulate pilot wire intervention surgery. ResultsThe user can use the Falcon Novint force feedback controller to carry out a variety of virtual instrument exercises of percutaneous coronary angioplasty, and also it can restore operation scene through Rift Oculus virtual reality device. ConclusionA simulation system for interventional surgery is designed, which provides the help for the extensive medical training.
ObjectiveTo identify the risk factors of bone metastasis in breast cancer and construct a predictive model. MethodsThe data of breast cancer patients met inclusion and exclusion criteria from 2010 to 2015 were obtained from the SEER*Stat database. Additionally, the data of breast cancer patients diagnosed with distant metastasis in the Affiliated Hospital of Southwest Medical University from 2021 to 2023 were collected. The patients from the SEER database were randomly divided into training (70%) and validation (30%) sets using R software, and the breast cancer patients from the Affiliated Hospital of Southwest Medical University were included in the validation set. The univariate and multivariate logistic regressions were used to identify risk factors of breast cancer bone metastasis. A nomogram predictive model was then constructed based on these factors. The predictive effect of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis. ResultsThe study included 8 637 breast cancer patients, with 5 998 in the training set and 2 639 (including 68 patients in the Affiliated Hospital of Southwest Medical University) in the validation set. The statistical differences in the race and N stage were observed between the training and validation sets (P<0.05). The multivariate logistic regression analysis revealed that being of white race, having a low histological grade (Ⅰ–Ⅱ), positive estrogen and progesterone receptors status, negative human epidermal growth factor receptor 2 status, and non-undergoing surgery for the primary breast cancer site increased the risk of breast cancer bone metastasis (P<0.05). The nomogram based on these risk factors showed that the AUC (95% CI) of the training and validation sets was 0.676 (0.533, 0.744) and 0.690 (0.549, 0.739), respectively. The internal calibration using 1 000 Bootstrap samples demonstrated that the calibration curves for both sets closely approximated the ideal 45-degree reference line. The decision curve analysis indicated a stronger clinical utility within a certain probability threshold range. ConclusionsThis study constructs a nomogram predictive model based on factors related to the risk of breast cancer bone metastasis, which demonstrates a good consistency between actual and predicted outcomes in both training and validation sets. The nomogram shows a stronger clinical utility, but further analysis is needed to understand the reasons of the lower differentiation of nomogram in both sets.
ObjectiveTo compare clinicopathologic characteristics and prognosis between HER2-low and HER2-negative patients with stage T1 and T2 triple-negative breast cancer (TNBC). MethodsThe patients with stage T1 and T2 TNBC treated at the Affiliated Hospital of Southwest Medical University from June 2019 to June 2021 were retrospectively collected. The clinicopathologic features were analyzed using two-sided Chi-square test. Multivariate binary logistic regression identified risk factors for 3-year postoperative recurrence/metastasis. Kaplan-Meier survival curves was used to compare 3-year disease-free survival (DFS) between the TNBC patients with HER2-low and HER2-negative. The statistical significance was defined as α=0.05. ResultsA total of 126 patients with stage T1 and T2 TNBC were enrolled, 63 were HER2-negative and 63 HER2-low. Compared with HER2-negative patients, HER2-low patients demonstrated significantly higher proportions of: Age ≥50 years old, postmenopausal status, lymphovascular invasion (P<0.05). HER2 expression level and axillary lymph node metastasis were the independent risk factors for 3-year postoperative recurrence/metastasis in the patients with stage T1 and T2 TNBC (P<0.05). The patients with HER2-low expressing demonstrated significantly inferior 3-year DFS compared to patients with HER2-negative (χ2=7.741, P=0.005). ConclusionsFindings of this study suggest that among patients with stage T1 and T2 TNBC, HER2-low expression is associated with advanced age (≥50 years), menopausal status, and lymphovascular invasion. It may serve as an indicator of a distinct biologic subgroup or unfavorable pathologic characteristics. Patients with stage T1 and T2 TNBC who have HER2-low expression and positive axillary lymph node metastasis require close monitoring for recurrence/metastasis within 3 years postoperatively.
【摘要】 目的 评价肾移植术后他克莫司（TAC）低剂量对比常规剂量干预的疗效和安全性。 方法 检索MEDLINE、EMbase、SCI、CBM、Cochrane图书馆，纳入肾移植术后TAC低剂量对比常规剂量免疫抑制治疗的随机对照试验（RCT）。检索时间从各个数据库建库至2009年12月，对纳入研究进行方法学质量评价和Meta分析。 结果 纳入3个RCT，其中A级研究2个，B级研究1个。分析结果显示:两组急性排斥反应发生率比较，无统计学意义[RR=1.39， 95%CI(0.64， 3.01)]；肾小球滤过率、受者/移植物生存率和纳入分析的安全性指标差异均无统计学意义。 结论 基于当前临床证据，肾移植术后TAC低剂量与常规剂量干预相比，近期疗效和安全性相似；远期结果尚需进一步研究探讨。【Abstract】 Objective To evaluate the effect and safety of low-dose versus standard-dose tacrolimus immunosuppressive therapy on kidney transplant recipients. Methods MEDLINE, EMbase, SCI, CBM and the Cochrane library were searched and randomized controlled trials (RCT) of low-dose versus standard-dose tacrolimus immunosuppressive therapy in kidney transplant recipients were gathered. The search was updated in December 2009. Quality assessment and meta-analysis were performed. Results A total of three RCT were identified, two of which were graded A and one was graded B. The analysis results indicated that RR (95%CI) value of the acute rejection rate was 1.39 (0.64, 3.01); glomerular filtration rate, patient/graft survival rate, and safety analysis were not significant different between the two groups. Conclusion Based on the evidence currently, compared to standard-dose TAC, Low-dose TAC has the same effect and safety results, but further study are needed to get the long term results.
ObjectiveTo explore the influence of sentinel lymph node (SLN) status on the prognosis of elderly breast cancer patients ≥70 years old, and to screen patients who may be exempted from sentinel lymph node biopsy (SLNB), so as to guide clinical individualized treatment for such patients. MethodsA retrospective analysis was made on 270 breast cancer patients aged ≥70 years old who underwent SLNB in the Affiliated Hospital of Southwest Medical University from 2012 to 2021. The clinicopathological characteristics of the total cases were compared according to the status of SLN. Kaplan-Meier method was used to draw the survival curve, and the influence of SLN status on the overall survival (OS) time, local recurrence (LR) and distant metastasis (DM) of patients were analyzed, and used log-rank to compare between groups. At the same time, the patients with hormone receptor (HR) positive were analyzed by subgroup. The differences between groups were compared by single factor χ2 test, and multivariate Cox regression model was used to analyze and determine the factors affecting OS, LR and DM of patients. ResultsThe age of 270 patients ranged from 70 to 95 years, with a median age of 74 years. One hundred and sixty-nine (62.6%) patients’ tumor were T2 stage. Invasive ductal carcinoma accounted for 83.0%, histological gradeⅡ accounted for 74.4%, estrogen receptor positive accounted for 78.1%, progesterone receptor positive accounted for 71.9%, and human epidermal growth factor receptor 2 negative accounted for 83.3%. The number of SLNs obtained by SLNB were 1-9, and the median was 3. SLN was negative in 202 cases (74.8%) and positive in 68 cases (25.2%). Thirty-five patients (13.0%) received axillary lymph node dissection. There was no significant difference in LR between the SLN positive group and the SLN negative group (P>0.05), but the SLN negative group had fewer occurrences of DM (P=0.001) and longer OS time (P=0.009) compared to the SLN positive group. The results of univariate and multivariate analysis suggest that the older the patient, the shorter the OS time and the greater the risk of DM. Analysis of HR positive subgroups showed that SLN status did not affect patient survival and prognosis, but age was still associated with poor OS time and DM. ConclusionsFor patients with invasive ductal carcinoma of breast in T1-T2 stage, HR positive, clinical axillary lymph nodes negative, and age ≥70 years old, SLNB may be exempted. According to the patient’s performance or tumor biological characteristics, patients who need systemic adjuvant chemotherapy may still consider SLNB.
ObjectiveTo investigate the clinicopathological significance of integrin α5β1 expression and microvessel density(MVD) in gastric cancer(GC) and the correlation of MVD with integrin α5β1. MethodsThe expression of integrin α5β1 was detected by means of immunohistochemical staining (SP method) on paraffinembeded tissue specimens from 35 primary gastric carcinoma(PGC), 10 metastasic lymph node of gastric cancer and 8 chronic superficial gastritis (CSG). Vascular endothelial cells were stained immunohistochemically using antiCD34 monoclonal antibody to recognize microvessel(MV) in 35 cases of PGC and 8 CSG, MV was counted in 4 hot spot per slide under lightmicroscope (×400) and the average was defined as MVD. The results combined with clinicopathological parameters were analyzed statistically to characterize the role of integrin α5β1 and MVD in the progression of gastric cancer. ResultsIntegrin α5β1 expression and MVD in PGC were significantly higher than those in CSG respectively （t=3.32, P lt;0.01; t=2.30, Plt;0.05）; the expression of integrin α5β1 in PGC showed only a correlation with the invasion depth of tumor (t=2.29, Plt;0.05） while MVD showed all correlations with invasion depth,lymph node status and TNM stage （t=3.07, Plt;0.01; t=2.48, Plt;0.05; t=2.94,Plt;0.01）. Neither integrin α5β1expression nor MVD showed a relation with differential of PGC （t=0.15, Pgt;0.05; t=0.41, Pgt;0.05）. Integrin α5β1 was significantly overexpressed in lymph node metastatic cancer compared with that in corresponding PGC （t=2.45, Plt;0.05）; the difference of MVD showed no statistical significance among levels of integrin α5β1 expression in PGC （F =1.43,P＞0.05） and it showed no correlation with integrin α5β1 expression（r= 0.156, P=0.37）.Conclusion Overexpression of integrin α5β1 is present in GC and associates with the progression of tumor, implying that it may be viewed as the indicator of invasion and metastasis and the candidate target of gene therapy of gastric cancer. However, integrin α5β1 may not play an important role in the vascularization of GC.