Objective To investigate the effect of radiotherapy after neoadjuvant chemotherapy and modified radical surgery on breast cancer specific survival (BCSS) of patients with stage cT1–2N1M0 breast cancer. Methods A total of 917 cT1–2N1M0 stage breast cancer patients treated with neoadjuvant chemotherapy and modified radical surgery from 2010 to 2017 were extracted from the The Surveillance, Epidemiology, and End Results (SEER) database. Of them 720 matched patients were divided into radiotherapy group (n=360) and non-radiotherapy group (n=360) by using propensity score matching (PSM). Cox proportional hazard regression model was used to explore the factors affecting BCSS. Results Patients were all interviewed for a median follow-up of 65 months, and the 5-year BCSS was 91.9% in the radiotherapy group and 93.2% in the non-radiotherapy group, there was no significant difference between the 2 groups (χ2=0.292, P=0.589). The results were the same in patients with no axillary lymph node metastasis, one axillary lymphnode metastasis, two axillary lymph node metastasis and 3 axillary lymph node metastasis group (χ2=0.139, P=0.709; χ2=0.578, P=0.447; χ2=2.617, P=0.106; χ2=0.062, P=0.803). The result of Cox proportional hazard regression analysis showed that, after controlling for Grade grade, time from diagnosis to treatment, efficacy of neoadjuvant chemotherapy, number of positive axillary lymph nodes, molecular typing, and tumor diameter at first diagnosis, radiotherapy had no statistically significant effect on BCSS [HR=1.048, 95%CI (0.704, 1.561), P=0.817]. Conclusions The effect of radiotherapy on the BCSS of patients with stage cT1–2N1M0 breast cancer who have received neoadjuvant chemotherapy and modified radical surgery with 0 to 3 axillary lymph nodes metastases is limited, but whether to undergo radiotherapy should still be determined according to the comprehensive risk of individual tumor patients.
ObjectiveTo investigate the risk factors of internal mammary lymph node (IMLN) metastasis in breast cancer patients, and to provide evidence for clarifying the TNM stage of tumors and formulating precise treatment plans. Methods The female patients who were admitted to the First Affiliated Hospital of Chongqing Medical University from February 2019 to January 2020 and diagnosed with breast cancer by tissue biopsy pathology based on the new tracer technology were retrospectively collected. All IMLNs were dissected. The associations of IMLN metastasis with patients’ age, tumor size (long diameter), tumor location, tumor grade, estrogen and progesterone receptor statuses, human epidermal growth factor receptor-2 (HER2) status, number of axillary lymph node (ALN) metastasis, and pathological molecular typing were analyzed. ResultsA total of 28 patients were included in this study. The visualization rates in the ALN and IMLN by the new tracer technique were 96.4% (27/28) and 35.7% (10/28), respectively. The pathological results of IMLN biopsy confirmed that 6 patients (The 6 cases were all displaying) had IMLN metastases, with an IMLN metastasis rate of 21.4%. The IMLN metastasis was related to the tumor location and ALN metastasis number of patients with breast cancer (P<0.05). That is to say, when the tumor located in the medial quadrant and the number of ALN metastasis was 4 or more, the IMLN metastasis rates were higher than those in the lateral quadrant (57.1% vs. 10.0%, P=0.028) and in the patients with ALN metastasis number <4 (50.0% vs. 11.1%, P=0.038). It was not found that IMLN metastasis was related to age, tumor size, tumor grade, estrogen and progesterone receptor statuses, HER2 status, and pathological molecular typing of patients with breast cancer (P>0.05). And the area of the receiver operating characteristic curve of the number of ALN metastasis for assessing IMLN metastasis was 0.697. ConclusionFrom the summarized results of cases in this study, the visualization rate of IMLN is higher based on the new tracer technology. When breast cancer locates in the medial quadrant and the number of ALN metastasis is 4 or more, it is recommended to actively carry out IMLN biopsy to clarify the results of pathological diagnosis, so as to accurately assess the tumor stage and formulate appropriate individualized treatment plan.
Objective To analyze the correlation among the clinicopathologic features, ultrasound imaging features, and axillary lymph node metastasis in breast cancer patients with negative clinical evaluation of axillary lymph nodes (cN0), and to establish a logistic regression model to predict axillary lymph node metastasis, so as to provide a reference for more accurate evaluation of axillary lymph node status in cN0 breast cancer patients. Methods The data of 501 female patients with cN0 breast cancer who were hospitalized and operated in the Affiliated Hospital of Wuhan University of Science and Technology (Xiaogan Central Hospital) from December 2013 to October 2020 were collected. Among them, 376 patients from December 2013 to December 2019 were selected to establish a prediction model for axillary lymph node metastasis of cN0 breast cancer. In the modeling group, the basic information, clinical pathological characteristics, and ultrasound imaging features of patients were analyzed by single factor analysis. The factors with statistical significance were included in the multivariate logistic regression analysis, and the logistic regression prediction model was established. The model was evaluated by the correction curve and Hosmer-Lemeshow test goodness of fit. The model was validated in the validation group (125 patients from January to October 2020), and the receiver operation characteristic (ROC) curve was drawn. Results The probability of positive axillary lymph nodes in 501 patients with cN0 breast cancer was 28.14% (141/501). The univariate analysis results of the modeling group showed that the histological grade, vascular invasion, progesterone receptor (PR), Ki-67, age, molecular typing, ultrasound breast imaging-reporting and data system (BI-RADS) grade were associated with axillary lymph node metastasis. Multivariate logistic regression analysis showed that the vascular infiltration, positive estrogen receptor (ER) , ultrasound BI-RADS grade 4C and Ki-67≥14% increased the probability of axillary lymph node metastasis (P<0.05). Using the above prediction factors to establish the prediction nomogram, the area under the ROC curve (AUC) of the modeling group was 0.72 [95%CI (0.66, 0.78)], the cut-off value was 0.30, the sensitivity was 61.00%, and the specificity was 71.20%. The newly established axillary lymph node transfer logistic regression model was applied to the validation group (n=125), and the AUC was 0.72 [95%CI (0.53, 0.76)]. The truncation value was 0.40, and the total coincidence rate was 69.60% (87/125), positive predictive value was 47.37% (18/38), and negative predictive value was 91.95% (80/87). Conclusions Vascular invasion, positive ER , ultrasound BI-RADS grade 4C, and Ki-67≥14% are risk predictors of axillary lymph node metastasis in cN0 breast cancer patients. The negative predictive value of the model is 91.95%, which has a higher value in predicting axillary lymph node metastasis in early breast cancer patients, and can provide a reference for screening exempt sentinel lymph node biopsy population.
ObjectiveTo summarize recent research on the surgical treatment of breast cancer after neoadjuvant chemotherapy (NAC) and to review the impact of NAC on the surgical treatment of breast cancer. MethodRelevant studies on NAC and surgical treatment of breast cancer from both domestic and international sources were reviewed. The literatures were analyzed, summarized, and discussed. ResultsFollowing NAC, the survival outcomes and risk of local recurrence in patients undergoing breast-conserving surgery were similar to those undergoing mastectomy. The using of image-guided minimally invasive biopsy accurately predicted pathological complete remission (pCR) of breast lesions after NAC, potentially allowed some breast cancer patients to undergo only radiation therapy after NAC, thus avoiding breast surgery. For patients with positive axillary lymph nodes, techniques such as dual-tracer, triple-tracer, and targeted axillary lymph node dissection had achieved clinical requirements in terms of detection rate and false-negative rate of sentinel lymph node biopsy, provided a safe alternative to axillary lymph node dissection. ConclusionsNAC is an important component of comprehensive breast cancer treatment. However, there is still controversy regarding the local treatment of the primary breast lesion and axillary lymph nodes after NAC. Currently, individualized treatment based on the specific circumstances of the patient remains the approach in clinical practice, aiming to achieve the optimal control of local recurrence and survival benefits for patients.
ObjectiveTo understand the progress of postmastectomy radiotherapy (PMRT) in patients with T1–2N1M0 breast cancer. MethodThe studies and the treatment guidelines relevant to PMRT in the patients with T1–2N1M0 breast cancer in recent years were analyzed and summarized. ResultsThe ability of PMRT to improve the prognosis of patients with T1–2N1M0 breast cancer remained controversial. Owing to the patients with T1–2N1M0 breast cancer were heterogeneous, and the indications for PMRT had not been standardized. With the increasing use of neoadjuvant chemotherapy for early-stage breast cancer, some studies had attempted to formulate decisions about PMRT based on changes in tumor characteristics before and after neoadjuvant chemotherapy, but the findings were currently controversial. ConclusionsWhether PMRT can improve prognosis and decision-making for patients with T1–2N1M0 breast cancer is still controversial. Some ongoing clinical trials may provide some references for the optimal decision-making of PMRT for patients with T1–2N1M0 breast cancer.
ObjectiveTo explore the factors associated with non-sentinel lymph node (NSLN) metastasis in early breast cancer patients with 1-2 positive sentinel lymph nodes (SLN), seeking the basis for exempting some SLN-positive patients from axillary lymph node dissection. MethodsA total of 299 early breast cancer patients who were diagnosed with positive sentinel lymph node (SLN) biopsy and underwent axillary lymph node dissection at the Affiliated Hospital of Southwest Medical University from January 2019 to April 2023 were selected. Univariate analysis was performed on the clinical and pathological data of patients, and multivariate logistic regression analysis was conducted to identify factors related to axillary non-sentinel lymph node (NSLN) metastasis of patients with SLN positive in early breast cancer. GraphPad Prim 9.0 was used to draw receiver operating characteristic (ROC) curve, and the area under curve (AUC) of ROC was calculated to quantify the predictive value of risk factors. ResultsAmong the 299 breast cancer patients with 1-2 SLN positive, 101 cases (33.78%) were NSLN positive and 198 cases (66.22%) were NSLN negative. Univariate analysis showed that the number of positive SLN, clinical T staging and lymphovascular invasion were related to the metastasis of NSLN (P<0.001). Multivariate logistic regression analysis indicated that having 2 positive SLN [OR=3.601, 95%CI (2.005, 6.470), P<0.001], clinical T2 staging [OR=4.681, 95%CI (2.633, 8.323), P<0.001], and presence lymphovascular invasion [OR=3.781, 95%CI (2.124, 6.730), P<0.001] were risk factors affecting axillary NSLN metastasis. The AUCs of the three risk factors were 0.623 3, 0.702 7 and 0.682 5, respectively, and the AUCs all were greater than 0.6, suggesting that the three risk factors had good predictive ability for NSLN metastasis. ConclusionThe number of positive SLN, clinical T staging, and lymphovascular invasion are related factors affecting NSLN metastasis in early breast cancer patients with positive SLN, and these factors have guiding significance for whether to exempt axillary lymph node dissection.
Objective To explore the axillary lymph node dissection (ALND) could be safely exempted in younger breast cancer patients (≤40 years of age) who receiving breast-conserving surgery combined with radiotherapy in metastasis of 1–2 sentinel lymph node (SLN) and T1–T2 stage. Methods The data of pathological diagnosis of invasive breast cancer from 2004 to 2015 in SEER database were extracted. Patients were divided into SLN biopsy group (SLNB group) and ALND group according to axillary treatment. Propensity matching score (PSM) method was used to match and equalize the clinicopathological features between two groups at 1∶1. Multivariate Cox proportional risk model was used to analyze the relationship between axillary management and breast cancer specific survival (BCSS), and stratified analysis was performed according to clinicopathological features. Results A total of 1 236 patients with a median age of 37 years (quartile: 34, 39 years) were included in the analysis, including 418 patients (33.8%) in the SLNB group and 818 patients (66.2%) in the ALND group. The median follow-up period was 82 months (quartile: 44, 121 months), and 111 cases (9.0%) died of breast cancer, including 33 cases (7.9%) in the SLNB group and 78 cases (9.5%) in the ALND group. The cumulative 5-year BCSS of the SLNB group and the ALND group were 90.8% and 93.4%, respectively, and the log-rank test showed no significant difference (χ2=0.70, P=0.401). After PSM, there were 406 cases in both the SLNB group and the ALND group. The cumulative 5-year BCSS rate in the ALND group was 4.1% higher than that in the SLNB group (94.8% vs. 90.7%). Multivariate Cox proportional hazard analysis showed that ALND could further improve BCSS rate in younger breast cancer patients [HR=0.578, 95%CI (0.335, 0.998), P=0.049]. Stratified analyses showed that ALND improved BCSS in patients diagnosed before 2012 or with a character of lymph node macrometastases, histological grade G3/4, ER negative or PR negative. Conclusions It should be cautious to consider the elimination of ALND in the stage T1–T2 younger patients receiving breast-conserving surgery combined with radiotherapy when 1–2 SLNs positive, especially in patients with high degree of malignant tumor biological behavior or high lymph node tumor burden. Further prospective trials are needed to verify the question.
ObjectiveTo investigate the effect of extranodal extension of axillary lymph nodes metastasis on the prognosis of patients with triple-negative breast cancer (TNBC). MethodsThe TNBC patients with axillary lymph node metastasis admitted to the Nanyang Central Hospital from January 2017 to January 2019 were collected. The clinicopathologic characteristics and prognosis of TNBC patients with or without extranodal extension were analyzed and compared, and the factors affecting prognosis were analyzed. ResultsA total of 216 patients were included, including 123 patients without extranodal extension and 93 patients with extranodal extension. Compared with the patients without extranodal extension, the proportions of the patients with histological grade Ⅲ, 10 or more metastatic lymph nodes, and 5 cm or greater tumor diameter were higher in the patients with extranodal extension (P<0.05). The results of multivariate analysis showed that the 10 or more metastatic lymph nodes was the risk factor affecting the overall survival (OS) and disease-free survival (DFS) of the TNBC patients (P<0.05), and the histological grade Ⅲ and lower human epidermal growth factor receptor-2 (HER-2) expression were the risk factors affecting the OS of the TNBC patients (P<0.05), as well as the extranodal extension was the risk factor affecting the DFS of the TNBC patients (P<0.05). The 5-year cumulative disease-free survival rate of the patients with extranodal extension was worse than that of the patients without extranodal extension (70.2% vs. 83.3%, χ2=6.934, P=0.008). The 5-year cumulative overall survival rate had no statistically significant difference between the them (75.3% vs. 82.1%, χ2=1.969, P=0.161). ConclusionsFrom the results of this study, the prognosis of TNBC patients with extranodal extension is worse. Especially the patients with histological grade Ⅲ, 10 or more metastatic lymph nodes, and with lower HER-2 expression should be paid attention.
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.
Breast cancer is one of the most common malignant tumors among women. Typically, the operation of breast cancer should include breast surgery and axillary lymph node surgery since breast cancer first metastasizes to regional axillary lymph nodes. However, postoperative breast cancer-related lymphedema (BCRL) in upper limb is the most common long-term complication. The injury to upper limb lymphatic system contributes to causing the postoperative BCRL. Therefore, precision medicine in the extent of axillary lymph node surgery plays an important role in preventing BCRL which can improve the quality of life in breast cancer patients.