纤维蛋白原/白蛋白比值比对可手术乳腺癌患者预后的影响

目的探讨纤维蛋白原/白蛋白比值比(FAR)对可手术乳腺癌患者预后的影响。 方法依据纳入、排除标准，收集中国医学科学院北京协和医院2013年1～12月收治的520例Ⅰ～Ⅲ期可手术乳腺癌患者临床资料进行回顾性研究。在术前检测血浆纤维蛋白原和白蛋白水平。将纤维蛋白原与白蛋白质量浓度比值乘以100定义为FAR。根据受试者工作特征曲线确定FAR最佳临界值，并依据最佳临界值将受试者分为高FAR组(FAR>6.99)147例和低FAR组(FAR≤6.99)343例。采用Kaplan-Meier法和log-rank检验评估2组患者的DFS和OS，用Cox比例风险回归模型分析患者DFS和OS的影响因素。 结果log-rank检验显示，高FAR组患者的DFS和OS均比低FAR组差(χ²＝32.885、16.320，P均<0.001)。Cox比例风险回归模型单因素分析和多因素分析均显示：高FAR为患者DFS的独立危险因素(HR＝4.092，95%CI：2.425～6.903，P<0.001；HR＝4.226，95%CI：2.476～7.212，P<0.001);高FAR为患者OS的独立危险因素(HR＝3.907，95%CI：1.913～7.978，P<0.001；HR＝4.320，95%CI：2.087～8.942，P<0.001)。 结论术前高FAR患者的无疾病进展时间更短，OS率更低。术前FAR水平有望成为预测乳腺癌患者预后的有效指标。     

Anti-neutrophil antibodies (anti-MPO-ANCAs) are associated with poor prognosis in breast cancer patients

Anti-neutrophil antibodies are capable of activating neutrophils in sterile environments, releasing extracellular traps containing myeloperoxidase (MPO) and anti-MPO antibodies (MPO-ANCAs or anti-MPO-ANCAs), which have been implicated in the pathogenesis of several diseases. The present study evaluated systemic and tumor tissue levels of anti-MPO-ANCAs breast cancer patients, and its relation to clinicopathological characteristics. Anti-MPO-ANCAs were measured in serum and tissue samples of 150 patients by enzyme-linked immunoassay. Samples were pooled according to clinicopathological characteristics of patients. Higher anti-MPO-ANCAs levels were detected in groups presenting negative clinicopathological characteristics, such as high histological grade tumors and risk factors such as body mass index, menopausal status and early onset at diagnosis. The present data highlights anti-MPO-ANCAs as associated to poor prognosis in breast cancer, a role beyond its actually discussed role in autoimmunity and vasculitis.     

Effect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study

BackgroundCancer has been the leading cause of death in the past decade in Taiwan, with breast cancer being the most common type of cancer in females. Very few studies looked at the risk of recurrence in patients who received multidisciplinary team (MDT) care. We analyzed the influence of MDT on the risk of recurrence and death in breast cancer patients.MethodIn this retrospective study, we included newly diagnosed patients from 2004 to 2010. The study included 9,266 breast cancer patients who were enrolled in MDT care and 9,266 patients who were not. The study used log-rank test to analyze patients’ characteristics, hospital characteristics, cancer staging, and treatment methods to compare the recurrence rates in MDT care and non-MDT care participants. We used Cox proportional hazards model to examine the effect of MDT and associated factors on the risk of recurrence and mortality of breast cancer patients.ResultsRelative risk of recurrence was lower for patients who received MDT care than for patients who did not (HR, 0.84; 95%CI: 0.70–0.99) after matching. The mortality risk for breast cancer patients with relapse was 8.48 times (95%CI: 7.53–9.54) than that for patients without relapse.ConclusionsThe relative risk of recurrence and death was significantly lower for breast cancer patients who received MDT care than for those who did not. We suggest that MDT care be implanted in the National Health Policy settings of breast cancer patients.     

基于医院信息系统的乳腺癌临床特征及中西医用药特征分析

目的 解析真实世界中乳腺恶性肿瘤患者的人群特征、诊断特征、中西医用药特征，为乳腺癌的临床防治提供参考。方法 采集2002年2月至2015年5月全国60家三级甲等医 院信息系统（Hospital Information System，HIS）中，出院诊断为“乳腺癌”的患者用药信息，采用SAS9.3统计软件，对人口学信息、诊断信息、医嘱用药信息等进行描述性分析。结果 39798例乳腺癌患者，平均年龄（50.93者，平均年龄）岁；多以门诊入院，入院病情以“一般”为主;合并疾病主要为高血压，骨肿瘤，联用西药以抑制肿瘤细胞增殖、治疗并发症、缓解放化疗不良反应为主；中医辨证以痰瘀互结证，气阴两虚证，肝气淤滞证，脾气亏虚证型最为常见，临床清热解毒剂、益气扶正剂，活血化瘀剂应用较多。结论 乳腺癌中西医结合治疗，联用药物广泛，临床治疗基本符合临床指南。     

Early assessment with magnetic resonance imaging for prediction of pathologic response to neoadjuvant chemotherapy in triple-negative breast cancer: Results from the phase III BrighTNess trial

IntroductionThe ability of breast magnetic resonance imaging (MRI) to predict pathologic complete response (pCR) to neoadjuvant systemic therapy (NST) varies across biological subtypes. We sought to determine how well breast MRI findings following initial treatment on the phase III BrighTNess trial correlated with pCR in patients with triple negative breast cancer (TNBC).MethodsBaseline and mid-treatment imaging and pathologic response data were available in 519 patients with stage II-III TNBC who underwent NST as per protocol. MRI complete response (mCR) was defined as disappearance of all target lesion(s) and MRI partial response (mPR) as a ≥50% reduction in the largest tumor diameter.ResultsOverall, mCR was demonstrated in 116 patients (22%), whereas 166 (32%) had mPR and 237 (46%) had stable/progressive disease (SD/PD). The positive predictive value (PPV), negative predictive value, and overall accuracy of the mid-treatment MRI for pCR were 78%, 56%, and 61%, respectively; accuracy did not differ significantly between gBRCA mutation carriers and non-carriers (52% vs. 63%, p = 0.10). When compared to patients with SD/PD, those with mPR or mCR were 3.35-fold (95% CI 2.07–5.41) more likely to have pCR at surgery. MRI response during NST was significantly associated with eligibility for breast-conserving surgery following completion of treatment (93.1% for mCR vs. 81.6% for SD/PD, p < 0.001).ConclusionsComplete response on mid-treatment MRI in the BrighTNess trial had a PPV of 78% for demonstration of pCR after completion of NST in TNBC. However, a substantial proportion of patients with mPR or SD/PD also achieved a pCR.Clinical trial registrationNCT02032277.     

Management of breast cancer: basic principles

Breast cancer is the most common cancer in the UK and in the world, exceeding lung cancer incidence. Screening has resulted in the earlier detection of breast cancer and resulted in a reduction in breast cancer deaths. Symptomatic presentation of breast disease should be investigated in specialized clinics where triple assessment involving clinical, radiological and pathological findings is recommended for optimal care. Treatment for breast cancer falls broadly into four categories – surgery, radiotherapy, chemotherapy (with or without anti-HER-2 treatments) and endocrine therapy. These depend on the type and extent of cancer, and recommendations for treatments should be made within a multidisciplinary team setting.     

结合CARC、CARE病例报告标准探究“和法”治疗乳腺癌

乳腺癌是世界范围内女性发病率第一的恶性肿瘤。中医药特有的辨证论治体系及整体治疗方式在乳腺癌的治疗中起到至关重要的作用。从古至今中医医案一直是中医理论基础及经验传承的重要载体，但其病例报告格式的不规范影响了中医药的继承和规范化。本文中我们试图采纳规范的CARC和CARE中医病例报告形式报告1例“和法”论治乳腺癌的有效病例，以为乳腺癌临床治疗和中医病案报告提供新的思路。     

Clinical Features and Survival of Single Hormone Receptor–Positive Breast Cancer: A Population-Based Study of 531,605 Patients

PurposeTo investigate the prognosis of single hormone receptor–positive (HR⁺) breast cancer (estrogen receptor [ER] positive and progesterone receptor [PR] negative, and ER⁻PR⁺) compared to double HR⁺ (ER⁺PR⁺) and double HR⁻ (ER⁻PR⁻) tumors.MethodsWe included 531,605 cases of invasive breast cancer between 1990 and 2012 from the US Surveillance, Epidemiology, and End Results (SEER) database for study and classified cases into 4 phenotypes according to expression of ER and PR: ER⁺PR⁺, ER⁺PR⁻, ER⁻PR⁺, and ER⁻PR⁻.ResultsOverall, 66,091 ER⁺PR⁻ tumors and 9320 ER⁻PR⁺ tumors were identified. The clinical characteristics of the ER⁺PR⁻ group were similar to those of the double HR⁺ group, while those of the ER⁻PR⁺ and double HR⁻ groups were similar. Overall survival of patients with single HR⁺ tumors was intermediate between that of double HR⁺ and double HR⁻ tumors. However, we observed no differences in disease-specific survival between ER⁻PR⁺ and ER⁻PR⁻ patients. In multivariate analysis, outcomes were similar. Relative to the double HR⁺ patient group, risk of death in the ER⁺PR⁻ group was higher (hazard ratio, 1.422, 95% confidence interval, 1.394-1.452). However, risk of death was comparable between ER⁻PR⁺ and ER⁻PR⁻ patients (hazard ratio, 1.03; 95% confidence interval, 0.98-1.08). Multivariate Cox proportional analysis showed that survival times of patients in the younger age bracket (< 60 years), those positive for human epidermal growth factor receptor 2 (HER2), and patients with tumor stage I-III were longer in the ER⁻PR⁺ group.ConclusionDisease-specific survival of single HR⁺ tumor cases was longer than that of double HR⁻ tumors but poorer than double HR⁺ tumors. However, differences in disease-specific survival were not significant between the ER⁻PR⁺ and ER⁻PR⁻ groups.     

以大型单中心的医院登记为基础的3.5万例乳腺癌患者长期生存报告

背景与目的：基于医院登记为基础的3.5万例乳腺癌患者的随访资料，分析其5年和10年观察生存率与无病生存率，为了解我国乳腺癌患者长期生存提供真实世界研究证据。方法：研究纳入2003年1月1日—2017年12月31日在复旦大学附属肿瘤医院确诊为乳腺癌并接受住院治疗的患者共35 872例，通过查阅患者复诊病史、电话随访和死因数据链接等方式收集患者的生存随访资料，随访统计时间截至2019年11月30日。采用Kaplan-Meier法估计患者1、3、5和10年总生存率（overall survival，OS）和无病生存率（disease-free survival，DFS），根据年龄组、性别、首次治疗时期各亚组分别描述。结果：所有患者经中位4.7年随访后，5和10年OS分别为92.5%和83.0%，相应DFS分别为86.6%、77.0%。不同年龄段患者OS和DFS的差异有统计学意义，不同性别患者OS和DFS的差异无统计学意义。2003—2005年、2006—2008年、2009—2011年、2012—2014年、2015—2017年各时期患者5年OS和DFS分别为85.8%、92.0%、92.1%、92.9%、93.8% 和70.2%、84.7%、86.0%、87.8%、90.1%；2003—2005年、2006—2008年患者10年OS分别为71.0%、82.6%，DFS分别为56.0%、75.2%，后3年相比前3年分别提升了11.6%和19.2%。结论：首次报告国内乳腺癌患者的10年长期生存结果，发现2003—2017年乳腺癌患者OS和DFS呈明显的增长趋势，预后和长期生存正在不断改善，可能与筛查应用早诊早治以及临床治疗方法的进步有关。35岁以下年轻乳腺癌患者预后稍差，值得关注。     

Patterns of axillary staging and management in clinically node positive breast cancer patients treated with neoadjuvant systemic therapy: Results of a survey amongst breast cancer specialists

IntroductionVarious options for axillary staging after neoadjuvant systemic therapy (NST) are available for breast cancer patients with a clinically positive axillary node (cN+). This survey assessed current practices amongst breast cancer specialists.Materials and methodsA survey was performed amongst members of the European Society of Surgical Oncology and two UK-based Associations: the Association of Breast Surgery and the British Association of Surgical Oncology. The survey included 3 parts: 1. general information, 2. diagnostic work-up and 3. axillary staging after NST.ResultsA total of 310 responses were collected: parts 1, 2 and 3 were fully completed by 282 (91%), 270 (87.1%) and 225 (72.6%) respondents respectively. After NST, 153/267 (57.3%) respondents currently perform ALND routinely and 114 (42.7%) respondents perform less invasive restaging of the axilla with possible omission of ALND. In the latter group, 85% does and 15% does not use nodal response seen on imaging to guide the axillary restaging procedure. Regarding respondents that do use imaging: 95% would perform a less invasive staging procedure in case of complete nodal response on imaging (63% sentinel lymph node biopsy (SLNB), excision of a previously marked positive node with SLNB (21%) and without SLNB (11%)). In case of no nodal response on imaging 77% would perform ALND.ConclusionCurrent axillary staging and management practices in cN + patients after NST vary widely. To determine optimal axillary staging and management in terms of quality of life and oncologic safety, breast specialists are encouraged to include patients in clinical trials/prospective registries.