Survival rates of breast carcinoma patients after surgery and anaesthetic.

Eighty-nine breast cancer patients were studied for the end result of therapy. During surgery, the anaesthesia administered was either halothane (61 cases) or ether (28 cases) mixture with nitrogen and oxygen. The holstead method for mastectomy was used for all cases. The results showed that the type of anaesthesia influenced the end results of therapy of breast cancer patients. The survival rates of patients receiving halothane were much higher than those of ether anaesthetized cases. The differences were most pronounced among cases who received both preoperative radiotherapy and postoperative chemotherapy, and in cases with metastasis into regional lymph node. A comparison of groups of patients on the basis of such parameters as the anaesthetic used, age and degree of tumor progression (according to TNM classification and post-operative histological assays) showed them to well matched. These results may be explained by the effects of the anaesthesia on the role of immunity in controlling tumor cell implantation and growth of metastasis.     

乳腺癌术后乳房重建热点讨论

乳腺癌是导致女性第二性征丢失的最主要原因。乳腺外科医师在探索保留乳房的同时,也开始为乳房切除患者探索重建乳房的方法,其中包括假体乳房重建、自体乳房重建和外负压抽吸的脂肪填充乳房重建等。本文从乳房分型、手术决策、假体选择、手术切口及层次、胸大肌处理及术后护理等方面的热点问题展开讨论,并提供“一步法”硅胶植入乳房重建的可执行、可重复手术方案。     

The influence of hospital volume and surgical treatment delay on long-term survival after cancer surgery

BackgroundWe conducted a population-based retrospective cohort study to investigate the influence of hospital volume, delay of surgery, and both together on the long-term survival of postoperative cancer patients.MethodsUsing information from the Korea Central Cancer Registry from 2001 through 2005 and the National Health Insurance claim database, we determined survival for 147 682 patients who underwent definitive surgery for any of six cancers.ResultsRegardless of cancer site, surgical patients in low- to medium-volume hospitals showed significantly worse survival [adjusted hazard ratio (aHR) = 1.36–1.86] than those in high-volume hospitals in multivariable analyses. Among the latter, treatment delays > 1 month were not associated with worse survival for stomach, colon, pancreatic, or lung cancer but were for rectal [aHR = 1.28; 95% confidence interval (CI), 1.17–1.40] and breast (aHR = 1.59; 95% CI, 1.37–1.84) cancer. For patients in low- to medium-volume hospitals, treatment delay was associated with worse survival for all types of cancer (aHR = 1.78–3.81).ConclusionOur findings suggest that the effect of hospital volume and surgical treatment delay on overall survival of cancer patients should be considered in formulating or revising national health policy.     

乳腺癌保乳术后不同放疗方式的疗效及不良反应

目的:回顾性分析早期乳腺癌保乳术后不同放疗方式对局部正常器官的影响,观察不同放疗方式与生存率的关系。方法:收集我院1998-2010年保乳术后接受不同放疗方式治疗的乳腺癌患者121例,其中37例接受常规二维放疗,80例接受三维放射治疗,放疗采用6MV-X线全乳腺放疗50Gy,瘤床电子线外照射加量10Gy或同步加量至60Gy,4例未接受放疗,雌、孕激素受体阳性的患者加用内分泌治疗。治疗结束后每三个月复查至2年,每半年复查至5年,以后每年复查,放射性不良反应按照RTOG评价标准进行评价。结果:全组3年生存率为97.0％,5年生存率为95.0％,5年无瘤生存率为95.0％,局部复发率为0％。二维放疗放射性肺损伤的发生率明显高于三维放疗（P=0.010）。左侧乳腺癌放射性心脏损伤发生率稍高于右侧,但无明显统计学差异（P=0.210）,二维放疗放射性心脏损伤的发生率明显高于三维放疗（P=0.007）。二维放疗引起II°及III°急性放射性皮肤损伤发生率明显高于三维放疗（P=0.003）。美容效果与放射性皮肤反应相关,发生II°及以上皮肤反应的乳腺外观美容效果差于I°及以下皮肤反应的美容效果（P=0.030）。保乳术后接受局部放疗的患者3年生存率为98.0%,5年生存率为98.0%,T1与Ｔ2患者1、3、5年生存率分别为100%与97%、100%与94%、100%与94%,差异具有统计学意义（P=0.014）。结论:保乳术后行局部放疗明显延长生存时间,三维放疗与二维放疗相比5年生存优势未体现,但在保护肺、心脏、皮肤及美容效果方面明显好于二维放疗。     

乳腺钼靶伴有倾向恶性钙化的乳腺癌患者保乳术后的预后分析

目的：回顾性分析乳腺钼靶伴有倾向恶性钙化以及不同年龄的乳腺癌患者行保乳术后的预后。方法：收集2005年1 月至2008年12月436 例天津医科大学肿瘤医院行保乳术的乳腺癌患者的临床病理资料。根据患者乳腺钼靶中是否伴有倾向恶性钙化分为钙化组（122 例）和对照组（314 例）。 根据年龄大小分为年轻组（年龄≤ 35岁）,中年组（36～55岁）,老年组（年龄> 55岁）3 个亚组。单因素生存分析采用Logrank 法,多因素分析采用Cox 回归模型。结果：乳腺钼靶伴有倾向恶性钙化是保乳患者的局部复发及总生存的独立危险因素。亚组分析显示,年轻患者中钙化组患者发生复发、转移及死亡事件的例数较对照组多;中年患者中钙化组局部无复发生存及总生存均较差,差异具有统计学意义;老年患者中有无倾向恶性钙化不影响患者的局部无复发生存及总生存。结论：乳腺钼靶伴有倾向恶性钙化是乳腺癌患者保乳术的局部复发及总生存的独立危险因素。对于老年患者钼靶伴有倾向恶性钙化不应作为其保乳的禁忌证。     

The influence of provider characteristics on resection rates and survival in patients with localized non-small cell lung cancer

Surgery remains the mainstay of treatment for localized non-small cell lung cancer (NSCLC). However, wide variations have been reported regarding rates of operative therapy. We examined the influence of characteristics of the hospital of diagnosis on the likelihood of receiving surgical treatment and on survival. We evaluated patients with primary, first-time, localized NSCLC diagnosed from 1998 to 2003 in the region of the Amsterdam Cancer Registry. Treatment and survival data were extracted from the registry database. We investigated which provider characteristics (hospital category, mean annual lung cancer caseload, presence of a cardiothoracic surgery unit) were predictive of receiving surgical treatment and of survival. 1591 patients were diagnosed with clinically localized NSCLC, of which 1097 (69%) had surgery. Resection rates varied significantly between the various hospitals (48-90%, chi(2), P<0.001). Patients diagnosed at specialized centers or higher volume hospitals were more likely to receive surgical therapy, especially for patients over 80 years of age. In addition, there was a trend that octogenarians had higher odds of undergoing surgery when diagnosed in a center with a cardiothoracic surgery unit. Patients had a better survival after resection than without surgery (P<0.001). Survival after surgery did not differ between the various hospital categories. In conclusion, there is wide institutional variability in rates of surgical treatment in lung cancer patients. In addition to patient characteristics, attributes of the hospital of diagnosis also have significant influence on the likelihood of receiving surgical therapy. Future studies should examine the underlying mechanisms for this phenomenon.     

Better survival after surgery of the primary tumor in stage IV inflammatory breast cancer

IntroductionInformation regarding the effects of resection of the primary tumor in stage IV inflammatory breast cancer (IBC) is scarce. We analyzed the impact of resection of the primary tumor on overall survival (OS) in a large stage IV IBC population.Materials and methodsPatients diagnosed with stage IV IBC between 2005 and 2016 were selected from the Netherlands Cancer Registry, excluding patients without any treatment. To correct for immortal time bias, we performed a landmark analysis including patients alive at least six months after diagnosis. With propensity score matching, patients undergoing surgery of the primary tumor were matched to patients not receiving surgery. Multivariable Cox proportional hazard analyses were performed to determine the association between treatment strategy and OS in the non-matched and matched cohort.ResultsOf the 580 included patients after landmark analysis, 441 patients (76%) received only non-surgical treatments and 139 (24%) underwent surgery (96% mastectomy). Median follow-up was 28.8 and 20.0 months in the surgery and no surgery group, respectively. Surgery in the non-matched cohort was independently associated with better survival (HR0.56[95%CI:0.42–0.75]). In the matched cohort (n = 202), surgically treated patients had improved survival over nonsurgically treated patients (p < 0.005). Multivariable analysis of the matched cohort revealed that surgery was still associated with better survival (HR0.62[95%CI:0.44–0.87]).ConclusionAlthough residual confounding and confounding by severity cannot be ruled out, this study suggests that surgery of the primary tumor is associated with improved OS and should be considered as part of the treatment strategy in stage IV IBC.     

肥胖对甲状腺癌全切术后甲状旁腺功能的影响

目的:研究肥胖对甲状腺癌全切术后患者甲状旁腺功能的影响。方法:选取2017年06月至2018年06月期间于我院甲乳外科428例甲状腺全切手术患者病例资料,分析其临床资料及预后情况。按体质量指数（body mass index,BMI）值分为两组,肥胖组85例（BMI≥30 kg/m2）,正常组343例（BMI<30 kg/m2）。对比两组术前、术后1 h、术后1日、术后2日和术后3日的血清甲状旁腺激素（PTH）、血钙和血磷水平,对所有术后出现甲状旁腺功能减退的患者门诊随访1年,观察低血钙症状及甲状旁腺功能的恢复状况。分析甲状腺癌全切术后肥胖患者甲状旁腺功能与正常患者之间的差异。结果:两组患者临床资料（性别、年龄、肿瘤直径和病理类型）比较无统计学意义;两组患者术后1 h、1 d、2 d、3 d的PTH及血钙均呈下降趋势,术后第3 天的PTH 及血钙均达最低值,PTH 及血钙在术后各时点均为正常组高于肥胖组,PTH及血钙在组内、时点间、组间·时点间交互作用比较差异均有统计学意义（P＜0.01）;肥胖组术后并发症发生率高于对照组,肥胖患者刀口感染、喉上及喉返神经损伤、甲状旁腺功能低下和低钙血症发病风险较正常组高（P＜0.05）;两组术后1年甲状旁腺功能减退或低钙血症患者恢复情况无明显差异（P＞0.05）。结论:肥胖患者甲状腺癌全切术后甲状旁腺功能低下比体重正常患者发生率高,术后同一时间点甲状旁腺激素和血钙水平低于体重正常患者,故肥胖患者术后应给予钙剂、维生素D预防甲状旁腺功能减退及低钙血症。     

Drainage-free management of patients after radical surgery for breast cancer

The paper deals with drainage-free management of disease and therapy after radical surgery for breast cancer. The data on the immediate results of surgery were assessed in 168 patients. Suture of a skin flap to the thoracic wall closed a gap in axillary area while ultrasound monitoring of the wound and aspiration of fluid made keeping track of postoperative recovery possible. Wound complications were registered in 51 patients (30.4%) serotoma--35 (20.8%).     

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

The aim of this study was to examine the possible influence on survival of delays prior to presentation and/or treatment among women with breast cancer. Duration of symptoms prior to hospital referral was recorded for 2964 women who presented with any stage of breast cancer to Guy's Hospital between 1975 and 1990. Median follow-up is 12.5 years. The impact of delay (defined as having symptoms for 12 or more weeks) on survival was measured from the date of diagnosis and from the date when the patient first noticed symptoms to control for lead-time bias. Thirty-two per cent (942/2964) of patients had symptoms for 12 or more weeks before their first hospital visit and 32% (302/942) of patients with delays of 12 or more weeks had locally advanced or metastatic disease, compared with only 10% (210/2022) of those with delays of less than 12 weeks (P < 0.0001). Survival measured both from the date of diagnosis (P < 0.001) and from the onset of the patient's symptoms (P = 0.003) was worse among women with longer delays. Ten years after the onset of symptoms, survival was 52% for women with delays less than 12 weeks and 47% for those with longer delays. At 20 years the survival rates were 34% and 24% respectively. Furthermore, patients with delays of 12-26 weeks had significantly worse survival rates than those with delays of less than 12 weeks. Multivariate analyses indicated that the adverse impact of delay in presentation on survival was attributable to an association between longer delays and more advanced stage. However, within individual stages, longer delay had no adverse impact on survival. Analyses based on 'total delay (i.e. the interval between a patient first noticing symptoms and starting treatment) yielded very similar results in terms of survival to those based on delay to first hospital visit (delay in presentation).     

De-escalation of breast radiotherapy after conserving surgery in low-risk early breast cancer patients

The reduction in the burden related to treatment is becoming more and more important in modern oncology. Radiation therapy is a mainstay option in the postoperative setting for early breast cancer patients after breast-conserving surgery. Nowadays, different options are available to de-escalate radiotherapy in this scenario such as the use of hypofractionated whole-breast radiation, the selective delivery of the boost dose to the lumpectomy cavity, the introduction of accelerated partial breast irradiation and the omission of treatment in appropriately selected patients with low-risk features. We herein provide a review article on this topic.     

Chemotherapy-induced amenorrhea: influence on disease-free survival and overall survival in receptor-positive premenopausal early breast cancer patients.

BACKGROUND: The aim of this study was to evaluate the influence of early chemotherapy-induced amenorrhea (CIA) on disease-free survival and overall survival in premenopausal patients with receptor-positive early breast cancer treated with adjuvant chemotherapy without any hormonotherapy. PATIENTS AND METHODS: Retrospectively, we reviewed data from 130 premenopausal patients with localized hormone-sensitive breast cancer. These patients were treated between 1985 and 1995 at the same institution. They all underwent a loco-regional treatment and adjuvant chemotherapy. Early CIA was defined as an amenorrhea arising during the first year following the beginning of chemotherapy. Predictors of early CIA were examined. The survival analyses were done using the Kaplan-Meier method and Cox analysis. RESULTS: Median follow-up was 9 years. Mean age was 42.9 +/- 5 years. Ninety-two per cent of patients had histologically-proven positive axillary nodes. Adjuvant chemotherapy contained no anthracycline in 63%. Early CIA occurred during or after adjuvant chemotherapy in 57% of the patients. It was definitive in 91%. In our study, age was the only CIA predictor in univariate analysis. Women who experienced early CIA tend to have a longer disease-free survival, but the difference was not significant. This trend was lost in multivariate analysis, most probably due to the small sample size. The overall survival was not different. CONCLUSION: Although not statistically significant, our results on a very selected population of patients suggest that a chemotherapy-induced amenorrhea might have its own therapeutic effect besides the cytotoxic action of chemotherapy.     

外科治疗70岁以上老年肺癌患者的预后因素分析

背景与目的随着手术和麻醉技术的提高,越来越多的老年肺癌患者接受手术治疗。本研究的目的是探讨70岁以上老年肺癌患者术后生存情况及其影响因素,为老年肺癌的治疗提供依据。方法回顾性分析192例手术治疗的70岁以上老年肺癌患者的术后生存情况,采用单因素和多因素方法分析各种预后因素的影响度。结果全组总的5年生存率为33.5%。手术方式、手术性质、病理类型及分期均可显著影响患者的预后,其中后三者为独立预后因素。结论老年肺癌患者术前应全面检查,尽量避免单纯探查手术和姑息手术。手术以肺叶切除为标准术式,某些特殊情况下,也可行部分肺叶切除术。     

肥胖对淋巴结阳性的乳腺癌患者总生存率的影响

目的:探讨肥胖对淋巴结阳性的乳腺癌患者预后的影响.方法:收集593例淋巴结阳性的女性乳腺癌患者的年龄、绝经状态、家族史、体质量指数(body mass index,BMI)、病理检查及临床治疗资料.用log-rank检验及COX回归分析分别进行影响总生存(overall survival,OS)的单因素和多因素分析;用卡方检验进行肥胖组与非肥胖组间临床病理特征的差异比较.结果:肥胖是影响淋巴结阳性乳腺癌预后的独立不良因素(P=0.003),是影响绝经前患者OS的独立不良预后因素(P=0.010),而对绝经后患者不存在这种影响;肥胖与肿瘤大小具有相关性(P＜0.001).结论:肥胖是影响淋巴结阳性的乳腺癌患者预后的不良因素,尤其是绝经前患者;肥胖患者的肿瘤直径较非肥胖患者的大,这可能是肥胖者预后不良的一个重要原因.