Radical Surgery For Breast Cancer Research Articles

Influence of Nonalcoholic Fatty Liver Disease on Locally Advanced Breast Cancer: A Retrospective Cohort Study

ABSTRACT Background: Nonalcoholic fatty liver disease (NAFLD) is associated with poor prognosis after radical breast cancer surgery. Locally advanced breast cancer (LABC) has a higher recurrence rate than early breast cancer does and requires multidisciplinary treatment including cardiotoxic and liver-metabolized anthracycline. The aim of the current study was to investigate the association between NAFLD and the prognosis and morbidity of patients with LABC. Patients and Methods: This single-center, retrospective, cohort study included patients with stage III breast cancer who underwent surgery between July 2015 and December 2018. Hepatic steatosis was defined as a ratio of liver-to-spleen attenuation (L/S) of <1.12 on pre-treatment unenhanced computed tomography. The primary outcome was recurrence-free survival (RFS). We used the log-rank test to compare survival curves and the Cox proportional hazards model to adjust for covariates. Results: We analyzed 44 patients, including 6 with NAFLD. The median follow-up time was 852.5 days. On univariate and multivariate analyses, NAFLD was not significantly associated with RFS (hazard ratio [HR], 1.474; 95% confidence interval [CI], 0.324–6.706, and HR, 1.297; 95% CI, 0.263–6.399, respectively). Neither cardiovascular events nor secondary cancers were associated with NAFLD. Known prognostic factors of breast cancer—such as older age, high histological grade, and estrogen receptor negativity—were significantly associated with a shorter RFS. Conclusion: When treating patients with LABC, physicians and patients should not worry much about the prognostic impact of mild NAFLD. Highlights:

Effects of Extended Care Based on the WeChat Platform on Self-Efficacy and Quality of Life of Postoperative Breast Cancer Patients

To explore the effects of extended care based on the WeChat platform on self-efficacy and quality of life of postoperative breast cancer patients. 126 patients who underwent modified radical breast cancer surgery in our hospital from January 2018 to March 2019 were divided into a control group (n=63) and an observation group (n=63) according to a randomly generated numerical table. The control group was given regular nursing care, and the observation group was given extended nursing care using the WeChat public platform on the basis of the control group. The Hospital Anxiety and Depression Scale was used to assess the anxiety and depression of the two groups; the Breast Cancer Treatment Discomfort Rating Scale was developed with reference to the National Cancer Society’s Common Symptom Assessment Criteria and the American Cancer Treatment Collaborative’s classification criteria; and the Generic Quality of Life Inventory-74 was used to assess the quality of life of the postoperative patients and to conduct a patient satisfaction survey. The results showed that there were no significant differences in hospital anxiety and depression scores and anxiety status between the two groups before the intervention care, and the differences in hospital anxiety and depression scores, anxiety status and depression status were statistically significant after the treatment care. After the nursing intervention, the time effect, group effect, and interaction effect were statistically significant when comparing the discomfort scores of the two groups. After the nursing intervention, patients self-efficacy scores and quality of life scores were significantly higher in the observation group than in the control group. Before the intervention, there was no statistically significant difference in nursing satisfaction between the two groups; after the intervention, the satisfaction of the observation group was higher than that of the control group, and the difference was statistically significant. Professional case management based on the WeChat mobile platform helps to improve the effectiveness of out-of-hospital care for breast cancer and adapt to the rapidly developing medical model.

Novel method of radiotherapy planning to improve the dose homogeneity at the junction region for breast cancer

AbstractObjectivesThis article introduces a new method to design the radiation therapy planning after radical surgery for breast cancer in order to provide a better homogeneity of the dose distribution in the junction region between the supra clavicular fossa and chest wall.MethodsA total of 15 women who received supra clavicular and chest wall irradiation therapy for breast cancer after radical surgery at Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, China, between 1 October 2018 and 30 November 2019 were included. The prescription dose was 50 Gy/25 fractions. We designed a new plan on the basis of the original plan for each patient on an Varian Eclipse 13.6 planning system, which added two subfields to each tangential opposing field to change the dose distribution at the junction region. Statistical analysis of the target dose distribution – homogeneity index, conformal index, and irradiation doses to the ipsilateral lung, contralateral lung, heart, left‐side breast, and spinal cord – was carried out for the two groups and the differences were compared.ResultsWhen comparing the two plans, the planning target volume minimum dose (P = 0.04) and planning target volume of the junction region, which was defined as the target in the junction region minimum dose (P = 0.04), homogeneity index (P = 0.02), and conformal index (P = 0.01) for the new method plan were better than those for the original plan. However, there was no statistically significant difference in all dosimetric parameters of the organs at risk (P > 0.05) between the new and traditional method plans .ConclusionBoth plans by new and traditional methods for breast cancer after radical surgery can meet the clinical requirements. The prescription dose coverage, conformal index, and homogeneity index for the target in the new method plan were better than those in the traditional method plan. The new method plan provided a better homogeneity of the dose distribution in the junction region, but had no obvious effect on the dose distribution of the organs at risk. As a result, this new planning method can be used in clinical settings.

Asymptomatic versus symptomatic metastatic breast cancer: Potential effects on prognosis and quality adjusted life years (QALYs).

e13073 Background: After radical surgery for breast cancer, routine laboratory or imaging studies for metastases screening are not indicated in the absence of clinical signs and symptoms suggestive of recurrence. While the goal of therapy is the extension of survival and maintenance of quality of life (QOL), therapies themselves could induce adverse events, resulting in deterioration of QOL. We evaluated quality adjusted life years (QALYs), which is survival adjusted by QOL, of the patients with recurrent breast cancer retrospectively and adequate follow-up measures. Methods: Fifty seven patients with recurrent breast cancer who died already were included. Survival curves were partitioned into two health states: time with ≥ grade 2 chemotherapy-related toxicity (TOX) and time without toxicity (TWiST). QALYs were acquired as follows: QALYs = TWiST + 0.7 * TOX. We compared clinical factors in the patients between with (symptomatic group, n = 32) and without symptoms (asymptomatic group, n = 25). Results: The median age of the patient at diagnosis of recurrence was 57 years. Luminal (hormone receptors (HR) - and human epidermal growth factor receptor-2 (HER2) -), HER2 (HER2 +), triple negative (TN) (HR - and HER2 -), and unknown were 29, 7, 15, and 6 cases, respectively. The proportion of HER2 and TN was significantly higher in the symptomatic group than that in the asymptomatic group (58.6, 21.7 %, p < 0.05). 44.6 % of the patients had visceral metastases at diagnosis of recurrence and the proportions were not different between the groups. Although post recurrent survival (PRS) was shorter significantly in the symptomatic group (22.5, 42,0 months, p < 0.01), overall survival from diagnosis of primary breast cancer (OS) was identical (60.5, 91.0 months). Additionally, QALYs after recurrence was shorter in the symptomatic group (23.0, 41.1 months, p < 0.01) and QALYs from diagnosis of primary breast cancer was identical (58.7, 91.0 months). Conclusions: Although there was no significant difference in OS between the both groups, the duration of therapy received was longer in the symptomatic group. In the present study, we acquired limited information due to retrospective manner. Prospective evaluation of QALYs, including patient reported outcome and symptoms derived from cancer itself, would turn out adequate measures of follow-up after radical surgery for primary breast cancer.

INTERDISCIPLINARY APPROACH TO THE TREATMENT OF POSTMASTECTOMY LYMPHEDEMA

A prospective randomized controlled clinical study included 80 women aged 54.9 ± 8 years, who underwent radical surgery for breast cancer and had late postmastectomy lymphedema (II–IV degree). No evidence of erysipelas was observed for the last 3 months. Material and methods. The severity of lymphedema and treatment outcomes were assessed using water plethysmography in relative units (in %). Changes in the subcutaneous adipose tissue thickness were measured by ultrasound. To assess the severity of liposuction complications, the Clavien–Dindo classification was used. Three homogeneous groups of patients were treated. In Group 1 (n=30), conservative methods (intermittent pneumatic compression of the arm, electrostimulation of skeletal muscles, magnetic therapy, massage, therapeutic exercises, compression bandaging) were performed in the preoperative period; in group 2 (n=30) – in the late postoperative period of liposuction; in group 3 (n=20) liposuction was followed by compression bandaging. Results. The average volume excess in the edematous upper extremity significantly decreased, being 84.2 ± 10.0 % in group1 patients, 87.8 ± 9.3 % in group 2 and 72.2 ± 9.6 % in group 3 (p<0.001). The regression rate of grade 2 lymphedema was 94.8 ± 1.2 % in group 1 patients, 96.1 ± 0.7 % in group 2 patients and 82.1 ± 2.5 % in group 3 patients. The regression rate of grades 3 lymphedema was 81.7 ± 2.2 % in group 1, 86.9 ± 2.2% in group 2 and 65.2 ± 0.8 % in group 3. The regression rate of grades 4 lymphedema was 71.0 ± 2.8% in group 1, 73.4 ± 2.2% in group 2 and 62.6 ± 4.2% in group 3 (p<0.001). Early complications of grade 1 liposuction occurred in 5% patients. Favorable immediate treatment outcome (reduction in lymphedema by 50100 % and reduction in the thickness of subcutaneous fat by 50 %) was noted in 100% of patients of groups 1 and 2 and in 90 % patients of group 3. A good long-term result (after 12–18 months) was observed in 93.3 % of group 1 patients, in 100 % of group 2 patients and in 55 % of group 3 patients. Conclusions. The results obtained show that the elimination of excess adipose component without improving the drainage function of the lymphatic system does not lead to good long-term treatment outcomes for late lymphedema.

Complications of breast cancer surgery at Conakry oncological surgery unit

To analyze surgical complications and their impact on the prognosis of operated breast cancer patients. This was a retrospective cohort study of breast cancer patients who underwent radical breast cancer surgery (RBS) or conservative breast cancer surgery (CBS) with axillary lymph node dissection. The oncological surgery unit of Donka National Hospital served as a framework for this study from January 2007 to December 2016. A total of one hundred and thirteen patients, including 111 women and 2 men were operated during the study period. The cancer was stage III in 92 (81.1%) cases. RBS was performed in 103 (91.1%) patients and CBS in 10 (8.9%) patients. Of the patients, 92.5% had neoadjuvant chemotherapy, 68.5% had adjuvant chemotherapy, 33.6% had adjuvant radiotherapy and 39.8% hormone therapy. Surgery was complicated by intraoperative hemorrhage in 2 (2.1%) cases. Early postoperative complications included pain 47 (50%), seroma 14 (14.9%), delayed healing 13 (13.8%), hematoma 9 (9.6%), infection 2 (2.1%) and embolism 2 (2.1%). Late complications includedrelapse in 59 (52.2%), brachial pain in 23 (20.4%), lymphedema in 19 (16.8%) and shoulder movement limitations in 8 (7.1%). There was 27.1% of relapsesoccurred in patients with lymphedema versus 5.7% in the absence of lymphedema (p=0.002). The overall mortality was 59 (52.2%), including 4 (3.5%) postoperative cases. Operative pain, seroma, lymphedema and recurrence were the most common complications. This study showed that the high risk of death was related to the occurrence of relapse, more commonly seen in patients with lymphoedema.

CEA, CA 15-3, and TPS as Prognostic Factors in the Follow-up Monitoring of Patients After Radical Surgery for Breast Cancer.

The aim of this study was to evaluate the ability of tissue polypeptide-specific antigen (TPS), carcinoembryonic antigen (CEA), and cancer antigen 15-3 (CA 15-3) to predict relapse in breast cancer patients, when the measurement of biomarkers is performed within 6 months after surgery. Four hundred and seventy-two patients with breast cancer were evaluated. TPS, CEA, and CA 15-3 were measured in months 1, 3, and 6, after surgery. Disease recurrence was recorded between 7-12 months after surgery. Disease recurrence occurred in 60 patients, while 412 patients remained in recurrence-free status. TPS levels of the recurrence group differed statistically significantly in the first and sixth month after surgery compared to recurrence-free group (p=0.0339, AUC=0.6056; p<0.0001, AUC=0.7196). CEA and CA 15-3 measurements did not achieve a statistically significant difference for any month examined. TPS level in the sixth month after surgery is the best candidate biomarker to predict disease recurrence.

Comparative analysis of efficacy of breast-conserving therapy combined with sentinel lymph node biopsy or conventional radical breast cancer surgery in the treatment of breast cancer

Objective: To compare the effects of breast-conserving therapy combined with sentinel lymph node biopsy (SLNB) and improved radical breast cancer surgery in the treatment of breast cancer. Methods: 280 cases of patients undergoing breast cancer surgery from June 2013 to June 2016 were included and divided into study group (n = 140) and control group ( n = 140) according to different types of surgery method. Study group was given breast-conserving therapy and SLNB surgery, and control group was given improved radical surgery. The effects of the two groups were compared. Results: The operation length, bleeding volume, total drainage volume, and time required for extubation were significantly lower in study group than those in control group ( P 0. 05), and there was no significant difference in the transfer rate between study group and control group (2.14% vs 1.43%) ( P > 0.05). Conclusions: Compared with improved radical surgery, breast-conserving therapy and SLNB for patients with breast cancer can reduce the operation length, intraoperative bleeding volume, total drainage volume and time required for extubation, decrease the complications, and improve the quality of life after operation, and there is no difference in the recurrence rate and transfer rate, therefore it is worth applying.

Effects of ultrasound-guided stellate-ganglion block on sleep and regional cerebral oxygen saturation in patients undergoing breast cancer surgery: a randomized, controlled, double-blinded trial.

Numerous factors could contribute to sleep disturbances in women with breast cancer. We hypothesized that stellate ganglion block (SGB) during surgery would preserve sleep after surgery and increase intraoperative regional cerebral oxygen saturation (rSO2) on the blocked side in patients undergoing breast cancer surgery. A randomized, double-blinded, controlled trial was conducted at the First Hospital of China Medical University from January 2016 to September 2016. Ninety-six patients who underwent radical breast cancer surgery requiring general anaesthesia were randomly assigned to one of two study groups: a control group that received a saline SGB and a block group that received a 0.25% ropivacaine hydrochloride SGB. The primary outcome measure was the postoperative sleep profile, which was assessed using the bispectral index on the first postoperative night. The secondary outcome measure was the intraoperative rSO2, monitored was throughout surgery using near-infrared spectroscopy. A total of 91 female patients (mean age: 45years; range 24-51years) were included in the study. The duration of sleep was significantly increased by 66.3min in the ropivacaine-SGB group compared with the saline-SGB group. No differences in rSO2 were observed on either the left or right side of the patients in either group 50min after anaesthesia induction. We conclude that ropivacaine-SGB combined with general anaesthesia might increase the first postoperative sleep duration without influencing the intraoperative rSO2 in female patients undergoing elective breast cancer surgery. Clinical trials.gov identifier NCT02651519.

Manual Lymphatic Drainage and Active Exercise Effects on Lymphatic Function Do Not Translate Into Morbidities in Women Who Underwent Breast Cancer Surgery

ObjectiveTo evaluate manual lymphatic drainage (MLD) and active exercise effects on lymphatic alterations of the upper limb (UL), range of motion (ROM) of shoulder, and scar complications after breast cancer surgery. DesignClinical trial. SettingHealth care center. ParticipantsWomen (N=105) undergoing radical breast cancer surgery who were matched for staging, age, and body mass index. InterventionsWomen (n=52) were submitted to MLD and 53 to active exercises for UL for 1 month and followed up. Main Outcome MeasuresShoulder ROM, surgical wound inspection and palpation, UL circumference measurements, and lymphoscintigraphy were performed in preoperative and postoperative periods. ResultsThere was no significant difference between groups with regard to wound healing complications, ROM, and UL circumferences. After surgery, 25 (48.1%) of the MLD group and 19 (35.8%) of the active exercise group showed worsening in radiopharmaceutical uptake velocity, whereas 9 (17.3%) of the MLD group and 11 (20.8%) of the active exercise group showed improved velocity (P=.445). With regard to uptake intensity, 27 (51.9%) of the MLD group and 21 (39.6%) of the active exercise group showed worsening whereas 7 (13.5%) of the MLD group and 7 (13.2%) of the active exercise group showed some improvement (P=.391). The presence of collateral circulation was similar in both groups at both time points evaluated. The active exercise group had a significant increase in postoperative liver absorption (P=.005), and the MLD group had a significant increase in postoperative dermal backflow (P=.024). ConclusionsMLD and active exercise effects are equivalent with regard to morbidity. Minor changes in lymphatic function associated with either MLD or active exercises were not related to patients' symptoms or signs.

Effects of the Zhikang capsule on healing of the flap after radical breast cancer surgery

This study aimed to investigate the effect and mechanism of trauma flap healing promoted by the Zhikang capsule after radical breast cancer surgery. The enrolled breast cancer patients were randomly divided into two groups: treatment and observation. The patients in the treatment group were treated with the Zhikang capsule in addition to the conventional dressing changes, while patients in the observation group underwent only the regular dressing changes. Serum samples of 98 breast cancer patients (with complete clinical data) who underwent modified radical mastectomy were collected and analyzed for expressions of transforming growth factor beta (TGF-β) and basic fibroblast growth factor (bFGF). The drainage fluid amount and tissue necrosis rate were found to be lower in the treatment group than in the observation group. Moreover, bFGF expression in peripheral blood was higher in the treatment group than in the observation group. However, no significant difference was found between the two groups in the expression of TGF-β in peripheral blood. In conclusion, Zhikang capsule is effective in promoting flap healing after radical breast cancer surgery, and the increase of bFGF expression in peripheral blood may be the underlying mechanism.

Dexmedetomidine-based Total Endovenous Anesthesia in Radical Surgery for Breast Cancer. An observational case series study involving 10 patients.

Dexmedetomidine-based Total Endovenous Anesthesia in Radical Surgery for Breast Cancer. An observational case series study involving 10 patients.

Metachronous pancreatic acinar cell carcinoma discovered in early stage during follow-up of breast cancer: report of a case.

We present an extremely rare case of early-stage acinar cell carcinoma of the pancreas. A 49-year-old woman, who had undergone radical surgery for breast cancer 3years earlier, was suspected to have a rib metastasis during follow-up. She also had a family history of cancer. No accumulation was seen in the left rib on (18)F-fluorodeoxyglucose positron emission tomography with computed tomography, but incidental high uptake into the pancreatic head suggested malignant pancreatic tumor. The tumor was completely resected by pancreatoduodenectomy, and pancreatic acinar cell carcinoma was demonstrated histopathologically. To the best of our knowledge, this is the first reported case of a pancreatic acinar cell carcinoma smaller than 1cm to be detected by (18)F-fluorodeoxyglucose positron emission tomography and computed tomography.

The emperor of all maladies

The emperor of all maladies

Androgen receptors as a prognostic and predictive factor in breast cancer.

Many theoretical and experimental models indicate that androgen receptors can play an important role as prognostic factors in breast cancer. The aim of this study was to evaluate the correlations between the presence of androgen receptors on cancer cells and other selected prognostic and predictive factors with established clinical significance in women with breast cancer after radical surgical treatment. 488 adult females were included in the study, who underwent primary radical surgery for breast cancer. 428 patients (87.7%) had Patey's conservative radical mastectomy and 60 (12.3%) Halsted's radical mastectomy. The mean age at operation was 54.3, ranging from 32 to 79. The mean length of hospitalization was 7.2 days for the patients after Patey's mastectomy and 9.8 days for those after Halsted's mastectomy. The androgen receptor is the most frequently detected steroid receptor on breast cancer cells. Therapeutic efficacy of adjuvant hormone therapy was higher in the group of androgen receptor-positive patients than in androgen receptor-negative ones. The prognosis for androgen receptor-positive patients who underwent adjuvant hormone therapy was better than for those androgen receptor-positive patients who did not receive hormone therapy after primary radical surgery for breast cancer. Assessment of androgen receptor levels on cancer cells should become a routine procedure with patients undergoing primary radical surgery for breast cancer, as it seems to be an important predictive factor.

Radical breast cancer surgery and its complications

Radical breast cancer surgery and its complications

Impact of Concurrent Radiotherapy on Chemotherapy Total Dose and Dose Intensity in Patients with Early Breast Cancer

A retrospective analysis was conducted to evaluate the tolerability as well as the impact of concurrent adjuvant CMF chemotherapy and radiation therapy on total CMF dose and dose intensity. The medical records of 59 patients who had received conservative or radical surgery for breast cancer were analyzed. All patients had been assigned to 6 cycles of "1,8 CMF" adjuvant chemotherapy and concomitant radiation therapy. Total drug dose and dose intensity were calculated. Toxicity was recorded scored according to WHO criteria. A total of 355 cycles was administered. Fifty of 59 patients received at least 85% of the programmed chemotherapy total dose, the median value being 100% (range, 42-100). The median relative dose intensity was 0.97 (range, 0.42-1.01). Forty-four of 59 (75%) patients experienced grade 3-4 neutropenia (20 febrile neutropenia) and 29 (49%) required G-CSF support. This retrospective analysis showed that it is possible to give concurrent CMF and breast radiation while ensuring adequate chemotherapy total doses and dose intensities to most patients. However, G-CSF support is required in a significant proportion of patients.

Surgical complications related to peri-operative adjuvant chemotherapy in breast cancer. Results of a prospective, controlled, randomized clinical trial

From May 1985 to June 1992, 375 patients were enrolled in a prospective controlled randomized clinical trial of peri-operative adjuvant chemotherapy (PAC) associated with long-term adjuvant chemo-endocrinotherapy in order to test the effectiveness of reducing the time interval between surgery and chemotherapy. The short-term surgical complications related to PAC are reported in order to verify whether such treatment might negatively affect the results of breast cancer surgery. One hundred and eighty-nine patients were randomly assigned to the peri-operative treatment, and 186 to the control group. Patients undergoing PAC received one course of cyclophosphamide (600 mg/sqm), epidoxorubicin (60 mg/ sqm), and 5-fluorouracil (600 mg/sqm) (CEF) within 48-72 h following surgery. Pathologically node-positive (N+) patients, who were given peri-operative CEF, had five further cycles of CEF alternated with six cycles of CMF (cyclophosphamide 600 mg/sqm, methotrexate 40 mg/sqm, and 5-fluorouracil 600 mg/sqm). All the other N+ patients received six cycles of CEF alternated with six cycles of CMF, starting within 30 days of surgery. No significant difference in post-operative morbidity was observed as regards median hospital stay (8 days), number of outpatient dressings (3.5 vs 3), seroma (51 (26.9%) vs 45 (24.2%)), lymphatic drainage (400 ml vs 409 ml), and post-operative infections, both local (10 vs 9) and in extraoperative foci (6 vs 7), in the study and control group, respectively. The toxicity of the peri-operative CEF was mainly gastrointestinal (nausea and vomiting, 55%; stomatitis, 3%), with only a small percentage (9%) reaching grades III-IV. Hair loss was the other main side effect (55%) with baldness in only 3%. Post-operative complications following radical breast cancer surgery seem to be primarily related to operative details (type of incision, accurate nerve-sparing technique, bleeding control, closure of subcutaneous and skin, drainage, aseptic technique) rather than to the one course of PAC.

Preservation surgery for malignant disease: why it works.

Local recurrence has been considered a grave prognostic sign after radical surgery for breast cancer. Controlled trials have recently discovered local recurrence to be an innocent event after limited surgery. Nine years ago I proposed a hypothesis to resolve this dilemma. The discovery of natural killer (NK) cells has added support to this hypothesis. Patients vary widely in their ability to kill metastasizing tumor cells. Patients who survive their initial tumor without subsequent distant disease may have an NK system sufficient to resist recurrence of a similar volume of tumor arising within the field of initial treatment. Both clinical and laboratory investigations suggest that this hypothesis may be applicable to a variety of solid tumors. Surgeons who support this perception of tumor-host balance may prudently limit the extent of their operations for those malignancies so affected.