ObjectiveTo explore the relationship between mdr1 gene expression of hepatocellular carcinoma (HCC) and pathological characteristics,chemotherapy and prognosis. MethodsThe mdr1 gene expression of HCC in 56 patients with the methods of immunohistochemistry was studied. The results were analysed with the pathological data by statistic methods. ResultsThe positive expression of mdr1 gene in cancer tissues and pericancerous tissues of HCC were 30/56(53.6%) and 19/56 (33.9%) respectively. The difference was statistically significant (χ2=4.39,P＜0.05). The positive expression of mdr1 gene in cancer tissues of untreated patients and in recurrent patients were 22/48(45.8%) and 8/8(100%) respectively.The expression of mdr1 gene was not associated with tumor size, number, tumor thrombus, differentiation, HBsAg and liver cirrhosis. The patients with positive mdr1 expression had a shorter survival time than that of negative ones. But the difference was not statistically significant. Conclusion The positive expression of mdr1 in HCC is 53.6%. It is not associated with tumor size, number, tumor thrombus, tumor differentiation, HBsAg and liver cirrhosis. There are innate multidrug resistance in HCC.
目的 分析原发性乳腺淋巴瘤（PBL）的临床病理特点、诊断、治疗及预后。 方法 回顾分析2000年12月－2011年10月收治的19例PBL患者的临床资料和治疗随访情况。 结果 19例PBL患者均为女性，年龄34～72岁。根据Ann Arbor临床分期，Ⅰ期患者9例，Ⅱ期7例，Ⅲ期3例，而病理类型以弥漫大B淋巴瘤为主（13/19）。全部患者随访时间为6～113个月，中位随访时间为45个月，5年生存率为36.8%。 结论 PBL其预后与病理类型、分期及治疗方式有关。手术联合放射化学疗法为主要治疗方式，腋窝淋巴结清扫有一定的意义，但对PBL预后的影响值得商榷。此外，PBL易出现中枢神经系统转移，应定期复查。
Objective To discuss the diagnosis and treatment of insulinoma, clinical characteristics and summarize our experiences. Methods The clinical, operative and pathologic findings from 15 cases of insulinoma of in our hospital from 1989 to 1998 were retrospectively studied. Results All 15 patients recieved surgical treatment. Fourteen patients were cured and the 15th patient died from hepatic failure six months later. Conclusion Insulinoma should be diagnosed and treated as early as possible. It can be cured by resection of the tumor.
ObjectiveThe study was aimed to further explore risk factors of axillary lymph node metastasis in Luminal A breast cancer and revealed high-risk clinicopathological features.MethodsFrom January 2017 to December 2019, the clinical and pathological data of 237 Luminal A breast cancer patients diagnosed in our hospital were retrospectively analyzed. For the identification of related risk factors of axillary lymph node metastasis in Luminal A breast cancer, χ2 test for univariate analysis and logistic regression model for multivariate analysis were conducted.ResultsAmong the 237 patients with Luminal A breast cancer, 115 patients were associated with lymph node metastasis (48.5%). The univariate analysis indicated that multifocal tumor (P=0.001), p53 mutation (P=0.012), and lymphovascular invasion (P=0.022) were correlated with axillary lymph node metastasis in the Luminal A breast cancer. The multivariate analysis identically showed that multifocal tumor (P=0.009), p53 mutation (P=0.019), and lymphovascular invasion (P=0.021) were independent risk factors of axillary lymph node metastasis.ConclusionMultifocal breast cancer, p53 mutation, and lymphovascular invasion are risk factors of axillary lymph node metastasis in Luminal A breast cancer.
目的 总结彩色多普勒超声（彩超）结合钼靶X线摄片标记定位对无临床体征乳腺肿块的定位诊断价值。 方法 2010年3月－2011年10月对48例彩超和钼靶X线检查发现可疑病灶而无任何临床体征的患者，在彩超引导下穿刺病灶金属导丝标记定位，并结合钼靶X线检查切除病灶，同时快速冰冻活检明确诊断。 结果 48倒中有11例确诊为乳腺癌（浸润性导管癌7例，导管内癌4例），37例为良性病变（纤维瘤5例，导管内乳头状瘤4例，乳腺腺病28例）。冰冻切片病理检查与术后石蜡病检结果一致。 结论 彩超引导下穿刺钢丝标记定位活检结合钼靶X线摄片，有效地解决了乳腺细小钙化和微小病灶活检术中精确定位和完整切除的难题，对无临床体征的微小乳腺肿块的诊断准确、可靠、实用。
ObjectiveTo explore the correlation between lipid profile and molecular typing of invasive breast cancer.MethodsThree hundreds and seventy-five patients with primary invasive breast cancer diagnosed from Breast Surgery, Affiliated Hospital of Southwest Medical University from January 2018 to June 2019. The total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (LDL-C), apolipoprotein A (ApoA), and apolipoprotein B (ApoB) concentrations were detected. Molecular classification based on the results of postoperative immunohistochemistry of breast cancer patients, compared the measured values of each subtype.ResultsThere were no significant difference in serum TG, HDL-C and ApoA among the four subtypes (P>0.05). Differences serum levels of TC, LDL-C, and ApoB among breast cancer patients of various subtypes were statistically significant (P<0.05). Serum TC concentration in the HER2 overexpression type [(5.08±1.00) mmol/L] and the triple negative type [(5.12±0.91) mmol/L] were significantly higher than the Luminal A type [(4.68±1.01) mmol/L] and the Luminal B type [(4.79± 0.93) mmol/L], P<0.05. Serum LDL-C concentration in the triple negative type [(3.14±0.88) mmol/L] was significantly higher than the LuminalA type [(2.77±0.84) mmol/L] and the LuminalB type [(2.87±0.81) mmol/L], P<0.05. Serum ApoB concentration in the Luminal B type [(0.94±0.23) g/L] was significantly lower than the triple negative type [(1.03±0.23) g/L].ConclusionThere are differences in serum TC, LDL-C and apoB concentrations among different subtypes of breast cancer, but TG, HDL-C and ApoA are not related to molecular typing of breast cancer.
ObjectiveTo compare the clinicopathologic characteristics and the difference of efficacy after neoadjuvant chemotherapy (NACT) between the patients with triple positive breast cancer (TPBC) and human epidermal growth factor receptor 2 (HER2) overexpression breast cancer. MethodsThe patients with TPBC and HER2 overexpression breast cancer admitted to the Affiliated Hospital of Southwest Medical University from January 2019 to July 2021 who met the inclusion conditions of this study were retrospectively collected, and the differences of clinicopathologic characteristics and the efficacy after NACT were compared between the patients with TPBC and HER2overexpression breast cancer. Meanwhile the risk factors affecting the efficacy of NACT were analyzed by logistic regression according to the risk factors of pCR based on the statistically significant indicators of univariate analysis and the indicators related to clinical characteristics. The HER2 overexpressing breast cancer was positive HER2, negative estrogen receptor (ER) and progesterone receptor (PR), and the TPBC was positive HER2, ER, and PR. The pathological complete response (pCR) was used to evaluate the efficacy, which was defined as ypT0/isypN0. ResultsA total of 105 patients were enrolled in this study, including 57 patients with TPBC and 48 patients with HER2 overexpression breast cancer, as well as 50 patients with pCR and 55 patients with non-pCR. ① Compared with patients with TPBC, the patients with HER2 overexpression breast cancer had the higher proportions of Miller-Payne system grade 4–5, partial response, pCR, and neutrophil-lymphocyte ratio (NLR) >2.77 (P<0.05). There were no statistical differences in other characteristics such as age, family history of breast cancer, histological grade, T and TNM stages, lymph node metastasis, lymphocyte-monocyte ratio, Ki-67 expression, and surgical method between them (P>0.05). ② The results of logistic multivariate analysis showed that the later T stage, the lower Ki-67 expression, the lower NLR, and the positive ER and PR statuses were not easy to achieve pCR after NACT (P<0.05). ConclusionsAccording to the results of this study, the efficacy of patients with HER2 overexpression breast cancer receiving NACT is more likely to achieve pCR than that of patients with TPBC. Positive hormone receptors (ER and PR), later T stage (stage 3–4), lower Ki-67 expression, and lower NLR (≤2.77) might be a worse efficacy after NACT for patients with breast cancer.
ObjectiveTo evaluate the predictive value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with multislice computed tomography (MSCT) in the evaluation of neoadjuvant chemotherapy (NACT) for breast cancer. MethodsThe clinical, imaging, and pathological data of breast cancer patients who received NACT in the Affiliated Hospital of Southwest Medical University from February 2019 to August 2021 were retrospectively collected. Based on the results of postoperative pathological examination, the patients were assigned into significant remission (Miller-Payne grade Ⅰ–Ⅲ) and non-significant remission (Miller-Payne grade Ⅳ–Ⅴ). The variables with statistical significance by univariate analysis or factors with clinical significance judged based on professional knowledge were included to conduct the logistic regression multivariate analysis to screen the risk factors affecting the degree of pathological remission after NACT. Then, the screened risk factors were used to establish a prediction model for the degree of pathological remission of breast cancer after NACT, and the efficacy of this model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) curve. ResultsAccording to the inclusion and exclusion criteria, a total of 211 breast cancer patients who received NACT were collected, including 116 patients with significant remission and 95 patients with non-significant remission. Logistic regression multivariate analysis results showed that the human epidermal growth factor receptor 2 positive, lower early enhancement rate after NACT, lower arterial stage net increment after NACT, and lower CT value of arterial phase of lesions would increase the probability of significant remission in patients with breast cancer after NACT (P<0.05). The area under the ROC curve of the model for predicting the degree of pathological remission of breast cancer after NACT was 0.984, the specificity was 93.7%, and the sensitivity was 95.7%. The calibration curve showed that the model result fit well with the actual result, and the DCA result showed that it had a high clinical net benefit value. ConclusionFrom the results of this study, DCE-MRI combined with MSCT enhanced scanning has a good predictive value for pathological remission degree after NACT for breast cancer, which can provide clinical guidance for further treatment.
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.