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05 October 2019, Volume 24 Issue 05 Previous Issue    Next Issue

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Incidence of female breast cancer in Shanghai: current evidence and a comparative retrospective study WU Chunxiao, GU Kai, WANG Chunfang, PENG Peng, GONG Yangming, SHI Liang, XIANG Yongmei, PANG Yi, BAO Pingping 2019, 24 (05):  421-427.  DOI: 10.16139/j.1007-9610.2019.05.011 Abstract ( 276 )   PDF (708KB) ( 182 )   Objective To analyze the current incidence and mortality of female breast cancer in Shanghai during the period 2002-2015 and to provide the reference for research on breast cancer prevention and control. Methods The data of female cases with breast cancer were collected by the Shanghai Cancer Registry. The incidence and mortality of female breast cancer in Shanghai between 2013 and 2015 were compared with those in international study in 2018. The age distribution, basis of diagnosis, pathological classification and diagnostic stage were studied. Both standardized rates and age-specific rates of incidence and mortality of breast cancer between 2002 and 2015 were analyzed. Results Breast cancer incidence lists the first rank and the mortality of breast cancer lists the 4th rank in female cancer in Shanghai between 2013 and 2015. Averagely, 5 293 female cases with breast cancer were diagnosed each year between 2013 and 2015 in Shanghai which accounted for 15.82% of total female cancer. The crude rate of incidence was 73.34 per 100 000 and standar-dized rate was 38.45 per 100 000 with ratio of mortality-incidence 0.27. There were 1 448 cases of death due to breast cancer each year accounting for 9.51% of all female cancer death. The crude rate of mortality was 20.06 per 100 000 with standardized rate 7.42 per 100 000. The crude rate of incidence and mortality in Shanghai were higher than that in the world, Eastern Asia, China but lower than in USA. Standardized mortality of breast cancer in Shanghai, however, was lower than that in all including Eastern Asia, USA, China and the world. The age-specific incidences of breast cancer increased with age from 20 to 59 years old with similar incidence in the groups between 55 to 74 years old, and decreased with age increasing from 75 years old. The age-specific mortality increased with age from 20 to 85 years and older. There were 94.39% of new cases of breast cancer with pathological diagnosis, 29.42% of cases on stage one and 30.82% of cases with incomplete data. Between 2002 and 2015, the age-standardized incidence of female breast cancer in Shanghai showed the trend increasing constantly and the trend of mortality without change. Conclusions The age-standardized incidence of female breast cancer increased in Shanghai between 2002 and 2015. The mortality of breast cancer without change suggests effective treatment and improvement of survival. References | Related Articles | Metrics

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Breast cancer patients with 1-2 positive sentinel lymph nodes without axillary lymph node dissection: influencing factors and prognosis CHEN Xiaosong, WU Jiayi, HUANG Ou, HE Jianrong, ZHU Li, LI Yafen, CHEN Weiguo, SHEN Kunwei 2019, 24 (05):  428-433.  DOI: 10.16139/j.1007-9610.2019.05.012 Abstract ( 1453 )   PDF (533KB) ( 65 )   Objective To analyze the factors influencing breast cancer patients with 1-2 positive sentinel lymph nodes which meets ACOSGO Z0011 criteria without further axillary lymph node dissection (ALND) and their prognosis. Methods Patients with cT1-2N0 invasive breast cancer received breast conserving surgery and radiotherapy were enrolled retrospectively in Comprehensive Breast Health Center, Rujin Hospital between January 2012 and August 2019. Factors which influenced not to receive further ALND in patients with 1-2 positive sentinel lymph node and its association with prognosis were analyzed. Results were listed as odds ratio and 95% confidence interval. Results A total of 161 patients were studied, including 78 patients without ALND in the SLNB group and 83 patients in the ALND group. There were 11 (13.3%) patients with non-SLN metastasis and 4 (4.8%) patients with 3 axillary lymph node (ALN) metastasis in the ALND group. Both univariate and multivariate analysis found that surgical-year was associated with ALND (P<0.001). Patients in more recent surgical-year were received less ALND. Eleven (14.1%) and 6 (3.6%) patients in the SLNB and ALND groups had no further adjuvant chemotherapy, respectively. Univariate analysis showed that age (P<0.001), menopausal status (P=0.016), and ALN surgery(P=0.018) were related with adjuvant chemotherapy. Multivariate analysis showed that only age was independently related with chemotherapy(P<0.001). With a median follow up of 42.0 months, ALN recurrence was found only 1 (1.3%) patient in the SLNB group and none in the ALND group. Conclusions Patients with 1-2 positive sentinel nodes who met the eligible criteria of ACOSOG Z0011 trial could be treated without ALND. The association of ALND with long-term survival deserves further evaluation. References | Related Articles | Metrics

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Lower axillary lymph node dissection in patients of breast cancer with negative sentinel lymph node WEN Tao, FANG Zhen, WANG Ke, SHE Qiuman, ZHENG Jingyan, HUANG Kaiming, SHI Yong 2019, 24 (05):  434-439.  DOI: 10.16139/j.1007-9610.2019.05.013 Abstract ( 610 )   PDF (706KB) ( 141 )   Objective To study lower axillary lymph node dissection in patients of breast cancer with negative sentinel lymph node (SLN). Methods From January 2015 to January 2017, a total of 718 patients of breast cancer with negative SLN had mastectomy and lower axillary lymph node dissection in both our department and Department of Surgery Comprehensive Breast Health Center Ruijin Hospital Shanghai Jiao Tong University School of Medicine. Metastasis rate of lower axillary lymph node and the factors related to metastasis were analyzed. Results Lower axillary lymph node was identified in 686 cases (95.5%) with (9.35±5.684) (0~21) lymph node per patients on average. Metastasis to lower axillary lymph nodes was found in 40 patients (5.6%, 40/718). Single-variant analysis showed that metastasis of lower axillary lymph nodes was related to enlarged axillary lymph nodes, number of SLN biopsy, tumor vascular thrombus, nerve invasion, HER2 positive, and molecular classification (P<0.05). Independent risk factors associated with lower axillary lymph node metastasis were shown in multivariate Logistic analysis including enlarged axillary lymph nodes, number of SLN biopsy, tumor vascular thrombus, nerve invasion, and molecular classification. There were 5 (0.7%) cases with postoperative upper limb lymphedema, and upper limb dysfunction was not found. Conclusions Metastasis of lower axillary lymph node was present combined with multiple risk factors in the patients of breast cancer with negative SLN and should be dissected. References | Related Articles | Metrics

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Analysis of invasive micropapillary mucinous carcinoma of breast CHEN Shujie, CHEN Xiaosong, JI Min, SHAO Yuguo, SHEN Kunwei, HE Qi 2019, 24 (05):  440-445.  DOI: 10.16139/j.1007-9610.2019.05.014 Abstract ( 394 )   PDF (552KB) ( 82 )   Objective To investigate differences in clinicopathological features and prognosis between invasive micropapillary mucinous carcinoma (IMpMC) and pure mucinous carcinoma (PMC) of breast. Methods The patients of IMpMC and those of PMC were enrolled in this study retrospectively with clinicopathological and follow-up data from Shanghai Jiao Tong University Breast Cancer Database (SJTU-BCDB) between September 2008 and December 2017. Differences in clinicopathology and prognosis between IMpMC and PMC were analyzed. Results A total of 239 patients were enrolled including 27 (11.3%) cases with IMpMC and 212 (88.7%) cases with PMC. Multivariate analysis on clinicopathological feature showed that there were more cases with IMpMC with lymph node metastasis (OR=4.84, P=0.014), lymphovascular invasion (OR=13.38, P=0.001) and higher expression of Ki67 (OR=4.07, P=0.044) when compared the patients with PMC. Multivariate analysis on treatment showed that radical mastectomy for breast cancer (OR=10.00, P=0.003), adjuvant chemotherapy (OR=7.11, P<0.001) and radiotherapy (OR=5.33, P=0.006) were performed for more cases with IMpMC than for cases with PMC. PMC patients had higher disease free survival (DFS) 92.5% and overall survival (OS) 98.6%, compared to IMpMC patients (DFS 79.2%, P=0.011, OS 93.8%, P=0.022). Pathological type and tumor size were independent factors associated with DFS shown in multivariate analysis. IMpMC patients had lower DFS than PMC patients (HR=10.39, P=0.014). Conclusions IMpMC was associated with aggressive behavior and worse prognosis when compare to PMC. References | Related Articles | Metrics

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Use head thermoplastic mask and breast bracket with body markers for breast cancer patient improves setup accuracy of intensity-modulated radiotherapy JIANG Qing, ZHU Ming, XU Cheng, WANG Shubei, CAO Lu, CAI Rong, CHEN Jiayi, CAI Gang 2019, 24 (05):  446-451.  DOI: 10.16139/j.1007-9610.2019.05.015 Abstract ( 474 )   PDF (898KB) ( 73 )   Objective To study the effect of using head thermoplastic mask and breast bracket combined with body marker to decrease setup errors in intensity-modulated radiotherapy (IMRT) of chest wall and clavicular region. Methods Ten breast cancer patients receiving IMRT on chest wall and sup/infraclavicular regional lymph nodes after breast surgery were enrolled. Each patient with breast bracket was immobilized into 3 positions: using breast bracket only (group A), using body marker with breast bracket (group B) and using body marker and head thermoplastic mask with breast bracket (group C). Setup errors of irradiation field center, spinous process of clavicular region and clavicle were examined using X-ray simulator once a week for 5 week with each position and compared. All ten patients were treated IMRT with position in group C. Results A total of 141 set of data in all 3 groups (47 set of data each group) were gotten. The setup errors of irradiation field center in 3 directions of left-right, superior-inferior and anterior-posterior in group C were significantly less than those in group A and B (P<0.05). Setup errors of spinous process of clavicular region in left-right direction increased with the distance from inferior margin to above of clavicular head. There were 12.8%, 6.4% and 2.1% of setup errors more than 5 mm in left-right direction at 6 cm above clavicular head in group A, B and C, respectively. Setup errors of patients in group C were significantly less than those in group A and B (P<0.05) except for those of superior margin of clavicular head and 1 cm, 2 cm above clavicular head. Setup errors of clavicle in superior-inferior direction in group C were significantly less than those in group A and B (P<0.001). Conclusions Head thermoplastic mask and breast bracket combined with body markers could reduce setup errors of irradiation field center, spinous process of clavicular region and clavicle, which improved setup accuracy of IMRT for breast cancer patients. References | Related Articles | Metrics

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Impact of information receiving status on presurgical anxiety of patients undergoing breast day surgery WU Liping, QIAN Qianjian, WANG Wei, SHEN Kunwei, LI Yafen, CHEN Weiguo, FANG Qiong 2019, 24 (05):  452-457.  DOI: 10.16139/j.1007-9610.2019.05.016 Abstract ( 399 )   PDF (603KB) ( 81 )   Objective To study the impact of information receiving on presurgical anxiety of the patients undergoing breast day surgery. Methods A cross-sectional study was done using general information collection form, the Amsterdam preoperative anxiety and information scale (APAIS) and quality of life questionnaire-information 25 (QLQ-INFO25). Patients undergoing breast day surgery were investigated. Results Presurgical anxiety score of 150 patients undergoing breast day surgery was (9.55±3.73) with 45.3% of high level anxiety ratio. Information requirement score was gotten (6.11±2.31) with ratio of moderate to high requirement of information 72%. Total standardized score of QLQ-INFO25 was (45.87±18.42). Information receiving was influenced by different education background (P<0.01). Presurgical anxiety was associa-ted with total standardized score of information receiving (P=0.043), disease information (P=0.032), medical examination (P=0.011), satisfaction to information receiving (P=0.012) and overall information help (P=0.021) significantly. Conclusions It was shown that more patients undergoing breast day surgery had moderate to high need of information receiving and moderate to high extent of presurgical anxiety. This study highlights improving of information receiving which would reduce presurgical anxiety of patients. References | Related Articles | Metrics

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Acute appendicitis: relationship between blood inflammatory markers with CT grading and pathological classification WANG Jian, PAN Xin, TANG Cui, MA Le, ZENG Siliang 2019, 24 (05):  458-464.  DOI: 10.16139/j.1007-9610.2019.05.017 Abstract ( 271 )   PDF (1137KB) ( 69 )   Objective To explore the relationship between blood inflammatory markers combined with abdominal computed tomography (CT) grading and pathological classification in the patient with acute appendicitis for early diagnosis of acute appendicitis. Methods The clinical data of 133 patients of acute appendicitis were retrospectively analyzed with blood inflammatory markers, abdominal CT scan and pathological classification. Results Pathological classification of patients including 14 cases with uncomplicated appendicitis, 108 cases with suppurative appendicitis and 11 cases with gangrenous or perforated appendicitis correlated abdominal CT grading significantly (R=0.374,P<0.001). Blood inflammatory markers, which were white blood cell (WBC) count, neutrophil percentage (N%), and CRP concentration, and appendiceal diameter from CT scan increased simultaneously. The indexes (WBC≥12.45×109/L,N%≥81.80%,CRP≥22.56 mg/L,and appendiceal diameter ≥8.75 mm) could help differentiation of uncomplicated acute appendicitis from gangrenous or perforated appendicitis. CRP concentration above cut-points 54.00 mg/L differentiated the diagnosis of patients with gangrenous or perforated appendicitis from suppurative or uncomplicated appendicitis. The patients with CT grade 1 were determined by any one of the indicators (WBC, N%, CRP and appendix diameter) exceeds the normal value. The patients with CT grade 2 presented elevation of both CRP and appendiceal diameter. The patients with CT grade 3 and 4 presented all elevation of WBC, N% and CRP levels. Conclusions Very high concentration levels of CRP in the patients with acute appendicitis might be useful for differential diagnose between gangrenous or perforated appendicitis and uncomplicated or suppurative appendicitis. Combined observation of WBC, N%, CRP or appendiceal diameter improves the accuracy of early diagnosis of acute appendicitis. References | Related Articles | Metrics