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25 September 2022, Volume 27 Issue 05 Previous Issue    Next Issue

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Editorial

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Diagnosis and treatment in early operable breast cancer: current status and prospect CHEN Xiaosong, SHEN Kunwei, Ll Hongwei 2022, 27 (05):  385-386.  DOI: 10.16139/j.1007-9610.2022.05.001 Abstract ( 312 )   HTML ( 16 )   PDF (210KB) ( 190 )   References | Related Articles | Metrics

Experts forum

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Post-mastectomy implant-based breast reconstruction WU Jiayi, LU Yujie, HE Jinguang, SHEN Kunwei, XU Hua 2022, 27 (05):  387-391.  DOI: 10.16139/j.1007-9610.2022.05.002 Abstract ( 214 )   HTML ( 13 )   PDF (732KB) ( 180 )   Figures and Tables | References | Related Articles | Metrics

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Surgical treatment of hereditary breast cancer CHEN Yiding, WU Shijie 2022, 27 (05):  392-395.  DOI: 10.16139/j.1007-9610.2022.05.003 Abstract ( 197 )   HTML ( 8 )   PDF (310KB) ( 108 )   References | Related Articles | Metrics

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Endoscopic and robotic breast surgery: present and future—the experience of West China Hospital XIE Yanyan, LU Qing, DU Zhenggui 2022, 27 (05):  396-402.  DOI: 10.16139/j.1007-9610.2022.05.004 Abstract ( 287 )   HTML ( 13 )   PDF (1483KB) ( 301 )   Figures and Tables | References | Related Articles | Metrics

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Application of local microwave ablation in treatment of breast cancer ZHOU Wenbin, TANG Xinyu, WANG Shui 2022, 27 (05):  403-405.  DOI: 10.16139/j.1007-9610.2022.05.005 Abstract ( 178 )   HTML ( 5 )   PDF (313KB) ( 127 )   References | Related Articles | Metrics

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Management of regional lymph nodes in early-stage breast cancer CAO Lu, ZHENG Siyue, CHEN Jiayi 2022, 27 (05):  406-410.  DOI: 10.16139/j.1007-9610.2022.05.006 Abstract ( 172 )   HTML ( 6 )   PDF (480KB) ( 126 )   References | Related Articles | Metrics

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Value and application of intervention in advanced breast cancer HUANG Wei, Ll Hengyu, DING Xiaoyi 2022, 27 (05):  411-415.  DOI: 10.16139/j.1007-9610.2022.05.007 Abstract ( 199 )   HTML ( 4 )   PDF (513KB) ( 203 )   References | Related Articles | Metrics

Guideline and consensus

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Multi-gene assay profiling testing in ER+/HER2- breast cancer: ASCO guidelinesinterpretation and Ruijin Hospital experience SHU Lan, CHEN Xiaosong 2022, 27 (05):  416-420.  DOI: 10.16139/j.1007-9610.2022.05.008 Abstract ( 160 )   HTML ( 4 )   PDF (504KB) ( 67 )   Figures and Tables | References | Related Articles | Metrics

Original article

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Study on tumour suppressor gene TP53 mutation and prognosis in patients with triple-negative breast cancer YANG Cuiyan, WANG Haoyu, CHEN Xiaosong, SHEN Kunwei 2022, 27 (05):  421-428.  DOI: 10.16139/j.1007-9610.2022.05.009 Abstract ( 362 )   HTML ( 4 )   PDF (1214KB) ( 131 )   Objective To investigate tumour suppressor gene TP53 mutation, clinicopathological features and prognosis in the patients with triple-negative breast cancer (TNBC). Methods The rate and distribution of TP53 mutation, clinicopathological features, and prognosis in the patients with TNBC and with surgery at our center from January 2012 to March 2019 were retrospectively analyzed. Results In total of 234 TNBC cases, 144 (61.54%) cases were with TP53 mutation type and 90 (38.46%) cases with TP53 wild type. Most mutation was located at exon 5-8 region. The cases with TP53 mutation were divided into the group of missense mutation 85(59.03%) cases and the group of non-missense mutation 59 (40.97%) cases. More cases with TP53 mutation type had higher proliferation antigen(Ki-67) expression (>30%) when compared with the cases with TP53 wild type (80.56% vs. 63.33%, P=0.004, OR=2.40). There was no significant diffe-rence in prognosis between the group of mutation type and the group of wild type in relapse-free survival (RFS) (P=0.447), overall survival (OS) (P=0.083), and distant relapse-free survival (DRFS) (P=0.131). Similarly, there was no significant difference in prognosis between TP53 missense mutation and non-missense mutation in RFS(P=0.226), OS(P=0.885), and DRFS(P=0.172). Conclusions TNBC patients with TP53 mutation exhibited higher Ki-67 expression, however, similar prognosis between TP53 mutation type and wild type. Figures and Tables | References | Related Articles | Metrics

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Metastatic lymph node ratio to evaluate prognosis of patients with stage Ⅱ-Ⅲ gastric cancer after radical gastrectomy DAI Zhiqiang, ZHENG Jinxin, TANG Zhaoqing, ZHANG Qi, GU Yuan, SHI Zhongyi, HU Guohua, SUN Yihong 2022, 27 (05):  429-434.  DOI: 10.16139/j.1007-9610.2022.05.010 Abstract ( 225 )   HTML ( 0 )   PDF (708KB) ( 91 )   Objective To study the metastatic lymph node ratio for grouping of gastric cancer patients and evaluate the prognosis. Methods A total of 392 patients of gastric cancer who underwent radical gastrectomy with stage Ⅱ-Ⅲ according to the American Joint Committee on Cancer (AJCC) 8th in Zhongshan Hospital of Fudan University from January 2004 to July 2018 were retrospectively analyzed. X-tile software was used to group patients based on the metastatic lymph node ratio. The correlation between metastatic lymph node ratio and other clinicopathological factors was made, and the evaluation of prognosis of patients was assessed. The nomogram model of prediction was established. Calibration curves were drawn, and comparison between the curves and data of patients was performed. Internal validation was done by the Bootstrap method. Concordance index (C-index) was calculated to test the accuracy of model. Results X-tile analysis showed that the best cut-off values were 0.20 (20%) and 0.70 (70%) of metastatic lymph node ratio. According to the cut-off values, the patients in this study were divided into 3 subgroups at metastatic lymph node ratio 1(0-20%), metastatic lymph node ratio 2 (21%-69%), and metastatic lymph node ratio 3 (70%-100%) with significant difference in survival statistically(P<0.001). Univariate analysis showed that metastatic lymph node ratio, TNM stage, T stage, N stage, lymphatic invasion, and age were related factors affecting prognosis. Multivariate analysis showed that metastatic lymph node ratio, T stage, N stage, lymphatic invasion, and age were independent factors affecting prognosis. Receiver operator characteristic curve of postoperative overall survival rates of patients were drawn using metastatic lymph node ratio, TNM stage, lympha-tic invasion and age, of which area under the curve were 0.699, 0.667, 0.587 and 0.561. The independent 4 risk factors were taken into account to construct nomogram prediction models. C-index was 0.707 (95% CI: 0.705-0.708). The 1-, 3- and 5- year survival rate predicted by the nomogram were consistent with the actual data. Conclusions Metastatic lymph node ratio is an independent factor affecting the prognosis of radical gastrectomy for stage Ⅱ-Ⅲ gastric cancer. Metastatic lymph node ratio is an effective supplement to pathological N stage, which can direct reasonable treatment. Figures and Tables | References | Related Articles | Metrics

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Short-term outcomes after total mesorectal excision for middle and low rectal cancer: transanal versus laparoscopic approach—a meta analysis QIN Wei, HU Yanyan, XU Ximo, CAI Zhenghao, LI Jianwen, GONG Kunmei, FENG Bo 2022, 27 (05):  435-442.  DOI: 10.16139/j.1007-9610.2022.05.011 Abstract ( 189 )   HTML ( 2 )   PDF (849KB) ( 69 )   Objective To compare the safety and efficacy of transanal total mesorectal excision (TaTME) and laparoscopic total mesorectal excision (LaTME) for middle and low rectal cancer. Methods This study searched the clinical studies systematically comparing the short-term efficacy of TaTME and LaTME published in PubMed, Web of Science, CNKI, China Biology Medicine disc and Wanfang medical database. Systematic reviews and meta-analysis were conducted to base on the Preferred Reporting Items for Systematic Evaluation and Meta-Analysis. Fixed-effects model or random-effects model was used for evaluation of data. Parameters of outcome evaluation included operation time, intraoperative blood loss, tumor size, conversion rate, length of hospital stay, number of lymph node dissection, distance of rectal lesion from anal verge, positive rate of distal resection margin(DRM), positive rate of circumferential resection margin(CRM), and postoperative complications. Results Nine studies with 1 of randomized controlled trial and 8 of prospective study were included to compare the outcomes of 451 TaTME and 438 LaTME in middle and low rectal cancer. TaTME had a significantly lower rate of conversion to open surgery (RR=0.13, P=0.002) and a lower DRM positive rate(RR=0.17, P<0.03) when compared to LaTME. There was no significant difference between two groups in operative time(RR=15.48, P=0.18), intraoperative blood loss (RR=2.34, P=0.81), postoperative complications (RR=1.05, P=0.72), length of hospital stay (RR=-0.91, P=0.14), tumor size (RR=0.04, P=0.55), number of lymph nodes dissection(RR=-0.71, P=0.17), distance of rectal lesion from anal verge(RR=-1.26, P=0.20) and positive rate of CRM(RR=0.77, P=0.53). Conclusions TaTME has the surgical safety same as LaTME. When the distal resection margin is at risk, TaTME may be a good choice for low and ultra-low rectal cancer. Figures and Tables | References | Related Articles | Metrics

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Clinical study on endoscopic injection of tissue adhesive with hardener in treatment of gastric varices and follow-up ZHANG Mengyin, CHEN Ping, YUAN Xiaoqin, CAI Boer, WU Yunlin 2022, 27 (05):  443-447.  DOI: 10.16139/j.1007-9610.2022.05.012 Abstract ( 173 )   HTML ( 1 )   PDF (863KB) ( 116 )   Objective To analyze the therapeutic effect of endoscopic injection of tissue adhesive combined with hardener for the portal hypertensive patients with gastric varicose and prognosis. Methods A total of 84 patients with upper gastrointestinal hemorrhage and gastric varices diagnosed by gastroscopy during 2006 to 2015, who were performed endoscopic injection with tissue adhesive with hardener, were included in this study. The rate of gastric hemorrhage was compared before and after endoscopic treatment. The rate of gastric varices elimination and the prognosis were analyzed. Results There were 111 times of endoscopic treatment for 84 cases with an average of(1.32±0.68) times per case. Bleeding was (0.72±0.54) times/month before treatment and (0.30±0.82) times/month after treatment respectively with significant difference statistically(P<0.01). The eradication rate of varicose veins with almost disappearance was 75.0% during the period of 6 months post endoscopic treatment and 70.8% after 6 months of endoscopic treatment. No re-bleeding was found without any complications, ectopic embolization and infection after follow-up of (14.82±19.30) months. Conclusions Endosco-pic injection of tissue adhesive and hardener for gastric varices would reduce the rate of bleeding of gastric varicose and the varicose vein, which was an important procedure for prevention of re-bleeding of gastric varicose vein and could be applied clinically. Figures and Tables | References | Related Articles | Metrics

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A prospective study on team-based learning combined with case-based learning in training thyroid surgery of medical intern LUO Zhiping, GUO Zichao, SUN Hanxing, CHENG Xi, LIU Zhuoran, ZHANG Tao, YAN Jiqi, QIU Weihua, KUANG Jie, ZHAO Ren 2022, 27 (05):  448-452.  DOI: 10.16139/j.1007-9610.2022.05.013 Abstract ( 178 )   HTML ( 0 )   PDF (524KB) ( 63 )   Objective To explore the application of team-based learning(TBL) combined with case-based learning (CBL) in training program of thyroid surgery on medical intern. Methods A prospective study was conducted in 94 interns with training program from November 2020 to June 2021 in thyroid surgery, Ruijin Hospital. The interns were grouped chronologically. Forty-six interns from November 2020 to February 2021 were included into control group and 48 interns from March 2021 to June 2021 into study group. Interns in control group were given traditional training and interns in study group with TBL with CBL training. Basic theory and knowledge, basic operative skill and ability of managing crisis were evaluated and compared between two groups. Results The basic theory and knowledge in study group were significantly better than that in control group (t=12.610, P<0.05). However, there was no significant difference in basic operative skill (t=1.566, P>0.05) and ability of managing crisis (t=1.313, P>0.05) between two groups. As for crisis management abi-lity, the team work ability (t=3.610, P<0.05) in study group was significantly better than that in control group and the completion time of patient rescue in study group (t=2.349, P<0.05) shorter than that in control group. Conclusions For learning thyroid surgery of medical intern, TBL combined with CBL training program could increase the effect of clinical teaching and team work ability of managing crisis, which would have prospects of application. Figures and Tables | References | Related Articles | Metrics

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Risk factors for Delphian lymph node metastasis in papillary thyroid carcinoma YAN Haibo, XIA Zhongping, CHEN Shan, JIANG Lin, HAN Chun 2022, 27 (05):  453-457.  DOI: 10.16139/j.1007-9610.2022.05.014 Abstract ( 197 )   HTML ( 0 )   PDF (551KB) ( 76 )   Objective To investigate the risk factors for Delphian lymph node metastasis in papillary thyroid carcinoma. Methods Retrospective analysis of 99 patients treated in Taizhou Cancer Hospital from July 2017 to July 2019 were done in this study. Delphian lymph nodes metastasis related with tumor diameter, location or central lymph node metastasis were analyzed. Results The rate of detected Delphian lymph node in the patients with radical operation of papillary thyroid carcinoma was 70.7% (70/99) with the metastasis rate 18.6% (13/70). Totally 13 in 99 cases (13.1%) were found metastasis. Univariate analysis showed that Delphian lymph node metastasis was related with the number of lymph nodes detected (t=7.040, P=0.008), age (t=4.714, P=0.030), the foci located at isthmus (t=11.588, P=0.001), and pretracheal lymph node metastasis (t=8.659, P=0.003). There was no significant relationship between Delphian lymph node metastasis and gender, tumor diameter, multiple foci, bilateral lesions, extrathyroid invasion, or foci located in upper third of thyroid lobe (P>0.05). Multivariate Logistics analysis showed that isthmus carcinoma (P=0.010, OR=9.079), more than 2 Delphian lymph nodes (P=0.005, OR=18.739), and pretracheal lymph node metastasis (P=0.013, OR=8.530) were independent risk factors of Delphian lymph node metastasis. Conclusions It should be paid more attention to Delphian lymph node during central department lymph node dissection for those patients with thyroid isthmus carcinoma, pretracheal lymph node metastasis and many lymph nodes. Figures and Tables | References | Related Articles | Metrics

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Spot stenting combined with false lumen endovascular occlusive repair in treatment of postoperative aortic dissecting aneurysm YUAN Ye, ZHOU Min, WANG Enci, LI Zheyun, ZHANG Yuchong, LIN Peng, MO Fandi, GUO Daqiao, FU Weiguo, WANG Lixin 2022, 27 (05):  458-462.  DOI: 10.16139/j.1007-9610.2022.05.015 Abstract ( 156 )   HTML ( 0 )   PDF (731KB) ( 110 )   Objective To retrospectively evaluate the mid-term outcome of spot stenting combined with false lumen endovascular occlusive repair(SS-FLEVOR) in the treatment of postoperative aortic dissection aneurysm. Methods Both perioperative and follow-up data of the patients with aortic dissection aneurysm after thoracic endovascular aortic repair (TEVAR) who underwent SS-FLEVOR from October 2016 to October 2020 were collected and analyzed. The preoperative and postoperative largest diameters of both thoracic aortic true lumen and abdominal aortic true lumen were analyzed combined with the thrombus in false lumen and stents patency of visceral arteries. Results A total of 17 cases were enrolled with an average age of (54.5±14.5) years and 3 cases female. SS-FLEVOR was all successful. Mean operative time was (151.4±37.9) min with follow-up time of (24.9±20.7) months. During the follow-up period, the stents in visceral arteries were all patent. Thrombus was formed in thoracoabdominal aortic false lumen 10 cases and in thoracic false lumen 3 cases. Partial blood flow was found 4 cases in thoracoabdominal aortic false lumen. The sac size did not increase due to decreasing in blood flow of the false lumen gradually and secondary intervention was not needed. The true lumens diameter increased compared with those of preoperative for thoracic aorta [(2.1±0.6) cm vs. (1.7±0.7) cm, P=0.001] and for abdominal aorta [(1.4±0.6) cm vs. (1.1±0.4) cm, P=0.001]. The diameter of true lumen decreased in 1 case after six months post operation (1.3 cm vs. 1.7 cm) due to the compression caused by the stent-graft in false lumen. There was no stent displacement, paraplegia, infection, visceral artery stent occlusion and other complications occured during the period of follow-up. Conclusions SS-FLEVOR might be relatively safe, effective and feasible with satisfied results for specific cases. Figures and Tables | References | Related Articles | Metrics

Review

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Study on circulating tumor DNA and circulating tumor cell detecting minimal residual disease in breast cancer PAN Ruixin, CHEN Xiaosong, SHEN Kunwei 2022, 27 (05):  463-467.  DOI: 10.16139/j.1007-9610.2022.05.016 Abstract ( 263 )   HTML ( 5 )   PDF (555KB) ( 209 )   Breast cancer is the most commonly diagnosed female cancer in the world and 20%-30% patients faced the risk of recurrence and metastasis. Minimal residual disease(MRD) was believed as one of the important factors promo-ting disease progress in breast cancer and was closely associated with poor prognosis. Detection of MRD currently used liquid biopsy including detection of circulating tumor DNA and circulating tumor cell. The methods of detecting MRD in the evaluation of effect and prognosis and recurrence monitoring in breast cancer were explored in this review. Figures and Tables | References | Related Articles | Metrics

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Study on obesity associated with prognosis of early breast cancer and efficacy of adjuvant therapy ZHU Siyi, CHEN Xiaosong, SHEN Kunwei 2022, 27 (05):  468-472.  DOI: 10.16139/j.1007-9610.2022.05.017 Abstract ( 189 )   HTML ( 3 )   PDF (438KB) ( 139 )   With overweight and obese population increasing worldwide, the association of body mass index(BMI) of breast cancer patients with the prognosis and treatment efficacy has become a hot topic. Here we reviewed the impact of obesity on prognosis and efficacy of adjuvant therapy of early breast cancer. A number of studies have shown that higher BMI was associated with larger tumors and increased lymph node involvement, more grading and higher proliferation. The effect of obesity on prognosis of early breast cancer differed across disease subtypes. Obesity was associated with poorer prognosis for hormone receptor-positive breast cancer, while the association of obesity with prognosis for other breast cancer subtypes was still controversial. Obesity could probably decrease the efficacy of adjuvant lipophilic chemotherapies for early breast cancer. The impact of obesity on efficacy of adjuvant endocrine therapy might depend on the type of aromatase inhibitor. The correlation between obesity and efficacy of adjuvant HER2- targeted therapy has not been clear. References | Related Articles | Metrics

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Study on trophoblast cell-surface antigen 2 gene and triple-negative breast cancer WANG Jieqiang, MA Dekui 2022, 27 (05):  473-477.  DOI: 10.16139/j.1007-9610.2022.05.018 Abstract ( 384 )   HTML ( 6 )   PDF (616KB) ( 243 )   Trophoblast cell-surface antigen 2(Trop2) gene plays an important role in the development of various malignant tumors. Trop2 gene regulates the expression of cyclin D1 and E-cadherin in triple-negative breast cancer (TNBC), and promote the metastasis and invasion of TNBC. In this study, the structure, function, mechanism of action, the expression of Trop2 gene and treatment of TNBC were reviewed to find therapeutic targets for TNBC and explore new therapy. References | Related Articles | Metrics

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Classification of intrahepatic cholangiocarcinoma and hot topics in surgical treatment ZHANG Jixiang, XIE Zhihua, LI Wei, JIANG Xiaoqing 2022, 27 (05):  478-482.  DOI: 10.16139/j.1007-9610.2022.05.019 Abstract ( 230 )   HTML ( 8 )   PDF (525KB) ( 108 )   The classification of intrahepatic cholangiocarcinoma (ICC) is based on macroscopic pattern, pathological features, clinical manifestation and molecular type. Surgical resection is still the preferred treatment for ICC. Hot topics in surgical treatment include hepatic resection procedure, distance of resection margin, lymph node dissection, laparoscopic operation, liver transplantation, reoperation after recurrence, neoadjuvant therapy and conversion therapy. The classification of ICC and hot topics in surgical treatment were focused in this review. References | Related Articles | Metrics