Background: The eighth edition of the American Cancer Joint Committee on Cancer (AJCC) staging system for breast cancer put forward the prognostic stage groups for the first time based on the traditional anatomic tumor-node-metastasis staging system. Our study intends to validate the predictive significance of the eighth edition staging system in triplenegative breast cancer (TNBC) patients. Materials and methods: We collected and accessed 26,589 eligible cases of TNBC from the Surveillance, Epidemiology, and End Results database (2010-2015) and reclassified the patient cohort according to the eighth edition of the AJCC staging system into anatomic and prognostic stages. Results: The results showed that more than half of the patients upstaged in the prognostic stage when compared with the anatomic stage. By comparing with the anatomic stage, the prognostic stage had a higher likelihood ratio and linear trend c 2 values. The prognostic stage group also had higher Akaike information criterion and Bayesian information criterion values than the anatomic stage group. Conclusions: The prognostic staging system in TNBC patients performs more optimistic prognostic stratification and predictability than the anatomic staging system. Moreover,
BackgroundSurvival in elderly patients undergoing sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) has not been specifically analyzed. This study aimed to explore the association between different types of axillary lymph node (ALN) evaluations and survival of elderly breast cancer patients.MethodsA retrospective cohort study was conducted of invasive ductal breast cancer patients 70 years and older in the Surveillance, Epidemiology, and End Results database (2004–2016). Analyses were performed to compare the characteristics and survival outcomes of patients who received surgical lymph node dissection and those who did not. Breast cancer specific survival (BCSS) and overall survival were compared by using Cox proportional hazards regression analysis and propensity score matching (PSM) methods to account for selection bias from covariate imbalance.ResultsOf the 75,950 patients analyzed, patients without ALN evaluation had a significantly worse prognosis, while there was no significant difference for BCSS between using a sentinel lymph node biopsy (SLNB) and an axillary lymph node dissection (ALND) after adjustment for known covariates [adjusted hazard ratio (HR) = 0.991, 95% confidence interval (CI) = 0.925–1.062, p = 0.800]. In the stratification analyses after PSM, the ALND did not show a significant BCSS advantage compared with SLNB in any subgroups except for the pN1 stage or above. Furthermore, after PSM of the pN1 stage patients, SLNB was associated with a significantly worse BCSS in hormone receptor negative (HR−) patients (HR = 1.536, 95%CI = 1.213–1.946, p < 0.001), but not in the hormone receptor positive (HR+) group (HR = 1.150, 95%CI = 0.986–1.340, p = 0.075).ConclusionIn our study, ALND does not yield superior survival compared with SLNB for elderly patients with pN1 stage HR+ breast cancer. Although our findings are limited by the bias associated with retrospective study design, we believe that in the absence of results from randomized clinical trials, our findings should be considered when recommending the omission of ALND for elderly breast cancer patients.
As a critical infrastructure of cloud computing, data center networks (DCNs) directly determine the service performance of data centers, which provide computing services for various applications such as big data processing and artificial intelligence. However, current architectures of data center networks suffer from a long routing path and a low fault tolerance between source and destination servers, which is hard to satisfy the requirements of high-performance data center networks. Based on dual-port servers and Clos network structure, this paper proposed a novel architecture RClos to construct high-performance data center networks. Logically, the proposed architecture is constructed by inserting a dual-port server into each pair of adjacent switches in the fabric of switches, where switches are connected in the form of a ring Clos structure. We describe the structural properties of RClos in terms of network scale, bisection bandwidth, and network diameter. RClos architecture inherits characteristics of its embedded Clos network, which can accommodate a large number of servers with a small average path length. The proposed architecture embraces a high fault tolerance, which adapts to the construction of various data center networks. For example, the average path length between servers is 3.44, and the standardized bisection bandwidth is 0.8 in RClos(32, 5). The result of numerical experiments shows that RClos enjoys a small average path length and a high network fault tolerance, which is essential in the construction of high-performance data center networks.
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