Background: Positive lymph node ratio (LNR), defined as ratio of positive lymph nodes to all lymph nodes removed, is a powerful prognostic factor in invasive breast cancer. Here we focused on the impact of negative lymph node (NLN) count on the prediction of value of LNR in breast cancer survival.Methods: Of 929 invasive breast cancer patients were enrolled in our retrospective study. We use KaplanMeier to calculate the 5-year overall survival (OS) according to different clinicopathologic parameters. The prediction value of NLN count and LNR in OS was examined.Results: The optimal cutoff of NLN count was designated as 9. Five-year OS was 77.0% and 95.0% Conclusions: High NLN count is associated with improved survival in invasive breast cancer patients.Combining NLN count with LNR could be considered as an alternative to LNR alone in prediction of postoperative breast cancer survival.

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The study was aimed to evaluate oncological safety and patient satisfaction in relatively late stage breast cancer patients who was treated with skin-sparing mastectomy (SSM) followed by breast reconstruction with an extended latissimus dorsi (LD) flap. Oncological safety, postoperative complications, and cosmetic results were retrospectively analyzed in patients who underwent extended LD flap breast reconstruction following SSM between October 2011 and August 2014. A total of 62 patients who underwent 63 breast reconstructions were enrolled in the study. Local recurrence rate was 1.6% over a median follow-up of 63 months. On final aesthetic assessment, 37 reconstructions were rated excellent, 19 good, 5 fair, and 2 poor. Reconstruction-related complications occurred in 22 patients (34.9%); these patients’ satisfaction scores were significantly lower than those of patients without complications (P < .05). Five patients developed shoulder movement limitation, and 2 had minor twitching and pain in the reconstructed breast. However, these patients did not find their problems disabling and were able to live normally. SSM followed by breast reconstruction with extended LD flap can improve patients’ postoperative quality of life and is as oncologically safe as total mastectomy even in patients with tumors of relatively late stage.

Background: Radioisotopes and blue dyes are used as dual tracers in the current gold standard procedure of sentinel lymph node (SLN) biopsy (SLNB) performed for breast cancer. However, the blue dye or the radioisotope as a single tracer is also being applied in some institutes. We aimed to explore the risk factors for the miss-detection of SLNs with the radioisotope and the blue dye and to describe the distribution of SLNs missed by each tracer. Patients and Methods: Patients undergoing SLNB with radioisotope and blue dye as dual mapping agents were enrolled between August 2010 and August 2018. Radioactivity count, blue dye staining status, and size and location of each SLN were prospectively documented. Results: In total, 2382 SLNs from 1010 patients were included for statistical analyses. The sentinel node identification rate was 100% for dual tracers, 99.4% for radioisotope, and 89.1% for blue dye. SLN identification using the blue dye was more likely to fail in patients undergoing breast-conserving surgery (p < 0.001) and mastectomy with reconstruction (p = 0.005). Furthermore, miss-detection was significantly more frequent in smaller and uninvolved nodes. Among all SLNs, 8.2% were located in level II and one was in level III. Notably, single tracer of blue dye tended to fail in the detection of lymph nodes in higher levels (p < 0.001). Conclusion: This study explored the association between features and the incidence of the failure to detect SLNs using radioisotope and blue dye. The locations of the miss-detected SLNs are demonstrated to provide a reference for SLNBs conducted using blue dye or radioisotope as a single tracer.

Background: To investigate the related factors affecting the postoperative indwelling time of drainage tubes (hereinafter referred to as drainage time) in breast cancer (BC) and evaluate the effect of pseudomonas aeruginosa-mannose-sensitive hemagglutinin (PA-MSHA) preparation on reducing postoperative drainage time. Methods:The clinical data of 165 BC patients in our hospital, including the postoperative drainage time and occurrence of seroma and related complications (such as fever, incision infection, and flap necrosis) after extubation, were retrospectively analyzed. Univariate, multivariate, and stratified analyses were used to determine the correlations between 15 factors including age, body weight, body mass index (BMI), and PA-MSHA preparation, and the postoperative total drainage volume and drainage time.Results: Age, BMI, and PA-MSHA preparation were independent factors affecting the postoperative drainage volume and drainage time of BC patients. Age and BMI were positively correlated with postoperative drainage volume and drainage time (P≤0.004, P≤0.037). PA-MSHA preparation significantly reduced the postoperative total drainage volume and drainage time (P<0.001), decreased the incidence of seroma after extubation (P=0.024), and did not increase complications (P>0.05).Conclusions: Obese and elderly patients were at a significantly high risk of a high drainage volume and long drainage time. Local treatment with PA-MSHA preparation had the advantages of reducing postoperative drainage volume, reducing drainage time, preventing seroma, and not increasing complications, and was a safe and effective treatment. For BC patients aged over 60 years and with a BMI ≥25, the intraoperative local spraying of wounds with PA-MSHA preparation to reduce postoperative drainage times is a valuable option.

Background: Long non-coding RNA (lncRNA) TatD DNase Domain Containing 1 (TATDN1) is a recently characterized oncogenic lncRNA in several types of cancer including breast cancer. Our preliminary microarray analysis revealed its upregulation in triple negative breast cancer (TNBC) and its inverse correlation with microRNA-26b (miR-26b), which is a tumor suppressive miRNA in breast cancer. This study was therefore carried out to investigate the interaction between TATDN1 and miR-26b in TNBC. Methods: A total of 66 pairs of TNBC and non-tumor tissues were collected from 66 patients (45.8 ± 10.5 years old) with TNBC through biopsy under the guidance of MRI before initiation of any therapies. Quantitative reverse transcription PCR (RT-qPCR), transient cell transfection, methylation specific PCR (MSP) and cell proliferation assay were carried out in this study. Results: We found that TATDN1 was upregulated and miR-26b was downregulated in TNBC. Correlation analysis showed that the expression of TATDN1 and miR-26b was inversely correlated. In TNBC cells, overexpression of TATDN1 mediated the downregulation of miR-26b. Knockdown of TATDN1 led to the upregulation of miR-26b. Methylationspecific PCR showed that TATDN1 positively regulated the methylation of miR-26b gene. Cell proliferation analysis showed that TATDN1 positively regulated the proliferation of TNBC cells. Overexpression of miR-26b attenuated the effects of TATDN1 overexpression on cell proliferation. Conclusion: Therefore, overexpression of TATDN1 promotes cancer cell proliferation in TNBC by regulating the methylation of miR-26b gene.

Background: Cyclin-dependent kinase (CDK) inhibitors are widely used to treat hormone receptor-positive (HR+) breast cancer due to their efficient performance in improving survival outcomes. Although the side effects of these agents on the hematological and gastrointestinal systems have attracted significant attention, the adverse effects that have direct impacts on patients' quality of life, such as stomatitis, have not been well explored to date.Methods: A systematic literature search was conducted in the PubMed, Google Scholar, European Society of Medical Oncology (ESMO), and American Society of Clinical Oncology databases. Phase 2 and 3 randomized trials on CDK4/6 inhibitors (CDK4/6Is) were identified and used in the meta-analysis based on the completeness of their safety data.Results: Of the 904 records screened, 40 studies were considered relevant. Six studies were used in the meta-analysis, with a total of 2,980 patients in the safety population. The pooled relative risk (RR) and risk difference (RD) for any-grade stomatitis were 2.02 (95% CI: 1.65-2.48) and 0.10 (95% CI: 0.05-0.15), respectively. In the subgroup analysis, higher RRs were observed among patients receiving letrozole as basic endocrine therapy (ET) (8.50, 95% CI: 2.22-32.57) or palbociclib-containing regimens (2.44, 95% CI: 1.88-3.18), whereas the RDs showed no significant difference Discussion: All CDK4/6Is, especially palbociclib, could increase the risk of developing stomatitis among patients with breast cancer. Prevention and management of CDK4/6Is-related stomatitis may effectively reduce its secondary impacts. Due to the lack of individual-level data, some important personal confounding variables could not be controlled. Besides, the explanations of the secondary effects of stomatitis in this study were only based on the literature and professional knowledge. The specific quantitative impacts on patient quality of life and compliance require further questionnaire investigation. More in-depth individual-level data are needed to quantify the effect of stomatitis on patients' quality of life and treatment compliance.

BackgroundFor sentinel lymph node biopsy (SLNB) in patients with breast cancer, the dual tracer of blue dye and radioisotope with the 10% rule that all nodes with radioactive count of 10% or more of the hottest node ex vivo should be removed is widely accepted. However, the cut-off point of radioactivity is being questioned for possibly excessive removal of negative nodes.MethodsTo compare different percentile rules and optimize the criteria for identifying SLNs, we established a database which prospectively collected the radioactivity, status of blue dye and the pathological results of each SLN in breast cancer patients who successfully underwent SLNB with a combination of methylene blue and radioisotope.ResultsA total of 2,529 SLNs from 1,039 patients were identified from August 2010 to August 2019. 16.4% (414/2,529) positive nodes were removed at a cost of 83.6% (2115/2,529) negative nodes removed excessively. Up to 17.9% (375/2,115) negative nodes were removed as radioactively hot nodes without blue staining. By gradually increasing the threshold by each 10%, the number of negative nodes identified reduced by 18.2% (385/2,115) with only three node-positive patients (1.0%) missed to be identified using the “40% + blue” rule. In patients with ≥ 2 SLNs removed, 12.3% (238/1,942) negative nodes avoided unnecessary removal with only 0.8% (2/239) positive patients missed with the “hottest two + blue” rule.ConclusionsOur data indicated that the “40% + blue” rule or the “hottest two + blue” rule for SLNB with the dual tracer of blue dye and radioisotope may be considered as a potential alternative rule to minimize extra nodes resected. Nonetheless, it should be validated by prospective trials with long-term follow-up.