The role of locoregional surgery in de novo stage IV breast cancer: A meta-analysis of randomized controlled trials.

BACKGROUND: We performed an updated meta-analysis to explore the value of locoregional surgery in de novo stage IV breast cancer patients. METHODS: A literature search was conducted to identify randomized controlled trials comparing primary tumor resection with systemic therapy in de novo stage IV breast cancer. The hazard ratio (HR) of overall survival (OS), local relapse-free survival (LRFS), and distant relapse-free survival (DRFS) were estimated and pooled. RESULTS: Six studies were eligible, including a total of 1368 patients. Both OS (HR = 0.86; 95 %CI: 0.77-0.96; p = 0.01; I2 = 45 %) and LRFS (HR = 0.35; 95 %CI: 0.20-0.62; p = 0.0003; I2 = 83 %) were significantly improved with locoregional surgery compared with systemic therapy alone. There was no significant difference in terms of DRFS (HR = 0.96; 95 %CI: 0.41-2.22; p = 0.92; I2 = 86 %). The OS benefit was more pronounced in hormone receptor-positive patients (HR = 0.79; p = 0.003) and HER2-negative patients (HR = 0.80; p = 0.003). CONCLUSIONS: This study demonstrated that locoregional surgery conferred significant OS and LRFS benefits in de novo stage IV breast cancer patients and may serve as an alternative choice for selected patients.

Hypoxia preconditioning enhances the viability of ADSCs to increase the survival rate of ischemic skin flaps in rats.

UNLABELLED: Use of a skin flap has been a common technique in reconstructive surgery for more than five decades. However, partial necrosis of its distal end is still a serious postoperative complication. Many theories about this problem have been proposed, including deficient blood supply, which is the most accepted theory. In this study we demonstrated that hypoxic preconditioning enhanced the viability of adipose-derived stem cells (ADSCs) in vivo and improved their ability to increase the survival rate of ischemic skin flaps in rats. Seven days after flap elevation, the flap survival rate in the hypoxic preconditioned ADSC group was higher than that in the control group. Moreover, histological examination showed that more ADSCs survived in flaps treated by hypoxic preconditioning. Vascular density in the hypoxic preconditioned ADSC group was 30-90 % greater than that in the control group. In addition, the expressions of vascular endothelial growth factor and hypoxia inducible factor-1α (HIF-1α) were higher in the hypoxic preconditioned ADSC group than in the control group (p < 0.05). This enhancive phenomenon reached its highest level at the precondition times of 3 and 7 days in the hypoxic preconditioned ADSC group. We conclude that hypoxia preconditioning effectively enhances the viability of ADSCs to increase the survival rate of ischemic skin flaps. Furthermore, 3 days is the optimal preconditioning time point. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Change of HER2 status during disease recurrence predicts good prognosis for primary squamous cell carcinoma of the breast: A case report.

RATIONALE: Primary squamous cell carcinoma (PSCC) of the breast is one of the least common types of breast cancer. Adjuvant treatment for PSCC remains an unresolved issue. PATIENT CONCERNS: We reported a case of a 48-year-old postmenopausal female patients with a 2 × 2.5 cm lump presented with no symptoms. DIAGNOSES: This patient was diagnosed as PSCC of the breast. The original tumor and first recurrence exhibited triple negative phenotype, whereas the second recurrence was HER2-positive. INTERVENTIONS: A tumorectomy with latissimus dorsi flap reconstruction for the second recurrence was performed followed by targeted therapy with trastuzumab. OUTCOMES: The patient had a complete remission, which was sustained over the 25 months of follow-up after the tumorectomy. LESSONS: This is the first reported case in literature of a breast PSCC patient with switched immunohistochemical phenotypes during disease recurrence. Surgical resection with flap reconstruction and targeted therapy successfully treated the recurrence.

Benefit of Shear-wave Elastography in the differential diagnosis of breast lesion: a diagnostic meta-analysis.

AIMS: The purpose of this diagnostic meta-analysis was to explore the benefit of shear wave elastography (SWE) combinedly used with conventional ultrasound (US) in the diagnosis of the benign and malignant breast lesion. MATERIAL AND METHODS: After a literature search on MEDLINE, Cochrane library, and Embase we included 14 studies with a total 1951 patients and 2060 breast lesions for further analyses. Summary descriptive statistics such as pooled sensitivity, specificity, and summary receiver operating characteristics curve were generated via a bivariate random effect model. Summary indicators such as area under curve (AUC) and confident region were used to compare the performance of conventional US and combination of conventional US and shear wave imaging (SWI) or two-dimensional and three-dimensional SWI. RESULTS: As indicated by the results, the pooled sensitivity, specificity, and diagnostic odds ratio for combined usage of SWE and the conventional US were 0.877 (95%CI: 0.855-0.896) and 0.849 (95%CI: 0.826-0.869) and 40.164 (95%CI:31.135- 51.811). The AUC for combined use and the conventional US only were 0.928 and 0.899, suggesting a promise of integrating SWE in the routine of breast lesion examination. Also, the summary AUC for 2D and 3D SWE were 0.917 and 0.952 respectively. No significant difference was found between 2D and 3D SWE. No obvious publication bias was identified after employing Deeks' regression test for asymmetry. CONCLUSION: Our analysis concluded that SWE improved the differential diagnosis of the breast lesion.