[Clinical impact of extracapsular extension of axillary lymph node metastases in breast cancer].

OBJECTIVE: To study the clinical significance of extracapsular extension (ECE) of axillary lymph node metastases in breast cancer. METHODS: The clinicopathological data of 1230 cases of nodal positive breast cancer treated in our department from 1989 to 1995 were analyzed retrospectively. RESULTS: 486 (39.5%) from the 1230 cases were ECE positive. There was a higher incidence of ECE in postmenopausal women than premenopausal ones (47.5% versus 35.5%, respectively, P < 0.001). The patients in ECE positive group had a larger tumor size (5.11 +/- 2.53 cm versus 3.90 +/- 1.80 cm, P < 0.001). 18.3% of patients with stage T1 were ECE positive, stage T2 were 36.4%, and stage T3 were 54.4%, and the difference was significant (P < 0.001). ECE was correlated with the number of positive axillary lymph nodes. The ECE positive group had more positive nodes than ECE negative group (16.96 +/- 12.16 versus 5.24 +/- 6.60, P < 0.001). 6.1% of patients with 1 positive node were ECE positive, 13.5% with 2 - 3, 35.8% with 4 - 9, 62.3% with 10 - 19, and 84.0% with more than 20 positive axillary nodes, and there was a significant difference among those groups (P < 0.001). ECE had no association with ER/PR status (P = 0.706). ECE was a risk factor of local-regional recurrence, but the relapse time had no significant difference (P = 0.559). ECE was also a risk factor of distant metastasis, and the relapse time had a significant difference (P < 0.001). The median metastasis free time was 30.0 (2 approximately 172) months in ECE positive group, while 37.5 (2 approximately 170) months in ECE negative group (P = 0.006). CE occurred in 60.4% of the patients with firstly diagnosed bone, skin and distant lymph node metastasis, but in 42.0% of the patients with firstly diagnosed visceral metastasis (P = 0.001). The metastasis-free survival rate, locoregional recurrence-free survival rate and overall survival rate of the ECE positive group were much shorter than that of the ECE negative group. COX proportional hazard regression single factor analysis and multi-factor analysis suggested that ECE is an independent factor of metastasis-free survival, locoregional free recurrence and overall survival. CONCLUSION: The presence of ECE in breast cancer is positively related with tumor size and the number of positive lymph nodes. It is also a risk factor of locoregional recurrence and distant metastasis. ECE positive group has a much shorter metastasis-free survival, locoregional recurrence-free survival and overall survival. ECE is a risk factor of those three indexes.

[Relationship between the expression of matrix metalloproteinase-13 protein and other biomarkers, prognosis in invasive breast cancer].

OBJECTIVE: The study was designed to investigate the expression patterns of metalloproteinase (MMP)-13 protein in invasive breast carcinoma and to determine the clinicopathological and prognostic values of its various localization and relation to the tumor phenotypes. METHODS: Immunohistochemistry was performed on paraffin-embedded tissue array from 263 invasive breast carcinomas to investigate the protein expressions of MMP-13, estrogen receptor, progesterone receptor, HER2, MMP-2, MMP-9 and tissue inhibitor of matrix metalloproteinases (TIMP)-1, TIMP-2. RESULTS: MMP-13 protein was detected in the cytoplasm of carcinoma cells and peritumoral fibroblasts. High level expression of MMP-13 protein in tumor cells was associated with more lymph node involvement and higher tumor grade (both P < 0.01), and positively correlated with HER2 (P = 0.015) and TIMP-1 protein (P < 0.01) expression in carcinoma cells. Moreover, high expression of MMP-13 was associated with shortened overall survival for the entire patient population and the patient group with positive lymph node. Tumor cell derived MMP-13 had different impact on patients with different HER2 status. Peritumoral fibroblasts derived MMP-13 protein, although correlated with tumor cell derived MMP-13 and associated with lymph node stage and HER2 expression, was found having less prognostic impact. Univariate survival analysis showed that the tumor size, grade, lymph node status, PR status, HER2 expression, tumors TIMP-1 and MMP-13 expression were prognostic factors. However, multivariate survival analysis showed that only tumor size, lymph node status, HER2 expression, tumors TIMP-1 and MMP-13 were independent prognostic factors. CONCLUSION: MMP-13 protein expressed by tumor cells correlates with the invasion and metastasis of breast carcinoma, and therefore, may serve as a poor prognostic marker for the patient.

[Axillary skip metastases in breast cancer].

OBJECTIVE: To analyze the clinicopathologic characteristics and the prognostic factors of breast cancer patients with skip metastases in the axilla. METHODS: The clinical data of 1502 breast cancer patients who underwent complete axillary lymph node dissection were retrospectively reviewed. The patterns of skip metastases, clinical features and prognostic factors were analyzed. RESULTS: Of the 1502 patients, lymph node metastases were found in 814, of whom skip metastases in 119 (14.6%, 119/814). The Clinicopathologic factors such as age, tumor size, tumor location, clinical stage, hormonal receptor status and involved interpectoral lymph nodes were not correlated with skip metastases (P > 0.05). The disease free survival rate was lower in clinical stage I and II patients with skip metastases than that in those without (P = 0.003), while no significant difference was observed in clinical stage III patients (P = 0.457). Multivariate analysis showed that the tumor size, number of metastatic lymph nodes, extracapsular invasion of the lymph nodes and skip metastases in the axilla were significantly correlated with survival rate. CONCLUSION: Skip metastasis in the axilla cannot be accurately predicted by clinicopathologic factors. Early breast cancer patients with skip metastases should be treated properly due to poor prognosis.

[Application of latissimus dorsi-myocutaneous flap in breast reconstruction].

OBJECTIVE: To investigate the design, procedures and effect of latissimus dorsi-myocutaneous flap (LDMF) for breast reconstruction. METHODS: From May, 2005 to April, 2006, 18 consecutive patients underwent breast reconstruction with LDMF. Combined breast implants were also inserted in 8 of the 18 cases. The procedure duration, complication and aesthetic results were assessed. RESULTS: The mean procedure duration was 147 minutes. There was no flap loss and no severe complications. The reconstructed breast was a little over high in one patient. All the other 17 patients (94.4%) were very satisfied with the aesthetic result. CONCLUSIONS: LDMF or a combination of LDMF with breast implants is a reliable method for breast reconstruction with low complication. The procedure is easily performed with good aesthetic result.

[A study of reduction mammaplasty in patients with breast benign diseases].

OBJECTIVE: To study the efficacy and complications of the method for reduction mammaplasty in patients with breast benign diseases. METHODS: From November 1980 to December 2001, reduction mammaplasty was performed in 27 patients with breast hypertrophy, ptosis and benign diseases. The operation methods were selected according to the characters of the diseases and the extent of breast hypertrophy and ptosis. 9 patients received reduction mammaplasty using an inferior pyramidal pedicle technique; 16 patients received Mckissock vertical bipedicle technique and 2 patients received the bicyclic incision technique. RESULTS: The successful rate was 94.2%. Three breasts developed areola necrosis in Mckissock. Symptoms caused by breast hypertrophy and benign diseases were improved apparently. CONCLUSION: Reduction mammaplasty is the best option for the treatment of breast hypertrophy and ptosis with benign diseases. The method of reduction mammaplasty should be taken individually.

[Randomized trial on adjuvant radiotherapy for postoperative breast cancer: a 15 year experience].

OBJECTIVE: To evaluate the long term effects of adjuvant radiotherapy for postoperative breast cancer. METHODS: From 1985 to 1986, 162 patients with operable breast cancer were randomly given adjuvant radiotherapy according to clinical stage and involving condition of axillary lymph nodes (LN). The radiotherapy group (RG) was irradiated in the supraclavicular area and/or internal mammary area to 50 Gy, while the control group (CG) was not. RESULTS: The overall 5-, 10- and 15-year survival rates of the RG were 72.0%, 56.1% and 54.3%, while they were 66.3%, 51.3% and 49.4% in the CG (P > 0.05). Clinical stage I-IIIa and positive or negative LN showed no significant difference in the two groups. But in patients with LN(+) > or = 4, the 5-, 10- and 15-year survival rates of the RG were 55.6%, 38.9% and 37.1%, which were higher than the CG of 29.0%, 16.1% and 16.1% (P < 0.05). CONCLUSION: Adjuvant radiotherapy can improve the prognosis for breast cancer patients with LN(+) > or = 4, but not for LN(-).

[Local recurrence and distant metastasis after breast-conserving therapy for patients with breast cancer].

OBJECTIVE: To study the relative factors of local recurrence and distant metastasis after breast-conserving therapy (BCT) for patients with breast cancer. METHODS: The data on 174 patients with primary breast cancer who had been treated by BCT were analyzed retrospectively. The patients were followed up for 12 to 196 months with a rate of 97.13% (169/174). RESULTS: Nine patients showed local recurrence and 14 patients, distant metastasis. The 3-year recurrence rate was 3.79% (5/132), the the 5-year metastasis rate was 10.99% (10/91), and the 5-year survival rate was 92.31% (84/91). Those 3-year recurrence rate for patients without radiotherapy (12.12%) was significantly higher than that with radiotherapy (1.01%), (chi(2) = 5.61, P < 0.05). In patients with node-positive, the the 5-year metastasis rate for patients without chemotherapy (44.44%) was higher than that for those with chemotherapy (6.67%), (P < 0.05). Positive marginal status was associated with local recurrence (P < 0.01). Age at diagnosis of patient with breast cancer (