The composition and differences of antimony isotopic in sediments affected by the world's largest antimony deposit zone.

Antimony (Sb) isotopic fingerprinting is a novel technique for stable metal isotope analysis, but the use of this technique is still limited, especially in sediments. In this study, the world's most important Sb mineralization belt (the Xikuangshan mineralization belt) was taken as the research object and the Sb isotopic composition and Sb enrichment characteristics in the sediments of water systems from different Sb mining areas located in the Zijiang River (ZR) Basin were systematically studied. The results showed that the ε123Sb values in the sediments of the ZR and its tributaries, such as those near the Longshan Sb-Au mine, the Xikuangshan Sb mine, and the Zhazixi Sb mine, were 0.50‒3.13 ε, 2.31‒3.99 ε, 3.12‒5.63 ε and 1.14‒2.91 ε, respectively, and there were obvious changes in Sb isotopic composition. Antimony was mainly enriched in the sediments due to anthropogenic sources. Dilution of Sb along the river and adsorption of Sb to Al-Fe oxides in the sediment did not lead to obvious Sb isotopic fractionation in the sediment, indicating that the Sb isotopic signature was conserved during transport along the river. The Sb isotopic signatures measured in mine-affected streams may have differed from those in the original Sb ore, and further investigation of Sb isotopic fingerprints from other possible sources and unknown geochemical processes is needed. This study reveals that the apparent differences in ε123Sb values across regions make Sb isotopic analysis a potentially suitable tool for tracing Sb sources and biogeochemical processes in the environment.

Combining Cd and Pb isotope analyses for heavy metal source apportionment in facility agricultural soils around typical urban and industrial areas.

Facility agriculture enhances food production capabilities. However, concerns persist regarding heavy metal accumulation resulting from extensive operation of this type of farming. This study integrated the total content, five fractions, and isotope composition of Cd and Pb in intensively farmed soils in regions characterized by industrialization (Shaoguan, SG) and urbanization (Guangzhou, GZ), to assess the sources and mechanisms causing metals accumulation. We found significantly more severe Cd/Pb accumulation and potential mobility in SG than GZ. Cd displayed higher accumulation levels and potential mobility than Pb. The distinct isotopic signals in SG (-0.54 to 0.47‰ for δ114/110Cd and 1.1755 to 1.1867 for 206Pb/207Pb) and GZ (-0.86 to 0.12‰ for δ114/110Cd and 1.1914 to 1.2012 for 206Pb/207Pb) indicated significant differences in Cd/Pb sources. The Bayesian model revealed that industrial activities and related transportation accounted for over 40% and approximately 30%, respectively, of the average contributions of Cd/Pb in SG. While urban-related (26.6%) and agricultural-related (26.3%) activities primarily contributed to Cd in GZ. The integration of δ114/110Cd and 208Pb/206Pb has further enhanced the regional contrast in sources. The present study established a comprehensive tracing system for Cd-Pb, providing crucial insights into the accumulation and distribution of these metals in facility agricultural soils.

Using Mercury Stable Isotopes to Quantify Bidirectional Water-Atmosphere Hg(0) Exchange Fluxes and Explore Controlling Factors.

In this study, exchange fluxes and Hg isotope fractionation during water-atmosphere Hg(0) exchange were investigated at three lakes in China. Water-atmosphere exchange was overall characterized by net Hg(0) emissions, with lake-specific mean exchange fluxes ranging from 0.9 to 1.8 ng m-2 h-1, which produced negative δ202Hg (mean: -1.61 to -0.03‰) and Δ199Hg (-0.34 to -0.16‰) values. Emission-controlled experiments conducted using Hg-free air over the water surface at Hongfeng lake (HFL) showed negative δ202Hg and Δ199Hg in Hg(0) emitted from water, and similar values were observed between daytime (mean δ202Hg: -0.95‰, Δ199Hg: -0.25‰) and nighttime (δ202Hg: -1.00‰, Δ199Hg: -0.26‰). Results of the Hg isotope suggest that Hg(0) emission from water is mainly controlled by photochemical Hg(0) production in water. Deposition-controlled experiments at HFL showed that heavier Hg(0) isotopes (mean ε202Hg: -0.38‰) preferentially deposited to water, likely indicating an important role of aqueous Hg(0) oxidation played during the deposition process. A Δ200Hg mixing model showed that lake-specific mean emission fluxes from water surfaces were 2.1-4.1 ng m-2 h-1 and deposition fluxes to water surfaces were 1.2-2.3 ng m-2 h-1 at the three lakes. Results from the this study indicate that atmospheric Hg(0) deposition to water surfaces indeed plays an important role in Hg cycling between atmosphere and water bodies.

Antimony Isotope Fractionation Revealed from EXAFS during Adsorption on Fe (Oxyhydr)oxides.

A lack of knowledge about antimony (Sb) isotope fractionation mechanisms in key geochemical processes has limited its environmental applications as a tracer. Naturally widespread iron (Fe) (oxyhydr)oxides play a key role in Sb migration due to strong adsorption, but the behavior and mechanisms of Sb isotopic fractionation on Fe (oxyhydr)oxides are still unclear. Here, we investigate the adsorption mechanisms of Sb on ferrihydrite (Fh), goethite (Goe), and hematite (Hem) using extended X-ray absorption fine structure (EXAFS) and show that inner-sphere complexation of Sb species with Fe (oxyhydr)oxides occurs independent of pH and surface coverage. Lighter Sb isotopes are preferentially enriched on Fe (oxyhydr)oxides due to isotopic equilibrium fractionation, with neither surface coverage nor pH influencing the degree of fractionation (Δ123Sbaqueous-adsorbed). Limited Fe atoms are present in the second shell of Hem and Goe, resulting in weaker surface complexes and leading to greater Sb isotopic fractionation than with Fh (Δ123Sbaqueous-adsorbed of 0.49 ± 0.004, 1.12 ± 0.006, and 1.14 ± 0.05‰ for Fh, Hem, and Goe, respectively). These results improve the understanding of the mechanism of Sb adsorption by Fe (oxyhydr)oxides and further clarify the Sb isotope fractionation mechanism, providing an essential basis for future application of Sb isotopes in source and process tracing.

Distribution, Source Identification, and Output flux of Barium in Surface Waters in the Sanjiangyuan Region and Qilian Mountain Region of Tibetan Plateau.

Water safety concerning Barium (Ba) has become a public issue worldwide. As the "Asian water tower", Tibetan Plateau is the birthplace of many rivers. However, the distribution, source, and output flux of Ba are largely unknown. In this study, surface water samples were collected from different catchments in the Sanjiangyuan Region (SJY) and the Qilian Mountain Region (QLM) in Tibetan Plateau. The concentration of Ba was determined by inductively coupled plasma optical emission spectroscopy, the source of Ba was discussed by a Gibbs diagram, and the output flux of Ba was estimated using the observation data from different hydrological stations. The results showed that the Ba concentrations were less than 160 µg/L, which is much lower than the guideline value of 700 µg/L for surface waters. The main sources of Ba were rock weathering and evaporation concentration. The total Ba output flux from SJY and QLM to downstream waters was 1,240 t/yr, which accounts for about 0.01% of the global freshwater Ba output flux to the ocean. The Ba production rate in Tibetan Plateau was comparable with that in the Arctic rivers. Under the scenario of global warming, water safety issues concerning Ba will be more serious since the output flux of Ba to downstream waters will be increased by intensified rock weathering, evaporation concentration, glacial retreat, and permafrost thawing. This study reveals the Ba flux and production rate in Tibetan Plateau, which will provide important information for evaluating the environmental impact of global warming on public health.

The prognostic value of tumour-infiltrating lymphocytes, programmed cell death protein-1 and programmed cell death ligand-1 in Stage I-III triple-negative breast cancer.

BACKGROUND: Tumour-infiltrating lymphocytes (TILs) represent a robust biological prognostic biomarker in triple-negative breast cancer (TNBC); however, the contribution of different subsets of immune cells is unclear. We investigated the prognostic value of immune markers, including stromal TILs (sTILs), CD8+T and FOPX3+T cells, PD-1 and PD-L1 in non-metastatic TNBC. METHODS: In total, 259 patients with Stage I-III TNBC were reviewed. The density of sTILs along with the presence of total (t), stromal (s), and intratumoral (i) CD8+T cells and FOPX3+T cells were evaluated by haematoxylin and eosin and immunohistochemical staining. Immunohistochemical staining of PD-1, PD-L1 was also conducted. RESULTS: All immune markers were positively correlated with each other (P < 0.05). In the multivariate analysis, sTILs (P = 0.046), tCD8+T cells (P = 0.024), iCD8+T cells (P = 0.050) and PD-1 (P = 0.039) were identified as independent prognostic factors for disease-free survival (DFS). Further analysis showed that tCD8+T cells (P = 0.026), iCD8+T cells (P = 0.017) and PD-1 (P = 0.037) increased the prognostic value for DFS beyond that of the classic clinicopathological factors and sTILs. CONCLUSIONS: In addition to sTILs, inclusion of tCD8+T, iCD8+T cells, or PD-1 may further refine the prognostic model for non-metastatic TNBC beyond that including classical factors alone.

Histone deacetylases inhibitor chidamide synergizes with humanized PD1 antibody to enhance T-cell chemokine expression and augment Ifn-γ response in NK-T cell lymphoma.

BACKGROUND: Whether immunotherapy combined with different histone deacetylases (HDAC) inhibitors in refractory or relapsed natural killer/T-cell lymphoma (NKTCL) is superior to each agent is still lacking in head-to-head clinical trials or preclinical evidence. METHODS: NKTCL cell line xenograft models (CDX) in immunocompetent, human programmed cell death protein 1 (PD1) knock-in genetically engineered mice were used to investigate the combination effects. Different types and dosages of HDAC inhibitors were investigated. We explored the underlying mechanisms by RNA-sequencing and ChIP-sequencing. Two clinical cases treated with anti-PD1/chidamide were presented. FINDINGS: Anti-PD1/chidamide shows significant tumour rejection in two CDX models. RNA-seq and CHIP-seq revealed that chidamide is synergistic to enhance T-cell chemokine expression, augment the Ifn-γ response, and increase CD8 T-cell infiltration via histone modification. Ifn-γ neutralizing antibody can attenuate the efficacy of combination drugs. However, the anti-PD1/romidepsin failed to augment the Ifn-γ response. The expressions of Ifn-γ related gene set signatures are significantly correlated with tumour rejection in anti-PD1/chidamide. In the clinic, two NKTCL patients treated with the PD1/chidamide show promising efficacy and limited toxicity. INTERPRETATION: Anti-PD1/chidamide enhances T-cell chemokine expression and augments the IFN-γ response in preclinical NKTCL immunocompetent models. IFN-γ signatures may be good response biomarkers for the selection of potentially benefit patients. FUNDING: This study was supported by the Chinese National Major Project for New Drug Innovation (2017ZX09304015) and the Chinese Society of Clinical Oncology Research Fund (Y-BMS2019-026).

Proteomic Profiling Reveals the Molecular Control of Oocyte Maturation.

Meiotic maturation is an intricate and precisely regulated process orchestrated by various pathways and numerous proteins. However, little is known about the proteome landscape during oocytes maturation. Here, we obtained the temporal proteomic profiles of mouse oocytes during in vivo maturation. We successfully quantified 4694 proteins from 4500 oocytes in three key stages (germinal vesicle, germinal vesicle breakdown, and metaphase II). In particular, we discovered the novel proteomic features during oocyte maturation, such as the active Skp1-Cullin-Fbox pathway and an increase in mRNA decay-related proteins. Using functional approaches, we further identified the key factors controlling the histone acetylation state in oocytes and the vital proteins modulating meiotic cell cycle. Taken together, our data serve as a broad resource on the dynamics occurring in oocyte proteome and provide important knowledge to better understand the molecular mechanisms during germ cell development.

Restraint stress of female mice during oocyte development facilitates oocyte postovulatory aging.

Studies suggest that psychological stress on women can impair their reproduction and that postovulatory oocyte aging (POA) might increase the risk of early pregnancy loss and affect offspring's reproductive fitness and longevity. However, whether psychological stress during oocyte development would facilitate POA is unknown but worth exploring to understand the mechanisms by which psychological stress and POA damage oocytes. This study observed effects of female restraint stress during oocyte development (FRSOD) on oocyte resistance to POA. Female mice were restrained for 48 h before superovulation, and they were sacrificed at different intervals after ovulation to recover aging oocytes for analyzing their early and late aged characteristics. The effects of FRSOD on aging oocytes included: (1) increasing their susceptibility to activation stimulus with elevated cytoplasmic calcium; (2) impairing their developmental potential with downregulated expression of development-beneficial genes; (3) facilitating degeneration, cytoplasmic fragmentation and apoptosis; (4) worsening the disorganization of cortical granules and spindle/chromosomes; and (5) impairing redox potential with increased oxidative stress. In conclusion, FRSOD impairs oocyte resistance to POA, so that stressed oocytes become aged significantly quicker than unstressed controls. Thus, couples wishing to achieve pregnancy should take steps to avoid not only fertilization of aged oocytes but also pregestational stressful life events.

Concentrations, Speciation, and Potential Release of Hazardous Heavy Metals from the Solid Combustion Residues of Coal-Fired Power Plants.

Hazardous heavy metal-laden coal combustion byproducts exposed to precipitation or surface/groundwater are of environmental concern. This study analyzed fly ash (FA) and desulfurization gypsum (FGD gypsum) samples obtained from 16 coal-fired power plants in Guizhou Province, China. A combination of field and laboratory studies was used to investigate the binding forms of lead (Pb), cadmium (Cd), and chromium (Cr) and their leaching characteristics under natural storage conditions. The results showed that there were significant proportions of residual states of these elements in FA (84-99% for Pb, 83-91% for Cd, and 73-97% for Cr), indicating a lack of migration to other environmental media. FGD gypsum contained high proportions of metals in migratable states, but the environmental risks were low due to their very low concentrations. The release of Pb, Cd, and Cr from FA and FGD gypsum into extracts varied according to pH. This is related to the form of each element in the solid and the series of reactions that occurs during the leaching process. However, aside from Cr in FA, all heavy metals in FA and FGD gypsum samples were present in concentrations below the relevant standards for landfill leachate, indicating very low release rates. The Cr levels (206-273 µg/L) in some of the FA extracts were higher than the limits for water pollution from domestic landfill, indicating that Cr in FA poses a leaching risk. The results of field leachate sampling and indoor simulated rainfall experiments further validated these findings, indicating that the release of Cr from stockpiled coal FA is a cause for concern.

Understanding the excretion rates of methylmercury and inorganic mercury from human body via hair and fingernails.

Effective biomarkers are necessary to better understand the human mercury (Hg) exposure levels. However, mismatched biomarker sampling method causes extra uncertainty in assessing the risk of Hg exposure. To compare the differences between hair and fingernail, and further understand the excretion rates of methylmercury (MeHg) and inorganic mercury (IHg) via hair and fingernails, the total mercury (THg), MeHg, and IHg concentrations in paired hair and fingernail samples were investigated through paired samples collected from two typical mining areas, Wanshan mercury mine area (WMMA) and Hezhang zinc smelting area (HZSA). The positive correlation in THg, MeHg, and IHg concentrations (p <0.01) between hair and fingernail samples indicated that those two biomarkers can be corrected in application of assessing human Hg exposure. Compared to fingernails, the hair was suggested to be a more sensitive biomarker as the concentration of THg, MeHg and IHg were 2 ∼ 4 times higher than those in fingernails. Furthermore, the amounts of THg, MeHg, and IHg excreted via hair were 70 ∼ 226 times higher than that excreted via fingernails, and the hair plays a more important role than fingernails in the excretion of Hg from human bodies. Present study therefore provides some new insights to better understand the fate of human assimilated Hg.

Dissociation of Mercuric Oxides Drives Anomalous Isotope Fractionation during Net Photo-oxidation of Mercury Vapor in Air.

The atmosphere is the primary medium for long-distance transport and transformation of elemental mercury (Hg), a potent neurotoxin. The recent discovery of mass-independent fractionation (MIF) of even-mass Hg isotopes (even-MIF, measured as Δ200Hg and Δ204Hg) in the atmosphere is surprising and can potentially serve as a powerful tracer in understanding Hg biogeochemistry. Far-ultraviolet (UVC) light-induced gas-phase reactions have been suspected as a likely cause for even-MIF, yet the mechanism remains unknown. Here, we present the first experimental evidence of large-scale even-MIF caused by UVC-induced (wavelength: 254 nm) Hg oxidation in synthetic air at the pressure (46-88 kPa) and temperature (233-298 K) resembling those of the lower atmosphere. We observe negatively correlated Δ200Hg and Δ204Hg signatures with values as low as -50‰ and as high as 550‰, respectively, in the remaining atomic Hg pool. The magnitude of even-MIF signatures decreases with decreasing pressure with the Δ200Hg/Δ204Hg ratio being similar to that observed in global precipitation. This even-MIF can be explained by photodissociation of mercuric oxides that are photochemically formed in the UVC-irradiated Hg-O2 system. We propose that similar processes occurring in the atmosphere, where mercuric oxide species serve as intermediates, are responsible for the observed even-MIF in the environment.

Timing of postmastectomy radiotherapy following adjuvant chemotherapy for high-risk breast cancer: A post hoc analysis of a randomised controlled clinical trial.

PURPOSE: To investigate the appropriate timing of radiotherapy (RT) after mastectomy and adjuvant chemotherapy for women with high-risk breast cancer. PATIENTS AND METHODS: Post hoc analyses of 584 patients with stage II and III breast cancer from a randomised controlled clinical trial were performed. All patients underwent mastectomy followed by sequential chemotherapy and RT. The optimal cut-off values for the surgery-RT interval (SRI) and the chemotherapy-RT interval (CRI) for overall survival (OS) were determined using the hazard ratio for continuous predictors. The locoregional recurrence (LRR), distant metastasis (DM), disease-free survival (DFS), and OS rates were estimated using the Kaplan-Meier method. Multivariate analyses were performed using Cox proportional hazards regression. RESULTS: Median follow-up time was 83.5 months. Median SRI and CRI were 168 and 27 days, respectively. An SRI of >210 days was independently associated with higher DM (HR 2.65, 95% CI: 1.49-4.71; HR 2.78, 95% CI 1.51-5.26), lower OS (HR 2.44, 95% CI: 1.28-4.54; HR 2.50, 95% CI: 1.41-4.35), and lower DFS (HR 2.57, 95% CI: 1.45-4.57; HR 2.70, 95% CI: 1.45-5.00) than SRI of <180 or 180-210 days. Furthermore, a CRI of more than 42 days was independently associated with higher DM (HR 1.89, 95% CI: 1.17-3.06; HR 1.96, 95% CI: 1.19-3.22), lower OS (HR 2.44, 95% CI: 1.41-4.35; HR 1.92, 95% CI: 1.10-3.33), and lower DFS (HR 1.84, 95% CI: 1.14-2.96; HR 1.82, 95% CI: 1.12-2.94) than a CRI of <28 or 28-42 days. However, SRI and CRI had no significant effect on LRR. CONCLUSIONS: Based on the present findings, the timing of the initiation of RT both after mastectomy and after the completion of adjuvant chemotherapy is crucial for patients with high-risk breast cancer.

Flooding-drainage alternations impact mobilization and isotope fractionation of cadmium in soil-rice systems.

Sequential flooding and draining substantially alter Cd mobilization in paddy fields, primarily due to redox-driven changes in Fe-Mn (hydro)oxides and Cd-sulfides. However, the impacts of carbonates on Cd mobilization during flooding-drainage alternations remain poorly understood. In this study, Cd isotope compositions were analyzed in soils and plants at three growth stages, and the results show a pH-dependent Cd mobilization and isotope fractionation. Sequential extraction shows the Cd mainly binds to the exchangeable fraction and carbonates, and their amounts vary with pH. Exchangeable Cd with light isotopes coprecipitates into carbonates due to increased pH during flooding (tillering and panicle initiation). Whereas in drained soils (maturity), the carbonate-bound Cd releases with decreased pH. Light isotopes are enriched in rice compared with exchangeable Cd, but this enrichment is insignificant at maturity. This difference is mainly caused by the change in Cd isotope composition of exchangeable Cd pool due to carbonate coprecipitation during flooding. Limited isotope fractionation between roots and aboveground tissues is found at tillering, whereas significant isotope fractionation is observed at two other stages, suggesting the nodes might work during Cd translocation between tissues. These findings demonstrate alternating flooding-drainage impacts the mobilization of carbonate-bound Cd and, consequently, isotope fractionation in soil-rice systems.

Mass flow, enrichment and potential environmental impacts of mercury in a preheater-precalciner cement plant using multiple mining and industrial wastes.

Cement plants (CPs) are one of the most important anthropogenic sources of mercury (Hg) emissions in China. Over 1000 cement production lines operate in China and use various raw materials; however, little data on Hg emissions is recorded on site. This study investigated a CP in Guizhou Province that uses multiple mining and industrial wastes as part of the circular economy policy. Among the various raw materials, carbide slag had the highest Hg content (2.6 mg/kg) and contributed half of the Hg input. High Hg concentration (27 mg/kg) in the kiln tail dust and a strong Hg enrichment factor (39) was found, which was determined as the ratio of total Hg accumulated within the clinker production process to the daily Hg input from raw materials and fuel. The clinker had negligible Hg (0.001 mg/kg), while the Hg in cement products (0.04 mg/kg) mostly came from additives and retarders. The estimated atmospheric emission factor of Hg from this CP was 161.5 mg Hg/t clinker, which was much higher than those of other CPs in Guizhou that employ low-Hg raw materials. A five-step sequential extraction experiment with kiln tail dust indicates that Hg mainly existed in fraction of F4 (73-96% of the total Hg, possibly as Hg2Cl2) and that some samples had high proportions of water-soluble Hg (up to 21% of the total), which may be easily released into surrounding water bodies and pose high environmental risks. Using low-Hg raw (or alternative raw) materials and conducting proper disposal of kiln tail dust will reduce the environmental risk of Hg from CPs.

Concentrations, leachability, and health risks of mercury in green tea from major production areas in China.

Green tea has many health benefits and is the most consumed type in China. However, the heavy metals and contaminants in tea can also pose a great risk to human health. In this study, mercury (Hg) concentration in green tea collected from 11 provinces in China was examined. The leaching characteristics of Hg during brewing and the associated exposure to drinkers were also evaluated. Results indicated a low potential of Hg accumulation in green tea. The Hg content of green tea from Wanshan District, Guizhou Province-which has the largest Hg mine in China and is severely contaminated by Hg-could be limited by controlling the harvest time of tea leaves. The average Hg content of green tea from 43 tea production sites in China was only 6.3 ± 6.4 µg/kg dry weight. The brewing experiments of green tea showed that the leaching ratio of Hg was 22.61 ± 7.58% for 40 min of a single brew, and increased to 32.83 ± 12.37% after four rounds (3 min/ round) of brewing. The leaching of Hg from tea leaves was significantly affected by leaching time, temperature, and solid-liquid ratio but not by water hardness. The risk of Hg exposure from green tea intake was found to be very low, with an average hazard quotient (HQ) value of only 1.82 ± 1.85% for a single brew in 40 min and 2.64 ± 2.68% after four rounds of brewing. However, in some highly contaminated areas, with HQ values as high as 43.12 ± 2.41%, green tea intake may still pose a high risk of Hg exposure, and this risk should not be ignored.

Risk factors to identify the indication for regional nodal irradiation in T1-2N1M0 breast cancer: A joint analysis of 4,243 real-world cases from two institutions.

Purpose: The aim of this study is to evaluate the role of regional nodal irradiation (RNI) in patients with T1-2N1M0 breast cancer and to identify the subgroup that could benefit from RNI. Methods and materials: A total of 4,243 women with pT1-2N1M0 breast cancer treated at two institutions in China were retrospectively reviewed. Survival rates were calculated by the Kaplan-Meier method and compared by the log-rank test. The association of risk factors with survival outcomes was evaluated using multivariable proportional hazards regression. Results: A total of 932 patients (22.0%) received RNI. At a median follow-up of 5.9 years, the 5-year locoregional recurrence (LRR), distant metastasis (DM), disease-free survival (DFS), and overall survival (OS) rates were 4.0% and 7.2% (P = 0.001), 13.2% and 10.6% (P = 0.465), 85.0% and 84.7% (P = 0.131), and 93.9% and 92.8% (P = 0.004) in the RNI and non-RNI groups, respectively. Multivariate analysis revealed that RNI was an independent prognostic factor for lower LRR (P = 0.001) and longer DFS (P = 0.013). Patients were stratified into low-, intermediate-, and high-risk groups based on the eight non-therapeutic risk factors. RNI significantly decreased the 5-year LRR (2.2% vs. 7.0%, P = 0.001) and improved the 5-year DFS (88.8% vs. 84.9%, P = 0.015) and OS (95.8% vs. 93.9%, P = 0.010) in the intermediate-risk group. However, neither the low-risk group nor the high-risk group had survival benefit from RNI. Conclusion: T1-2N1M0 breast cancer is a heterogeneous disease. We found that RNI only improved survival in the intermediate-risk group. It might be omitted in low-risk patients, and the role of RNI in high-risk patients needs further study.

Effect of postmastectomy radiotherapy on pT1-2N1 breast cancer patients with different molecular subtypes.

OBJECTIVE: To clarify the effect of postmastectomy radiotherapy (PMRT) on pT1-2N1 breast cancer patients with different molecular subtypes. METHODS: We retrospectively analyzed the data of 5442 patients with pT1-2N1 breast cancer treated using modified radical mastectomy in 11 hospitals in China. Univariate, multivariate, and propensity score matching (PSM) analyses were used to evaluate the effect of PMRT on locoregional recurrence (LRR). RESULTS: With a median follow-up duration of 63.8 months, the 5-year LRR rates were 4.0% and 7.7% among patients treated with and without PMRT, respectively (p < 0.001). PMRT was independently associated with reduced LRR after adjustments for confounders (p < 0.001). After grouping the patients according to the molecular subtype of cancer and conducting PSM, we found that the 5-year LRR rates among patients treated with and without PMRT (in that order) were as follows: luminal HER2-negative cancer, 1.9% and 6.5% (p < 0.001); luminal HER2-positive cancer, 3.8% and 13.7% (p = 0.041); HER2-overexpressing cancer, 10.2% and 15.5% (p = 0.236); and triple-negative cancer, 4.6% and 15.9% (p = 0.002). Among patients with HER2-overexpressing and triple-negative cancers, the LRR hazard rate displayed a dominant early peak, and was extremely low after 5 years. However, patients with luminal cancer continued to have a long-lasting high annual LRR hazard rate during follow-up. CONCLUSION: PMRT significantly reduced the LRR risk in patients with pT1-2N1 luminal and triple-negative breast cancers, but had no effect on the LRR risk in patients with HER2-overexpressing cancer. Patients with different molecular subtypes displayed different annual LRR patterns, and the late recurrence of the luminal subtype suggests the necessity of long-term follow-up to evaluate the efficacy of PMRT.

Quality of Life After Partial or Whole-Breast Irradiation in Breast-Conserving Therapy for Low-Risk Breast Cancer: 1-Year Results of a Phase 2 Randomized Controlled Trial.

PURPOSE: To report patients' quality of life (QoL) at 1 year in a phase 2 randomized trial comparing partial breast irradiation (PBI) with whole-breast irradiation (WBI) after breast-conserving surgery (BCS) for breast cancer. METHODS: Women aged ≥ 45 years with low-risk breast cancer after BCS were randomly assigned (1:1) to receive PBI (40 Gy in 10 fractions over 2 weeks) or WBI (43.5 Gy in 15 fractions over 3 weeks). The primary endpoint-the incidence of toxicities of grade 2 or higher-will be reported when participants complete 5 years of follow-up. QoL was assessed at baseline (T0), at the end of radiotherapy (RT) (T1), 6 months (T2) and 1 year (T3) after RT by using the EORTC QLQ-C30 and QLQ-BR23 questionnaires. We calculated the scores for all QOL subscales and differences in mean scores were compared. This study was registered at ClinicalTrials.gov (NCT03583619). RESULTS: Between June 2017 and January 2019, 140 women were randomly assigned to receive PBI or WBI (n = 70 per group). Fifty-nine and 56 patients treated with PBI and WBI, respectively, were eligible for the QoL analysis. There were no significant differences in any subscale scores at T0, T1, T2, or T3 between the PBI and WBI arms. The scores for most QoL subscales that were influenced by RT recovered to a similar or better level relative to T0 scores within 1 year after RT, except for the scores of the dyspnea subscale. Longitudinal analysis showed that time since RT had a significant impact on physical functioning, role functioning, social functioning, fatigue, pain, dyspnea, financial difficulties, body image, and breast and arm symptoms. CONCLUSION: PBI using the intensity-modulated RT affords QoL comparable to that provided by WBI. Most QoL subscale scores that were influenced by RT recovered to a similar or better level relative to baseline scores within 1 year after RT.