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Objective To retrospectively investigate the incidence of severe neutropenia and elevation of transaminase during neoadjuvant chemotherapy using epirubicin, cyclophosphamide and fluorouracil in breast cancer patients. Methods From January 2011 to December 2012, 303 consecutive breast cancer patients with complete treatment data treated in our department were included in this analysis. All patients received neoadjuvant chemotherapy with equal dose of EPI (100 mg/m2 ) administered every 3 weeks for 4 cycles before surgery. Results 200 patients (66. 0% ) experienced at least one episode of grade ¾ neutropenia/leukopenia, among them 176 patients experienced their first episode after the first cycle. Febrile neutropenia (FN) occurred in 13 patients for 14 episodes. Elevation of transaminase occurred in a total of 46 patients ( 15. 2%), among them, grade 2 or higher elevation occurred in 15 patients (5.0%). Three blood test plans were adopted to monitor the patients during chemotherapy;( 1 ) Routine blood count repeated every week; (2) Routine blood count belore and on day 10 of each chemotherapy episode; (3) Routine blood count before and on day 7, 10 and 14 of each chemotherapy episode. The number of patients whose chemotherapy was delayed due to ¾ neutropenia/leucopenia in each blood lest plan was 3 (5.0% ), 7 (3. 9% ) and 2 (3. 2%), respectively. The number of palienls with febrile neutropenia ( FIN ) in each blood test plan was 2 (3. 3% ) , 8 (4. 4% ) and 3 (4. 8% ) , respectively. No statistically significant difference in treatment delay or the incidence of FN was observed among different blood lest plans. No statistically significant difference in the incidence of grade ¾ neutropenia/leukopenia or grade 2 or higher transaminase elevation was observed among different 5-Fu regimens. Conclusions During neoadjuvant chemotherapy using FE100C, Fci E100 C or E100 C for breast cancer patients without routine prophylactic G-CSF, the incidence of grade ¾neutropenia/leukopenia is 66.0%. With the patient management plan we adopted, 4.3% of patients developed febrile neutropenia. Prophylactic medication may not be necessary for patients without evident liver dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of risk factors on ipsilateral breast tumor recurrence (IBTR) and distant disease-free survival (DDFS) for patients with triple-negative breast cancer (TNBC) who underwent breast-conserving treatment (BCT)., Methods: A series of 1 835 patients with primary breast cancer treated with BCT in a single institute between December 1999 and August 2010 were analyzed retrospectively. Totally 1 614 patients, whose characteristics were intact, were analyzed to compare their outcomes with respect to the incidence of IBTR, DDFS and disease-free survival (DFS). All of patients were female. Median age was 47 years (ranging 21 to 92 years, interquartile range 14 years). According to the immunohistochemical results of the patients, 1 614 cases were divided into TNBC group (n=308) and non-TNBC group (n=1 306). The risk factors of relapse after breast-conserving treatment (age at diagnosis, spread to axillary lymph nodes, hormone receptor status, neoadjuvant chemotherapy, and maximal tumor diameter, human epidermal growth factor receptor 2 (HER-2) status, preoperative MRI, the location and extent of the tumor bed defined by CT scans for electron boost planning as part of breast radiotherapy) were studied.χ(2) test was used to compare the distribution of baseline characteristics among subtypes. The probability of survival (or relapse occurrence), and DDFS were calculated using the Kaplan-Meier method. Cumulative incidence functions were used to describe the cumulative hazard from LR, IBTR and DDFS in the presence of competing risks., Results: A total of 1 614 women with primary breast cancer underwent a breast-conserving surgery followed by radiotherapy. The median follow-up period was 77 months (interquartile range 36 months). One hundred and forty patients (8.6%) were lost to follow-up. Overall 5-year IBTR rate was 3.1% (95% CI: 2.2% to 4.0%), 5-year DDFS rate was 95.8% (95% CI: 94.9% to 96.7%) and 5-year DFS rate was 93.8% (95% CI: 92.7% to 94.9%). Lymph nodal involvement (HR=3.03, 95% CI: 1.66 to 5.51, P=0.000) and use of CT information in boost field planning (HR=0.40, 95% CI: 0.20 to 0.80, P=0.010) were associated significantly with IBTR in Cox multivariable analysis. Multivariable analysis showed that TNBC doesn't have a significantly increased risk of IBTR compared with the non-TNBC subtype (HR=0.90, 95% CI: 0.50 to 1.76, P=0.78). TNBC was not an independent risk factor for DDFS or DFS. The multivariable model showed significant effect of nodal status and age at diagnosis on 5-year DDFS rate and 5-year DFS rate., Conclusions: Breast-conserving treatment for TNBC is not associated with increased IBTR compared with non-TNBC subtype. Use of CT information in boost field planning can reduce the risk of ipsilateral breast tumor recurrence for patients undergoing BCT.

Objective: To explore the relationship between response of primary tumor and positive axillary lymph node to neoadjuvant chemotherapy and examine its correlation with breast cancer distant disease-free survival (DDFS)., Methods: The clinical data of 678 needle biopsy proved node positive breast cancer patients on neoadjuvant chemotherapy were analyzed retrospectively., Results: The median follow-up period was 45 (6-143) months. The 4-year DDFS in group A (ypT0/is ypN0),B (ypT0/is ypN+), C (ypT ≥ 1mi ypN0) and D (ypT ≥ 1mi ypN+) were 96.4%, 85.7%, 86.7% and 80.2% respectively. As compared with group A, the relative risk ratios of groups B, C and D were 2.32, 2.09 and 4.07 (P = 0.006).Significant difference existed in DDFS between groups A and B (96.4% vs 85.7%, P = 0.045) and groups A and C (96.4% vs 86.7%, P = 0.040)., Conclusion: Pathological response of both primary tumor and positive axillary node are prognostic and crucial for evaluating the efficacy of neoadjuvant chemotherapy.

Objective: To evaluate the risk factors for non-sentinel lymph node (NSLN) metastasis in patients after neoadjuvant chemotherapy (NCT) so as to develop a new predictive model., Methods: A total of 512 consecutive patients with metastasis in sentinel lymph node (SLN) on neoadjuvant chemotherapy between August 2005 and March 2013 were recruited to evaluate the factors affecting the involvement of NSLN. Logistic regression analysis was performed to construct a predictive model., Results: There were 115 (22.4%) patients with metastasis in NSLN after axillary lymph node dissection. Univariate analysis showed that tumor size, number of positive SLN, hormone receptor (HR), micrometastasis and clinical response of primary tumor after NCT were associated with the involvement of NSLN (P < 0.05). Multivariate analysis indicated that tumor size, number of positive SLN, HR, micrometastasis and clinical response of primary tumor after NCT were significant independent predictors for NSLN metastasis. Area under the curve was 0.779., Conclusion: Tumor size, number of positive SLN, HR, micrometastasis and clinical response of primary tumor after NCT were significant independent predictors for NSLN metastasis in patients after NCT. The new model is to be further validated.

Objective: To investigate the correlations between circulating tumor cell (CTC) and clinicopathologic characteristics of tumors obtained by core needle biopsy in axillary lymph node positive primary breast cancer patients., Methods: The peripheral venous blood samples were collected from 126 patients with axillary lymph node positive primary breast cancer and were detected to found CTCs using the CellSearch automatic detection system. The associations between CTCs and clinicopathologic characteristics of tumors were analyzed in axillary lymph node positive primary breast cancer patients. All patients were female, age ranging from 27 to 65 years (median, 49 years)., Results: One or more CTCs were detected from the peripheral blood in 25.4% (32/126) patients. The positive rate of CTCs was 36.2% (17/47) in the human epidermal growth factor receptor 2 (HER-2) (+) patients, 19.0% (15/79) in the HER-2 (-) patients. In univariate analysis, there were significant differences about the positive rate of CTCs between the two groups (χ² = 4.592, P < 0.05). In multivariate analysis, the risk of circulating tumor cells positive in HER-2 (+) patients was 2.712 times higher than in HER-2 (-) patients (OR = 2.712, 95% CI: 1.117-6.584, P = 0.027), whereas the positive rate of CTCs in axillary lymph node positive primary breast cancer patients showed no significant differences among the different subgroups with regards to age, menopausal status, the T staging of the tumor, histological type, histological grade, hormone receptor status and Ki-67 expression level (P > 0.05)., Conclusions: There are significant correlations between the presence of CTCs and the HER-2 status of the tumor in axillary lymph node positive primary breast cancer patients. No significant correlations are found between the presence of CTCs and the age, menopausal status, T staging of the tumor, histological type, histological grade, hormone receptor status and Ki-67 expression level.