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Objective To evaluate the clinical efficacy and safety of platinum-containing neoadjuvant immunotherapy for triple-negative breast cancer. Methods Sixty-four patients with PD-L1 positive triple-negative breast cancer were enrolled and randomly divided into the control（n = 32）and observation groups（n = 32）. In the control group，preoperative chemotherapy regimen of albumin-bound paclitaxel plus cisplatin（TP）was given，while the observation group received platinum-containing neoadjuvant immunotherapy--combined with programmed death receptor-1（PD-1）inhibitor carrilizumab on the basis of TP chemotherapy regimen of control group. At 4 weeks post-neoadjuvant chemotherapy，whether modified radical surgery or breast-conserving surgery was chosen based on surgical indications，and whether axillary lymph node dissection was performed according to intraoperative sentinel lymph node biopsy results. The objective response rate，disease control rate，pathological complete response rate，breast conservation rate，axillary lymph node exemption rate，T lymphocyte subset levels，hypoxia-inducible factor-1αlevels，vascular endothelial growth factor levels，and the incidence of adverse reactions were compared between two groups. Results After 6 cycles of neoadjuvant chemotherapy，the objective remission rate，pathological complete remission rate，and elevated level of CD4+ T lymphocytes in the observation group were higher than those in the control group（all P < 0.05）. The levels of hypoxia-inducible factor-1α and vascular endothelial growth factor in the observation group were lower than those in the control group（all P < 0.05）. Although the disease control rate，breast conservation rate and exemption rate of axillary lymph node dissection were relatively high in the observation group，the difference was not significant when compared with that in the control group（P > 0.05）. There was no significant difference in the incidence of adverse reactions between two groups（P > 0.05）. Conclusion Platinum-containing neoadjuvant immunotherapy is efficacious and safe for triple-negative breast cancer，which reduces the tumor load and improves clinical prognosis of the patients.

This paper summarized the postoperative nursing of a patient undergoing breast-conserving surgery for left-sided breast cancer. Key issues of postoperative nursing included pain management, infection prevention, skin care, prevention of deep venous thrombosis and psychological care. Targeted postoperative nursing interventions are effective in pain relief and prevention of complication of breast-conserving surgery for left-sided breast cancer. (本文总结1例左侧乳腺癌保乳手术患者术后护理经验, 包括疼痛护理、感染预防、皮肤护理、深静脉血栓预防、心理护理, 通过实施针对性护理, 有效缓解患者疼痛, 避免并发症, 对患者的早期康复有积极意义。)

Objective To evaluate the clinical efficacy and safety of platinum-containing neoadjuvant immunotherapy for triple-negative breast cancer. Methods Sixty-four patients with PD-L1 positive triple-negative breast cancer were enrolled and randomly divided into the control(n = 32) and observation groups(n = 32) . In the control group, preoperative chemotherapy regimen of albumin-bound paclitaxel plus cisplatin(TP) was given, while the observation group received platinum-containing neoadjuvant immunotherapy--combined with programmed death receptor-1（PD-1) inhibitor carrilizumab on the basis of TP chemotherapy regimen of control group. At 4 weeks post-neoadjuvant chemotherapy, whether modified radical surgery or breast-conserving surgery was chosen based on surgical indications, and whether axillary lymph node dissection was performed according to intraoperative sentinel lymph node biopsy results. The objective response rate, disease control rate, pathological complete response rate, breast conservation rate, axillary lymph node exemption rate, T lymphocyte subset levels, hypoxia-inducible factor-1αlevels, vascular endothelial growth factor levels, and the incidence of adverse reactions were compared between two groups. Results After 6 cycles of neoadjuvant chemotherapy, the objective remission rate, pathological complete remission rate, and elevated level of CD4+ T lymphocytes in the observation group were higher than those in the control group(all P < 0.05) . The levels of hypoxia-inducible factor-1α and vascular endothelial growth factor in the observation group were lower than those in the control group(all P < 0.05) . Although the disease control rate, breast conservation rate and exemption rate of axillary lymph node dissection were relatively high in the observation group, the difference was not significant when compared with that in the control group(P > 0.05) . There was no significant difference in the incidence of adverse reactions between two groups(P > 0.05) . Conclusion Platinum-containing neoadjuvant immunotherapy is efficacious and safe for triple-negative breast cancer, which reduces the tumor load and improves clinical prognosis of the patients. [ABSTRACT FROM AUTHOR]

Objective：To evaluate the effects of combined use of oxycodone and propofol for total intravenous anesthesia in patients with breast cancer undergoing breast-conserving surgery，on the intraoperative anesthesia，perioperative adverse reactions and analgesic effects. Methods：Eighty patients elective undergoing breast-conserving surgery for breast cancer，with American Society of Anesthesiologists (ASA) physical status classification Ⅰ or Ⅱ，aged 26-61 year，and body mass index (BMI) of 19~28 kg/m², were randomly divided into oxycodone group (n=40) and fentanyl group (n=40) . The systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded at the following time points：before anesthesia induction (T0), immediately before tracheal intubation (T1), at the start of surgery (T2), during resection of the breast specimen (T3), and at the end of surgery (T4) . The numerical rating scale (NRS) for pain were recorded at rest and during movement at 2 h，6 h，24 h and 48 h after surgery. The time to awakening， extubation time，and propofol consumption were also recorded. The incidence of cough reflex during induction，intraoperative awareness，intraoperative hypotension，postoperative agitation，nausea and vomiting，and skin itching were observed in both groups. Results：At T2 and T3，the SBP，DBP and HR in the oxycodone group were significantly higher than those in the fentanyl group (P < 0.05) . The NRS scores for resting pain and movement pain at 2 h after surgery were significantly lower in the oxycodone group than the fentanyl group (P < 0.05) . The incidence of cough reflex during induction was significantly lower in the oxycodone group than in the fentanyl group (P < 0.05) . Conclusion：Oxycodone combined with propofol for total intravenous anesthesia can be safely used in breast- conserving surgery for breast cancer. It provides satisfactory anesthesia induction and maintenance，has minimal impact on circulation during surgery，and has effective postoperative analgesic effects. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between preoperative magnetic resonance imaging (MRI) examination and the success rate and prognosis of breast-conserving surgery in ductal carcinoma in situ (DCIS) patients. Methods: Patients with DCIS received surgery between January 2009 and January 2017 in the breast cancer medical record database of Shanghai Jiao Tong University were retrospectively analyzed. Patients who received preoperative MRI was defined as MRI group, who did not receive preoperative MRI was defined as non-MRI group. Results: A total of 210 DCIS patients were included, of which 167 cases in the MRI group and 43 cases in the non-MRI group, respectively. Initial negative resection margin rates were similar between MRI and non-MRI groups undergoing breast-conserving surgery (91.0% vs. 97.7%, P=0.142). There was also no significant difference in the success rate of breast-conserving surgery between MRI and non MRI groups (95.2% vs. 100.0%, P=0.143). In terms of prognosis, there was no significant difference in 10-year loco-regional recurrence rate (4.8% vs. 2.3%, P=0.426) and breast cancer related mortality (0.9% vs. 0.5%, P=0.668) between MRI and non-MRI groups. Conclusions: Preoperative breast MRI examination in patients with DCIS had no effect on the rate of negative resection margin, success rate of breast preservation and the prognosis of the patients.

Objective: To investigate the effect of breast-conserving surgery (BCS) or mastectomy (M) in patients with stage Ⅰ-Ⅲ triple-negative breast cancer (TNBC) on disease free survival (DFS) and overall survival (OS). Methods: A total of 844 patients with stage Ⅰ-Ⅲ TNBC who were admitted to Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2009 to December 2018 were collected and divided into BCS and M groups according to the surgical method. COX regression analysis was used to evaluate the influence of clinical characteristics and surgical methods on DFS and OS of the patients. The propensity score was further used to balance the differences in baseline characteristics between the two groups of patients, and to evaluate the differences in the prognosis of two groups of patients. Results: There were 533 patients (63.15%) underwent M and 311 patients (36.85%) underwent BCS. Patients with younger age, smaller tumor size, negative lymph node, and loss of HER2 expression (HER2-0) were more tend to BCS group compared to M group. Median follow-up time was 72 months. Multivariate COX analysis showed that the OS of M group was lower than that of BCS group (HR=2.02, 95% CI: 1.04-3.91, P=0.038), but there was no significant difference in DFS between the two groups (HR=1.42, 95% CI: 0.94-2.15, P=0.100). After propensity score matching for factors such as T stage, N stage and age, the results showed that there was no significant difference in OS (P=0.114) and DFS (P=0.124) between BCS and M groups. Conclusions: Among patients with stage Ⅰ-Ⅲ TNBC, patients with younger age, smaller tumor, negative lymph node, and HER2-0 were more likely to choose BCS. After propensity score matching for relevant clinicopathological parameters, the results indicated that there was no significant difference in OS and DFS of the TNBC patients undergoing BCS or M surgery.

Background and purpose: Adjuvant radiotherapy for breast cancer after early breast-conserving surgery has been recommended by the guidelines. However, the feasibility of hypofractionated radiotherapy with simultaneous integrated boost is not available. In this randomized controlled study, the cardiac dosimetry parameters and cardiac ultrasound indexes of the two radiotherapy plans were compared to evaluate the safety of hypofractionated radiotherapy with simultaneous integrated boost plan in terms of cardiotoxicity. Methods: A total of 40 patients with breast cancer who received breast-conserving surgery were selected in Zhongshan Hospital, Fudan University from March 2017 to March 2018. They were randomly divided into two groups, including 20 patients reveiving hypofractionated radiotherapy with simultaneous integrated boost plan (whole breast 4 005 cGy/15 Fx, tumor bed 4 500 cGy/15 Fx) and 20 patients reveiving conventional fractionation with simultaneous integrated boost plan (whole breast 5 000 cGy/25 Fx, tumor bed 6 000 cGy/25 Fx). The cardiac dosimetric parameters and cardiac ultrasound indexes of the two groups were compared. The dosimetric parameters included the average doses (Dmean) of the whole heart, left ventricle, right ventricle, right ventricular free wall, ventricular septum and left anterior descending (LAD) coronary artery, and the relative volume fraction of each structure irradiated by 5-35 Gy (V5 Gy-V35 Gy). The follow-up indexes of echocardiography included aortic root diameter, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness, pulmonary artery systolic pressure, left ventricular ejection fraction, E peak, A peak, E-peak deceleration time (DT), E, A, E/A and S wave peak. In addition, the cosmetic effect on breast after radiotherapy in the two groups was also evaluated. Results: Dmean of the whole heart in the hypofractionated group and the conventional group were (471.86±170.54) and (733.07±79.11) cGy (P0.05); Dmean of left ventricle were (908.64±865.60) vs (946.93±116.13) cGy (P>0.05). Dmean of right ventricle were (590.37±197.99) vs (905.73±180.82) cGy (P0.05). There was no significant difference in cosmetic effect between the two groups (P>0.05). Conclusion: Compared with the conventional fractionation plan, hypofractionated radiotherapy with simultaneous integrated boost significantly reduced the radiation dose of the whole heart and some cardiac substructures, and there were no abnormal cardiac ultrasound indexes during one-year follow-up. The dose fractionation method in this study is safe and feasible. Limiting the whole heart dose alone can not effectively protect LAD, so it is recommended to outline the cardiac substructure and limit the dose alone to better protect the heart.

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Objective To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget′s disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ² test or Fisher exact test was used to analyze the influencing factors. Results Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer. [ABSTRACT FROM AUTHOR]

Background and purpose: Adjuvant radiotherapy for breast cancer after early breast-conserving surgery has been recommended by the guidelines. However, the feasibility of hypofractionated radiotherapy with simultaneous integrated boost is not available. In this randomized controlled study, the cardiac dosimetry parameters and cardiac ultrasound indexes of the two radiotherapy plans were compared to evaluate the safety of hypofractionated radiotherapy with simultaneous integrated boost plan in terms of cardiotoxicity. Methods: A total of 40 patients with breast cancer who received breast-conserving surgery were selected in Zhongshan Hospital, Fudan University from March 2017 to March 2018. They were randomly divided into two groups, including 20 patients reveiving hypofractionated radiotherapy with simultaneous integrated boost plan (whole breast 4 005 cGy/15 Fx, tumor bed 4 500 cGy/15 Fx) and 20 patients reveiving conventional fractionation with simultaneous integrated boost plan (whole breast 5 000 cGy/25 Fx, tumor bed 6 000 cGy/25 Fx). The cardiac dosimetric parameters and cardiac ultrasound indexes of the two groups were compared. The dosimetric parameters included the average doses (Dmean) of the whole heart, left ventricle, right ventricle, right ventricular free wall, ventricular septum and left anterior descending (LAD) coronary artery, and the relative volume fraction of each structure irradiated by 5-35 Gy (V5 Gy-V35 Gy). The follow-up indexes of echocardiography included aortic root diameter, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness, pulmonary artery systolic pressure, left ventricular ejection fraction, E peak, A peak, E-peak deceleration time (DT), E, A, E/A and S wave peak. In addition, the cosmetic effect on breast after radiotherapy in the two groups was also evaluated. Results: Dmean of the whole heart in the hypofractionated group and the conventional group were (471.86±170.54) and (733.07±79.11) cGy (P<0.05); V20 Gy of the whole heart was (3.63±1.74) and (8.43±0.74)% (P<0.05), and V30 Gy was (1.55±1.15) and (4.48±1.01)% (P<0.05). Dmean of LAD were (1 250.17±600.33) and (1 847.20±933.23) cGy (P>0.05); Dmean of left ventricle were (908.64±865.60) vs (946.93±116.13) cGy (P>0.05). Dmean of right ventricle were (590.37±197.99) vs (905.73±180.82) cGy (P<0.05); Dmean of right ventricular free wall were (939.40±284.23) vs (1 597.30±446.3) cGy (P<0.05); Dmean of ventricular septum were (1 637.49±248.19) vs (988.60±159.77) cGy (P<0.05). After one year of follow-up, the cardiac ultrasound indexes in the hypofractionated group and the conventional group were in the normal range, and there was no significant difference between the two groups (P>0.05). There was no significant difference in cosmetic effect between the two groups (P>0.05). Conclusion: Compared with the conventional fractionation plan, hypofractionated radiotherapy with simultaneous integrated boost significantly reduced the radiation dose of the whole heart and some cardiac substructures, and there were no abnormal cardiac ultrasound indexes during one-year follow-up. The dose fractionation method in this study is safe and feasible. Limiting the whole heart dose alone can not effectively protect LAD, so it is recommended to outline the cardiac substructure and limit the dose alone to better protect the heart. [ABSTRACT FROM AUTHOR]

Objective: To review the development of endoscopic techniques in breast surgery, focusing on their use in benign breast lump resection and breast-conserving surgery for cancer, and also summarize the development and application of these techniques in China, highlighting promotion and homogenization challenges and future directions., Methods: A systematic review of relevant literature was conducted to trace the historical evolution, clinical applications, and related research of endoscopic techniques in breast surgery, emphasizing their advantages and disadvantages of endoscopic benign breast lump resection and breast-conserving surgery for cancer., Results: Endoscopic benign breast lump resection and breast-conserving surgery for cancer have improved patients' postoperative psychological health and quality of life, particularly in scar-free surgery. However, challenges such as limited intraoperative visibility and prolonged surgery time lead to controversy in clinical practice., Conclusion: Despite significant advancements, endoscopic techniques in breast surgery also face challenges. Future efforts should focus on technological improvements and clinical research to address these issues, promoting widespread application and standardization. The key to future development lies in the promotion and homogenization of these technologies.

Objective. To study the feasibility of not using opioids in breast-conserving surgery under general anesthesia with laryngeal mask airway. Methods. Forty female patients who underwent breast-conserving surgery for breast cancer were selected and randomly divided into an experimental group and a control group by random number table method, twenty cases in each. The experimental group underwent ultrasound-guided pectoral nerve block and serratus anterior plane block (SAPB) before induction, combined with dexmedetomidine and nonsteroidal anti-inflammatroy drug (NSAID) during the operation, and did not use opioids. The control group was given opioids without nerve block. The rest of the drugs were the same in both groups. The hemodynamic changes (systolic blood pressure, diastolic blood pressure and mean arterial pressure) of the patients at six time points were observed: before induction (T0), start induction (T1), 5 min after induction (T2), 10 min after induction (T3), incision (T4), and 5 min after incision (T5). The use of vasoactive agent, operation time, the recovery time of spontaneous breathing, laryngeal mask removal time, postoperative nausea, postoperative vomiting, postoperative delirium and visual analogue score (VAS) of patients in resuscitation room at rest and during activity, postoperative VAS at 6 h (at rest and during activity), and postoperative VAS at 24 h (at rest and during activity) between the two groups were compared. Results. The differences in systolic blood pressure, diastolic blood pressure and mean arterial pressure between the two groups at time points T3 and T5 were statistically significant (all P<0.05). The differences in heart rate at time points T3, T4 and T5 were statistically significant (all P<0.05). One patient in the experimental group used vasoactive agent and six patients in the control group used vasoactive agent. No statistical difference was found between the recovery time of spontaneous breathing and laryngeal mask removal time in the two groups. No patients in the experimental group experienced postoperative nausea and vomiting. In the control group, two patients had nausea, and another two patients had nausea and vomiting. The resting VAS at 6 h after surgery in the experimental group was higher than that in the control group, and the result had statistical significance (P<0.05). Four patients in the experimental group took oral analgesic after surgery, and no patients in the control group used oral analgesic after surgery. Conclusion. Pectoral nerve block, and SAPB combined with dexmedetomidine and NSAID under ultrasound make it possible not to use opioids during breast-conserving surgery under general anesthesia with laryngeal mask airway. The postoperative analgesic effect needs to be improved. [ABSTRACT FROM AUTHOR]

Objective: To investigate the overall efficacy of early breast cancer after breast-conserving treatment. To analyze risk factors affecting local regional recurrence (LRR), distant metastasis (DM) and survival. Methods: 1 791 breast cancer patients treated with breast-conserving surgery were retrospectively analyzed. The inclusion criteria were pathologic diagnosis of invasive breast cancer without supraclavicular and internal mammary node metastasis, T1-2N0-3M0, and no neoadjuvant therapy. Univariate analysis of survival was performed by Kaplan-Meier method and log rank test. Cox regression model was used for multivariate analysis. Results: The median follow-up time was 4.2 years. For all patients, the 5-year LRR, DM, disease-free survival(DFS) and overall survival(OS) rates were 3.6%, 4.6%, 93.0% and 97.4%, respectively. The LRR rates of patients with Luminal A, Luminal B1, Luminal B2, HER-2 over-expressed and triple-negative breast cancer were 2.0%, 6.1%, 5.9%, 0 and 10.0%, while the DM rates were 3.2%, 6.7%, 8.3%, 4.8% and 7.3%, respectively. Among the N0 patients, axillary dissection was performed in 689 cases and sentinel lymph node biopsy in 652 cases. The 5-year LRR rates were 3.3% and 3.2% (P=0.859), and the OS rates were 98.2% and 98.3% (P=0.311) respectively, which showed no statistically significant. There were 1 576 patients that underwent postoperative radiotherapy. Postoperative radiotherapy significantly reduced the 5-year LRR compared with surgery alone (2.5% vs 12.9%). The 5-year LRR rates of patients who received conventional fractionated radiotherapy and hypo-fractionated radiotherapy were 2.7% and 3.1%, respectively. But the difference was not statistically significant (P=0.870). Multivariate analysis showed that age, lymphovascular invasion, pathological T staging, postoperative radiotherapy, ER/PR status and endocrine therapy were independent factors of LRR in breast cancer patients (all P<0.05). Histological grade and pathological N staging were independent factors of DM (all P<0.05). The age, lymphovascular invasion, pathological T and N staging, postoperative radiotherapy, ER/PR status and endocrine therapy were independent factors for DFS (all P<0.05). Histological grade, pathological N staging, ER/PR status and endocrine therapy were factors for OS (all P<0.05). Conclusions: With contemporary standard treatment, the recurrence rate of early breast cancer after breast conserving treatment is less than 10%. Node-negative patients after sentinel lymph node biopsy did not need axillary dissection. The overall utilization of radiotherapy after breast conserving surgery is satisfactory. Hypofractionated radiotherapy is as effective as conventional fractionated radiotherapy. Local regional recurrence and distant metastasis have different risk factors. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of axillary lymph node status in evaluating the prognosis of patients with local recurrence after breast-conserving surgery. Methods The clinical data of 72 patients with local-regional recurrence who had undergone breast-conserving therapy in Tianjin Cancer Hospital from February 2001 to December 2009 were collected and retrospectively analyzed. These patients were divided into axillary lymph node positive group (23 cases) and negative group (49 cases), according to their axillary lymph node status. Results Among 72 patients, 21 cases were local recurrence, 35 cases were regional recurrence, and 16 cases were local-regional recurrence. In the axillary lymph node positive group, 7 cases were local recurrence, 10 cases were regional recurrence, 6 cases were local-regional recurrence. In the axillary lymph node negative group, 14 cases were local recurrence, 25 cases were regional recurrence, 10 cases were local-regional recurrence. There was no significant difference between these two groups (P= 0.807). Moreover, no significant differences of the age, recurrent site, estrogen receptor (ER) and/or progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER-2) status, disease-free period, local and systemic therapeutic effect, non-distant metastasis survival between these two groups were observed (P>0.05). However, the overall survival of axillary lymph node positive group after recurrence was significantly lower than that of negative group (P = 0.014). Cox multivariate analysis showed that recurrent site is an independent prognostic factor of disease-free survival of patients with regional recurrence after breast-conserving surgery (OR = 2.050, P = 0.002). The axillary lymph node status and recurrent site were independent prognostic factors of overall survival of these patients (OR= 3.469, P = 0.003; OR = 3.676, P<0.001). Conclusions Axillary lymph node status is an independent factor of overall survival of patients with regional recurrence after breast-conserving surgery, but it is marginally related with their non-distant metastasis survival. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical effect of different surgical methods combined with Neoadjuvant chemotherapy in treating patients with breast cancer. Methods: 80 patients treated and diagnosed in our hospital from January, 2012 to January, 2014 were enrolled in the present study. According to the willingness, physical condition and financial situation, they were divided them into group A (23 cases) and group B (57 cases). Neoadjuvant chemotherapy of EC regimens (epirubicin+cyclophosphamide) was applied to both groups, on the basis of which, group A received breast-conserving surgery, group B received modified radical mastectomy. The clinical effect,breast cosmetic result, life quality, psychological states were compared in both groups. Results: The operation time, extubation time were significantly shorter than those of group B (p ＜0.05), the amount of bleeding, AMA, HRSD score, occurrence rate of complications in group A were significantly lower than those of group B (p＜0.05), the breast cosmetic result of group A was obviously better than that of group B (p＜0.05), and the QLQ-BR23 score in group A was significantly higher than that of group B (p＜0.05). The 2-year survival rate and 2 year recurrence rate showed no statistical difference between the two groups (p ＞0.05). Conclusion:Breast-conserving surgery combined with epirubicin neoadjuvant chemotherapy was effective in treating breast cancer, which could decrease the complications, improve the breast cosmetic result and quality of life. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy and significance of breast-conserving surgery combined with reduction mammoplasty for breast cancer. Methods From October 2016 to December 2018, 11 patients with unilateral breast cancer and bilateral macromastia were treated by breast-conserving surgery combined with reduction mammoplasty. The postoperative clinical efficacy was summarized and analyzed. Results All patients underwent unilateral breast conserving surgery and bilateral reduction mammoplasty. Sentinel lymph node biopsy was performed in 1 patient. Axillary lymph node dissection was performed in 10 patients. The median follow- up duration was 13.1 months (from 2 to 26 months). No obvious complications occurred. There was no distant metastasis or local recurrence during the follow-up period. All patients were satisfied with the postoperative efficacy. Conclusion For patients with unilateral breast cancer and bilateral macromastia, breast-conserving surgery combined with immediate reduction mammoplasty not only achieves the goal of removal of the tumor, but also improves the difficulties caused by macromastia. It can achieve a good cosmetic effect and increase the quality of the patients' lives. [ABSTRACT FROM AUTHOR]

Objective: To explore the efficacy of different neo-adjuvant methods before breast-conserving surgery in the treatment of patients with triple-negative breast cancer. Methods: 90 patients with triple-negative breast cancer admitted in our hospital from Jan. 2006 to June 2015 were selected and randomly divided into the observation group and control group with 45 cases in each group. AC-T neo-adjuvant chemotherapy was given to the observation group, and TAC chemotherapy was given to the control group before surgery. Then the efficacy, adverse reactions, complications after surgery and improvement of quality of life in two groups were compared. Results: The total efficacy of observation group and control group were 82.22%, 73.33%. The disease control rate of observation group and control group were 95.56%, 91.11%. There was no significant difference between two groups (P>0.05). The incidence rates of neutropenia, gastrointestinal adverse reaction and mouth ulcers of observation roup were obviously lower than those of the control group (P<0.05). The complication rate of two groups were 6.67% and 11.11% respectively with no difference between two groups (P>0.05). The improvement rate of quality of life was 86.67% and 82.22% in the observation group and control group respectively, which had no statistically significance (P>0.05). Conclusion: AC-T neo-adjuvant chemotherapy before breast-conserving surgery had equal efficacy as TAC chemotherapy in the treatment of patients with triple-negative breast cancer, but the adverse reaction of AC-T was obviously less, which was worth clinical application. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effect of breast-conserving surgery and modified radical surgery on the treatment of breast cancer, so as to provide a reference for clinical diagnosis and treatment. Methods: 88 cases with breast cancer who were treated in our hospital from February 2010 to December 2011 were chosen as the research objects. According to the different treatment methods, the patients were divided into the study group and the control group, with 44 patients in each group. The patients in the study group were treated with the breast-conserving surgery, while the patients in the control group were treated with the modified radical surgery. Then the operation time, the hospitalization, the blood loss, the complications, and physical and psychological scores, and social and spiritual stages were observed and compared between the two groups before and after the treatment. Results: The operation time in the study group was shorter than that of the control group, and the hospitalization in the study group was shorter than that of the control group, the blood loss in the study group was less than that of the control group, the incidence of complications in the study group w:as lower than that of the control group, and the differences were statistically significant (P<0.05). The physical score, score psychological, social and spiritual score ratings and other quality of life scores in the study group were higher than that the control group, and the differences were statistically significant (P<0.05). Conclusion: Compared with modified radical surgery, the clinical effect of breast-conserving surgery for breast cancer is more significant, the postoperative quality of life of patients is better, and it is one of the ideal w7ays for the clinical treatment of breast cancer. [ABSTRACT FROM AUTHOR]

Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ (2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND ( P =0.040) and nipple invagination ( P =0.031). There were no correlations between tumor size ( P =0.519), lymph node metastasis ( P =0.847), bloody nipple discharge ( P =0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.

Objective To investigate the clinical efficacy of breast conserving surgery combined with neoadjuvant chemotherapy treatment for breast cancer. Methods 90 breast cancer patients from March 2010 to October 2012 of our hospital were divided into the observation group and the control group. The observation group was treated with breast-conserving surgery combined with neoadjuvant therapy, while the control group was treated with traditional radical mastectomy. The chemotherapy postoperative and follow-up were made, and the clinical efficacies of the two groups were compared comprehensively. Results Various indicators such as surgery operative time, blood loss, postoperative recovery time, incidence of complications, and postoperative recovery levels in the observation group were better than the control group, with a statistical difference (P < 0.05). Conclusion Compared with modified radical mastectomy, breast conserving surgery combined with neoadjuvant chemotherapy for breast cancer has obvious advantages in all aspects during operation, rehabilitation and restoring patients' confidence. It is worth to popularize in the clinical application. [ABSTRACT FROM AUTHOR]

Objective: To analyze the safety and short-term efficacy of breast-conserving surgery combined with intraoperative radiotherapy for early-stage breast cancer. Methods: A total of 101 consecutive patients who received breast-conserving surgery plus intraoperative radiotherapy were recruited to summarize the recent follow-up results and clinicopathological data. Univariate analysis and Logistic regression model were used to evaluate the factors affecting the postoperative adverse reactions and cosmetic effects. Results: Among 101 patients, 4 patients had recurrence or metastasis. The 3-years disease free survival rate was 94.9%, and the 3-years cumulative recurrence rate was 5.1%. Univariate analysis showed that the menstrual status and postoperative whole breast radiotherapy were associated with the postoperative adverse reactions ( P <0.05). The T stage and applicator diameter were associated with the cosmetic effect ( P <0.05). Multivariate analysis indicated that the diameter of the applicator ( OR =3.701, P =0.026) and postoperative whole breast radiotherapy ( OR =5.962, P =0.005) were independent factors for the postoperative adverse reactions, and the diameter of the applicator ( OR =2.522, P =0.037) was an independent factor for the cosmetic effect. Conclusion: Breast-conserving surgery combined with intraoperative radiotherapy shows safety and good short-term efficacy in low-risk early-stage breast cancer.

Objective: To investigate the overall efficacy of early breast cancer after breast-conserving treatment. To analyze risk factors affecting local regional recurrence (LRR), distant metastasis (DM) and survival. Methods: 1 791 breast cancer patients treated with breast-conserving surgery were retrospectively analyzed. The inclusion criteria were pathologic diagnosis of invasive breast cancer without supraclavicular and internal mammary node metastasis, T1-2N0-3M0, and no neoadjuvant therapy. Univariate analysis of survival was performed by Kaplan-Meier method and log rank test. Cox regression model was used for multivariate analysis. Results: The median follow-up time was 4.2 years. For all patients, the 5-year LRR, DM, disease-free survival(DFS) and overall survival(OS) rates were 3.6%, 4.6%, 93.0% and 97.4%, respectively. The LRR rates of patients with Luminal A, Luminal B1, Luminal B2, HER-2 over-expressed and triple-negative breast cancer were 2.0%, 6.1%, 5.9%, 0 and 10.0%, while the DM rates were 3.2%, 6.7%, 8.3%, 4.8% and 7.3%, respectively. Among the N0 patients, axillary dissection was performed in 689 cases and sentinel lymph node biopsy in 652 cases. The 5-year LRR rates were 3.3% and 3.2% ( P =0.859), and the OS rates were 98.2% and 98.3% ( P =0.311) respectively, which showed no statistically significant. There were 1 576 patients that underwent postoperative radiotherapy. Postoperative radiotherapy significantly reduced the 5-year LRR compared with surgery alone (2.5% vs 12.9%). The 5-year LRR rates of patients who received conventional fractionated radiotherapy and hypo-fractionated radiotherapy were 2.7% and 3.1%, respectively. But the difference was not statistically significant ( P =0.870). Multivariate analysis showed that age, lymphovascular invasion, pathological T staging, postoperative radiotherapy, ER/PR status and endocrine therapy were independent factors of LRR in breast cancer patients (all P <0.05). Histological grade and pathological N staging were independent factors of DM (all P <0.05). The age, lymphovascular invasion, pathological T and N staging, postoperative radiotherapy, ER/PR status and endocrine therapy were independent factors for DFS (all P <0.05). Histological grade, pathological N staging, ER/PR status and endocrine therapy were factors for OS (all P <0.05). Conclusions: With contemporary standard treatment, the recurrence rate of early breast cancer after breast conserving treatment is less than 10%. Node-negative patients after sentinel lymph node biopsy did not need axillary dissection. The overall utilization of radiotherapy after breast conserving surgery is satisfactory. Hypofractionated radiotherapy is as effective as conventional fractionated radiotherapy. Local regional recurrence and distant metastasis have different risk factors.

Objective: To investigate the effect of axillary lymph node status in evaluating the prognosis of patients with local recurrence after breast-conserving surgery. Methods: The clinical data of 72 patients with local-regional recurrence who had undergone breast-conserving therapy in Tianjin Cancer Hospital from February 2001 to December 2009 were collected and retrospectively analyzed. These patients were divided into axillary lymph node positive group (23 cases) and negative group (49 cases), according to their axillary lymph node status. Results: Among 72 patients, 21 cases were local recurrence, 35 cases were regional recurrence, and 16 cases were local-regional recurrence. In the axillary lymph node positive group, 7 cases were local recurrence, 10 cases were regional recurrence, 6 cases were local-regional recurrence. In the axillary lymph node negative group, 14 cases were local recurrence, 25 cases were regional recurrence, 10 cases were local-regional recurrence. There was no significant difference between these two groups ( P =0.807). Moreover, no significant differences of the age, recurrent site, estrogen receptor (ER) and/or progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER-2) status, disease-free period, local and systemic therapeutic effect, non-distant metastasis survival between these two groups were observed ( P >0.05). However, the overall survival of axillary lymph node positive group after recurrence was significantly lower than that of negative group ( P =0.014). Cox multivariate analysis showed that recurrent site is an independent prognostic factor of disease-free survival of patients with regional recurrence after breast-conserving surgery ( OR =2.050, P =0.002). The axillary lymph node status and recurrent site were independent prognostic factors of overall survival of these patients ( OR =3.469, P =0.003; OR =3.676, P <0.001). Conclusions: Axillary lymph node status is an independent factor of overall survival of patients with regional recurrence after breast-conserving surgery, but it is marginally related with their non-distant metastasis survival.