Objective To investigate the risk distribution of breast cancer for location and time of recurrence metastasis in molecular subtype.Methods We studied retrospectively the female patients who were diagnosed as invasive ductal breast cancer in our hospital from July 2004 to June 2012,detected ER,PR,and HER2 expressions in the paraffin sections.The patients with recurrence metastasis were divided into local recurrence and distant metastasis with the first transfer site as standard for analyzing the distribution in molecular subtype and the time of the first site of recurrence metastasis.Results Sixty two patients were encountered recurrence metastasis,including 23 patients with local recurrence,and 39 patients with distant metastasis,death 11.The rates of distant metastasis for patients who belonged to HER2 type and basal-like type were higher than that of local recurrence (P =0.01,P =0.001).The risk distribution of recurrence metastasis time in molecular recurrence metastasis showed that 35 percent of recurrence metastasis time of luminal A type was first 3 years,75 percent of molecular subtype of basa1-1ike type recurrence metastasis time in first 3 years and advanced.The peak of luminal B and HER2 type was first 3 years,and very low in 5 years.Conclusions Molecular subtype of breast cancer is an important complement for TNM method in accurately assessing the patients of recurrence metastasis for location and time,and is helpful for the individual screening of patients for recurrence metastasis.

Objective:To investigate the clinical characteristics, treatment effect and prognosis of children with nearly diploid neuroblastoma (NB).Methods:A retrospective analysis of the general clinical characteristics (including age, Gender, risk grouping, location of primary tumor, etc.), laboratory test results, treatment and recent prognosis of NB children with nearly diploidy in bone marrow chromosomes by G-banding technology who admitted to Beijing Children′s Hospital, Capital Medical University from January 2015 to December 2018. Kaplan- Meier method was adopted to calculate survival rate.Univariate analysis was performed using Log- Rank test, and multivariate analysis was conducted with Cox regression model. Results:A total of 43 patients, including 27 males and 16 females, with diagnosis were included, with 14 cases in the hypodiploid group and 29 cases in the hyperdiploid group, and the median age was 35.5 months.The 43 children were all in the high-risk group of International Neuroblastoma Staging System(INSS)-Ⅳ.The primary tumors were mainly located in the retroperitoneal adrenal region (83.7%, 36/43 cases). The largest diameter of the tumors was more than 10 cm (53.5%, 23/43 cases), and often accompanied by 2 or more metastases at the time of consultation.In terms of chromosome karyotype and chromosome karyotype of 14 children in the hypodiploid group was 41-45, the most common karyotype was 45 chromosomes[9 cases(64.3%)]. Among 29 children in the hyperdiploid group of the 47 chromosome karyotypes, 11 cases were common (37.9%). Tumor markers were as follows: neuron enolase (NSE) increased in 41 cases children (95.3%) at first diagnosis, and 25 cases (58.1%)> 370 μg/L; 42 cases (97.7%)had lactate dehydrogenase (LDH). The LDH of children in the hypodiploid group was all> 500 U/L, with 1 case was> 10 000 U/L.Nine cases (20.9%) of MYCN gene were detected by fluorescence in situ hybridization (FISH). Treatment and prognosis: the total course of chemotherapy for 43 patients was 1-12, 19(44.2%) patients received autologous stem cell transplantation, 21 patients (46.5%) received postoperative or autologous radiotherapy or metaiodobenzylguanidine treatment, 28 children developed or relapsed with a median duration of 13.8 months, and 15 cases (34.9%) died.The median follow-up time of the 14 children in the hypodiploid group was 14.9 months (2-38 months), 12 cases progressed or relapsed, and 7 died.The median follow-up of 29 children in the hyperdiploid group was 20.0 months (8.1-51.6 months), with 16 patients progressed or relapsed and 8 cases died. Kaplan- Meier survival analysis illustrated that the 3-year projected event free survival (EFS) rate of 43 children was 18.4%, of which 17.1% were in the hypodiploid group and 29.8% in the hyperdiploid group. Conclusions:Preliminary analysis reveals that children with nearly diploid NB are mostly in the stage Ⅳ high-risk group over the age of 18 months, and 2 or more metastases at the time of consultation.The 3-year estimated EFS of 43 children was 18.4%, and the prognosis was worse in the hypodiploid group.

BACKGROUNDTo study the metastatic pattern of thoracic lymph nodes in patients with resectable lung cancer.

METHODSFrom January 1992 to December 2000, radical lobectomy or pneumonectomy and systemic lymphadenectomy were performed in 306 patients with lung cancer. Number, size, colour and hardness of lymph nodes in each region were recorded and neoplastic metastasis was examined by pathology.

RESULTSOut of 4 614 resected lymph nodes from 2 456 regions, 954 lymph nodes from 521 regions were confirmed to have metastasis. The metastatic rates of thoracic lymph nodes and mediastinal lymph nodes were 61.8% and 43.5% , respectively. The metastatic frequencies in regions around the hilar or root of lung (11,10,7,5,4) were higher than those of regions far from the root of lung (9,6,3,2,1). There was a remarkably higher metastatic rate of lymph nodes in small cell lung cancer than that in non small cell lung cancer (P < 0.01 ). The metastatic rate was closely related to size, colour and hardness of lymph nodes (P < 0.001, P < 0.001 , P < 0.001 ).

CONCLUSIONSMost of neoplastic metastasis of lymph nodes spreads from proximal to distal areas, lower to upper regions, and from the hilar to the mediastinal. A few mediastinal lymph nodes show a skipping pattern. It is necessary to perform systemic lymphadenectomy during pulmonary resection.

BACKGROUNDTo summarize the experience of carinal resection and bronchial sleeve lobectomy in the treatment of 105 patients with central lung cancer from November, 1991, to November, 2001.

METHODSA total of 105 patients with central lung cancer underwent pulmonary resection. Carinal resection and reconstruction was performed in 19 patients, bronchial sleeve resection in 81, and bronchial sleeve combined with pulmonary artery sleeve lobectomy in 5.

RESULTSThere was no operative mortality. Postoperative complications such as anastomotic leakage, cardiac arrhythmia, asthma, pulmonary atelectasis occurred in 10.5% of total group. The 1-, 3- and 5- year survival rates were 89.9%, 60.0% and 47.2%, respectively.

CONCLUSIONSBronchial sleeve lobectomy and double-sleeve lobectomy are capable of excising pulmonary tumor as much as possible while remaining healthy lung tissues. Carinal resection and reconstruction is helpful to extend the surgical indication.