Objective To investigate the natural progression of pulmonary ground-glass nodule(GGN)to invasive adenocarcinoma(IAC)and the diagnostic value of follow-up CT.Methods A retrospective analysis was performed on 45 GGN in 45 patients who were followed up for more than 2 years,surgically resected and pathologically confirmed.They were divided into IAC group(n=25)and non-IAC group(n=20),and the clinical and imaging characteristics between the two groups were compared.Results Significant differences were observed in initial volume(P=0.025),initial mass(P=0.005),margin(P=0.027),and time to GGN progression(P=0.005)between the IAC group and the non-IAC group.Multivariate logistic regression analysis indicated that initial mass and time to GGN progression were independent predictors for the diagnosis of IAC.The receiver operating characteristic(ROC)curve analysis results revealed that when using a maximum Youden's index of 0.456,the optimal cutoff for time to GGN progression was 30 months,with a sensitivity of 75.0%and a specificity of 70.6%,and an area under the curve(AUC)of 0.761[95%confidence interval(CI)0.606-0.916](P=0.005).When the maximum Youden's index reached 0.615,the sensitivity,specificity and AUC of the logistic regression model in the diagnosis of IAC were 79.2%,82.4%,and 0.860(95%CI 0.743-0.977)(P=0.001),respectively.The calibration curves demonstrated an excellent consistency between predicted and observed probabilities.Conclusion The optimal observation window for GGN is 30 months,during which IAC generally progresses.Close monitoring is recommended after the initiation of lesion growth.

Objective To investigate the natural progression of pulmonary ground-glass nodule(GGN)to invasive adenocarcinoma(IAC)and the diagnostic value of follow-up CT.Methods A retrospective analysis was performed on 45 GGN in 45 patients who were followed up for more than 2 years,surgically resected and pathologically confirmed.They were divided into IAC group(n=25)and non-IAC group(n=20),and the clinical and imaging characteristics between the two groups were compared.Results Significant differences were observed in initial volume(P=0.025),initial mass(P=0.005),margin(P=0.027),and time to GGN progression(P=0.005)between the IAC group and the non-IAC group.Multivariate logistic regression analysis indicated that initial mass and time to GGN progression were independent predictors for the diagnosis of IAC.The receiver operating characteristic(ROC)curve analysis results revealed that when using a maximum Youden's index of 0.456,the optimal cutoff for time to GGN progression was 30 months,with a sensitivity of 75.0%and a specificity of 70.6%,and an area under the curve(AUC)of 0.761[95%confidence interval(CI)0.606-0.916](P=0.005).When the maximum Youden's index reached 0.615,the sensitivity,specificity and AUC of the logistic regression model in the diagnosis of IAC were 79.2%,82.4%,and 0.860(95%CI 0.743-0.977)(P=0.001),respectively.The calibration curves demonstrated an excellent consistency between predicted and observed probabilities.Conclusion The optimal observation window for GGN is 30 months,during which IAC generally progresses.Close monitoring is recommended after the initiation of lesion growth.

Purpose: The 21-gene recurrence score (RS) can guide adjuvant chemotherapy decisions in the multidisciplinary treatment (MDT) of patients with early breast cancer. This study aimed to evaluate the influence of the 21-gene RS assay on patient’ compliance with MDT and its association with disease outcomes. Methods: Patients diagnosed with pN0-1, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer between January 2013 and June 2019 were enrolled. A logistic regression model was used to identify parameters associated with treatment adherence. Prognostic indicators were evaluated using the Cox proportional hazard models. Results: After the assay, patients were less likely to violate the treatment plan (14.9% vs. 23.1%, p < 0.001), and higher compliance rates were observed for chemotherapy (p = 0.042), radiotherapy (p = 0.012), and endocrine therapy (p < 0.001). Multivariable analysis demonstrated that the 21-gene RS assay (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.09–1.88; p = 0.009) was independently associated with MDT compliance. Moreover, compliance with MDT was independently associated with better disease-free survival (hazard ratio, 0.43; 95% CI, 0.29–0.64; p < 0.001), regardless of the 21-gene RS assay (interaction p = 0.842). Conclusion The 21-gene RS assay improved the MDT compliance rate in patients with early breast cancer. Adherence to MDT is associated with a better prognosis.

Objective To evaluate the safety of immediate breast reconstruction using deep inferior epigastric perforator (DIEP) flaps in the patients after neoadjuvant treatment. Methods From January 2019 to February 2021, the data of patients with breast cancer undergoing total mastectomy and immediate breast reconstruction using DIEP flap in Comprehensive Breast Health Center, Department of General Surgery, Ruijin Hospital were collected. Comparison of clinicopathological features was done between neoadjuvant treatment group and control group. Univariate analysis was used to compare the rate of surgical complications between two groups. Results A total of 110 patients were enrolled with 23 cases (20.9%) in neoadjuvant treatment group and 87 cases (79.1%) in control group. None of carcinoma in situ (0 vs. 19.5%, P=0.003) and higher pTNM stage (P<0.001) was present in neoadjuvant treatment group compared with those in control group. However, there were no significant differences in the number of flap perforator of DIEP (P=0.472), the proportion of bipedicled flaps (P=0.489), operative time (P=0.651) and hospital length of stay (P=0.275) between two groups. No significant difference was found in the incidence of postoperative complications between two groups. Breast seroma was the most common recipient complication (13.0%, 3 cases) without donor complication in neoadjuvant treatment group. The most common complication was fat necrosis (12.6%, 11 cases) in recipient site and abdominal seroma (3.4%, 3 cases) in donor site of control group. Reoperation was done in one case (4.3%) of neoadjuvant treatment group and 4 cases (4.6%) of control group. DIEP flap necrosis with total flap loss occurred in 2 cases (2.3%) in control group, but none in neoadjuvant treatment group. Conclusions The imme-diate breast reconstruction with epigastric free flap for breast cancer patients after neoadjuvant treatment would be a safe surgical scheme.

Multi-gene assays have emerged as crucial tools for risk stratification in early-stage breast cancer. This study aimed to evaluate the prognostic significance of the 21-gene recurrence score (RS) in Chinese patients with pN0-1, estrogen receptor-positive (ER
Biomarkers, Tumor/genetics* ; Breast Neoplasms/pathology* ; Female ; Humans ; Neoplasm Recurrence, Local/pathology* ; Neoplasm Staging ; Prognosis ; Receptor, ErbB-2/genetics* ; Receptors, Estrogen

OBJECTIVE: To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas. METHODS: A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, =33) and inverse ventilation group (group R, =33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T), OLV30 min (T), OLV60 min (T), and 15 min after recovery of TLV (T). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE). RESULTS: Sixty-three infants were finally included in this study. At T and T, Cdyn, PaO and OI in group R were significantly higher ( < 0.05) and Ppeak, PaCO and PA-aO were significantly lower than those in group N ( < 0.05). There was no significant difference in HR or MAP between the two groups at T and T ( > 0.05). The level of RAGE significantly increased after the surgery in both groups ( < 0.05), and was significantly lower in R group than in N group ( < 0.05). CONCLUSIONS In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.
Cystadenoma ; surgery ; Humans ; Infant ; Lung ; surgery ; One-Lung Ventilation ; Positive-Pressure Respiration ; Thoracoscopy ; Treatment Outcome

OBJECTIVE: To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas. METHODS: A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, =33) and inverse ventilation group (group R, =33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T), OLV30 min (T), OLV60 min (T), and 15 min after recovery of TLV (T). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE). RESULTS: Sixty-three infants were finally included in this study. At T and T, Cdyn, PaO and OI in group R were significantly higher ( < 0.05) and Ppeak, PaCO and PA-aO were significantly lower than those in group N ( < 0.05). There was no significant difference in HR or MAP between the two groups at T and T ( > 0.05). The level of RAGE significantly increased after the surgery in both groups ( < 0.05), and was significantly lower in R group than in N group ( < 0.05). CONCLUSIONS In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.
Cystadenoma ; therapy ; Humans ; Infant ; Lung ; One-Lung Ventilation ; Positive-Pressure Respiration ; Thoracoscopy

Purpose: Despite the rapid growing of cancer survivors, prior cancer history is a commonly adoptedexclusion criterion. Whether prior cancer will impact the survival of patients with advancedbreast cancer (ABC) remains uncertain. Materials and Methods: Patients with ABC diagnosed between 2004 and 2010 were identified using Surveillance,Epidemiology, and End Results (SEER) database. Timing, stage, and type were used to characterizeprior cancer. Multivariable analyses using propensity score–adjusted Cox regressionand competing risk regression were conducted to evaluate the prognostic effect of priorcancer on overall survival (OS) and breast cancer-specific survival (BCSS). Results: A total of 14,176 ABC patients were identified, of whom 10.5% carried a prior cancer history.The most common type of prior cancer was female genital cancer (32.4%); more than half(51.7%) were diagnosed at localized stage; most were diagnosed more than 5 years (42.9%)or less than 1 year (28.3%) prior to the index cancer. In multivariate analyses, patients withprior cancer presented a slightly worse OS (hazard ratio, 1.18; 95% confidence interval [CI],1.07 to 1.30; p=0.001) but a better BCSS (subdistribution hazard ratio, 0.64; 95% CI, 0.56to 0.74; p < 0.001). In subset analyses, no survival detriment was observed in patients withprior malignancy from head and neck or endocrine system, at in situ or localized stage, ordiagnosed more than 4 years. Conclusion Prior cancer provides an inferior OS but a superior BCSS for patients with ABC. It does notaffect the survival adversely in some subgroups and these patients should not be excludedfrom clinical trials.

Purpose: This retrospective study aimed to evaluate the distribution pattern and prognostic value of 21-gene recurrence score (RS) in Chinese patients with mucinous breast cancer (MC) and compared with infiltrating ductal carcinoma (IDC). Materials and Methods: Patients diagnosed with MC or IDC from January 2010 to January 2017 were retrospectively recruited. Reverse transcriptase–polymerase chain reaction assay of 21 genes was conducted to calculate the RS. Univariate and multivariate analyses were performed to assess the association between RS and clinicopathological factors. Survival outcomes including disease-free survival (DFS) and overall survival (OS) were estimated by Kaplan-Meier method and compared by log-rank test. Results: The MC cohort included 128 patients and the IDC cohort included 707 patients. The proportions of patients with a low (RS < 18), intermediate (18-30), or high risk (RS > 30) were 32.0%, 48.4%, and 19.5% in MC cohort, and 26.9%, 46.8% and 26.3% in IDC cohort. The distribution of RS varied significantly according to different Ki-67 index and molecular subtype in both cohorts. Moreover, the receipt of chemotherapy was associated with RS in both cohorts. Among patients with MC, tumor stage was related to the DFS (p=0.040). No significant differences in DFS and OS were found among MC patients in different RS risk groups (OS, p=0.695; DFS, p=0.926). Conclusion RS was significantly related to Ki-67 index and molecular subtypes in MC patients, which is similar in IDC patients. However, RS was not able to predict DFS and OS in patients with MC.

Objective: To analyze the association between clinicopathological factors and clinical diagnosis, treatment and surgery of local regional recurrence (LRR) in breast cancer. Methods: A retrospective study was done to evaluate consecutive 7 823 breast cancer LRR cases between January 2009 and August 2018 at Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine. A total of 108 LRR patients were enrolled: 35 cases (32.4%) with ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery, 40 cases (37.0%) of chest wall recurrence (CR), and 33 cases (30.6%) with regional lymph node recurrence (LNR). All patients were female, aged from 26 to 83 years with a mean of 49 years. Clinicopathological factor and its relationship with different sites of LRR and following surgical choice were analyzed by χ² test, rank-sum test and Logistic regression. Survival analysis were performed between different LRR patterns and whether undergoing second surgery. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of overall survival. Results: Both univariate analysis and multivariate analysis found that axillary lymph nodes (ALN) status (OR=7.27, 95% CI: 1.30 to 40.53, P=0.042) and disease-free interval (OR=0.18, 95% CI: 0.06 to 0.60, P=0.013) were related to different site of LRR. Compared with patients with IBTR, LNR and CR patients had a higher rate of ALN metastasis and a shorter disease-free interval. A total of 36 LRR patients underwent following surgery. In univariate analysis, initial ALN surgery (χ²=16.705, P=0.001), pathological type (χ²=7.047, P=0.03), ALN status (χ²=10.812, P=0.002), disease-free interval (χ²=6.118, P=0.023) and LRR site(χ²=19.328, P=0.000) were associated with surgical treatment for LRR patients. Multivariate analysis demonstrated that only site of LRR was independently associated with surgery (OR=0.17, 95% CI: 0.05 to 0.65, P=0.024). The 5-year overall survival was 100% and 60.1% (P=0.018) for LRR patients treated with surgery or not. Furthermore, CR patients had significantly worse overall survival than LNR and IBTR patients, with 5-year overall survival 53.1%, 73.5%, and 100% respectively (P=0.021). Conclusions Initial lymph nodes metastasis and disease-free interval are associated with different site of LRR. LRR site significantly influenced following surgery choice after LRR, which are both related with overall survival after LRR.