Female ; Humans ; Breast Neoplasms/surgery* ; Inflammatory Breast Neoplasms ; Mastectomy ; Medical Oncology

BACKGROUND: Inflammatory breast cancer (IBC) is an aggressive type of cancer with poor prognosis and outcomes. This study aimed to investigate clinicopathological features, molecular characteristics, and treatments among Chinese patients diagnosed with IBC. METHODS: We collected data of 95 patients with IBC who were treated by members of the Chinese Society of Breast Surgery, from January 2017 to December 2018. The data, including demographic characteristics, pathological findings, surgical methods, systemic treatment plans, and follow-up, were obtained using a uniform electronic questionnaire. The clinicopathological features of different molecular types in patients without distant metastases were compared using the Kruskal-Wallis (H) test followed by post hoc analyses. RESULTS: Lymph node metastasis was noted in 75.8% of all patients, while distant metastasis was noted in 21.4%. Pathological findings indicated invasive ductal and lobular carcinomas in 86.8% and 5.3% of cases, respectively. Hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) (41.5%) and HR-/HER2+ (20.1%) were the most common biologic subtypes, followed by HR+/HER2+ (19.1%) and HR-/HER2- (19.1%). Stage III IBC was treated via pre-operative neoadjuvant chemotherapy in 87.7% of the cases, predominantly using anthracycline and taxanes. A total of 91.9% of patients underwent surgical treatment. Among them, 77.0% of the patients underwent modified radical mastectomy, 8.1% of whom also underwent immediate breast reconstruction. The Kruskal-Wallis test revealed that the efficacy of chemotherapy significantly differed among those with HR+/HER2- and HR-/HER2- tumors (adjusted P = 0.008), and Ki-67 expression significantly differed in HR-/HER2+ and HR+/HER2+ molecular subtypes (adjusted P = 0.008). CONCLUSION: Our study provides novel insight into clinicopathological characteristics and treatment status among patients with IBC in China, and might provide a direction and basis for further studies. TRIAL REGISTRATION chictr.org.cn, No. ChiCTR1900027179; http://www.chictr.org.cn/showprojen.aspx?proj=45030.
Antineoplastic Combined Chemotherapy Protocols ; Breast Neoplasms/surgery* ; Chemotherapy, Adjuvant ; China ; Humans ; Inflammatory Breast Neoplasms/surgery* ; Mastectomy ; Neoadjuvant Therapy ; Prognosis ; Receptor, ErbB-2 ; Receptors, Progesterone

PURPOSE: Skin grafts have been widely used in managing extensive chest wall defects after mastectomy for advanced breast cancer. However, their durability and tolerability to radiotherapy is still controversial. A thoracoabdominal (TA) flap with a few technical refinements can safely transfer a larger flap while minimizing complications. METHODS: From January 2007 to February 2018, a retrospective review was performed to compare 2 groups after wide breast excision: skin graft group (group 1) and lateral-based, single vertical incision rotation-advancement TA flap (group 2). Patients' demographics, operative details, complications, hospital stay, postoperative outpatient visits, cost, and start of adjuvant therapy were analyzed between the 2 groups. RESULTS: During the study period, 34 patients received skin graft and 41 patients received TA flap. group 2 had a shorter hospital stay (6.41 ± 2.64 days vs. 12.62 ± 4.60 days, P < 0.001) and shorter time to complete wound healing (29.27 ± 18.68 days vs. 39.24 ± 27.70 days, P = 0.03) than group 1. There was also a difference in the period from surgery to initiation of adjuvant therapy (group 1, 45.04 days ± 17.79 days; group 2, 37.07 ± 15.38 days, P = 0.073). Although limitation in shoulder motion was more frequent in group 2, limitation of motion for >1 year was observed in 4 patients in only group 1 (43.90% vs. 38.24%, P = 0.613). CONCLUSION: TA flap has a simple design that minimizes concerns involving the donor site. Moreover, it does not require complicated procedures and allows for re-elevation whenever necessary. Finally, it guarantees faster wound recovery than skin graft with fewer complications.
Breast Neoplasms ; Breast ; Demography ; Humans ; Inflammatory Breast Neoplasms ; Length of Stay ; Mastectomy ; Outpatients ; Radiotherapy ; Reconstructive Surgical Procedures ; Retrospective Studies ; Shoulder ; Skin ; Surgical Flaps ; Thoracic Wall ; Thorax ; Tissue Donors ; Transplants ; Wound Healing ; Wounds and Injuries

Central venous stenosis is a rare cause of unilateral breast edema occurring in hemodialysis patients that needs to be differentiated from other differential diagnoses, including, but not limited to, inflammatory breast carcinoma, mastitis, lymphedema, and congestive heart failure. All reports of similar cases in the available literature have described improvement or resolution of the edema after treatment. Herein, we report and discuss the pathophysiology of breast edema formation in a patient who presented with massive left-sided breast edema 7 years after being diagnosed with central venous stenosis. Medical and minimally invasive therapy had not been successful, so she underwent reduction mammoplasty to relieve the symptoms.
Axillary Vein ; Breast ; Constriction, Pathologic* ; Diagnosis, Differential ; Edema ; Female ; Heart Failure ; Humans ; Inflammatory Breast Neoplasms ; Lymphedema ; Mammaplasty* ; Mastitis ; Renal Dialysis ; Upper Extremity Deep Vein Thrombosis

PURPOSE: This study aimed to determine whether clinicopathological factors are potentially associated with successful breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) and develop a nomogram for predicting successful BCS candidates, focusing on those who are diagnosed with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative tumors during the pre-NAC period. METHODS: The training cohort included 239 patients with an HR-positive, HER2-negative tumor (≥3 cm), and all of these patients had received NAC. Patients were excluded if they met any of the following criteria: diffuse, suspicious, malignant microcalcification (extent >4 cm); multicentric or multifocal breast cancer; inflammatory breast cancer; distant metastases at the time of diagnosis; excisional biopsy prior to NAC; and bilateral breast cancer. Multivariate logistic regression analysis was conducted to evaluate the possible predictors of BCS eligibility after NAC, and the regression model was used to develop the predicting nomogram. This nomogram was built using the training cohort (n=239) and was later validated with an independent validation cohort (n=123). RESULTS: Small tumor size (p < 0.001) at initial diagnosis, long distance from the nipple (p=0.002), high body mass index (p=0.001), and weak positivity for progesterone receptor (p=0.037) were found to be four independent predictors of an increased probability of BCS after NAC; further, these variables were used as covariates in developing the nomogram. For the training and validation cohorts, the areas under the receiver operating characteristic curve were 0.833 and 0.786, respectively; these values demonstrate the potential predictive power of this nomogram. CONCLUSION: This study established a new nomogram to predict successful BCS in patients with HR-positive, HER2-negative breast cancer. Given that chemotherapy is an option with unreliable outcomes for this subtype, this nomogram may be used to select patients for NAC followed by successful BCS.
Biopsy ; Body Mass Index ; Breast Neoplasms* ; Breast* ; Cohort Studies ; Diagnosis ; Drug Therapy* ; Humans ; Inflammatory Breast Neoplasms ; Logistic Models ; Mastectomy, Segmental ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Nipples ; Nomograms ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; ROC Curve

PURPOSE: The use of immediate breast reconstruction (IBR) following total mastectomy (TM) has increased markedly in patients with breast cancer. As the indications for IBR have been broadened and more breast-conserving surgery-eligible patients are undergoing IBR, comparing the oncologic safety between TM only and IBR following TM becomes more difficult. This study aimed to analyze the oncologic outcomes between TM only and IBR following TM via a matched case-control methodology. METHODS: A retrospective review was conducted to identify all patients who underwent TM between 2008 and 2014. We excluded patients who underwent neoadjuvant chemotherapy, including palliative chemotherapy, and had a follow-up duration <12 months, inflammatory breast cancer, or incomplete data. We divided the remaining patients into two groups: those who underwent TM only (control group) and those who underwent IBR following TM (study group). The groups were propensity score-matched. Matched variables included age, pathologic stage, estrogen or progesterone receptor status, human epidermal growth factor receptor 2 status, and year of operation. RESULTS: After matching, 878 patients were enrolled in the control group and 580 patients in the study group. The median follow-up duration was 43.4 months (range, 11–100 months) for the control group and 41.3 months (range, 12–100 months) for the study group (p=1.000). The mean age was 47.3±8.46 years for the control group and 43.9±7.14 years for the study group (p>0.050). Matching was considered successful for the matching variables and other factors, such as family history, histology, multiplicity, and lymphovascular invasion. There were no significant differences in overall survival (log-rank p=0.454), disease-free survival (log-rank p=0.186), local recurrence-free survival (log-rank p=0.114), or distant metastasis-free survival rates (logrank p=0.537) between the two groups. CONCLUSION: Our results suggest that IBR following TM is a feasible treatment option for patients with breast cancer.
Breast Neoplasms* ; Breast* ; Case-Control Studies* ; Disease-Free Survival ; Drug Therapy ; Estrogens ; Female ; Follow-Up Studies ; Humans ; Inflammatory Breast Neoplasms ; Mammaplasty* ; Mastectomy, Simple* ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Retrospective Studies ; Survival Rate ; Treatment Outcome

Asparagus cochinchinensis has been used to treat various diseases including fever, cough, kidney disease, breast cancer, inflammatory disease and brain disease, while IL-4 cytokine has been considered as key regulator on the skin homeostasis and the predisposition toward allergic skin inflammation. However, few studies have investigated its effects and IL-4 correlation on skin inflammation to date. To quantitatively evaluate the suppressive effects of ethyl acetate extracts of A. cochinchinensis (EaEAC) on phthalic anhydride (PA)-induced skin inflammation and investigate the role of IL-4 during their action mechanism, alterations in general phenotype biomarkers and luciferase-derived signals were measured in IL-4/Luc/CNS-1 transgenic (Tg) mice with PA-induced skin inflammation after treatment with EaEAC for 2 weeks. Key phenotype markers including lymph node weight, immunoglobulin E (IgE) concentration, epidermis thickness and number of infiltrated mast cells were significantly decreased in the PA+EaEAC treated group compared with the PA+Vehicle treated group. In addition, expression of IL-1β and TNF-α was also decreased in the PA+EaEAC cotreated group, compared to PA+Vehicle treated group. Furthermore, a significant decrease in the luciferase signal derived from IL-4 promoter was detected in the abdominal region, submandibular lymph node and mesenteric lymph node of the PA+EaEAC treated group, compared to PA+Vehicle treated group. Taken together, these results suggest that EaEAC treatment could successfully improve PA-induced skin inflammation of IL-4/Luc/CNS-1 Tg mice, and that IL-4 cytokine plays a key role in the therapeutic process of EaEAC.
Animals ; Biomarkers ; Brain Diseases ; Cough ; Epidermis ; Fever ; Homeostasis ; Immunoglobulin E ; Immunoglobulins ; Inflammation* ; Inflammatory Breast Neoplasms ; Interleukin-4 ; Kidney Diseases ; Luciferases ; Lymph Nodes ; Mast Cells ; Mice ; Phenotype ; Skin*

PURPOSE: Given the promising activity of capecitabine and vinorelbine in metastatic breast cancer, this randomized phase II trial evaluated the efficacy and safety of this combination as neoadjuvant chemotherapy in breast cancer. MATERIALS AND METHODS: Patients with operable breast cancer (n=75) were randomly assigned to receive either four cycles of adriamycin 60 mg/m2 plus cyclophosphamide 600 mg/m2 every 3 weeks followed by four cycles of docetaxel 75 mg/m2 every 3 weeks (AC-D) or four cycles of capecitabine 2,000 mg/m2 (day 1-14) plus vinorelbine 25 mg/m2 (days 1 and 8) every 3 weeks followed by four cycles of docetaxel 75 mg/m2 (CV-D). The primary endpoint was pathologic complete response (pCR) in the primary breast (ypT0/is). RESULTS: Most patients (84%) had locally advanced (n=41) or inflammatory breast cancer (n=22). pCR rates in the primary breast were 15% (95% confidence interval [CI], 7% to 30%) and 11% (95% CI, 4% to 26%) in the AC-D and CV-D groups, respectively. The overall response rates and 5-year progression-free survival rates in the AC-D and CV-D groups were 62% and 64%, and 51.3% (95% CI, 34.6% to 68.0%) and 30.2% (95% CI, 13.3% to 47.1%), respectively. Although both regimens were well tolerated, CV-D showed less frequent grade 3-4 neutropenia and vomiting than AC-D, whereas manageable diarrhea and hand-foot syndrome were more common in the CV-D group. CONCLUSION: CV-D is a feasible and active non-anthracycline-based neoadjuvant chemotherapy regimen for breast cancer.
Anthracyclines ; Breast ; Breast Neoplasms* ; Cyclophosphamide* ; Diarrhea ; Disease-Free Survival ; Doxorubicin* ; Drug Therapy* ; Hand-Foot Syndrome ; Humans ; Inflammatory Breast Neoplasms ; Neoadjuvant Therapy ; Neutropenia ; Polymerase Chain Reaction ; Vomiting

Primary neuroendocrine carcinoma of the breast (NECB) is a very rare type of invasive breast carcinoma. Most NECBs appear on breast imaging as solid masses of varied shapes and margins, and have worse clinical outcomes than does invasive ductal carcinoma, not otherwise specified. However, there have been no reports to date regarding NECB with features of inflammatory breast carcinoma. Here, we describe the clinical, radiol-ogic, and pathologic findings of the first reported case of primary NECB presenting as inflammatory breast carcinoma. The patient complained of diffuse right breast enlargement and erythema. Mammography identified severe breast edema and axillary lymphadenopathy. Ultrasound detected an irregular, angular, hypoechoic mass with dermal lymphatic dilatation. On magnetic resonance imaging, the mass had rim enhancement and the entire right breast showed heterogeneous enhancement with malignant kinetic features. Pathology identified the mass as a primary NECB with positive for synaptophysin, CD56, estrogen and progesterone receptors.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Neuroendocrine* ; Dilatation ; Edema ; Erythema ; Estrogens ; Humans ; Inflammatory Breast Neoplasms* ; Lymphatic Diseases ; Magnetic Resonance Imaging ; Mammography ; Pathology ; Receptors, Progesterone ; Synaptophysin ; Ultrasonography

No abstract available.
Inflammatory Breast Neoplasms* ; Neoplasm Metastasis* ; Stomach Neoplasms*