Objective To investigate the prognostic differences and decision-making role in postoperative radiotherapy of four molecular subtypes in pT1-2N1M0 stage breast cancer. Methods The clinicopathological data of 1526 patients with pT1-2N1M0 breast cancer treated at West China Hospital of Sichuan University between 2008 and 2018 were retrospectively analyzed. χ2 test was used to compare the clinicopathological features among patients with different molecular subtypes. Kaplan-Meier survival analysis and log-rank test were used to draw the survival curves and compare the overall survival (OS) and breast cancer-specific survival (BCSS) among patients with different molecular subtypes. Cox regression model was used to determine the influencing factors of OS of patients after radical mastectomy. Results Among the 1526 patients with pT1-2N1M0 breast cancer, there were 674 cases (44.2%) of Luminal A subtype, 530 cases (34.7%) of Luminal B subtype, 174 cases (11.4%) of human epidermal growth factor receptor 2 (Her-2) overexpression subtype, and 148 cases (9.7%) of triple-negative subtype. The 5-year OS rates of Luminal A, Luminal B, Her-2 overexpression and triple negative patients were 98.6%, 94.3%, 95.5% and 91.2%, respectively (χ2=11.712, P=0.001), and the 5-year BCSS rates were 99.3%, 94.6%, 95.5% and 92.5%, respectively (χ2=18.547, P<0.001). Multiple Cox regression analysis showed that menstrual status [hazard ratio (HR)=0.483, 95% confidence interval (CI) (0.253, 0.923), P=0.028] and whether endocrine therapy [HR=2.021, 95%CI (1.012, 4.034), P=0.046] were prognostic factors for the 5-year OS rate of breast cancer patients after radical mastectomy (P<0.05). However, it failed to reveal that Luminal subtypes and postoperative radiotherapy were prognostic factors for the 5-year OS rate (P>0.05). Conclusions In pT1-2N1M0 breast cancer patients, the 5-year OS rate and 5-year BCSS rate in triple-negative patients are the lowest. The relationship between Luminal classification, postoperative radiotherapy and survival in patients after radical mastectomy needs further study in the future.
Objective To analyze the efficacy of breast-conserving surgery with adjuvant radiation therapy (BCS+RT) vs. mastectomy (MAST) for early breast cancer among young Chinese patients. Methods Young female breast cancer patients (≤40 years old) treated at West China Hospital of Sichuan University between January 1st, 2008, and December 31st, 2019 were analyzed for clinical staging, molecular subtypes, surgical techniques, and prognostic assessments using follow-up data. Results Of 974 eligible patients in this study, 211 underwent BCS+RT and 763 underwent MAST. The Kaplan-Meier analyses indicated that there was no significant difference in the 5-year locoregional recurrence-free survival rate (99.1% vs. 99.4%, P=0.299), distant metastasis-free survival rate (97.9% vs. 96.4%, P=0.309), breast cancer-specific survival rate (100.0% vs. 97.0%, P=0.209), or overall survival rate (99.4% vs. 96.8%, P=0.342) between patients who underwent BCS+RT and those who underwent MAST. The multiple Cox proportional hazards regression analyses revealed that the treatment approach (BCS+RT or MAST) did not significantly predict locoregional recurrence-free survival (P=0.427), distant metastasis-free survival (P=0.154), breast cancer-specific survival (P=0.155), or overall survival (P=0.263). Subgroup analyses showed that there was no statistically significant difference in survival outcomes between BCS+RT and MAST in different clinical stages or molecular subtypes. Clinical stage and molecular subtype should also not be regarded as independent factors in deciding the treatment approach. Conclusions Receiving BCS+RT or MAST treatment does not affect the survival outcomes of young early-stage breast cancer patients, showing similar efficacy across various clinical stages and molecular subtypes. Choosing BCS+RT is considered safe for early-stage young female breast cancer patients eligible for breast conservation.
【Abstract】 Objective To explore the biomechanical properties of a new intramedullary controlled dynamicnail ing (ICDN). Methods Ten pairs of specimens of adult femurs, with the age of 18 to 55 years, were divided into twogroups (groups A1 and B2, n=10). The length of the specimens was (438 ± 10) mm , and the external diameter was (26.4 ± 1.5) mm. The specimens of the two groups were osteotomized transversely after the biomechanical test. ICDNs and GK nails were randomly implanted into the femurs, respectively (groups A2 and B2). Torsional, bending and axial compressive tests were made in each group, and the effect of dynamic compression between the fracture fragments was tested. Results The resistance to compression of groups A1, B1, A2 and B2 were (0.19 ± 0.18) × 106, (0.22 ± 0.12) × 106, (1.67 ± 0.68) × 106 and (0.86 ± 0.32) × 106 N/mm, respectively. There was statistically significant difference between groups A2 and B2 (P lt; 0.01). The bending stiffnesses of coronal section of groups A1, B1, A2 and B2 were (0.94 ± 0.25) × 103, (1.10 ± 0.21) × 103, (0.70 ± 0.22) × 103, (0.64 ± 0.21) × 103 N/mm, respectively. The bending stiffness of sagittal plane of groups A1, B1, A2 and B2 were (1.06 ± 0.26) × 103, (0.96 ± 0.25) × 103, (0.67 ± 0.25) × 103, (0.61 ± 0.18) × 103 N/mm, respectively. There were no statistically significant differences between groups A1 and B1 or between groups A2 and B2 (P gt; 0.05). When the torque was 5 Nm, the torsional stiffness of groups A1, B1, A2 and B2 were (4.00 ± 2.54), (4.76 ± 1.93), (0.50 ± 0.63), (0.35 ± 0.31) Nm/°, respectively. When the torque was8 Nm, the torsional stiffness of groups A1, B1, A2 and B2 were (4.30 ± 3.27), (3.94 ± 2.01), (0.42 ± 0.52), (0.36 ± 0.18) Nm/°, respectively. There were statistically significant differences between groups A1 and A2 or between groups B1 and B2 (P lt; 0.05), and no statistically significant difference between between groups A2 and B2 (P gt; 0.05). The average maximal pressure generated between the fracture fragments which were fixed with ICDN was 21.6 N, and the pressure between the fracture fragments which were fixed with GK nail ing could not be tested. Conclusion The design of ICDN conforms to the special anatomical structure of the femur. ICDN could provide a completely different structure, a different fixation principal and a more balancedfixation than GK nail. ICDN incorporates the flexible and rigid fixation, which is l ikely to be the trend of the fracture fixation.
Objective To elucidate the protective effect of leukocyte depletion on the myocardium during the settings of myocardial reperfusion injury. Methods Twenty patients undergoing cardiopulmonary bypass with continuous infusion of blood cardioplegia were randomized into two groups:the control group (n=10) with no leukocyte depletion filter used, and the experimental group (n=10) with the use of leukocyte depletion filter on the bypass circuit. The blood cells count before and after the filtration were measure...
目的:探讨后路椎弓根螺钉固定在地震伤胸腰椎骨折中的应用及优点。方法:对19例胸腰椎骨折的地震伤患者行后路椎弓根螺钉内固定术。结果:本组病例的手术时间70～115分钟,平均出血量约280mL,两例病员术中出血超过400mL进行输血,复位椎体前缘高度由术前平均57.5%恢复到术后平均93.6%,后突角由术前平均21°矫正到术后平均3°,术后3～7天转往外地继续治疗,Frankel分级平均提高0.4。结论:后路椎弓根螺钉固定具有省时、节约医疗资源、提高救治效率、减轻患者痛苦的优点,尤其适用于大批伤病员的紧急救治。
目的:比较人工股骨头置换与骨折内固定治疗高龄股骨转子间骨折的临床疗效。方法:筛选1997年6月至2008年6月间收治的60例高龄新鲜不稳定性股骨转子间骨折患者分为A、B两组。A组为行人工股骨头置换者,B组为行骨折内固定者。A组30例,平均年龄83.6岁;B组30例,平均年龄81.7岁。随访时间8个月～9年(平均2.3年)。结果:两种术式在住院时间和术后引流量的差异无统计学意义(Pgt;0.05);而在手术时间、术中出血量、下地开始行走时间、术后早期并发症、术后内科合并症和髋关节功能恢复、术后1年内死亡率等方面,两组比较差异均有统计学意义(Plt;0.05)。结论:人工股骨头置换术可以作为治疗高龄股骨转子间骨折的一种选择,术后能早期离床负重活动、较快恢复伤前活动能力、降低术后短期并发症和内科合并症的发生率、减低术后一年内死亡率。