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Purpose The assess the clinical value of different types of surgical procedures and further analyze the effect of adjuvant radiation therapy (RT) for adenoid cystic carcinoma (ACC) of the breast. Methods Patients with ACC of the breast were identified using a population-based national registration database (Surveillance, Epidemiology, and End Results, SEER). The Kaplan-Meier method and Cox regression models were performed to determine the impact of the surgical procedures and adjuvant RT associated with cause-specific survival (CSS) and overall survival (OS). Results A total of 478 patients with ACC of the breast were identified. The median follow-up was 59 months. The 10-year CSS and OS were 87.5% and 75.3%, respectively. For the Kaplan-Meier analysis, the 5-year CSS were 96.1%, 91.8%, 90.2%, and 94.1% in patients that received lumpectomy + adjuvant RT, lumpectomy alone, mastectomy alone, and mastectomy + adjuvant RT, respectively (p = 0.026). In the multivariate Cox analyses, lumpectomy + adjuvant RT was an independent prognostic factor for CSS and OS. Patients that received lumpectomy + adjuvant RT had better survival rates than patients that underwent lumpectomy only (CSS, p = 0.018; OS, p = 0.031) and mastectomy only (CSS, p = 0.010; OS, p = 0.004). Conclusion ACC of the breast has an excellent prognosis. Breast-conserving surgery is a reasonable alternative for patients with ACC of the breast, and adjuvant RT after lumpectomy improved survival rates. [ABSTRACT FROM AUTHOR]

Background This study aimed to investigate the patterns of regional lymph node recurrence after radical surgery for thoracic esophageal squamous cell carcinoma (ESCC). Methods We retrospectively reviewed clinical characteristics of ESCC patients admitted to two institutions from 1990 to 2011, and analyzed the patterns of regional lymph node recurrence. Results The records of 315 eligible patients with ESCC were reviewed. Of the 378 regional lymph node recurrence sites, 177 (46.8%) were in the supraclavicular areas, 120 (31.7%) in the mediastinum, and 81 (21.4%) in the upper abdominal areas. The most common sites of recurrence were the supraclavicular and mediastinum areas in patients with upper and middle thoracic ESCC. Approximately equal percentages of patients with lower thoracic tumors had supraclavicular, mediastinal, and upper abdominal (celiac) lymph node recurrence. Patients with tumor located in the lower thoracic esophagus had a lower probability of supraclavicular lymph node recurrence ( p = 0.013). None of the assessed factors was associated with mediastinal lymph node recurrence. Celiac lymph node recurrence was more frequent among patients with lower thoracic ESCC ( p = 0.004) and advanced pathologic nodal (pN) stage (pN2, p = 0.034; pN3, p = 0.009). Conclusions After radical surgery for thoracic ESCC, the patterns of regional lymph node recurrence are related to the tumor location and pN stage. [ABSTRACT FROM AUTHOR]

Background This study aimed to investigate the prognostic value of number of involved lymph nodes, number of removed lymph nodes, ratio of involved to removed nodes (lymph node ratio), and number of negative lymph nodes in esophageal squamous cell carcinoma (ESCC) patients after esophagectomy. Methods A retrospective review of 603 patients receiving esophagectomy for ESCC was made. Cox regression analysis was performed to identify significant prognostic factors. Results The median follow-up time was 36.7 months, and the 5-year overall survival (OS) was 43.5%. Patients with negative lymph node count ≥14 had better survival ( p < 0.001). Univariate Cox analysis showed that the number of involved lymph nodes, number of removed lymph nodes, lymph node ratio, and number of negative lymph nodes influenced OS ( p < 0.05 for all). Multivariate Cox analysis indicated that the number of involved lymph nodes and number of negative lymph nodes were independent prognostic factors for OS, and a higher number of negative lymph nodes was associated with lower mortality. The number of removed lymph nodes and lymph node ratio had no significant effect on OS. The number of negative lymph nodes had prognostic value in different lymph node stages and in two-field or three-field lymphadenectomy. Conclusions For ESCC patients after esophagectomy, the number of involved lymph nodes and the number of negative lymph nodes had a better prognostic value than did the number of removed lymph nodes and lymph node ratio. [ABSTRACT FROM AUTHOR]

Abstract: The prognostic significance of preoperative carcinoembryonic antigen (CEA) and cancer antigen 15-3 (CA15-3) levels in breast cancer is controversial. This study evaluated the prognostic value of preoperative serum CEA and CA15-3 levels in Chinese breast cancer patients. A total of 470 patients with breast cancer had preoperative CEA and CA15-3 concentrations measured. The relationships between preoperative concentration and clinicopathological factors and outcomes were determined. CEA and CA15-3 levels were increased in 34 (7.2%) and 58 (12.3%) patients, respectively. Elevations of serum CEA and CA-15-3 levels correlated with the primary tumor size and axillary lymph node status. CEA levels were lower in patients with triple-negative breast cancer than in those with other subtypes (P = 0.002). The 5-year distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) of CEA-negative vs. CEA-positive patients were 84.1% vs. 54.5% (P < 0.001), 82.7% vs. 54.8% (P < 0.001), and 89.7% vs. 78.5% (P = 0.007), respectively. The 5-year DMFS, DFS, and OS of CA15-3-negative vs. CA15-3-positive patients were 84.0% vs. 69.6% (P = 0.002), 83.0% vs. 66.2% (P < 0.001), 90.9% vs. 74.2% (P = 0.005), respectively. Multivariate analysis of prognosis indicated that CEA and CA15-3 levels were independent prognostic factors for DMFS (P = 0.021) and DFS (P = 0.032), and DFS (P = 0.014) and OS (P = 0.032), respectively. Serum levels of CEA and CA15-3 may differ in breast cancer molecular subtypes and preoperative levels of CEA and CA15-3 have a significant effect on prognosis in Chinese women with breast cancer. [Copyright &y& Elsevier]

Abstract: The molecular subtypes of breast cancer based on status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her2) expression are associated with markedly different clinical outcomes. We retrospectively analyzed 774 breast cancer patients with four or more positive nodes, who underwent mastectomy between March 1999 and December 2007. Treatment with postmastectomy radiotherapy (PMRT) reduced the rates of locoregional recurrence-free survival (LRFS; 6.7% vs. 26.6%), distant metastasis-free survival (DMFS; 26.9% vs. 50.0%), and mortality (24.4% vs. 45.3%) for luminal-A subtypes (ER+ or PR+, Her2−) and reduced LRFS (12.1% vs. 27.5%) for the luminal-B subtype (ER+ or PR+, Her2+) compared with patients not receiving PMRT. However, PMRT did not affect the endpoints for the Her2-enriched or basal subtypes. Thus, understanding the differences in patterns of relapse between the different subtypes of breast cancer may enable targeted adjuvant therapy and improved surveillance decisions. [Copyright &y& Elsevier]

The recently developed preoperative systemic inflammation response index (SIRI) was reported as a useful biomarker that could predict survival in certain types of malignant tumors. However, the prognostic value of preoperative SIRI in postmenopausal breast cancer remains unclear. This study aimed to explore the relationship between SIRI and survival in postmenopausal patients with breast cancer. A total of 390 postmenopausal patients with breast cancer who underwent a mastectomy at Sun Yat-sen University Cancer Center were retrospectively studied. SIRI was based on peripheral neutrophil, monocyte, and lymphocyte counts, calculated as: neutrophil count × monocyte count/lymphocyte count. The best cut-off value for SIRI was determined using receiver operating characteristic curve analysis. Patients were divided into 2 groups:Low SIRI < 0.54 and high SIRI > 0.54. High SIRI was significantly related to progesterone receptor status. Kaplan-Meier survival analysis showed that T stage, N stage, clinical stage, carcinoembryonic antigen, estrogen receptor, progesterone receptor, endocrinotherapy, and SIRI were significantly correlated with overall survival (OS). Multivariate analysis showed that SIRI could also independently predict OS. Preoperative SIRI may be a reliable predictor of OS in postmenopausal patients with operable breast cancer to provide personalized prognostication and to assist in the formulation of a clinical treatment strategy. [ABSTRACT FROM AUTHOR]

Background: Given the growing evidence that sarcopenia and inflammation influence the survival of patients with cancer, we evaluated the prognostic significance of the skeletal muscle index (SMI) combined with an inflammation marker in patients with breast cancer who underwent postoperative adjuvant radiotherapy. Methods: We conducted a retrospective analysis of 301 patients with breast cancer who received postoperative adjuvant radiotherapy between 2010 and 2012. The SMI was measured using preradiotherapy computed tomography (CT) simulation images at the level of the fourth thoracic vertebra (T4). Receiver operating characteristic curve analyses were used to determine the optimal cutoff values for the SMI and inflammatory marker. Patients were divided into 2 groups (high SMI and low SMI), based on the SMI cutoff of 10.57 cm2/m2. Results: Patients in the high-SMI group had a median overall survival (OS) of 62.4 months, which was significantly shorter than those in the low-SMI group, with a median OS of 68.5 months (P = 0.025). Patients in the high-SMI group had a median recurrence-free survival (RFS) of 62.3 months, which was shorter but not significantly than the median RFS of 65.2 months of the low-SMI group (P = 0.159). Univariate and multivariate survival analyses revealed SMI was an independent predictor of OS (P = 0.044). The SMI-MLR combination was found to be an independent predictor of OS (P = 0.006) and RFS (P = 0.009). Conclusions: The current findings support the SMI as a promising indicator for predicting clinical outcomes in patients with breast cancer receiving postoperative adjuvant radiotherapy. A high SMI accompanied by systemic inflammation was significantly associated with reduced OS and RFS. [ABSTRACT FROM AUTHOR]

• We developed a model integrating MRI-detected features with EBV DNA to predict the PFS for patients with stage II NPC. • This combined model exhibited better predictive accuracy over the clinical-radiological model, the clinical model and the current TNM stage. • This model could distinguish the low-risk patients with stage II NPC for whom IMRT alone is sufficient. To develop and validate a prognostic nomogram based on MRI-detected features of retropharyngeal and cervical lymph nodes and Epstein–Barr virus (EBV) DNA in patients with stage II nasopharyngeal carcinoma (NPC) to distinguish low-risk patients for whom intensity-modulated radiotherapy (IMRT) alone is sufficient. This retrospective study enrolled 894 patients with stage II NPC (596 and 298 in the training and validation cohorts, respectively) with pretreatment MRI between August 2010 and May 2019. All patients received IMRT with or without additional chemotherapy. We identified independent risk factors using univariate and multivariate Cox regression analyses. Survival was compared using Kaplan–Meier curves with the log-rank test. Independent factors derived from the multivariate analysis include cervical nodal necrosis (CNN), the extracapsular spread (ECS) of cervical and retropharyngeal lymph nodes, and gamma-glutamyl transferase (γ-GGT). Nomograms A, B, and C were established based on the clinical [tumor-node-metastasis (TNM) stage + Epstein–Barr virus (EBV) DNA], the clinical-radiological [all independent predictors] and the combined models [the clinical-radiological model + EBV DNA], respectively. Nomogram C (C-index 0.769 [0.718–0.820]) demonstrated better risk discrimination than nomogram B (0.762 [0.715–0.809]), nomogram A (0.619 [0.564–0.674]), and the TNM stage (0.560 [0.509–0.611]). In the low-risk group divided by nomogram C, no significant survival differences were observed between patients treated with radiotherapy (RT) alone and other regimens including additional chemotherapy. The nomogram combining MRI-detected retropharyngeal and cervical lymph node features with pretreatment EBV-DNA improved the prognostic risk stratification for stage II NPC. [ABSTRACT FROM AUTHOR]