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Purpose: To comparing the survival in different strategies, preoperative systemic treatment (PST) versus upfront surgery (US) in patients of HER2-positive early breast cancer in real-world.Methods: Eligible patients from 2012 to 2015 were classified as PST or US group prospectively, according to the real upfront treatment. The primary endpoint is disease-free survival (DFS), the second endpoint is overall survival (OS). All the outcomes were examined in unadjusted model, propensity score matching (PSM) model, and inverse probability of treatment weighting (IPTW) model. Results: Finally, 1067 eligible patients (215 in PST group, 852 in US group) were included into analysis (Table 1). In unweighted analysis, the cumulative DFS of PST group was significantly lower than US group (78.1% vs 87.7%, P *Proportions and medians are weighted using IPTW, all covariates included in the propensity analysis. Abbreviations: PSM, propensity score matching, IPTW, inverse probability of treatment weighting, PST, preoperative systemic treatment, US, upfront surgery, SMD, standardized mean difference, ER, estrogen receptor, PR, progesterone receptor.In IPTW model, the DFS rate of the PST group was 81.3% versus 80.8% of the US group, and the OS rate of the PST group was 92.1% versus 90.3% (Figure 2E, 2F), both having no significantly differences (Table 4). In further stratified analysis (Figure 3E, 3F), as in PSM model, the DFS and OS rate of the patients without pCR after PST (73.1%, 88.4%) were worse than those with pCR (96.6%, 99.3%) and US group (80.8%, 90.3%), respectively. Table 1. The clinicopathologic characteristics of two groups in PSM and IPTW modelsCharacteristicsNumber of casesUnweighted primary samplePSM modelIPTW model*PST group (215)US group (852)SMDPST group (145)US group (145)SMDPST group (765)US group (1021)SMDN (%)N (%)N (%)N (%)N (%)N (%)Age (years, medium, 95%CI)50, 39~6150, 33~640.0550, 40~6549, 34~620.1049, 39~6750, 31~640.03Stage T14588 (3.7)450 (52.8)0.7018(3.7)10 (6.9)0.03280 (10.5)450 (44.1)0.4672529157 (73.0)372 (43.7)118 (81.4)116 (80.0)635 (83.0)458 (44.9)38050 (23.3)30 (3.5)19 (13.1)19 (13.1)50 (6.5)113 (11.1)Stage N057137 (17.2)534 (62.7)1.04837 (17.2)32 (22.1)0.081310 (40.5)538 (52.7)0.2461596178 (82.8)318 (37.3)108 (81.4)113 (77.9)455 (59.5)483 (47.3)Grade1 and 252292 (42.8)430 (50.5)0.15477 (53.1)89 (61.4)0.168345 (45.1)493 (48.3)0.0643545123 (57.2)422 (49.5)68 (46.9)56 (38.6)420 (54.9)528 (51.7)ERNegative536142 (66.0)394 (46.2)0.40787 (60.0)68 (46.9)0.265386 (50.5)513 (50.2)0.004Positive53173 (34.0)458 (53.8)58 (40.0)77 (53.1)379 (49.5)508 (49.8)PRNegative649171 (79.5)478 (56.1)0.418108 (74.5)113 (77.9)0.081499 (65.2)625 (61.2)0.083Positive41844 (20.5)374 (43.9)37 (25.5)32 (22.1)266 (34.8)396 (38.8) Citation Format: Yang Hongjian, Xingfei Yu, Chen Wang, Zheng Yabing, Hu Jiejie, Xiying Shao, Liming Sheng, Juan Lin, Yuqin Ding, Haojun Xuan, Lijie Gong, Weiliang Feng, Chengdong Qin, Daobao Chen, Yang Yu. Preoperative systemic therapy versus upfront surgery in HER2-positive early breast cancer: A prospective nested case-control study in the real world [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS13-52.

Jiejie Hu, Xianghou Xia, Hongjian Yang, Yang Yu Breast Surgery Department, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou City, Zhejiang Province, People’s Republic of ChinaCorrespondence: Yang YuBreast Surgery Department, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, No. 1, Banshan East Road, Gongshu District, Hangzhou City, Zhejiang Province, 310022, People’s Republic of ChinaTel +8613758252681Email yuyangkaiyu@163.comAbstract: Axillary lymph node dissection is an indispensable step in modified radical mastectomy for breast cancer. It is the most reliable method and the golden standard to determine the status of axillary lymph nodes. It is also of great importance to evaluate the prognosis and develop treatment plans for breast cancer patients. Axillary lymph node dissection can be anatomically divided into levels I, II, and III. Level I and Level II axillary lymph dissection is the standard clinical treatment of axillary lymph nodes positive breast cancer, whereas level III axillary lymph node dissection has been controversial. Level III axillary lymph node metastasis is one of the important factors that can easily cause distant metastasis and recurrence. It is also an important index to estimate the prognosis of breast cancer patients. To facilitate the decision of whether or not to perform level III lymph node dissection, we reviewed the indications, complications, and surgical procedures of level III lymph node dissection.Keywords: breast cancer, axillary lymph node dissection, level III

Background As the critical regulators for tumorigenesis and progression, long-noncoding RNAs (lncRNAs) are becoming novel prognostic biomarkers for tumor patients. By the levels of lncRNAs expression, the patients with breast carcinoma may be divided into subgroups with different risk scores. Nevertheless, there is limited evidence to evaluate the role of lncRNAs in the prognosis of breast carcinoma. The present study aimed to construct lncRNA signatures for prognostic analysis and assist clinicians in choosing optimal therapies. Methods Abnormal expression profiles of breast cancer-associated lncRNAs were analyzed based on the TCGA datasets. Univariate and multivariate Cox regression analysis was used to build a prognostic risk signature according to the lncRNAs expression. The prognostic ability of this signature was verified in various subgroups. Functional enrichment analysis was employed to reveal the potential roles of these predictive lncRNAs in cancer-related biological processes and pathways. Results Compared with normal breast tissues, the differential analysis demonstrated that 286 lncRNAs were abnormally expressed in breast carcinoma. A four-lncRNA signature (RP1-193H18.2, AL022341.3, WDR86-AS1, LINC00511) was found to be closely related to the prognosis of breast carcinoma. The four-lncRNA signature could also qualify the magnitude of treatment benefits for different breast cancer subtypes. Additionally, it was an independent risk factor out of other clinicopathological parameters based on the multivariate Cox analysis. We also uncovered that the four predictive lncRNAs are involved in multiple cellular progression and pathways of breast cancer. Conclusions The four-lncRNA signature could be an essential reference for prognostic prediction and making therapeutic strategies.