Early-stage node negative cervical adenocarcinoma and squamous cell carcinoma show similar survival outcomes after hysterectomy: a population-based study

San-Gang Wu,Jia-Yuan Sun,Zhen-Yu He,Qiong-Hua Chen,Juan Zhou 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.6

Objective: To investigate the clinicopathological features and outcomes between node-negative, early-stage cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) after hysterectomy. Methods: Patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stages I–IIA cervical SCC and AC between 1988 and 2013 were retrospectively reviewed using the Surveillance, Epidemiology, and End Results database. We used propensity score-matching to balance patient baseline characteristics. Univariate and multivariate Cox regression analyses were used for prognostic analyses of cause-specific survival (CSS) and overall survival (OS). Results: A total of 9,858 patients were identified, comprising 6,117 patients (62.1%) and 3,741 (37.9%) patients with cervical SCC and AC, respectively. Compared with cervical SCC, cervical AC cases were more likely to be younger, diagnosed after 2000, white, and have well-differentiated and FIGO stage IB1 disease. For SCC and AC, the 10-year CSS rates were 93.4% and 94.7%, respectively (p=0.011), and the 10-year OS rates were 89.6% and 92.2%, respectively (p<0.001). Multivariate analysis revealed that age, ethnicity, tumor grade, and FIGO stage were independent prognostic factors of CSS and OS, but that histologic subtype was not associated with CSS and OS. In the propensity score-matched patient population, univariate and multivariate analyses also showed that histologic subtype was not associated with survival outcomes. Conclusion: Cervical AC has equivalent survival to cervical SCC in node-negative, early-stage disease after hysterectomy and lymphadenectomy.

Using the Lymph Node Ratio to Evaluate the Prognosis of Stage II/III Breast Cancer Patients Who Received Neoadjuvant Chemotherapy and Mastectomy

San-Gang Wu,Qun-Li Zeng,Juan Zhou,Jia-Yuan Sun,Fengyan Li,Qin Lin,Huan-Xin Lin,Xun-Xing Gaun,Zhen-Yu He 대한암학회 2015 Cancer Research and Treatment Vol.47 No.4

Purpose This study was conducted to investigate the prognostic value of lymph node ratio (LNR) instage II/III breast cancer patients who undergo mastectomy after neoadjuvant chemotherapy. Materials and MethodsClinical and pathological data describing stage II/III breast cancer patients were includedin this retrospective study. The primary outcomes were locoregional recurrence-free survival(LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overallsurvival (OS). ResultsAmong 277 patients, there were 43 ypN0, 64 ypN1, 89 ypN2, and 81 ypN3 cases. Additionally, there were 43, 57, 92 and 85 cases in the LNR 0, 0.01-0.20, 0.21-0.65, and> 0.65 groups, respectively. The median follow-up was 49.5 months. Univariate analysisshowed that both ypN stage and LNR were prognostic factors of LRFS, DMFS, DFS, and OS(p < 0.05). Multivariate analysis showed that LNR was an independent prognostic factor ofLRFS, DMFS, DFS, and OS (p < 0.05), while ypN stage had no effect on prognosis (p > 0.05). ConclusionThe integrated use of LNR and ypN may be suitable for evaluation the prognosis of stageII/III breast cancer patients who undergo mastectomy after neoadjuvant chemotherapy.

Ovarian Ablation Using Goserelin Improves Survival of Premenopausal Patients with Stage II/III Hormone Receptor-Positive Breast Cancer without Chemotherapy-Induced Amenorrhea

Juan Zhou,San-Gang Wu,Jun-Jie Wang,Jia-Yuan Sun,Fengyan Li,Qin Lin,Huan-Xin Lin,Zhen-Yu He 대한암학회 2015 Cancer Research and Treatment Vol.47 No.1

Purpose The purpose of this study was to assess the value of ovarian ablation using goserelin inpremenopausal patients with stage II/III hormone receptor-positive breast cancer withoutchemotherapy-induced amenorrhea (CIA). Materials and MethodsWe retrospectively reviewed the data of breast patients treated between October 1999 andNovember 2007 without CIA. The Kaplan-Meier method was used for calculation of thesurvival rate. Log rank method and Cox regression analysis were used for univariate andmultivariate prognostic analysis. ResultsThe median follow-up period was 61 months. Initially, 353 patients remained without CIAafter chemotherapy and 98 among those who received goserelin and tamoxifen (TAM). Inunivariate analysis, goserelin improved locoregional recurrence-free survival (LRFS) (98.9%vs. 94.1%, p=0.041), distant metastasis-free survival (DMFS) (85.4% vs. 71.9%, p=0.006),disease-free survival (DFS) (85.4% vs. 71.6%, p=0.005), and overall survival (OS) (93.5%vs. 83.5%, p=0.010). In multivariate analysis, goserelin treatment was an independentfactor influencing DMFS (hazard ratio [HR], 1.603; 95% confidence interval [CI], 1.228 to2.092; p=0.001), DFS (HR, 1.606; 95% CI, 1.231 to 2.096; p=0.001), and OS (HR, 3.311;95% CI, 1.416 to 7.742; p=0.006). In addition, treatment with goserelin resulted in significantlyimproved LRFS (p=0.039), DMFS (p=0.043), DFS (p=0.036), and OS (p=0.010) inpatients aged < 40 years. In patients aged  40 years, goserelin only improved DMFS(p=0.028) and DFS (p=0.027). ConclusionOvarian ablation with goserelin plus TAM resulted in significantly improved therapeuticefficacy in premenopausal patients with stage II/III hormone receptor-positive breast cancerwithout CIA.

Accelerated Partial Breast Irradiation with Intensity-Modulated Radiotherapy Is Feasible for Chinese Breast Cancer Patients

Zhenyu He,San-Gang Wu,Juan Zhou,Fengyan Li,Jiayan Sun,Qin Lin,Huanxin Lin,Xunxing Guan 한국유방암학회 2014 Journal of breast cancer Vol.17 No.3

Purpose: Several accelerated partial breast irradiation (APBI)techniques are being investigated in patients with early-stagebreast cancer. The present study evaluated the feasibility, earlytoxicity, initial efficacy, and cosmetic outcomes of acceleratedpartial breast intensity-modulated radiotherapy (IMRT) for Chinesefemale patients with early-stage breast cancer after breastconservingsurgery. Methods: A total of 38 patients met the inclusioncriteria and an accelerated partial breast intensity-modulatedradiotherapy (APBI-IMRT) plan was designed for each patient. The prescription dose was 34 Gy in 10 fractions, 3.4 Gy per fraction,twice a day, in intervals of more than 6 hours. Results: Of the38 patients, six patients did not meet the planning criteria. Theremaining 32 patients received APBI-IMRT with a mean targetvolume conformity index of 0.67 and a dose homogeneity indexof 1.06. The median follow-up time was 53 months and no localrecurrence or distant metastasis was detected. The most commonacute toxicities observed within 3 months after radiotherapywere erythema, breast edema, pigmentation, and pain in the irradiatedlocation, among which 43.8%, 12.5%, 31.3%, and28.1% were grade 1 toxicities, respectively. The most commonlate toxicities occurring after 3 months until the end of the followupperiod were breast edema, pigmentation, pain in the irradiatedlocation, and subcutaneous fibrosis, among which 6.2%,28.1%, 21.9%, and 37.5% were grade 1 toxicities, respectively. Thirty-one patients (96.8%) had fine or excellent cosmetic outcomes,and only one patient had a poor cosmetic outcome. Conclusion: It is feasible for Chinese females to receive APBIIMRTafter breast conserving surgery. The radiotherapeutic toxicityis acceptable, and both the initial efficacy and cosmeticoutcomes are good.

Benefit of Post-mastectomy Radiotherapy of the Supra-/infraclavicular Lymphatic Drainage Area in Breast Cancer Patients

He, Zhen-Yu,Wu, San-Gang,Zhou, Juan,Sun, Jia-Yuan,Li, Feng-Yan,Lin, Qin,Guo, Ling,Lin, Huan-Xin Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.14

Background: This study investigated the survival benefit of radiotherapy (RT) of the supra- and infraclavicular lymphatic drainage area in Chinese women with T1-2N1M0 breast cancer receiving mastectomy. Methods: A total of 593 cases were retrospectively reviewed from 1998 to 2007. The relationship between supra- or infraclavicular fossa relapse (SCFR) and post-operative RT at the supra-/infraclavicular lymphatic drainage area was evaluated. Results: The majority of patients (532/593; 89. 8%) received no RT while 61 patients received RT. The median follow-up was 85 months. Among patients without RT, 54 (10. 2%) developed recurrence in the chest wall or ipsilateral SCFR. However, none of the 61 patients who underwent RT demonstrated SCFR. One patient who received RT (1. 6%) experienced recurrence in the chest wall. Univariate analysis revealed that age and molecular subtype (both P < 0. 05) were two prognostic factors related to supraclavicular and infraclavicular fossa relapse-free survival (SFRFS). Multivariate analysis revealed that only Her-2 positive status (P = 0. 011) was an independent predictor of SFRFS. RT had no influence on distant metastasis (P = 0. 328) or overall survival (P = 0. 541). SCFR significantly affected probability of distant metastasis (P < 0. 001) and overall survival (P < 0. 001). Conclusion: Although RT was not significantly associated with SFRFS, postoperative RT was significantly associated with a lower locoregional (i. e., supraclavicular/infraclavicular and chest wall) recurrence rate. SCFR significantly influenced distant metastasis-free survival, which significantly influenced the overall survival of T1-2N1M0 breast cancer patients after mastectomy. Thus, prophylactic RT is recommended in T1-2N1M0 breast cancer patients, especially those who have Her-2 positive lesions.

Impact of 21-Gene Recurrence Score on Chemotherapy Decision in Invasive Ductal Carcinoma of Breast with Nodal Micrometastases

Wei-Rong Chen,Jia-Peng Deng,Jun Wang,Jia-Yuan Sun,Zhen-Yu He,San-Gang Wu 대한암학회 2019 Cancer Research and Treatment Vol.51 No.4

Purpose The purpose of this study was to investigate the effect of 21-gene recurrence score (RS) on predicting prognosis and chemotherapy decision in node micrometastases (N1mi) breast invasive ductal carcinoma (IDC). Materials and Methods Patients with stage T1-2N1mi and estrogen receptor-positive IDC diagnosed between 2004 and 2015 were included. The associations of 21-gene RS with breast cancer-specific survival (BCSS), chemotherapy decision, and benefit of chemotherapy were analyzed. Results We identified 4,758 patients including 1,403 patients (29.5%) treated with adjuvant chemotherapy. In the traditional RS cutoffs, 2,831 (59.5%), 1,634 (34.3%), and 293 (6.2%) patients were in the low-, intermediate-, and high-risk RS groups, respectively. In 3,853 patients with human epidermal growth factor receptor-2 (HER2) status available, most patients were HER2-negative disease (98.3%). A higher RS was independently related to chemotherapy receipt, and 14.0%, 47.7%, and 77.8% of patients in the low-, intermediate-, and high-risk RS groups received chemotherapy, respectively. The multivariate analysis indicated that a higher RS was related to worse BCSS (p < 0.001). The 5-year BCSS rates were 99.3%, 97.4%, and 91.9% in patients with low-, intermediate-, and high-risk RS groups, respectively (p < 0.001). However, chemotherapy receipt did not correlate with better BCSS in low-, intermediate-, or high-risk RS groups. There were similar trends using Trial Assigning Individualized Options for Treatment RS cutoffs. Conclusion The 21-gene RS does predict outcome and impact on chemotherapy decision of N1mi breast IDC. Large cohort and long-term outcomes studies are needed to identify the effects of chemotherapy in N1mi patients by different 21-gene RS groups.

KIF11 Functions as an Oncogene and Is Associated with Poor Outcomes from Breast Cancer

Juan Zhou,Wei-Rong Chen,Li-Chao Yang,Jun Wang,Jia-Yuan Sun,Wen-Wen Zhang,Zhen-Yu He,San-Gang Wu 대한암학회 2019 Cancer Research and Treatment Vol.51 No.3

Purpose The study aimed to search and identify genes that were differentially expressed in breast cancer, and their roles in cancer growth and progression. Materials and Methods The Gene Expression Omnibus (Oncomine) and The Cancer Genome Atlas databases (https://cancergenome.nih.gov/) were screened for genes that were expressed differentially in breast cancer and were closely related to a poor prognosis. Gene expressions were verified by quantitative real-time polymerase chain reaction, and genes were knocked down by a lentivirus-based system. Cell growth and motility were evaluated and in vivo nude mice were used to confirm the in vitro roles of genes. Markers of epithelial-to-mesenchymal transition and the associations of KIF11 with the classical cancer signaling pathways were detected by Western blot. Results A series of genes expressed differentially in patients with breast cancer. The prognosis associated with high KIF11 expression was poor, and the expression of KIF11 increased significantly in high stage and malignant tumor cells. Inhibiting KIF11 expression in lentivirussuppressed cells revealed that KIF11 inhibition significantly reduced cell viability and colony formation, inhibited migration and invasion, but promoted apoptosis. The sizes and weights of KIF11-inhibited tumors in nude mice were significantly lower than in the negative controls. Western blot showed that E-cadherin in breast cancer was significantly upregulated in KIFinhibited cells and tumor tissues, whereas N-cadherin and vimentin were significantly downregulated. BT549 and MDA231 cells with KIF11 knockdown exhibited decreased ERK, AMPK, AKT, and CREB phosphorylation. Conclusion KIF11 acts as a potential oncogene that regulates the development and progression of breast cancer.