BackgroundAsthma-chronic obstructive pulmonary disorder (COPD) overlap (ACO) is characterized by the coexistence of features of both asthma and COPD and is associated with rapid progress and a poor prognosis. Thus, the early recognition of ACO is crucial.ObjectivesWe sought to explore the plasma levels of biomarkers associated with asthma (periostin, TSLP and YKL-40), COPD (NGAL) and their possible correlation with lung function, the bronchodilator response and radiographic imaging in patients with asthma, COPD and with features of ACO.MethodsWe enrolled 423 subjects from 6 clinical centers. All participants underwent blood collection, lung function measurements, bronchodilator response tests and high-resolution CT. Correlations of the plasma biomarkers with lung function, the bronchodilator response and percentemphysema were calculated by Spearman’s rank correlation and multivariate stepwise regressionanalysis.Results1) Patients with features of ACO had lower plasma YKL-40 than COPD patients and a moderate elevated plasma level of NGAL compared with asthma patients. 2) Patients with features of ACO had an intermediate degree of airflow obstruction, the bronchodilator response and emphysema between patients with COPD and asthma. 3) Plasma YKL-40 was negatively correlated with lung function and with the bronchodilator response, and plasma NGAL was positively correlated with the extent of emphysema.ConclusionsPlasma YKL-40 is a promising candidate for distinguishing between patients with features of ACO and COPD patients, while plasma NGAL may be a valuable biomarker for differentiating between patients with features of ACO and asthma patients.Clinical trial registrationChiCTR-OOC-16009221.

BackgroundNeoadjuvant systemic therapy (NST) could make some clinically node-positive (cN+) breast cancer patients achieve axillary pathologic complete response (pCR). This study aimed to identify the patients who are likely to achieve axillary pCR and help surgeons make surgical decisions on the axilla.MethodsThe cN+ breast cancer patients who received NST from 2015 to 2021 at The First Affiliated Hospital of Nanjing Medical University were enrolled. Univariate and multivariate logistic regression analyses were performed, and a nomogram was constructed based on the results of multivariate logistic regression analysis to predict the probability of axillary pCR and validated.ResultsThe axillary pCR was achieved in 208 (38.7%) patients. Patients who had a higher radiological response rate of breast tumor (P = 0.039), smaller longest diameter of positive node after NST (P = 0.028), ER-negative status (P = 0.006), HER2-positive status (P = 0.048) and breast pCR (P < 0.001) were more likely to achieve axillary pCR. The nomogram had an area under the receiver operating characteristic curve (AUC) of 0.795 (95% CI: 0.747–0.843), and the calibration curve showed good agreement.ConclusionA nomogram was constructed to predict the axillary pCR of cN+ patients receiving NST based on baseline and efficacy indicators to assist surgeons in making surgical decisions on the axilla.

Previous studies have observed that human epidermal growth factor receptor 2 (HER2)-low-positive patients and HER2-zero patients have different prognoses. This study was conducted to investigate whether there are differences in clinicopathological characteristics and the response to neoadjuvant systemic therapy (NST) defined as systemic treatment prior to surgery between HER2-low-positive patients and HER2-zero patients. We retrospectively analyzed the data of patients with HER2-negative breast cancer who received NST at the First Affiliated Hospital of Nanjing Medical University from 2014 to 2021. There were 238 patients with HER2-low-positive status and 198 patients with HER2-zero status. The proportion of hormone receptor (HR)-positive patients in the HER2-low-positive group was significantly higher than that in the HER2-zero group (82.8% vs 52.0%, p < 0.001). The HER2-low-positive group had more patients with low Ki67 expression (23.9% vs 16.2%, p = 0.045), higher mastectomy rate (94.5% vs 88.9%, p = 0.031), and larger pathological tumor size (21.6 vs 17.8 mm, p = 0.028) than the HER2-zero group. However, no significant differences were found in pathologic complete response (pCR) rates between the two groups. We draw a conclusion that patients with HER2-low status and HER2-zero status were not found to have different pCR rates after NST, irrespective of HR status. However, differences were observed in some clinicopathological characteristics between the two groups.

Background Patients who do not achieve a pathological complete response (pCR) after neoadjuvant systemic treatment (NST) have a significantly worse prognosis. A reliable predictor of prognosis is required to further subdivide non‐pCR patients. To date, the prognostic role in terms of disease‐free survival (DFS) between the terminal index of Ki‐67 after surgery (Ki‐67 T ) and the combination of the baseline Ki‐67 at biopsy before NST (Ki‐67 B ) and the percentage change in Ki‐67 before and after NST (Ki‐67 C ) has not been compared. Aim This study aimed to explore the most useful form or combination of Ki‐67 that can provide prognostic information to non‐pCR patients. Patients and Methods We retrospectively reviewed 499 patients who were diagnosed with inoperable breast cancer between August 2013 and December 2020 and received NST with anthracycline plus taxane. Results Among all the patients, 335 did not achieve pCR (with a follow‐up period of ≥1 year). The median follow‐up duration was 36 months. The optimal cutoff value of Ki‐67 C to predict a DFS was 30%. A significantly worse DFS was observed in patients with a low Ki‐67 C ( p < 0.001). In addition, the exploratory subgroup analysis showed relatively good internal consistency. Ki‐67 C and Ki‐67 T were considered as independent risk factors for DFS (both p < 0.001). The forecasting model combining Ki‐67 B and Ki‐67 C showed a significantly higher area under the curve at years 3 and 5 than Ki‐67 T ( p = 0.029 and p = 0.022, respectively). Conclusions Ki‐67 C and Ki‐67 T were good independent predictors of DFS, whereas Ki‐67 B was a slightly inferior predictor. The combination of Ki‐67 B and Ki‐67 C is superior to Ki‐67 T for predicting DFS, especially at longer follow‐ups. Regarding clinical application, this combination could be used as a novel indicator for predicting DFS to more clearly identify high‐risk patients.