Current Status and Factors Influencing Surgical Options for Breast Cancer in China: A Nationwide Cross-Sectional Survey of 110 Hospitals

Yang, Baoxue; Ren, Guosheng; Song, Erwei; Pan, Da; Zhang, Jing; Wang, Yongsheng; Liao, Ning; Tang, Jinhai; Wang, Xiang; Cui, Shude; Jin, Feng; Geng, Cuizhi; Sun, Qiang; Li, Hongyuan; Fan, Zhimin; Cao, Xuchen; Wang, Haibo; Wang, Shu; Shao, Zhimin; Wu, Jiong

doi:10.1634/theoncologist.2020-0001

Cited by 48 publications

(46 citation statements)

References 18 publications

(22 reference statements)

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“…Based on the results of these trials, the latest NCCN guidelines also recommended that ALND not be performed in patients with 1-2 involved SLNs who were planning to undergo breast-conserving surgery and subsequent radiotherapy [15]. However, in most developing countries, such as China, the BCR is only approximately 20%, compared to 50%-80% in Western countries [6,16,17]. Even in some leading centres in China, the BCR is only 30% [18].…”

Section: Discussionmentioning

confidence: 99%

“…Even in some leading centres in China, the BCR is only 30% [18]. Because of the low BCR in developing countries and the absence of evidence for ALND omission in Eastern populations, most clinicians in developing countries such as China still hold a conservative view and recommend ALND for patients with positive SLNs [16]. In addition, the ALN status remains one of the most important prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

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Development of a prediction model based on LASSO regression to evaluate the risk of non-sentinel lymph node metastasis in Chinese breast cancer patients with 1-2 positive sentinel lymph nodes

Meng

Tian

Wang

et al. 2020

Preprint

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Background: Our study aimed to investigate the correlative factors influencing non-sentinel lymph node (NSLN) metastasis in Chinese breast cancer patients with 1-2 positive sentinel lymph nodes (SLNs) and to develop an intraoperative prediction model based on the least absolute shrinkage and selection operator (LASSO) algorithm to evaluate the risk of NSLN metastasis.Methods: The factors affecting NSLN status were investigated in a cohort of 714 patients with 1-2 positive SLNs treated at The First Affiliated Hospital of Chongqing Medical University between January 2013 and December 2018. A new mathematical prediction model based on the LASSO algorithm was developed and was validated in a cohort of 131 patients treated between January 2019 and December 2019.Results: In the training cohort, 266/714 (37.3%) patients had NSLN metastasis. In univariate analysis, the histologic grade (P =0.010), number of positive SLNs (P<0.001), number of negative SLNs (P<0.001), number of SLNs dissected (P<0.001), SLN metastasis ratio (P <0.001), lymphovascular invasion (LVI) status (P <0.001), estrogen receptor (ER) status (P =0.011), human epidermal growth factor receptor 2 (HER2) status (P =0.005), molecular subtype (P =0.001), and risk score (P <0.001) were related with NSLN involvement. In multivariate analysis, the histologic grade (P =0.026), LVI status (P =0.005), number of positive SLNs (P=0.001), number of negative SLNs (P=0.005), SLN metastasis ratio (P =0.005), and molecular subtype (P=0.007) were identified as the independent predictors of NSLN metastasis. A LASSO regression-based mathematical prediction model was developed and had an area under the curve (AUC) of 0.764 (95% CI: 0.729-0.798). In the 131-patient validation cohort, the AUC was 0.777 (95% CI: 0.692-0.862).Conclusions: We present a new prediction model to assess the risk of NSLN metastasis in Chinese breast cancer patients with 1-2 positive SLNs. The model was further validated in the validation cohort and showed excellent clinical applicability and diagnostic performance. It can be used as an intraoperative clinical tool for clinicians to predict the risk of NSLN metastasis and make the final decision regarding axillary lymph node dissection (ALND).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Development of a prediction model based on LASSO regression to evaluate the risk of non-sentinel lymph node metastasis in Chinese breast cancer patients with 1-2 positive sentinel lymph nodes

Meng

Tian

Wang

et al. 2020

Preprint

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“…Besides, a close margin was defined as tumor within 1 mm of the inked margin ( 6 ). Most surgeons in our country would re-excise a close margin in patients intraoperatively ( 7 ). However, re-excision surgeries after the first surgery are a source of physical burden, financial burden, anxiety, and worse cosmesis for patients ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Precision Breast-Conserving Surgery With Microwave Ablation Guidance: A Pilot Single-Center, Prospective Cohort Study

et al. 2021

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IntroductionNegative margins in breast-conserving surgery (BCS) are essential for preventing recurrence. The aim of this study was to determine the use of preoperative microwave ablation (MWA) in the guidance of BCS for early-stage breast cancer and access whether MWA could influence the rates of positive resection margins.MethodsFrom 2016 to 2018, 22 women with T1/T2 invasive breast cancer were enrolled for MWA prospectively in the guidance of BCS. US-guided MWA was performed under local anesthesia, followed by BCS and sentinel lymph node biopsy (SLNB) one week after ablation. Women who underwent palpation-guided BCS directly were included as control, and propensity score matching analysis was applied.ResultsMWA was performed in 22 patients. Of the 21 MWA cases with effect information, the mean tumor size in US was 20.9 ± 6.2 mm (6-37 mm). Compared with control group (BCS directly), a lower rate of positive/close margins was observed in MWA guidance group (P = 0.018), and MWA caused a higher rate of accurate surgery (the largest margin ≤ 3 cm and the smallest margin ≥ 1mm, P = 0.042). Of these 21 patients treated with MWA, 18 were candidates for SLNB. And sentinel lymph nodes were successfully identified in all cases, and no recurrence was found with a mean follow-up of 23 months.ConclusionFor patients with T1/T2 breast cancer, the application of preoperative MWA could guide BCS accurately without impairing SLNB. Clinical trials with long-term results are required to validate MWA in the guidance for breast cancer excision.

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“…BCS is sometimes called lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy depending on how much tissue is removed. Some selective breast cancer patients with larger tumor to breast ratio can undergo oncoplastic surgery after partial mastectomy, thus avoiding total mastectomy and obtaining better breast appearance [3][4][5]. Relational data have shown that the rate of positive margins in patients undergoing oncoplastic BCS was signi cantly lower than that of traditional BCS, and there were no differences in either overall survival rates or relapse-free survival rates between the two techniques [4].…”

Section: Introductionmentioning

confidence: 99%

Short-term Outcomes and Safety of Radiotherapy for Immediate Breast Reconstruction with Autologous Flap Transfer Following Breast-conserving Surgery

Zhang

Song

Wang

et al. 2020

Preprint

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Background: The outcomes of immediate autologous breast reconstruction (IABR) after partial mastectomy followed by postoperative radiotherapy (RT) in terms of aesthetics, treatment-related complications, and local control are unclear. In this study, we evaluated the efficacy of IABR after partial mastectomy with or without breast RT, and thus the impact of radiation on autologous flap transfer.Method: A retrospective cohort study involving consecutive breast cancer patients who underwent IABR after partial mastectomy between July 2011 and December 2017 at Shengjing Hospital was performed. Patients were divided into two groups based on whether or not they received RT after IABR. We compared aesthetic outcomes and changes in the flap size over the three-dimensional coordinates at various timepoints (pre-RT, 1, 6, and 12 months post-RT), as well as postoperative complications, survival, and recurrence rates between the two groups. Results: No significant difference was found in the rate of regional recurrence between the two groups (3.13% vs. 3.85%, P=1.00), and no local recurrences occurred in either group. At the timepoints pre-RT, 1, and 6 months post-RT (approximately 4, 7, and 12 months after IABR, respectively), 77 (91.7%), 70 (83.3%), and 83 (98.8%) patients, respectively, had achieved very good or good cosmetic outcomes, and only changes in breast skin color at 1 month after RT (7 months after IABR) significantly differed between the RT and non-RT groups, with very good or good cosmetic result rates of 62.5% vs. 96.2%, respectively (P<0.001). No significant difference in the reduction of flap size was observed at any timepoint between the RT and non-RT groups. The flap size was significantly reduced at 4 months after IABR compared with the initial size during surgery, and then tended to be stable in both groups. There were no significant differences between the two groups in the rates of postoperative complications including necrosis of the flap, infection, hematoma, or seroma (all P>0.05). Finally, no grade 3 or greater RT-associated adverse events occurred during or after RT.Conclusion: RT following IABR provides aesthetically satisfactory results without intolerable adverse complications and may safely be performed in patients who underwent IABR after partial mastectomy.

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Current Status and Factors Influencing Surgical Options for Breast Cancer in China: A Nationwide Cross-Sectional Survey of 110 Hospitals

Cited by 48 publications

References 18 publications

Development of a prediction model based on LASSO regression to evaluate the risk of non-sentinel lymph node metastasis in Chinese breast cancer patients with 1-2 positive sentinel lymph nodes

Development of a prediction model based on LASSO regression to evaluate the risk of non-sentinel lymph node metastasis in Chinese breast cancer patients with 1-2 positive sentinel lymph nodes

Precision Breast-Conserving Surgery With Microwave Ablation Guidance: A Pilot Single-Center, Prospective Cohort Study

Short-term Outcomes and Safety of Radiotherapy for Immediate Breast Reconstruction with Autologous Flap Transfer Following Breast-conserving Surgery

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