Publications by authors named "Chen-Lu Lian"

28 Publications

  • Page 1 of 1

Evaluation of Subjective Sleep Disturbances in Cancer Patients: A Cross-Sectional Study in a Radiotherapy Department.

Front Psychiatry 2021 18;12:648896. Epub 2021 Mar 18.

Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China.

The factors associated with sleep disturbances in cancer patients remains unclear. This study aimed to explore the prevalence of sleep disorders and predictors associated with sleep disturbance in cancer patients from a radiotherapy department. Patients with cancers were recruited before the start of radiotherapy from our institution between January 2019 and February 2020. Pittsburgh Sleep Quality Index (PSQI) scale was used to assess sleep quality. Descriptive statistics, Chi-square test, and multivariate logistic regression analysis were used to conduct statistical analysis. A total of 330 eligible patients were included. Of them, 38.3% ( = 127) had the globe PSQI score >7, indicating that they suffered from sleep disorders. Patients with lung cancer (45.2%) were more likely to suffer from sleep disturbance, followed by cervical cancer (43.8%), nasopharyngeal carcinoma (41.7%), esophageal cancer (41.5%), breast cancer (37.7%), and colorectal cancer (30%). With regard to the PSQI components, the mean sleep duration was 8 h, 20.3% ( = 67) of them reported poor subjective sleep quality, 6.1% ( = 20) needed medication to improve sleep, and 53.6% ( = 177) suffered daytime dysfunction. Multivariate logistic regression models showed body mass index (BMI) ≥ 20 kg/m [odds ratio (OR) 0.599, 95% confidence interval (CI) 0.329-0.948, = 0.031] and the receipt of surgery (OR 0.507, 95% CI 0.258-0.996, = 0.048) were the significant favorable predictors for sleep disturbance, while age, gender, marital status, education level, comorbidity, metastasis status, diagnostic status, and cancer type were not significantly associated with sleep disturbance. Approximately 40% of the cancer patients suffer from sleep disturbance before the start of radiotherapy. Patients with BMI ≥ 20 kg/m and receiving surgery are less likely to develop sleep disturbance in comparison with others.
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http://dx.doi.org/10.3389/fpsyt.2021.648896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044927PMC
March 2021

Identification of MEG8/miR-378d/SOBP axis as a novel regulatory network and associated with immune infiltrates in ovarian carcinoma by integrated bioinformatics analysis.

Cancer Med 2021 Apr 19;10(8):2924-2939. Epub 2021 Mar 19.

Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.

Background: To investigate the potential molecular mechanism of ovarian cancer (OC) evolution and immunological correlation using the integrated bioinformatics analysis.

Methods: Data from the Gene Expression Omnibus was used to gain differentially expressed genes (DEGs). Gene Ontology and Kyoto Encyclopedia of Gene and Genome pathway analysis were completed by utilizing the Database for Annotation, Visualization, and Integrated Discovery. After multiple validations via The Cancer Genome Atlas (TCGA), Genotype-Tissue Expression (GTEx) projects, the Human Protein Atlas, Kaplan-Meier (KM) plotter, and immune logical relationships of the key gene SOBP were evaluated based on Tumor Immune Estimation Resource, and Gene Set Enrichment Analysis (GSEA) software. Finally, the lncRNAs-miRNAs-mRNAs subnetwork was predicted by starBase, TargetScan, miRBD, and LncBase, individually. Correlation of expression and prognosis for mRNAs, miRNAs, and lncRNAs were confirmed by TCGA, Gene Expression Profiling Interactive Analysis 2 (GEPIA 2), starBase, and KM.

Results: A total of 192 shared DEGs were discovered from the four data sets, including 125 upregulated and 67 downregulated genes. Functional enrichment analysis presented that they were mainly enriched in cartilage development, pathway in PI3 K-Akt signaling pathway. Lower expression of SOBP was the independent prognostic factor for inferior prognosis in OC patients. The downregulation of SOBP enhanced the infiltration levels of B cells, CD8+ T cells, Macrophage, Neutrophil, and Dendritic cells. GSEA also disclosed low SOBP showed a significantly associated with the activation of various immune-related pathways. Finally, we first reported that the MEG8/miR-378d/SOBP axis was linked to the development and prognosis of OC through regulating the cytokines pathway.

Conclusions: Our study establishes a novel MEG8/miR-378d/SOBP axis in the development and prognosis of OC, and the triple subnetwork probably affects the progression of the OC by regulating the cytokines pathway.
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http://dx.doi.org/10.1002/cam4.3854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026926PMC
April 2021

The prognostic and predictive value of the 8th American Joint Committee on Cancer (AJCC) staging system among early breast cancer patients aged <50 years.

Gland Surg 2021 Jan;10(1):233-241

Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, China.

Background: This study respectively analyzed the prognostic value and the role in treatment decision-making [breast-conserving surgery (BCS) + radiotherapy (RT) or mastectomy (MAST)] of the 8th American Joint Committee on Cancer (AJCC) pathological prognostic staging system compared with the 7th AJCC anatomical staging system among early breast cancer patients aged <50 years.

Methods: Patients with T1-2N0M0 breast cancer aged <50 years were extracted from the Surveillance, Epidemiology, and End Results database between 2010 and 2014. Breast cancer-specific survival (BCSS) was used as the primary endpoint. Chi-squared test, receiver operating characteristics analysis, Kaplan-Meier method, and multivariate Cox proportional models were used to conduct statistical analysis.

Results: A total of 22,640 female patients were identified, and 24.4% of them reallocated to new stage groups from the 7th to the 8th AJCC staging. Among them, 46.2% (n=10,450) and 53.8% (n=12,190) of patients received BCS + RT and MAST, respectively. The 8th AJCC staging system was an independent prognostic factor for BCSS. Patients treated with BCS + RT had better BCSS compared to those treated with MAST (P<0.001). According to the 8th AJCC staging, BCS + RT could improve 5-year BCSS compared with MAST in patients with stage IA (P=0.006) and stage IB (P=0.001) diseases, while comparable BCSS was found between the two treatment arms in patients' stage IIA disease (P=0.366). Multivariate analyses replicated similar findings after stratification by the 8th AJCC stages.

Conclusions: In patients with T1-2N0 breast cancer and aged <50 years, the 8th AJCC pathological staging system provides accurate prognostic information than the 7th anatomical staging. BCS + RT is the optimal local management for stage IA and IB diseases, while it is the optional management in stage IIA disease according to the 8th AJCC staging.
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http://dx.doi.org/10.21037/gs-20-587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882352PMC
January 2021

Adjuvant chemotherapy and survival outcome in node-negative breast cancer with a 21-gene recurrence score of 26-30.

Future Oncol 2021 Feb 19. Epub 2021 Feb 19.

Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen 361003, PR China.

To investigate the benefit of chemotherapy among early-stage breast cancer patients with 21-gene recurrence scores of 26-30. We identified 3754 patients in the Surveillance, Epidemiology, and End Results database. 57.6% of the patients received adjuvant chemotherapy. Patients with higher tumor grade, larger tumors and younger age were more likely to receive chemotherapy. The receipt of chemotherapy was independently associated with better breast cancer-specific survival than in patients without chemotherapy before (p = 0.016) and after (p = 0.043) propensity score matching. The sensitivity analyses showed that survival gain was pronounced in patients with poorly differentiated or undifferentiated disease. Adjuvant chemotherapy improves the outcome for early-stage breast cancer with 21-gene recurrence score of 26-30, especially for patients with high-grade tumors.
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http://dx.doi.org/10.2217/fon-2020-1315DOI Listing
February 2021

Additional radiotherapy to breast-conserving surgery is an optional treatment for de novo stage IV breast cancer: A population-based analysis.

Cancer Med 2021 Mar 14;10(5):1634-1643. Epub 2021 Feb 14.

Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China.

Background: We aim to assess the value of locoregional treatment (LRT) including breast-conserving surgery (BCS), mastectomy (MAST), and radiotherapy (RT) in patients with de novo stage IV breast cancer.

Methods: Patients with de novo stage IV breast cancer were retrospectively identified from the Surveillance, Epidemiology, and End Results database between 2004 and 2014. Kaplan-Meier analysis, log-rank tests, propensity score matching (PSM), and the multivariate Cox proportional model were used for statistical analysis.

Results: A total of 5798 patients were identified including 849 (14.6%), 763 (13.2%), 2338 (40.3%), and 1848 (31.9%) who received BCS alone, BCS+RT, MAST alone, and MAST+RT, respectively. The proportions of receiving BCS decreased from 35.9% in 2004 to 26.2% in 2014 (p = 0.002), and the probability of patients receiving MAST increased from 64.1% in 2004 to 74.8% in 2014 (p = 0.002). Before PSM, there was a significant difference in breast cancer-specific survival (BCSS) among the treatment arms. Patients who received RT had better BCSS, the 5-year BCSS was 40.5%, 52.3%, 41.5%, and 47.7% in patients treated with BCS alone, BCS+RT, MAST alone, and MAST+RT, respectively (p < 0.001). In the PSM cohort, patients treated with BCS alone had lower 5-year BCSS compared to those treated with BCS+RT (43.9% and 52.1%, p = 0.002). However, there were comparable 5-year BCSS between BCS+RT and MAST alone groups (51.3% and 50.1%, p = 0.872), and BCS+RT and MAST+RT cohorts (51.5% and 55.7%, p = 0.333). Similar results were confirmed in multivariate analysis.

Conclusions: Postoperative RT improves BCSS in patients with de novo stage IV breast cancer, and BCS+RT shows a non-inferior outcome compared to MAST+RT. BCS+RT may be the optimal local management of de novo stage IV breast cancer.
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http://dx.doi.org/10.1002/cam4.3751DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940213PMC
March 2021

Staging for Breast Cancer With Internal Mammary Lymph Nodes Metastasis: Utility of Incorporating Biologic Factors.

Front Oncol 2020 14;10:584009. Epub 2021 Jan 14.

Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China.

Purpose: To validate the 8th edition of the American Joint Committee on Cancer (AJCC) pathological prognostic staging system for breast cancer patients with internal mammary lymph nodes (IMN) metastasis (N3b disease, stage IIIC in 7th AJCC anatomical staging).

Methods: Breast cancer patients with IMN metastasis diagnosed between 2010 and 2014 were retrieved from the Surveillance, Epidemiology, and End Results program. Chi-squared test, Log-rank test, Kaplan-Meier method, and Cox proportional hazard analysis were applied to statistical analysis.

Results: We included 678 patients with N3b disease in this study. Overall, 68.4% of patients were downstaged to IIIA and IIIB diseases from the 7th anatomical staging to 8th pathological prognostic staging. The new pathological prognostic staging system had better discriminatory value on prognosis prediction among IMN-metastasized breast cancer patients, with a 5-year breast cancer-specific survival (BCSS) of 92.7, 77.4, and 66.0% in stage IIIA, IIIB, and IIIC diseases, respectively (P<0.0001), and the 5-year overall survival (OS) rates was 85.9, 72.1, and 58.7%, respectively (P<0.0001). The results of the multivariate prognostic analysis showed that the new pathological prognostic staging was the independent prognosis related to BCSS and OS, the 8th AJCC pathological prognostic stages showed worse BCSS and OS with gradually increased hazard ratios.

Conclusion: The 8th AJCC pathological prognostic staging system offers more refined prognostic stratification to IMN-metastasized breast cancer patients and endorses its use in routine clinical practice for this specificsubgroupofbreastcancer.
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http://dx.doi.org/10.3389/fonc.2020.584009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840897PMC
January 2021

Prognostic and Predictive Value of the American Joint Committee on Cancer Pathological Prognostic Staging System in Nodal Micrometastatic Breast Cancer.

Front Oncol 2020 18;10:570175. Epub 2020 Dec 18.

Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, China.

Introduction: To investigate the prognostic and predictive effect of the American Joint Committee on Cancer (AJCC) 8 edition pathological prognostic staging system in patients with T1-2N1micM0 breast cancer who underwent mastectomy.

Methods: Data from T1-2N1micM0 breast cancer patients who underwent mastectomy from 2010-2014 were obtained from the Surveillance, Epidemiology, and End Results program. The chi-square test, binomial logistics regression, receiver-operating characteristics curve, competing-risk regression model, Cox proportional hazards regression model, and proportional hazard assumption were used for statistical analyses.

Results: We identified 4,729 patients, including 1,062 patients were received postmastectomy radiotherapy (PMRT). Stage change occurred in 88.2% of the patients, of which 84.4% were downstaged and 3.7% were upstaged. Patients with higher pathological prognostic stages were independently predicted to receive PMRT. The 5-year breast cancer-specific survival (BCSS) was 97.5, 93.7, 90.1, 86.0, and 73.5% in disease stages IA, IB, IIA, IIB, and IIIA, respectively, according to the 8 edition criteria (P < 0.001). The AJCC 8 edition demonstrated moderate discriminative ability, and it had a significantly better ability to predict the BCSS than the AJCC 7 edition criteria (P < 0.001). The multivariate prognostic analysis showed that the new pathological prognostic staging was an independent prognostic factor affecting the BCSS. The BCSS worsened with an increase in the stage. The PMRT did not affect the BCSS regardless of the pathological prognostic stage. Similar trends were found using the competing-risks regression model.

Conclusions: The 8 AJCC breast cancer pathological prognostic staging system downstaged 84.4% of patients with T1-2N1micM0 disease and the survival outcome prediction with this staging system was more accurate than the AJCC 7 edition system. Our study does not support using the prognostic stage as a guideline to escalate of PMRT.
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http://dx.doi.org/10.3389/fonc.2020.570175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775531PMC
December 2020

The longitudinal risk of mortality between invasive ductal carcinoma and metaplastic breast carcinoma.

Sci Rep 2020 12 16;10(1):22070. Epub 2020 Dec 16.

Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.

The management of metaplastic breast carcinoma (MBC) has largely paralleled the paradigms used for invasive ductal carcinoma (IDC) in the current National Comprehensive Cancer Network guidelines of breast cancer. However, patients with IDC and MBC have been shown to have a different prognosis, and there are significant differences in risk and failure patterns after treatment. The purpose of this study was to compare breast cancer specific survival (BCSS) and hazard function between IDC and MBC. We included patients from the Surveillance, Epidemiology, and End Results program with stage I-III IDC and MBC between 2000 and 2012. Statistical analyses were including chi-square analysis, life-table methods, multivariate Cox proportional hazards models, and propensity score matching (PSM). We identified 294,719 patients; 293,199 patients with IDC and 1520 patients with MBC. Multivariate analyses showed that the MBC subtype had significantly lower BCSS than the IDC subtype before and after PSM (p < 0.001). There were significant differences in the hazard curve between IDC and MBC. The hazard curve for breast cancer mortality in the IDC cohort peaked at 3 years (2%), and then changed to a slowly decreasing plateau after prolonged follow up. However, the hazard curve for breast cancer mortality in the MBC cohort peaked at 2 years (7%), then declined sharply between 3 and 6 years, and changed to a low death rate after a follow-up time exceeding 6 years. Subgroup analyses revealed that the hazard curves significantly differed between IDC and MBC after stratifying by tumor stage and hormone receptor status. Our study suggests that patients with MBC should receive more effective systemic agents and intensive follow-up because of their significantly augmented risk of death compared to IDC patients.
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http://dx.doi.org/10.1038/s41598-020-79166-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744577PMC
December 2020

Aggressive Local Treatment Improves Survival in Stage IV Breast Cancer With Synchronous Metastasis.

Front Oncol 2020 16;10:522580. Epub 2020 Nov 16.

Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China.

Introduction: To investigate the effect of local treatment strategy on survival outcome in stage IV breast cancer patients who received chemotherapy.

Methods: We identified stage IV breast cancers that presented with synchronous metastasis from the Surveillance, Epidemiology, and End Results database. Binomial logistic regression, Kaplan-Meier survival curves, propensity score matching (PSM), and multivariate Cox regression model were used for statistical analyses.

Results: We identified 5,374 patients in total, including 2,319 (43.2%), 2,137 (39.8%), and 918 (17.1%) patients who received surgery alone, surgery+radiotherapy, and radiotherapy alone, respectively. The probability of patients receiving surgery alone decreased over time, and the probability of patients receiving radiotherapy alone increased over time. However, no significant difference was observed in the probability of patients receiving postoperative radiotherapy (P = 0.291). The 3-year breast cancer-specific survival (BCSS) in patients treated with surgery alone, radiotherapy alone, and surgery+radiotherapy was 57.1, 35.9, and 63.9%, respectively (P < 0.001). The local treatment strategy was the independent prognostic factor related to BCSS. Using surgery alone as the reference, radiotherapy alone was related to lower BCSS (P < 0.001), while additional radiotherapy after surgery improved BCSS (P < 0.001). Similar results were observed using PSM.

Conclusions: Compared to radiotherapy alone, surgery to the primary site may confer a survival benefit in stage IV breast cancer with synchronous metastasis, and additional postoperative radiotherapy further improves outcome after primary tumor removal. Local treatment can only be an option in highly selected patients with stage IV disease in the treatment guidelines. More prospective studies are needed to investigate the role of local management for this patient subset.
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http://dx.doi.org/10.3389/fonc.2020.522580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706410PMC
November 2020

Chemotherapy and 21-gene recurrence score testing for older breast cancer patients: A competing-risks analysis.

Breast 2020 Dec 28;54:319-327. Epub 2020 Nov 28.

Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China. Electronic address:

Purpose: To evaluate the effect of the 21-gene recurrence score (RS) assay in breast cancer-specific mortality (BCSM) and decision-making for chemotherapy in older (aged ≥65 years) breast cancer.

Methods: We retrospectively included older patients with T1-2N0 and estrogen receptor-positive breast cancer in the Surveillance, Epidemiology, and End Results database. Cox regression model and competing-risks model were used for data analysis.

Results: This study included 8524 patients, 1987 (23.3%) had low RS, 5059 (59.4%) had intermediate RS, and 1478 (17.3%) had high RS. Chemotherapy was administrated in 2.0%, 8.6%, and 51.2% for low, intermediate, and high RS cohorts, respectively (P < 0.001). A total of 597 deaths were recorded, including one-quarter of breast cancer-related deaths and three-quarters as competing causes of death. The 5-year BCSM was 5.4%, 4.7%, and 9.1% for low, intermediate, and high RS cohorts, respectively (P < 0.001), using the Cox regression model, and was 0.8%, 0.9%, and 5.2% for low, intermediate, and high RS cohorts using the competing-risks regression, respectively (P < 0.001). RS was independently correlated with BCSM in both prognostic models. The stratified analysis demonstrated that chemotherapy was not correlated with a lower risk of BCSM in intermediate and high RS cohorts in both prognostic models. Sensitivity analyses replicated similar findings after stratification by the year of diagnosis and patients' age.

Conclusions: The competing-risks model is useful in dealing with multiple end events for older breast cancer patients. 21-gene RS was independently associated with BCSM. However, chemotherapy did not significantly decrease the risk of BCSM in intermediate and high RS cohorts.
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http://dx.doi.org/10.1016/j.breast.2020.11.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718160PMC
December 2020

Analysis of the Trends in Publications on Clinical Cancer Research in Mainland China from the Surveillance, Epidemiology, and End Results (SEER) Database: Bibliometric Study.

JMIR Med Inform 2020 Nov 17;8(11):e21931. Epub 2020 Nov 17.

Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China.

Background: The application of China's big data sector in cancer research is just the beginning. In recent decades, more and more Chinese scholars have used the Surveillance, Epidemiology, and End Results (SEER) database for clinical cancer research. A comprehensive bibliometric study is required to analyze the tendency of Chinese scholars to utilize the SEER database for clinical cancer research and provide a reference for the future of big data analytics.

Objective: Our study aimed to assess the trend of publications on clinical cancer research in mainland China from the SEER database.

Methods: We performed a PubMed search to identify papers published with data from the SEER database in mainland China until August 31, 2020.

Results: A total of 1566 papers utilizing the SEER database that were authored by investigators in mainland China were identified. Over the past years, significant growth in studies based on the SEER database was observed (P<.001). The top 5 research topics were breast cancer (213/1566, 13.6%), followed by colorectal cancer (185/1566, 11.8%), lung cancer (179/1566, 11.4%), gastrointestinal cancer (excluding colorectal cancer; 149/1566, 9.5%), and genital system cancer (93/1566, 5.9%). Approximately 75.2% (1178/1566) of papers were published from the eastern coastal region of China, and Fudan University Shanghai Cancer Center (Shanghai, China) was the most active organization. Overall, 267 journals were analyzed in this study, of which Oncotarget was the most contributing journal (136/267, 50.9%). Of the 1566 papers studied, 585 (37.4%) were published in the second quartile, 489 (31.2%) in the third quartile, 312 (19.9%) in the first quartile, and 80 (5.1%) in the fourth quartile, with 100 (6.4%) having an unknown Journal Citation Reports ranking.

Conclusions: Clinical cancer research based on the SEER database in mainland China underwent constant and rapid growth during recent years. High-quality and comprehensive cancer databases based on Chinese demographic data are urgently needed.
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http://dx.doi.org/10.2196/21931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708086PMC
November 2020

Integration the biologic factors into the staging of breast cancer patients with ipsilateral supraclavicular lymph node metastasis.

J Cancer 2020 30;11(23):6834-6840. Epub 2020 Sep 30.

Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China.

To investigate the accuracy and the discriminatory performance in the prognostic prediction in breast cancer (BC) patients with ipsilateral supraclavicular lymph node (ISLN) metastasis using the between the American Joint Committee on Cancer (AJCC) 7th and 8th edition staging system. Female patients diagnosed as BC were retrieved from the Surveillance, Epidemiology, and End Results database between 2010 and 2014. Chi-squared test, Kaplan-Meier method, Cox proportional hazard analysis, and the receiver operating characteristics were used to conduct statistical analysis. We included 1097 BC patients with ISLN metastasis (N3c disease), including 29.4% (n=322) and 70.6% (n=775) of patients with non-metastatic and metastatic stage at diagnosis, respectively. In non-metastatic stage patients, 64.9% of the patients categorized as having stage IIIC disease in the 7th edition AJCC staging system were downstaged to stage IIIA or IIIB according to the 8th AJCC staging criteria. The AJCC 8th edition staging system had better discriminatory prognostic value than the 7th AJCC staging (area under the curve: 0.586 vs. 0.577, =0.0006), with a 5-year breast cancer-specific survival (BCSS) rate of 71.3%, 62.2%, 45.2% and 39.1% in stage IIIA, IIIB, IIIC, and IV cohorts, respectively (<0.0001). The multivariate prognostic analysis revealed that the AJCC 8th edition staging system was an independent prognostic factor for BCSS, while no statistical difference in BCSS was found between the 8th AJCC stage IIIC and IV patients (=0.188). The AJCC 8th edition pathological prognostic staging showed a better discriminatory prognostic value in ISLN-metastasized breast cancer patients. An additional clarification strategy in stage IIIC disease based on the 8th AJCC staging should be developed to differentiate patients who are curable with multimodality therapy and patients who have less benefit from curative treatment.
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http://dx.doi.org/10.7150/jca.52449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592016PMC
September 2020

Incorporation of biologic factors for the staging of de novo stage IV breast cancer.

NPJ Breast Cancer 2020 7;6:43. Epub 2020 Sep 7.

Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, 361003 Xiamen, People's Republic of China.

This study aimed to investigate the prognostic value of biological factors, including histological grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status in de novo stage IV breast cancer. Based on eligibility, patient data deposited between 2010 and 2014 were collected from the surveillance, epidemiology, and end results database. The receiver operating characteristics curve, Kaplan-Meier analysis, and Cox proportional hazard analysis were used for analysis. We included 8725 patients with a median 3-year breast cancer-specific survival (BCSS) of 52.6%. Higher histologic grade, HER2-negative, ER-negative, and PR-negative disease were significantly associated with lower BCSS in the multivariate prognostic analysis. A risk score staging system separated patients into four risk groups. The risk score was assigned according to a point system: 1 point for grade 3, 1 point if hormone receptor-negative, and 1 point if HER2-negative. The 3-year BCSS was 76.3%, 64.5%, 48.5%, and 23.7% in patients with 0, 1, 2, and 3 points, respectively, with a median BCSS of 72, 52, 35, and 16 months, respectively ( < 0.001). The multivariate prognostic analysis showed that the risk score staging system was an independent prognostic factor associated with BCSS. Patients with a higher risk score had a lower BCSS. Sensitivity analyses replicated similar findings after stratification according to tumor stage, nodal stage, the sites of distant metastasis, and the number of distant metastasis. In conclusion, our risk score staging system shows promise for the prognostic stratification of de novo stage IV breast cancer.
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http://dx.doi.org/10.1038/s41523-020-00186-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477201PMC
September 2020

Cognitive dysfunction in patients with nasopharyngeal carcinoma after induction chemotherapy.

Oral Oncol 2020 12 4;111:104921. Epub 2020 Aug 4.

Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, People's Republic of China. Electronic address:

Objective: This prospective study aimed to assess the incidence, details of the change of cognitive dysfunction, and predictive factors of cognitive function impairment associated with induction chemotherapy (IC) in nasopharyngeal carcinoma (NPC) patients.

Method: We prospectively included NPC patients who treated with IC from December 2018 to January 2020. Montreal cognitive assessment (MoCA) was used to measure cognitive function, and score less than 26 was defined as cognitive dysfunction. Multivariate logistic regression analysis was applied to assess the independent predictors associated with cognitive function impairment.

Results: A total of 76 patients were recruited, 10 patients were excluded due to refusal or unable to finish the questionnaire, and 66 patients were analyzed in this study. The median age of the patients was 48.5 years (range, 24-69 years). There was 89.4% of patients received ≥3 circles of IC. For the entire group, 27.3% had cognitive dysfunction, of which attention, language, short-term memory, and orientation showed significant downward trends, while visuospatial/executive function, naming, and abstraction demonstrated no prominent decrease. In patients having cognitive function impairment, 77.8% of them occurred after the first circle of IC. Gender (P = 0.039) and education (P = 0.03) were significant predictors for cognitive dysfunction. Female patients (female vs. male: 50% vs. 20%) and patients with lower educational levels (lower vs. higher: 37.8% vs. 11.8%) were more likely to suffer cognitive dysfunction. In addition, age (P = 0.572) and chemotherapy circles (P = 0.68) had no association with cognitive dysfunction.

Conclusion: Approximately 25% of NPC patients suffered cognitive dysfunction after IC, especially in female patients and patients with lower educational levels.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104921DOI Listing
December 2020

Prognostic validation and treatment decision making of the 8 edition of the American Joint Committee on Cancer pathological staging system for elderly women with early-stage breast cancer.

Aging (Albany NY) 2020 07 25;12(14):15077-15090. Epub 2020 Jul 25.

Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, People's Republic of China.

Purpose: To determine the prognostication and treatment decision making of the American Joint Committee on Cancer (AJCC) 8 pathological staging system in elderly women (aged ≥65 years) with T1-2N0M0 breast cancer (BC).

Results: We included 67699 patients, and patients were restaged into stage IA (84.9%), IB (8.9%), and IIA (6.2%) using the 8 AJCC edition criteria. Overall, 69.4% and 30.6% of them underwent breast-conservation surgery (BCS) and mastectomy (MAST), respectively. In patients who received BCS, 30.3% of them underwent postoperative radiotherapy (RT). Patients with a higher pathological stage were more likely to receive MAST. The 5-year breast cancer-specific mortality rate was 2.2%, 6.5% and 13.7% in stage IA, IB, and IIA, respectively. Patients treated with BCS and RT had significantly lower risk of breast cancer-specific mortality compared to those treated with MAST or with BCS alone regardless of the pathological prognostic stages (P<0.001).

Conclusions: The 8 AJCC pathological prognostic staging system provides accurate risk stratification and impacts the treatment decision making for elderly women with early-stage BC.

Methods: We identified stage T1-2N0M0 BC patients using the Surveillance, Epidemiology, and End Results database. Statistical analyses were used binomial logistic regression, and multivariable competing risk models in the Cox model framework.
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http://dx.doi.org/10.18632/aging.103574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425443PMC
July 2020

Prognostic validation and therapeutic decision-making of the AJCC eighth pathological prognostic staging for T3N0 breast cancer after mastectomy.

Clin Transl Med 2020 Jan 23;10(1):125-136. Epub 2020 Apr 23.

Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.

Background: T3N0 breast cancer might be a distinct clinical and biological entity, with higher heterogeneity and presenting diverse responses to locoregional and systemic therapy. The aim of the current study was to validate the prognostic effect and assess the treatment decision-making of the American Joint Committee on Cancer (AJCC) eighth pathological prognostic staging in T3N0 breast cancer after mastectomy.

Methods: We retrospectively included 2465 patients with stage T3N0 breast cancer who had undergone mastectomy between 2010 and 2014 using the data from Surveillance, Epidemiology, and End Results program. The primary endpoint of this study was breast cancer-specific survival (BCSS).

Results: Of the entire cohort, 76.0% of patients in the seventh AJCC staging system were restaged to the eighth AJCC pathological prognostic staging system. A total of 1431 (58.1%) and 1175 (47.7%) of them received chemotherapy and postmastectomy radiotherapy (PMRT), respectively. Pathological staging was an independent prognostic factor for BCSS. Using pathological prognostic stage IA as the reference, BCSS gradually became worse with increased hazard ratios. The 5-years BCSS was 96.9%, 95.5%, 91.1%, 85.6%, and 75.5% in pathological prognostic stage IA, IB, IIA, IIB, and IIIA breast cancers, respectively (P < .001). In pathological prognostic stage IA, IB, and IIA breast cancers, the receipt of PMRT or chemotherapy was not correlated with better BCSS. However, PMRT was correlated with better BCSS in pathological prognostic stage IIB disease (P = .006), but not in pathological prognostic IIIA disease. Moreover, chemotherapy was correlated with better BCSS in pathological prognostic stage IIIA disease (P = .006), but not in pathological prognostic stage IIB disease.

Conclusions: The eighth AJCC pathological prognostic staging system provides more risk stratification of T3N0 breast cancers after mastectomy and might affect individualized decision-making for chemotherapy and PMRT in this patient subset.
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http://dx.doi.org/10.1002/ctm2.3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240839PMC
January 2020

Real-world impact of postmastectomy radiotherapy in T1-2 breast cancer with one to three positive lymph nodes.

Ann Transl Med 2020 Apr;8(7):489

Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China.

Background: The utility of postmastectomy radiotherapy (PMRT) in breast cancer patients with T1-2 (tumor size ≤5 cm) and N1 (one to three lymph nodes involved) disease remains controversial. The aim of this population-based study was to investigate the effectiveness of PMRT in this patient subset in the current clinical practice.

Methods: We included T1-2N1 breast cancer patients treated with mastectomy from 2004 to 2012 using the data form the Surveillance, Epidemiology, and End Results program. The association of PMRT administration with breast cancer-specific survival was determined using multivariable Cox analysis.

Results: We identified 10,248 patients of this study, including 3,725 (36.3%) received PMRT and 6,523 (63.7%) patients did not receive PMRT. Use of PMRT showed increase from 2008 onward; the percentage of patients receiving PMRT was 30.6% in 2004 and was 47.1% in 2012 (P<0.001). Patients diagnosis after 2008, aged <50 years, high tumor grade, T2 stage, and ≥2 positive lymph nodes were independently related to PMRT receipt. Multivariate analysis indicated that PMRT was not related to better breast cancer-specific survival compared to those without PMRT both before (P=0.186) and after propensity score matching (P=0.137).

Conclusions: In breast cancer with T1-2N1 disease, PMRT does not appear to improve survival in the era of modern systemic therapy.
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http://dx.doi.org/10.21037/atm.2020.03.49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210210PMC
April 2020

Validation of the 8 edition of the American Joint Committee on Cancer Pathological Prognostic Staging for young breast cancer patients.

Aging (Albany NY) 2020 04 22;12(8):7549-7560. Epub 2020 Apr 22.

Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China.

Purpose: This study aimed to validate the newly proposed American Joint Committee on Cancer (AJCC) pathological prognostic staging system for young breast cancer patients (aged ≤40 years).

Results: We included 12811 women in this study. Overall, 52.8% of patients in the 7 AJCC stages were restaged to the 8 AJCC pathological staging system, including 10.7% upstaged and 42.1% downstaged. The receiver operating characteristics analysis showed that the new staging system had a better role in predicting breast cancer-specific survival (BCSS) compared with 7 edition staging (P<0.001). The results of the multivariate prognostic analysis showed that the hazard ratio of BCSS increased with the 8 AJCC stages, while the 7 anatomic stages had no significant difference in BCSS.

Conclusions: The novel pathological staging system could provide more accurate prognostic stratification for young women with breast cancer because of the high proportion of stage migration.

Patients And Methods: Data for young breast cancer patients diagnosed between 2010 and 2014 were included from the Surveillance, Epidemiology, and End Results program. Chi-squared test, Kaplan-Meier method, receiver operating characteristics curve, and Cox proportional hazard analysis were applied to statistical analysis.
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http://dx.doi.org/10.18632/aging.103111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202534PMC
April 2020

Evaluation of the 8th edition of the American joint committee on cancer's pathological staging system in prognosis assessment and treatment decision making for stage T1-2N1 breast cancer after mastectomy.

Breast 2020 Jun 3;51:2-10. Epub 2020 Mar 3.

Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, PR China. Electronic address:

Purpose: The 8th edition of the American Joint Committee on Cancer (AJCC) pathological staging system for breast cancer considers biologic factors in addition to the anatomical features included in the previous systems. The purpose of this study was to determine the validity of the 8th AJCC staging system for T1-2N1 breast cancer and to assess the effect of additional chemotherapy and radiotherapy according to the new pathologic stages.

Methods: The cohort included patients from the Surveillance, Epidemiology, and End Results program (2010-2012) who had stage T1-2N1 invasive breast carcinoma and underwent mastectomy. All patients were restaged using the 8th AJCC staging system. The Kaplan-Meier method, Cox proportional hazards regression, and competing risks models were used for data analysis.

Results: We identified 9908 patients including 3022 (30.5%), 3131 (31.6%), 1940 (19.6%), 1194 (12.1%), and 621 (6.3%) were classified with stage IA, IB, IIA, IIB, and IIIA disease, respectively. The 5-year breast cancer-specific survival (BCSS) was 97.3%, 94.3%, 88.3%, 84.0%, and 71.1% for stage IA, IB, IIA, IIB, and IIIA disease, respectively. Higher pathological stage was associated with a significantly higher risk of breast cancer-related death. Chemotherapy was associated with better BCSS regardless of the pathological stage, but radiotherapy was only associated with better BCSS in stage IIIA disease.

Conclusions: The 8th AJCC pathological staging system provides more refined stratification for T1-2N1 breast cancer patients after mastectomy and may meet the needs of the current trend of individualized decision making for chemotherapy and radiotherapy in this patient subset.
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http://dx.doi.org/10.1016/j.breast.2020.02.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375569PMC
June 2020

The effect of histological subtypes on survival outcome in nasopharyngeal carcinoma after extensive follow up.

Ann Transl Med 2019 Dec;7(23):768

Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China.

Background: No consensus exists regarding the follow-up of nasopharyngeal carcinoma (NPC) patients stratified by different histological subtypes. The purpose of this study was to determine the hazard function of disease-related death and assess the prognostic effect of early and late disease-related death in NPC according to histological subtypes.

Methods: We included non-metastatic NPC patients between 2004 and 2014 using the Surveillance, Epidemiology and End-Results (SEER) program. Life-table methods, Kaplan-Meier methods, and a multivariate Cox regression model were used in the analysis.

Results: We identified 2,845 patients in this study including 1,218 (42.8%), 849 (29.8%), and 778 (27.3%) patients with keratinizing squamous cell carcinoma (KSCC), differentiated non-keratinizing carcinoma (DNKC), and undifferentiated non-keratinizing carcinoma (UNKC), respectively. Most NPC-related death (89.8%) occurred within 5 years of diagnosis. In the entire cohort, the hazard curve for NPC-related death peaked at 2 years. It peaked at 1 year, 2- and 5-year, and 2- and 6-year in patients with KSCC, DNKC, and UNKC, respectively. Within the follow-up period over 5 years, patients with DNKC had poorer NPC-specific survival (NPC-SS) compared to UNKC, and had comparable NPC-SS between the two subtypes after more than 5 years of follow-up. Moreover, within the follow-up period of 1, 2, and 3 years, patients with KSCC experienced poorer NPC-SS compared to UNKC but there was comparable NPC-SS between KSCC and UNKC patients after more than 3 years of follow-up.

Conclusions: The hazard rate patterns for NPC-related mortality significantly differed between histological subtypes. Tailored surveillance and follow-up strategies should be designed in NPC patients according to histological subtypes.
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http://dx.doi.org/10.21037/atm.2019.11.75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989997PMC
December 2019

Bioinformatics-Based Discovery of -Like Transmembrane Member 5 as a Novel Biomarker for Breast Cancer.

Front Cell Dev Biol 2019 9;7:361. Epub 2020 Jan 9.

Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China.

Chemokine-like factor (CKLF)-like transmembrane members () represent a novel protein family linking the chemokine and transmembrane-4 superfamily families, which potentially play several roles in diverse physiological and pathological processes. The detailed functions and underlying molecular mechanisms of remain elusive in breast cancer. Herein, we performed a comprehensive bioinformatic analysis to investigate the prognostic effect, potential functions, and biomolecular regulatory network of in breast cancer. The mRNA expression level of , in particular, was significantly downregulated in breast cancer; moreover, high mRNA expression level of was significantly associated with better relapse-free survival. DNA promoter hypermethylation of was negatively correlated with its mRNA expression levels. Furthermore, strongly associated with pathway in MARVEL domains, chemotaxis, cytokines, transmembrane structures, and integral component of membrane. For example, genes related to MARVEL domains, transmembrane structures, and chemokines were significantly enriched. Our findings indicate that can be used as a prognostic biomarker and potential therapeutic target for breast cancer.
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http://dx.doi.org/10.3389/fcell.2019.00361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962189PMC
January 2020

Should women with early breast cancer under 40 years of age have a routine 21-gene recurrence score testing: A SEER database study.

Breast 2020 Feb 26;49:233-241. Epub 2019 Dec 26.

Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, 361003, People's Republic of China. Electronic address:

Purpose: To investigate the effect of 21-gene recurrence score (RS) on chemotherapy-decision making and prognosis in breast cancer patients aged <40 years.

Methods: Using the Surveillance, Epidemiology, and End Results program, we included patients aged <40 years with tumor size ≤5 cm, node negative, and estrogen receptor-positive breast cancer between 2004 and 2015. Correlations among the 21-gene RS, chemotherapy decision-making and prognosis were analyzed.

Results: We included 2721 patients in this study. According to TAILORx cutoffs, 352 (12.9%), 1814 (66.7%), and 555 (20.4%) patients were classified as low-, intermediate-, and high-risk cohorts, respectively. The 21-gene RS categories were associated with the probability of receiving chemotherapy, with 7.1%, 33.4%, and 77.1% of patients in low-, intermediate-, and high-risk cohorts treated with chemotherapy, respectively (P < 0.001). Those in the intermediate-risk cohort were significantly less likely to receive chemotherapy over time (P = 0.008), and the trends of chemotherapy receipt were stable in the low-risk and high-risk cohorts over time. Multivariate analysis showed that the 21-gene RS was an independent prognostic indicator for breast cancer specific survival. In the stratified analysis, the receipt of chemotherapy was associated with better breast cancer specific survival in the high-risk cohort (P = 0.028), but not in the intermediate-risk cohort (P = 0.223).

Conclusions: 21-gene RS has clinical implications for young breast cancer patients with respect to optimizing chemotherapy-decisions. Despite increasing rates of chemotherapy receipt in young patients, more studies are needed to determine the definitive effect of chemotherapy in young patients with three RS categories.
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http://dx.doi.org/10.1016/j.breast.2019.12.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375685PMC
February 2020

Impact of the 21-gene recurrence score assay on chemotherapy decision making and outcomes for breast cancer patients with four or more positive lymph nodes.

Ann Transl Med 2019 Sep;7(18):446

Department of Radiation Oncology, Cancer Hospital, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, China.

Background: To assess the impact of the 21-gene recurrence score (RS) on chemotherapy decision making and survival outcomes for breast cancer patients with >4 positive lymph nodes.

Methods: Patients with non-metastatic estrogen receptor-positive breast cancer with >4 positive lymph nodes diagnosed between 2004 and 2013 were identified using the Surveillance, Epidemiology, and End Results database. The relationships between the 21-gene RS value and survival outcomes, chemotherapy decision-making, and chemotherapy benefit were analyzed.

Results: A total of 410 patients were identified, including 191 (46.6%), 164 (40.0%), and 55 (13.4%) in the low-, intermediate-, and high-risk RS groups, respectively. The 21-gene RS assay results were independently related to chemotherapy receipt. A total of 59.0%, 68.0%, and 78.0% of patients received chemotherapy in the low-, intermediate-, and high-risk RS groups, respectively. The 21-gene RS was an independent indicator of breast cancer specific survival (BCSS) and overall survival (OS). Intermediate-risk [BCSS: hazards ratio (HR), 2.832, 95% confidence interval (CI): 1.160-6.910, P=0.022; OS: HR, 3.704, 95% CI: 1.750-7.836, P=0.001] and high-risk RS (BCSS: HR, 6.440, 95% CI: 2.597-15.974, P<0.001; OS: HR, 5.053, 95% CI: 2.199-11.608, P<0.001) cohorts had significantly lower survival outcomes compared to low-risk RS cohort. The 5-year BCSS were 92.7%, 88.3%, and 70.7% in patients in the low-, intermediate-, and high-risk RS cohorts, respectively (P<0.001), and the 5-year OS were 92.1%, 80.6%, and 66.6%, respectively (P<0.001).

Conclusions: The 21-gene RS is an independent predictor of chemotherapy receipt and survival outcomes for breast cancer patients with > 4 positive lymph nodes.
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http://dx.doi.org/10.21037/atm.2019.08.82DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6803245PMC
September 2019

Omission of adjuvant radiotherapy following breast-conserving surgery for elderly women with early-stage pure mucinous breast carcinoma.

Radiat Oncol 2019 Nov 4;14(1):190. Epub 2019 Nov 4.

Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, 510060, People's Republic of China.

Background: We aimed to ascertain population-based practice patterns and survival outcomes of postoperative radiotherapy following breast conserving-surgery (BCS) in elderly women (aged ≥65 years) with early-stage pure mucinous breast carcinoma (PMBC).

Methods: Patients aged ≥65 years diagnosed with T1-2N0 and hormone receptor-positive PMBC between 1990 and 2010 were identified from the Surveillance, Epidemiology, and End Results database. Binomial logistic regression, Kaplan-Meier method, Multivariate Cox proportional hazards models, and propensity score matching (PSM) were used for statistical analysis.

Results: We enrolled 3416 patients, including 1225 (35.9%) and 2191 (64.1%) in the no-radiotherapy and radiotherapy cohorts, respectively. The percentage of patients receiving postoperative radiotherapy following BCS was significantly lower after 2004 (59.5% between 2004 and 2010), relative to that before 2004 (71.1% between 1990 and 2003; P < 0.001). Before PSM, the 10-year breast cancer-specific survival (BCSS) rates were 98.1 and 93.2% for patients with and without postoperative radiotherapy (log-rank test, P < 0.001), respectively. In the PSM cohort, receiving postoperative radiotherapy was associated with better BCSS rates, with 10-year BCSS rates of 97.6 and 94.5% in patients with and without postoperative radiotherapy, respectively (log-rank test, P = 0.001). Multivariate Cox proportional analysis indicated that receiving postoperative radiotherapy was an independent factor associated with better BCSS before (P < 0.001) and after PSM (P = 0.001), relative to those not receiving postoperative radiotherapy.

Conclusions: This study shows a decreasing utilization of postoperative radiotherapy following BCS of elderly PMBC patients over time. However, postoperative radiotherapy following BCS should be administered for elderly women with PMBC owing to independent association with better survival.
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http://dx.doi.org/10.1186/s13014-019-1394-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829954PMC
November 2019

Lymph Node Status and Outcomes for Nasopharyngeal Carcinoma According to Histological Subtypes: A SEER Population-Based Retrospective Analysis.

Adv Ther 2019 11 26;36(11):3123-3133. Epub 2019 Sep 26.

Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, People's Republic of China.

Introduction: We aimed to investigate the clinical effect of histological subtypes on survival in nasopharyngeal carcinoma (NPC), and assess the effect of nodal stage on outcome according to histological subtypes.

Methods: Patients with non-metastatic NPC were identified from the Surveillance, Epidemiology and End-Results (SEER) database between 2004 and 2014. Statistical analysis was performed using the chi-squared test, Kaplan-Meier methods, and multivariate Cox regression models.

Results: We identified 2845 patients in this study including 1218 (42.8%), 849 (29.8%), and 778 (27.3%) patients with keratinizing squamous cell carcinoma (KSCC), differentiated non-keratinizing squamous cell carcinoma (DNKSCC), and undifferentiated non-keratinizing squamous cell carcinoma (UNKSCC), respectively. The multivariate analysis indicated that patients with UNKSCC subtype had better NPC-specific survival (NPC-SS) (P < 0.001) compared to KSCC (P < 0.001) and DNKSCC (P < 0.001) patients. The 5-year NPC-SS was 75.2%, 77.9%, and 88.9% in patients with KSCC, DNKSCC, UNKSCC, respectively (P < 0.001). Subgroup analysis showed that advanced nodal stage was related to lower NPC-SS in patients with DNKSCC and UNKSCC but not in patients with KSCC.

Conclusions: Histology is an independent prognostic factor in patients with NPC. However, advanced nodal stage is not associated with lower survival in KSCC.
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http://dx.doi.org/10.1007/s12325-019-01100-7DOI Listing
November 2019

The Effect of Post-mastectomy Radiotherapy in Patients With Metaplastic Breast Cancer: An Analysis of SEER Database.

Front Oncol 2019 12;9:747. Epub 2019 Aug 12.

Department of Radiation Oncology, Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China.

Metaplastic breast cancer (MBC) is a rare and aggressive form of breast cancer. The present study aimed to assess the effect of post-mastectomy radiotherapy (PMRT) in MBC patients with intermediate-risk (T1-2N1M0 and T3N0M0) and high-risk (T1-4N2-3M0 and T4N0-1M0) disease. The Surveillance, Epidemiology and End Results database was used to analyze patients with MBC between 2000 and 2014. Kaplan-Meier analysis, log-rank tests, and the multivariate Cox proportional model were used for statistical analysis. We identified 460 patients with a median follow-up time of 31 months (range, 2-178 months). Five-year breast cancer specific survival (BCSS) for all patients was 57.5%. In the entire group, multivariate analysis showed that PMRT was associated with better BCSS (hazard ratio (HR) 0.500, 95% confidence interval (CI) 0.366-0.683, < 0.001). The 5-year BCSS in PMRT and non-PMRT groups were 62.3 and 50.3%, respectively ( = 0.001). When stratified the patients into intermediate-risk and high-risk groups, PMRT could improve BCSS compared with that in non-PMRT patients in both the intermediate- and high-risk groups. For the intermediate-risk group, the 5-year BCSS was 74.3 and 64.7% in PMRT and non-PMRT groups ( = 0.042), respectively, and was 52.1 and 28.8% in high-risk patients treated with PMRT and non-PMRT, respectively ( < 0.001). PMRT could improve the BCSS of MBC patients with intermediate- and high-risk disease.
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http://dx.doi.org/10.3389/fonc.2019.00747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6705228PMC
August 2019

The 1-year mortality after radiotherapy for nasopharyngeal carcinoma: a population-based analysis.

Future Oncol 2019 Oct 14;15(29):3357-3365. Epub 2019 Aug 14.

Department of Radiation Oncology, Cancer Hospital, the First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen 361003, PR China.

To assess the incidence and predictors of nasopharyngeal carcinoma (NPC)-specific mortality in the first year among NPC patients. We identified 2714 patients in the SEER program. Of the patients, 151 (5.6%) patients who died as NPC-related disease within 1 year of diagnosis. Specifically, 67.5% of the NPC-related deaths were attributed to keratinizing tumors, while 67.6% were attributed to advanced T stage. Older age, keratinizing squamous tumors and stage T3-4 disease were independent predictors of 1-year NPC-related death. The 1-year mortality rate is low among NPC patients after radiotherapy. Older age, keratinizing tumor and advanced T stage are predictors of high-mortality risk within 1 year in NPC patients.
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http://dx.doi.org/10.2217/fon-2019-0371DOI Listing
October 2019

Progesterone receptor status and tumor grade predict the 21-gene recurrence score of invasive lobular breast cancer.

Biomark Med 2019 08 25;13(12):1005-1012. Epub 2019 Jun 25.

Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangdong, 510060, PR China.

To assess the association between established clinicopathological variables and the 21-gene recurrence score (RS) stratification of invasive lobular carcinoma (ILC) of the breast. We identified 9030 ILC patients from the Surveillance, Epidemiology and End Results database. Older age, higher grade tumor and progesterone receptor (PR)-negative disease were independent predictors of high-risk RS stratification. Among patients with PR-positive tumors, 3, 6 and 15% with well-differentiated (G1), moderately-differentiated (G2) and poorly and/or undifferentiated (G3) disease were in the high-risk cohort, respectively. In patients with PR-negative tumors: 16, 24 and 41% of patients with G1, G2 and G3 disease were in the high-risk cohort, respectively. The 21-gene RS testing may not be necessary for patients with PR+/G1-2 ILC.
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http://dx.doi.org/10.2217/bmm-2019-0209DOI Listing
August 2019