Risk factors of local recurrence following implant-based breast reconstruction in breast cancer patients

Background The number of patients desiring implant-based breast reconstruction has been increasing. While local recurrence is observed in patients with breast reconstruction, only a few reports have focused on the risk factors for local recurrence and the prognosis after developing local recurrence. Methods We analyzed 387 patients who underwent implant-based breast reconstruction during the period from 2004 to 2017 in Hiroshima City Hospital. We retrospectively examined the risk factors for local recurrence and the outcomes of patients developing such recurrence after implant-based breast reconstruction. Results The median follow-up time was 59 months. The local recurrence rate was 3.1% (n = 12). The most common reason for detecting local recurrence was a palpable mass. Four patients with local recurrence had recurrence involving the skin just above the primary lesion and needle biopsy tract. All patients with local recurrence received surgery and systemic therapy and most patients received radiation therapy, all have remained free of new recurrence to date. Multivariate analysis showed lymphatic vessel invasion (HR, 6.63; 95% CI, 1.40–31.36; p = 0.017) and positive or < 2 mm vertical margin (HR, 9.72; 95%CI, 1.23–77.13; p = 0.047) to be associated with significantly increased risk of local recurrence. Conclusions The risk factors for local recurrence following implant-based breast reconstruction were lymphatic vessel invasion and positive or < 2 mm vertical margin. Removal of the skin just above the primary lesion and needle biopsy tract and adjuvant radiation therapy might improve local outcomes. Patients with local recurrence following implant-based breast reconstruction appear to have good outcomes with appropriate treatment.

Recurrence in node-negative advanced gastric cancer with novel clinical and pathologic findings

Background Node-negative gastric cancer patients carry a better prognosis than node-positive. However, a subset of these patients eventually died due to the high recurrence rate of recurrence. This study investigated the clinic-pathologic factors for recurrent patterns and prognosis. Methods The detailed medical records of 947 gastric cancer patients who underwent gastrectomy from the prospectively collected database of the Gastrointestinal Surgery Department of the First Affiliated Hospital of Zhejiang Chinese Medical University From January 2012 to December 2014 were analyzed retrospectively. Results Tumor size, tumor invasion, histological grading were the predictive factors for locoregional recurrence. Tumor invasion, histological grading, Lauren type and lymphatic vessel invasion resulted significantly in predicting peritoneal recurrence. Two parameters, tumor invasion and lymphatic vessel invasion, were significantly associated with hematogenous spread. The combinatorial biomarker of positive for both Ki67 and P53 was significantly associated with recurrence-free survival (RFS) (P = 0.037). Histological grading (P = 0.020), tumor invasion (P = 0.007) and lymphatic vessel invasion (P = 0.012) were independent factors related to overall survival (OS) in node-negative advanced gastric cancer patients. Conclusion The reported clinicopathologic factors for different recurrence patterns and the prognostic factors of RFS and OS should be considered to guide clinicians choose appropriate postoperative treatment strategy and construct individual follow-up schedule to improve prognosis of node-negative gastric cancer.

Association between the degree of fibrosis in fibrotic focus and the unfavorable clinicopathological prognostic features of breast cancer

Objective To explore the association between the degree of fibrosis in fibrotic focus (FF) and the unfavorable clinicopathological prognostic features of breast cancer. Methods A total of 169 cases of breast invasive ductal carcinoma (IDC) were included in the study. Hematoxylin and eosin (H&E) staining was performed in the primary lesion of breast IDC and the degree of fibrosis in tumor-stromal FF was assessed. The association between the degree of fibrosis in FF and the well-known clinicopathologic features of breast cancer was investigated and the influence of the degree of fibrosis in FF on the survival was analyzed. Results Tumor size >2 cm (P = 0.023), vascular invasion (P = 0.011), lymphatic vessel invasion (P < 0.001) and HER-2+ (P = 0.032) were positively correlated with the degree of fibrosis in FF in breast IDC. The result of multivariate analysis showed that lymphatic vessel invasion was the only independent correlation factor of high fibrosis in FF in breast IDC (OR = 3.82, 95% CI[1.13 ∼ 12.82], P = 0.031). The Nottingham prognostic index (NPI) of high fibrosis in FF was significantly higher than that of mild and moderate fibrosis in FF in the no vascular infiltration subgroup, the no nerve infiltration subgroup, and the Luminal A subgroup (P = 0.014, 0.039, and 0.018; respectively). Conclusions The high fibrosis in FF is closely associated with the strong invasiveness and the high malignancy of breast IDC. The degree of fibrosis in FF might be considered as a very practical and meaningful pathological feature of breast cancer.