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Breast-conserving therapy and modified radical mastectomy for primary breast carcinoma:a matched comparative study

Chinese Journal of Cancer Research 2015年第6期27卷 545-552页

作者： Lize Wang Tao Ouyang Tianfeng Wang Yuntao Xie Zhaoqing Fan Benyao Lin Jinfeng Li Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Breast Cancer Center Peking University Cancer Hospital & Institute

Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with primary breast cancer treated with BCT or MRM in a single Chinese institute between January 2000 and February 2009 were analyzed retrospectively to compare their outcomes with respect to the incidence of local recurrence （LR）, distant metastasis, and survival. The patients were matched with regard to age at diagnosis, spreading to axillary lymph nodes, hormone receptor status, the use of neoadjuvant chemotherapy and maximal tumor diameter. The match ratio was 1：1, and each arm included 873 patients. Results： The median follow-up period was 71 months. The 6-year disease-free survival （DFS） and 6-year distant disease-free survival （DDFS） rates differed significantly between two groups. The 6-year local recurrence-free survival （LRFS） rates were 98.2% [95% confidence interval （CI）： 0.973-0.989] in the BCT group and 98.7% （95% CI： 0.980-0.994） in the MRM group （P=0.182）, respectively. DFS rates in BCT and MRM groups were 91.3% （95% CI： 0.894-0.932） and 86.3% （95% CI： 0.840-0.886）（P〈0.001）, respectively, whereas the DDFS rates in BCT and MRM groups were 93.6% （95% CI： 0.922-0.950） and 87.7% （95% CI： 0.854-0.900）（P〈0.001）, respectively. Conclusions： BCT in eligible patients is as effective as MRM with respect to local tumor control, DFS and DDFS, and may result in a better outcome than MRM in Chinese primary breast cancer patients.

关键词： Breast carcinoma breast-conserving therapy （BCT） mastectomy recurrence survival

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Comparison of breast-conserving surgery and mastectomy in early breast cancer using observational data revisited:a propensity score-matched analysis

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Science China(Life Sciences) 2018年第12期61卷 1528-1536页

作者： Kai Chen Zihao Pan Liling Zhu Tingting Hu Min Peng Weijuan Jia Fengxi Su Shunrong Li Erwei Song Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China Breast Tumor Center Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China Department of Thoracic-Cardiac Surgery Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhou 510120China Fountain-Valley Institute for Life Sciences Guangzhou Institute of Biomedicine and HealthChinese Academy of SciencesGuangzhou 510530China

Recent observational studies showed that breast-conserving surgery(BCS) resulted in superior survival compared to mastectomy in breast cancer patients. This study compared the clinical outcomes of BCS and mastectomy using propensity score(PS)matching analysis, which had advantages over conventional methods in reducing bias. Nonmetastatic breast cancer patients who underwent BCS and mastectomy were matched 1:1 based on their PS. We used the Kaplan-Meier method and Cox-regression model to estimate the treatment effects. A total of 2,866 patients with a median follow-up time of 67 months were included in the original study population. Although the mastectomy cohort(N=1,219) had more advanced disease compared to the BCS cohort(N=1,647), LRFS was similar between the two groups(93.8% vs. 92.4%, P>0.05). BCS(vs. mastectomy) was associated with improved DFS(73.8% vs. 58.7%, Pmastectomy) was not associated with improved DFS(70.7% vs. 66.9%, P>0.05) or CSS(87.5% vs. 84.9%, P>0.05). We found that PS methods reduce bias when estimating treatment effects using observational data. BCS and mastectomy show equivalent outcomes in nonmetastatic breast cancer patients.

关键词： breast-conserving surgery mastectomy breast cancer propensity score survival

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Clinical practice guidelines for post-mastectomy breast reconstruction: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021

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Chinese Medical Journal 2021年第19期134卷 2272-2274页

作者： Yan-Shuang Li Jun-Xian Du Hong-Chuan Jiang Wei Zhu Chinese Society of Breast Surgery Department of Breast Surgery Beijing Chaoyang HospitalCapital Medical UniversityBeijing 100020China Department of General Surgery Zhongshan HospitalFudan UniversityShanghai 200032China 不详

To promote the standardization of post-mastectomy breast reconstruction in China,the Chinese Society of Breast Surgery(CSBrS)determined the key issues in post-mastectomy breast reconstruction in clinical practice through a literature review and expert discussions,and then developed the CSBrS Clinical Practice Guidelines for Post-mastectomy Breast Reconstruction(2021 version)by systematically assessing relevant published evidence according to the Grading of Recommendations Assessment,Development,and Evaluation recommendations and based on the accessibility of clinical practice in China.This guideline provides a reference for Chinese breast surgeons.

关键词： Surgery Breast mastectomy

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Clinical practice guidelines for modified radical mastectomy of breast cancer: Chinese Society of Breast Surgery (CSBrs) practice guidelines 2021

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Chinese Medical Journal 2021年第8期134卷 895-897页

作者： De-Chuang Jiao Jiu-Jun Zhu Li Qin Xu-Hui Guo Ya-Jie Zhao Xiu-Chun Chen Cheng-Zheng Wang Zhen-Duo Lu Lian-Fang Li Shu-De Cui Zhen-Zhen Liu Department of Breast Disease Henan Breast Cancer CenterAffiliated Cancer Hospital of Zhengzhou University&Henan Cancer HospitalZhengzhouHenan 450003China.

The proportion of patients with early-stage breast cancer undergoing mastectomy exceeds 70%in China/11 among which Auchincloss operation is the major surgical technique for patients with axillary lymph node positive breast cancer.In order to standardize the clinical application of modified radical mastectomy of breast cancer,Chinese Society of Breast Surgery(CSBrS)organized domestic experts to conduct literature retrieval and expert discussion on the theoretical basis and technical details of modified radical mastectomy for breast cancer.With reference to the grading of recommendations assessment,development,and evaluation system。

关键词： Surgery mastectomy breast

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Hypereosinophilia, mastectomy, and nephrotic syndrome in a male patient: A case report

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World Journal of Clinical Cases 2019年第19期7卷 3145-3152页

作者： Jian Wu Peng Li Yu Chen Xiang-Hong Yang Meng-Yun Lei Li Zhao Department of Anesthesiology Shengjing HospitalChina Medical UniversityShenyang 110004Liaoning ProvinceChina Department of Respiratory Medicine Shengjing HospitalChina Medical UniversityShenyang 110004Liaoning ProvinceChina Department of Pathology Shengjing HospitalChina Medical UniversityShenyang 110004Liaoning ProvinceChina Department of Endocriology Shengjing HospitalChina Medical UniversityShenyang 110004Liaoning ProvinceChina

BACKGROUND Hypereosinophilia(HE)is a heterogeneous disease of unknown etiology in which tissue and organ injury is inflicted by excess numbers of circulating or infiltrating eosinophils.Herein,we describe a patient with rare organ damage due to HE and review the pertinent literature.CASE SUMMARY A 43 year-old Chinese man with a 13-year history of eosinophilia and shortness of breath for 7 d presented to our hospital.During the course of his illness,the patient variably presented with gastrointestinal symptoms,eczema,vitiligo,mastitis,joint symptoms,nephrotic syndrome,and interstitial pneumonia.The chronic mastitis proved burdensome,necessitating bilateral mastectomy.HE was diagnosed by repeat bone marrow biopsy,and a kidney biopsy showed focal segmental glomerulosclerosis.Intermittent steroidal therapy is typically initiated to relieve such symptoms,although relapse and organ involvement often ensue once treatment is withdrawn.We administered methylprednisolone sodium succinate(40 mg/d)intravenously for 3 d,followed by oral tablets at the same dose.Subsequent computed tomography(CT)of the chest CT showed relative improvement of the interstitial pneumonia.The patient is currently on a continuous regimen of oral steroid,and his condition is stable.CONCLUSION HE is heterogeneous condition.This is the first reported case of bilateral mastectomy in a male patient with longstanding HE.

关键词： Hypereosinophilia mastectomy Nephrotic syndrome Interstitial pneumonia Case report

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Multi-center investigation of breast reconstruction after mastectomy from Chinese Society of Breast Surgery:A survey based on 31 tertiary hospitals(CSBrS-004)

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Chinese Journal of Cancer Research 2021年第1期33卷 33-41页

作者： Feng Xu Chuqi Lei Heng Cao Jun Liu Jie Li Hongchuan Jiang Chinese Society of Breast Surgery Department of Breast Surgery Beijing Chao-Yang HospitalCapital Medical UniversityBeijing 100020China 不详

Objective:Multi-center data on the current status and trends of breast reconstruction after mastectomy in China are lacking.Herein,we conducted a cross-sectional survey to investigate the current clinical practice pattern of postmastectomy breast reconstruction among Chinese female patients with breast cancer.Methods:A standardized questionnaire used to collect information on breast reconstruction among females diagnosed with breast cancer was distributed by 31 members of the Chinese Society of Breast Surgery between January 1,2018 and December 31,2018.Information was collected on tumor characteristics,treatment,mesh application,nipple-areola complex(NAC)preservation,postoperative complications,bilateral reconstruction,patient satisfaction and local recurrence.The overall rate of breast reconstruction was assessed,and the characteristics were compared across patient groups with different reconstruction approaches.Results:A total of 1,554 patients underwent breast reconstruction after total mastectomy,with a reconstruction rate of 9.6%.Among them,1,190 were implant-based,and 262 underwent autologous reconstructions,while 102 cases underwent a combination of both.Patients who underwent implant-based reconstruction were younger than those who received autologous reconstruction(40.1±4.6 vs.45.0±5.9,P=0.004).Compared to patients with autologous reconstruction,mesh application(25.5%vs.6.5%),NAC preservation(51.8%vs.40.5%)and reconstruction failure(1.8%vs.0)were more frequently reported among those with implant-based reconstruction.There was no significant difference in general satisfaction across three reconstruction approaches,though patients with autologous reconstruction reported the highest aesthetic satisfaction among the three groups(P=0.044).Conclusions:Implant-based breast reconstruction remains the dominant choice among patients,while autologous reconstruction was associated with higher aesthetic satisfaction.Our multi-center investigation based on the findings of the tertiary hospitals of Chinese Society of B

关键词： Breast cancer mastectomy breast reconstruction questionnaire survey patient satisfaction

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Therapeutic Approaches to Post-mastectomy Pain Syndrome

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Journal of Biosciences and Medicines 2023年第12期11卷 304-317页

作者： Vanessa Ferreira Dias Duarte Da Costa Giovanna Schwarz Mazzucca Carlos Augusto Pires Zerbini Oscar César Pires Camila Dos Santos Leite Laboratory of Pharmacology and Physiology Department of Medicine Taubaté University Taubaté Brazil

Background: Breast cancer is increasingly common in society and post-mastectomy pain is a striking condition associated with surgery, both intra and postoperatively. The post-mastectomy syndrome is characterized by the persistence of pain for more than 3 months after the procedure. It is mostly of neuropathic origin and is highly refractory to treatments, which vary from clinical to surgical measures and alternative techniques. In this context, it is essential to understand the possible approaches to these patients. Objective: Understand alternatives for pain management in patients undergoing mastectomy, especially in those in whom pain persists for more than 3 months. Methods: Systematic literature review, conducted in the Virtual Health Library databases includes: Lilacs, SciELO, Medline, PubMed and Cochrane between 2018 and 2023, restricted to articles in English with the descriptors: mastectomy, chronic Pain, Nerve Blocks and Breast Cancer. 317 articles were found involving the descriptors presented, all in English. After reading the abstracts, 28 articles were selected. Results: This review analyzed 28 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects: author/year of publication, article title, objective, type of study and database. Conclusion: It was concluded that, according to the analyzed studies, post-mastectomy pain is a problem that has increased its incidence and that needs the attention of health professionals. The use of antineuropathic medications, nerve blocks, fat grafting, lymph node transplantation, therapy, physical activity and acupuncture are some examples of therapeutic approaches for these women. Therefore, the team must assist the patients, seeking to provide a better prognosis, quality of life and comfort.

关键词： mastectomy Chronic Pain Nerve Blocks Breast Cancer

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Breast Cancer Treatment (mastectomy Experiences) May Initiate Individuation Process That Redefines Identities: A Systematic Review

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Health 2023年第11期15卷 1277-1297页

作者： Motlalepule Lekeka University of KwaZulu-Natal Pietermaritzburg South Africa Discipline of Psychology School of Applied Human Sciences University of KwaZulu-Natal Pietermaritzburg South Africa

This systematic literature review examines the impact of breast cancer treatment experiences, with a focus on mastectomy, on the psychosocial well-being of women. While previous studies have shown that mastectomy is associated with negative psychological outcomes such as anxiety, depression, and a loss of femininity, a new body of literature suggests that it can also be a catalyst for post-traumatic growth and personal transformation. The article argues that mastectomy experiences can initiate an individuation process that leads to a more empowered sense of self and a higher quality of life. The review identified 25 studies that employed qualitative methods and analyzed data from interviews, focus groups, and surveys. The article discusses the application of Jung’s individuation theory to categorize the experiences of women with breast cancer and links breast cancer diagnosis and treatment to the death-experience stage of the theory. The content highlights the importance of movement, contemplation, and spirituality in the healing process, and how they can help women connect with their bodies and develop a new sense of identity. Additionally, the content discusses the role of spirituality in enhancing growth and healing among indigenous native women patients with breast cancer. Overall, this article provides insights into how breast cancer treatment experiences can shape women’s identity, enhance resilience, and provide opportunities for personal growth and transformation.

关键词： Breast Cancer mastectomy Psychosocial Well-Being Post-Traumatic Growth Individuation Indigenous Native Women

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Patients with Shoulder Dysfunction After mastectomy Can Benefit from Nurse-Assisted Home-Based Range of Motion Exercises

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Journal of Clinical and Nursing Research 2022年第6期6卷 37-41页

作者： Waqas Ahmed Farjad Afzal Department of Allied Health Sciences University of SargodhaSargodha 40100PunjabPakistan

Background:Shoulder dysfunction is very common after mastectomy,and there is also less follow-up for physiotherapy services among patients with mastectomy.Objective:A study was conducted to determine the role of nurse-assisted home-based range of motion(ROM)exercises in patients with shoulder dysfunction after mastectomy.Methods:A pre-and post-interventional study design was used to collect data from 30 post-mastectomy patients.The subjects were selected on a voluntary basis.Informed consent was obtained from post-mastectomy patients who were discharged from different oncology hospitals in Pakistan prior to their inclusion in this study.After obtaining a baseline measurement,the patients were supervised with nurse-assisted ROM exercises at home.The nurse-assisted home-based ROM exercise program was designed for such patients,and the patients were followed-up for up to 1 month.The total duration of the study was 1 year from August 2015 to August 2016.Post-intervention measurement was performed at the patients’home.The difference in terms of pain reduction and ROM improvement at the shoulder joint was recorded using goniometric measurements and the 100 mm visual analogue scale(VAS).Results:The mean age of the 30 subjects was 39.83±5.89.The mean ROM of shoulder flexion before the exercise program was 106.03°,which improved to 133.93°after 1 month of the exercise program.The mean ROM of shoulder abduction before treatment was 94.83°,which improved to 127.13°after 1 month of supervised exercise program.The mean ROM of shoulder rotation before the exercise program was 127.53°,which improved to 152.03°after 1 month of the exercise program.Conclusion:The nurse-assisted home-based shoulder ROM exercise program is effective in terms of improving the range of motion and reducing pain at the shoulder joint in post-mastectomy patients.

关键词： mastectomy Shoulder Dysfunction Adhesive capsulitis ROM Exercises

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mastectomy Blood Loss: Can We Predict the Need for Blood Transfusion?

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International Journal of Clinical Medicine 2014年第20期5卷 1294-1299页

作者： Joe Nat Clegg-Lamptey Jonathan C. B. Dakubo Department of Surgery School of Medicine and Dentistry Accra Ghana

Background: Bleeding during total mastectomy and axillary clearance is inevitable, and blood transfusion is often required when bleeding is excessive. Objectives: To predict the probability of transfusion, we tested the hypothesis: “The blood loss during total mastectomy and axillary clearance in Accra is related to the stage of the disease and the size of the breast”. Design: Patients undergoing total mastectomy and axillary clearance were prospectively studied from June 2008 to June 2011. The breast and used swabs were weighed immediately after surgery, and patients’ full blood count was checked before and after surgery. Setting: Surgical wards and theatres of the Korle Bu Teaching Hospital, Accra. Results: There were 80 women, aged 31 to 85 (Mean 50, SD 3.4) years, with body mass index between 20 and 46 (mean 23.7, median 28). Fifty one (63.8%) had Stage 3 disease, and 47 (58.8%) required neoadjuvant chemotherapy. Pre-operative haemoglobin was 9.5 g/dl to 14.9g/dl (mean 11.6 g/dl, SD 1.1). Post-operative haemoglobin was 9.2 g/dl - 13.4 g/dl (mean 10.9, SD 0.97). The mean drop in haemoglobin level was 0.75 g/dl. None of the 80 patients received blood transfusion. There was a linear increase in breast weight with increasing BMI. Blood loss ranged from 95 g to 1185 g, with majority (59;73.8%) losing between 100 and 400 gram blood. Only 2 patients (2.5%) lost more than 1000 g of blood. Less than 400 g of blood was lost with breast weights below 2 kg. Above that, blood loss increased to more significant volumes. Conclusions: Blood loss during total mastectomy and axillary clearance in Accra was directly related to the size of the breast. There was, however, inconclusive association between tumour stage and blood loss.

关键词： Total mastectomy and Axillary Clearance Bleeding Haemorrhage Blood Transfusion

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