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Carcinosarcoma of the breast:Facing the challenge of a rare nosologic entity

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World Journal of Clinical Cases 2025年第2期13卷 14-20页

作者： Aikaterini Mastoraki Maria Tsamopoulou Foivos-Konstantinos Stamatis Alexios Strimpakos Ero Mouchtouri Christiana Panagi Evgenia Mela Sotiria Mastoraki Aristotelis Kechagias Dimitrios Schizas department of Surgery National and Kapodistrian University of AthensLaikon General HospitalAthens 11527Greece department of Surgery National and Kapodistrian University of AthensAthens 11527Greece department of Medical oncology Hygeia HospitalAthens 15123Greece department of Radiology Henry Dunant Hospital CenterAthens 11526Greece department of Surgery Athens Metropolitan HospitalAthens 15562Greece

Carcinosarcoma(CS),also known as metaplastic breast carcinoma with mesenchymal differentiation,is one of the five distinct subtypes of metaplastic breast *** is considered as a mixed,biphasic neoplasm consisting of a carcinomatous component combined with a malignant nonepithelial element of mesenchymal origin without an intermediate transition *** cellular origin of this neoplasm remains controversial,most researchers declare that neoplastic cells derive from a cellular structure with potential biphasic *** recent research on the therapeutic strategies against CS neoplastic disorders,surgical resection appears the only potentially curative *** CS metastasize by the lymphatic route,axillary assessment with sentinel lymph node biopsy and/or axillary lymph node dissection is always ***,the tumor also presents a hematogenous metastatic pattern including pleural,pulmonary,liver,brain and less commonly bone ***,surgical removal of breast CS does not necessarily ensure patient’s long-term ***,alternative therapies,such as radio-and chemotherapy proved insufficient and 5-year survival rate is ***,there is evidence that following surgery,the combination of radio and chemotherapy is associated with a better prognosis than either treatment *** aim of this review is to evaluate the results of surgical treatment for breast CS with special reference to the extent of its histological *** features,histogenesis,morphological and immunochemical findings are discussed,while the role of current diagnostic and therapeutic management of this aggressive neoplasm is emphasized.

关键词： Carcinosarcoma Breast Diagnostic approach Therapeutic management Prognostic parameters

Prognostic impact of inflammatory and nutritional biomarkers in pancreatic cancer

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World Journal of Clinical oncology 2025年第1期16卷 5-9页

作者： Macarena Teja María I Garrido Abrahams Ocanto Felipe Counago department of Radiation oncology GenesisCare-San Francisco de Asís University HospitalMadrid 28002Spain department of Radiation oncology GenesisCare-Vithas La Milagrosa University HospitalMadrid 28010Spain National Director GenesisCare SpainMadrid 28043Spain department of Medicine School of MedicineHealth and SportEuropean University of MadridMadrid 28670Spain

Pancreatic cancer is usually associated with a poor *** is the main curative treatment but pancreatic operations are aggressive and new tools that help clinicians to predict surgical and prognostic outcomes are *** et al recently published a retrospective,single centre cohort study evaluating the impact of seven nutritional and inflammatory markers in pancreatic cancer surgical patients:The albumin-to-globulin ratio,prognostic nutritional index(PNI),systemic immune-inflammation index(SII),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),nutritional risk index,and the geriatric nutritional risk index.A significant correlation was found between the PNI,SII,NLR,and PLR and a hospital discharge of less than 15 *** a univariable analysis,PNI,SII,NLR and PLR were significantly related to recurrence-free survival and,in a multivariable analysis PNI was associated with overall *** meta-analyses corroborate the results in terms of prognosis but individual studies are discordant on their ***,the cut-off values for these markers vary significantly between studies and there are no clinical trials comparing them to identify the most relevant *** are limitations when implementing nutritional and inflammatory biomarkers into clinical practice and further studies are needed in order to answer these questions.

关键词： Inflammatory biomarkers Nutritional biomarkers Pancreatic cancer Prognosis surgical complications

Minimally invasive surgical approach to pancreatic malignancies

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World Journal of Gastrointestinal oncology 2015年第12期7卷 411-421页

作者： Lapo Bencini Mario Annecchiarico Marco Farsi Ilenia Bartolini Vita Mirasolo Francesco Guerra Andrea Coratti department of oncology Division of Surgical Oncology and Robotics Careggi University Hospital

Pancreatic surgery for malignancy is recognized as challenging for the surgeons and risky for the patientsdue to consistent perioperative morbidity and mortality. Furthermore, the oncological long-term results are largely disappointing, even for those patients who experience an uneventfully hospital stay. Nevertheless, surgery still remains the cornerstone of a multidisciplinary treatment for pancreatic cancer. In order to maximize the benefits of surgery, the advent of both laparoscopy and robotics has led many surgeons to treat pancreatic cancers with these new methodologies. The reduction of postoperative complications, length of hospital stay and pain, together with a shorter interval between surgery and the beginning of adjuvant chemotherapy, represent the potential advantages over conventional surgery. Lastly, a better cosmetic result, although not crucial in any cancerous patient, could also play a role by improving overall well-being and patient self-perception. The laparoscopic approach to pancreatic surgery is, however, difficult in inexperienced hands and requires a dedicated training in both advanced laparoscopy and pancreatic surgery. The recent large diffusion of the da Vinci® robotic platform seems to facilitate many of the technical maneuvers, such as anastomotic biliary and pancreatic reconstructions, accurate lymphadenectomy, and vascular sutures. The two main pancreatic operations, distal pancreatectomy and pancreaticoduodenectomy, are approachable by a minimally invasive path, but more limited interventions such as enucleation are also feasible. Nevertheless, a word of caution should be taken into account when considering the increasing costs of these newest technologies because the main concerns regarding these are the maintenance of all oncological standards and the lack of long-term follow-up. The purpose of this review is to examine the evidence for the use of minimally invasive surgery in pancreatic cancer(and less aggressive tumors), w

关键词： Pancreatic cancer Pancreatic adenocarcinoma Neuroe

Vascular Endothelial Growth Factor Expression in Invasive Ductal Carcinoma of Breast

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Chinese Journal of Cancer Research 2007年第1期19卷 56-59页

作者：徐卫国王刚邹玉环宋纪宁杨小青王文雅 department of surgical oncology the Affiliated Hospital department of oncology the Affiliated Kailuan Hospital department of Pathology North China Coal Medical University

Objective： To detect the expression of VEGF and MVD count in invasive ductal carcinoma of breast to clarify the association of VEGF expression and MVD count with the clinicopathologic features. Methods： The expressions of VEGF, ER, PR, C-erbB-2 and MVD count in 88 cases of invasive ductal carcinoma of breast were examined by immunohistochemistry staining （SP-method）. Results： Sixty-two out of the eighty-eight specimens of breast carcinoma （70.45%） showed positive expression of VEGF. The positive rate of VEGF in cases with lymph node metastasis was higher than that without lymph node metastasis （P〈0.05）. The positive rate of VEGF in stage IIb-Ⅲ was higher than that in stage Ⅰ-Ⅱa （P〈0.05）. The positive rate of VEGF in C-erbB-2 positive group was higher than that in C-erbB-2 negative group （P〈0.05）. Higher expression of VEGF was observed in cases with higher tissue differentiation degree （P〈0.05）. Also, significant higher MVD count was observed in cases with higher tissue differentiation degree （P〈0.01）. The MVD count increased significantly with the increase of the expression of VEGF （P〈0.01）. Conclusion： The result of this study suggested that in invasive ductal carcinoma of breast, angiogenesis and metastasis were mediated mainly by VEGF. The expression of VEGF and MVD might be reference predictors for the biological behavior of breast carcinoma. The antiangiogenic therapy which used VEGF as a target would become a new method to treat patients who were C-erbB-2 positive in the future.

关键词： Invasive ductal carcinoma of breast VEGF MVD

Corticosteroid-free immunosuppression in liver transplantation: An evidence-based review

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World Journal of Gastroenterology 2014年第31期20卷 10703-10714页

作者： George Sgourakis Georgia Dedemadi 2~(nd) surgical department and surgical oncology Unit "Korgialenio-Benakio" Red Cross Hospital surgical department of "Amalia Fleming" General hospital

Thirty-six randomized controlled trials and two metaanalyses were reviewed. With respect to adult patients undergoing first orthotopic liver transplantation(OLT), steroid replacement resulted in fewer cases of overall acute rejection in the corticosteroid free-immunosuppression arm. Initial steroid administration for two weeks and early tacrolimus monotherapy is a feasible immunosuppression regimen without steroid replacement, although further investigations are needed in view of chronic rejections. No significant differences were noted between the treatment groups in terms of patient and graft survival independently of steroid replacement. Renal insufficiency, de novo hypertension, neurological disorders and infectious complications did not differ significantly among steroid and steroidfree groups. Diabetes mellitus, cholesterol levels and cytomegalovirus infection are more frequent in patients within the steroid group. With respect to diabetes mellitus and hypercholesterolemia, the difference was independent of steroid replacement. In relation to transplanted hepatitis C virus patients, mycophenolate mofetil does not appear to have a significant antiviral effect despite early reports. Male gender of donors and recipients, living donors, cold ischemia times, acute rejection, and early histological recurrence were related to the development of advanced hepatitis. There is sufficient scientific clinical evidence advocating avoidance of the ab initio use of steroids in OLT.

关键词： Meta-analysis Evidence based Hepatitis C virus recurrence Liver transplantation Steroid withdrawal Orthotopic liver transplantation

Identification of optimal contemporary antiemetic prophylaxis for doxorubicin-cyclophosphamide chemotherapy in Chinese cancer patients: post-hoc analysis of 3 prospective studies

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Cancer Biology & Medicine 2021年第3期18卷 825-832页

作者： Winnie Yeo Leung Li Thomas KH Lau Kwai T Lai Vicky,TC Chan Kwan H Wong Christopher CH Yip Elizabeth Pang Maggie Cheung Vivian Chan Carol CH Kwok Joyce JS Suen Frankie KF Mo department of Clinical oncology Prince of Wales HospitalFaculty of MedicineHong Kong Cancer InstituteHong KongChina State Key Laboratory of Translational oncology The Chinese University of Hong KongHong KongChina department of Clinical oncology Princess Margaret HospitalHong KongChina

Objective:Chemotherapy-induced nausea and vomiting(CINV)are common with doxorubicin-cyclophosphamide(AC)*** antiemetic regimens incorporate neurokinin-1 receptor antagonist(NK1 RA),5-hydroxytryptamine type-3 receptor antagonist(5 HT3 RA),corticosteroid,and dopamine *** post-hoc analysis compared results of 3 prospective antiemetic studies conducted among Chinese breast cancer patients who received(neo)adjuvant AC,in order to identify optimal antiemetic ***:A total of 304 patients were included:Group 1,ondansetron/dexamethasone(D1);Group 2,aprepitant/ondansetron/dexamethasone(D1);Group 3,aprepitant/ondansetron/dexamethasone(D1–3);Group 4,aprepitant/ondansetron/dexamethasone(D1–3)/olanzapine;and Group 5,netupitant/palonosetron/dexamethasone(D1–3).Antiemetic efficacies of Groups 3,4,and 5 during cycle 1 of AC were individually compared with Group *** addition,emesis outcomes of patients in Groups 3 and 5,and those of Groups 2 and 3,were ***:When comparing efficacies of a historical doublet(5 HT3 RA/dexamethasone)with triplet antiemetic regimens(NK1 RA/5 HT3 RA/dexamethasone)with/without olanzapine,complete response(CR)percentages and quality of life(QOL)in overall phase of cycle 1 AC were compared between Group 1 and the other groups:Group 1 vs.3,41.9%vs.38.3%(P=0.6849);Group 1 vs.4,41.9%vs.65.0%(P=0.0107);and Group 1 vs.5,41.9%vs.60.0%(P=0.0460).Groups 4 and 5 achieved a better *** comparing netupitant-based(Group 3)with aprepitant-based(Group 5)triplet antiemetics,CR percentages were 38.3%vs.60.0%,respectively(P=0.0176);Group 5 achieved a better *** comparing 1 day(Group 2)vs.3 day(Group 3)dexamethasone,CR percentages were 46.8%and 38.3%,respectively(P=0.3459);Group 3 had a worse ***:Aprepitant-containing triplets were non-superior to doublet ***-containing triplets and adding olanzapine to aprepitant-containing triplets were superior to ***/palono

关键词： Netupitant palonosetron aprepitant olanzapine NEPA Asians

Laparoscopic approach to gastrointestinal malignancies: Toward the future with caution

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World Journal of Gastroenterology 2014年第7期20卷 1777-1789页

作者： Lapo Bencini Marco Bernini Marco Farsi Division of surgical oncology Department of OncologyCareggi University Hospital50134 FlorenceItaly

After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts,some surgeons started to treat malignancies by the same ***,if the limits of laparoscopy for benign diseases are mainly represented by technical issues,oncologic outcomes remain the foundation of any procedures to cure *** patients represent an important group with peculiar aspects including reduced survival expectancy,worsened quality of life due to surgery itself and adjuvant therapies,and challenging psychological *** these issues could,potentially,receive a better management with a laparoscopic surgical *** order to confirm such aspects,similarly to testing the newest weapons(surgical or pharmacologic)against cancer,long-term follow-up is always recommendable to assess the real benefits in terms of overall survival,cancer-free survival and quality of ***,it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive ***,laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences,as compared to those achieved for inflammatory bowel diseases,gastroesophageal reflux disease or diverticular *** review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.

关键词： Gastrointestinal cancer Laparoscopic oncology Laparoscopic surgery Robotic surgery surgical outcomes Oncologic outcomes

Neoadjuvant chemotherapy for gastric cancer. Is it a must or a fake?

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World Journal of Gastroenterology 2018年第2期24卷 274-289页

作者： Rossella Reddavid Silvia Sofia Paolo Chiaro Fabio Colli Renza Trapani Laura Esposito Mario Solej Maurizio Degiuli surgical oncology and Digestive Surgery Department of Oncology University of Turin San Luigi University Hospital department of surgical Sciences Digestive and Oncological Surgery University of Turin Molinette Hospital

AIM To investigate the neoadjuvant chemotherapy(NAC) effect on the survival of patients with proper stomach cancer submitted to D2 *** We proceeded to a review of the literature with Pub Med, Embase, ASCO and ESMO meeting abstracts as well as computerized use of the Cochrane Library for randomized controlled trials(RCTs) comparing NAC followed by surgery(NAC + S) with surgery alone(SA) for gastric cancer(GC). The primary outcome was the overall survival rate. Secondary outcomes were the site of the primary tumor, extension of node dissection according to Japanese Gastric Cancer Association(JGCA) performed in both arms, disease-specific(DSS) and disease-free survival(DFS) rates, clinical and pathological response rates and resectability rates after perioperative treatment. RESULTS We identified a total of 16 randomized controlled trials comparing NAC + S(n = 1089) with SA(n = 973) published in the period from January 1993-March 2017. Only 6 of these studies were well-designed, structured trials in which the type of lymph node(LN) dissection performed or at least suggested in the trial protocol was reported. Two out of three of the RCTs with D2 lymphadenectomy performed in almost all cases failed to show survival benefit in the NAC arm. Inthe third RCT, the survival rate was not even reported, and the primary end points were the clinical outcomes of surgery with and without NAC. In the remaining three RCTs, D2 lymph node dissection was performed in less than 50% of cases or only recommended in the "Study Treatment" protocol without any description in the results of the procedure really perfomed. In one of the two studies, the benefit of NAC was evident only for esophagogastric junction(EGJ) cancers. In the second study, there was no overall survival benefit of NAC. In the last trial, which documented a survival benefit for the NAC arm, the chemotherapy effect was mostly evident for EGJ cancer, and more than one-fourth of patients did not have a proper

关键词： gastric cancer neoadjuvant chemotherapy perioperative chemotherapy D2 lymphadenectomy randomized control trial

Metastatic suppressor genes inactivated by aberrant methylation in gastric cancer

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World Journal of Gastroenterology 2007年第43期13卷 5692-5698页

作者： Jian-Feng Wang Dong-Qiu Dai department of surgical oncology the FirstAffiliated Hospital China Medical University Dalian UniversityAffiliated Xinhua Hospital Shenyang 110001 Liaoning ProvinceChina department of surgical oncology the FirstAffiliated Hospital China Medical University Shenyang 110001Liaoning Province China

AIM: To screen out the differentially methylated DNA sequences between gastric primary tumor and metastatic lymph nodes, test the methylation difference of gene PTPRG between primary gastric tumor and metastatic lymph nodes, and test the regulatory function of 5-aza- 2-deoxycytidine which is an agent with suppression on methylation and the level of methylation in gastric cancer cell line. METHODS: Methylated DNA sequences in genome were enriched with methylated CpG islands amplification (MCA) to undergo representational difference analysis (RDA), with MCA production of metastatic lymph nodes as tester and that of primary tumor as driver. The obtained differentially methylated fragments were cloned and sequenced to acquire the base sequence, which was analyzed with bioinformatics. With methylation-specific PCR (MSP) and RT-PCR, methylation difference of gene PTPRG was detected between primary tumor and metastatic lymph nodes in 36 cases of gastric cancer. Methylation of gene PTPRG and its regulated expression were observed in gastric cancer cell line before and after being treated with methylation-suppressive agent. RESULTS: Nineteen differentially methylated sequences were obtained and located at 5' end, exons, introns and 3' end, in which KL59 was observed to be located at 9p21 as the first exon of gene p16 and KL22 to be located at promoter region of PRPRG . KL22, as the probes, was hybridized with driver, tester and 3-round RDA products respectively with all positive signals except with the driver. Significant difference was observed in both methylation rate of gene PTPRG and PTPRG mRNA expression rate between primary tumor and metastatic lymph nodes. Demethylation of gene PTPRG, with recovered expression of PTPRG mRNA, was observed after gastric cancer cell line being treated with methylation-suppressive agent. CONCLUSION: Difference exists in DNA methylation between primary tumor and metastatic lymph nodes of gastric cancer, with MCA-RDA as one of the good anal

关键词： Gastric cancer Methylated CpG islandsamplification Representational difference analysis DNA methylation gene PTPRG