Impact of the 21-Gene Recurrence Score Assay in adjuvant chemotherapy selection for node-negative, hormone receptor-positive breast cancer in the Chinese population

The 21-Gene Recurrence Score Assay has been intensively studied and recommended by major guidelines for treatment decision in early breast cancer. Its impact in adjuvant chemotherapy selection for Chinese population has not been revealed.The prospective part of this study enrolled consecutive node-negative, hormone receptor-positive patients who underwent 21-gene RS testing at Breast Surgery Department of PUMCH (n=134) between May 2012 and August 2013(21-gene RS group). Risk categories were assigned based on the RS and on standard clinicopathologic criteria according to St. Gallen and Adjuvant! Online. The chemotherapy selection and the oncologists' confidence in decision-making before and after RS testing were recorded. The retrospective part of this study compared the chemotherapy decision in the 21-gene RS group and a control group without RS testing (diagnosed between Jan 2011 and Apr 2012,n=170). A total of 304 patients were included in the analysis (134 21-gene RS group, 170 controls). Based on RS, 97 patients were classified as low risk, 29 patients as intermediate risk, and 8 patients as high risk. Tumor grade (P=0.002), PR expression (P<0.001) and Ki-67 index (P<0.001) were significantly different between the 3 risk cohorts.Comparing the St. Gallen guidelines and RS, there was a 41% concordance between risk groups. By using Adjuvant! Online, the correlation between the predicted BCSM and RS was nominal (r=0.10). A total of 29% 21-gene RS group patients changed their treatment decisions after RS testing (P<0.001, 95% CI, 0.18 to 0.49) with 6% (8/134) patients changing to receive chemotherapy besides endocrine therapy and 23% (31/134) changing to reject chemotherapy. After RS testing, more than one half of the oncologists increased their confidence level in treatment recommendation. In the control group, 67.6% (115/170) patients chose chemotherapy plus endocrine therapy. The chemotherapy percentage was much higher than that of 21-gene RS group (30/134, 22%).This is the first study to demonstrate a reduction in the use of adjuvant chemotherapy in women with node-negative hormone receptor-positive breast cancer, based on use of the RS. The RS had an impact on the physicians' treatment decision-making.

Influence of graphene coating on the adsorption and tribology of Xe on Au(1 1 1) substrate

The adsorption and tribological properties of graphene have received increasing attention for the further development of graphene-based coatings in applications. In this work, we performed first principles calculations with the inclusion of the nonlocal van der Waals correction to study the effect of graphene coating on the adsorption geometries, sliding frictions and electronic properties of Xe monolayer on the Au(1 1 1) substrate. The calculated activation energies indicate that Xe becomes movable on pure Au(1 1 1) surface at a temperature of around 30 K, whereas its motion can be activated only at a high temperature of ~50 K on graphene and on graphene-coated Au(1 1 1) substrates, in good agreement with recent experimental measurements by quartz crystal microbalance technique.

Pharmacokinetics of niacin, simvastatin and their metabolites in healthy Chinese subjects after single and multiple doses of a fixed dose combination tablet of niacin extended release/simvastatin

OBJECTIVE

A fixed dose combination tablet of niacin extended release (ER)/simvastatin was recently developed in China. This study was designed to assess and compare the pharmacokinetics of niacin, simvastatin and their metabolites in healthy Chinese subjects after single and multiple doses administration.

METHODS

From day 1 to day 7, 12 Chinese subjects were given a tablet every day at approximately 10 p.m. Serial blood samples were collected. Niacin and nicotinuric acid (NUA) in plasma, niacin, NUA, N-methylnicotinamide (MNA) and N-methyl-2-pyridone-5-carboxamide (2PY) in urine, simvastatin and simvastatin acid in plasma were determined by LC/MS/MS methods. Pharmacokinetic parameters on days 1 and 7 were compared.

RESULTS

The main pharmacokinetic parameters for the single and multiple doses were as -follows: Niacin: Tmax were 3.8±1.5 h and 3.9±2.0 h; Cmax were 2 091±1 315 ng/ml and 2 323±1 542 ng/ml; AUC0-t were 4 123.88±3 138.48 ng ∙ h/ml and 4 385.98±3 127.05 ng ∙ h/ml. NUA: Tmax were 4.7±1.7 h and 3.8±1.5 h; Cmax were 1 057±549 ng/ml and 1 087±470 ng/ml; AUC0-t were 4 012.49±2 168.68 ng ∙ h/ml and 4 040.45±1 886.57 ng ∙ h/ml. Simvastatin: Tmax were 1.8±1.0 h and 2.5±2.5 h; Cmax were 3.15±1.67 ng/ml and 4.87±4.11 ng/ml; AUC0-t were 9.03±5.10 ng ∙ h/ml and 17.63±13.93 ng ∙ h/ml. Simvastatin acid: Tmax were 5.8±1.7 h and 6.5±1.4 h; Cmax were 4.22±2.10 ng/ml and 9.30±8.09 ng/ml; AUC0-t were 34.65±16.89 ng ∙ h/ml and 61.62±46.41 ng ∙ h/ml. Urine Recovery rate of total niacin: (40.55±7.38)% and (62.87±12.04)%.

CONCLUSION

Compared with those after a single dose, pharmacokinetics of niacin and NUA was similar; total urine recovery of niacin was higher; exposure to simvastatin and simvastatin acid were higher following multiple doses.

Surface termination of cleaved Bi2Se3 investigated by low energy ion scattering

It has been widely assumed that Se terminates the surface of the topological insulator, bismuth selenide. Although some Se is initially at the surface after cleaving at 80 K, low energy ion scattering reveals a complete Bi termination at room temperature. Density functional theory shows that a Bi bilayer atop the bulk-terminated structure is energetically favorable. It is thus proposed that a thermally activated process induces a spontaneous termination change after cleaving. This has profound implications on the electrical transport and long-term stability of such materials and devices.

Expression of beclin 1, an autophagy-related protein, in human cervical carcinoma and its clinical significance

PURPOSE

To investigate the impact of beclin 1 on prognosis of cervical cancer, we determined the expression of beclin 1 in cervical cancer, cervical intraepithelial neoplasia (CIN) and normal cervical tissues.

METHODS

A total of 122 cases of cervical cancer, 35 cases with CIN and 31 cases with uterine fibroids were collected at the Cancer Center of Sun Yat University to determine the expression of beclin 1.

RESULTS

Beclin 1 positive rate in normal cervical tissues, CIN tissues and cervical cancers was 83.9%, 74.3% and 53.3%, respectively, and it was significantly different between the three groups (p < 0.01). Beclin 1 expression was negatively correlated with cervical cancer differentiation, lymph node metastasis, recurrence and death (p < 0.05). The negative expression is the risk factor affecting overall survival (p < 0.05) and progression-free survival (PFS) (p < 0.05). Multivariate analysis showed that beclin 1 negative expression was an independent risk factor of PFS time.

CONCLUSIONS

Beclin 1 may play a role in the occurrence and development of cervical cancer. Beclin 1 positive expression in patients indicates a better prognosis.

Prediction model of pelvic lymph node metastasis in early stage cervical cancer and its clinical value

AIM

This study was designed to investigate the risk factors of pelvic lymph node metastasis in early stage cervical cancer in order to establish a prediction model for this metastasis and to explore the feasibility of conservative surgery.

METHODS

The records of 207 stage IB-IIA cervical cancer patients were retrospectivly analyzed. The risk factors of pelvic lymph node metastasis were analyzed using univariate and multivariate methods. The prediction model for pelvic lymph node metastasis was established by logistic regression.

RESULTS

Without preoperative adjuvant therapy, the metastatic rate of pelvic lymph node in stage IB-IIA cervical cancer was 25.1%. The serum SCCAg, the tumor diameter, the depth of cervical stroma invasion, and the cervical canal involvement were revealed as the risk factors of pelvic lymph node metastasis by univariate analysis (P<0.05). Multivariate analysis showed that the serum SCCAg and the depth of cervical stroma invasion were the independent risk factors of pelvic lymph node metastasis (P<0.05, OR = 6.917, 2.227). The patients were divided into three groups according to different independent risk factors: the low-risk group, the medium-risk group, and the high-risk group, which showed metastatic rates of pelvic lymph node of 5.7%, 16.9%, and 48.7%, respectively (P<0.001). A prediction model for pelvic lymph node metastasis was established as follows: Logti(P) = -2.534 + serum SCCAg×1.934 + depth of cervical stroma invasion×0.801. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of this prediction model were 53.8%, 83.9 %, 52.8%, 84.4%, and 76.3%, respectively.

CONCLUSION

The serum SCCAg and the depth of cervical stroma invasion were the independent risk factors of pelvic lymph node metastasis in early stage cervical cancer. The proposed prediction model may help to improve the conservative surgery for early stage cervical cancer.

Real-space imaging of Kondo screening in a two-dimensional O₂ lattice

Kondo lattice systems can exhibit unusual many-body behaviors that result from the interplay between onsite Kondo screening and intersite coupling. We used scanning tunneling microscopy to image the Kondo resonance in a nonconventional Kondo lattice formed by self-assembled oxygen (O(2)) molecules, which are paramagnetic, on the gold reconstructed surface [Au(110)-1×2]. The interplay between the intermolecular coupling for molecules adsorbed along chains and the onsite Kondo effect leads to the coexistence of both local and nonlocal Kondo screening at the atomic level. The latter provides evidence for collective deconfinement of magnetization induced in Au, whereas the former shows local "hybridization" between the Kondo clouds of nearest-neighbor O(2) molecules.

Why sliding friction of Ne and Kr monolayers is so different on the Pb(111) surface

To understand the tribological properties of Ne and Kr on Pb(111), the potential energy surfaces for sliding motion of Ne, Kr, and Xe monolayers on the Pb(111) surface are examined through density functional calculations, using either local density or self-consistent nonlocal van der Waals functionals. The calculated adsorption energy for Xe/Pb(111) agrees well with experiment, validating the present approach and parameters. Activation energies along a sliding path indicate that Ne motion is much faster than Kr and Xe on Pb(111) at T∼6  K, which explains the puzzling experimental observation.

Sensitive and rapid detection of Paragonimus westermani infection in humans and animals by loop-mediated isothermal amplification (LAMP)

In the present study, a loop-mediated isothermal amplification (LAMP) assay was developed and validated for the detection of Paragonimus westermani adults, metacercariae, and eggs in human and animal samples. The LAMP amplification can be finished in 45 min under isothermal condition at 60°C by employing a set of four species-specific primer mixtures and the results can be checked by naked-eye visualization. No amplification products were detected with deoxyribunucleic acid (DNA) of related trematode species including Fasciola hepatica, Fasciola gigantica, Clonorchis sinensis, Opisthorchis viverrini, Schistosoma mansoni, and Schistosoma japonicum. The method was further validated by examining P. westermani DNA in intermediate hosts including freshwater crabs and crayfish, as well as in sputum and pleural fluid samples from patients of paragonimiasis. These results indicated that the LAMP assay was highly specific, sensitive, and rapid, and it was approximately 100 times more sensitive than conventional specific PCR. The LAMP assay established in this study provides a rapid and sensitive tool for the detection of P. westermani DNA in freshwater crabs, crayfish, sputum, and pleural fluid samples, which has important implications for effective control of human paragonimiasis.

Nature of the individual Ca binding sites in Ca-regenerated bacteriorhodopsin

The binding constants, K(1) and K(2), and the number of Ca(2+) ions in each of the two high affinity sites of Ca(2+)-regenerated bacteriorhodopsin (bR) are determined potentiometrically at different pH values in the range of pH 3.5-4.5 by using the Scatchard plot method. From the pH dependence of K(1) and K(2), it was found that two hydrogen ions are released for each Ca(2+) bound to each of the two high affinity sites. Furthermore, we have measured by a direct spectroscopic method the association constant, K(s), for the binding of Ca(2+) to deionized bR, which is responsible for producing the blue to purple color change. Comparing the value of K(s) and its pH dependence with those of K(1) and K(2) showed that the site corresponding to K(s) is to be identified with that of K(2). This is in agreement with the conclusion reached previously, using a different approach, which showed that it is the second Ca(2+) that causes the blue to purple color change.Our studies also show that in addition to the two distinct high affinity sites, there are about four to six sites with lower binding constants. These are attributed to the nonspecific binding in bR.

An enzymatic route to produce pyruvate from lactate

A bacterial strain of Acinetobacter sp., which was capable of enzymatic production of pyruvate from lactate, was cultured in a 5-l reactor with a basal salt medium. After 14 h of fed-batch fermentation, 9.56 g l(-1) cell concentration in the broth was obtained with 20 g l(-1) (178 mM) sodium lactate and 4 g l(-1) NH(4)Cl in the medium; and the biotransformation ability was 2.51 units ml(-1). The cells were harvested from one reactor and then used for pyruvate production from lactate in the same reactor. l-lactate at a concentration about 527 mM was almost stoichiometrically converted to pyruvate in 28 h. After a total 42 h of cell culture and biotransformation, the transformative yield was about 0.72 g g(-1) pyruvate from lactate and the rate of pyruvate production was calculated as 1.33 g l(-1) h(-1) during the process. The results suggested this simple enzymatic production of pyruvate from lactate should be a promising process and may bring a yield higher than that by microbial fermentation. By this process, the recovery of pyruvate from such a simple reaction liquid is relatively easy and inexpensive to perform.

Gene sequencing for identification of Paragonimus eggs from a human case

OBJECTIVE

To identify the etiologic agent from a paragonimiasis patient using molecular techniques.

METHODS

The complete nuclear ribosomal DNA second internal transcribed spacer (ITS2) gene sequence of eggs in sputum from a paragonimiasis patient was obtained by directly auto-sequencing its PCR product. ITS2 genes from eggs of Paragonimus westermani and Pagumogonimus skrjabini (both from animal hosts) were also sequenced for comparison. In addition, morphological comparisons were made with the eggs of the two species.

RESULTS

The ITS2 gene from the human case was 100% identical with the sequence from the eggs of P. westermani from an experimentally infected dog but only 92% identical with the sequence from the eggs of P. skrjabini. Morphologically, the eggs from the human case more resembled those from P. westermani infected dog.

CONCLUSION

The patient was diagnosed to be suffered from paragonimiasis westermani by gene sequence analysis.

[Studies on chemical constituents of leaves of Salix matsudana Koidz and their influence on lipolysis]

OBJECTIVE

To study the chemical constituents of the leaves Salix matsudana and their influence on norepinephrine-induced lipolysis.

METHOD

The chemical constituents were studied by means of chemical methods and spectral analysis. Rat's epididymal lipocytes were used to observe the effect of these constituents on the lipolysis promoted by norepinephrine (NE).

RESULT

Three constituents were isolated from the leaves of S. matsudana, and identified as apigenin-7-O-beta-D-glucopyranoside, luteolin-7-O-beta-D-glucopyranoside, luteolin-3'-methyl ether-7-O-beta-D-glucopyranoside, of which two can increase the release of free fatty acids(FFA) in the process lipolysis promoted by NE.

CONCLUSION

All the three constituents were isolated from the leaves of Salix spp. for the first time.

A molecular perspective on the genera Paragonimus Braun, Euparagonimus Chen and Pagumogonimus Chen

The status of the genera Euparagonimus Chen, 1963 and Pagumogonimus Chen, 1963 relative to Paragonimus Braun, 1899 was investigated using DNA sequences from the mitochondrial cytochrome c oxidase subunit I (CO1) gene (partial) and the nuclear ribosomal DNA second internal transcribed spacer (ITS2). In the phylogenetic trees constructed, the genus Pagumogonimus is clearly not monophyletic and therefore not a natural taxon. Indeed, the type species of Pagumogonimus, P. skrjabini from China, is very closely related to Paragonimus miyazakii from Japan. The status of Euparagonimus is less obvious. Euparagonimus cenocopiosus lies distant from other lungflukes included in the analysis. It can be placed as sister to Paragonimus in some analyses and falls within the genus in others. A recently published morphological study placed E. cenocopiosus within the genus Paragonimus and probably this is where it should remain.

[Protective effects of extract of Ginkgo biloba (EGb) on lysophosphatidylcholine induced damages of vascular endothelial cells in vitro]

Effects of EGb on cultured bovine aortic endothelial cells (BAEC) damaged by lysophosphatidylcholine (LPC) were investigated. When endothelial cells were incubated with LPC (2.5 micrograms.ml-1) for 24 h, the endothelial cells turned round pyknotic, exfoliated and broken, and the contents of malondialdehyde (MDA), lactate dehydrogenase (LDH) and plasminogen activator inhibitor (PAI) were markedly increased and the superoxide dismutase (SOD) activity was inhibited. Treatment with EGb at concentrations of 125 and 250 micrograms.ml-1, caused a reduction in MDA, LDH and PAI contents, while the SOD activity in the medium was increased and the morphologically damaged BAECs were alleviated. These results suggest that EGb afforded protection against BAECs damages induced by LPC and that the protective effect of EGb may be due to anti-lipid peroxidation via free-radical scavenging activity.

Kinetic mechanism and divalent metal activation of human erythrocyte pyridoxal phosphatase

Human erythrocyte pyridoxal phosphatase has an essential requirement for divalent cations. Its activation by Mg2+, Co2+, Ni2+, or Mn2+ followed Michaelis-Menten kinetics. Other divalent cations inhibited the enzyme. The kinetic properties of the enzyme were investigated with pyridoxal phosphate and Mg2+ alone and in the presence of the product, Pi, or dead-end inhibitors at pH 7.4 and 37 degrees C. The enzyme bound both the substrate and Mg2+ before products were released. Pi gave competitive inhibition vs substrate and noncompetitive inhibition vs Mg2+. Molybdate also was a competitive inhibitor vs substrate and noncompetitive inhibitor vs Mg2+. Ca2+ gave competitive inhibition vs Mg2+ and noncompetitive inhibition vs substrate. The effects of Mg2+ and substrate on the inactivation of pyridoxal phosphatase by a variety of group-specific reagents were studied. The inactivation of the enzyme by iodoacetate was potentiated by MgCl2. The Kd of the enzyme-Mg complex determined in the inactivation analysis was similar to the Km of the free enzyme for Mg2+, indicating that Mg2+ binds to the free enzyme. Low concentrations of a substrate, pyridoxine phosphate, or Pi protected pyridoxal phosphatase from inactivation by N-ethylmaleimide in the absence or presence of Mg2+. Thus, the substrate binds to the free enzyme and the enzyme-Mg complex. The steady-state kinetics and the kinetics of inactivation are consistent with random binding of pyridoxal phosphate and Mg2+ and with the formation of a dead-end complex of Pi with the enzyme-Mg complex.

[Clinical evaluation of fetal blood flow velocity in cerebral artery and umbilical artery by color Doppler imaging]

Fetal cerebral blood flow velocity waveforms were examined by color Doppler imaging. The results showed that the ratio of fetal middle cerebral artery resistance index (RImca) to umbilical artery resistance index (RIua) in normal late pregnancy was greater than 1 (RImca/RIua > 1). It was negatively correlated with blood pressure in pregnancy induced hypertension (PIH). It indicated that RIua increased gradually in PIH and RImca decreased when cerebral vessel damage occurred. RImca/RIua ratio < 1 in PIH patient has higher prognostic value for perinatal outcome than umbilical artery flow velocity waveform alone. The positive likelihood ratio is 25.97, and the negative likelihood ratio is 0.15.

Effects of mutagenetic substitution of prolines on the rate of deprotonation and reprotonation of the Schiff base during the photocycle of bacteriorhodopsin

Membrane-buried proline residues are found in many transport proteins. To study their roles in the structure and function of bacteriorhodopsin (bR), effects of the individual substitutions of Pro-50, Pro-91 and Pro-186 on the deprotonation and reprotonation kinetics of the Schiff base (SB) were determined by flash photolysis. The obtained rate constants and the amplitudes of the slow and fast components were compared with those of ebR (wild-type bR, the native protein that is expressed in Escherichia coli). The deprotonation rates of PSB were found to be 10 times faster than that of ebR for P50A, P91A and P91G mutants, and 4 times faster for the P50G mutant. These mutations also increased the initial reprotonation rate of the SB, although the overall change in the reprotonation rate is not as significant as that in the deprotonation rate. Our results indicate that Pro-50 and Pro-91, as well as Pro-186, are important for the proton-pumping function of bR.

Effects of genetic replacements of charged and H-bonding residues in the retinal pocket on Ca2+ binding to deionized bacteriorhodopsin

Metal cations are known to be required for proton pumping by bacteriorhodopsin (bR). Previous studies found that bR has two high-affinity and four to six low-affinity Ca(2+)-binding sites. In our efforts to find the location of these Ca2+ sites, the effects of replacing charged (Asp-85, Asp-212, and Arg-82) and H-bonding (Tyr-185) residues in the retinal pocket on the color control and binding affinity of Ca2+ ions in Ca(2+)-regenerated bR were examined. The important results are as follows: (i) The removal of Ca2+ from recombinant bR in which charged residues were replaced by neutral ones shifted the retinal absorption to the blue, opposite to that observed in wild-type bR or in recombinant bR in which the H-bonding residue, Tyr-185, was replaced by a non-H-bonding amino acid (Phe). (ii) Similar to the observation in wild-type bR, the binding of Ca2+ to the second site gave the observed color change in the recombinant bR samples in which charged residues were replaced by neutral ones. (iii) The residue replacements had no effect on the affinity constants of the four to six weakly bound Ca2+. (iv) The two high-affinity sites exhibited reduced affinity with substitutions; while the extent of the reduction depended on the specific substitution, each site was reduced by the same factor for each of the charged residue substitutions but by different factors for the mutant where Tyr-185 was replaced with Phe(Y185F). The above results suggest that the two Ca2+ ions in the two high-affinity sites are within interaction distance with one another and with the charged residues in the retinal pocket. The results further suggest that, while the interaction between Tyr-185 and the high-affinity Ca2+ ions is relatively short range and specific (with more coupling to the Ca2+ ion in the second affinity site), between the charged residues and Ca2+ ions it seems to be of the electrostatic (e.g., ion-ion) long range, nonspecific type. Although neither Asp-85, Asp-212, nor Arg-82 is individually directly involved in the binding of Ca2+ in these two sites, they might all participate in it. Together with the protonated Schiff base, the charged residues along with Tyr-185 and one or two Ca2+ ions (and probably a few water molecules) seem to form an electrostatically coupled system that is part of a cavity that controls the color and function of bR.

In vitro and in vivo evaluation in dogs of a miniaturized glucose sensor

A miniaturized glucose sensor was developed, consisting of a platinum wire entirely coated with teflon, except for a 1 mm section near its extremity where glucose oxidase is immobilized. The in vitro sensitivity to glucose of the sensors was 2.3 +/- 0.4 nA/mM, mean +/- SEM (n = 23). These sensors were implanted in the subcutaneous tissue of normal beagles. Two consecutive glucose infusions (15-30 mg/kg/min) were performed. The current generated by the sensor was used for calculation of the sensitivity coefficient (SC) (nA/mM), and the background current in the absence of glucose (lo) (nA). These parameters were used for determination of the apparent subcutaneous glucose concentration. The in vivo sensitivity was less than the in vitro sensitivity (0.5 +/- 0.1 vs. 2.2 +/- 0.2; n = 12 comparisons; p less than 0.01). Stability of sensor function was demonstrated by the absence in variation of SC and lo, calculated from the different plateaus obtained during the glucose infusions. This study provides a simple method for evaluating in vivo the function of a miniaturized sensor implanted in subcutaneous tissue.

[Prognostic factors in endometrial carcinoma]

From Apr. 1964 to Dec. 1985, the prognostic factors of 325 patients suffering from endometrial cancer treated by total hysterosalpingo-oophorectomy and bilateral pelvic lymph node dissection are analyzed. The results indicated that pelvic lymph node metastasis was related to the prognosis of this cancer, the 5-year survival rate was 86.56% in the negative group and 44.74% in the positive group (P less than 0.01). The factors leading to lymph node metastasis were: (1) The more advanced stage, the higher the pelvic lymph node metastatic rate (stage I 12.50%, II 27.16%, III 55.56%) (P less than 0.01); (2) The deeper the myometrial invasion, the higher the metastatic rate (no myometrial invasion 0%, superficial 8.25%, medium 36.96%, deep 40.74%) (P less than 0.01); (3) The higher the histological grade, the higher the metastatic rate (G1 12.50%, G2 21.57%, G3 30.00%) (P less than 0.05), implying that the histological grade is in direct proportion to the myometrial invasion and (4) The metastatic rate to pelvic lymph node is higher in the cervical invaded group than that without it (29.41% in the positive group and 15.42% in the negative group) (P less than 0.05). In this paper, the method of operation for endometrial cancer is discussed, suggesting that hysterosalpingo-oophorectomy be performed before opening the cavity of uterus. Should the cancer invades to a medium or deep degree in the myometrium, histological grade was high or the cervix was infiltrated pelvic lymph node dissection can be performed. After the operation, radiotherapy should be supplemented in those with positive lymph nodes.