1
|
Glavas Tahtler J, Djapic D, Neferanovic M, Miletic J, Milosevic M, Kralik K, Neskovic N, Tomas I, Mesaric D, Marjanovic K, Rajc J, Orkic Z, Cicvaric A, Kvolik S. Long-Term Outcomes of Breast Cancer Patients Receiving Levobupivacaine Wound Infiltration or Diclofenac for Postoperative Pain Relief. Pharmaceutics 2023; 15:2183. [PMID: 37765154 PMCID: PMC10534840 DOI: 10.3390/pharmaceutics15092183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Breast cancer is the most common malignant disease in women. Preclinical studies have confirmed that the local anesthetic levobupivacaine has a cytotoxic effect on breast cancer cells. We examined whether postoperative wound infiltration with levobupivacaine influences survival in 120 patients who were operated on for breast cancer and underwent quadrantectomy or mastectomy with axillary lymph node dissection. Groups with continuous levobupivacaine wound infiltration, bolus wound infiltration, and diclofenac analgesia were compared. Long-term outcomes examined were quality of life, shoulder disability, and hand grip strength (HGS) after one year and survival after 5 and 10 years. Groups that had infiltration analgesia had better shoulder function compared to diclofenac after one year. The levobupivacaine PCA group had the best-preserved HGS after 1 year (P = 0.022). The most significant predictor of the 5-year outcome was HGS (P = 0.03). Survival at 10 years was 85%, 92%, and 77% in the diclofenac, levobupivacaine bolus, and levobupivacaine PCA groups (ns. P = 0.36). The extent of the disease at the time of surgery is the most important predictor of long-term survival (P = 0.03). A larger prospective clinical study could better confirm the effect of levobupivacaine wound infiltration on outcomes after breast cancer surgery observed in this pilot study-trial number NCT05829707.
Collapse
Affiliation(s)
- Josipa Glavas Tahtler
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Dajana Djapic
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Marina Neferanovic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Jelena Miletic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Marta Milosevic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Kristina Kralik
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Nenad Neskovic
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Ilijan Tomas
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Oncology and Radiotherapy, Osijek University Hospital, 31000 Osijek, Croatia
| | - Dora Mesaric
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Oncology and Radiotherapy, Osijek University Hospital, 31000 Osijek, Croatia
| | - Ksenija Marjanovic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Pathology and Forensic Medicine, Osijek University Hospital, 31000 Osijek, Croatia
| | - Jasmina Rajc
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Pathology and Forensic Medicine, Osijek University Hospital, 31000 Osijek, Croatia
| | - Zelimir Orkic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
- Department of Surgery, Osijek University Hospital, 31000 Osijek, Croatia
| | - Ana Cicvaric
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| | - Slavica Kvolik
- Department of Anesthesiology, Resuscitation and Intensive Care, Osijek University Hospital, 31000 Osijek, Croatia; (J.G.T.); (A.C.)
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (M.N.); (J.M.); (M.M.); (K.K.); (I.T.); (D.M.); (K.M.); (J.R.); (Z.O.)
| |
Collapse
|
2
|
Zhu X, Song J, Wang M, Wang X, Lv L. Dysregulated ceRNA network modulated by copy number variation-driven lncRNAs in breast cancer: A comprehensive analysis. J Gene Med 2023; 25:e3471. [PMID: 36525372 DOI: 10.1002/jgm.3471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/09/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Breast cancer is a malignancy harmful to physical and mental health in women, with quite high mortality. Copy number variations (CNVs) are vital factors affecting the progression of breast cancer. Detecting CNVs in breast cancer to predict the prognosis of patients has become a promising approach to accurate treatment in recent years. The differential analysis was performed on CNVs of long noncoding RNAs (lncRNAs) as well as the expression of lncRNAs, microRNAs (miRNAs) and mRNAs in normal tissue and breast tumor tissue based on The Cancer Genome Atlas (TCGA) database. The CNV-driven lncRNAs were identified by the Kruskal-Wallis test. Meanwhile, a competitive endogenous RNA (ceRNA) network regulated by CNV-driven lncRNA was constructed. As the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses revealed, the mRNAs in the dysregulated ceRNA network were mainly enriched in the biological functions and signaling pathways, including the Focal Adhesion-PI3K-Akt-mTOR-signaling pathway, the neuronal system, metapathway biotransformation Phase I and II and blood circulation, etc. The relationship between the CNVs of five lncRNAs and their gene expression in the ceRNA network was analyzed via a chi-square test, which confirmed that except for LINC00243, the expression of four lncRNAs was notably correlated with the CNVs. The survival analysis revealed that only the copy number gain of LINC00536 was evidently related to the poor prognosis of patients. The CIBERSORT algorithm showed that five lncRNAs were correlated with the abundance of immune cell infiltration and immune checkpoints. In a word, by analyzing CNV-driven lncRNAs and the ceRNA network regulated by these lncRNAs, this study explored the mechanism of breast cancer and provided novel insights into new biomarkers.
Collapse
Affiliation(s)
- Xiaotao Zhu
- Department of Breast and Thyroid Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Jialu Song
- Department of Breast and Thyroid Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Mingzheng Wang
- Department of Breast and Thyroid Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Xiaohui Wang
- Department of Breast and Thyroid Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Lin Lv
- Department of Breast and Thyroid Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| |
Collapse
|
3
|
Kim R, Kawai A, Wakisaka M, Shimoyama M, Yasuda N, Kin T, Arihiro K. Breast cancer recurrence and survival rates in patients who underwent breast-conserving surgery under non-mechanically ventilated anesthesia. Cancer Rep (Hoboken) 2023; 6:e1643. [PMID: 35655440 PMCID: PMC9875645 DOI: 10.1002/cnr2.1643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/25/2022] [Accepted: 05/12/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recurrence after primary treatment is an important obstacle to the curing of primary breast cancer. Less-immunosuppressive anesthetic techniques, such as local anesthesia with lidocaine, intravenous anesthesia (IVA) with propofol, and/or sedation with midazolam under spontaneous breathing may reduce breast cancer recurrence compared with standard general anesthesia techniques such as IVA and inhalation anesthesia with opioids under mechanical ventilation. AIM The aim of this study was to analyze the factors involved in breast cancer recurrence in patients who underwent breast-conserving surgery (BCS) under non-mechanically ventilated anesthesia. METHODS The study included 491 consecutive patients with stages 0-III breast cancer who underwent BCS/axillary lymph-node management with local anesthesia and IVA and/or sedation under non-mechanical ventilation between May 2008 and September 2021. Survival and recurrence were assessed by retrospective cohort analysis. RESULTS The median follow-up period was 2565 days (range, 28-4834 days). The overall and breast cancer-specific survival rates were 92.9% and 95.6%, respectively. Twenty-one deaths, of which 11 were breast cancer-related, occurred. Disease recurred in 29 (5.9%) patients, of whom 15 patients received neoadjuvant chemotherapy (NAC) and 14 patients received adjuvant therapy (chemotherapy in 12 cases). The surgical procedure performed, but not other clinicopathological factors [recurrence site, P stage, tumor subtype, and disease-free interval (DFI)], differed between the NAC and adjuvant therapy groups. The DFI tended to be shorter in the NAC group than in the adjuvant therapy group. The pathological therapeutic effect grade after NAC was 1 in 12 patients and ≥2 in 3 patients. CONCLUSION More than 50% (15/29) of patients with recurrence who underwent BCS were given NAC, but most patients did not respond to it. Similarly, adjuvant chemotherapy may not have contributed to the eradication of residual tumor cells after BCS. To reduce breast cancer recurrence in patients undergoing BCS, treatment strategies, especially for patients who do not respond to NAC or adjuvant chemotherapy, need to be developed. Non-mechanical ventilation anesthesia may also affect the incidence of breast cancer recurrence.
Collapse
Affiliation(s)
- Ryungsa Kim
- Department of Breast SurgeryHiroshima Mark ClinicHiroshimaJapan
| | - Ami Kawai
- Department of Breast SurgeryHiroshima Mark ClinicHiroshimaJapan
| | - Megumi Wakisaka
- Department of Breast SurgeryHiroshima Mark ClinicHiroshimaJapan
| | - Mika Shimoyama
- Department of Breast SurgeryHiroshima Mark ClinicHiroshimaJapan
| | - Naomi Yasuda
- Department of Breast SurgeryHiroshima Mark ClinicHiroshimaJapan
| | - Takanori Kin
- Department of Breast SurgeryHiroshima City HospitalHiroshimaJapan
| | - Koji Arihiro
- Department of Anatomical PathologyHiroshima University HospitalHiroshimaJapan
| |
Collapse
|
4
|
Kim R, Kawai A, Wakisaka M, Shimoyama M, Yasuda N, Ito M, Kin T, Arihiro K. Outcomes in patients with non‐invasive breast carcinoma. Cancer Rep (Hoboken) 2022; 6:e1768. [PMID: 36494178 PMCID: PMC10075290 DOI: 10.1002/cnr2.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIM Non-invasive breast carcinoma is considered to be localized disease and is distinguished from invasive ductal and lobular carcinomas. The local recurrence of non-invasive carcinoma after surgery may lead to development of invasive carcinoma and promote distant metastasis, which worsens the prognosis for breast cancer mortality. The distant metastasis of non-invasive carcinoma may involve the ductal microvasculature without invasion. The outcomes of non-invasive breast carcinoma were examined in this retrospective cohort study. METHODS AND RESULTS Of 872 primary breast cancers diagnosed at a single center between May 2008 and March 2022, 93 (10.6%) were found to be non-invasive carcinomas and were examined in this study. The breast cancer recurrence and survival rates of patients with non-invasive carcinoma were analyzed retrospectively. The median follow-up period was 1891 (range, 5-4804) days. All patients underwent surgical treatment [mastectomy with sentinel lymph node biopsy (SLNB) and partial mastectomy with or without SLNB, tumorectomy, and microdochectomy]. Postoperatively, radiation therapy was administered to 73 (78.4%) of the patients and endocrine therapy was administered to 64 (81.0%) of 79 patients with hormone-receptor positivity. Of 26 patients who underwent partial mastectomy with SLNB, 24 (92.3%) showed isolated tumor cells in the SLNs on one-step nucleic acid amplification. Local recurrence was observed in three (0.3%) patients; no distant metastasis was observed. One patient died of a noncancerous disease. The overall survival rate was 98.0% and the breast cancer-specific survival rate was 100.0%. CONCLUSIONS Non-invasive breast carcinoma, like invasive breast carcinoma, causes local recurrence, but has a good prognosis without distant metastasis. The clinical significance of isolated tumor cells in the SLNs as a systemic component of non-invasive breast carcinoma remains to be elucidated.
Collapse
Affiliation(s)
- Ryungsa Kim
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Ami Kawai
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Megumi Wakisaka
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Mika Shimoyama
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Naomi Yasuda
- Department of Breast Surgery Hiroshima Mark Clinic Hiroshima Japan
| | - Mitsuya Ito
- Department of Breast Surgery Hiroshima City Hospital Hiroshima Japan
| | - Takanori Kin
- Department of Breast Surgery Hiroshima City Hospital Hiroshima Japan
| | - Koji Arihiro
- Department of Anatomical Pathology Hiroshima University Hospital Hiroshima Japan
| |
Collapse
|
5
|
Application of Intravenous Anesthesia in Laparoscopic Hiatal Hernia Repair of Children. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5290813. [PMID: 35845740 PMCID: PMC9259264 DOI: 10.1155/2022/5290813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 01/13/2023]
Abstract
In order to solve the stress problem in laparoscopic hiatal hernia repair of children, improve surgical safety, and reduce surgical risk, this study compared the perioperative changes of epinephrine, norepinephrine, IL-6, IL-10, and hemodynamics in children undergoing laparoscopic surgery under intravenous general anesthesia and general anesthesia combined with an epidural block. In this study, 40 children aged 1-3 years who planned to undergo laparoscopic ortopexy and those who planned to undergo laparoscopic high ligation of hernia sac, aged 23.84 1.6 months and weighed 14.9 1.1 kg, were randomly divided into general anesthesia combined with the epidural block group (group A) and a total intravenous anesthesia group (group B), with 20 subjects in each group. The results are as follows: There were no differences in age, gender, body weight, anesthesia time, pneumoperitoneum duration, and functional time between the two groups. Cytokines: Compared with T0, the levels of IL-6 in T2, T3, T4, and T5 groups were significantly increased (P < 0.01). IL-10 levels: T2, T3, T4, and T5 groups were further increased, and the difference was statistically significant compared with T0 (P < 0.01). There was no difference between groups (P > 0.05). The recovery time in group B was shorter than that in group A (P < 0.01), and the total amount of propofol and fentanyl in group B was less than that in group A (P < 0.01). Through research on intravenous anesthesia treatment, it has been proved that total intravenous anesthesia can relieve perioperative pressure, reduce intravenous injection, and reduce the recovery time of children. However, its effect on cytokines is not obvious, so intravenous anesthesia is the most appropriate anesthesia mode in laparoscopic hiatal hernia repair surgery, which has practical significance.
Collapse
|
6
|
Capitán del Río I, Sánchez Andújar B, Capitán Vallvey JM. Profitability of the CMA Unit for breast pathology during the COVID-19 pandemic. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2022; 100:248-249. [PMID: 35431167 PMCID: PMC8940577 DOI: 10.1016/j.cireng.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 01/13/2023]
|
7
|
Kim R, Kawai A, Wakisaka M, Kin T. Current Status and Prospects of Anesthesia and Breast Cancer: Does Anesthetic Technique Affect Recurrence and Survival Rates in Breast Cancer Surgery? Front Oncol 2022; 12:795864. [PMID: 35223475 PMCID: PMC8864113 DOI: 10.3389/fonc.2022.795864] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/17/2022] [Indexed: 01/13/2023] Open
Abstract
The relationship between the anesthetic technique and cancer recurrence has not yet been clarified in cancer surgery. Surgical stress and inhalation anesthesia suppress cell-mediated immunity (CMI), whereas intravenous (IV) anesthesia with propofol and regional anesthesia (RA) are known to be protective for CMI. Surgical stress, general anesthesia (GA) with inhalation anesthesia and opioids contribute to perioperative immunosuppression and may increase cancer recurrence and decrease survival. Surgical stress and GA activate the hypothalamic-pituitary-adrenal axis and release neuroendocrine mediators such as cortisol, catecholamines, and prostaglandin E2, which may reduce host defense immunity and promote distant metastasis. On the other hand, IV anesthesia with propofol and RA with paravertebral block or epidural anesthesia can weaken surgical stress and GA-induced immunosuppression and protect the host defense immunity. IV anesthesia with propofol and RA or in combination with GA may reduce cancer recurrence and improve patient survival compared to GA alone. We review the current status of the relationship between anesthesia and breast cancer recurrence using retrospective and prospective studies conducted with animal models and clinical samples, and discuss the future prospects for reducing breast cancer recurrence and improving survival rates in breast cancer surgery.
Collapse
Affiliation(s)
- Ryungsa Kim
- Department of Breast Surgery, Hiroshima Mark Clinic, Hiroshima, Japan
| | - Ami Kawai
- Department of Breast Surgery, Hiroshima Mark Clinic, Hiroshima, Japan
| | - Megumi Wakisaka
- Department of Breast Surgery, Hiroshima Mark Clinic, Hiroshima, Japan
| | - Takanori Kin
- Department of Breast Surgery, Hiroshima City Hospital, Hiroshima, Japan
| |
Collapse
|
8
|
Lu Y, Liu T, Wang P, Chen Y, Ji F, Hernanz F, Zucca-Matthes G, Youssif S, Peng S, Xu D. Can anesthetic effects and pain treatment influence the long-term prognosis of early-stage lymph node-negative breast cancer after breast-conserving surgery? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1467. [PMID: 34734019 PMCID: PMC8506746 DOI: 10.21037/atm-21-4392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/10/2021] [Indexed: 01/13/2023]
Abstract
Background Breast cancer is currently the leading cause of women’s death. It is crucial to further improve the approach to treatment and the long-term survival rate of breast cancer patients, and to reduce the rates of recurrence and metastasis. It has been reported that the possibility of tumor metastasis depends on the metastatic potential of the tumor and the host defense against tumor metastasis, in which cellular immunity and the function of natural killer (NK) cells are critical to maintaining this balance. Surgical stress response and postoperative pain inhibit perioperative immune function in patients and increase the likelihood of dissemination and metastasis of cancer cells after cancer surgery. The study aims to investigate the effect of anesthetic factors and pain treatment on the long-term prognosis of patients with early stage lymph node negative breast preservation surgery. Methods A total of 337 patients with early-stage lymph node negative breast cancer (ASA I-II) who had undergone successful breast-conserving surgery in our hospital were included in this retrospective analysis. Cases were divided into general anesthesia with postoperative analgesia group (GA + PCA), general anesthesia without postoperative analgesia group (GA), epidural anesthesia with postoperative analgesia group (EA + PCA), and epidural anesthesia without postoperative analgesia group (EA). The 5-year survival rate and 5-year disease-free survival were recorded in the 4 groups. Results The general condition and length of hospital stay of the patients were not statistically different between the 4 groups. However, the 5-year survival rate and 5-year disease-free survival rate of the 4 groups were statistically different. The 5-year survival rate and 5-year disease-free survival rate were the lowest in the GA group, while the EA + PCA group had the highest 5-year disease-free survival rate. The 5-year survival rate and 5-year disease-free survival rate in the GA + PCA group were significantly higher than those in the GA group. The 5-year disease-free survival rate in EA group was significantly higher than GA group. Conclusions Epidural anesthesia and postoperative pain treatment maybe beneficial to the long-term prognosis of patients with early-stage lymph node-negative breast cancer.
Collapse
Affiliation(s)
- Yanan Lu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ting Liu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peizong Wang
- Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi Chen
- Su Fengxi Clinic, Guangzhou, China
| | - Fengtao Ji
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fernando Hernanz
- Oncoplastic Breast Unit, Hospital Universitario Valdecilla, University of Cantabria, Santander, Spain
| | - Gustavo Zucca-Matthes
- Department of Gynaecology, Obstetrics and Mastology, School of Medicine of Botucatu, UNESP, Botucatu-SP, Brazil
| | - Sherif Youssif
- Plastic and Reconstructive Surgery Division, Good Hope Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK.,Plastic surgery department, Assiut University, Assiut, Egypt
| | - Shuling Peng
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongni Xu
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
9
|
Capitán Del Río I, Sánchez Andújar B, Capitán Vallvey JM. Profitability of the CMA Unit for breast pathology during the COVID-19 pandemic. Cir Esp 2021; 100:S0009-739X(21)00074-9. [PMID: 33766442 PMCID: PMC7931680 DOI: 10.1016/j.ciresp.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Inés Capitán Del Río
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Jaén, Jaén, España
| | - Belén Sánchez Andújar
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Jaén, Jaén, España
| | | |
Collapse
|
10
|
Kim R, Kin T. Clinical Perspectives in Addressing Unsolved Issues in (Neo)Adjuvant Therapy for Primary Breast Cancer. Cancers (Basel) 2021; 13:926. [PMID: 33672204 PMCID: PMC7927115 DOI: 10.3390/cancers13040926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 01/13/2023] Open
Abstract
The treatment of primary breast cancer has evolved over the past 50 years based on the concept that breast cancer is a systemic disease, with the escalation of adjuvant and neoadjuvant therapies and de-escalation of breast cancer surgery. Despite the development of these therapies, recurrence with distant metastasis during the 10 years after surgical treatment is observed, albeit infrequently. Recent advances in genomic analysis based on circulating tumor cells and circulating tumor DNA have enabled the development of targeted therapies based on genetic mutations in residual tumor cells. A paradigm shift involving the application of neoadjuvant chemotherapy (NAC) has enabled the prediction of treatment response and long-term prognoses; additional adjuvant chemotherapy targeting remaining tumor cells after NAC improves survival. The activation of antitumor immunity by anticancer agents may be involved in the eradication of residual tumor cells. Elucidation of the manner in which antitumor immunity is induced by anticancer agents and unknown factors, and the overcoming of drug resistance via the targeted eradication of residual tumor cells based on genomic profiles, will inevitably lead to the achievement of 0% distant recurrence and a complete cure for primary breast cancer.
Collapse
Affiliation(s)
- Ryungsa Kim
- Breast Surgery, Hiroshima Mark Clinic, 1-4-3F, 2-Chome, Ohte-machi, Naka-ku, Hiroshima 730-0051, Japan
| | - Takanori Kin
- Department of Breast Surgery, Hiroshima City Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan;
| |
Collapse
|