ObjectiveTo sort out the key evidence-based data and recent advances in the systemic treatment of advanced triple-negative breast cancer (TNBC), to summarize the therapeutic strategies so as to provide guidance for clinical practice. MethodThe key evidence and research progress on immune checkpoint inhibitors, antibody-drug conjugates (ADCs), poly ADP-ribose polymerase (PARP) inhibitors, anti-angiogenic agents, and novel microtubule inhibitors were summarized. ResultsThe treatment landscape for advanced TNBC has shifted from chemotherapy-centric approaches to biomarker-driven, stratified precision therapy. Based on programmed cell death ligand 1 (PD-L1) expression levels, immune therapy combined with chemotherapy is prioritized. For patients with germline breast cancer gene 1/2 (gBRCA1/2) mutations, PARP inhibitors are recommended. ADCs are suggested for second-line treatment, while novel microtubule inhibitors, either alone or in combination with anti-angiogenic agents, are preferred for later-line therapy to extend patient survival. ConclusionDynamic monitoring of molecular biomarkers such as PD-L1 and gBRCA, combined with sequential or combined “targeted–immunotherapy–ADC” regimens in a “chemotherapy-free” approach, has shown promise in improving overall survival in advanced TNBC.
ObjectiveTo explore the clinical application of oncoplastic surgery in breast-conserving surgery after neoadjuvant chemotherapy.MethodsFrom May 2016 to May 2018, 32 breast cancer patients (cT2–3N0–3M0) who were scheduled for neoadjuvant chemotherapy (NAC) and agreed to accept breast-conserving surgery after NAC in the Henan Tumor Hospital were enrolled into the retrospective study. These patients were originally unable to perform traditional breast conserving surgery because of the size or location of the tumor. We observed the success rate, safety and cosmetic effects of breast-conserving therapy, which were applicated of tumor down-staging after neoadjuvant chemotherapy combined with oncoplastic surgery.ResultsIn this study, after neoadjuvant chemotherapy, 31 patients achieved CR or PR, and 1 patient had SD. All 32 patients underwent breast-conserving surgery successfully, 3 patients underwent breast-conserving combined with volume replacement, and 29 patients underwent breast-conserving combined with volume displacement. One patient was not satisfied with the cosmetic effects, the other patients were satisfied or basically satisfied with the cosmetic effects. The median follow-up was 18 months (5–24 months), and no local recurrence or distant metastasis was found in 32 patients.ConclusionsBy tumor down-staging after neoadjuvant chemotherapy combined with oncoplastic surgery, we can make some patients who are originally not suitable for breast conserving due to tumor size and tumor location succeed in breast-conserving therapy, and the safety and cosmetic effect are basically satisfied.
ObjectiveTo investigate the value of interictal scalp high-frequency oscillations (HFOs) in localizing the epileptogenic zone (EZ) in children with infantile epileptic spasms syndrome (IESS). Methods A retrospective analysis was conducted on surgical IESS patients treated at the Epilepsy Center of Shenzhen Children’s Hospital from August 2018 to November 2021. Preoperative EEG and clinical data were collected. Based on Engel classification at 2-year follow-up, patients were divided into a seizure-free group (Engel Ia) and a non–seizure-free group (non–Engel Ia). An automated detection system was used to identify ripple events (80–250 Hz), and the H-index (ripples per channel per minute) was calculated in the resection zone (RZ) and non-resection zone (non-RZ). Result 35 children were included (19 seizure-free, 16 non–seizure-free). The H-index in the RZ was significantly higher than in the non-RZ in the seizure-free group [(58.16±43.95) vs. (24.07±22.85), P<0.05]. Using the RZ of the seizure-free group as the gold standard, the area under the ROC curve (AUC) of the H-index for predicting the EZ was 0.83 [95%CI (0.70, 0.96) , P<0.001], with an optimal diagnostic threshold of 21.50 (sensitivity 73.68%, specificity 84.21%). Conclusion The results confirm that the interictal scalp HFO index may serve as a potential biomarker for localizing the EZ in IESS children with structural etiologies.