Clinical breast cancer最新文献

Background: Low skeletal muscle mass and poor muscle quality are associated with poor outcomes in women with breast cancer. However, gaps exist in our understanding of prognostic factors for young women (≤ 40 years), as they often have different body composition than older women. We evaluated pretreatment body composition measures in young women with breast cancer, including associations with overall survival (OS) and progression-free survival (PFS).

Methods: The Young Women's Database at Levine Cancer Institute was queried for women aged 18 to 40 at diagnosis (2009-2018) of single primary breast cancer (N = 870); patients with Stage 0 and 4 were excluded. Deceased patients with pretreatment computed tomography (CT) scans were identified (N = 40) and matched (1:1) to patients presumed alive by age, diagnosis year, and disease characteristics. CT-derived body composition measures included skeletal muscle index (SMI) and intramuscular adipose tissue corrected (IMAT-C). Sarcopenia (low muscle mass) was defined as SMI<40.

Results: Of 80 subjects, median age at diagnosis was 35 years. Median follow-up 8.6 years. Total 33% had low muscle mass (sarcopenic), and 56% had poor muscle quality (high IMAT-C). Independent of age, clinical disease stage, and primary insurer, high IMAT-C was associated with shorter PFS (HR 2.33, 95% CI 1.15-4.72; P = .020).

Conclusions: Poor muscle quality at diagnosis was associated with shorter progression-free survival in young women with breast cancer. Future research should determine the significance of changes in muscle quality throughout treatment.

Background: Breast cancer brain metastasis (BCBM) prognosis has not been evaluated dynamically, which may underestimate patient survival. This study aimed to perform a conditional survival (CS) analysis and develop and validate an individualized real-time prognostic monitoring model for survivors.

Methods: The study included patients with BCBM from the Surveillance, Epidemiology, and End Results database (training group, n = 998) and our institution (validation group, n = 45) and updated patient overall survival (OS) over time using the CS method: CS(t2|t1)=OS(t1+t2)OS(t1). Multivariate Cox regression was used to identify prognostic factors for the nomogram, which estimated individualized OS. Furthermore, a novel CS-nomogram and its web version were further developed based on the CS formula.

Results: CS analysis showed that the 5-year OS of BCBM survivors gradually improved from 13.5% estimated at diagnosis to 26.0%, 39.7%, 57.9%, and 77.6% (surviving 1-4 years, respectively). Cox regression identified age, marital status, estrogen receptor status, human epidermal growth factor receptor 2 (Her-2) status, histological grade, surgery, and chemotherapy as significant factors influencing OS (P < .05). We then constructed and deployed the CS-nomogram based on the CS formula and the nomogram to predict real-time prognosis dynamically (https://wh-wang.shinyapps.io/BCBM/). During performance evaluation, the model performed well in both the training and validation groups.

Conclusions: CS analysis showed a gradual improvement in prognosis over time for BCBM survivors. We developed and deployed on the web a novel real-time dynamic prognostic monitoring system, the CS-nomogram, which provided valuable survival data for clinical decision-making, patient counseling, and optimal allocation of healthcare resources.

Objective: This study aimed to enhance outcomes for women undergoing breast cancer screening in a low utilization setting by implementing structured improvement cycles.

Methods: Improvement cycles were conducted using the Plan-Do-Study-Act (PDSA) methodology. Three cycles were implemented: (1) dedicating a specific day for breast screening and increasing appointment slots; (2) establishing a breast screening clinic with same-day registration; and (3) introducing a breast surgery clinic to expedite biopsy procedures for BI-RADS-4 category cases.

Results: Following each improvement cycle, dramatic increases in patient attendance were observed. In 2021, there was a 67.5% rise compared to the previous year, and a 72% increase in 2022 compared to 2021 figures. Patient characteristics revealed that 60% of attendees were new patients, with 53% of cancer and precancerous cases observed in women below 50 years old. Before the third cycle, the estimated diagnosis turnaround time (TAT) showed that only 23% of patients had their biopsy completed within 5 working days. However, after the third cycle (n = 131), 63.5% of biopsies were done within five working days.

Conclusion: Structured improvement cycles guided by the PDSA methodology effectively enhanced breast cancer screening outcomes. These cycles led to increased patient attendance, expedited biopsy procedures, and improved access to timely diagnosis. The findings highlight the importance of systematic approaches in optimizing breast cancer screening and improving patient care.

The COVID-19 pandemic exposed significant challenges in breast cancer care including healthcare inequities, limited access to surgeries, and difficulties in delivering virtual care. This letter builds upon the findings from the article "The Impact of COVID-19 on Breast Cancer Care" and proposes innovative solutions to address these challenges. Key suggestions include the use of AI-powered digital platforms for remote monitoring, robotic-assisted surgery for enhanced precision, mobile health applications for marginalized populations, and 3D printing for personalized breast reconstruction. Additionally, wearable health devices, nanotechnology for targeted drug delivery, and blockchain for secure medical data sharing are proposed to further improve the future of breast cancer care. These innovations offer practical approaches to overcoming the obstacles highlighted during the pandemic and aim to create a more equitable and efficient healthcare system.

Objective: Literature regarding nonpharmacological interventions (NPI) for PMPS or CP after mastectomy is scarce and not fully appraised, therefore we conducted this systematic review to explore the current panorama of treatment options.

Methods: A systematic review to assess the existing evidence regarding nonpharmacological approaches for PMPS. We reviewed the following databases: PubMed-MEDLINE, Embase, and Ovid (including the Cochrane Database for Clinical studies) using the following search terms: CP, mastectomy, and PMPS, and adjusted the terms depending on the database used. We included observational studies including case reports, cross sectional studies, cohort studies, and clinical trials (randomized or not) that included a NPI to treat PMPS.

Results: Total 1061 records were identified. After duplicate elimination, 863 records were screened for eligibility. A total of 717 records were excluded using our criteria, 138 records were sought for retrieval, and 117 full text records were assessed. Finally, 30 studies were included: seven case series, one cross-sectional study, two cohort studies, one case-control study, five nonrandomized clinical trials, ten randomized clinical trials (RCT), one qualitative study, and three systematic reviews of the literature, including two meta analyses, were included.

Discussion: Findings suggest that there is a great response of patients to some NPI. Regarding surgical interventions, autologous fat grafting and lymph node transplantation showed to have the greatest benefit for patients in terms of quality of life and reduced pain scores. Pulsed radiofrequency demonstrated the highest quality of evidence for energy related procedures. Within the physical therapy interventions, transcutaneous electric nerve stimulation and dry needling showed the greatest benefit. Finally, virtual reality demonstrated the greatest benefit in educational interventions.

Purpose: The deubiquitylase OTUD7B plays a facilitates role in lung tumorigenesis through VEGF protein, but its role in breast cancer remains unclear. In the present study, we proposed to explore the role of deubiquitylase OTUD7B in breast cancer.

Methods: The expression of OTUD7B in breast cancer and adjacent tissues was detected. The role of OTUD7B in cell proliferation and invasion of breast cancer cell lines such as MCF-7 and MDA-MB-453 was explored.

Results: OTUD7B is highly expressed in human breast cancer tissues and its higher expression correlates with better survival of patients. Further mechanistic studies reveal that OTUD7B associates with RASGRF1 and PLCE1 to disrupt RAS signaling pathway. Knockdown of OTUD7B results in decreasing levels of RASGRF1 protein, suppression cell growth and invasion in breast cancer. Collectively, our results reveal a previously unappreciated anti-oncogentic role OTUD7B involved in RAS signaling pathway in breast cancer and indicate that deubiquitylases could induce tumor-suppressing or tumor-promoting activities in a cell- and tissue-dependent context.

Background: Data are needed to improve the current understanding of the epidemiology of patients with high-risk, HER2-negative, early breast cancer (eBC) (hormone receptor positive [HR+]/HER2-negative BC and triple-negative BC [TNBC]).

Patients and methods: This retrospective longitudinal cohort study used real-world, population-level data that included all individuals newly diagnosed with high-risk, HER2-negative eBC in Alberta, Canada, between 2010 and 2019. Data on treatment, laboratory results and pathology findings were collected through electronic health records and administrative databases.

Results: The annual cumulative incidence of high-risk, HER2-negative eBC ranged from 6% to 9% of all incident BC cases. Individuals with TNBC were more likely to be younger, had stage II disease, grade 3 histology and received systemic therapy at a community centre (P < .05) compared to individuals with HR+/HER2-negative eBC. Only 14% of individuals diagnosed in 2010-2017 underwent germline BRCA testing postdiagnosis. Neoadjuvant systemic therapy was given to 37% of individuals. Adjuvant systemic therapy use increased from 77% (2012-2015) to 84% (2019). The 5-year overall survival (OS) from initiation of adjuvant systemic therapy or date of surgery (for individuals who did not receive adjuvant systemic therapy) was 77% (95% CI: 75-79). OS was significantly worse among individuals who were older, had grade 3 histology, had stage III disease, or had nodal involvement (P < .05). OS among individuals with TNBC between 2016 and 2019 who initiated adjuvant capecitabine was markedly worse compared to the overall cohort (2-year OS: 70% vs. 89%).

Conclusion: Outcomes analyses in this high-risk, HER2-negative eBC population suggest a continued unmet clinical need.

Background: The appropriateness of BCT for MF/MCBC is debated, with concerns about higher recurrence rates. This study aims to provide an updated systematic review and meta-analysis of LR and survival outcomes for MF/MCBC patients undergoing BCT.

Methods: PubMed, Web of Science, Embase, and the Cochrane Library were searched up to May 2024. Eligible studies included original research articles comparing LR, DFS, or OS in patients with MF/MC or UF breast cancer undergoing BCT or mastectomy. Meta-analyses for LR were conducted using the Mantel-Haenszel method. Published Kaplan-Meier curves for DFS and OS were digitized and aggregated to estimate summary survival curves.

Results: 21 studies were included in the meta-analysis for LR, comprising 28,589 participants, and 7 studies for survival analysis. The meta-analysis revealed that MF/MC breast cancer patients undergoing BCT had a significantly higher LR rate compared to UF patients (OR = 1.76, 95% CI: 1.24-2.49, P = .002), though recent studies indicated comparable LR rates. No significant difference in LR was found between MF/MC patients treated with BCT versus mastectomy (OR = 1.72, 95% CI: 0.96-3.10, P = .07). The estimated 3-, 5-, and 8-year DFS rates were 92.4%, 88.3%, and 84.5%, respectively, while the OS rates were 98.0%, 95.8%, and 91.8%.

Conclusion: BCT for MF/MC breast cancer was associated with higher LR rates compared to UF breast cancer, but the disparity was reducing in recent years. BCT offers comparable LR outcomes to mastectomy in MF/MC patients. Survival outcomes for MF/MC patients treated with BCT were favorable, affirming its oncological safety.