Clinical breast cancer最新文献_第2页

Prediction of Microinvasion in Breast Ductal Carcinoma in Situ Using Conventional Ultrasound Combined with Contrast-Enhanced Ultrasound Features: A Two-Center Study 使用传统超声结合对比度增强超声特征预测乳腺原位导管癌的微小浸润：一项双中心研究

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clbc.2024.09.014

Tingting Wu , Jing Chen , Sihui Shao , Yu Du , Fang Li , Hui Liu , Liping Sun , Xuehong Diao , Rong Wu

Background

To develop and validate a model based on conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) features to preoperatively predict microinvasion in breast ductal carcinoma in situ (DCIS).

Patients and Methods

Data from 163 patients with DCIS who underwent CUS and CEUS from the internal hospital was retrospectively collected and randomly apportioned into training and internal validation sets in a ratio of 7:3. External validation set included 56 patients with DCIS from the external hospital. Univariate and multivariate logistic regression analysis were performed to determine the independent risk factors associated with microinvasion. These factors were used to develop predictive models. The performance was evaluated through calibration, discrimination, and clinical utility.

Results

Multivariate analysis indicated that centripetal enhancement direction (odds ratio [OR], 13.268; 95% confidence interval [CI], 3.687-47.746) and enhancement range enlarged on CEUS (OR, 4.876; 95% CI, 1.470-16.181), lesion size of ≥20 mm (OR, 3.265; 95% CI, 1.230-8.669) and calcification detected on CUS (OR, 5.174; 95% CI, 1.903-14.066) were independent risk factors associated with microinvasion. The nomogram incorporated the CUS and CEUS features achieved favorable discrimination (AUCs of 0.850, 0.848, and 0.879 for the training, internal and external validation datasets), with good calibration. The nomogram outperformed the CUS model and CEUS model (all P < .05). Decision curve analysis confirmed that the predictive nomogram was clinically useful.

Conclusion

The nomogram based on CUS and CEUS features showed promising predictive value for the preoperative identification of microinvasion in patients with DCIS.

背景：目的：开发并验证一种基于常规超声（CUS）和对比增强超声（CEUS）特征的模型，用于术前预测乳腺导管原位癌（DCIS）的微小病灶：回顾性收集内部医院163名接受CUS和CEUS检查的DCIS患者的数据，并按7:3的比例随机分为训练集和内部验证集。外部验证集包括外部医院的 56 例 DCIS 患者。通过单变量和多变量逻辑回归分析，确定与微小浸润相关的独立风险因素。这些因素被用于开发预测模型。通过校准、区分度和临床实用性对模型的性能进行了评估：多变量分析表明，CEUS 上向心性增强方向（几率比 [OR]，13.268；95% 置信区间 [CI]，3.687-47.746）和增强范围扩大（OR，4.876；95% CI，1.470-16.181）、病灶大小≥20 毫米（OR，3.265；95% CI，1.230-8.669）和 CUS 上检测到的钙化（OR，5.174；95% CI，1.903-14.066）是与微小病灶相关的独立危险因素。包含 CUS 和 CEUS 特征的提名图具有良好的区分度（训练、内部和外部验证数据集的 AUC 分别为 0.850、0.848 和 0.879）和校准性。提名图的表现优于 CUS 模型和 CEUS 模型（所有 P < .05）。决策曲线分析证实，预测提名图在临床上是有用的：基于CUS和CEUS特征的提名图对术前识别DCIS患者的微小病灶具有很好的预测价值。

{"title":"Prediction of Microinvasion in Breast Ductal Carcinoma in Situ Using Conventional Ultrasound Combined with Contrast-Enhanced Ultrasound Features: A Two-Center Study","authors":"Tingting Wu , Jing Chen , Sihui Shao , Yu Du , Fang Li , Hui Liu , Liping Sun , Xuehong Diao , Rong Wu","doi":"10.1016/j.clbc.2024.09.014","DOIUrl":"10.1016/j.clbc.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>To develop and validate a model based on conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) features to preoperatively predict microinvasion in breast ductal carcinoma in situ (DCIS).</div></div><div><h3>Patients and Methods</h3><div>Data from 163 patients with DCIS who underwent CUS and CEUS from the internal hospital was retrospectively collected and randomly apportioned into training and internal validation sets in a ratio of 7:3. External validation set included 56 patients with DCIS from the external hospital. Univariate and multivariate logistic regression analysis were performed to determine the independent risk factors associated with microinvasion. These factors were used to develop predictive models. The performance was evaluated through calibration, discrimination, and clinical utility.</div></div><div><h3>Results</h3><div>Multivariate analysis indicated that centripetal enhancement direction (odds ratio [OR], 13.268; 95% confidence interval [CI], 3.687-47.746) and enhancement range enlarged on CEUS (OR, 4.876; 95% CI, 1.470-16.181), lesion size of ≥20 mm (OR, 3.265; 95% CI, 1.230-8.669) and calcification detected on CUS (OR, 5.174; 95% CI, 1.903-14.066) were independent risk factors associated with microinvasion. The nomogram incorporated the CUS and CEUS features achieved favorable discrimination (AUCs of 0.850, 0.848, and 0.879 for the training, internal and external validation datasets), with good calibration. The nomogram outperformed the CUS model and CEUS model (all <em>P</em> < .05). Decision curve analysis confirmed that the predictive nomogram was clinically useful.</div></div><div><h3>Conclusion</h3><div>The nomogram based on CUS and CEUS features showed promising predictive value for the preoperative identification of microinvasion in patients with DCIS.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 2","pages":"Pages e178-e189"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

USP4/CARM1 Axis Promotes the Malignant Transformation of Breast Cancer Cells by Upregulating SLC7A11 Expression USP4/CARM1 轴通过上调 SLC7A11 的表达促进乳腺癌细胞的恶性转化

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clbc.2024.10.001

Xin Li , Changjiao Yan , Jun Yun, Xin Xu, Hongliang Wei, Xiaolong Xu, Yike Li, Jun Yi

Background

Coactivator associated arginine methyltransferase 1 (CARM1) has been identified as a regulator of breast cancer (BC) progression, yet the underlying mechanisms remain elusive.

Methods

Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to assess the mRNA expression of CARM1 and solute carrier family 7 member 11 (SLC7A11). Western blotting was conducted to detect the protein expressions of CARM1, ubiquitin specific peptidase 4 (USP4), and SLC7A11. Cell viability, apoptosis, invasion, and migration were evaluated using CCK-8 assay, flow cytometry, transwell assay, and wound-healing assay, respectively. Fe²⁺ and GSH levels were determined by colorimetric assay. Fluorescence microscopy and flow cytometry were utilized to quantify reactive oxygen species (ROS) production. Co-immunoprecipitation (Co-IP) assay and cycloheximide (CHX) assay were performed to investigate the relationship between USP4 and CARM1. Xenograft mouse model assay was conducted to validate the effects of USP4 silencing and CARM1 overexpression on the malignant phenotypes of BC cells.

Results

CARM1 and SLC7A11 expression was upregulated in BC tissues and cells when compared with normal breast tissues and cells. Silencing of CARM1 inhibited the malignant phenotypes of BC cells, including decreased cell viability, invasion, and migration and increased cell apoptosis, ferroptosis and oxidative stress. In addition, USP4 stabilized CARM1 protein expression through its deubiquitinating activity. Overexpression of CARM1 attenuated the effects of USP4 silencing in both MCF-7 and MDA-MB-231 cells. Furthermore, silencing of CARM1 reduced SLC7A11 expression, and SLC7A11 overexpression relieved the CARM1 silencing-induced effects. Further, overexpression of CARM1 counteracted the inhibitory effects of USP4 silencing on tumor growth in vivo.

Conclusion

Our study reveals a novel mechanism by which USP4-dependent CARM1 promotes the malignant growth of BC cells by interacting with SLC7A11. Targeting this axis may provide a potential therapeutic strategy for BC.

背景：与激活剂相关的精氨酸甲基转移酶 1（CARM1）已被确定为乳腺癌（BC）进展的调控因子，但其潜在机制仍不清楚：共激活因子相关精氨酸甲基转移酶1（CARM1）已被确定为乳腺癌（BC）进展的调控因子，但其潜在机制仍不明确：方法：采用定量实时聚合酶链反应（qRT-PCR）评估CARM1和溶质运载家族7成员11（SLC7A11）的mRNA表达。采用 Western 印迹法检测 CARM1、泛素特异性肽酶 4 (USP4) 和 SLC7A11 的蛋白表达。细胞活力、凋亡、侵袭和迁移分别采用 CCK-8 检测法、流式细胞仪、Transwell 检测法和伤口愈合检测法进行评估。Fe2+和GSH水平通过比色法测定。荧光显微镜和流式细胞术用于量化活性氧（ROS）的产生。进行了共免疫沉淀（Co-IP）测定和环己亚胺（CHX）测定，以研究USP4和CARM1之间的关系。进行了异种移植小鼠模型试验，以验证USP4沉默和CARM1过表达对BC细胞恶性表型的影响：结果：与正常乳腺组织和细胞相比，CARM1和SLC7A11在BC组织和细胞中表达上调。沉默 CARM1 可抑制 BC 细胞的恶性表型，包括降低细胞活力、侵袭和迁移，增加细胞凋亡、铁变态反应和氧化应激。此外，USP4 通过其去泛素化活性稳定了 CARM1 蛋白的表达。在 MCF-7 和 MDA-MB-231 细胞中，过表达 CARM1 可减轻 USP4 沉默的影响。此外，沉默 CARM1 会降低 SLC7A11 的表达，而过表达 SLC7A11 则会缓解 CARM1 沉默引起的影响。此外，过表达 CARM1 抵消了 USP4 沉默对体内肿瘤生长的抑制作用：我们的研究揭示了一种新的机制，即依赖于 USP4 的 CARM1 通过与 SLC7A11 相互作用促进 BC 细胞的恶性生长。我们的研究揭示了一种新的机制，即依赖于 USP4 的 CARM1 通过与 SLC7A11 相互作用促进 BC 细胞的恶性生长。

{"title":"USP4/CARM1 Axis Promotes the Malignant Transformation of Breast Cancer Cells by Upregulating SLC7A11 Expression","authors":"Xin Li , Changjiao Yan , Jun Yun, Xin Xu, Hongliang Wei, Xiaolong Xu, Yike Li, Jun Yi","doi":"10.1016/j.clbc.2024.10.001","DOIUrl":"10.1016/j.clbc.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Coactivator associated arginine methyltransferase 1 (CARM1) has been identified as a regulator of breast cancer (BC) progression, yet the underlying mechanisms remain elusive.</div></div><div><h3>Methods</h3><div>Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to assess the mRNA expression of CARM1 and solute carrier family 7 member 11 (SLC7A11). Western blotting was conducted to detect the protein expressions of CARM1, ubiquitin specific peptidase 4 (USP4), and SLC7A11. Cell viability, apoptosis, invasion, and migration were evaluated using CCK-8 assay, flow cytometry, transwell assay, and wound-healing assay, respectively. Fe<sup>2+</sup> and GSH levels were determined by colorimetric assay. Fluorescence microscopy and flow cytometry were utilized to quantify reactive oxygen species (ROS) production. Co-immunoprecipitation (Co-IP) assay and cycloheximide (CHX) assay were performed to investigate the relationship between USP4 and CARM1. Xenograft mouse model assay was conducted to validate the effects of USP4 silencing and CARM1 overexpression on the malignant phenotypes of BC cells.</div></div><div><h3>Results</h3><div>CARM1 and SLC7A11 expression was upregulated in BC tissues and cells when compared with normal breast tissues and cells. Silencing of CARM1 inhibited the malignant phenotypes of BC cells, including decreased cell viability, invasion, and migration and increased cell apoptosis, ferroptosis and oxidative stress. In addition, USP4 stabilized CARM1 protein expression through its deubiquitinating activity. Overexpression of CARM1 attenuated the effects of USP4 silencing in both MCF-7 and MDA-MB-231 cells. Furthermore, silencing of CARM1 reduced SLC7A11 expression, and SLC7A11 overexpression relieved the CARM1 silencing-induced effects. Further, overexpression of CARM1 counteracted the inhibitory effects of USP4 silencing on tumor growth <em>in vivo</em>.</div></div><div><h3>Conclusion</h3><div>Our study reveals a novel mechanism by which USP4-dependent CARM1 promotes the malignant growth of BC cells by interacting with SLC7A11. Targeting this axis may provide a potential therapeutic strategy for BC.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 2","pages":"Pages e196-e207"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Clinical Review of Subcutaneous Trastuzumab and the Fixed-Dose Combination of Pertuzumab and Trastuzumab for Subcutaneous Injection in the Treatment of HER2-Positive Breast Cancer 关于皮下注射曲妥珠单抗以及固定剂量的帕妥珠单抗和曲妥珠单抗皮下注射组合治疗 HER2 阳性乳腺癌的临床综述》（A Clinical Review of Subcutaneous Trastuzumab and the Fixed-Dose Combination of Pertuzumab and Trastuzumab for Subcutaneous Injection in the Treatment of HER2-Positive Breast Cancer）。

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clbc.2024.10.005

Julia L. Ziegengeist , Antoinette R. Tan

Therapy directed against human epidermal growth factor receptor type 2 (HER2) is the standard of care for patients with early-stage and metastatic HER2-positive breast cancer. Treating patients with HER2-positive breast cancer with anti-HER2-monoclonal antibodies, specifically trastuzumab and pertuzumab, is considered standard of care in the neoadjuvant and adjuvant settings and in the first-line setting for metastatic HER2-positive breast cancer. Pertuzumab and trastuzumab are commonly administered intravenously. Subcutaneous (SC) formulations of trastuzumab alone and as a combined product of pertuzumab and trastuzumab are now available for clinical use. Phase III trial results demonstrate that the efficacy and safety of SC trastuzumab and fixed-dose combination of pertuzumab, trastuzumab, and hyaluronidase-zzxf for subcutaneous (PH FDC SC) injection and the intravenous (IV) formulation counterparts are comparable. SC formulations of anti-HER2 monoclonal antibodies offer several advantages over IV counterparts, including shorter administration time, less need for IV access, and better resource utilization for treatment facilities. This review summarizes the clinical data supporting the use of SC trastuzumab and PH FDC SC injection in treating early-stage and metastatic HER2-positive breast cancer and highlights the benefits of SC injection compared to the IV formulations.

针对人类表皮生长因子受体 2 型（HER2）的治疗是早期和转移性 HER2 阳性乳腺癌患者的标准治疗方法。使用抗 HER2 单克隆抗体（特别是曲妥珠单抗和培妥珠单抗）治疗 HER2 阳性乳腺癌患者被视为新辅助治疗和辅助治疗以及转移性 HER2 阳性乳腺癌一线治疗的标准疗法。帕妥珠单抗和曲妥珠单抗通常采用静脉注射。曲妥珠单抗的皮下注射（SC）制剂以及pertuzumab 和曲妥珠单抗的复方制剂现已用于临床。III期试验结果表明，曲妥珠单抗皮下注射剂型以及pertuzumab、曲妥珠单抗和透明质酸酶-zzxf的固定剂量联合皮下注射剂型（PH FDC SC）与静脉注射剂型的疗效和安全性相当。抗 HER2 单克隆抗体的皮下注射制剂与静脉注射制剂相比具有一些优势，包括给药时间更短、无需静脉注射以及治疗设施的资源利用率更高。本综述总结了支持使用曲妥珠单抗皮下注射剂和PH FDC皮下注射剂治疗早期和转移性HER2阳性乳腺癌的临床数据，并强调了皮下注射剂与静脉注射剂相比的优势。

{"title":"A Clinical Review of Subcutaneous Trastuzumab and the Fixed-Dose Combination of Pertuzumab and Trastuzumab for Subcutaneous Injection in the Treatment of HER2-Positive Breast Cancer","authors":"Julia L. Ziegengeist , Antoinette R. Tan","doi":"10.1016/j.clbc.2024.10.005","DOIUrl":"10.1016/j.clbc.2024.10.005","url":null,"abstract":"<div><div>Therapy directed against human epidermal growth factor receptor type 2 (HER2) is the standard of care for patients with early-stage and metastatic HER2-positive breast cancer. Treating patients with HER2-positive breast cancer with anti-HER2-monoclonal antibodies, specifically trastuzumab and pertuzumab, is considered standard of care in the neoadjuvant and adjuvant settings and in the first-line setting for metastatic HER2-positive breast cancer. Pertuzumab and trastuzumab are commonly administered intravenously. Subcutaneous (SC) formulations of trastuzumab alone and as a combined product of pertuzumab and trastuzumab are now available for clinical use. Phase III trial results demonstrate that the efficacy and safety of SC trastuzumab and fixed-dose combination of pertuzumab, trastuzumab, and hyaluronidase-zzxf for subcutaneous (PH FDC SC) injection and the intravenous (IV) formulation counterparts are comparable. SC formulations of anti-HER2 monoclonal antibodies offer several advantages over IV counterparts, including shorter administration time, less need for IV access, and better resource utilization for treatment facilities. This review summarizes the clinical data supporting the use of SC trastuzumab and PH FDC SC injection in treating early-stage and metastatic HER2-positive breast cancer and highlights the benefits of SC injection compared to the IV formulations.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 2","pages":"Pages e124-e132"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Another Biosignature for Ductal Carcinoma In Situ—Have We Moved the Needle? 乳腺导管原位癌的另一个生物特征--我们移针了吗？

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clbc.2024.10.017

Hannah Bacon , Ezra Hahn

引用次数: 0

Real-World Analysis of Breast Cancer Patients Qualifying for Adjuvant CDK4/6 Inhibitors 对符合 CDK4/6 抑制剂辅助治疗条件的乳腺癌患者进行真实世界分析

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clbc.2024.08.022

Yada Kanjanapan , Wayne Anderson , Mirka Smith , Jenny Green , Elizabeth Chalker , Paul Craft

Background

Adjuvant CDK4/6 inhibitors abemaciclib and ribociclib improved disease-free survival (DFS) added to endocrine therapy in hormone receptor (HR)-positive HER2-negative early breast cancer (EBC), in monarchE (NCT03155997) and NATALEE (NCT03701334) trials respectively. We assessed the proportion and outcome of EBC patients qualifying for adjuvant CDK4/6 inhibitors in the real-world.

Methods

Consecutive female patients with HR-positive HER2-negative EBC between 1997 and 2017 from the Australian Capital Territory and South-East New South Wales Breast Cancer Treatment Group registry were analyzed. Patients eligible for abemaciclib had ≥4 axillary nodes involved or 1-3 nodes plus primary >5 cm or grade 3. Ribociclib eligibility was defined as node-positive and node-negative with primary >5 cm or >2 cm grade 3.

Results

Of 3840 patients, 671 (17.5%) were abemaciclib-eligible and 1587 (41.3%) ribociclib-eligible . The 5-year DFS was 77% and 94% in abemaciclib-eligible and noneligible registry patients respectively (HR 2.6, 95% CI 2.26-3.05, P < .001). The 5-year DFS was 86% and 97% in ribociclib-eligible and noneligible registry patients respectively (HR 1.92, 95% CI 1.67-2.19, P < .001). Compared with monarchE trial patients, abemaciclib-eligible registry patients were older (median 55 years in registry vs. 51 years in trial), with lower nodal burden (≥4 nodes in 44% in registry vs. 60% in trial). There were more stage III cancers in NATALEE trial patients (60%) than ribociclib-eligible registry patients (24%).

Conclusions

Many women with EBC will qualify for adjuvant CDK4/6 inhibitors (17.5% abemaciclib, 41.3% ribociclib) with resource and workforce implications. In the real-world setting, a greater proportion of adjuvant CDK4/6-eligible patients have lower stage disease, therefore the absolute benefit from treatment may be smaller than estimated by the trials.

在 monarchE (NCT03155997) 和 NATALEE (NCT03701334) 试验中，在激素受体 (HR) 阳性 HER2 阴性早期乳腺癌 (EBC) 中，辅助 CDK4/6 抑制剂 abemaciclib 和 ribociclib 在内分泌治疗的基础上提高了无病生存率 (DFS)。我们评估了现实世界中符合CDK4/6抑制剂辅助治疗条件的EBC患者的比例和疗效。我们对澳大利亚首都直辖区和新南威尔士东南部乳腺癌治疗小组登记处 1997 年至 2017 年间 HR 阳性 HER2 阴性 EBC 连续女性患者进行了分析。符合abemaciclib治疗条件的患者腋窝受累结节≥4个，或1-3个结节加原发灶>5厘米或3级。Ribociclib资格定义为结节阳性和结节阴性且原发灶>5厘米或>2厘米的3级患者。在3840例患者中，671例（17.5%）符合abemaciclib资格，1587例（41.3%）符合ribociclib资格。符合abemaciclib条件和不符合条件的登记患者的5年DFS分别为77%和94%（HR 2.6，95% CI 2.26-3.05，< .001）。符合Ribociclib条件和不符合条件的登记患者的5年DFS分别为86%和97%（HR 1.92，95% CI 1.67-2.19，< .001）。与 monarchE 试验患者相比，符合 abemaciclib 资格的登记患者年龄更大（中位 55 岁对 51 岁），结节负荷更低（44% 的患者结节数≥4 个，60% 的患者结节数≥4 个）。NATALEE试验患者的III期癌症比例（60%）高于符合ribociclib资格的登记患者（24%）。许多EBC女性患者将符合CDK4/6抑制剂辅助治疗的条件（17.5%为abemaciclib，41.3%为ribociclib），这将对资源和劳动力产生影响。在现实世界中，更多符合 CDK4/6 辅助治疗条件的患者病情处于较低阶段，因此治疗的绝对获益可能小于试验的估计值。

{"title":"Real-World Analysis of Breast Cancer Patients Qualifying for Adjuvant CDK4/6 Inhibitors","authors":"Yada Kanjanapan , Wayne Anderson , Mirka Smith , Jenny Green , Elizabeth Chalker , Paul Craft","doi":"10.1016/j.clbc.2024.08.022","DOIUrl":"10.1016/j.clbc.2024.08.022","url":null,"abstract":"<div><h3>Background</h3><div>Adjuvant CDK4/6 inhibitors abemaciclib and ribociclib improved disease-free survival (DFS) added to endocrine therapy in hormone receptor (HR)-positive HER2-negative early breast cancer (EBC), in monarchE (<span><span>NCT03155997</span><svg><path></path></svg></span>) and NATALEE (<span><span>NCT03701334</span><svg><path></path></svg></span>) trials respectively. We assessed the proportion and outcome of EBC patients qualifying for adjuvant CDK4/6 inhibitors in the real-world.</div></div><div><h3>Methods</h3><div>Consecutive female patients with HR-positive HER2-negative EBC between 1997 and 2017 from the Australian Capital Territory and South-East New South Wales Breast Cancer Treatment Group registry were analyzed. Patients eligible for abemaciclib had ≥4 axillary nodes involved or 1-3 nodes plus primary >5 cm or grade 3. Ribociclib eligibility was defined as node-positive and node-negative with primary >5 cm or >2 cm grade 3.</div></div><div><h3>Results</h3><div>Of 3840 patients, 671 (17.5%) were abemaciclib-eligible and 1587 (41.3%) ribociclib-eligible . The 5-year DFS was 77% and 94% in abemaciclib-eligible and noneligible registry patients respectively (HR 2.6, 95% CI 2.26-3.05, <em>P</em> < .001). The 5-year DFS was 86% and 97% in ribociclib-eligible and noneligible registry patients respectively (HR 1.92, 95% CI 1.67-2.19, <em>P</em> < .001). Compared with monarchE trial patients, abemaciclib-eligible registry patients were older (median 55 years in registry vs. 51 years in trial), with lower nodal burden (≥4 nodes in 44% in registry vs. 60% in trial). There were more stage III cancers in NATALEE trial patients (60%) than ribociclib-eligible registry patients (24%).</div></div><div><h3>Conclusions</h3><div>Many women with EBC will qualify for adjuvant CDK4/6 inhibitors (17.5% abemaciclib, 41.3% ribociclib) with resource and workforce implications. In the real-world setting, a greater proportion of adjuvant CDK4/6-eligible patients have lower stage disease, therefore the absolute benefit from treatment may be smaller than estimated by the trials.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 2","pages":"Pages e159-e169.e2"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Performance of Digital Breast Tomosynthesis Versus Digital Mammography in Women With a Family History of Breast Cancer: A Systematic Review 在有乳腺癌家族史的女性中，数字乳腺 X 线断层摄影与数字乳腺 X 线照相术的性能对比：系统回顾

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clbc.2024.09.013

Tong Li , Jennifer Isautier , Janie M. Lee , M. Luke Marinovich , Nehmat Houssami

Background

There is limited evidence on the performance of digital breast tomosynthesis (DBT) in populations at increased risk of breast cancer. Our objective was to systematically review evidence on the performance of DBT versus digital mammography (DM) in women with a family history of breast cancer (FHBC).

Methods

We searched 5 databases (2011–January 2024) for studies comparing DBT and DM in women with a FHBC that reported any measure of cancer detection, recall, sensitivity and specificity. Findings were presented using a descriptive and narrative approach. Risk of bias was assessed using QUADAS-2/C.

Results

Five (4 screening, 1 diagnostic) studies were included (total 3089 DBT, 3024 DM) with most (4/5) being prospective including 1 RCT. All studies were assessed as being at high risk of bias or applicability concern. Four screening studies reported recall rate (range: DBT: 2.7%-4.5%, DM: 2.8%-11.5%) with 3 reporting DBT had lower rates than DM. Cancer detection rates (CDR) were reported in the same studies (DBT: 5.1-11.6 per 1000, DM: 3.8-8.3); 3 reported higher CDR for DBT (vs. DM), and 1 reported same CDR for both. Compared with DM, higher values for sensitivity, specificity and PPV for DBT were reported in 2 studies.

Conclusion

This review provides early evidence that DBT may outperform DM for screening women with a FHBC. Our findings support further evaluation of DBT in this population. However, summarized findings were based on few studies and participants, and high-quality studies with improved methodology are needed to address biases identified in our review.

背景：关于数字乳腺断层扫描（DBT）在乳腺癌高危人群中的表现，目前证据有限。我们的目的是系统地回顾有乳腺癌家族史（FHBC）的女性中，数字乳腺断层摄影（DBT）与数字乳腺X光摄影（DM）的性能对比证据：我们检索了 5 个数据库（2011 年 1 月至 2024 年 1 月），以查找在有乳腺癌家族史的女性中比较 DBT 和 DM 的研究，这些研究报告了癌症检测、召回、灵敏度和特异性的任何指标。研究结果采用描述性和叙述性方法呈现。使用 QUADAS-2/C 评估偏倚风险：结果：共纳入了五项（4 项筛查，1 项诊断）研究（共计 3089 项 DBT，3024 项 DM），其中大部分（4/5）为前瞻性研究，包括一项 RCT。所有研究均被评估为存在高偏倚风险或适用性问题。四项筛查研究报告了召回率（范围：DBT：2.7%-4.5%，DM：2.8%-11.5%），其中三项报告称 DBT 的召回率低于 DM。相同的研究报告了癌症检出率（CDR）（DBT：5.1-11.6‰，DM：3.8-8.3‰）；3 项研究报告 DBT 的 CDR 较高（与 DM 相比），1 项研究报告两者的 CDR 相同。与 DM 相比，2 项研究报告了 DBT 更高的灵敏度、特异性和 PPV 值：本综述提供了早期证据，证明在筛查患有 FHBC 的女性时，DBT 可能优于 DM。我们的研究结果支持在这一人群中进一步评估 DBT。然而，总结的结果是基于少数研究和参与者得出的，因此需要进行方法改进的高质量研究，以解决我们的综述中发现的偏差。

{"title":"Performance of Digital Breast Tomosynthesis Versus Digital Mammography in Women With a Family History of Breast Cancer: A Systematic Review","authors":"Tong Li , Jennifer Isautier , Janie M. Lee , M. Luke Marinovich , Nehmat Houssami","doi":"10.1016/j.clbc.2024.09.013","DOIUrl":"10.1016/j.clbc.2024.09.013","url":null,"abstract":"<div><h3>Background</h3><div>There is limited evidence on the performance of digital breast tomosynthesis (DBT) in populations at increased risk of breast cancer. Our objective was to systematically review evidence on the performance of DBT versus digital mammography (DM) in women with a family history of breast cancer (FHBC).</div></div><div><h3>Methods</h3><div>We searched 5 databases (2011–January 2024) for studies comparing DBT and DM in women with a FHBC that reported any measure of cancer detection, recall, sensitivity and specificity. Findings were presented using a descriptive and narrative approach. Risk of bias was assessed using QUADAS-2/C.</div></div><div><h3>Results</h3><div>Five (4 screening, 1 diagnostic) studies were included (total 3089 DBT, 3024 DM) with most (4/5) being prospective including 1 RCT. All studies were assessed as being at high risk of bias or applicability concern. Four screening studies reported recall rate (range: DBT: 2.7%-4.5%, DM: 2.8%-11.5%) with 3 reporting DBT had lower rates than DM. Cancer detection rates (CDR) were reported in the same studies (DBT: 5.1-11.6 per 1000, DM: 3.8-8.3); 3 reported higher CDR for DBT (vs. DM), and 1 reported same CDR for both. Compared with DM, higher values for sensitivity, specificity and PPV for DBT were reported in 2 studies.</div></div><div><h3>Conclusion</h3><div>This review provides early evidence that DBT may outperform DM for screening women with a FHBC. Our findings support further evaluation of DBT in this population. However, summarized findings were based on few studies and participants, and high-quality studies with improved methodology are needed to address biases identified in our review.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 2","pages":"Pages e103-e112"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enhancing Early Breast Cancer Diagnosis With Contrast-Enhanced Ultrasound Radiomics: Insights From Intratumoral and Peritumoral Analysis 增强对比超声放射组学增强早期乳腺癌诊断：来自肿瘤内和肿瘤周围分析的见解。

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clbc.2024.11.011

Guoqiu Li , Xiaoli Huang , Huaiyu Wu , Hongtian Tian , Zhibin Huang , Mengyun Wang , Qinghua Liu , Jinfeng Xu , Ligang Cui , Fajin Dong

Introduction

To develop and validate contrast-enhanced ultrasound (CEUS) radiomics model for the accurate diagnosis of breast cancer by integrating intratumoral and peritumoral regions.

Materials and Methods

This study enrolled 333 patients with breast lesions from Shenzhen people's hospital between March 2022 and March 2024. Radiomics features were extracted from both intratumoral and peritumoral (3 mm) regions on CEUS images. Significant features were identified using the Mann–Whitney U test, Spearman's correlation coefficient, and least absolute shrinkage and selection operator logistic regression. These features were used to construct radiomics models. The model's performance was evaluated using the area under the receiver operating characteristic curve, area under curve (AUC), decision curve analysis, and calibration curves.

Results

The radiomics models demonstrated robust diagnostic performance in both the training and testing sets. The model that combined intratumoral and peritumoral features showed superior predictive accuracy, with AUCs of 0.933 (95% CI: 0.891, 0.974) and 0.949 (95% CI: 0.916, 0.983), respectively, compared to the intratumoral model alone. Calibration curves indicated excellent agreement between predicted and observed outcomes, with Hosmer–Lemeshow test P = .97 and P = .62 for the both the training and testing sets, respectively. decision curve analysis revealed that the combined model provided significant clinical benefits across a wide range of threshold probabilities, outperforming the intratumoral model in both sets.

Conclusion

The radiomics model integrating intratumoral and peritumoral features shows significant potential for the accurate diagnosis of breast cancer, enhancing clinical decision-making and guiding treatment strategies.

目的：建立并验证超声造影（CEUS）放射组学模型，通过整合肿瘤内和肿瘤周围区域来准确诊断乳腺癌。材料与方法：本研究纳入深圳市人民医院2022年3月至2024年3月乳腺病变患者333例。从超声造影图像上的瘤内和瘤周（3mm）区域提取放射组学特征。使用Mann-Whitney U检验、Spearman相关系数、最小绝对收缩和选择算子逻辑回归来确定显著特征。利用这些特征构建放射组学模型。通过接收方工作特征曲线下面积、曲线下面积（AUC）、决策曲线分析和校准曲线对模型的性能进行了评价。结果：放射组学模型在训练集和测试集都表现出强大的诊断性能。结合瘤内和瘤周特征的模型与单独瘤内模型相比，auc分别为0.872 （95% CI: 0.829, 0.915）和0.863 (95% CI: 0.770, 0.956)，预测精度更高。校正曲线显示预测结果与观测结果非常吻合，训练集和测试集的Hosmer-Lemeshow检验P= 0.97和P= 0.62。决策曲线分析显示，联合模型在广泛的阈值概率范围内提供了显著的临床效益，在两组模型中都优于肿瘤内模型。结论：整合肿瘤内和肿瘤周围特征的放射组学模型在乳腺癌的准确诊断、临床决策和指导治疗策略方面具有重要潜力。

{"title":"Enhancing Early Breast Cancer Diagnosis With Contrast-Enhanced Ultrasound Radiomics: Insights From Intratumoral and Peritumoral Analysis","authors":"Guoqiu Li , Xiaoli Huang , Huaiyu Wu , Hongtian Tian , Zhibin Huang , Mengyun Wang , Qinghua Liu , Jinfeng Xu , Ligang Cui , Fajin Dong","doi":"10.1016/j.clbc.2024.11.011","DOIUrl":"10.1016/j.clbc.2024.11.011","url":null,"abstract":"<div><h3>Introduction</h3><div>To develop and validate contrast-enhanced ultrasound (CEUS) radiomics model for the accurate diagnosis of breast cancer by integrating intratumoral and peritumoral regions.</div></div><div><h3>Materials and Methods</h3><div>This study enrolled 333 patients with breast lesions from Shenzhen people's hospital between March 2022 and March 2024. Radiomics features were extracted from both intratumoral and peritumoral (3 mm) regions on CEUS images. Significant features were identified using the Mann–Whitney U test, Spearman's correlation coefficient, and least absolute shrinkage and selection operator logistic regression. These features were used to construct radiomics models. The model's performance was evaluated using the area under the receiver operating characteristic curve, area under curve (AUC), decision curve analysis, and calibration curves.</div></div><div><h3>Results</h3><div>The radiomics models demonstrated robust diagnostic performance in both the training and testing sets. The model that combined intratumoral and peritumoral features showed superior predictive accuracy, with AUCs of 0.933 (95% CI: 0.891, 0.974) and 0.949 (95% CI: 0.916, 0.983), respectively, compared to the intratumoral model alone. Calibration curves indicated excellent agreement between predicted and observed outcomes, with Hosmer–Lemeshow test <em>P</em> = .97 and <em>P</em> <strong>=</strong> .62 for the both the training and testing sets, respectively. decision curve analysis revealed that the combined model provided significant clinical benefits across a wide range of threshold probabilities, outperforming the intratumoral model in both sets.</div></div><div><h3>Conclusion</h3><div>The radiomics model integrating intratumoral and peritumoral features shows significant potential for the accurate diagnosis of breast cancer, enhancing clinical decision-making and guiding treatment strategies.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 2","pages":"Pages 180-191"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Plasma-free Amino Acid Profile is Beneficial for Breast Cancer Screening in Women With Dense Breasts 无血浆氨基酸谱对致密乳房妇女的乳腺癌筛查有益。

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clbc.2024.11.001

Saeko Teraoka , Hiroshi Yamamoto , Shinya Kikuchi , Yoshiya Horimoto , Kimito Yamada , Hiroshi Kaise , Mari Hosonaga , Takahiko Kawate , Kana Miyahara , Ai Ueda , Mariko Asaoka , Miki Okazaki , Natsuki Uenaka , Saori Kawai , Takashi Ishikawa

Background

AminoIndex™ Cancer Screening (AICS breast) was developed as a breast cancer screening test using multivariate analysis of plasma free amino acid (PFAA) profiles. This study investigated the relationship between the AICS breast rank and breast density on mammography (MMG) for the detection of breast cancer.

Materials and Methods

MMG and blood samples were obtained preoperatively from 224 patients with breast cancer who did not receive neoadjuvant chemotherapy between 2017 and 2019. PFAA concentration was measured using liquid chromatography-mass spectrometry, and the AICS breast and AICS ranks were calculated. Detection rates were compared between MMG (categories 3-5) and AICS breasts (ranks B and C) according to breast density.

Results

Breast density was classified as extremely dense in 9.4%, heterogeneously dense in 48.2%, scattered in 29.9%, and fatty in 12.5% of patients. Dense breasts (extremely dense and heterogeneously dense) represented 57.6%. The overall detection rate by MMG was 82.6% and significantly lower in patients with dense breasts (74.4%) compared to non-dense breasts (93.7%). The overall detection rate by AICS breast was 50.0%, with no difference between patients with dense breasts (45.7%) and those with non-dense breasts (55.8%). The combination of MMG and AICS breast increased the detection rate to 91.5% overall, 88.3% in patients with dense breasts, and 95.8% in those with non-dense breasts.

Conclusion

This study demonstrated that the detection rate of AICS breast was not associated with breast density, unlike MMG. Adding AICS breast to MMG may be beneficial for breast cancer screening in patients with dense breasts.

背景：AminoIndex™Cancer Screening （AICS breast）是一种利用血浆游离氨基酸（PFAA）谱进行多变量分析的乳腺癌筛查试验。本研究探讨乳房x线摄影（MMG）检测乳腺癌的AICS乳房等级与乳腺密度的关系。材料与方法：对2017 - 2019年未接受新辅助化疗的224例乳腺癌患者术前采集MMG和血液样本。采用液相色谱-质谱法测定PFAA浓度，计算AICS乳房和AICS等级。根据乳腺密度比较MMG（3-5类）和AICS （B、C类）乳腺的检出率。结果：乳腺密度为极致密者占9.4%，非均匀致密者占48.2%，散在性致密者占29.9%，脂肪性致密者占12.5%。致密性乳房（极致密和非均匀致密）占57.6%。MMG的总检出率为82.6%，致密乳房患者的MMG检出率（74.4%）明显低于非致密乳房患者（93.7%）。总体AICS乳房检出率为50.0%，致密乳房患者（45.7%）与非致密乳房患者（55.8%）之间无差异。MMG联合AICS乳房的检出率总体提高到91.5%，致密乳房的检出率为88.3%，非致密乳房的检出率为95.8%。结论：与MMG不同，AICS乳腺的检出率与乳腺密度无关。在MMG中加入AICS乳房可能有利于致密乳房患者的乳腺癌筛查。

{"title":"Plasma-free Amino Acid Profile is Beneficial for Breast Cancer Screening in Women With Dense Breasts","authors":"Saeko Teraoka , Hiroshi Yamamoto , Shinya Kikuchi , Yoshiya Horimoto , Kimito Yamada , Hiroshi Kaise , Mari Hosonaga , Takahiko Kawate , Kana Miyahara , Ai Ueda , Mariko Asaoka , Miki Okazaki , Natsuki Uenaka , Saori Kawai , Takashi Ishikawa","doi":"10.1016/j.clbc.2024.11.001","DOIUrl":"10.1016/j.clbc.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>AminoIndex™ Cancer Screening (AICS breast) was developed as a breast cancer screening test using multivariate analysis of plasma free amino acid (PFAA) profiles. This study investigated the relationship between the AICS breast rank and breast density on mammography (MMG) for the detection of breast cancer.</div></div><div><h3>Materials and Methods</h3><div>MMG and blood samples were obtained preoperatively from 224 patients with breast cancer who did not receive neoadjuvant chemotherapy between 2017 and 2019. PFAA concentration was measured using liquid chromatography-mass spectrometry, and the AICS breast and AICS ranks were calculated. Detection rates were compared between MMG (categories 3-5) and AICS breasts (ranks B and C) according to breast density.</div></div><div><h3>Results</h3><div>Breast density was classified as extremely dense in 9.4%, heterogeneously dense in 48.2%, scattered in 29.9%, and fatty in 12.5% of patients. Dense breasts (extremely dense and heterogeneously dense) represented 57.6%. The overall detection rate by MMG was 82.6% and significantly lower in patients with dense breasts (74.4%) compared to non-dense breasts (93.7%). The overall detection rate by AICS breast was 50.0%, with no difference between patients with dense breasts (45.7%) and those with non-dense breasts (55.8%). The combination of MMG and AICS breast increased the detection rate to 91.5% overall, 88.3% in patients with dense breasts, and 95.8% in those with non-dense breasts.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that the detection rate of AICS breast was not associated with breast density, unlike MMG. Adding AICS breast to MMG may be beneficial for breast cancer screening in patients with dense breasts.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 2","pages":"Pages 149-156"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A 7-Gene Biosignature for Ductal Carcinoma in situ of the Breast Identifies Subpopulations of HER2-positive Patients With Distinct Recurrence Rates After Breast-Conserving Surgery and Radiation Therapy 乳腺原位导管癌的 7 基因生物特征可识别 HER2 阳性患者亚群，这些患者在接受保乳手术和放疗后的复发率各不相同。

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clbc.2024.08.016

Frank Vicini , Chirag Shah , Karuna Mittal , Jame Abraham , Megan Kruse , Sheila Weinmann , Michael Leo , Rachel Rabinovitch , Fredrik Wärnberg , Pat W. Whitworth , Brian J. Czerniecki , Steven C. Shivers , Troy Bremer

Purpose

A subpopulation of women with ductal carcinoma in situ (DCIS) remains at risk for in-breast recurrence (IBR) following breast-conserving surgery (BCS) and radiation therapy (RT). The NSABP B-43 trial evaluated the role of concurrent RT and trastuzumab in patients with HER2-positive DCIS but did not reach the prespecified endpoint. We hypothesized that a 7-gene biosignature (DCISionRT) with its Residual Risk subtype (RRt) could identify 2 groups of HER2(3+) patients with significantly different IBR risks after BCS plus RT.

Patients and Methods

All patients with HER2(3+) DCIS (n = 178) treated with BCS plus RT were selected from a combined multinational patient cohort. Treatment decisions were neither randomized nor strictly rules-based. Biosignature testing was performed on all patients and stratified with previously defined groups: (1) Combined Low Risk group (DS ≤ 2.8) and Elevated Risk group (DS > 2.8) without RRt or (2) Residual Risk subtype. Kaplan–Meier analysis was used to compute IBR curves.

Results

Sixty-three percent of HER2(3+) patients (113/178) were classified into the Residual Risk subtype. These patients had significantly higher 10-year rates of IBR compared to the nonresidual risk group (16.2% vs. 1.6%, P = .01). The Residual Risk subtype had more nuclear grade 3 disease (87% vs. 63%, P < .001), but age, size, and grade were not associated with IBR rate (P = NS) on univariate and multivariable analysis. Only the Residual Risk group was associated with IBR (P = .05) in multivariate analysis.

Conclusion

The 7-gene biosignature with RRt identified a subset of HER2(3+) patients with greater IBR rates following BCS and RT beyond traditional clinical and pathologic features. Consideration of therapies to reduce these elevated IBR rates should be evaluated, including the incorporation of HER2-targeted therapy.

目的：在接受保乳手术（BCS）和放疗（RT）后，一部分患有导管原位癌（DCIS）的女性仍面临乳房内复发（IBR）的风险。NSABP B-43 试验评估了同期 RT 和曲妥珠单抗在 HER2 阳性 DCIS 患者中的作用，但未达到预设终点。我们假设，7 个基因生物特征（DCISionRT）及其残余风险亚型（RRt）可以识别出 BCS 加 RT 后 IBR 风险显著不同的两组 HER2(3+) 患者：所有接受BCS加RT治疗的HER2(3+) DCIS患者（n = 178）都是从一个多国联合患者队列中挑选出来的。治疗决定既不是随机的，也不是严格基于规则的。对所有患者进行了生物特征检测，并按之前定义的组别进行了分层：(1) 联合低风险组（DS ≤ 2.8）和高风险组（DS > 2.8），无 RRt 或 (2) 残余风险亚型。采用卡普兰-梅耶尔分析法计算IBR曲线：63%的HER2(3+)患者（113/178）被归入残余风险亚型。与非残余风险组相比，这些患者的10年IBR率明显更高（16.2% vs. 1.6%，P = .01）。残余风险亚型有更多的核3级疾病（87% vs. 63%，P < .001），但在单变量和多变量分析中，年龄、大小和分级与IBR率无关（P = NS）。在多变量分析中，只有残余风险组与IBR相关（P = .05）：结论：具有 RRt 的 7 基因生物特征确定了 HER2(3+)患者的一个子集，该子集在 BCS 和 RT 后的 IBR 率高于传统的临床和病理特征。应考虑采用哪些疗法来降低这些升高的IBR率，包括纳入HER2靶向疗法。

{"title":"A 7-Gene Biosignature for Ductal Carcinoma in situ of the Breast Identifies Subpopulations of HER2-positive Patients With Distinct Recurrence Rates After Breast-Conserving Surgery and Radiation Therapy","authors":"Frank Vicini , Chirag Shah , Karuna Mittal , Jame Abraham , Megan Kruse , Sheila Weinmann , Michael Leo , Rachel Rabinovitch , Fredrik Wärnberg , Pat W. Whitworth , Brian J. Czerniecki , Steven C. Shivers , Troy Bremer","doi":"10.1016/j.clbc.2024.08.016","DOIUrl":"10.1016/j.clbc.2024.08.016","url":null,"abstract":"<div><h3>Purpose</h3><div>A subpopulation of women with ductal carcinoma in situ (DCIS) remains at risk for in-breast recurrence (IBR) following breast-conserving surgery (BCS) and radiation therapy (RT). The NSABP B-43 trial evaluated the role of concurrent RT and trastuzumab in patients with HER2-positive DCIS but did not reach the prespecified endpoint. We hypothesized that a 7-gene biosignature (DCISionRT) with its Residual Risk subtype (RRt) could identify 2 groups of HER2(3+) patients with significantly different IBR risks after BCS plus RT.</div></div><div><h3>Patients and Methods</h3><div>All patients with HER2(3+) DCIS (n = 178) treated with BCS plus RT were selected from a combined multinational patient cohort. Treatment decisions were neither randomized nor strictly rules-based. Biosignature testing was performed on all patients and stratified with previously defined groups: (1) Combined Low Risk group (DS ≤ 2.8) and Elevated Risk group (DS > 2.8) without RRt or (2) Residual Risk subtype. Kaplan–Meier analysis was used to compute IBR curves.</div></div><div><h3>Results</h3><div>Sixty-three percent of HER2(3+) patients (113/178) were classified into the Residual Risk subtype. These patients had significantly higher 10-year rates of IBR compared to the nonresidual risk group (16.2% vs. 1.6%, <em>P</em> = .01). The Residual Risk subtype had more nuclear grade 3 disease (87% vs. 63%, <em>P</em> < .001), but age, size, and grade were not associated with IBR rate (<em>P</em> = NS) on univariate and multivariable analysis. Only the Residual Risk group was associated with IBR (<em>P</em> = .05) in multivariate analysis.</div></div><div><h3>Conclusion</h3><div>The 7-gene biosignature with RRt identified a subset of HER2(3+) patients with greater IBR rates following BCS and RT beyond traditional clinical and pathologic features. Consideration of therapies to reduce these elevated IBR rates should be evaluated, including the incorporation of HER2-targeted therapy.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 2","pages":"Pages e152-e158.e1"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of [18F] FDG PET/CT and [18F]FDG PET/MRI in the Detection of Distant Metastases in Breast Cancer: A Meta-Analysis 比较[18F] FDG PET/CT和[18F] FDG PET/MRI检测乳腺癌远处转移：元分析。

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clbc.2024.09.015

Fangqian Shen, Qi Liu, Yishuang Wang, Can Chen, Hu Ma

Purpose

This meta-analysis aims to assess and compare the diagnostic effectiveness of [¹⁸F] FDG PET/CT and [¹⁸F] FDG PET/MRI for distant metastases in breast cancer patients.

Methods

A comprehensive search of the PubMed and Embase databases was performed to identify relevant articles until September 22, 2023. Studies were eligible to be included if they assessed the diagnostic performance of [¹⁸F] FDG PET/CT and/or [¹⁸F] FDG PET/MRI in detecting distant metastases of breast cancer patients. The DerSimonian and Laird method was used to assess sensitivity and specificity, and then transformed through the Freeman-Tukey double arcsine transformation.

Results

29 articles consisting of 3779 patients were finally included in this study. The overall sensitivity of [¹⁸F] FDG PET/CT in diagnosing distant metastases of breast cancer was 0.96 (95% CI: 0.93-0.98), and the overall specificity was 0.95 (95% CI: 0.92-0.97). The overall sensitivity of [¹⁸F] FDG PET/MRI was 1.00 (95% CI: 0.97-1.00), and the specificity was 0.97 (95% CI: 0.94-1.00). The results suggested that [¹⁸F] FDG PET/CT and [¹⁸F] FDG PET/MRI appears to have similar sensitivity (P = .16) and specificity (P = .30) in diagnosing distant metastases of breast cancer.

Conclusions

The results of our meta-analysis indicated that [¹⁸F] FDG PET/CT and [¹⁸F] FDG PET/MRI in diagnosing distant metastases of breast cancer appear to have similar sensitivity and specificity. Patients who have access to only one of these modalities will not have the accuracy of their staging compromised. In clinical practice, both of these imaging techniques have their respective strengths and limitations, and physicians should take these into account when making the most suitable choice for patients.

目的：本荟萃分析旨在评估和比较[18F] FDG PET/CT和[18F] FDG PET/MRI对乳腺癌患者远处转移的诊断效果：对PubMed和Embase数据库进行了全面检索，以确定截至2023年9月22日的相关文章。如果研究评估了[18F] FDG PET/CT和/或[18F] FDG PET/MRI在检测乳腺癌患者远处转移方面的诊断性能，则符合纳入条件。本研究采用 DerSimonian 和 Laird 方法评估灵敏度和特异性，然后通过 Freeman-Tukey 双弧线变换进行转换。18F] FDG PET/CT 诊断乳腺癌远处转移的总体敏感性为 0.96（95% CI：0.93-0.98），总体特异性为 0.95（95% CI：0.92-0.97）。18F] FDG PET/MRI 的总体敏感性为 1.00（95% CI：0.97-1.00），特异性为 0.97（95% CI：0.94-1.00）。结果表明，[18F] FDG PET/CT 和 [18F] FDG PET/MRI 在诊断乳腺癌远处转移方面具有相似的敏感性（P = .16）和特异性（P = .30）：我们的荟萃分析结果表明，[18F] FDG PET/CT 和 [18F] FDG PET/MRI 在诊断乳腺癌远处转移方面具有相似的敏感性和特异性。患者如果只能使用其中一种方法，其分期的准确性也不会受到影响。在临床实践中，这两种成像技术都有各自的优势和局限性，医生在为患者做出最合适的选择时应将这些因素考虑在内。

{"title":"Comparison of [18F] FDG PET/CT and [18F]FDG PET/MRI in the Detection of Distant Metastases in Breast Cancer: A Meta-Analysis","authors":"Fangqian Shen, Qi Liu, Yishuang Wang, Can Chen, Hu Ma","doi":"10.1016/j.clbc.2024.09.015","DOIUrl":"10.1016/j.clbc.2024.09.015","url":null,"abstract":"<div><h3>Purpose</h3><div>This meta-analysis aims to assess and compare the diagnostic effectiveness of [<sup>18</sup>F] FDG PET/CT and [<sup>18</sup>F] FDG PET/MRI for distant metastases in breast cancer patients.</div></div><div><h3>Methods</h3><div>A comprehensive search of the PubMed and Embase databases was performed to identify relevant articles until September 22, 2023. Studies were eligible to be included if they assessed the diagnostic performance of [<sup>18</sup>F] FDG PET/CT and/or [<sup>18</sup>F] FDG PET/MRI in detecting distant metastases of breast cancer patients. The DerSimonian and Laird method was used to assess sensitivity and specificity, and then transformed through the Freeman-Tukey double arcsine transformation.</div></div><div><h3>Results</h3><div>29 articles consisting of 3779 patients were finally included in this study. The overall sensitivity of [<sup>18</sup>F] FDG PET/CT in diagnosing distant metastases of breast cancer was 0.96 (95% CI: 0.93-0.98), and the overall specificity was 0.95 (95% CI: 0.92-0.97). The overall sensitivity of [<sup>18</sup>F] FDG PET/MRI was 1.00 (95% CI: 0.97-1.00), and the specificity was 0.97 (95% CI: 0.94-1.00). The results suggested that [<sup>18</sup>F] FDG PET/CT and [<sup>18</sup>F] FDG PET/MRI appears to have similar sensitivity (<em>P</em> = .16) and specificity (<em>P</em> = .30) in diagnosing distant metastases of breast cancer.</div></div><div><h3>Conclusions</h3><div>The results of our meta-analysis indicated that [<sup>18</sup>F] FDG PET/CT and [<sup>18</sup>F] FDG PET/MRI in diagnosing distant metastases of breast cancer appear to have similar sensitivity and specificity. Patients who have access to only one of these modalities will not have the accuracy of their staging compromised. In clinical practice, both of these imaging techniques have their respective strengths and limitations, and physicians should take these into account when making the most suitable choice for patients.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 2","pages":"Pages e113-e123.e4"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0