Clinical breast cancer最新文献

Background: Encapsulated papillary carcinoma (EPC) is a rare breast malignancy. Controversy persists over its classification and whether its prognosis stems from histology or biology. This study clarified the role of molecular subtypes in EPC prognosis and evaluated treatment de-escalation feasibility.

Patients and methods: EPC and contemporary invasive ductal carcinoma (IDC) patients (2010-2019) were identified from the surveillance, epidemiology, and end results (SEER) database. A 1:1 propensity score matching (PSM) balanced baseline characteristics, including age, grade, stage, and molecular subtype. Breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed using Kaplan-Meier and Cox regression.

Results: We included 165 EPC and 247,581 IDC patients. EPC patients were significantly older with lower grade tumors, less nodal involvement, and higher HR+/HER2- proportions (89.7% vs. 71.1%, P < .001). Before matching, EPC showed superior BCSS (P = .044). After PSM (n = 165 per group), no significant differences were observed in BCSS (P = .207) or OS (P = .733) between groups. Subgroup analysis of HR+/HER2- patients yielded consistent results. Chemotherapy usage was low (10.3%) in EPC with excellent outcomes; radiotherapy was an independent protective factor for survival.

Conclusion: EPC's favorable prognosis is primarily driven by its molecular profile (HR+/HER2-) rather than histology. After subtype adjustment, EPC survival is equivalent to IDC. Findings support chemotherapy omission for most EPC patients while emphasizing radiotherapy for local control.

Background: Whole-breast radiation therapy (RT) following lumpectomy has become a standard of care for early-stage breast cancer (ESBC) treatment. Hypofractionated RT (HFRT) has demonstrated equivalent oncologic efficacy to standard fractionation (SFRT). The COVID-19 pandemic accelerated adoption of shorter treatment regimens; however, its impact on RT completion rates and treatment equity has not been well-characterized.

Methods: Using the National Cancer Database, patients with ESBC who received post-lumpectomy RT from 2018 to 2022 were identified. SFRT was defined as 1.8-2.0 Gy per fraction and HFRT as 2.66-2.70 Gy per fraction. RT completion was defined as receipt of ≥ 46 Gy for SFRT and ≥ 40 Gy for HFRT. Pre-COVID (2018-2019) and post-COVID (2021-2022) RT completion and HFRT adoption rates were compared using chi-square tests. Adoption and completion were analyzed by race, ethnicity, income, and facility type.

Results: Among 25,658 patients (pre-COVID n = 13,381; post-COVID n = 12,277), HFRT use increased from 82.9% to 93.6%, while SFRT declined from 17.1% to 6.4% (P < .0001). Overall RT completion improved from 94.8% to 96.4% (P < .0001). HFRT completion rates remained higher than SFRT (pre-COVID: 97.2% HFRT vs. 83.1% SFRT; post-COVID: 97.5% vs. 80.5%). HFRT adoption increased across all racial and income groups (all P < .0001), with completion exceeding 96% across all subgroups. Racial and income disparities in HFRT differences decreased by a relative reduction of 53.3% and 40.5%, respectively.

Conclusions: Post-COVID shifts toward HFRT were associated with higher RT completion and reduced disparities, suggesting more efficient and equitable treatment delivery of adjuvant breast RT.

Introduction: Breast reconstruction aims to improve quality of life after mastectomy, but women's underlying goals vary widely and are often complex. Limited research has explored how these goals differ according to indication for mastectomy, timing of reconstruction, or reconstructive technique. Understanding patients' goals is essential for shared decision-making, managing expectations, and improving patient satisfaction.

Methods: This cross-sectional mixed-methods study included women undergoing breast reconstruction within the preference arm of the GoBreast II trial at a Swedish university hospital. Participants completed a preoperative PEGASUS (Patients' Expectations and Goals: Assisting Shared Understanding of Surgery) consultation to identify individual goals. Goals were analyzed using inductive qualitative content analysis and quantified by category frequency. Comparisons were made between reconstructive technique (autologous vs. implant-based), timing (immediate vs. delayed), and indication for mastectomy (therapeutic vs. risk-reducing).

Results: Eighty-nine women were included (median age 48 years). Five main goal categories were identified: Achieving a feeling, just wanting the breast back, Aesthetic wishes, Practical matters, and the process. Women opting for implant-based reconstruction expressed more aesthetic goals than those choosing autologous reconstruction. Patients undergoing delayed reconstruction reported more goals related to practical matters. Women undergoing risk-reducing mastectomy expressed more aesthetic wishes and fewer practical concerns than women treated for breast cancer.

Conclusions: Women's goals for breast reconstruction extend beyond physical restoration and include emotional, identity-related, and aesthetic dimensions. Structured identification of patient goals may improve preoperative counselling, shared decision-making, and management of expectations in breast reconstruction.

Background: Breast cancer is a major health burden in Malaysia, where a shortage of pathologists causes long diagnostic delays, patient anxiety, and late treatment. Conventional histopathology workflows use a first-in-first-out (FIFO) system, which is inefficient since most biopsies are benign. This simulation-based study developed and validated a deep learning triage system to prioritize suspicious breast biopsy cases for pathologist review.

Materials and methods: A convolutional neural network was trained on a large, ethically sourced synthetic dataset of whole-slide images, labelled as benign or suspicious (including atypical, in situ, and invasive carcinoma), and validated on an independent synthetic test set. A discrete-event simulation replicated the pathology workflow of a typical Malaysian hospital, comparing the deep learning triage system with standard FIFO reporting. Outcomes assessed included diagnostic turnaround time (TAT), pathologist workload, and laboratory resource use.

Results: The model achieved an area under the receiver operating characteristic curve of 0.98. Simulation showed a 38.2% reduction in average TAT for suspicious cases (7.2 to 4.5 days), with a small increase for benign cases. Pathologist workload fell by 22.5%, equivalent to saving 422 hours annually, while reagent and slide use declined by 15%.

Conclusion: These in-silico findings project potential efficiency gains, though real-world validation is required. By expediting critical case reporting, reducing workload, and conserving resources, this approach offers a promising simulation-informed framework to address diagnostic bottlenecks in resource-constrained healthcare systems.

Background: The present study is designed to ascertain the occurrence rate of biomarker changes in different subtypes and their influence on the survival prognosis of breast cancer (BC) patients after neoadjuvant chemotherapy (NAC). A pathological complete response (pCR) in BC after NAC foretells a favorable prognosis, while patients who do not achieve pCR (non-pCR) may have alterations in certain biomarker profiles.

Methods: Upon institutional review board approval, we analyzed data from 3151 BC patients treated with NAC from August 2008 to December 2019. Biomarker alterations (HR, HER2) were independently evaluated by 2 to 3 senior pathologists, with follow-up ending December 31, 2024. We applied the Cox model and Kaplan-Meier curves to assess the impact of biomarker changes on Overall Survival (OS), Invasive Disease-Free Survival (iDFS), and Distant Disease-Free Survival (DDFS).

Result: A total number of 2417 non-pCR patients were included in the analysis, with 14.15% experiencing changes in biomarker profiles. HER2-positive patients had the highest rate of change post-NAC (28.01%, 184/657). HR-positive patients converting to TNBC or HR-/HER2+ had significantly poorer outcomes, with hazard ratios of 2.58 (95% CI, 1.75-3.80; P < .001) and 1.61 (95% CI, 1.61-2.50; P = .035), respectively. Conversely, TNBC patients with upregulated hormone receptors experienced improved prognosis, with a hazard ratio of 0.67 (95% CI, 0.46-0.97; P = .036).

Conclusion: Reassessment of biomarkers in residual disease (RD) may help inform Post-NAC decisions in routine clinical practice. This study reveals the impact of subtype conversion on long-term outcomes and offers theoretical support for re-evaluating RD and molecular re-stratification.

Introduction: Sentinel lymph node biopsy (SLNB) is the standard for axillary staging in breast cancer (BC). The prevalence of nodal metastases is ∼30%-40% and correlates with tumor size. For T1 tumors, nodal positivity is ∼20%, with 70% of these being micrometastases. The SOUND study demonstrated that omitting SLNB is not inferior to performing it in small tumors with negative axillary ultrasound. The objectives of this study were to evaluate the diagnostic capability of preoperative axillary ultrasound and to estimate the impact of applying SOUND criteria on staging and adjuvant treatment planning.

Materials and methods: We conducted a retrospective analysis of 597 consecutive patients with invasive BC c/uT1 c/uN0, diagnosed and treated between 2015 and 2020. Sentinel lymph nodes were assessed using the OSNA technique.

Results: Demographic and treatment data were comparable to the SOUND population. Sentinel node metastases were found in 24.1% of cases (including pN0sn i+ and pN1sn mic), higher than the 17.3% in SOUND. However, considering only pN1sn and pN2sn, metastases were 9.5%, closely resembling SOUND's 8.7%. Preoperative axillary ultrasound showed high specificity (97.7%) but very low sensitivity (7.0%) for detecting macrometastases. MRI had the highest sensitivity (31.8%). Biological features, staging, treatments and survival were overall consistent with the SOUND trial. Applying SOUND criteria would mean 10.2% of patients losing staging, which could impact chemotherapy and CDK inhibitor eligibility.

Conclusion: Despite methodological differences in sentinel node evaluation, the SOUND results may be applicable to our population. Additional imaging adds little value beyond axillary physical assessment in this context.

Background: Pathological nodal (pN) staging in breast cancer is based on the number of positive nodes but may be influenced by surgical extent and technique. Lymph node ratio (LNR)-the ratio of positive to total nodes-accounts for both tumor burden and nodal yield, potentially improving prognostic accuracy.

Methods: We retrospectively analyzed data from 4060 breast cancer patients who underwent axillary lymph node dissection (ALND) between 1995 and 2021 at a tertiary cancer center in India. Disease-free survival (DFS) and overall survival (OS) were assessed using Kaplan-Meier curves and log-rank tests. Correlation analysis and multivariate analysis were used to compare prognostic utility of LNR versus pN stage. Optimal LNR cutoffs were identified using Youden's index.

Results: The median follow-up was 93.8 months. On multivariate analysis, LNR retained a strong independent prognostic value for both DFS (HR = 2.00 for LNR 0.2-0.5; HR = 3.29 for LNR > 0.5; P < .001) and OS (HR = 1.77 for LNR 0.2 to 0.5; HR = 2.77 for LNR > 0.5; P < .001). LNR cutoffs of 0.24 (DFS) and 0.21 (OS) were identified. Stratification into 3 LNR groups (≤ 0.20, 0.21-0.50, > 0.50) showed significantly different survival outcomes (log-rank P < 0.001).

Conclusions: LNR is a superior and independent prognostic marker compared to pN stage in breast cancer patients undergoing ALND. Incorporating LNR into prognostic models may enhance risk stratification and guide adjuvant treatment decisions.

Background: Breast cancer remains the most common oncological condition and the leading cause of cancer-related mortality in the world. In addition to the breast cancer stage at diagnosis, its histology and subtype, the social determinants of health have a substantial role in cancer survivorship.

Methods: Utilizing administrative health databases, a retrospective analysis of stage I-III HER2-negative breast cancer was conducted, examining a cohort of 10,634 women treated with surgery and adjuvant chemotherapy in Ontario, Canada.

Results: Our study registered a median follow-up of 5.5 years. The 5-year OS ranging from the lowest to the highest socioeconomic status (SES) was (Q1) 91.3%, (Q2) 92.8%, (Q3) 93.0%, (Q4) 92.9% and (Q5) 94.0%. The 5-year OS rate between the SES groups showed (Q5 vs. Q1) HR 0.65 (95% CI, 0.52-0.81), P = .002), (Q4 vs. Q1) HR 0.79 (95% CI, 0.64-0.97, P = .029) and (Q3 vs. Q1) HR 0.75 (95% CI, 0.60-0.94, P = .013). In the analysis of underlying medical conditions, the mean range of the Charlson comorbidity index was Q1 (2.73 ± 2.96) versus Q5 (2.52 ± 2.63), P < .001.

Conclusion: Our study shows that there are inequities in the delivery of oncological care amongst women with HER2-negative breast cancer. Those within the lower SES, thereby likely with a socioeconomic disadvantage, exhibited a greater probability of presenting with more advanced cancer staging, were more prone to receive anthracycline-based chemotherapy, while also being confronted with an increased likelihood of significant comorbidities and mortality rates, compared to their wealthier counterparts.

Background: The Oncotype DX Recurrence Score (RS), Nottingham Prognostic Index (NPI), and Ki-67 are commonly used tools to assess recurrence risk and guide adjuvant treatment decisions in early breast cancer. This study evaluated the relationship between NPI, Ki-67, and Oncotype DX RS, and explored whether NPI and Ki-67 may help contextualize patient selection for genomic testing.

Patients: Patients had ER-positive, HER2-negative breast cancer and were node-negative or had micrometastatic disease or 1 to 3 macrometastatic lymph nodes.

Methodology: This retrospective observational study analyzed five years of breast cancer data from East Cheshire. Associations between NPI, Ki-67, and Oncotype DX RS were assessed using correlation analysis. Chemotherapy recommendations based on NPI, Ki-67, and Oncotype DX RS were compared. Statistical significance was defined as P < .05.

Results: Among 195 patients (mean age 58.7 ± 9.4 years), chemotherapy was recommended in 62 (31.8%) based on Oncotype DX RS, with 52 (26.7%) ultimately receiving treatment. Ki-67 demonstrated a moderate correlation with Oncotype DX RS (r = 0.463, P < .001), while NPI showed a weaker but statistically significant correlation (r = 0.232, P = .001). Concordance with Oncotype DX RS was modest for both markers (51.8% for Ki-67 and 44.6% for NPI), indicating substantial discordance.

Conclusion: NPI, using a threshold of 3.4 as recommended by NICE, may assist in identifying patients for whom Oncotype DX testing could be considered. Ki-67 may provide additional prognostic context when interpreted alongside NPI. These markers may contribute to broader risk stratification frameworks but should be viewed as complementary to genomic testing.

Background: Sentinel lymph node biopsy (SLNB) omission is increasingly considered in carefully selected postmenopausal patients with low-risk, early-stage breast cancer. However, the prevalence of occult nodal disease and wether nodal information alters adjuvant management remain key concerns in real-world implementation.

Methods: We conducted a retrospective, two-center observational study using an institutional REDCap database. Consecutive patients treated surgically between 2023 and 2024 were screened and a strict proxy of ASCO eligibility criteria for SLNB omission was applied (postmenopausal; HR-positive/HER2-negative; invasive ductal carcinoma; T0 to T1; grade 1 to 2; no neoadjuvant therapy). The primary outcome was the prevalence of pN1 disease within the ASCO-eligible cohort. Secondary outcomes included adjuvant chemotherapy use, whole-breast radiotherapy (WBRT), and availability of genomic testing.

Results: Among 662 screened patients, 211 met all ASCO proxy eligibility criteria. Occult nodal involvement was observed in 20/211 patients (9.5%, pN1). Adjuvant chemotherapy was administered in 10/211 patients (4.7%), while WBRT was delivered in 203/211 (95.7%). Genomic testing was available in 17/211 patients (8.1%) and was predominantly low-risk among those tested (13/17, 76%). Within the pN1 subgroup (n = 20), chemotherapy was administered in 4/20 patients (20%), and genomic testing was available in 8/20 (40%).

Conclusion: In a real-world cohort meeting strict ASCO proxy criteria, approximately 1 in ten patients had occult pN1 disease, yet chemotherapy use remained uncommon and WBRT was near-universal. These findings suggest nodal status may have limited impact on downstream adjuvant treatment escalation in highly selected low-risk luminal breast cancers.