Clinical breast cancer最新文献

Background: The aim of this study was to evaluate the metabolic profile of non-obese postmenopausal women with breast cancer (BC) compared to non-obese women without breast cancer.

Methods: In this case-control study, 130 women with BC, aged 45-75years, body mass index < 30kg/m² and without established cardiovascular disease were included. The control group consisted of 130 women with the same inclusion criteria, but without BC. The groups were matched by age and time since menopause. Clinical, anthropometric, and biochemical data were collected. Women who presented three or more diagnostic criteria were considered to have metabolic syndrome (MetS): waist circunference > 88cm; triglycerides ≥ 150mg/dL; HDL-cholesterol < 50mg/dL; blood pressure (BP) ≥ 130/85mmHg; glucose ≥ 100mg/dL.

Results: Women with BC had a higher occurrence of MetS and elevated BP compared to the control (30.8% vs. 20.0% and 25.4% vs. 14.6%, respectively) (P < 0.05). A higher percentage of women with BC had values above the desirable range for total cholesterol and glucose compared to the control (56.2% vs. 43.1% and 29.2% vs. 15.4%, respectively) (P < 0.05). In the risk analysis of the metabolic profile, adjusted for age and menopausal status, women with BC had a significantly higher risk for MetS (OR =%2.76, 95% CI 1.48-5.15), elevated glucose (OR = 2.69, 95% CI 1.46-4.96), and hypertension (OR = 3.03, 95% CI 1.51-6.10).

Conclusion: Non-obese women with BC had a higher risk for MetS, hypertension, and diabetes, with a worse metabolic profile compared to non-obese women without BC. Prospective studies are needed to validate our results.

Objective: Lymphedema is a chronic, progressive disease that results from the accumulation of protein-rich fluid in the interstitial tissue spaces. The aim of this study is to assess disease severity, respiratory muscle strength, respiratory functions, pectoralis minor muscle shortening, functionality, and quality of life(QoL) in patients with upper limb lymphedema (ULL), and to compare these findings with healthy controls.

Methods: The disease severity was assessed using the Stillwell classification system; respiratory muscle strength was measured through maximum inspiratory and expiratory intraoral pressures (MIP, MEP, respectively); respiratory functions were evaluated with a spirometer; muscle length of pectoralis minor (PM) was measured with a tape measure; functionality was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH); and QoL was evaluated with the Lymphedema Quality of Life Questionnaire - Arm (LYMQOL-Arm). The participants were divided into 2 groups, patients with ULL in Group 1; the healthy individuals were included in Group 2.

Results: The group 1 had lower values for MIP, MEP, FEV₁, FVC, FEF₂₅, FEF₇₅, PEF, muscle length of PM, and DASH scores compared to group 2(p:0.018, p:0.010, P < .001, P < .001, p:0.001, p:0.043, P < .001, P < .001, P < .001, respectively). A negative correlation was found between disease severity and MIP, MEP, FEV1, FVC, and muscle length of PM (r:-0.598, r:-0.451, r:-0.458, r:-0.347, r:-0.498 (fair to good) respectively, P < .05). A positive correlation was observed between disease severity and LYMQOL-Arm (r:0.496 (good), P < .05).

Conclusion: Patients with ULL were found to be impaired in respiratory muscle strength, respiratory function tests, functionality and muscle length of PM compared to healthy individuals.

Background: Most published data on EMC consists of individual case reports, and survival outcomes are not clearly defined to guide evidence-based management.

Methods: All women with a histologic diagnosis of EMC irrespective of age and stage at diagnosis till 2018 in the National Cancer Database were included (N = 111). Overall survival (OS) was compared among groups using the Kaplan-Meier and log-rank methods.

Results: The median age at diagnosis was 67 years, and 101 (88.6%) were over 50 years of age. Ten percent were ER+/Her2-, 29.7% were ER-/Her2-, 0.9% were Her2+, 5.4% were ER+/Her2 unknown, 24% were ER-/Her2 unknown, and 29.7% had no data on ER status. Most patients underwent surgical resection (91.9%), whereas chemotherapy and radiation were utilized in 35.2% and 40.6% of the patients, respectively. At a median follow-up of 67.6 months, the 5-year OS was 74.3%. Among patients who received chemotherapy or radiation, the 5-year OS was 80.1% (vs. 68.9% in nonrecipients, P = .02) and 83.1% (vs. 68.5% in nonrecipients, P = .03), respectively. The 5-year OS was 82.7%, 76.5%, and 50% for tumor ≤ 2 cm, 2 to 5 cm, and > 5 cm respectively (P = .009). Chemotherapy or radiation treatment were associated with improved OS in tumors >5 cm (both P < .05).

Conclusion: EMC demonstrates distinctive clinicopathologic features and receptor status. Receipt of adjuvant chemotherapy and radiation demonstrates improved survival in larger tumor (> 5cm) although small sample size and lack of recurrence data limit this conclusion. Studies using larger cohorts are needed to demonstrate objective efficacy of systemic treatment in lymph node positive and metastatic EMC.

Background: Hematoma formation is a possible postoperative occurrence following breast surgery. It might increase the risk of long-term complications and thereby delay start of adjuvant therapy. Tranexamic acid (TXA) is suggested to decrease the risk of postoperative hematoma, but the evidence is based on small and heterogeneous studies. The primary objective of this systematic review and meta-analysis is to assess the impact of TXA on hematoma formation and secondarily on drain output, time upon drain removal, seroma formation, infection incidents, and thromboembolic events.

Methods: A literature search was conducted in PubMed, Embase, Medline, Cochrane Library, and Google Scholar. Studies examining either intravenous or topically administered TXA were included and underwent risk of bias assessment.

Results: A total of 989 studies were screened and 19 studies fulfilled the inclusion criteria. Of the 7673 breasts in total, topical TXA was given to 2106 breasts, intravenous to 1722 and the remaining 4347 breasts were controls having no TXA. Hematoma formation was significantly reduced by both topical administered TXA (RR, 0.33; 95% CI, 0.15-0.75) and intravenous TXA (RR, 0.45; 95% CI, 0.29-0.68) across all breast procedures. The same result was found when only including oncological breast procedures; topical TXA (RR, 0.16; 95% CI, 0.05-0.56) and intravenous TXA (RR, 0.50; 95% CI, 0.31-0.81). A reduction in drain output and time until drain removal was noted. No significant reduction in seroma formation was observed.

Conclusion: Both topical and intravenous TXA in breast surgery significantly reduce hematoma and reduce drain output and time upon drain removal. Studies show no effect on seroma formation, infection rates, or thromboembolic events.

Background: Mammography is the gold standard technique for early breast cancer screening, but it has a limited specificity for microcalcifications. Radiomics represents a promising tool for enhancing lesion risk stratification. This study aims to evaluate the reliability of radiomics in combination with clinical data to classify benign and malignant microcalcifications, potentially enhancing the standard radiological assessment and reducing the need for biopsies.

Materials and methods: This study retrospectively analyzed patients with BI-RADS 4A microcalcifications who underwent mammography (MX) and vacuum-assisted breast biopsy (VABB) at our center from January 2019 to February 2023. About 104 radiomics features were extracted from a region of interest, manually defined on images. Clinical data from each patient were collected. Using the Tyrer-Cuzick Model, we classified patients according to the risk of developing breast cancer. Two logistic regression models, using clinical and radiomics data were trained to predict the pathological classification of breast calcifications.

Results: A total of 167 calcification groups were included in the study. The final dataset was made of 14 radiomics features. The radiomics model alone achieved an AUC of 0.72 (95% CI, 0.61-0.33) while the model trained on clinical and radiomics features obtained AUC values of 0.81 (95% CI, 0.69-0.92).

Conclusions: Our findings suggest that the integration of clinical data with radiomics has the potential to reduce unnecessary biopsies for BI-RADS 4A microcalcifications, leading to more targeted and personalized patient care.

Introduction: The quality, reliability and accuracy of health-related videos available online is controversial. Research has examined YouTube® in terms of reconstruction, breast screening, radiotherapy, postoperative arm exercises and mastectomy. The aim of this study is to assess YouTube® as a form of health information on breast cancer surgery/operation.

Methods: YouTube® was searched using the terms ``breast cancer surgery'' and ``breast cancer operation.'' Video data was recorded including time since upload, video length, viewer engagement, content and upload source. The quality, accuracy and educational usefulness of videos were analyzed using 3 online quality assessment tools by a single clinician. Gender and ethnic representation of the patient was recorded.

Results: About 48 videos were reviewed, 62% of videos uploaded from a Healthcare source and the most common video category was post-op complications/issues (25% of videos). Engagement was highest for videos uploaded from individuals which showed 54.36 "likes"/day and 6.9 comments/day. Healthcare sourced videos were higher quality. The mean DISCERN score for healthcare videos was 34.33 ± 11.44 compared with non-Healthcare scoring 26.33 ± 8.35 (P = .013). 100% of videos referenced females with breast cancer only. 71% showed only white/Caucasian patients/models.

Discussion: In line with previous research, this study showed Healthcare sourced videos were of higher quality. Quality of life information hasn't been reported elsewhere however this study found it was limited and of poor quality. While high levels of misleading information have been reported elsewhere, this study highlighted only 4% as misleading/unsafe.

Conclusions: Healthcare professional interaction with YouTube® should be encouraged and empowered, in order to educate with the delivery of high-quality health information which is reliable and valid. Quality of life content should be considered by healthcare professionals. This study highlights a paucity of videos on male breast cancer, and suggests the need for more ethnically diverse patient representation on breast cancer surgery/operation on YouTube.

Background: Residual disease after neoadjuvant chemotherapy (NAC) has important role in triple negative breast cancer (TNBC). The CREATE-X study demonstrated a survival benefit from adjuvant capecitabine (adjC) in breast cancer patients, especially for TNBC populations. Because the landscape of early TNBC treatment has been changing rapidly, an optimal adjuvant strategy for real-world practice is needed. We evaluated the effectiveness of adjC in TNBC patients with residual disease after NAC.

Method: We used de-identified, anonymous data from an institutional clinical data warehouse to retrospectively analyze 934 TNBC patients who received NAC between 2017 and 2023. Among them, 405 patients received at least 1 cycle of adjC, and 77 received no adjuvant treatment. The primary outcomes of the study were distant-disease free survival (DDFS) rate and overall survival (OS) rate at 3 years. The secondary outcomes were subgroup analyses and Cox regression analyses of survival outcomes.

Result: The median follow up period was 34.3 months (range 1.8-71.5). The DDFS rate at 3 years was higher in the capecitabine group: 86.3% of the capecitabine group and 74.4% of the no adjuvant group (P = .019). The OS rates at 3 years were 93.3% and 83.8%, respectively (P = .032). Subgroup analyses indicated a greater benefit from adjC in patients aged 50 years or older and those who received platinum-based NAC, both in terms of DDFS and OS.

Conclusion: Our study showed that adjC was more effective than no adjuvant treatment for TNBC patients with residual disease in terms of DDFS and OS.