Clinical breast cancer最新文献

Studies were meticulously selected based on a literature search conducted across multiple databases. Data on overall survival (OS), progression-free survival (PFS), and clinicopathological characteristics were extracted. Heterogeneity was assessed among studies for reliability. Sensitivity analysis confirmed result stability, and Egger's test checked for publication bias. Ten studies with 1761 cases were analyzed. Patients with high TK1a level had a significantly higher risk of poor OS (HR 1.80; 95% CI, 1.35-2.41, Z = 3.99, P < .05) compared to those with low TK1a level. Similar finding is revealed in PFS analysis. The overall heterogeneity in the analysis was substantial. After regression analysis, sample type likely caused it. We performed an analysis to indicate that high TK1a level linked to negative ER status (OR: 0.651, 95% CI, 0.43-0.985, P < .001) but not other factors. Funnel plot test showed no publication bias in the included articles. Assessing TK1a level may offer supportive insights into the prognosis of breast cancer patients. This biomarker could potentially aid in evaluating patient outcomes and gauging the effectiveness of treatment strategies in clinical interventions.

Purpose: Omission of sentinel lymph node biopsy (SLNB) in selected hormone receptor-positive (HR+), HER2-negative (HER2-) early breast cancer patients has demonstrated safety in prospective trials. However, accurate axillary staging remains important for identifying candidates for adjuvant CDK4/6 inhibitor therapy. We quantified the impact of SLNB omission on CDK4/6 eligibility and explored predictors of occult nodal disease in a real-world cohort.

Methods: We retrospectively analyzed 948 patients treated 2014 to 2022 at Tübingen University Hospital who met criteria proposed for potential SLNB omission: age ≥ 50 years, cT1 cN0, HR+/HER2-, grade 1 to 2 tumors treated with breast-conserving surgery and whole-breast irradiation. We assessed the prevalence of occult nodal metastases and potential eligibility for adjuvant abemaciclib (monarchE-criteria) or ribociclib (NATALEE-criteria) based on final pathology and fitted multivariable logistic models.

Results: Among 948 patients meeting SLNB omission criteria, 143 (15.1%) harbored occult nodal disease. Of these node-positive patients, 17 fulfilled the criteria for abemaciclib eligibility. For ribociclib, 105 node-positive patients were eligible. On multivariable analysis, multifocality (OR = 2.3; P ≤ .001) and cT1c tumor stage (OR = 1.76; P = .008) predicted axillary upstaging; invasive lobular carcinoma (ILC) showed higher crude upstaging than IDC/NST (22.6% vs. 14.0%) but did not retain independent significance after adjustment.

Conclusions: Omitting sentinel node biopsy in selected patients leads to under-detection of nodal metastasis in a relevant proportion of patients, particularly with cT1c tumors, multi-focal tumors and ILC. As these patients may benefit from more intensive adjuvant treatment, omission of sentinel-node biopsy should be part of decision-making. Future trials should investigate the impact of adjuvant treatment for patients with occult lymph node metastases.

Post-operative radiation therapy (PORT) following breast-conserving surgery (BCS) has become a conventional care for early-stage breast cancer (EBC). This meta-analysis aimed to compare overall survival (OS) between patients receiving PORT and those not receiving PORT and to identify clinicopathologic features of low-risk patients with EBC who may be suitable for PORT omission after BCS with respect to OS. Comparative studies investigating PORT versus non-PORT in EBC patients after BCS were included, focusing on hazard ratio (HRs) for OS. Medline, Embase, and the Cochrane Central Library were searched from First January 2014 to First January 2025. A meta-analysis was performed to determine the HR for OS between PORT and non-PORT groups. Subgroup analyses were conducted to identify potential clinicopathologic features associated with low-risk patients suitable for PORT omission. A total of 28 studies (2 randomized controlled trials and 26 retrospective cohort studies) with 589,508 patients were included in the final analysis. According to the meta-analysis, patients with EBC derived an OS benefit from PORT (pooled HR = 0.60 [95% CI, 0.55-0.65]). Subgroup analyses identified clinicopathologic features associated with low-risk patients suitable for PORT omission. This systematic review and meta-analysis demonstrated that PORT is associated with improved OS in patients with EBC following BCS. However, certain clinicopathologic features, including age 65-70 years, progesterone receptor (-), luminal B subtype, triple-negative breast cancer, and low-risk 21-gene recurrence score, were identified as potential low-risk factors in patients who may be considered for PORT omission.

Background: This is the first study looking at breast cancer risk using the polymorphisms CYP3A4*1B, GSTP1 Ile105Val, MTHFR C677T, and COMT Val158Met for breast cancer predisposed Iraqi population with specific environmental carcinogenic exposures.

Methods: Aged matched healthy controls were 610 individuals of Iraqi origin alongside 414 histologically confirmed breast cancer patients forming a case-control study cohort. CDNA was obtained from peripheral blood samples, which underwent genotyping via tetra-primer ARMS-PCR. Statistical evaluation was performed based on several genetic models with odds ratios (OR) and 95% confidence intervals (CI) calculated by logistic regression.

Results: For 3 polymorphisms, crucial associations were found and these include CYP3A4*1B which showed a protective effect against breast cancer (OR = 0.72, 95% CI, 0.54-0.96, P = .027), the effect being strong in women less than 50 years old. Increased cancer risk was associated with GSTP1 Ile105Val (OR = 1.68, 95% CI, 1.23-2.31, P = .001) especially in older females and those with elevated BMI. The same risk was also conferred by MTHFR C677T (OR = 1.45; 95% CI, 1.12-1.89, P = .005). No significant association for COMT Val158Met was observed (P = .156). All polymorphisms among controls were in Hardy-Weinberg equilibrium.

Conclusions: The study presented the taw evidence of both CYP3A4*1B and GSTP1 Ile105Val along with MTHFR C677T polymorphisms associating them to breast cancer susceptibility in Iraqi population which reflects these specific genetic risks and reinforces middle eastern populations towards precision medicine frameworks concerning breast cancer treatment and intervention strategies.

Introduction: Breast conserving therapy (BCT) for nonpalpable lesions can be performed using various localization devices. For larger or multifocal lesions, "bracketing" with multiple localizers is required for complete excision. SAVI Scout utilizes radar localization (RL) to target clip location(s), while SmartClip employs electromagnetic chips (EMC) to provide 3D navigation and distinguish up to three devices. This study aimed to compare the excision of breast lesions using non wire localization devices such as EMC and RL versus traditional wires.

Methods: A single institution, retrospective study was conducted from August 25, 2020 to August 6, 2024, comparing EMC, RL, and wire localization in bracketed BCT. Case length, positive margins requiring re-excision, and complete retrieval of localizers in a single specimen were analyzed. Statistical analyses were performed using Kruskal-Wallis, and χ² or Fisher's exact tests.

Results: A total of 118 cases were analyzed: 43 wire, 44 RL, and 31 EMC cases. The groups were similar in lesion size and number of localizers used (P = .736 and P = 1.000, respectively). There were fewer positive margins when EMC or RL were utilized (EMC 29%, RL 22.7%, wires 50%, P = .022). EMC was also associated with significantly shorter operative times (33.9 minutes vs. RL 45.6 minutes, wire 40 minutes, P = .025). There was no significant difference in complete retrieval of localizers among the groups (EMC 93.5%, RL 97.7%, wire 100%, P = .264).

Conclusion: Non-wire localization method is effective for bracketed BCT with lower rates of margin positivity and faster operative times with EMC. This supports their use in BCS, especially when multiple localizers are needed.

Background: Patients increasingly turn to online resources for breast reconstruction information, yet the quality, readability, and inclusivity of such materials remain unclear. This study assessed top-ranking websites for content accuracy, usability, visual representation, readability, and search engine visibility.

Methods: The top 10 English-language websites were selected based on rankings from major search engines and top search engine optimization (SEO) metrics. Two independent reviewers evaluated each site using JAMA benchmarks, the DISCERN instrument, and a modified EQIP tool. Readability was assessed using Flesch-Kincaid Reading Ease, Gunning Fog, SMOG, Coleman-Liau, Automated Readability Index, and the percentage of complex words. Additional analyses examined image diversity (skin tone and body type) and content. Inter-rater reliability was confirmed using Cohen's κ and intraclass correlation coefficients.

Results: Twelve websites were analyzed, and only 41.7% met all 4 JAMA benchmarks. DISCERN scores rated just 1 site as "excellent," with nonprofit sources performing significantly better (P = .019). EQIP findings showed only 25% were of good quality, with frequent gaps in procedural details and decision-making support. Sites covered 62.2% of essential content, with limited focus on financial aspects or patient experiences. Only 33.4% met the recommended 8th-grade reading level. Image analysis showed 76.7% of websites portrayed only light skin tones, and 71% depicted a lean body type.

Conclusion: Online breast reconstruction resources are often inconsistent, hard to understand, and lack diversity. More readable, inclusive, and trustworthy content is needed. Clinicians should guide patients to reliable sources and support efforts to improve online health education.

Purpose/objectives: Suitability criteria for partial breast irradiation (PBI) are narrowly constrained for those with ductal carcinoma in situ (DCIS). In comparison to invasive disease, guidance is limited regarding the optimal application of PBI to treat DCIS. Here, we report disease outcomes for a heterogeneous cohort of patients with DCIS who received PBI.

Materials/methods: Using a prospectively maintained institutional database, we identified patients with DCIS who underwent lumpectomy and adjuvant PBI from 2008 to 2022. Based on clinicopathologic characteristics patients were classified as suitable, cautionary, or unsuitable for PBI by American Society for Radiation Oncology (ASTRO) criteria. The primary endpoint was local recurrence (LR).

Results: The cohort comprised 176 patients with DCIS who received PBI, median age 60 years (interquartile range (IQR) 52, 66). Median DCIS size was 9 mm (IQR 4, 15 mm), and approximately 20% had multifocal disease. Most patients had negative (≥ 2 mm) final surgical margins (n = 160, 91%), 10 had < 2 mm margins and 6 had ≤ 1 mm margins for DCIS. 18 (10%) patients had nuclear grade 1 disease, 111 (63%) had grade 2 disease, and 33 (19%) had grade 3 disease, with a small subset classified as grade 1-2 or 2-3. Most patients (n = 161, 91%) had estrogen receptor (ER) positive DCIS, and 72 (41%) received endocrine therapy. By ASTRO criteria, 118 (67%) patients were suitable for PBI, 57 (32%) were considered cautionary, and 1 (0.6%) was unsuitable. At a median 24 months of follow up (range 2-127 months) we observed a single LR, yielding a 2-year LR rate of 0.6%. The LR occurred in a patient classified as cautionary, yielding a 2-year LR rate of 1.8% for the cautionary subset. No breast cancer mortality events were observed.

Conclusions: These early-term results exhibit excellent local control for patients with DCIS who received lumpectomy and PBI, even among those classified as "cautionary" by national guidelines. Although our findings are limited by short follow up, these results suggest that broadening the application of PBI for patients with DCIS may warrant further investigation.

To evaluate the efficacy and safety of neoadjuvant chemoimmunotherapy in patients with early-stage estrogen receptor (ER)-low/HER2-negative breast cancer (BC), a population often overlooked in clinical trials. A systematic review and meta-analysis were conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards and registered with PROSPERO. Comprehensive searches were performed across PubMed, Cochrane CENTRAL, Embase, and major oncology conferences for studies with data on neoadjuvant chemoimmunotherapy in ER-low BC. The primary endpoint was the pathologic complete response (pCR) rate, with a secondary descriptive analysis of safety data. Seven studies encompassing 260 patients with ER-low BC were included (3 cohorts and 4 clinical trials). All studies utilized humanized anti-PD-1 antibodies, with 4 administering pembrolizumab, 1 using nivolumab, and 1 employing camrelizumab. The overall pooled pCR rate for ER-low BC was 64.88% (95% confidence interval [CI], 56.72%-73.04%; I² = 37.5%). No significant differences in pCR rates were identified between clinical trials and cohort studies (P = .724). Adverse event data were reported in 2 studies, revealing that 34.4% of patients experienced hospitalizations, with notable rates of grade ≥ 3 adverse events (AEs) and immune-related AEs (irAEs). Neoadjuvant chemoimmunotherapy shows high rates of pCR for ER-low BC, resembling triple-negative BC, with safety data indicating fewer severe complications than observed in pivotal trials.

Background: Free flap breast reconstruction (FFBR) offers substantial benefits after mastectomy. However, the impact of operative time on outcomes remains unclear.

Patients and methods: In this retrospective cohort study, the American College of Surgeons National Surgical Quality Improvement Program database (2011-2022) was queried for patients undergoing immediate FFBR. Multivariate logistic regression assessed operative time as both a continuous and dichotomous variable. Thresholds for operative duration were determined using receiver operating characteristic (ROC) analysis and Youden's Index.

Results: Of 5826 patients, 61% underwent unilateral and 39% bilateral FFBR. Complications occurred in 27% of cases-25% in unilateral and 30% in bilateral procedures. In unilateral FFBR, prolonged operative time was significantly associated with increased risks of overall complications (OR 1.0020 per minute, P < .001), surgical (OR 1.0023, P < .001) and medical complications (OR 1.0019, P = .0011), reoperation (OR 1.0011, P = .013), and readmission (OR 1.0014, P = .0030). Each additional hour increased overall complication risk by 12%, with a 397-minute threshold identified (OR 1.8, P < .001). For bilateral FFBR, longer operative time correlated with higher odds of overall complications (OR 1.0012 per minute, P < .001), surgical complications (OR 1.0012, P = .0014), and reoperation (OR 1.0010, P = .026). A 7.2% increase in adverse event risk was noted per additional hour, with 536 minutes as a critical threshold (OR 1.6, P < .001).

Conclusion: Prolonged operative time significantly increases complication risk in FFBR. Patients with procedures exceeding 397 and 536 minutes were 80% and 60% more likely to experience adverse events, respectively. These findings highlight the need to maximize surgical efficiency and minimize postoperative morbidity.