Clinical breast cancer最新文献

Background: Risk-reducing mastectomy (RRM) significantly lowers breast cancer risk as a preventive surgery. While racial disparities in breast cancer treatment are well-documented, research on racial differences in the utilization and outcomes of RRM is limited.

Methods: We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program (2008-2022) to identify women who underwent RRM. Patient demographics, comorbidities, surgical characteristics, and 30-day postoperative outcomes were compared between White and racial minority patients, including Black/African American women.

Results: Among 1,285 patients, 88% (n = 1,126) self-identified as White and 12.4% (n = 159) as racial minorities, including 5.8% (n = 74) Black. Minority patients were younger than White patients (50.7±11.4 years vs. 52.6±12.6 years; P = .66). Black patients had a significantly higher mean BMI than White patients (33.6±8.4 kg/m² vs. 30.6±8.0 kg/m²; P = .03), and higher prevalence of obesity (65%, n = 48 vs. 47%, n = 524; P = .03) and hypertension (51%, n = 38 vs. 30%, n = 342; P = .007). Racial minority patients were more likely to undergo outpatient surgery (81%, n = 129 vs. 57%, n = 645; P < .001) and had shorter hospital stays than White patients (0.8±1.3 days vs. 1±2 days; P = .001). Black patients experienced higher rates of superficial incisional infections (9.5%, n = 7 vs. 2.9%, n = 33; P = .18) and overall complications (18%, n = 13 vs. 10%, n = 113; P = .48) CONCLUSION: This multi-institutional study reveals racial disparities in RRM, with minority patients significantly more likely to present with comorbidities and experience higher complication rates. These findings underscore the need for targeted strategies to ensure equitable access to RRM and improve outcomes for minority patients, advancing health equity in breast cancer prevention.

Purpose: The clinical benefits of pyrotinib plus taxanes or vinorelbine have not been studied systemically. Consequently, we conducted a prospective evaluation to assess the efficacy and safety of pyrotinib plus taxanes or vinorelbine in patients with human epidermal growth factor 2 (HER2)-positive metastatic breast cancer (MBC).

Methods: Patients with HER2-positive MBC were included to receive pyrotinib combined with taxanes or vinorelbine in Jiangsu Cancer Hospital. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were objective response rate (ORR), disease control rate (DCR), clinical benefit rate (CBR), and adverse effects (AEs).

Results: Between December 22, 2020 and January 11, 2023, a total of 101 patients were assigned to pyrotinib plus taxanes (n = 83) and pyrotinib plus vinorelbine (n = 18) groups. As of May 24, 2023, the median PFS for all patients was 11.5 months (95% confidence interval [CI], 8.8-15.7). The median PFS was significantly longer in pyrotinib plus taxanes group than in pyrotinib plus vinorelbine group (median PFS, 12.2 months [95% CI, 9.2-18.6] vs. 8.4 months [95% CI, 5.5-13.7]; P = .005). All the treatment-related side effects were tolerated. The most frequent grade 3 or 4 side effects included diarrhea (22.8%), leukopenia (19.5%), and neutropenia (18.2%).

Conclusion: Pyrotinib plus taxanes could be an alternative or even the preferred treatment strategy for patients with HER2-positive MBC after trastuzumab and small-molecule tyrosine kinase inhibitors (TKIs). We also suggest that pyrotinib combined with vinorelbine has a therapeutic potential.

Registration: This trial was registered in Chinese Clinical Trial Registry. URL: https://www.chictr.org.cn/showproj.html?proj=65697 (ChiCTR2000041217).

Background: In the DESTINY-B04 trial, patients with pretreated HER2 low metastatic breast cancer (defined as immunohistochemistry score of 1+ or 2+ and negative in situ hybridization) had significant survival improvement with Trastuzumab therapy.

Methods: The goal of our study was to compare the HER2 immunohistochemistry scores of paired primary and metastatic breast cancer, with emphasis on HER2 low criteria and its implications for detailed immunohistochemistry interpretation. Using the pathology database from 2011, we identified 272 cases of primary breast cancers with paired metastases. We reviewed and performed immunohistochemistry concordance between the primary and metastases and calculated the HER2 low incidence.

Results: Compared to the primary, HER2 immunohistochemistry score in the metastases remained the same in 156/272 cases (57%) and by immunohistochemistry was: 0 (67/114 = 59%), 1+ (22/52 = 42%), 2+ (34/67 = 51%), 3+ (33/39 = 85%) and HER2 low (85/119 = 71%). The HER2 score changed from 0 to HER2 low in 46 cases (17%) and vice versa in 30 (11%).

Conclusions: The concordance rate of HER2 immunohistochemistry scores was 57%, highest in 3+ cases, followed by HER2 low and then HER2 negative. The incidence of HER2 low was higher in the metastases by 6% compared to the primary. HER2 should be tested in all metastases and compared with the primary, due to differences in scores as seen in 28% of our cases, which may have clinical implications in the new HER2 low era.

Black women experience disproportionate breast cancer-related mortality, with similar overall incidence to White women. Approaches to address these racial health disparities should be multifaceted. Universal genetic counseling and testing for Black women could represent one dimension of a comprehensive approach in guiding early identification of those more likely to experience higher breast cancer-related mortality. The increased risk of triple-negative breast cancer and greater likelihood of early-onset breast cancer among Black women are 2 major justifications, given that these elements are already preexisting testing criteria per the National Comprehensive Cancer Network. Increasing assessment of breast cancer-related risk in the Black community through universal genetic counseling and testing should be considered to focus enhanced screening and preventive measures in a tailored risk-appropriate context.

Background: Breast cancer (BC) is a multifactorial disease of unknown etiology whose major risk factors are genetic alterations of cell proliferation and migration pathways. HOX transcript antisense RNA gene (HOTAIR) is a long noncoding RNA (lncRNA) related to cell proliferation, progression, invasion, metastasis, and poor survival of multiple cancers, including BC. Controversial results have emerged on the association between breast cancer risk in multiple ethnicities. This study explores the association of rs12826786, rs920778, and rs4759314 variants in the HOTAIR gene in BC patients.

Methods: DNA of peripheral blood samples was obtained from 588 women (289 patients and 299 control females). Genotypes were identified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methodology. The association was calculated using the odds ratio (OR) test. p-values were adjusted by the Bonferroni test (0.016).

Results: The rs12826786 (C > T), rs920778 (T > C), and rs4759314 (A > G) variants were associated with BC and with TNM stage, histologic type, and histologic molecular subtype (P = .001). Likewise, the haplotype C-T-G in the HOTAIR gene (rs12826786-rs920778-rs4759314) was significantly related to BC (OR = 5.44, 95% CI, 2.22-13.32, P = .001).

Conclusion: The results suggest that rs12826786, rs920778, and rs4759314 variants in HOTAIR significantly influence breast cancer risk.

In the era of personalized oncology biomarkers that identify subgroups of specific cancers and help predict response to specific therapies are critical tools for prognosis determination and therapeutic decisions. The Estrogen Receptor (ER) had been one of the first biomarkers used in breast cancer and has helped advance the field of breast oncology by contributing to the success of hormonal therapies for the ER positive subgroup of the disease. Expression of the receptor in 1% or more of tumor cells in immunohistochemical sections define currently the ER positive subgroup of breast cancers, which may be treated with regimens that include hormonal inhibitors. The highest sensitivity and benefit of hormonal therapies is observed in cancers with robust ER expression (in 90% to 100% of tumor cells). However, it has become clear that the subgroup of breast cancers with low ER expression (in 1% to 10% of tumor cells) behaves similarly to ER negative breast cancers and has an inferior response to hormonal therapies. The behavior of the rest of ER positive breast cancers with an intermediate ER expression between these 2 extremes (ER expression between 10% and 90%) is less well described and their response to estrogen targeting therapies is less clear. Breast cancers with intermediate ER expression represent a small subgroup of ER positive breast cancers and the wide range of expressions suggests heterogeneity. This review will discuss this subgroup of ER positive breast cancers and examine their genomic landscape and therapeutic repercussions.

Background: There are documented differences in Breast cancer (BrCA) presentations and outcomes between Black and White patients. In addition to molecular factors, socioeconomic, racial, and clinical factors result in disparities in outcomes for women in the United States. Using machine learning and unsupervised biclustering methods within a multiomics framework, here we sought to shed light on the biological and clinical underpinnings of observed differences between Black and White BrCA patients.

Materials and methods: We examined The Cancer Genome Atlas BrCA samples from stage II patients aged 50 or younger that are Black (BAA50) or White (W50) (n = 139 patients; 36 BAA50 and 103 W50) These patients were chosen because marked differences in survival were observed in an earlier study. A variety of multiomic data sets were analyzed to further characterize the clinical and molecular disparities for insights.

Results: We coupled RNAseq data with protein-protein interaction as well as BrCA-specific protein co-expression network data to identify 2 novel biclusters. These biclusters are significantly associated with clinical features including race, number of lymph nodes involved with disease, estrogen receptor status, progesterone receptor status and menopausal status. There were also differentially mutated genes. Using DNA methylation data, we identified differentially methylated genes. Machine learning algorithms were trained on differential methylation values of driver genes. The trained algorithms were successful in predicting the bicluster assignment of each sample.

Conclusion: These results demonstrate that there was a significant association between the cluster membership and BAA50 and W50 cohorts, indicating that these biclusters accurately stratify these cohorts.

Objective: To explore the correlation between heart rate variability (HRV), peripheral cytokines, anxiety and pain scores in patients with breast cancer (BC).

Methods: We collected blood samples from 100 BC patients and measured the concentrations of Interleukin 6 (IL-6), Interleukin 4 (IL-4) and Interferon gamma (IFN-γ). We collected the patients' 5-minute dynamic electrocardiograms and evaluated their anxiety and pain levels through the Anxiety Self-Rating Scale and the Short-Form McGill Pain Questionnaire (SF-MPQ) Scale.

Results: Compared with patients in the high HRV group, the low HRV group had lower IL-4 levels and higher IFN-γ/IL-4 concentrations. At the same time, the level of anxiety was also higher, but there was no significant difference in pain. Spearman correlation analysis showed that the normal-to-normal cardiac intervals (SDNN), the square root of the mean of the sum of the squares of differences between adjacent normal-to-normal cardiac intervals (RMSSD), high frequency -HRV (HF-HRV) and IL-4 were positively correlated, SDNN and RMSSD were negatively correlated with IFN-γ/IL-4. HRV is negatively correlated with anxiety. Higher SDNN predicts higher IL-4 levels.

Conclusion: Our results indicate that BC patients with low HRV are associated with higher levels of inflammation and anxiety. Therefore, the measurement of HRV may serve as an objective and non-invasive measurement method for monitoring the immune system and anxiety problems of BC patients.

Purpose: The aim of this study is to analyse PR independently and its relationship with demographic and clinicopathological information.

Introduction: Steroid hormones, particularly estrogen and progesterone, play a crucial role in breast cancer (BC) etiology. Research attention has focused mainly on estrogen while the progesterone impact on breast cancer has yet to be fully uncover. Hormone receptors, including those for estrogen and progesterone, are crucial in BC molecular classification, shaping prognosis and treatment strategies. Beyond its metabolic effects, progesterone and its receptor (PR) have significant clinical implications, impacting clinical outcomes.

Materials and methods: The study comprised 2223 women who were diagnosed with BC at the Comprehensive Cancer Centre in Portugal (IPO-Porto) between 2012 and 2016. Variables, including age at diagnosis, body mass index (BMI), laterality, topographic localization, histological type, differentiation grade, tumor stage, estrogen receptor (ER) and Human Epidermal growth factor Receptor 2 (HER2) expression, were stratified according to the expression of Progesterone Receptor. Statistical analysis included Pearson's Chi-squared test, binary and multinomial regression, and Cox proportional hazard model. Statistical significance was set for P < .05.

Results: The results reveal a statistical association between PR and BMI, histological type, differentiation grade, tumour stage, ER and HER2. Progesterone receptor negativity is associated with adverse clinical outcomes, including advanced tumor stages, and diminished overall survival.

Conclusion: Further research is needed to elucidate the precise contributions of progesterone to breast cancer progression and to optimize therapeutic approaches for improved patient outcomes.