Pub Date : 2024-08-30DOI: 10.1016/j.clbc.2024.08.009
Kishaanth S, Abishek VP, Lokeswari Y Venkataramana, Venkata Vara Prasad D
Cancer, the second leading cause of death globally, claimed 685,000 lives among 2.3 million women affected by breast cancer in 2020. Cancer prognosis plays a pivotal role in tailoring treatments and assessing efficacy, emphasizing the need for a comprehensive understanding. The goal is to develop predictive model capable of accurately predicting patient outcomes and guiding personalized treatment strategies, thereby advancing precision medicine in breast cancer care. This project addresses limitations in current cancer prognosis models by integrating omics and non-omics data. While existing models often neglect crucial omics data like DNA methylation and miRNA, the method utilizes the TCGA dataset to incorporate these data types along with others. Employing mRMR feature selection and CNN models for each type of data for feature extraction, features are stacked and a Random Forest classifier is employed for final prognosis. The proposed method is applied to the dataset to predict whether the patient is a long-time or a short-time survivor. This strategy showcases excellent performance, with an AUC value of 0.873, precision at 0.881, and sensitivity reaching 0.943. With an accuracy rate of 0.861, signaling an improvement of 11.96% compared to prior studies. In conclusion, integrating diverse data with advanced machine learning holds promise for improving breast cancer prognosis. Addressing model limitations and leveraging comprehensive datasets can enhance accuracy, paving the way for better patient care. Further refinement offers potential for significant advancements in cancer prognosis and treatment strategies.
{"title":"Enhancing Breast Cancer Survival Prognosis Through Omic and Non-Omic Data Integration","authors":"Kishaanth S, Abishek VP, Lokeswari Y Venkataramana, Venkata Vara Prasad D","doi":"10.1016/j.clbc.2024.08.009","DOIUrl":"https://doi.org/10.1016/j.clbc.2024.08.009","url":null,"abstract":"Cancer, the second leading cause of death globally, claimed 685,000 lives among 2.3 million women affected by breast cancer in 2020. Cancer prognosis plays a pivotal role in tailoring treatments and assessing efficacy, emphasizing the need for a comprehensive understanding. The goal is to develop predictive model capable of accurately predicting patient outcomes and guiding personalized treatment strategies, thereby advancing precision medicine in breast cancer care. This project addresses limitations in current cancer prognosis models by integrating omics and non-omics data. While existing models often neglect crucial omics data like DNA methylation and miRNA, the method utilizes the TCGA dataset to incorporate these data types along with others. Employing mRMR feature selection and CNN models for each type of data for feature extraction, features are stacked and a Random Forest classifier is employed for final prognosis. The proposed method is applied to the dataset to predict whether the patient is a long-time or a short-time survivor. This strategy showcases excellent performance, with an AUC value of 0.873, precision at 0.881, and sensitivity reaching 0.943. With an accuracy rate of 0.861, signaling an improvement of 11.96% compared to prior studies. In conclusion, integrating diverse data with advanced machine learning holds promise for improving breast cancer prognosis. Addressing model limitations and leveraging comprehensive datasets can enhance accuracy, paving the way for better patient care. Further refinement offers potential for significant advancements in cancer prognosis and treatment strategies.","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"30 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261301","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}
Pub Date : 2024-08-30DOI: 10.1016/j.clbc.2024.08.014
André Mattar, Francisco Pimentel Cavalcante, Marcelo Antonini, Felipe Zerwes, Eduardo de Camargo Millen, Fabrício Palermo Brenelli, Antônio Luiz Frasson, Lucas Miyake Okumura
{"title":"Letter to the Editor of Clinical Breast Cancer, on “Omitting Axillary Lymph Node Dissection is Associated With an Increased Risk of Regional Recurrence in Early Stage Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Clinical Trials” Conducted by Jorge Henrique Cardoso and Collaborators and Published in Clinical Breast Cancer doi.org/10.1016/j.clbc.2024.07.011","authors":"André Mattar, Francisco Pimentel Cavalcante, Marcelo Antonini, Felipe Zerwes, Eduardo de Camargo Millen, Fabrício Palermo Brenelli, Antônio Luiz Frasson, Lucas Miyake Okumura","doi":"10.1016/j.clbc.2024.08.014","DOIUrl":"https://doi.org/10.1016/j.clbc.2024.08.014","url":null,"abstract":"","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261299","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}
Pub Date : 2024-08-30DOI: 10.1016/j.clbc.2024.08.019
Vanessa B. Sheppard , Fariha Tariq , Dustin Bastiach , Malik Philips , Robert Winn , Megan C. Edmonds , Hayley S. Thompson
Introduction
This study evaluated the relationships between patient and cancer delivery factors with trust in oncology providers in a racial/ethnically diverse group of cancer patients.
Methods
Data were analyzed from a prospective cohort study of women with hormone receptor positive (HR+) breast cancer. A standardized survey collected validated measures of trust in providers, psychosocial factors, and cancer care delivery factors. Multivariable logistic regression models and race-stratified models were employed to calculate odds ratios and 95% confidence intervals associated with trust.
Results
Of the 567 participants, 28% identified as Black and the rest were White. Compared to White women Black women reported lower trust in providers. Four domains of cancer care delivery were significantly associated with patients’ higher trust in their providers: general satisfaction with care (P < .0001), technical quality of the provider (P < .001), interpersonal manner of the provider (P = .0008) and provider communication (P = .0010). Race-stratified models revealed 2 significant cancer care delivery domains for both groups (ie, general satisfaction and interpersonal) and 2 care domains (technical quality and communication) that were only significant among White women.
Conclusion
Efforts are needed to nurture trusting relationships between Black women and their oncology providers. Factors related to the organization and delivery of cancer care are modifiable targets for interventions as these were robust predictors of patient trust regardless of a woman's self-reported race. Investments in strategies that strengthen the structure and organization of care towards a structures of trust worthiness may better support providers and patients and ultimately reduce cancer care disparities.
{"title":"Trust in Black and White Breast Cancer Patients: Opportunities to Enhance Trustworthiness in Cancer Care","authors":"Vanessa B. Sheppard , Fariha Tariq , Dustin Bastiach , Malik Philips , Robert Winn , Megan C. Edmonds , Hayley S. Thompson","doi":"10.1016/j.clbc.2024.08.019","DOIUrl":"10.1016/j.clbc.2024.08.019","url":null,"abstract":"<div><h3>Introduction</h3><div>This study evaluated the relationships between patient and cancer delivery factors with trust in oncology providers in a racial/ethnically diverse group of cancer patients.</div></div><div><h3>Methods</h3><div>Data were analyzed from a prospective cohort study of women with hormone receptor positive (HR+) breast cancer. A standardized survey collected validated measures of trust in providers, psychosocial factors, and cancer care delivery factors. Multivariable logistic regression models and race-stratified models were employed to calculate odds ratios and 95% confidence intervals associated with trust.</div></div><div><h3>Results</h3><div>Of the 567 participants, 28% identified as Black and the rest were White. Compared to White women Black women reported lower trust in providers. Four domains of cancer care delivery were significantly associated with patients’ higher trust in their providers: <em>general satisfaction with care</em> (<em>P</em> < .0001), <em>technical quality</em> of the provider (<em>P</em> < .001), <em>interpersonal manner</em> of the provider (<em>P</em> = .0008) and provider <em>communication (P</em> = .0010). Race-stratified models revealed 2 significant cancer care delivery domains for both groups (ie, <em>general satisfaction</em> and <em>interpersonal</em>) and 2 care domains (<em>technical quality</em> and <em>communication</em>) that were only significant among White women.</div></div><div><h3>Conclusion</h3><div>Efforts are needed to nurture trusting relationships between Black women and their oncology providers. Factors related to the organization and delivery of cancer care are modifiable targets for interventions as these were robust predictors of patient trust regardless of a woman's self-reported race. Investments in strategies that strengthen the structure and organization of care towards a structures of trust worthiness may better support providers and patients and ultimately reduce cancer care disparities.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages e748-e756"},"PeriodicalIF":2.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261297","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}
Pub Date : 2024-08-30DOI: 10.1016/j.clbc.2024.08.015
Ryan T. Morse, Nathan W. Bean, Jacob Hall, Allison Deal, Kirsten A. Nyrop, Yara Abdou, Elizabeth C. Dees, Emily M. Ray, Trevor A. Jolly, Katherine E. Reeder-Hayes, Ellen Jones, Gaorav P. Gupta, Shekinah Elmore, Hyman B. Muss, Dana L. Casey
Understanding quality of life (QOL) implications of individual components of breast cancer treatment is important as systemic therapies continue to improve oncologic outcomes. We hypothesized that adjuvant radiation therapy does not significantly impact QOL domains in breast cancer patients undergoing chemotherapy. Data was drawn from 3 prospective studies in women with localized breast cancer being treated with chemotherapy from March 2014 to December 2019. Patient-reported measures were collected at baseline (pretreatment) and post-treatment using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) measure, which consists of 5 subscales. Changes in mean QOL scores in patients who received radiotherapy were compared to those who did not using a 1-sided noninferiority method. Statistical significance was determined below 0.05 to meet noninferiority. In a sample of 175 patients, 131 were treated with radiation and 44 had no radiation. The sample consisted mostly of stage I-II breast cancer (78%) with hormone receptor positive (59%) disease, receiving either neoadjuvant (36%) or adjuvant chemotherapy (64%). Mean change in QOL for the group treated with radiation compared to no radiation was noninferior with respect to Physical Well-Being ( = .0027), Social/Family Well-Being ( = .0002), Emotional Well-Being ( = .0203), FACIT-Fatigue Subscale ( = .0072), and the Total FACIT-F score ( = .0005); however, mean change in QOL did not meet noninferiority for Functional Well-Being ( = .0594). Patient-reported QOL from baseline to post-treatment, using the Total FACIT-F score, was noninferior in patients treated with versus without radiation therapy. This finding, in addition to individualized QOL subscales, provides important information in the informed decision-making process when discussing the effects of locoregional radiation on QOL in localized breast cancer patients treated with chemotherapy.
随着系统疗法不断改善肿瘤治疗效果，了解乳腺癌治疗的各个组成部分对生活质量（QOL）的影响非常重要。我们假设辅助放疗不会对接受化疗的乳腺癌患者的 QOL 领域产生显著影响。数据来自于2014年3月至2019年12月期间对接受化疗的局部乳腺癌女性患者进行的3项前瞻性研究。在基线（治疗前）和治疗后使用慢性疾病治疗功能评估-疲劳（FACIT-F）测量方法收集了患者报告的测量结果，该测量方法由5个分量表组成。采用单侧非劣效法比较接受放疗与未接受放疗患者的平均 QOL 评分变化。统计显著性低于 0.05 即为达到非劣效性。在 175 例样本患者中，131 例接受了放射治疗，44 例未接受放射治疗。样本中大部分患者为 I-II 期乳腺癌（78%），激素受体阳性（59%），接受了新辅助化疗（36%）或辅助化疗（64%）。与无放射治疗相比，接受放射治疗组的平均QOL变化在身体健康（= 0.0027）、社会/家庭幸福（= 0.0002）、情感幸福（= 0.0203）、FACIT-疲劳分量表（= 0.0072）和FACIT-F总分（= 0.0005）方面不具劣势；但在功能幸福（= 0.0594）方面，平均QOL变化不具劣势。使用 FACIT-F 总分，患者报告的从基线到治疗后的 QOL 在接受放疗与不接受放疗的患者中并无劣势。在讨论局部放射治疗对接受化疗的局部乳腺癌患者的 QOL 的影响时，这一发现以及个体化 QOL 子量表为知情决策过程提供了重要信息。
{"title":"Quality of Life Outcomes in Breast Cancer Patients Receiving Chemotherapy With or Without Radiation Therapy","authors":"Ryan T. Morse, Nathan W. Bean, Jacob Hall, Allison Deal, Kirsten A. Nyrop, Yara Abdou, Elizabeth C. Dees, Emily M. Ray, Trevor A. Jolly, Katherine E. Reeder-Hayes, Ellen Jones, Gaorav P. Gupta, Shekinah Elmore, Hyman B. Muss, Dana L. Casey","doi":"10.1016/j.clbc.2024.08.015","DOIUrl":"https://doi.org/10.1016/j.clbc.2024.08.015","url":null,"abstract":"Understanding quality of life (QOL) implications of individual components of breast cancer treatment is important as systemic therapies continue to improve oncologic outcomes. We hypothesized that adjuvant radiation therapy does not significantly impact QOL domains in breast cancer patients undergoing chemotherapy. Data was drawn from 3 prospective studies in women with localized breast cancer being treated with chemotherapy from March 2014 to December 2019. Patient-reported measures were collected at baseline (pretreatment) and post-treatment using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) measure, which consists of 5 subscales. Changes in mean QOL scores in patients who received radiotherapy were compared to those who did not using a 1-sided noninferiority method. Statistical significance was determined below 0.05 to meet noninferiority. In a sample of 175 patients, 131 were treated with radiation and 44 had no radiation. The sample consisted mostly of stage I-II breast cancer (78%) with hormone receptor positive (59%) disease, receiving either neoadjuvant (36%) or adjuvant chemotherapy (64%). Mean change in QOL for the group treated with radiation compared to no radiation was noninferior with respect to Physical Well-Being ( = .0027), Social/Family Well-Being ( = .0002), Emotional Well-Being ( = .0203), FACIT-Fatigue Subscale ( = .0072), and the Total FACIT-F score ( = .0005); however, mean change in QOL did not meet noninferiority for Functional Well-Being ( = .0594). Patient-reported QOL from baseline to post-treatment, using the Total FACIT-F score, was noninferior in patients treated with versus without radiation therapy. This finding, in addition to individualized QOL subscales, provides important information in the informed decision-making process when discussing the effects of locoregional radiation on QOL in localized breast cancer patients treated with chemotherapy.","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"85 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261298","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}
Pub Date : 2024-08-29DOI: 10.1016/j.clbc.2024.08.022
Yada Kanjanapan, Wayne Anderson, Mirka Smith, Jenny Green, Elizabeth Chalker, Paul Craft
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. 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. 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, < .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, < .001). Compared with monarchE trial patients, abemaciclib-eligible registry patients were older (median 55 vs. 51 years), with lower nodal burden (≥4 nodes in 44% vs. 60%). There were more stage III cancers in NATALEE trial patients (60%) than ribociclib-eligible registry patients (24%). 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.
{"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":"https://doi.org/10.1016/j.clbc.2024.08.022","url":null,"abstract":"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. 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. 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, < .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, < .001). Compared with monarchE trial patients, abemaciclib-eligible registry patients were older (median 55 vs. 51 years), with lower nodal burden (≥4 nodes in 44% vs. 60%). There were more stage III cancers in NATALEE trial patients (60%) than ribociclib-eligible registry patients (24%). 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.","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"35 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-29","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1016/j.clbc.2024.08.021
Yumeng Wei , Peinan Liu , Xingyu Liu , Meng Wang , Dandan Liu , Hanxiao Cui , Shuai Lin , Hao Wu , Xiaobin Ma , Huafeng Kang
Purpose
This study aimed to analyze the association between the primary tumor site and clinicopathological characteristics and survival prognosis of breast cancer (BC) patients using a large population database.
Methods
BC patients screened in the Surveillance, Epidemiology, and End Results (SEER) database were categorized into 6 groups based on primary sites. Descriptive statistics, Kaplan-Meier curves, Cox regression models, forest plots were used to assess the effect of primary sites on overall survival (OS) and breast cancer-specific survival (BCSS). Multivariate Cox proportional analyses were conducted to calculate hazard ratios (HRs) and adjusted subgroups’ hazard ratios (AHRs). Nomograms were utilized to predict OS and BCSS.
Results
Among 193,043 BC patients, the highest incidence was found in the upper outer quadrant (52.60%). Central portion patients are associated with more clinical features indicating a poor prognosis, and had worse OS and BCSS than other sites. Univariate and multifactorial Cox analyses showed associations between OS/BCSS and various factors. Subgroup analyses revealed differences in OS and BCSS between central portion and upper outer quadrant varied among age, T and N stage. The nomogram was established to predict the survival of central portion BC patients.
Conclusions
Primary tumor site is associated with clinicopathological features and prognosis of BC, may be influenced by age at diagnosis and T and N stage. Central portion BC patients have worse prognosis due to older age at diagnosis, higher T stage and higher likelihood of lymph node metastasis. Early diagnosis and treatment may help to improve survival of central portion BC.
本研究旨在利用大型人口数据库分析乳腺癌（BC）患者的原发肿瘤部位与临床病理特征和生存预后之间的关系。在监测、流行病学和最终结果（SEER）数据库中筛查出的乳腺癌患者根据原发部位分为 6 组。采用描述性统计、卡普兰-梅耶曲线、Cox回归模型和森林图来评估原发部位对总生存期（OS）和乳腺癌特异性生存期（BCSS）的影响。采用多变量考克斯比例分析法计算危险比（HRs）和调整亚组危险比（AHRs）。采用提名图预测OS和BCSS。在 193 043 名 BC 患者中，外上象限的发病率最高（52.60%）。与其他部位相比，中央部位患者具有更多预后不良的临床特征，其OS和BCSS也更差。单变量和多因素Cox分析显示，OS/BCSS与各种因素有关。亚组分析显示，中央部分和外上象限的OS和BCSS因年龄、T期和N期而异。建立了预测中央型 BC 患者生存期的提名图。原发肿瘤部位与BC的临床病理特征和预后有关，可能受诊断时的年龄、T期和N期的影响。中央型 BC 患者的预后较差，原因是诊断时年龄较大、T 分期较高以及淋巴结转移的可能性较高。早期诊断和治疗可能有助于提高中央型 BC 的生存率。
{"title":"Analysis of the Relationship Between Primary Tumor Site and Clinicopathological Characteristics and Survival Prognosis of Breast Cancer Patients Based on SEER Database","authors":"Yumeng Wei , Peinan Liu , Xingyu Liu , Meng Wang , Dandan Liu , Hanxiao Cui , Shuai Lin , Hao Wu , Xiaobin Ma , Huafeng Kang","doi":"10.1016/j.clbc.2024.08.021","DOIUrl":"10.1016/j.clbc.2024.08.021","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to analyze the association between the primary tumor site and clinicopathological characteristics and survival prognosis of breast cancer (BC) patients using a large population database.</div></div><div><h3>Methods</h3><div>BC patients screened in the Surveillance, Epidemiology, and End Results (SEER) database were categorized into 6 groups based on primary sites. Descriptive statistics, Kaplan-Meier curves, Cox regression models, forest plots were used to assess the effect of primary sites on overall survival (OS) and breast cancer-specific survival (BCSS). Multivariate Cox proportional analyses were conducted to calculate hazard ratios (HRs) and adjusted subgroups’ hazard ratios (AHRs). Nomograms were utilized to predict OS and BCSS.</div></div><div><h3>Results</h3><div>Among 193,043 BC patients, the highest incidence was found in the upper outer quadrant (52.60%). Central portion patients are associated with more clinical features indicating a poor prognosis, and had worse OS and BCSS than other sites. Univariate and multifactorial Cox analyses showed associations between OS/BCSS and various factors. Subgroup analyses revealed differences in OS and BCSS between central portion and upper outer quadrant varied among age, T and N stage. The nomogram was established to predict the survival of central portion BC patients.</div></div><div><h3>Conclusions</h3><div>Primary tumor site is associated with clinicopathological features and prognosis of BC, may be influenced by age at diagnosis and T and N stage. Central portion BC patients have worse prognosis due to older age at diagnosis, higher T stage and higher likelihood of lymph node metastasis. Early diagnosis and treatment may help to improve survival of central portion BC.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages 728-745"},"PeriodicalIF":2.9,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261302","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}
Pub Date : 2024-08-24DOI: 10.1016/j.clbc.2024.08.013
Chirag Shah, Sheen Cherian
{"title":"Deintensification of Locoregional Therapy Following Neoadjuvant Chemotherapy for Breast Cancer: Where do We Go From Here?","authors":"Chirag Shah, Sheen Cherian","doi":"10.1016/j.clbc.2024.08.013","DOIUrl":"https://doi.org/10.1016/j.clbc.2024.08.013","url":null,"abstract":"","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"18 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261303","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}
Pub Date : 2024-08-24DOI: 10.1016/j.clbc.2024.08.018
Nengying Zhang , Liyi Pan , Tao Weng , Jiayang Li , Yuxiang Bao , Zhongliang Yan , Taolang Li , Xiaoming Cheng , Junyuan Lv
Both chemotherapy (CT) and endocrine therapy (ET) play important roles in the systemic treatment of breast cancer (BC). However, previous studies have shown an antagonistic effect when CT and ET are administered simultaneously. Therefore, sequential administration is more effective than combined administration. The current guidelines and consensus recommend a sequential schedule of CT and ET for patients with hormone receptor-positive (HR+) BC. However, with the continuous introduction of new endocrine drugs, the question of whether the simultaneous administration of CT and ET is superior to sequential therapy has surfaced again as a hot topic of clinical concern. Recent studies have shown that the combination of certain chemotherapeutic agents with endocrine drugs has a synergistic effect. This review aims to summarize the new advances achieved in recent years on the old topic of CT combined with ET in the treatment of BC.
化疗（CT）和内分泌治疗（ET）在乳腺癌（BC）的全身治疗中都发挥着重要作用。然而，以往的研究表明，同时使用 CT 和 ET 会产生拮抗作用。因此，序贯用药比联合用药更有效。目前的指南和共识建议对激素受体阳性（HR+）的乳腺癌患者按顺序使用 CT 和 ET。然而，随着新型内分泌药物的不断推出，CT 和 ET 同时使用是否优于序贯治疗的问题再次浮出水面，成为临床关注的热点话题。最新研究表明，某些化疗药物与内分泌药物联合使用具有协同作用。本综述旨在总结近年来在 CT 联合 ET 治疗 BC 这一老话题上取得的新进展。
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Pub Date : 2024-08-23DOI: 10.1016/j.clbc.2024.08.012
Adil Ayub , Kazim Senol , Makris Eleftherios , Michael S. Cowher , Ronald R. Johnson , Kristin M. Lupinacci , Quratulain Sabih , Jennifer G. Steiman , Emilia J. Diego , Priscilla F. McAuliffe , Atilla Soran
Background
Sentinel lymph node biopsy (SLNB) for axillary staging in patients with ductal carcinoma in situ (DCIS) undergoing mastectomy is debated due to low nodal positivity rate and risk of morbidity. Standard SLNB entails removing all lymph nodes (LN) that have a radioactive count > 10% of the most radioactive node, contain blue dye or are palpably suspicious. In this study, we hypothesize that judicious SLNB with attempt to remove only the node with the highest radioactive count provides sufficient pathologic information while minimizing morbidity.
Method
A single institution prospective database was retrospectively reviewed to identify women with DCIS who underwent mastectomy and SLNB between 2010 and 2022. Patient characteristics, number of SLNs retrieved, pathologic results and long-term upper extremity complications were analyzed.
Results
A total of 743 LNs were removed in 324 pts. Median (IQR) age was 62 (51-70) years. Dual tracer technique, with technetium-99m labeled radiocolloid and blue dye, was used in 311 (96%) pts, whereas single agent (radioisotope or blue dye alone) was utilized in 9 (2.8%) and 4 (1.2%) patients, respectively. Median (IQR) number of SLN removed was 2 (1-3) (range 1-9). In 99% of cases, the SLN with the highest radioactive count was identified among the first 3 dissected LNs. Final pathology revealed upstaging to invasive cancer in 27.5% (n = 89) of the breasts and nodal positivity in 1.9% (n = 6) of the patients. In all 6 cases, metastatic disease was identified in the LN with highest radioactive count among the LNs retrieved. No additional metastatic nodes were identified after > 3 SLN had been removed. At median follow-up of 57 (range 28-87) months, 8.3% (n = 27) of pts complained of long-term upper extremity symptoms. 7.1% (23 pts) were referred to physical therapy for symptoms such as swelling, fullness, heaviness, stiffness, or sensory discomfort in the upper extremity and/or axillary cording. Long-term upper extremity complications were higher when > 3 SLNs compared to ≤ 3 SLNs were removed (10.4% vs. 6.5%, P = .005).
Conclusion
In this cohort of patients with DCIS undergoing mastectomy who were upstaged on final pathology to node positive invasive cancers, the SLN with the highest radioactive count provided sufficient information for axillary staging. Acknowledging that the “hottest” LN is not always the first 1 removed, these data support an increased likelihood of developing long-term complications when more than 3 SLNs are removed. Rather than comprehensive removal of all SLNs meeting the standard “10% rule,” prioritizing the sequence of removal to the highest count provides the same prognostic information with reduced morbidity.
{"title":"De-Escalating the Extent of Sentinel Lymph Node Biopsy in Patients With Ductal Carcinoma in Situ Undergoing Mastectomy","authors":"Adil Ayub , Kazim Senol , Makris Eleftherios , Michael S. Cowher , Ronald R. Johnson , Kristin M. Lupinacci , Quratulain Sabih , Jennifer G. Steiman , Emilia J. Diego , Priscilla F. McAuliffe , Atilla Soran","doi":"10.1016/j.clbc.2024.08.012","DOIUrl":"10.1016/j.clbc.2024.08.012","url":null,"abstract":"<div><h3>Background</h3><div>Sentinel lymph node biopsy (SLNB) for axillary staging in patients with ductal carcinoma in situ (DCIS) undergoing mastectomy is debated due to low nodal positivity rate and risk of morbidity. Standard SLNB entails removing all lymph nodes (LN) that have a radioactive count > 10% of the most radioactive node, contain blue dye or are palpably suspicious. In this study, we hypothesize that judicious SLNB with attempt to remove only the node with the highest radioactive count provides sufficient pathologic information while minimizing morbidity.</div></div><div><h3>Method</h3><div>A single institution prospective database was retrospectively reviewed to identify women with DCIS who underwent mastectomy and SLNB between 2010 and 2022. Patient characteristics, number of SLNs retrieved, pathologic results and long-term upper extremity complications were analyzed.</div></div><div><h3>Results</h3><div>A total of 743 LNs were removed in 324 pts. Median (IQR) age was 62 (51-70) years. Dual tracer technique, with technetium-99m labeled radiocolloid and blue dye, was used in 311 (96%) pts, whereas single agent (radioisotope or blue dye alone) was utilized in 9 (2.8%) and 4 (1.2%) patients, respectively. Median (IQR) number of SLN removed was 2 (1-3) (range 1-9). In 99% of cases, the SLN with the highest radioactive count was identified among the first 3 dissected LNs. Final pathology revealed upstaging to invasive cancer in 27.5% (<em>n</em> = 89) of the breasts and nodal positivity in 1.9% (<em>n</em> = 6) of the patients. In all 6 cases, metastatic disease was identified in the LN with highest radioactive count among the LNs retrieved. No additional metastatic nodes were identified after > 3 SLN had been removed. At median follow-up of 57 (range 28-87) months, 8.3% (<em>n</em> = 27) of pts complained of long-term upper extremity symptoms. 7.1% (23 pts) were referred to physical therapy for symptoms such as swelling, fullness, heaviness, stiffness, or sensory discomfort in the upper extremity and/or axillary cording. Long-term upper extremity complications were higher when > 3 SLNs compared to ≤ 3 SLNs were removed (10.4% vs. 6.5%, <em>P</em> = .005).</div></div><div><h3>Conclusion</h3><div>In this cohort of patients with DCIS undergoing mastectomy who were upstaged on final pathology to node positive invasive cancers, the SLN with the highest radioactive count provided sufficient information for axillary staging. Acknowledging that the “hottest” LN is not always the first 1 removed, these data support an increased likelihood of developing long-term complications when more than 3 SLNs are removed. Rather than comprehensive removal of all SLNs meeting the standard “10% rule,” prioritizing the sequence of removal to the highest count provides the same prognostic information with reduced morbidity.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages 716-720"},"PeriodicalIF":2.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215914","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}
Pub Date : 2024-08-23DOI: 10.1016/j.clbc.2024.08.011
Ru Yao , Fengzhou Du , Runzhu Liu , Linjuan Tan , Jie Lian , Lu Gao , Hailin Zhang , Li Huang , Bo Pan , Yidong Zhou , Qiang Sun , Jun Zhao , Xiao Long
Background
Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are challenging for surgical training among fellow trainees. We developed a surgical training course with novel concept of breast modular resection (BMR) for NSM/SSM procedure, and performed this study to investigate whether BMR could improve surgical outcomes compared to classical procedure resection (CPR).
Methods
The records of 105 breast cancer patients undergoing NSM/SSM with immediate reconstruction performed by fellow trainees were reviewed. Clinicopathological characteristics and surgical outcomes were compared between 2 groups. Laser speckle contrast imaging (LSCI) was performed to intraoperatively evaluate the blood supply of the NAC, and the absolute perfusion unit (PU) values and relative perfusion unit (rPU) values were further compared.
Results
Surgical training outcomes of BMR group (N = 52) were insignificantly improved compared to CPR group (N = 53). The rates of NAC necrosis, flap necrosis and implant removal all reduced respectively. Among the 60 NSM patients, the blood loss (P = .011) and surgery time (P < .001) was significantly reduced in BMR group (N = 30) and all the other outcomes were insignificantly improved. Both the absolute PU values and rPU values were significantly higher among patients without NAC necrosis (P < .001). The absolute PU values were significantly higher in BMR group (P = .002).
Conclusion
Compared to CPR, the BMR-based surgical training course for NSM demonstrated the reduction in complications and operating time, offering a potential streamlined, efficient, and safe method for NSM procedure. LSCI was effective for intraoperative visualized evaluation of NAC blood supply and could provide effective real-time feedback for fellow trainees.
{"title":"Breast Modular Resection (BMR) in Nipple-Sparing Mastectomy (NSM) With Intraoperative Laser Speckle Contrast Imaging (LSCI) Monitoring Improved Surgical Training Outcome Among Fellows","authors":"Ru Yao , Fengzhou Du , Runzhu Liu , Linjuan Tan , Jie Lian , Lu Gao , Hailin Zhang , Li Huang , Bo Pan , Yidong Zhou , Qiang Sun , Jun Zhao , Xiao Long","doi":"10.1016/j.clbc.2024.08.011","DOIUrl":"10.1016/j.clbc.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are challenging for surgical training among fellow trainees. We developed a surgical training course with novel concept of breast modular resection (BMR) for NSM/SSM procedure, and performed this study to investigate whether BMR could improve surgical outcomes compared to classical procedure resection (CPR).</div></div><div><h3>Methods</h3><div>The records of 105 breast cancer patients undergoing NSM/SSM with immediate reconstruction performed by fellow trainees were reviewed. Clinicopathological characteristics and surgical outcomes were compared between 2 groups. Laser speckle contrast imaging (LSCI) was performed to intraoperatively evaluate the blood supply of the NAC, and the absolute perfusion unit (PU) values and relative perfusion unit (rPU) values were further compared.</div></div><div><h3>Results</h3><div>Surgical training outcomes of BMR group (<em>N</em> = 52) were insignificantly improved compared to CPR group (<em>N</em> = 53). The rates of NAC necrosis, flap necrosis and implant removal all reduced respectively. Among the 60 NSM patients, the blood loss (<em>P</em> = .011) and surgery time (<em>P</em> < .001) was significantly reduced in BMR group (<em>N</em> = 30) and all the other outcomes were insignificantly improved. Both the absolute PU values and rPU values were significantly higher among patients without NAC necrosis (<em>P</em> < .001). The absolute PU values were significantly higher in BMR group (<em>P</em> = .002).</div></div><div><h3>Conclusion</h3><div>Compared to CPR, the BMR-based surgical training course for NSM demonstrated the reduction in complications and operating time, offering a potential streamlined, efficient, and safe method for NSM procedure. LSCI was effective for intraoperative visualized evaluation of NAC blood supply and could provide effective real-time feedback for fellow trainees.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 8","pages":"Pages 705-715"},"PeriodicalIF":2.9,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142215829","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}
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