Clinical breast cancer最新文献_第7页

Breast Cancer Patient Flap Management After Mastectomy: A Best Practice Implementation Project 乳腺癌患者乳房切除术后的皮瓣管理：最佳实践实施项目。

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-01-01 DOI: 10.1016/j.clbc.2024.09.004

Minshan Liang , Yuanzhen Luo , Xiaojun Wang , Chunhua Chen , Piao Chen , Zhenchong Xiong , Li Liu , Mengxiao Jiang , Huiting Zhang

Background

Breast cancer is a prevalent malignancy in women, with mastectomy as the main surgery. Common postmastectomy complications are seroma (15%-81%), infections (2.9%-3.8%), and flap necrosis (10%-18%), severely impacting quality of life and costs. However, there's a lack of standardized flap care protocols and limited staff knowledge.

Objectives

This study aims to apply best evidence for flap management post-mastectomy to standardize practices, reduce complications, and enhance patient's quality of life.

Methods

This project followed JBI PACES and GRiP principles, implementing evidence-based practices in a Chinese tertiary hospital between January and May 2023. It entailed evidence identification, integration into clinical context, protocol development, baseline audits, barrier/enabler analysis. The study compared pre- and post-evidence implementation rates of flap complications, healthcare staff's knowledge/skill scores on mastectomy flap management, and audit indicator adherence by both staff and patients.

Results

After evidence application, flap ischemia/necrosis rates dropped from 8.57% to 5.56% (P < .001), wound infection rates after surgery reduced from 5.71% to 2.78% (P < .001), and seroma rates decreased from 17.14% to 2.78% (P < .001). Healthcare staff's knowledge and skill scores for flap management following mastectomy increased from 50.67 ±18.32 preimplementation to 98.33 ± 4.01 (t = -13.90, P < .001). Audit criterion compliance rates increased from 8.57% to 94.29% to between 91.67% and 100%, with statistically significant differences in all 15 criteria (P < .001).

Conclusions

Evidence-based management of flaps after mastectomy improves healthcare staff's knowledge and skills, enhances nursing quality, effectively reduces flap complications in patients, and boosts their quality of life.

背景：乳腺癌是女性的常见恶性肿瘤，主要手术是乳房切除术。常见的乳房切除术后并发症有血清肿（15%-81%）、感染（2.9%-3.8%）和皮瓣坏死（10%-18%），严重影响生活质量和费用。然而，目前缺乏标准化的皮瓣护理方案，工作人员的知识也有限：本研究旨在应用最佳证据进行乳房切除术后皮瓣管理，以规范操作、减少并发症并提高患者的生活质量：该项目遵循 JBI PACES 和 GRiP 原则，于 2023 年 1 月至 5 月在一家中国三级医院实施循证实践。项目包括证据识别、临床整合、方案制定、基线审计、障碍/促进因素分析。研究比较了实施前和实施后的皮瓣并发症发生率、医护人员对乳房切除皮瓣管理的知识/技能评分，以及医护人员和患者对审计指标的遵守情况：应用证据后，皮瓣缺血/坏死率从 8.57% 降至 5.56% (P < .001)，术后伤口感染率从 5.71% 降至 2.78% (P < .001)，血清肿发生率从 17.14% 降至 2.78% (P < .001)。医护人员对乳房切除术后皮瓣管理的知识和技能评分从实施前的 50.67 ± 18.32 增加到 98.33 ± 4.01（t = -13.90，P < .001）。审计标准符合率从 8.57% 到 94.29% 增加到 91.67% 到 100%，所有 15 项标准的符合率差异均有统计学意义（P < .001）：乳房切除术后皮瓣的循证管理提高了医护人员的知识和技能，提升了护理质量，有效减少了患者的皮瓣并发症，提高了患者的生活质量。

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引用次数: 0

Psychiatric Diagnoses and Their Treatment in Women With Breast Cancer: A Latent Class Analysis of 1062 Inpatients 乳腺癌女性患者的精神诊断及其治疗：对 1062 名住院患者的潜类分析

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-01-01 DOI: 10.1016/j.clbc.2024.06.011

Jan Ben Schulze , Marc Dörner , Mona Huber , Katja-Daniela Jordan , Roland von Känel , Sebastian Euler

Introduction

Psycho-oncological support (POS) and psychopharmacological interventions are effective in treating psychiatric symptoms in patients with breast cancer. However, despite high prevalences of psychiatric disorders in patients with breast cancer, a significant proportion remains untreated.

Methods

Data from 1062 breast cancer patients who had been diagnosed and treated at a Comprehensive Cancer Center between 2012 and 2019 were analyzed retrospectively. We descriptively evaluated the number of patients with a psychiatric diagnosis, POS and psychiatric medication. Latent class analysis was used to examine the relationship between ICD-10 coded psychiatric diagnoses, POS, psychiatric medication, and, as important prognostic factors, tumor stage and somatic comorbidity.

Results

31.5% of all patients had a psychiatric diagnosis, 20% received POS and up to 60% received psychiatric medication. Latent class analysis revealed three subgroups: 1) patients with a low cancer stage, low somatic comorbidity, no psychiatric diagnosis, no POS and no psychiatric medication; 2) patients with a low cancer stage, low somatic comorbidity, a psychiatric diagnosis, and a higher probability of POS and psychiatric medication than class 1 and class 3; 3) patients with advanced cancer stage, high somatic comorbidity, a higher probability of a psychiatric diagnosis and POS than class 1, and no psychiatric medication.

Conclusion

This study indicated a high prevalence of psychiatric disorders among patients with breast cancer and a discrepancy between the number of patients having a psychiatric disorder and those receiving psychiatric medication. The identification of subgroups might contribute to better tailored treatment for those patients whose needs are insufficiently met.

肿瘤心理支持（POS）和精神药物干预可有效治疗乳腺癌患者的精神症状。然而，尽管乳腺癌患者的精神障碍患病率很高，但仍有很大一部分患者未得到治疗。我们对 2012 年至 2019 年期间在综合癌症中心接受诊断和治疗的 1062 名乳腺癌患者的数据进行了回顾性分析。我们对患有精神疾病的患者人数、POS 和精神疾病药物进行了描述性评估。我们使用潜类分析来研究 ICD-10 编码的精神科诊断、POS、精神科药物以及作为重要预后因素的肿瘤分期和躯体合并症之间的关系。31.5%的患者有精神科诊断，20%的患者接受了 POS 治疗，60%的患者接受了精神科药物治疗。潜类分析显示了三个亚组：1）癌症分期低、躯体合并症低、无精神诊断、无 POS 和无精神药物治疗的患者；2）癌症分期低、躯体合并症低、有精神诊断、POS 和精神药物治疗的概率高于 1 类和 3 类的患者；3）癌症分期晚、躯体合并症高、有精神诊断和 POS 的概率高于 1 类、无精神药物治疗的患者。这项研究表明，乳腺癌患者中精神障碍的发病率很高，而患有精神障碍的患者人数与接受精神药物治疗的患者人数之间存在差异。确定亚组可能有助于为那些需求未得到充分满足的患者提供更有针对性的治疗。

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引用次数: 0

Navigating Lymphedema: The Impact of Indocyanine Green Lymphography on Personalized Therapy Outcomes in Breast Cancer Patients 为淋巴水肿导航：吲哚菁绿淋巴造影对乳腺癌患者个性化治疗结果的影响。

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-01-01 DOI: 10.1016/j.clbc.2024.10.010

Atilla Soran , Kazim Senol, Kristin Lupinacci

Aim

To evaluate the role of Indocyanine Green Lymphography (ICG_L) in the early diagnosis and personalized management of breast cancer-related lymphedema (BCRL) among high-risk breast cancer (BC) survivors.

Methods

Patients who admitted to the UPMC Magee-Womens Hospital Lymphedema Program between October 2018 and December 2021 with episodic symptoms were enrolled into the study. Patient demographics, clinical characteristics, and outcomes were prospectively collected and retrospectively analysed. Lymphatic flow disruptions were identified and guided personalized therapeutic interventions were guided by ICG_L.

Results

Among 154 BC survivors, 184 arms were evaluated. Initial ICG_L showed 57.1% had no lymphedema, while 42.9% were classified as stage 1 to 3 lymphedema. Early diagnosis and personalized interventions provided improved outcomes, with only 4.3% developing clinical lymphedema after a median follow-up of 27 months. Patients exhibited stable or improved symptoms with individualized treatments such as manual lymphatic drainage, compression therapies, and physiotherapy.

Conclusion

ICG_L evaluation is essential for patients at high-risk of developing BCRL. Early diagnosis before clinical onset of lymphedema, and ICG_L guided therapy significantly enhances the clinical outcomes and improves lymphedema management.

目的：评估吲哚菁绿淋巴造影术（ICG_L）在高危乳腺癌（BC）幸存者乳腺癌相关淋巴水肿（BCRL）的早期诊断和个性化管理中的作用：在2018年10月至2021年12月期间，UPMC马吉-妇科医院淋巴水肿项目收治的有偶发症状的患者被纳入研究。对患者的人口统计学特征、临床特征和结果进行了前瞻性收集和回顾性分析。通过ICG_L确定淋巴流动障碍，并指导个性化治疗干预：结果：在 154 名 BC 幸存者中，对 184 条手臂进行了评估。初步ICG_L显示，57.1%的人没有淋巴水肿，42.9%的人被归类为淋巴水肿1至3期。早期诊断和个性化干预改善了治疗效果，在中位随访27个月后，仅有4.3%的患者出现临床淋巴水肿。患者在接受人工淋巴引流、压力疗法和物理疗法等个性化治疗后，症状得到稳定或改善：结论：ICG_L 评估对于 BCRL 高危患者至关重要。结论：ICG_L 评估对 BCRL 高危患者至关重要，在淋巴水肿临床发作前进行早期诊断，并在 ICG_L 指导下进行治疗，可显著提高临床疗效，改善淋巴水肿管理。

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引用次数: 0

Deep Learning for Distinguishing Mucinous Breast Carcinoma From Fibroadenoma on Ultrasound 通过深度学习在超声波上区分黏液性乳腺癌和纤维腺瘤

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-01-01 DOI: 10.1016/j.clbc.2024.09.001

Yuan Yao , Yang Zhao , Xu Guo , Xiangli Xu , Baiyang Fu , Hao Cui , Jian Xue , Jiawei Tian , Ke Lu , Lei Zhang

Purpose

Mucinous breast carcinoma (MBC) tends to be misdiagnosed as fibroadenomas (FA) due to its benign imaging characteristics. We aimed to develop a deep learning (DL) model to differentiate MBC and FA based on ultrasound (US) images. The model could contribute to the diagnosis of MBC for radiologists.

Methods

In this retrospective study, 884 eligible patients (700 FA patients and 184 MBC patients) with 2257 US images were enrolled. The images were randomly divided into a training set (n = 1805 images) and a test set (n = 452 images) in a ratio of 8:2. First, we used the training set to establish DL model, DL+ age-cutoff model and DL+ age-tree model. Then, we compared the diagnostic performance of three models to get the optimal model. Finally, we evaluated the diagnostic performance of radiologists (4 junior and 4 senior radiologists) with and without the assistance of the optimal model in the test set.

Results

The DL+ age-tree model yielded higher areas under the receiver operating characteristic curve (AUC) than DL model and DL+ age-cutoff model (0.945 vs. 0.835, P < .001; 0.945 vs. 0.931, P < .001, respectively). With the assistance of DL+ age-tree model, both junior and senior radiologists’ AUC had significant improvement (0.746-0.818, P = .010, 0.827-0.860, P = .005, respectively).

Conclusions

The DL+ age-tree model based on US images and age showed excellent performance in the differentiation of MBC and FA. Moreover, it can effectively improve the performance of radiologists with different degrees of experience that may contribute to reducing the misdiagnosis of MBC.

目的：粘液性乳腺癌（MBC）由于其良性成像特征，往往被误诊为纤维腺瘤（FA）。我们旨在开发一种深度学习（DL）模型，根据超声（US）图像区分 MBC 和 FA。该模型有助于放射科医生诊断 MBC：在这项回顾性研究中，884 名符合条件的患者（700 名 FA 患者和 184 名 MBC 患者）接受了 2257 张 US 图像。这些图像按 8:2 的比例随机分为训练集（n = 1805 张图像）和测试集（n = 452 张图像）。首先，我们利用训练集建立了 DL 模型、DL+ 年龄截断模型和 DL+ 年龄树模型。然后，我们比较了三种模型的诊断性能，以获得最佳模型。最后，我们评估了放射科医生（4 名初级放射科医生和 4 名高级放射科医生）在测试集中使用和不使用最优模型的情况下的诊断性能：结果：与 DL 模型和 DL+ 年龄截断模型相比，DL+ 年龄树模型产生了更高的接收者操作特征曲线下面积（AUC）（分别为 0.945 vs. 0.835，P < .001；0.945 vs. 0.931，P < .001）。在 DL+ 年龄树模型的帮助下，初级和高级放射医师的 AUC 均有显著提高（分别为 0.746-0.818, P = .010, 0.827-0.860, P = .005）：结论：基于 US 图像和年龄的 DL+ 年龄树模型在 MBC 和 FA 的鉴别中表现出色。结论：基于 US 图像和年龄的 DL+ 年龄树模型在 MBC 和 FA 的鉴别中表现出色，而且能有效提高具有不同经验的放射科医生的工作效率，从而有助于减少 MBC 的误诊。

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引用次数: 0

Potential of MRI in Assessing Treatment Response After Neoadjuvant Radiation Therapy Treatment in Breast Cancer Patients: A Scoping Review 磁共振成像在评估乳腺癌患者新辅助放疗后治疗反应方面的潜力：范围综述。

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-01-01 DOI: 10.1016/j.clbc.2024.05.010

Ayyaz Qadir , Nabita Singh , Aung Aung Kywe Moe , Glenn Cahoon , Jessica Lye , Michael Chao , Farshad Foroudi , Sergio Uribe

The objective of this scoping review is to evaluate the potential of Magnetic Resonance Imaging (MRI) and to determine which of the available MRI techniques reported in the literature are the most promising for assessing treatment response in breast cancer patients following neoadjuvant radiotherapy (NRT). Ovid Medline, Embase, CINAHL, and Cochrane databases were searched to identify relevant studies published from inception until March 13, 2023. After primary selection, 2 reviewers evaluated each study using a standardized data extraction template, guided by set inclusion and exclusion criteria.

A total of 5 eligible studies were selected. The positive and negative predictive values for MRI predicting pathological complete response across the studies were 67% to 88% and 76% to 85%, respectively. MRI's potential in assessing postradiotherapy tumor sizes was greater for volume measurements than uni-dimensional longest diameter measurements; however, overestimation in surgical tumor sizes was observed. Apparent diffusion coefficient (ADC) values and Time to Enhance (TTE) was seen to increase post-NRT, with a notable difference between responders and nonresponders at 6 months, indicating a potential role in assessing treatment response.

In conclusion, this review highlights tumor volume measurements, ADC, and TTE as promising MRI metrics for assessing treatment response post-NRT in breast cancer. However, further research with larger cohorts is needed to confirm their utility. If MRI can accurately identify responders from nonresponders to NRT, it could enable a more personalized and tailored treatment approach, potentially minimizing radiation therapy related toxicity and enhancing cosmetic outcomes.

本范围综述旨在评估磁共振成像（MRI）的潜力，并确定文献中报道的现有磁共振成像技术中哪些技术最有希望用于评估乳腺癌患者在接受新辅助放疗（NRT）后的治疗反应。研究人员检索了 Ovid Medline、Embase、CINAHL 和 Cochrane 数据库，以确定从开始到 2023 年 3 月 13 日发表的相关研究。初选后，两名审稿人在既定纳入和排除标准的指导下，使用标准化数据提取模板对每项研究进行评估。共筛选出 5 项符合条件的研究。在所有研究中，磁共振成像预测病理完全反应的阳性和阴性预测值分别为67%至88%和76%至85%。核磁共振成像在评估放疗后肿瘤大小方面的潜力是体积测量大于单维最长直径测量；但也观察到手术肿瘤大小被高估。显像扩散系数（ADC）值和增强时间（TTE）在 NRT 后有所增加，6 个月时有反应者和无反应者之间存在明显差异，这表明它在评估治疗反应方面具有潜在作用。总之，本综述强调肿瘤体积测量、ADC 和 TTE 是评估乳腺癌 NRT 后治疗反应的有前途的 MRI 指标。不过，还需要对更大规模的队列进行进一步研究，以确认它们的效用。如果核磁共振成像能准确识别对 NRT 有反应者和无反应者，就能实现更加个性化和量身定制的治疗方法，从而有可能最大限度地减少放疗相关毒性并提高美容效果。

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引用次数: 0

Impacts of Tumor Stage at Diagnosis and Adjuvant Therapy on Long-Term Survival Outcomes in Patients With Triple-Negative Breast Cancer Achieving Pathologic Complete Response After Neoadjuvant Chemotherapy 诊断时的肿瘤分期和辅助治疗对新辅助化疗后获得病理完全反应的三阴性乳腺癌患者长期生存结果的影响

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-01-01 DOI: 10.1016/j.clbc.2024.06.013

Ao-Xiang Chen , Xiao Chen , Xin-Xin Li , Zhang-Yin Guo , Xu-Chen Cao , Xin Wang , Bin Zhang

Background

It remains unknown whether the tumor stage at initial diagnosis and adjuvant treatments had any impacts on the long-term survival outcomes of patients with triple-negative breast cancer (TNBC) achieving pathologic complete response (pCR) following neoadjuvant chemotherapy (NACT).

Methods

Clinical stage II-III patients with TNBC who achieved pCR after NACT were identified from the Surveillance, Epidemiology, and End Results (SEER) program (SEER cohort) and the National Clinical Research Center for Cancer (Tianjin) in China (TMUCIH cohort). Survival analyses were conducted based on tumor stages and the types of adjuvant treatment received by the patients. The outcomes of interest were overall survival (OS) and breast cancer-specific survival (BCSS).

Results

The TMUCIH cohort comprised 178 patients with a median follow-up of 55.5 months. Two and 3 patients experienced BCSS and OS events, respectively. The SEER cohort included 1218 patients with a median follow-up of 65.5 months, where 53 and 78 patients experienced BCSS and OS events, respectively. Patients diagnosed with stage III disease had significantly higher hazards of death compared to stage II disease (OS: hazard ratio [HR], 3.34; 95% confidence interval [CI], 1.84-6.07; P < .001; BCSS: HR, 2.86; 95% CI, 1.38-5.92; P < .001). Adjuvant systemic and radiation therapy did not confer additional benefits to OS and BCSS.

Conclusion

Tumor stage at initial diagnosis remains an independent predictor of long-term survival outcomes in patients with TNBC achieving pCR after NACT. Postoperative adjuvant chemotherapy and radiation therapy do not appear to provide additional benefit to their long-term prognosis.

对于新辅助化疗（NACT）后获得病理完全反应（pCR）的三阴性乳腺癌（TNBC）患者的长期生存结果，初诊时的肿瘤分期和辅助治疗是否有影响，目前仍是未知数。临床II-III期TNBC患者在接受新辅助化疗（NACT）后获得了pCR，这些患者是从监测、流行病学和最终结果（SEER）项目（SEER队列）和中国国家癌症临床研究中心（天津）（TMUCIH队列）中筛选出来的。根据肿瘤分期和患者接受的辅助治疗类型进行了生存期分析。研究结果包括总生存期（OS）和乳腺癌特异性生存期（BCSS）。TMUCIH队列由178名患者组成，中位随访时间为55.5个月。分别有2名和3名患者发生了BCSS和OS事件。SEER队列包括1218名患者，中位随访时间为65.5个月，分别有53名和78名患者发生BCSS和OS事件。与 II 期疾病相比，诊断为 III 期疾病的患者死亡风险明显更高（OS：危险比 [HR]，3.34；95% 置信区间 [CI]，1.84-6.07；< .001；BCSS：HR，2.86；95% 置信区间，1.38-5.92；< .001）。辅助性全身治疗和放射治疗并未给OS和BCSS带来额外的益处。初诊时的肿瘤分期仍是预测NACT后获得pCR的TNBC患者长期生存结果的独立指标。术后辅助化疗和放疗似乎并不能为患者的长期预后带来额外的益处。

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引用次数: 0

The Predictive Value of Blood-Derived Exosomal miRNAs as Biomarkers in Breast Cancer: A Systematic Review 血液中的外泌体 miRNA 作为乳腺癌生物标记物的预测价值：系统综述

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-01-01 DOI: 10.1016/j.clbc.2024.06.016

Marina Linares-Rodríguez , Isabel Blancas , Fernando Rodríguez-Serrano

Breast cancer (BC) remains a widespread disease worldwide, despite advances in its detection and treatment. microRNAs (miRNAs) play a significant role in cancer, and their presence within exosomes may confer several advantages in terms of tumor initiation, propagation, immune evasion, and drug resistance compared to freely circulating miRNAs in the blood. The objective of this study was to conduct a systematic review to analyze the role of exosomal miRNAs present in serum or plasma as biomarkers in BC. Bibliographic sources were collected from various databases with no starting date limit until March 2023. The search terms used were related to “breast cancer,” “microRNAs,” and “exosomes.” Following the search, inclusion and exclusion criteria were applied, resulting in a total of 46 articles. Data were extracted from the selected studies and summarized to indicate the miRNAs, type of dysregulation, sample source, number of patients and controls, and clinical relevance of the miRNAs. We carried out an enrichment study of the microRNAs that appeared in at least 3 studies, those that were suitable for selection were miR-16, miR-21 and miR-155. Exosomal miRNAs isolated from blood samples of patients diagnosed with BC could be valuable in the clinical setting. They could provide information about early diagnosis, disease progression, recurrence, treatment response, and metastases. It is crucial to reach a consensus on the specific exosomal miRNAs to detect and the most appropriate type of sample for comprehensive utilization of miRNAs as biomarkers for BC.

{"title":"The Predictive Value of Blood-Derived Exosomal miRNAs as Biomarkers in Breast Cancer: A Systematic Review","authors":"Marina Linares-Rodríguez , Isabel Blancas , Fernando Rodríguez-Serrano","doi":"10.1016/j.clbc.2024.06.016","DOIUrl":"10.1016/j.clbc.2024.06.016","url":null,"abstract":"<div><div>Breast cancer (BC) remains a widespread disease worldwide, despite advances in its detection and treatment. microRNAs (miRNAs) play a significant role in cancer, and their presence within exosomes may confer several advantages in terms of tumor initiation, propagation, immune evasion, and drug resistance compared to freely circulating miRNAs in the blood. The objective of this study was to conduct a systematic review to analyze the role of exosomal miRNAs present in serum or plasma as biomarkers in BC. Bibliographic sources were collected from various databases with no starting date limit until March 2023. The search terms used were related to “breast cancer,” “microRNAs,” and “exosomes.” Following the search, inclusion and exclusion criteria were applied, resulting in a total of 46 articles. Data were extracted from the selected studies and summarized to indicate the miRNAs, type of dysregulation, sample source, number of patients and controls, and clinical relevance of the miRNAs. We carried out an enrichment study of the microRNAs that appeared in at least 3 studies, those that were suitable for selection were miR-16, miR-21 and miR-155. Exosomal miRNAs isolated from blood samples of patients diagnosed with BC could be valuable in the clinical setting. They could provide information about early diagnosis, disease progression, recurrence, treatment response, and metastases. It is crucial to reach a consensus on the specific exosomal miRNAs to detect and the most appropriate type of sample for comprehensive utilization of miRNAs as biomarkers for BC.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"25 1","pages":"Pages e48-e55.e15"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707551","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}

引用次数: 0

Axillary Recurrence in Sentinel Lymph Node Negative Mastectomy Patients at 16 Years Median Follow Up: Natural History in the Absence of Radiation 前哨淋巴结阴性乳房切除术患者腋窝复发的 16 年中位随访：无放射治疗的自然史

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-01-01 DOI: 10.1016/j.clbc.2024.07.010

Heidi S. Santa Cruz , Francys C. Verdial , Julia N. Shanno , Alexandra J. Webster , Rachel B. Jimenez , Tawakalitu O. Oseni , Tolga Ozmen , Rebecca M. Kwait , Michele A. Gadd , Michelle C. Specht , Barbara L. Smith

Background

Axillary recurrence following lumpectomy with a negative sentinel lymph node biopsy (SLNB) is rare, possibly due to routine use of whole breast radiation. In this study, we characterized the rate of any axillary recurrence among mastectomy patients with a negative SLNB and no adjuvant radiation therapy.

Methods

We identified women who underwent mastectomy with SLNB for early-stage breast cancer (1999-2005) and included patients with pathologically negative nodes and no axillary dissection or adjuvant radiation. The primary outcome was ipsilateral axillary recurrence.

Results

A total of 234 women, median age 50 years, underwent 242 mastectomies. Histology showed 112 (46%) invasive cancers, 16 (7%) ductal carcinoma in-situ (DCIS) with microinvasion, and 114 (47%) pure DCIS. Cancers were predominantly estrogen receptor positive (59%) and moderate (41%) or high grade (32%). A mean of 2 final sentinel nodes were excised (range 1-6) and 21 patients (9%) had isolated tumor cells on SLNB pathology. At 16 years median follow up (range 1-22 years), 3 patients (1.2%) developed an isolated axillary failure, and 1 had concurrent axillary and chest wall recurrences (total axillary recurrence rate 1.7%). Three of four axillary recurrences occurred in patients with moderate or high-grade estrogen receptor-positive DCIS without invasion on mastectomy histology. Median time to axillary recurrence was 70.5 months (range 29-132 months).

Conclusions

Axillary recurrence is rare after a negative SLNB, even in the absence of adjuvant radiation. This supports the safety of forgoing additional surgery or radiation to the axilla in the early-stage breast cancer and a negative SLNB.

前哨淋巴结活检（SLNB）阴性的乳房肿块切除术后腋窝复发非常罕见，这可能是由于常规使用全乳房放射治疗所致。在这项研究中，我们分析了SLNB阴性且未接受辅助放疗的乳房切除术患者的腋窝复发率。我们确定了因早期乳腺癌接受乳房切除术并行 SLNB 的女性（1999-2005 年），并纳入了病理结节阴性且未进行腋窝清扫或辅助放疗的患者。主要结果是同侧腋窝复发。共有 234 名妇女接受了 242 例乳房切除术，中位年龄为 50 岁。组织学显示，112例（46%）为浸润性癌症，16例（7%）为伴有微小浸润的原位导管癌（DCIS），114例（47%）为纯DCIS。癌症主要为雌激素受体阳性（59%）、中度（41%）或高度（32%）。最后切除的前哨结节平均为 2 个（1-6 个不等），有 21 名患者（9%）在 SLNB 病理检查中发现了孤立的肿瘤细胞。中位随访16年（1-22年不等），3名患者（1.2%）出现孤立性腋窝复发，1名患者同时出现腋窝和胸壁复发（总腋窝复发率为1.7%）。4例腋窝复发中的3例发生在雌激素受体阳性的中度或高度DCIS患者中，乳房切除术组织学检查未发现侵犯。腋窝复发的中位时间为70.5个月（29-132个月）。即使没有辅助放射治疗，SLNB 阴性后腋窝复发的情况也很罕见。这支持了早期乳腺癌和SLNB阴性患者放弃额外手术或腋窝放疗的安全性。

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引用次数: 0

Evaluation of the Effect of Menopausal Status and BMI on Polymorphisms in Fas/Fas L and the Risk of Breast Cancer 评估绝经状态和体重指数对 Fas/Fas L 多态性和乳腺癌风险的影响

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-01-01 DOI: 10.1016/j.clbc.2024.07.006

Zahra Tahmasebi Fard

Background

FAS and FAS ligand play an essential role in cell apoptosis. An identifying feature of malignant cells is the loss of FAS and increased FASL expression. A study analyzing the effects of menopausal status and body mass index (BMI) on functional polymorphisms of FAS-(1377G/A; rs2234767 & 670 A/G; rs1800682) and FASL (−844T/C; rs763110 & Ivs-2nt; rs5030772) in breast cancer evaluated these effects.

Patients and Methods

316 blood samples were collected from breast cancer patients and healthy controls in this case/control study. RFLP-PCR was used after DNA extraction to determine genotypes. Age, BMI, menopausal status, smoking, and family history were also analyzed with genotypes. It was analyzed using SPSS software, X2 statistical tests, logistic regression, and Pearson's correlation. The study evaluated the role of indices and polymorphisms in breast cancer risk.

Results

While BMI and family history were significantly different, age, menopause status, and smoking were not. Examining the average BMI between menopausal and nonmenopausal people in the 2 groups showed a statistically significant difference between menopausal people (P <0.0001). As a result of 1377AA, 670GG, 844TT, and IVS-2ntGG, the risk of breast cancer increased by 1.83 times, 2.35 times, and 2.38 times respectively. In addition, mutant alleles increased disease risk significantly. The risk of disease increased considerably for postmenopausal females with certain genotypes (except 1377GA and 844CT genotypes) and high BMI.

Conclusion

Having a high BMI during postmenopause increases your risk of breast cancer. In addition to menopause, BMI also influences disease progression. Different genotypes are needed to clarify this issue.

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引用次数: 0

Optimizing Postneoadjuvant Treatment of Residual Breast Cancer With Adjuvant Bevacizumab Alone, With Metronomic or Standard-Dose Chemotherapy: A Combined Analysis of DFCI 05-055 and DFCI 09-134/TBCRC 012/ABCDE Clinical Trials.

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-12-31 DOI: 10.1016/j.clbc.2024.12.018

Dario Trapani, Qingchun Jin, Kathy D Miller, Hope S Rugo, Katherine E Reeder-Hayes, Tiffany Traina, Yara Abdou, Carla Falkson, Vandana Abramson, Jennifer Ligibel, Wendy Chen, Steven Come, Anju Nohria, Nicole Ryabin, Nabihah Tayob, Sara M Tolaney, Harold J Burstein, Erica L Mayer

Background: Breast cancer patients with residual disease after neoadjuvant therapy have increased risk of recurrence. Novel therapies to decrease this risk are urgently needed.

Methods: Two clinical trials (05-055 and 09-134) offered adjuvant bevacizumab-based therapy to stage I-III breast cancer patients with residual disease after neoadjuvant chemotherapy. Study 05-055 evaluated four treatment regimens: bevacizumab (cohort A); bevacizumab with metronomic cyclophosphamide and methotrexate (CM) (cohort B); and bevacizumab with body surface area-dosed capecitabine (cohorts C); or flat-dosed capecitabine (cohort D). The primary endpoint was feasibility and tolerability. In 09-134, patients were randomized to bevacizumab with or without CM; the primary endpoint was recurrence-free survival (RFS). Study 09-134 closed prematurely for lack of accrual. A pooled survival analysis with participants from 05-055 and 09-134 was conducted.

Results: Among 213 total patients (05-055, n = 163; 09-134, n = 50), the most common adverse events (AEs) of any grade were headache (49.3%) and fatigue (57.3%). Grade 3-4 AEs were highest in cohorts C (71.4%) and D (72.5%). The 36-month RFS was 58.0% with bevacizumab monotherapy, 62.3% with bevacizumab plus CM, and 72.7%-75.0% with bevacizumab plus capecitabine (depending on schedule). Treatment with capecitabine was independently associated with improved RFS in triple-negative breast cancer (TNBC) (HR: 0.47; 95% CI, 0.23-0.96).

Conclusion: This pooled analysis demonstrates that postneoadjuvant bevacizumab plus capecitabine may be associated with improved RFS, especially in TNBC. Each regimen carries moderate toxicity, and despite these treatments, patients with residual disease after neoadjuvant therapy still experience high rates of recurrence, indicating that new strategies are warranted.

Clinical trial registration: clinicaltrials.gov, NCT00121134 (DFCI Protocol Number: 05-055); NCT00925652 (DFCI Protocol Number: 09-134).

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