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An Individual Patient Data Meta-Analysis on the Characteristics, Treatments, and Outcomes of the Patients With Neuroendocrine Neoplasm of the Breast Reported in Literature Until August 2024 截至2024年8月,文献报道的乳腺神经内分泌肿瘤患者的特征、治疗和结局的个体患者数据荟萃分析。
IF 2.5 3区 医学 Q2 ONCOLOGY Pub Date : 2026-02-01 Epub Date: 2025-09-02 DOI: 10.1016/j.clbc.2025.08.016
Lena Schnell , Helmut Orawa , Georg W. Wurschi , Klaus Pietschmann
Neuroendocrine neoplasm (NEN) of the breast is a rare type of breast cancer with limited knowledge about its characteristics and optimal management. The diagnostic criteria have been constantly updated by the World Health Organization (WHO) with increasing understanding, most recently in 2019. Focusing on characteristics, treatments and outcomes, we performed a comprehensive individual patient data (IPD) meta-analysis of the cases reported in literature between 2003 and August 2024. PubMed and Web of Science were searched systematically for case reports using predefined search terms. The protocol was prospectively registered with the international prospective register of systematic reviews (PROSPERO CRD42022356345). 185 publications, consisting of case reports or small case series published between 2003 and 2024, were eligible. They reported on 202 patients. Median age at diagnosis was 54 years (range 13-86). The 5-year overall survival proportion was 77%. On univariable analysis, overall survival was significantly influenced by regional and distant metastases, histologic grading, receptor status, Ki-67 index and surgical intervention. We did not observe any significant outcome improvement over time. Only poorly differentiated neuroendocrine carcinoma and lack of surgery were found to be prognostic factors for poor overall survival in multivariable analysis. This rare subtype of breast cancer is associated with a poor prognosis with no meaningful treatment progress in the last 2 decades. The present study identified key prognostic factors. However, the available data are insufficient to determine the optimal treatment approach. Establishing uniform diagnostic criteria and consistently reporting cases is crucial to generate a larger pool of data, thereby advancing our understanding and management of this rare disease.
乳腺神经内分泌肿瘤(NEN)是一种罕见的乳腺癌类型,对其特征和最佳治疗的认识有限。世界卫生组织(世卫组织)不断更新诊断标准,了解越来越多,最近一次是在2019年。着眼于特征、治疗和结局,我们对2003年至2024年8月文献报道的病例进行了全面的个体患者数据(IPD)荟萃分析。使用预定义的搜索词系统地搜索PubMed和Web of Science的病例报告。该方案已在国际前瞻性系统评价注册(PROSPERO CRD42022356345)进行前瞻性注册。包括2003年至2024年间发表的病例报告或小病例系列在内的185份出版物符合条件。他们报告了202例患者。诊断时的中位年龄为54岁(范围13-86岁)。5年总生存率为77%。在单变量分析中,局部和远处转移、组织学分级、受体状态、Ki-67指数和手术干预对总生存率有显著影响。随着时间的推移,我们没有观察到任何显著的结果改善。在多变量分析中,只有低分化的神经内分泌癌和缺乏手术被发现是总生存差的预后因素。这种罕见的乳腺癌亚型与预后不良有关,在过去的20年里没有任何有意义的治疗进展。本研究确定了关键的预后因素。然而,现有的数据不足以确定最佳的治疗方法。建立统一的诊断标准和持续报告病例对于产生更大的数据池至关重要,从而促进我们对这种罕见疾病的理解和管理。
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引用次数: 0
Cost Analysis of Technetium-99m versus Indocyanine Green for Sentinel Lymph Node Biopsy in Breast Cancer 锝-99m与吲哚菁绿在乳腺癌前哨淋巴结活检中的成本分析。
IF 2.5 3区 医学 Q2 ONCOLOGY Pub Date : 2026-02-01 Epub Date: 2025-12-20 DOI: 10.1016/j.clbc.2025.12.005
Iva M. Borisova Boyanova , Lidia Blay Aulina , Marta de la Iglésia , David López-Cano , Cristina Serra-Serra , Neus Ruiz-Edo , Maite Salcedo-Pujantell , Juan Francisco Julián Ibañéz , Sandra López Gordo

Background

Sentinel lymph node biopsy (SLNB) using Technetium-99 (Tc-99) is the standard technique for axillary staging in breast cancer. However, it has logistic issues, especially in hospitals without a nuclear medicine department (NMD). As the sensitivity and specificity of indocyanine green (ICG) are comparable to those of Tc-99, the aim of this study was to perform a cost-benefit analysis of the 2 methods.

Materials and Methods

A prospective observational cohort of patients undergoing breast cancer surgery was included. Tc-99 and ICG were administered during the same procedure for SLNB. Three clinical pathways were constructed: Tc-99 administration at hospitals without NMD (first clinical pathway), Tc-99 administration at hospitals with NMD (second), and the ICG method (third). A cost comparison between the pathways was performed using the monetary unit of Euros (€).

Results

Between April 2021 and April 2024, 112 patients with breast cancer underwent SLNB using Tc-99 and ICG detection. The total cost per patient for the first clinical pathway was €322.29, for the second, €308.29 and for the third, €61.35 per patient. The cumulative cost for 112 patients in the first and second clinical pathways (€37,216.48 and €34,528.48, respectively) resulted to be 5.2 times the cost of the ICG pathway (€6871.2). The use of ICG results in an average saving of approximately 80% of the Tc-99 expenses.

Conclusion

ICG is a cost-effective option as a tracer for sentinel lymph node biopsy in breast cancer. ICG also offers logistic advantages and it should be considered in clinical practice and protocols.
背景:使用锝-99 (Tc-99)进行前哨淋巴结活检(SLNB)是乳腺癌腋窝分期的标准技术。然而,它有后勤问题,特别是在没有核医学部门(NMD)的医院。由于吲哚菁绿(ICG)的敏感性和特异性与Tc-99相当,本研究的目的是对两种方法进行成本效益分析。材料和方法:纳入一组接受乳腺癌手术患者的前瞻性观察队列。Tc-99和ICG在SLNB的相同程序中给予。构建了3条临床通路:无NMD医院给药Tc-99(第一临床通路)、有NMD医院给药Tc-99(第二临床通路)和ICG法给药(第三临床通路)。使用货币单位欧元(€)进行了两种途径之间的成本比较。结果:2021年4月至2024年4月,112例乳腺癌患者采用Tc-99和ICG检测行SLNB。第一种临床途径每位患者的总成本为322.29欧元,第二种为308.29欧元,第三种为61.35欧元。112名患者在第一和第二临床途径中的累积成本(分别为37,216.48欧元和34,528.48欧元)是ICG途径成本(6871.2欧元)的5.2倍。ICG的使用平均节省了约80%的Tc-99费用。结论:ICG作为乳腺癌前哨淋巴结活检的示踪剂是一种经济有效的选择。ICG还具有后勤优势,在临床实践和方案中应予以考虑。
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引用次数: 0
Triple Technique (Radioisotope, Blue Dye, and Embedded Fiducial Marker) for Identifying Sentinel Lymph Nodes Following Neoadjuvant Chemotherapy for Clinical Lymph Node Positive Breast Cancer; Is More Really Better? 临床淋巴结阳性乳腺癌新辅助化疗后前哨淋巴结识别的三重技术(放射性同位素、蓝色染料和嵌入基准标志物)越多真的越好吗?
IF 2.5 3区 医学 Q2 ONCOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI: 10.1016/j.clbc.2025.12.003
Fuzesi Sarah , Paily Jacienta , Ha Richard , Wiechmann Lisa , Sun Luona , Rao Roshni , Taback Bret

Purpose

To determine the accuracy of radioisotope, blue dye and implanted fiducial marker for identification of the histopathologically positive percutaneous/previously biopsied lymph node (PBLN) following neoadjuvant chemotherapy (NAC). Detection of the PBLN is critical for monitoring disease response and guiding subsequent treatment decisions. However, conventional sentinel lymph node biopsy (SLNB) techniques have shown unacceptable false negative rates. Recommendations for improvement suggest using dual tracers, removing more lymph nodes and implantable markers in the PBLN. This study evaluated the accuracy of PBLN identification using each of the 3 most common localization techniques: blue dye (lymphazurin), radioisotope (Technetium-99m sulfur colloid), and implanted fiducial marker (SAVI SCOUT).

Methods

Patients with PBLN marked with a SAVI SCOUT, with or without a metallic clip, and who received NAC were identified from our breast cancer surgery database. The accuracy of the 3 localizing techniques was evaluated. Secondary outcomes included total number of lymph nodes retrieved and number of sampling events per patient for each technique.

Results

We identified 65 patients who underwent percutaneous lymph node biopsy prior to NAC. The clip marking the PBLN was identified in 64 patients (98%). The PBLN was identified by the SAVI SCOUT in 61 (95%) of 64 patients, radioisotope in 44 (71%) of 62 patients and blue dye in 28 (64%) of 44 patients. A SAVI SCOUT was placed at the time of biopsy instead of a clip in 13 patients and identification of the PBLN was 100% for those patients. The mean number of lymph nodes removed with the SAVI SCOUT was 2.7, with radioisotope was 4.3 and with blue dye was 3.6 (P = .004). The mean number of SLN sampling events with the SAVI SCOUT was 1, with radioisotope was 2.0 (range: 0-6) and with blue dye was 1.8 (range: 0-5) (P < .005). When radioisotope was used, the clip was found in the hottest lymph node 40% of the time, in the second and third hottest lymph node 5% and 11% of the time, respectively. The clipped node was not hot in 29% of cases.

Conclusions

This study demonstrates that the most accurate method for identifying the PBLN is with placement of a fiducial marker. Furthermore, the addition of radioisotope and blue dye may result in an excessive number of lymph nodes removed and more retrieval events during SLNB following NAC. Placement of the SAVI SCOUT marker at the time of percutaneous lymph node biopsy may subsequently obviate the need for additional mapping techniques of blue dye and radioisotope during sentinel lymph node surgery.
目的探讨放射性同位素、蓝色染料和植入式基准标志物在新辅助化疗(NAC)后经皮/活检组织阳性淋巴结(PBLN)鉴别中的准确性。PBLN的检测对于监测疾病反应和指导后续治疗决策至关重要。然而,传统的前哨淋巴结活检(SLNB)技术显示出不可接受的假阴性率。改善的建议是使用双示踪剂,切除更多淋巴结和植入PBLN标记物。本研究使用3种最常见的定位技术:蓝色染料(淋巴管蛋白)、放射性同位素(锝-99m硫胶体)和植入式基准标记(SAVI SCOUT)来评估PBLN鉴定的准确性。方法从我们的乳腺癌手术数据库中识别带有SAVI SCOUT标记的PBLN,有或没有金属夹,并接受NAC的患者。对3种定位技术的精度进行了评价。次要结果包括每项技术中每个患者的淋巴结总数和采样事件数。结果我们确定了65例在NAC前接受经皮淋巴结活检的患者。64例(98%)患者发现PBLN标记夹。64例患者中61例(95%)经SAVI SCOUT鉴定为PBLN, 62例患者中44例(71%)为放射性同位素,44例患者中28例(64%)为蓝色染料。在13例患者中,在活检时放置SAVI SCOUT而不是夹子,这些患者的PBLN识别率为100%。SAVI SCOUT平均切除淋巴结数为2.7个,放射性同位素组为4.3个,蓝色染料组为3.6个(P = 0.004)。使用SAVI SCOUT进行SLN采样的平均次数为1次,放射性同位素为2.0次(范围:0-6),蓝色染料为1.8次(范围:0-5)(P < 0.005)。当使用放射性同位素时,在最热的淋巴结中发现夹子的几率为40%,在第二和第三最热的淋巴结中发现夹子的几率分别为5%和11%。在29%的病例中,被夹的淋巴结不热。结论本研究表明,确定PBLN最准确的方法是放置基准标记。此外,放射性同位素和蓝色染料的加入可能导致NAC后SLNB切除的淋巴结数量过多和更多的恢复事件。在经皮淋巴结活检时放置SAVI SCOUT标记物,可能随后在前哨淋巴结手术中不需要额外的蓝色染料和放射性同位素作图技术。
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引用次数: 0
Relationship Between Census Tract-Level Social Determinants of Health and Cardiovascular Care among Individuals Diagnosed With Breast Cancer 人口普查水平的健康社会决定因素与乳腺癌患者心血管护理之间的关系
IF 2.5 3区 医学 Q2 ONCOLOGY Pub Date : 2026-02-01 Epub Date: 2025-08-26 DOI: 10.1016/j.clbc.2025.08.020
Pei-Lin Huang , Manu M. Mysore , Brian Barr , Eberechukwu Onukwugha

Purpose

Cardiovascular care is impacted by social determinants of health (SDoH), however implications for physician visits among individuals diagnosed with breast cancer (BC) who received potentially cardio-toxic treatments (PCT) are poorly understood. We investigate these relationships among older adults.

Methods

This study used Surveillance, Epidemiology, and End Results-Medicare data linked with Census tract SDoH measures. We included female patients diagnosed with BC between 2007 and 2018 who received PCT within 12 months of diagnosis. Framework-guided tract-level SDoH variables and empirically-derived tract-level SDoH domains were used in separate regression models. Study outcomes included cardiologist or primary care physician (PCP) visits within 90 days of treatment and time to first physician visit. Logistic regression and Cox proportional hazards models included patient- and tract-level measures.

Results

A total of 2637 patients were included. Living in a low food access tract (aOR: 0.78, 95%CI: 0.63-0.96) and a primary care health professional shortage area (aOR: 0.66, 95%CI: 0.52-0.84) were associated with lower odds of first cardiologist visit within 90 days of treatment. Living in a tract ranked higher on the empirical domain of “poor community infrastructure and inequity” was associated with a longer time to a first cardiologist visit (aHR: 0.90, 95%CI: 0.81-0.99).

Conclusions

Individuals residing in worse-off tracts experienced barriers to physician visits following PCT initiation. “poor community infrastructure and inequity,” was associated with a longer time to first cardiologist visit. These findings support incorporating contextual SDoH factors into pretreatment risk assessment tools to better identify patients who may benefit from cardio-oncology referrals.
目的:心血管护理受到健康社会决定因素(SDoH)的影响,然而,在接受潜在心脏毒性治疗(PCT)的乳腺癌(BC)患者中,对医生就诊的影响知之甚少。我们在老年人中调查了这些关系。方法:本研究使用了与人口普查区SDoH措施相关的监测、流行病学和最终结果医疗数据。我们纳入了2007年至2018年间诊断为BC的女性患者,这些患者在诊断后12个月内接受了PCT治疗。在不同的回归模型中使用框架引导的通道级SDoH变量和经验派生的通道级SDoH域。研究结果包括治疗90天内就诊的心脏病专家或初级保健医生(PCP)以及首次就诊的时间。Logistic回归和Cox比例风险模型包括患者和呼吸道水平的测量。结果:共纳入2637例患者。生活在低食物通道(aOR: 0.78, 95%CI: 0.63-0.96)和初级保健卫生专业人员短缺地区(aOR: 0.66, 95%CI: 0.52-0.84)与治疗90天内首次就诊心脏病专家的几率较低相关。生活在“社区基础设施差和不平等”经验领域排名较高的地区,与第一次心脏病专家就诊的时间较长相关(aHR: 0.90, 95%CI: 0.81-0.99)。结论:生活在条件较差地区的个体在PCT启动后就诊遇到障碍。“糟糕的社区基础设施和不平等”与第一次看心脏病专家的时间较长有关。这些发现支持将背景SDoH因素纳入预处理风险评估工具,以更好地识别可能从心脏肿瘤学转诊中获益的患者。
{"title":"Relationship Between Census Tract-Level Social Determinants of Health and Cardiovascular Care among Individuals Diagnosed With Breast Cancer","authors":"Pei-Lin Huang ,&nbsp;Manu M. Mysore ,&nbsp;Brian Barr ,&nbsp;Eberechukwu Onukwugha","doi":"10.1016/j.clbc.2025.08.020","DOIUrl":"10.1016/j.clbc.2025.08.020","url":null,"abstract":"<div><h3>Purpose</h3><div>Cardiovascular care is impacted by social determinants of health (SDoH), however implications for physician visits among individuals diagnosed with breast cancer (BC) who received potentially cardio-toxic treatments (PCT) are poorly understood. We investigate these relationships among older adults.</div></div><div><h3>Methods</h3><div>This study used Surveillance, Epidemiology, and End Results-Medicare data linked with Census tract SDoH measures. We included female patients diagnosed with BC between 2007 and 2018 who received PCT within 12 months of diagnosis. Framework-guided tract-level SDoH variables and empirically-derived tract-level SDoH domains were used in separate regression models. Study outcomes included cardiologist or primary care physician (PCP) visits within 90 days of treatment and time to first physician visit. Logistic regression and Cox proportional hazards models included patient- and tract-level measures.</div></div><div><h3>Results</h3><div>A total of 2637 patients were included. Living in a low food access tract (aOR: 0.78, 95%CI: 0.63-0.96) and a primary care health professional shortage area (aOR: 0.66, 95%CI: 0.52-0.84) were associated with lower odds of first cardiologist visit within 90 days of treatment. Living in a tract ranked higher on the empirical domain of “poor community infrastructure and inequity” was associated with a longer time to a first cardiologist visit (aHR: 0.90, 95%CI: 0.81-0.99).</div></div><div><h3>Conclusions</h3><div>Individuals residing in worse-off tracts experienced barriers to physician visits following PCT initiation. “poor community infrastructure and inequity,” was associated with a longer time to first cardiologist visit. These findings support incorporating contextual SDoH factors into pretreatment risk assessment tools to better identify patients who may benefit from cardio-oncology referrals.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 2","pages":"Pages 191-203.e1"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111671","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}
引用次数: 0
CDK4/6 Inhibitors in HER2-positive Metastatic Breast Cancer CDK4/6抑制剂在her2阳性转移性乳腺癌中的作用
IF 2.5 3区 医学 Q2 ONCOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-09 DOI: 10.1016/j.clbc.2026.01.003
Hervé Bischoff, Thierry Petit
HR +/HER2 + breast cancer (BC) represents a unique clinical entity distinct from HR−/HER2 + BC, with specific molecular characteristics and resistance mechanisms. The interaction between estrogen receptor (ER) and HER2 signaling pathways promotes tumor growth and therapeutic resistance, highlighting the need for tailored approaches. This review focuses on the clinical and molecular features of HR + /HER2 + metastatic BC, with an emphasis on recent data exploring the integration of CDK4/6 inhibitors (CDK4/6i) into anti-HER2 therapeutic strategies. Key findings from metastatic trials are summarized. HR + /HER2 + metastatic BC is characterized by a predominance of luminal molecular subtypes, associated with distinct patterns of metastatic spread and prolonged progression-free survival compared to nonluminal subtypes. Despite the efficacy of dual HER2 blockade, resistance remains a challenge, driven by crosstalk between ER and HER2 pathways. CDK4/6i disrupt the cell cycle at the G1/S checkpoint and have shown promise in overcoming resistance, inducing sustained senescence, and improving outcomes in luminal subtypes. Recent trials suggest that CDK4/6i may play a key role in maintenance therapy and chemotherapy-free regimens for selected patients with HR + /HER2 + metastatic BC. The integration of CDK4/6 inhibitors into anti-HER2 treatment strategies represents a promising approach to address the unique biology of HR + /HER2 + BC. Molecular profiling and personalized treatment strategies are essential to optimize patient outcomes and reduce unnecessary toxicity.
HR +/HER2 +乳腺癌(BC)是一种不同于HR - /HER2 +乳腺癌的独特临床实体,具有特定的分子特征和耐药机制。雌激素受体(ER)和HER2信号通路之间的相互作用促进肿瘤生长和治疗耐药性,强调需要量身定制的方法。本文综述了HR + /HER2 +转移性BC的临床和分子特征,重点介绍了CDK4/6抑制剂(CDK4/6i)整合到抗HER2治疗策略中的最新数据。总结了转移性试验的主要发现。HR + /HER2 +转移性BC以腔内分子亚型为主,与非腔内亚型相比,具有明显的转移扩散模式和延长的无进展生存期。尽管双重HER2阻断有效,但由于ER和HER2通路之间的串扰,耐药性仍然是一个挑战。CDK4/6i在G1/S检查点破坏细胞周期,并在克服耐药、诱导持续衰老和改善管腔亚型预后方面显示出希望。最近的试验表明,CDK4/6i可能在HR + /HER2 +转移性BC患者的维持治疗和无化疗方案中发挥关键作用。将CDK4/6抑制剂整合到抗HER2治疗策略中代表了一种解决HR + /HER2 + BC独特生物学问题的有希望的方法。分子谱分析和个性化治疗策略对于优化患者预后和减少不必要的毒性至关重要。
{"title":"CDK4/6 Inhibitors in HER2-positive Metastatic Breast Cancer","authors":"Hervé Bischoff,&nbsp;Thierry Petit","doi":"10.1016/j.clbc.2026.01.003","DOIUrl":"10.1016/j.clbc.2026.01.003","url":null,"abstract":"<div><div>HR +/HER2 + breast cancer (BC) represents a unique clinical entity distinct from HR−/HER2 + BC, with specific molecular characteristics and resistance mechanisms. The interaction between estrogen receptor (ER) and HER2 signaling pathways promotes tumor growth and therapeutic resistance, highlighting the need for tailored approaches. This review focuses on the clinical and molecular features of HR + /HER2 + metastatic BC, with an emphasis on recent data exploring the integration of CDK4/6 inhibitors (CDK4/6i) into anti-HER2 therapeutic strategies. Key findings from metastatic trials are summarized. HR + /HER2 + metastatic BC is characterized by a predominance of luminal molecular subtypes, associated with distinct patterns of metastatic spread and prolonged progression-free survival compared to nonluminal subtypes. Despite the efficacy of dual HER2 blockade, resistance remains a challenge, driven by crosstalk between ER and HER2 pathways. CDK4/6i disrupt the cell cycle at the G1/S checkpoint and have shown promise in overcoming resistance, inducing sustained senescence, and improving outcomes in luminal subtypes. Recent trials suggest that CDK4/6i may play a key role in maintenance therapy and chemotherapy-free regimens for selected patients with HR + /HER2 + metastatic BC. The integration of CDK4/6 inhibitors into anti-HER2 treatment strategies represents a promising approach to address the unique biology of HR + /HER2 + BC. Molecular profiling and personalized treatment strategies are essential to optimize patient outcomes and reduce unnecessary toxicity.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 2","pages":"Pages 93-104"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074578","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}
引用次数: 0
Effects of Different Glucose Concentrations and Hypoxia and its Impact on the Expression of Sox2 and CAIX in Breast Cancer: In Vitro And Silico Analysis 不同葡萄糖浓度和缺氧对乳腺癌中Sox2和CAIX表达的影响:体外和硅分析
IF 2.5 3区 医学 Q2 ONCOLOGY Pub Date : 2026-02-01 Epub Date: 2025-09-03 DOI: 10.1016/j.clbc.2025.08.023
Niloufar Esmaeilizadeh MS.c , Hadi Maleki-Kakelar PhD , Rasoul Sharifi PhD , Sevda Valilou MD , Akbar Jalili MS.c , Mohammad Reza Asgharzadeh PhD

Background

Cancer is a an uncontrolled proliferation of transformed cells as a genetic variation in human diseases. In the present study, we investigated how different concentrations of glucose and hypoxia affect the expression of CAIX and Sox2 genes in breast cancer cell lines MCF-7 and MDA-MB-231.

Methods

MCF-7 and MDA-MB-231 cells were exposed to different concentrations of glucose (5.5, 11, and 25 mM), normoxia, and hypoxia. SNARF-AM labeling was used to quantify intracellular pH, which was then evaluated using flow cytometry. Finally, the expression levels of CAIX and Sox2 genes were examined using quantitative real-time PCR. In addition, the interaction of the ligand with carbonic anhydrase was analyzed using Chimera software, and the docking results were checked in the corresponding servers. The relationship between structural disorder and pH was investigated using DispHred.

Results

Metastasis and intracellular pH (pHi) are glucose-dependent in MCF-7 cells, but hypoxia-dependent in MDA-MB-231 cells. Our findings showed a significant increase in the expression of CAIX (P = .0032) and but Sox2 (P = .5309) also had an increase in expression, it was not significant in the MCF-7 cell line compared with control cells maintained in normal oxygen. In addition, the genes CAIX (P = .0712) and Sox2 (P = .0004) were up-regulated in MDA-MB-231 cells. The DispHred results showed that the total CAIX load changes somewhat with pH changes.

Conclusions

Increased or decreased glucose concentration and hypoxia lead to changes in the gene expression patterns of cancer cells. Consequently, the genes may be used as biomarkers to aid in the diagnosis and prognosis of breast cancer.
背景:癌症是一种转化细胞不受控制的增殖,是人类疾病的一种遗传变异。在本研究中,我们研究了不同浓度的葡萄糖和缺氧对乳腺癌细胞系MCF-7和MDA-MB-231中CAIX和Sox2基因表达的影响。方法:将MCF-7和MDA-MB-231细胞分别暴露于不同浓度的葡萄糖(5.5、11和25 mM)、常氧和缺氧环境中。使用SNARF-AM标记来量化细胞内pH,然后使用流式细胞术评估。最后,采用实时荧光定量PCR检测CAIX和Sox2基因的表达水平。此外,利用Chimera软件分析了配体与碳酸酐酶的相互作用,并在相应的服务器上检查对接结果。利用DispHred研究了结构紊乱与pH的关系。结果:转移和细胞内pH (pHi)在MCF-7细胞中是葡萄糖依赖的,但在MDA-MB-231细胞中是缺氧依赖的。结果显示,MCF-7细胞系中CAIX的表达显著增加(P = 0.0032), Sox2的表达也显著增加(P = 0.5309),但与维持在正常氧条件下的对照细胞相比,CAIX和Sox2的表达均不显著。此外,CAIX (P = .0712)和Sox2 (P = .0004)基因在MDA-MB-231细胞中表达上调。DispHred结果表明,随着pH值的变化,CAIX的总负荷发生了一定的变化。结论:葡萄糖浓度升高或降低和缺氧可导致癌细胞基因表达模式的改变。因此,这些基因可能被用作生物标志物,以帮助乳腺癌的诊断和预后。
{"title":"Effects of Different Glucose Concentrations and Hypoxia and its Impact on the Expression of Sox2 and CAIX in Breast Cancer: In Vitro And Silico Analysis","authors":"Niloufar Esmaeilizadeh MS.c ,&nbsp;Hadi Maleki-Kakelar PhD ,&nbsp;Rasoul Sharifi PhD ,&nbsp;Sevda Valilou MD ,&nbsp;Akbar Jalili MS.c ,&nbsp;Mohammad Reza Asgharzadeh PhD","doi":"10.1016/j.clbc.2025.08.023","DOIUrl":"10.1016/j.clbc.2025.08.023","url":null,"abstract":"<div><h3>Background</h3><div>Cancer is a an uncontrolled proliferation of transformed cells as a genetic variation in human diseases. In the present study, we investigated how different concentrations of glucose and hypoxia affect the expression of CAIX and Sox2 genes in breast cancer cell lines MCF-7 and MDA-MB-231.</div></div><div><h3>Methods</h3><div>MCF-7 and MDA-MB-231 cells were exposed to different concentrations of glucose (5.5, 11, and 25 mM), normoxia, and hypoxia. SNARF-AM labeling was used to quantify intracellular pH, which was then evaluated using flow cytometry. Finally, the expression levels of CAIX and Sox2 genes were examined using quantitative real-time PCR. In addition, the interaction of the ligand with carbonic anhydrase was analyzed using Chimera software, and the docking results were checked in the corresponding servers. The relationship between structural disorder and pH was investigated using DispHred.</div></div><div><h3>Results</h3><div>Metastasis and intracellular pH (pHi) are glucose-dependent in MCF-7 cells, but hypoxia-dependent in MDA-MB-231 cells. Our findings showed a significant increase in the expression of CAIX (<em>P</em> = .0032) and but Sox2 (<em>P</em> = .5309) also had an increase in expression, it was not significant in the MCF-7 cell line compared with control cells maintained in normal oxygen. In addition, the genes CAIX (<em>P</em> = .0712) and Sox2 (<em>P</em> = .0004) were up-regulated in MDA-MB-231 cells. The DispHred results showed that the total CAIX load changes somewhat with pH changes.</div></div><div><h3>Conclusions</h3><div>Increased or decreased glucose concentration and hypoxia lead to changes in the gene expression patterns of cancer cells. Consequently, the genes may be used as biomarkers to aid in the diagnosis and prognosis of breast cancer.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 2","pages":"Pages 228-237"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198623","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}
引用次数: 0
Minutes that Matter? The Significance of Operative Time in Immediate Unilateral and Bilateral Free Flap Breast Reconstruction 重要的分钟数?手术时间在单侧和双侧即刻自由皮瓣乳房重建中的意义。
IF 2.5 3区 医学 Q2 ONCOLOGY Pub Date : 2026-02-01 Epub Date: 2025-10-01 DOI: 10.1016/j.clbc.2025.09.019
Samuel Knoedler , Thomas Schaschinger , Felix J. Klimitz , Fortunay Diatta , Tobias Niederegger , Leonard Knoedler , Barbara Kern , Henriette Grundig , Julius M. Wirtz , Doha Obed , Mario Cherubino , Raffi Gurunian , Martin Kauke-Navarro , Bohdan Pomahac

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.
背景:自由皮瓣乳房重建(FFBR)提供了乳房切除术后实质性的好处。然而,手术时间对预后的影响尚不清楚。患者和方法:在这项回顾性队列研究中,查询了美国外科医师学会国家手术质量改进计划数据库(2011-2022)中立即接受FFBR的患者。多变量逻辑回归评估手术时间为连续变量和二分类变量。采用受试者工作特征(ROC)分析和约登指数(Youden's Index)确定手术时间阈值。结果:5826例患者中,61%行单侧FFBR, 39%行双侧FFBR。27%的病例发生并发症,其中单侧手术25%,双侧手术30%。在单侧FFBR中,延长手术时间与总并发症(OR 1.0020 /分钟,P < 0.001)、手术(OR 1.0023, P < 0.001)和内科并发症(OR 1.0019, P = 0.0011)、再手术(OR 1.0011, P = 0.013)和再入院(OR 1.0014, P = 0.0030)的风险增加显著相关。每增加1小时,总并发症风险增加12%,确定397分钟阈值(OR 1.8, P < 0.001)。对于双侧FFBR,较长的手术时间与总并发症(OR 1.0012 /分钟,P < 0.001)、手术并发症(OR 1.0012, P = 0.0014)和再手术(OR 1.0010, P = 0.026)的发生率相关。不良事件风险每增加1小时增加7.2%,536分钟为临界阈值(OR 1.6, P < 0.001)。结论:延长手术时间明显增加FFBR并发症的发生风险。手术时间超过397分钟和536分钟的患者发生不良事件的可能性分别增加80%和60%。这些发现强调了提高手术效率和减少术后发病率的必要性。
{"title":"Minutes that Matter? The Significance of Operative Time in Immediate Unilateral and Bilateral Free Flap Breast Reconstruction","authors":"Samuel Knoedler ,&nbsp;Thomas Schaschinger ,&nbsp;Felix J. Klimitz ,&nbsp;Fortunay Diatta ,&nbsp;Tobias Niederegger ,&nbsp;Leonard Knoedler ,&nbsp;Barbara Kern ,&nbsp;Henriette Grundig ,&nbsp;Julius M. Wirtz ,&nbsp;Doha Obed ,&nbsp;Mario Cherubino ,&nbsp;Raffi Gurunian ,&nbsp;Martin Kauke-Navarro ,&nbsp;Bohdan Pomahac","doi":"10.1016/j.clbc.2025.09.019","DOIUrl":"10.1016/j.clbc.2025.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Free flap breast reconstruction (FFBR) offers substantial benefits after mastectomy. However, the impact of operative time on outcomes remains unclear.</div></div><div><h3>Patients and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>P</em> &lt; .001), surgical (OR 1.0023, <em>P &lt; .</em>001) and medical complications (OR 1.0019, <em>P = .</em>0011), reoperation (OR 1.0011, <em>P = .</em>013), and readmission (OR 1.0014, <em>P = .</em>0030). Each additional hour increased overall complication risk by 12%, with a 397-minute threshold identified (OR 1.8, <em>P &lt; .</em>001). For bilateral FFBR, longer operative time correlated with higher odds of overall complications (OR 1.0012 per minute, <em>P &lt; .</em>001), surgical complications (OR 1.0012, <em>P = .</em>0014), and reoperation (OR 1.0010, <em>P = .</em>026). A 7.2% increase in adverse event risk was noted per additional hour, with 536 minutes as a critical threshold (OR 1.6, <em>P &lt; .</em>001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 2","pages":"Pages 304-312"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421390","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}
引用次数: 0
Knowledge, Awareness, Perceptions, and Attitudes Toward Breast Reconstruction Among Breast Cancer Women in Jordan: A Cross-Sectional Study 约旦乳腺癌妇女对乳房重建的知识、意识、观念和态度:一项横断面研究
IF 2.5 3区 医学 Q2 ONCOLOGY Pub Date : 2026-02-01 Epub Date: 2025-12-31 DOI: 10.1016/j.clbc.2025.12.008
Saleh Abualhaj , Lina Alshadfan , Mosleh M. Abualhaj , Yasmin Safi , Mohammad Al-Share , Huda Alzagatit , Aseel Qandil , Tamara Abdalkader , Weam Sowan , Younis Hizzani , Zain aldeen Saleh , Yousef Albustanji , Mahmoud Al-Masri

Purpose

This study conducted to assess the knowledge, perceptions, attitudes, and barriers toward breast reconstruction (BR) among women who underwent mastectomy for a breast cancer primary and identify predictors of BR uptake.

Methods

A cross-sectional study was conducted at KHCC. Data were collected using a structured Arabic questionnaire. The questionnaire covered demographics, clinical background, knowledge, attitudes, and perceived barriers. Descriptive statistics, Chi-square tests, and multivariate regression models were used to analyze predictors of BR uptake.

Results

Of the 603 participants (mean age 49.5 years), 50.3% had undergone BR. Uptake was significantly higher among younger women (P < .001), those employed (P = .002), with higher education levels (P < .001), no chronic illness (P = .03), and premenopausal status (P = .001). While 70.8% had received BR information from physicians, 58.2% were unaware of BR before their diagnosis. Implants were more commonly recognized (87.2%) compared to autologous methods (39.5%). Though 69% believed BR improves quality of life, 72% viewed it as cosmetic rather than medically necessary. Regression analysis showed that younger age (OR = 0.94), employment (OR = 2.19), higher knowledge (OR = 1.29), and positive attitudes (OR = 1.25) significantly predicted BR uptake. Among those who had not undergone BR, barriers included fear of surgery (50%), misinformation, lack of interest, and financial constraints (39.5).

Conclusion

Despite clinical advancements, BR remains underutilized in Jordan due to knowledge gaps, limited counseling, and sociocultural misconceptions. Empowering patients through targeted education, integrating BR into oncologic care pathways, and enhancing provider communication are warranted to ensure equitable, informed, and holistic breast cancer survivorship.
目的本研究旨在评估因乳腺癌原发手术接受乳房切除术的女性对乳房重建(BR)的知识、观念、态度和障碍,并确定BR摄取的预测因素。方法采用横断面研究方法。使用结构化阿拉伯语问卷收集数据。调查问卷涵盖人口统计、临床背景、知识、态度和感知障碍。使用描述性统计、卡方检验和多元回归模型分析BR摄取的预测因素。结果603名参与者(平均年龄49.5岁)中,50.3%的人接受了BR。年轻女性(P < 0.001)、在职女性(P = 0.002)、高学历女性(P < 0.001)、无慢性病女性(P = 0.03)和绝经前女性(P = 0.001)的摄取率明显较高。70.8%的人从医生那里获得了BR信息,58.2%的人在诊断前不知道BR。种植体(87.2%)比自体方法(39.5%)更常见。虽然69%的人认为BR可以提高生活质量,但72%的人认为它是美容而不是医学上必需的。回归分析显示,年龄(OR = 0.94)、就业(OR = 2.19)、知识水平(OR = 1.29)和积极态度(OR = 1.25)对BR摄取有显著影响。在未接受过BR的患者中,障碍包括害怕手术(50%)、错误信息、缺乏兴趣和经济拮据(39.5%)。结论:尽管临床取得了进步,但由于知识差距、咨询有限和社会文化误解,BR在约旦仍未得到充分利用。通过有针对性的教育赋予患者权力,将BR纳入肿瘤治疗途径,并加强提供者沟通,以确保公平、知情和全面的乳腺癌生存。
{"title":"Knowledge, Awareness, Perceptions, and Attitudes Toward Breast Reconstruction Among Breast Cancer Women in Jordan: A Cross-Sectional Study","authors":"Saleh Abualhaj ,&nbsp;Lina Alshadfan ,&nbsp;Mosleh M. Abualhaj ,&nbsp;Yasmin Safi ,&nbsp;Mohammad Al-Share ,&nbsp;Huda Alzagatit ,&nbsp;Aseel Qandil ,&nbsp;Tamara Abdalkader ,&nbsp;Weam Sowan ,&nbsp;Younis Hizzani ,&nbsp;Zain aldeen Saleh ,&nbsp;Yousef Albustanji ,&nbsp;Mahmoud Al-Masri","doi":"10.1016/j.clbc.2025.12.008","DOIUrl":"10.1016/j.clbc.2025.12.008","url":null,"abstract":"<div><h3>Purpose</h3><div>This study conducted to assess the knowledge, perceptions, attitudes, and barriers toward breast reconstruction (BR) among women who underwent mastectomy for a breast cancer primary and identify predictors of BR uptake.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted at KHCC. Data were collected using a structured Arabic questionnaire. The questionnaire covered demographics, clinical background, knowledge, attitudes, and perceived barriers. Descriptive statistics, Chi-square tests, and multivariate regression models were used to analyze predictors of BR uptake.</div></div><div><h3>Results</h3><div>Of the 603 participants (mean age 49.5 years), 50.3% had undergone BR. Uptake was significantly higher among younger women (<em>P</em> &lt; .001), those employed (<em>P</em> = .002), with higher education levels (<em>P</em> &lt; .001), no chronic illness (<em>P</em> = .03), and premenopausal status (<em>P</em> = .001). While 70.8% had received BR information from physicians, 58.2% were unaware of BR before their diagnosis. Implants were more commonly recognized (87.2%) compared to autologous methods (39.5%). Though 69% believed BR improves quality of life, 72% viewed it as cosmetic rather than medically necessary. Regression analysis showed that younger age (OR = 0.94), employment (OR = 2.19), higher knowledge (OR = 1.29), and positive attitudes (OR = 1.25) significantly predicted BR uptake. Among those who had not undergone BR, barriers included fear of surgery (50%), misinformation, lack of interest, and financial constraints (39.5).</div></div><div><h3>Conclusion</h3><div>Despite clinical advancements, BR remains underutilized in Jordan due to knowledge gaps, limited counseling, and sociocultural misconceptions. Empowering patients through targeted education, integrating BR into oncologic care pathways, and enhancing provider communication are warranted to ensure equitable, informed, and holistic breast cancer survivorship.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 2","pages":"Pages 59-69"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035521","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}
引用次数: 0
CanAssist Breast Provides Additional Insightful Prognostic Information in Retrospective, Pooled Secondary Analysis in Clinically Low/ High-Risk Patients With HR+/HER2- EBC CanAssist Breast为临床低/高危HR+/HER2- EBC患者的回顾性、汇总二级分析提供了更多有见地的预后信息。
IF 2.5 3区 医学 Q2 ONCOLOGY Pub Date : 2026-02-01 Epub Date: 2025-08-30 DOI: 10.1016/j.clbc.2025.08.022
Tejal Deepak Durgekar , Susmita Ghosh , Badada Ananthamurthy Savitha, Payal Shrivastava, Naveen Krishnamoorthy, Manvi Sunder, Deepti KS, Manjiri Bakre

Background

In patients with early-stage HR+/ HER2- breast cancer, younger age, node positivity (N+), and higher Ki67 index are considered ``clinically high-risk'' and are treated with chemotherapy, although some can do well without it. Chemotherapy is often avoided in ``clinically low-risk'' patients with older age, small (T1-T2) or node-negative (N0) or lower Ki67 tumors; however, some of these patients do recur. Unlike earlier studies, this study aimed to explore the potential of CanAssist Breast (CAB), a prognostic test in providing ``additional'' information beyond ``clinicopathological parameters'' in ``clinically'' low-risk/ high-risk patients for effective treatment management.

Methods

This is a secondary pooled data analysis of previously published retrospective studies wherein CAB risk stratification data of 3045 patients were used to assess the risk of recurrence at five years from diagnosis. Distant recurrence-free interval (DRFI) was evaluated from Kaplan–Meier curves.

Results

In patients having N0 disease, CAB identified 13% and 8% high-risk patients with small tumors and small tumors with low Ki67 levels, respectively. In patients with N+ disease, CAB identified 44% of patients with higher Ki67 (≥20%) as low-risk. In younger patients, CAB identified >46% of patients as low-risk. In low ER-expressing patients, CAB identified 67% of patients as low-risk. All CAB low-risk patients have an acceptable DRFI of ≥ 89% at five years from diagnosis.

Conclusions

CAB provides additional prognostic information by identifying ``low-risk'' and ``high-risk'' patients from the ``clinically'' high-risk and low-risk groups, thereby guiding oncologists to either avoid aggressive therapies or govern significant treatment decisions on additional therapies.
背景:在早期HR+/ HER2-乳腺癌患者中,年龄较小、淋巴结阳性(N+)、Ki67指数较高的患者被认为是“临床高危”患者,并接受化疗,尽管有些患者不化疗也能很好地治疗。对于年龄较大、肿瘤较小(T1-T2)或淋巴结阴性(N0)或Ki67较低的“临床低风险”患者,通常避免化疗;然而,其中一些患者确实会复发。与早期的研究不同,本研究旨在探索CanAssist Breast (CAB)的潜力,这是一种预后测试,为“临床”低风险/高风险患者提供“临床病理参数”之外的“额外”信息,以进行有效的治疗管理。方法:这是对先前发表的回顾性研究的二次汇总数据分析,其中使用3045例患者的CAB风险分层数据来评估诊断后5年的复发风险。用Kaplan-Meier曲线评价远端无复发间隔(DRFI)。结果:在没有疾病的患者中,CAB分别识别出13%和8%的小肿瘤和低Ki67水平的小肿瘤高危患者。在N+疾病患者中,CAB鉴定44% Ki67较高的患者(≥20%)为低风险。在年轻患者中,CAB将46%的患者确定为低风险患者。在低er表达的患者中,CAB鉴定67%的患者为低风险患者。所有CAB低危患者在诊断后5年的可接受DRFI≥89%。结论:CAB通过从“临床”高风险和低风险人群中识别“低风险”和“高风险”患者提供了额外的预后信息,从而指导肿瘤学家避免积极治疗或管理额外治疗的重大治疗决策。
{"title":"CanAssist Breast Provides Additional Insightful Prognostic Information in Retrospective, Pooled Secondary Analysis in Clinically Low/ High-Risk Patients With HR+/HER2- EBC","authors":"Tejal Deepak Durgekar ,&nbsp;Susmita Ghosh ,&nbsp;Badada Ananthamurthy Savitha,&nbsp;Payal Shrivastava,&nbsp;Naveen Krishnamoorthy,&nbsp;Manvi Sunder,&nbsp;Deepti KS,&nbsp;Manjiri Bakre","doi":"10.1016/j.clbc.2025.08.022","DOIUrl":"10.1016/j.clbc.2025.08.022","url":null,"abstract":"<div><h3>Background</h3><div>In patients with early-stage HR+/ HER2- breast cancer, younger age, node positivity (N+), and higher Ki67 index are considered ``clinically high-risk'' and are treated with chemotherapy, although some can do well without it. Chemotherapy is often avoided in ``clinically low-risk'' patients with older age, small (T1-T2) or node-negative (N0) or lower Ki67 tumors; however, some of these patients do recur. Unlike earlier studies, this study aimed to explore the potential of CanAssist Breast (CAB), a prognostic test in providing ``additional'' information beyond ``clinicopathological parameters'' in ``clinically'' low-risk/ high-risk patients for effective treatment management.</div></div><div><h3>Methods</h3><div>This is a secondary pooled data analysis of previously published retrospective studies wherein CAB risk stratification data of 3045 patients were used to assess the risk of recurrence at five years from diagnosis. Distant recurrence-free interval (DRFI) was evaluated from Kaplan–Meier curves.</div></div><div><h3>Results</h3><div>In patients having N0 disease, CAB identified 13% and 8% high-risk patients with small tumors and small tumors with low Ki67 levels, respectively. In patients with N+ disease, CAB identified 44% of patients with higher Ki67 (≥20%) as low-risk. In younger patients, CAB identified &gt;46% of patients as low-risk. In low ER-expressing patients, CAB identified 67% of patients as low-risk. All CAB low-risk patients have an acceptable DRFI of ≥ 89% at five years from diagnosis.</div></div><div><h3>Conclusions</h3><div>CAB provides additional prognostic information by identifying ``low-risk'' and ``high-risk'' patients from the ``clinically'' high-risk and low-risk groups, thereby guiding oncologists to either avoid aggressive therapies or govern significant treatment decisions on additional therapies.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 2","pages":"Pages 216-227.e1"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174027","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}
引用次数: 0
Digital Health Management via IKAP Theory Improves Upper Limb Function and Psychological Adaptation in Postmastectomy Patients: A Randomized Controlled Trial 通过IKAP理论的数字健康管理改善乳房切除术后患者上肢功能和心理适应:一项随机对照试验。
IF 2.5 3区 医学 Q2 ONCOLOGY Pub Date : 2026-02-01 Epub Date: 2025-08-31 DOI: 10.1016/j.clbc.2025.08.017
Panpan Xu , Xiaomei Zhang , Lihua Lu , Xiaofeng Chen , Yunxia Chen , Jia Chen , Xiaoling Yan , Xiaohong Jin , Yiju Li

Objective

This study aimed to evaluate IKAP theory-based digital health management in improving upper limb function and psychological adaptation in postmastectomy breast cancer survivors.

Methods

We conducted a two-arm, parallel-group RCT with 200 postmastectomy patients at Nantong University Affiliated Hospital from July to December 2024. All patients were divided into two categories: 100 patients each in the experimental and control groups. The experimental group underwent a 12-week digital health management using IKAP theory, and the control group received routine care. We assessed all primary outcome measures, including the Information Needs Questionnaire (INQ), the Disabilities of the Arm, Shoulder and Hand (DASH) scale, the Cancer Post-Traumatic Growth Inventory (C-PTGI), the Breast Cancer Postoperative Functional Exercise Adherence Scale, and the Functional Assessment of Cancer Therapy—Breast (FACT-B) Questionnaire, at two distinct time points: before and after the intervention.

Results

After 12 weeks of IKAP theory-based digital health management, breast cancer patients exhibited reduced information needs compared with the control group. Furthermore, this cohort exhibited marked improvement in upper extremity dysfunction when compared with the control cohort. The experimental group’s post-traumatic growth levels, compliance with postoperative functional exercises, and quality of life were higher than the control group, respectively. The inter-group differences in all these indicators were statistically significant (P < .01).

Conclusion

IKAP theory-based digital health management significantly enhanced breast cancer survivors’ functional recovery and psychological adaptation.
目的:评价基于IKAP理论的数字化健康管理对乳腺癌术后患者上肢功能和心理适应的改善作用。方法:我们于2024年7月至12月在南通大学附属医院对200例乳房切除术后患者进行双组平行随机对照试验。所有患者分为两组:实验组和对照组各100例。实验组采用IKAP理论进行为期12周的数字化健康管理,对照组采用常规护理。我们在干预前后两个不同的时间点评估了所有主要结局指标,包括信息需求问卷(INQ)、手臂、肩膀和手的残疾(DASH)量表、癌症创伤后生长量表(C-PTGI)、乳腺癌术后功能运动依从性量表和癌症治疗-乳房功能评估问卷(FACT-B)。结果:经过12周基于IKAP理论的数字化健康管理,乳腺癌患者的信息需求较对照组减少。此外,与对照组相比,该队列在上肢功能障碍方面表现出明显的改善。实验组创伤后生长水平、术后功能锻炼依从性、生活质量均高于对照组。各组间差异均有统计学意义(P < 0.01)。结论:基于IKAP理论的数字化健康管理能显著促进乳腺癌幸存者的功能恢复和心理适应。
{"title":"Digital Health Management via IKAP Theory Improves Upper Limb Function and Psychological Adaptation in Postmastectomy Patients: A Randomized Controlled Trial","authors":"Panpan Xu ,&nbsp;Xiaomei Zhang ,&nbsp;Lihua Lu ,&nbsp;Xiaofeng Chen ,&nbsp;Yunxia Chen ,&nbsp;Jia Chen ,&nbsp;Xiaoling Yan ,&nbsp;Xiaohong Jin ,&nbsp;Yiju Li","doi":"10.1016/j.clbc.2025.08.017","DOIUrl":"10.1016/j.clbc.2025.08.017","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate IKAP theory-based digital health management in improving upper limb function and psychological adaptation in postmastectomy breast cancer survivors.</div></div><div><h3>Methods</h3><div>We conducted a two-arm, parallel-group RCT with 200 postmastectomy patients at Nantong University Affiliated Hospital from July to December 2024. All patients were divided into two categories: 100 patients each in the experimental and control groups. The experimental group underwent a 12-week digital health management using IKAP theory, and the control group received routine care. We assessed all primary outcome measures, including the Information Needs Questionnaire (INQ), the Disabilities of the Arm, Shoulder and Hand (DASH) scale, the Cancer Post-Traumatic Growth Inventory (C-PTGI), the Breast Cancer Postoperative Functional Exercise Adherence Scale, and the Functional Assessment of Cancer Therapy—Breast (FACT-B) Questionnaire, at two distinct time points: before and after the intervention.</div></div><div><h3>Results</h3><div>After 12 weeks of IKAP theory-based digital health management, breast cancer patients exhibited reduced information needs compared with the control group. Furthermore, this cohort exhibited marked improvement in upper extremity dysfunction when compared with the control cohort. The experimental group’s post-traumatic growth levels, compliance with postoperative functional exercises, and quality of life were higher than the control group, respectively. The inter-group differences in all these indicators were statistically significant (<em>P</em> &lt; .01).</div></div><div><h3>Conclusion</h3><div>IKAP theory-based digital health management significantly enhanced breast cancer survivors’ functional recovery and psychological adaptation.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 2","pages":"Pages 161-169"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205778","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}
引用次数: 0
期刊
Clinical breast cancer
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