Clinical breast cancer最新文献_第8页

Effect of Kinesiology Taping on Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis of Randomized Controlled Trials 运动绑带对乳腺癌相关淋巴水肿的影响：随机对照试验的系统回顾和荟萃分析

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-08-01 DOI: 10.1016/j.clbc.2024.04.013

Purpose

The objective of this systematic review and meta-analysis was to evaluate the impact of kinesiology taping on individuals suffering from breast cancer-related lymphedema.

Methods and Methods

We conducted a comprehensive search in PubMed, Cochrane Library, and Embase databases, spanning from their inception date to December 20, 2023, to identify pertinent studies. Inclusion criteria comprised studies that (1) enrolled participants diagnosed with breast cancer-related lymphedema; (2) implemented kinesiology taping as the intervention; (3) incorporated either complete decongestive therapy, exercise, or sham taping as the control treatment; and (4) included clinical measurements such as the severity of lymphedema, upper limb function assessment, quality of life, and perceived comfort.

Results

Information was extracted from 14 randomized controlled trials (RCTs). The analyses demonstrated statistically significant improvement, indicating a preference for kinesiology taping in the outcomes of upper limb functional assessment (standardized mean difference [SMD] = −0.88, 95% confidence interval [CI]: [−1.22, −0.55]), quality of life (SMD = 0.50, 95% CI: [0.16, 0.84]), and perceived comfort (SMD = 0.85, 95% CI: [0.34, 1.36]).

Conclusion

The findings suggest that kinesiology taping could be considered a viable option for individuals dealing with breast cancer-related lymphedema. Nevertheless, acknowledging certain limitations within this study, further confirmation of its benefits necessitates additional larger-scale and better-designed RCTs.

目的本系统综述和荟萃分析的目的是评估运动学绑带对乳腺癌相关淋巴水肿患者的影响。纳入标准包括以下研究：（1）纳入确诊为乳腺癌相关淋巴水肿的参与者；（2）采用运动绑带作为干预措施；（3）采用完全解除充血疗法、运动或假绑带作为对照治疗；（4）包括临床测量，如淋巴水肿严重程度、上肢功能评估、生活质量和感知舒适度。分析表明，在上肢功能评估结果方面，运动绑带具有统计学意义上的显著改善，表明运动绑带更受青睐（标准化平均差 [SMD] = -0.88，95% 置信区间 [CI]：[-1.22, -0.22]）：[结论研究结果表明，对于乳腺癌相关淋巴水肿患者来说，运动绑带疗法是一种可行的选择。尽管如此，由于本研究存在一定的局限性，要进一步证实其益处，还需要进行更大规模、设计更合理的研究性试验。

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引用次数: 0

Development of an Ultrasound-based Nomogram for Predicting Pathologic Complete Response and Axillary Response in Node-Positive Patients with Triple- Negative Breast Cancer 开发基于超声的提名图，用于预测三阴性乳腺癌结节阳性患者的病理完全反应和腋窝反应

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-08-01 DOI: 10.1016/j.clbc.2024.03.012

Background

The accurate prediction of pathological complete response (pCR) in the breast and axillary lymph nodes (ALN) before neoadjuvant chemotherapy (NAC) is of utmost importance for the development of treatment strategies. We aim to construct a nomogram on ultrasound (US) and clinical-pathologic factors to predict breast and ALN pCR in node-positive triple-negative breast cancers (TNBCs).

Methods

Patients identified with TNBCs from institution 1 (n = 328) were used for training cohort and those from institution 2 (n = 192) were for validation cohort. US was conducted before and after NAC, and characteristics were obtained from medical records. Univariate and multivariate regression analysis were performed to identify US and clinical-pathologic factors associated with breast and ALN pCR in the training cohort. The assessment of predictive performance was conducted using the receiving operating characteristic curve (ROC), discrimination, and calibration.

Results

Overall, 34.6% of patients achieved breast pCR and 48.1% of patients achieved ALN pCR. The nomogram 1 used for predicting pCR in the breast (AUC, 0.84; 95% CI: 0.79, 0.88) outperformed the clinical (AUC, 0.73; 95% CI: 0.68, 0.78) and US models (AUC, 0.79; 95% CI: 0.74, 0.83). The nomogram 2 used for predicting pCR in the axllia (AUC, 0.83; 95% CI: 0.78, 0.87) also outperformed the clinical (AUC, 0.64; 95% CI: 0.58, 0.69) and US models (AUC, 0.80; 95% CI: 0.75, 0.84). The calibration curve and discrimination curve indicate that the nomogram has good calibration performance and clinical applicability.

Conclusion

The nomogram showed promising predictive performance for predicting breast and ALN pCR in patients with TNBCs.

在新辅助化疗（NAC）前准确预测乳腺和腋窝淋巴结（ALN）的病理完全反应（pCR）对制定治疗策略至关重要。我们旨在根据超声（US）和临床病理学因素构建一个提名图，以预测结节阳性三阴性乳腺癌（TNBC）的乳腺和腋窝淋巴结 pCR。第一研究机构的328名TNBC患者为训练队列，第二研究机构的192名TNBC患者为验证队列。NAC前后均进行了US检查，并从病历中获得了患者的特征。通过单变量和多变量回归分析，确定了与训练队列中乳腺和 ALN pCR 相关的 US 和临床病理因素。使用接收操作特征曲线（ROC）、区分度和校准对预测性能进行了评估。总体而言，34.6% 的患者获得了乳腺癌 pCR，48.1% 的患者获得了 ALN pCR。用于预测乳腺 pCR 的提名图 1（AUC，0.84；95% CI：0.79，0.88）优于临床模型（AUC，0.73；95% CI：0.68，0.78）和美国模型（AUC，0.79；95% CI：0.74，0.83）。用于预测腋窝 pCR 的提名图 2（AUC：0.83；95% CI：0.78，0.87）也优于临床模型（AUC：0.64；95% CI：0.58，0.69）和 US 模型（AUC：0.80；95% CI：0.75，0.84）。校准曲线和判别曲线表明，提名图具有良好的校准性能和临床适用性。该提名图在预测 TNBC 患者的乳腺癌和 ALN pCR 方面显示出良好的预测性能。

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引用次数: 0

Plasma Thioredoxin Reductase as a Potential Diagnostic Biomarker for Breast Cancer 作为乳腺癌潜在诊断生物标志物的血浆硫氧还蛋白还原酶

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-08-01 DOI: 10.1016/j.clbc.2024.03.008

Background

Early diagnosis of breast cancer is critical to the treatment and prognosis of breast cancer patients. Our aim is to explore more practical and effective diagnostic methods to facilitate early treatment and improve prognosis for breast cancer patients.

Materials and Methods

The Mann–Whitney U test, receiver operating characteristic curve, Youden index, Chi-square test, and Fisher's exact test were used to determine whether plasma thioredoxin reductase (TrxR) could be used for the clinical diagnosis of breast cancer. The Wilcoxon signed-rank test was used to validate the prognostic potential of plasma TrxR activity assessment.

Results

A total of 761 patients were included, including 537 cases of breast cancer and 224 cases of benign breast diseases. Plasma TrxR activity in the breast cancer group [8.0 (6.0, 9.45) U/mL] was significantly higher than that in the benign group [3.05 (1.20, 6.275) U/mL]. The diagnostic efficiency of TrxR for breast cancer was higher than that of other conventional breast cancer biomarkers, with an area under the curve of 0.821 (95% CI = 0.791-0.852). In addition, TrxR can be used in combination with conventional tumor markers to further improve the diagnostic efficiency. The optimal TrxR threshold for identifying benign and malignant diseases is 7.45 U/mL. We detected plasma TrxR activity and serum tumor markers before and after antitumor therapies in 333 breast cancer patients and found that their trends were basically the same, with a significant decrease in plasma TrxR activity after treatment.

Conclusion

Plasma TrxR activity can be used as a suitable biomarker for breast cancer diagnosis and efficacy assessment.

乳腺癌的早期诊断对乳腺癌患者的治疗和预后至关重要。我们的目的是探索更实用、更有效的诊断方法，以促进乳腺癌患者的早期治疗和改善预后。为了确定血浆 TrxR 是否可用于乳腺癌的临床诊断，我们采用了 Mann-Whitney U 检验、接收者操作特征曲线（ROC）、Youden 指数、Chi-square 检验和 Fisher's 精确检验。Wilcoxon 符号秩检验用于验证血浆 TrxR 活性评估的预后潜力。研究共纳入了 761 例患者，其中包括 537 例乳腺癌患者和 224 例良性乳腺疾病患者。乳腺癌组的血浆TrxR活性[8.0 (6.0, 9.45) U/mL]明显高于良性组[3.05 (1.20, 6.275) U/mL]。与其他常规乳腺癌生物标志物相比，TrxR 对乳腺癌的诊断效率更高，其 AUC 为 0.821（95% CI= 0.791-0.852）。此外，TrxR 还可与传统肿瘤标志物结合使用，进一步提高诊断效率。鉴别良性和恶性疾病的最佳 TrxR 阈值为 7.45 U/ml 。我们对 333 例乳腺癌患者进行了抗肿瘤治疗前后血浆 TrxR 活性和血清肿瘤标志物的检测，发现两者的变化趋势基本一致，治疗后血浆 TrxR 活性显著下降。血浆 TrxR 活性可作为乳腺癌诊断和疗效评估的合适生物标记物。

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引用次数: 0

Screening Mammography for Males With Elevated Breast Cancer Risk, Mutation Carriers, and Gynecomastia "为乳腺癌风险较高、基因突变携带者和妇科乳腺增生的男性进行乳房 X 射线筛查"

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-08-01 DOI: 10.1016/j.clbc.2024.03.014

Introduction

The recommendations for annual mammography for male carriers with gynecomastia are controversial. This study investigated the potential link between gynecomastia and breast cancer in male carriers.

Patients and Methods

The database of a tertiary medical center was retrospectively searched for all male patients who underwent at least 1 digital mammography study from 2016 to 2023. Known carriers of a pathogenic variant in a high-risk breast-cancer gene were identified. Patients were stratified by carrier status, diagnosis of breast cancer, and diagnosis of gynecomastia. Data on demographics, hormone profile, and pathology results were compared.

Results

The cohort included 446 men of whom 82 were known carriers. Gynecomastia was diagnosed by mammography in 251 patients: 239/364 noncarriers (66%) and 12/82 carriers (15%) (P < .0001). Breast cancer was found in 21/364 noncarriers (6%) and 6/82 carriers (7%) (P < .6), and in 10/251 patients with gynecomastia (4%) and 17/193 (9%) without gynecomastia (P < .05). Among patients without gynecomastia, the number of breast cancer cases was similar in carriers and noncarriers (P = .3). Among patients with gynecomastia, the rate of breast cancer was higher in carriers (P < .08). On logistic regression analysis, the effect of gynecomastia on carriers was significant (P = .02). The odds ratio for a breast cancer diagnosis was 5.8 in the presence of gynecomastia (95% CI, 1.1-31, P < .04) and 0.52 in the absence of gynecomastia (95% CI, 0.2-1.7, P < .3).

Conclusion

Gynecomastia may be associated with an increased risk of breast cancer in carriers. Larger studies are needed to determine whether and when to screen male carriers.

导言：对患有妇科乳腺增生的男性乳腺携带者每年进行乳腺 X 射线检查的建议存在争议。本研究调查了男性妇科乳腺增生症携带者与乳腺癌之间的潜在联系。患者和方法回顾性检索了一家三级医疗中心的数据库，其中包括在2016年至2023年期间接受过至少一次数字乳腺X光检查的所有男性患者。确定了高风险乳腺癌基因致病变异的已知携带者。根据携带者状态、乳腺癌诊断和妇科乳腺增生诊断对患者进行分层。结果该队列包括 446 名男性，其中 82 人为已知携带者。251名患者通过乳房X光检查确诊为妇科炎症：239/364名非携带者（66%）和12/82名携带者（15%）（P < .0001）。在 21/364 名非携带者（6%）和 6/82 名携带者（7%）中发现了乳腺癌（P < .6），在 10/251 名有妇科乳腺增生的患者（4%）和 17/193 名没有妇科乳腺增生的患者（9%）中发现了乳腺癌（P < .05）。在没有妇科乳腺增生的患者中，携带者和非携带者的乳腺癌病例数相似（P = .3）。在有妇科炎症的患者中，携带者的乳腺癌发病率更高（P < .08）。在逻辑回归分析中，妇科乳腺增生对携带者的影响是显著的（P = .02）。有妇科乳腺增生者确诊乳腺癌的几率为 5.8（95% CI，1.1-31，P < .04），无妇科乳腺增生者为 0.52（95% CI，0.2-1.7，P < .3）。需要进行更大规模的研究，以确定是否以及何时对男性携带者进行筛查。

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引用次数: 0

The Impact of COVID-19 on Breast Cancer Care: A Qualitative Analysis of Surgeons’ Perspectives COVID-19 对乳腺癌护理的影响：对外科医生观点的定性分析。

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-08-01 DOI: 10.1016/j.clbc.2024.04.011

Introduction

While studies have documented delays in breast cancer (BC) care during the COVID-19 pandemic due to healthcare restrictions, there have been no studies on the experiences, and, particularly, the challenges with providing care faced by breast surgeons during this unprecedented time. This paper aims to understand the perspectives of breast surgeons regarding the impact of the COVID-19 pandemic on BC care.

Methods

We used purposeful and snowball sampling to identify breast surgeons in Ontario, Canada. One-on-one qualitative semi-structured interviews were conducted exploring the impact of the pandemic on BC treatment, psychosocial well-being of patients and providers, and the future state of BC care. Audio-recorded interviews were transcribed verbatim and analyzed using Thematic Analysis.

Results

A total of 10 breast surgeons (5 community and 5 academic) were interviewed. Breast surgeons reported that the pandemic led to increased multidisciplinary collaboration and innovations in delivery of BC surgery (e.g., increased use of regional anesthesia). Multiple surgeons identified that the pandemic created disparities in BC care based geographic location and that existing disparities in care based on ethnicity or marginalization were exacerbated. Last, surgeons identified that virtual care improved, but also created some challenges to how BC care was delivered, with many hoping for this to be continued after the pandemic was over.

Conclusions

In this study, breast surgeons identified unique challenges and solutions to BC care delivery during the pandemic. Concerns regarding disparities in care based on geographic location and marginalized patients require further study to improve future BC care.

引言虽然有研究记录了在 COVID-19 大流行期间由于医疗保健限制而导致的乳腺癌（BC）治疗延误，但还没有关于乳腺外科医生在这一前所未有的时期的经历，尤其是在提供治疗方面所面临的挑战的研究。本文旨在了解乳腺外科医生对 COVID-19 大流行对不列颠哥伦比亚省医疗服务影响的看法。我们进行了一对一的半结构化定性访谈，探讨大流行病对不列颠哥伦比亚省治疗的影响、患者和提供者的社会心理健康以及不列颠哥伦比亚省护理的未来状况。访谈录音被逐字转录，并使用主题分析法进行了分析。乳腺外科医生报告说，大流行病加强了多学科合作，并在提供乳腺外科手术方面进行了创新（例如，增加了区域麻醉的使用）。多位外科医生指出，大流行造成了基于地理位置的 BC 护理差异，并且加剧了基于种族或边缘化的现有护理差异。最后，外科医生们发现虚拟护理得到了改善，但也给如何提供 BC 护理带来了一些挑战，许多外科医生希望在大流行结束后继续提供虚拟护理。需要进一步研究基于地理位置和边缘化患者的护理差异，以改善未来的乳腺癌护理。

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引用次数: 0

Implementing Indicators and Trajectories of Return to Work After Breast Cancer Diagnosis: A Mixed-Methods Study Using the French National Healthcare Insurance Database and Stakeholder Consultation 实施乳腺癌诊断后重返工作岗位的指标和轨迹：利用法国国家医疗保险数据库和利益相关者咨询开展的混合方法研究

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-08-01 DOI: 10.1016/j.clbc.2024.04.004

Purpose

Return to work (RTW) is important for quality of life after breast cancer but its analysis at the population-level remains limited in France. This study aimed to implement Electronic Healthcare Data (EHD)-based indicators and trajectories to measure RTW after breast cancer diagnosis, and to examine stakeholders’ perspectives regarding these indicators.

Methods

We followed a mixed-methods approach that consisted of (i) implementing RTW indicators and identifying clusters of trajectories using state sequence analysis with data from a representative sample of the French National Health Data System and (ii) exploring, through qualitative focus group and interviews, stakeholders’ perceptions on the interpretation, limitations, and utility of these indicators.

Results

We extracted data from 317 women aged 25-55 years with a first diagnosis of early-stage breast cancer. The median number of sickness absence periods was 2 for a total of 434 days during the 3-year follow-up, and the median time to sustainable RTW was 240 days. Three clusters of RTW trajectories were identified: “early RTW” (49.5% of the population), “RTW after partial resumption” (37.5%) and “continuous compensation” (12.9%). Feedback from stakeholders highlighted the multi-factorial nature of RTW and underscored the added value of EHD for studying RTW, despite certain limitations.

Conclusions

We demonstrated the feasibility of calculating RTW indicators and identifying trajectories using the French National Health Data System. These indicators can serve as outcome measures in RTW promotion and provide a basis for designing targeted interventions for breast cancer survivors.

目的重返工作岗位（RTW）对乳腺癌术后的生活质量非常重要，但在法国，对其进行的人群分析仍然有限。本研究旨在采用基于电子医疗数据（EHD）的指标和轨迹来衡量乳腺癌确诊后的复工情况，并考察利益相关者对这些指标的看法。方法我们采用了一种混合方法，其中包括：(i) 实施复工指标，并利用法国国家健康数据系统代表性样本中的数据，通过状态序列分析确定轨迹集群；(ii) 通过定性焦点小组和访谈，探讨利益相关者对这些指标的解释、局限性和效用的看法。在 3 年的随访中，病假次数的中位数为 2 次，共计 434 天，可持续复工时间的中位数为 240 天。确定了三组复工轨迹："早期复工"（占总人数的 49.5%）、"部分复工后复工"（占总人数的 37.5%）和 "持续补偿"（占总人数的 12.9%）。利益相关者的反馈意见强调了复工的多因素性质，并强调了 EHD 在研究复工方面的附加价值，尽管存在某些局限性。这些指标可作为促进复工的结果衡量标准，并为设计针对乳腺癌幸存者的干预措施提供依据。

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引用次数: 0

Survival Outcomes in Thyroid Cancer Patients with Co-Occurring Breast Cancer: Evidence of Mortality Risk Attenuation 合并乳腺癌的甲状腺癌患者的生存结果：死亡率风险降低的证据

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-08-01 DOI: 10.1016/j.clbc.2024.04.002

Background

Previous studies have reported a strong correlation between breast cancer (BC) and thyroid cancer (TC) incidence. However, the clinical and oncological impact of these associations are not yet fully understood. Here, we aimed to explore the differences in clinicopathological characteristics between TC patients with and without BC, and the effect of a history of positive BC on TC survival.

Methods

We retrospectively compared the clinical characteristics and survival rates of patients with TC alone and those with TC and BC in a primary cohort at our institution and in a second cohort using the Surveillance, Epidemiology, and End Results (SEER) database.

Results

In our institutional cohort, survival rates were similar between patients with TC alone and those with TC-associated BC. However, using SEER data, we found that BC had a protective effect on TC patients and was associated with reduced TC mortality rates (hazard ratio [HR] = 0.72, 95% confidence interval [CI] 0.57 to 0.92; P = .026). After stratifying the TC patients according to co-occurring BC subtypes, we observed that higher survival rates were restricted to patients with coexisting luminal A BC (P = .015), which exhibit positive hormone receptors and do not express HER-2.

Conclusion

These findings suggest that hormone pathways may play a role in the co-occurrence of thyroid and breast cancers. Patients with TC coexisting with luminal A BC have higher survival rates. However, further studies on the mechanisms underlying the association between BC and TC are warranted.

背景以前的研究报道了乳腺癌（BC）和甲状腺癌（TC）发病率之间的密切联系。然而，这些关联对临床和肿瘤学的影响尚未完全明了。方法我们回顾性比较了本机构主要队列中单纯甲状腺癌患者和甲状腺癌合并BC患者的临床特征和生存率，以及使用监测、流行病学和最终结果（SEER）数据库进行的第二队列中单纯甲状腺癌患者和甲状腺癌合并BC患者的临床特征和生存率。然而，利用 SEER 数据，我们发现 BC 对 TC 患者有保护作用，并与 TC 死亡率的降低有关（危险比 [HR] = 0.72，95% 置信区间 [CI] 0.57 至 0.92；P = .026）。根据并存的 BC 亚型对 TC 患者进行分层后，我们观察到，只有并存管腔 A 型 BC 的患者存活率更高（P = .015），这些患者的激素受体呈阳性，但不表达 HER-2。TC与管腔A型BC并存的患者生存率更高。然而，还需要进一步研究BC与TC之间的关联机制。

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引用次数: 0

Triglyceride-Glucose Index: A Candidate Prognostic Marker in HR-Positive/HER2-Negative Metastatic Breast Cancer Patients Treated With CDK4/6 Inhibitors 甘油三酯-葡萄糖指数：接受 CDK4/6 抑制剂治疗的 HR 阳性/HER2 阴性转移性乳腺癌患者的候选预后指标

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-08-01 DOI: 10.1016/j.clbc.2024.05.004

Aims and Objectives

Although cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i) are a vital part of the treatment of hormone receptor (HR)-positive/HER-2-negative metastatic breast cancer (BC), individuals have different sensitivities to CDK4/6i, indicating the need for biomarkers. The fasting triglyceride glucose (TyG) index is an easily accessible surrogate marker of insulin resistance (IR). Herein, we investigated the prognostic significance of the fasting triglyceride glucose (TyG) index in HR+/HER2- metastatic BC patients treated with CDK4/6i plus endocrine therapy (ET).

Methods

About 333 patients with HR+/HER2-metastatic BC treated with CDK4/6i plus ET were analyzed retrospectively. The TyG index was calculated within 3 months before the initiation of CDK4/6i plus ET. The median value of 8.43 was taken as the cutoff for the TyG index.

Results

The median overall survival (OS) was 73.6 months (95% CI, 66.0-81.1) in the whole cohort. The progression-free survival (PFS) was significantly longer in the low-TyG subgroup than in the high-TyG subgroup (30.1 vs. 21.3 months, multivariate adjusted [HR] = 0.666, 95% CI, 0.450-0.987, P = .043). While the median OS was not reached in the low TyG subgroup, it was 69.0 months in the high TyG subgroup (multivariate-adjusted HR = 0.513, 95% CI, 0.281-0.936, P = .030). Although the ORR and DCR were numerically greater in the low-TyG subgroup, no significant differences were observed between the low-TyG subgroup and high-TyG subgroup (28.1% vs. 24.7%, P = .476; 83.2% vs. 80.1%, P = .463, respectively).

Conclusions

These data imply that the TyG index could be a predictive biomarker for the therapeutic efficacy of CDK4/6is. Extensive prospective studies are needed to confirm these findings.

目的和目标尽管细胞周期蛋白依赖性激酶4/6抑制剂（CDK 4/6i）是治疗激素受体（HR）阳性/HER-2阴性转移性乳腺癌（BC）的重要组成部分，但个体对CDK4/6i的敏感性不同，这表明需要生物标志物。空腹甘油三酯血糖（TyG）指数是胰岛素抵抗（IR）的替代标志物，很容易获得。在此，我们研究了空腹甘油三酯血糖（TyG）指数在接受CDK4/6i加内分泌治疗（ET）的HR+/HER2-转移性BC患者中的预后意义。方法回顾性分析了约333例接受CDK4/6i加ET治疗的HR+/HER2-转移性BC患者。在CDK4/6i加ET治疗开始前3个月内计算TyG指数。结果整个队列的中位总生存期（OS）为73.6个月（95% CI，66.0-81.1）。低TyG亚组的无进展生存期（PFS）明显长于高TyG亚组（30.1个月 vs. 21.3个月，多变量调整[HR] = 0.666, 95% CI, 0.450-0.987, P = .043）。虽然低TyG亚组未达到中位OS，但高TyG亚组的中位OS为69.0个月（多变量调整HR = 0.513，95% CI，0.281-0.936，P = .030）。虽然低TyG亚组的ORR和DCR在数字上更高，但低TyG亚组和高TyG亚组之间未观察到显著差异（分别为28.1% vs. 24.7%，P = .476；83.2% vs. 80.1%，P = .463）。需要进行广泛的前瞻性研究来证实这些发现。

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引用次数: 0

Does Sentinel Lymph Node Biopsy Influence Subsequent Management Decisions in Women With Breast Cancer ≥ 70 Years Old? 前哨淋巴结活检是否会影响≥70 岁女性乳腺癌患者的后续治疗决策？

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-08-01 DOI: 10.1016/j.clbc.2024.05.002

Background

There have been ongoing attempts to de-escalate surgical intervention in older breast cancer patients in recent years. However, there remains ongoing hesitancy amongst surgeons to de-implement axillary staging in this cohort. The supporting argument for performing a sentinel lymph node biopsy (SLNB) is that it may guide subsequent management.

Methods

A retrospective review was performed of 356 SLNBs, in 342 women ≥ 70 years of age with invasive breast cancer, between 2014 and 2022 in a single institution. Data were collected on patient and tumor characteristics and subsequent management for all patients and for patients with ER+/HER2-, early-stage disease.

Results

Positive SLNB significantly increased likelihood of receiving adjuvant chemotherapy (CTh) in patients aged 70-75 in all clinical subtypes (OR 4.0, 95% CI, 1.6-10; P = .0035). Positive SLNB did not significantly increase likelihood of receiving adjuvant CTh in patients aged 75-80, however, an Oncotype Dx score of ≥ 26 did (OR 34.50, 95% CI, 3.00-455.2; P = .0103). Positive SLNB was significantly associated with receiving adjuvant radiotherapy (RTh) in all patients aged 70-75 (OR 4.5, 95% CI, 2.0-11; P = .0004) and 75-80 (OR 9.7, 95% CI, 2.7-46; P = .0015). In patients aged ≥ 80 years, positive SLNB did not have a significant influence on subsequent treatments.

Conclusion

In this study, SLNB did not significantly influence subsequent management decisions in patients over 80 and should rarely be performed in this cohort. However, SLNB still had a role in patients aged 70-80 and should be used selectively in this cohort.

背景近年来，人们一直在尝试减少对老年乳腺癌患者的手术干预。然而，外科医生对于是否在这类患者中取消腋窝分期仍犹豫不决。方法在 2014 年至 2022 年期间，对一家医疗机构 342 名年龄≥ 70 岁的浸润性乳腺癌女性患者的 356 例前哨淋巴结活检（SLNB）进行了回顾性研究。结果在所有临床亚型中，SLNB 阳性显著增加了 70-75 岁患者接受辅助化疗 (CTh) 的可能性（OR 4.0，95% CI，1.6-10；P = .0035）。在 75-80 岁的患者中，SLNB 阳性并不会显著增加接受 CTh 辅助治疗的可能性，但是，Oncotype Dx 评分≥ 26 分则会增加接受 CTh 辅助治疗的可能性（OR 34.50，95% CI，3.00-455.2；P = .0103）。在所有 70-75 岁（OR 4.5，95% CI，2.0-11；P = .0004）和 75-80 岁（OR 9.7，95% CI，2.7-46；P = .0015）的患者中，SLNB 阳性与接受辅助放疗 (RTh) 显著相关。在年龄≥80 岁的患者中，SLNB 阳性对后续治疗没有显著影响。然而，SLNB 对 70-80 岁的患者仍有一定的作用，应选择性地用于这一人群。

{"title":"Does Sentinel Lymph Node Biopsy Influence Subsequent Management Decisions in Women With Breast Cancer ≥ 70 Years Old?","authors":"","doi":"10.1016/j.clbc.2024.05.002","DOIUrl":"10.1016/j.clbc.2024.05.002","url":null,"abstract":"<div><h3>Background</h3><p>There have been ongoing attempts to de-escalate surgical intervention in older breast cancer patients in recent years. However, there remains ongoing hesitancy amongst surgeons to de-implement axillary staging in this cohort. The supporting argument for performing a sentinel lymph node biopsy (SLNB) is that it may guide subsequent management.</p></div><div><h3>Methods</h3><p>A retrospective review was performed of 356 SLNBs, in 342 women ≥ 70 years of age with invasive breast cancer, between 2014 and 2022 in a single institution. Data were collected on patient and tumor characteristics and subsequent management for all patients and for patients with ER+/HER2-, early-stage disease.</p></div><div><h3>Results</h3><p>Positive SLNB significantly increased likelihood of receiving adjuvant chemotherapy (CTh) in patients aged 70-75 in all clinical subtypes (OR 4.0, 95% CI, 1.6-10; <em>P</em> = .0035). Positive SLNB did not significantly increase likelihood of receiving adjuvant CTh in patients aged 75-80, however, an Oncotype Dx score of ≥ 26 did (OR 34.50, 95% CI, 3.00-455.2; <em>P</em> = .0103). Positive SLNB was significantly associated with receiving adjuvant radiotherapy (RTh) in all patients aged 70-75 (OR 4.5, 95% CI, 2.0-11; <em>P</em> = .0004) and 75-80 (OR 9.7, 95% CI, 2.7-46; <em>P</em> = .0015). In patients aged ≥ 80 years, positive SLNB did not have a significant influence on subsequent treatments.</p></div><div><h3>Conclusion</h3><p>In this study, SLNB did not significantly influence subsequent management decisions in patients over 80 and should rarely be performed in this cohort. However, SLNB still had a role in patients aged 70-80 and should be used selectively in this cohort.</p></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"24 6","pages":"Pages 510-518.e4"},"PeriodicalIF":2.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1526820924001150/pdfft?md5=8fb6befa74331196c3e27ba7982a0d24&pid=1-s2.0-S1526820924001150-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141053802","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

Expression and Clinical Significance of NUDCD1, PI3K/AKT/mTOR Signaling Pathway-Related Molecules and Immune Infiltration in Breast Cancer 乳腺癌中 NUDCD1、PI3K/AKT/mTOR 信号通路相关分子和免疫浸润的表达及临床意义

IF 2.9 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2024-08-01 DOI: 10.1016/j.clbc.2024.02.022

Background

NUDCD1 (NudC Domain Containing 1) performs an essential function in biological processes such as cell progression, migration, cell cycle, and intracellular material transport. Many solid tumors express it highly, which is a prospective biomarker and therapeutic approach. However, the expression and clinical importance of NUDCD1 across breast cancer is unclear.

Methods

The expressions of NUDCD1 in breast cancers and normal breast tissues were studied utilizing the TIMER database and immunohistochemical analysis. Subsequently, we validate the association between the expression of NUDCD1 and clinicopathologic features and prognosis of breast cancer. The immunohistochemical experiments of pathway-related molecules were done on 214 breast cancer tissue microarrays. The investigation of correlation between NUDCD1 expression and tumor immune infiltration was subsequently conducted.

Results

Through the utilization of bioinformatics analysis and immunohistochemical experiments, it was determined that NUDCD1 exhibited upregulation within breast cancer. Furthermore, it was discovered that an elevated expression of NUDCD1 may potentially be linked to a worse prognosis in breast cancer. Our study reveals that the PI3K/AKT/mTOR signaling pathway may perform a function in NUDCD1 regulating breast cancer progression via enrichment analysis. Furthermore, the expression of NUDCD1 may be associated with the degree of immunological infiltration.

Conclusion

The expression of NUDCD1 was explored to be elevated in breast cancer and was observed to be correlated with a poorer prognosis. p-AKT, PI3K, AKT, mTOR, and p-mTOR expression levels underwent significant elevation in breast cancer. The function of NUDCD1 within breast cancer might be associated with the PI3K/AKT/mTOR signaling pathway.

NUDCD1（NudC Domain Containing 1）在细胞进展、迁移、细胞周期和细胞内物质运输等生物过程中发挥着重要功能。许多实体瘤都高表达 NUDCD1，这是一种前瞻性的生物标记物和治疗方法。然而，NUDCD1在乳腺癌中的表达和临床重要性尚不清楚。我们利用 TIMER 数据库和免疫组化分析研究了 NUDCD1 在乳腺癌和正常乳腺组织中的表达。随后，我们验证了 NUDCD1 的表达与乳腺癌临床病理特征和预后之间的关联。我们在 214 个乳腺癌组织芯片上进行了通路相关分子的免疫组化实验。随后研究了 NUDCD1 表达与肿瘤免疫浸润的相关性。通过生物信息学分析和免疫组化实验，确定了 NUDCD1 在乳腺癌中的上调。此外，研究还发现，NUDCD1 表达的升高可能与乳腺癌预后的恶化有关。我们的研究通过富集分析发现，PI3K/AKT/mTOR 信号通路可能在 NUDCD1 调控乳腺癌进展的过程中发挥作用。此外，NUDCD1的表达可能与免疫浸润程度有关。研究发现，NUDCD1 的表达在乳腺癌中升高，并与较差的预后相关。NUDCD1在乳腺癌中的功能可能与PI3K/AKT/mTOR信号通路有关。乳腺癌是女性最常见的恶性肿瘤之一。在这项研究中，我们分别利用生物信息学方法和免疫组化实验分析了 1226 例和 214 例乳腺癌病例。研究发现，NUDCD1 在乳腺癌中高表达，可能与临床预后不良有关。它可能是乳腺癌患者的一个新的治疗靶点。

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引用次数: 0