Clinical breast cancer最新文献_第8页

Occupational Exposure to Ionizing Radiation in Female Physicians and Breast Cancer Risk: A Systematic Review and Meta-analysis 女性医生职业电离辐射暴露与乳腺癌风险：系统回顾和荟萃分析。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2026-02-01 Epub Date: 2025-08-20 DOI: 10.1016/j.clbc.2025.08.012

Milena Martello Cristófalo, Yedda Nunes Reis, Jonathan Yugo Maesaka, Bruna Salani Mota, José Maria Soares Júnior, Edmund Chada Baracat, José Roberto Filassi

Introduction

Advancements in health technologies have enabled the performance of minimally invasive procedures using ionizing radiation for radioscopy and fluoroscopy by various physicians including orthopedic surgeons, radiologists, urologists, cardiologists, vascular surgeons, and plastic surgeons. Simultaneously, there appears to be an increasing frequency of breast cancer among these professionals. In addition to other risk factors to which they are exposed, ionizing radiation plays a role in carcinogenesis. This study is a systematic review and meta-analysis conducted to summarize the available literature on breast cancer risk among female physicians occupationally exposed to ionizing radiation.

Methods

A systematic search was conducted in the PubMed, Embase, and LILACS databases, as well as reference lists based on PRISMA checklist (PROSPERO CRD42024553635). The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Statistical analyses were performed at Review Manager.

Results

Six observational studies were included, evaluating 34,744 participants: 8103 exposed to ionizing radiation and 26,641 controls, with a minimum 10-year follow-up. According to the NOS, 5 studies were classified as high quality and one as moderate. The meta-analysis revealed an increased breast cancer risk among female physicians exposed to ionizing radiation, with an odds ratio (OR) 1.84 (95% CI 1.11-3.06). A sensitivity analysis excluding the study classified as moderate quality showed a breast cancer risk in the exposed group with an OR 1.42 (95% CI 1.06-1.89).

Conclusions

Based on the results of this meta-analysis, female physicians occupationally exposed to ionizing radiation have an increased risk of breast cancer compared to those who are not exposed.

导读：医疗技术的进步使得各种医生（包括骨科医生、放射科医生、泌尿科医生、心脏病专家、血管外科医生和整形外科医生）使用电离辐射进行放射检查和透视检查的微创手术成为可能。同时，这些专业人员患乳腺癌的频率似乎也在增加。除了他们接触到的其他危险因素外，电离辐射在致癌方面也起着作用。本研究是一项系统综述和荟萃分析，旨在总结有关电离辐射职业女性医生患乳腺癌风险的现有文献。方法：系统检索PubMed、Embase和LILACS数据库，并根据PRISMA检查表（PROSPERO CRD42024553635）检索文献列表。纳入研究的方法学质量采用纽卡斯尔-渥太华量表（NOS）进行评估。统计分析在评审经理处进行。结果：纳入了6项观察性研究，评估了34,744名参与者：8103名暴露于电离辐射，26,641名对照，至少随访10年。根据NOS， 5项研究被归类为高质量，1项被归类为中等质量。荟萃分析显示，暴露于电离辐射的女医生患乳腺癌的风险增加，优势比（OR）为1.84 （95% CI 1.11-3.06）。敏感度分析将该研究排除在中等质量之外，显示暴露组的乳腺癌风险OR为1.42 （95% CI 1.06-1.89）。结论：基于本荟萃分析的结果，职业暴露于电离辐射的女医生患乳腺癌的风险比未暴露于电离辐射的女医生高。

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引用次数: 0

The Use and Impact on Treatment Decision of the 21-Gene Recurrence Score Assay for Patients With HR+/HER2− Early Breast Cancer in Portugal: A Nationwide Retrospective Cohort Study 葡萄牙HR+/HER2-早期乳腺癌患者21基因复发评分法的使用及其对治疗决策的影响：一项全国性的回顾性队列研究。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2026-02-01 Epub Date: 2025-09-23 DOI: 10.1016/j.clbc.2025.09.013

Teresa Gantes Padrão , Diana Pessoa , Joana Alves Luís , Diogo Alpuim Costa , Mário Fontes e Sousa , Ídilia Pina , Susana Palma de Sousa , Débora Cardoso , Sandra Bento , Joana Simões , Ana Ferreira , Renato Cunha , Diogo Martins-Branco , Tiago Dias Domingues , José Luís Passos-Coelho

Background

The 21-Gene Recurrence Score Assay (Oncotype DX) is a genomic test that quantifies the likelihood of distant recurrence and predicts the potential benefit from adjuvant chemotherapy in patients with hormone receptor–positive (HR+), HER2– early breast cancer. This study aimed to evaluate the use and impact of the assay on treatment decision-making in Portugal through a nationwide retrospective cohort analysis.

Methods

We conducted a nationwide, multicenter, retrospective cohort study of 1083 RSA tests in 1079 patients with HR+/HER2− breast cancer between 2012 and 2021, across 36 oncology centers. We analyzed Recurrence Score (RS) distribution, adjuvant chemotherapy (ACT) prescribing patterns, correlations with clinicopathologic features, and recurrence data. Predictors of RS > 25 were evaluated using multivariable analysis and the Johns Hopkins RS Estimator (JHRE).

Results

Most patients had pT1 tumors (> 60%) and luminal B-like profiles (75%) with high hormone receptor expression (median ER 100%, PR 80%). RS > 25 occurred in 14.9% of node-negative and 15.5% of node-positive cases. ACT use shifted after TAILORx publication, with decreased use in RS < 16 and increased use in RS > 25, including among patients ≤50. ACT use for intermediate RS (16-25) dropped from 62% to 30% in patients ≤50. PR and Ki-67 were independent predictors of RS > 25. The JHRE showed moderate accuracy (53.6%) and specificity (47.7%). Among patients with a predicted RS > 25 risk < 5%, only 5% had actual high scores. Recurrence was observed in 2.3% of patients (median follow-up: 29 months).

Conclusion

RSA has been increasingly adopted in Portugal and influenced ACT decisions. PR and Ki-67 can help refine patient selection for RSA, particularly in resource-limited settings. Clinical trial results significantly shaped treatment patterns.

背景：21基因复发评分法（Oncotype DX）是一种基因组检测，可量化激素受体阳性（HR+）、HER2-早期乳腺癌患者远处复发的可能性，并预测辅助化疗的潜在益处。本研究旨在通过全国回顾性队列分析，评估该检测在葡萄牙治疗决策中的使用和影响。方法：我们开展了一项全国性、多中心、回顾性队列研究，在2012年至2021年间，在36个肿瘤中心对1079例HR+/HER2-乳腺癌患者进行了1083项RSA检测。我们分析了复发评分（RS）分布、辅助化疗（ACT）处方模式、与临床病理特征的相关性以及复发数据。采用多变量分析和约翰霍普金斯RS估计器（JHRE）评估RS bbbb25的预测因子。结果：大多数患者为pT1肿瘤（> 60%）和腔内b样谱（75%），激素受体高表达（中位ER 100%， PR 80%）。14.9%的淋巴结阴性病例和15.5%的淋巴结阳性病例发生RS bbb25。在TAILORx发表后，ACT的使用发生了变化，RS < 16的使用减少，RS < 25的使用增加，包括≤50的患者。在≤50岁的患者中，ACT用于中期RS（16-25）的比例从62%降至30%。PR和Ki-67是RS的独立预测因子。JHRE具有中等准确度（53.6%）和特异性（47.7%）。在预测RS bbbb25风险< 5%的患者中，只有5%的患者实际得分较高。2.3%的患者出现复发（中位随访29个月）。结论：RSA已越来越多地采用在葡萄牙和影响ACT的决定。PR和Ki-67可以帮助改进RSA的患者选择，特别是在资源有限的情况下。临床试验结果显著影响了治疗模式。

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引用次数: 0

Microsurgery on Steroids: The Impact of Chronic Immunosuppressive Therapy on Outcomes Following Free Flap Breast Reconstruction. 类固醇显微外科：慢性免疫抑制治疗对游离皮瓣乳房重建后预后的影响。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2026-01-30 DOI: 10.1016/j.clbc.2026.01.014

Samuel A Knoedler, Thomas Schaschinger, Tobias Niederegger, Leonard Knoedler, Omar Allam, Felix Klimitz, Joanna Kempa-Timler, Karen Lynn Zhao, Stefano Pompei, Barbara Kern, Henriette Grundig, Giuseppe Sofo, Francesco Mazzarone, Fortunay Diatta, Martin Kauke-Navarro

Background: Free flap breast reconstruction (FFBR) is a well-established technique for postmastectomy rehabilitation. However, chronic immunosuppressive therapy may compromise wound healing, increase infection susceptibility, and adversely affect surgical results. However, evidence regarding the impact of chronic immunosuppression on FFBR outcomes remains sparse.

Methods: We analyzed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2013-2023), identifying female breast cancer patients who underwent immediate FFBR. Chronic immunosuppression was defined as continuous systemic administration of corticosteroids or other immunosuppressants for ≥ 30 days preoperatively. Multivariable logistic regression and propensity score matching were applied to assess the impact of immunosuppression on surgical outcomes.

Results: Of 5473 patients (mean age 52 ± 9.4 years; mean BMI 30 ± 5.6 kg/m²), 139 (2.5%) were chronically immunosuppressed. In confounder-adjusted multivariable analysis, chronic immunosuppression was independently associated with an increased risk of any complication (OR 1.5; 95% CI, 1.0-2.2; P = .048) and surgical complications (OR 2.0; 95% CI, 1.3-3.0; P = .0011), particularly postoperative bleeding (23% vs. 10%; P < .001). No significant associations were observed with medical complications (P = .73), reoperations (P = .11), or readmissions (P = .45). Propensity score matching validated these correlations, revealing elevated odds of any complications (OR 1.7; P = .044) and surgical complications (OR 2.4; P = .0026) in chronically immunosuppressed patients.

Conclusion: Chronic immunosuppression doubles the risk of surgical complications following FFBR, with postoperative bleeding representing the predominant concern. These findings mandate enhanced perioperative surveillance and bleeding prevention protocols for immunosuppressed patients while supporting the continued feasibility of FFBR in this population when appropriate precautions are implemented.

背景：游离皮瓣乳房重建（FFBR）是一种成熟的乳房切除术后康复技术。然而，慢性免疫抑制治疗可能会损害伤口愈合，增加感染易感性，并对手术结果产生不利影响。然而，关于慢性免疫抑制对FFBR结果影响的证据仍然很少。方法：我们分析了美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库（2013-2023），确定了立即接受FFBR的女性乳腺癌患者。慢性免疫抑制被定义为术前连续全身使用皮质类固醇或其他免疫抑制剂≥30天。应用多变量logistic回归和倾向评分匹配来评估免疫抑制对手术结果的影响。结果：5473例患者（平均年龄52±9.4岁，平均BMI 30±5.6 kg/m²）中，139例（2.5%）为慢性免疫抑制。在混杂因素调整后的多变量分析中，慢性免疫抑制与任何并发症（OR 1.5; 95% CI, 1.0-2.2; P = 0.048）和手术并发症（OR 2.0; 95% CI, 1.3-3.0; P = 0.0011）的风险增加独立相关，特别是术后出血（23%对10%，P < 0.001）。与医学并发症（P = 0.73）、再手术（P = 0.11）或再入院（P = 0.45）无显著相关性。倾向评分匹配验证了这些相关性，显示慢性免疫抑制患者出现任何并发症（OR 1.7, P = 0.044）和手术并发症（OR 2.4, P = 0.0026）的几率升高。结论：慢性免疫抑制使FFBR术后并发症的风险增加一倍，术后出血是主要的关注点。这些发现要求加强免疫抑制患者的围手术期监测和出血预防方案，同时支持在实施适当预防措施的情况下，FFBR在该人群中的持续可行性。

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引用次数: 0

Predicting Skeletal-Related Events in Bone Metastasis from Advanced Breast Cancer Using Machine Learning. 使用机器学习预测晚期乳腺癌骨转移的骨骼相关事件。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2026-01-12 DOI: 10.1016/j.clbc.2026.01.005

Hirotaka Miyashita, Ken Aoshima

Purpose: The purpose of this study is to develop a machine learning (ML) model to predict skeletal-related events (SREs) in patients with bone metastasis from breast cancer.

Patients and methods: Publicly available, patient-level data of patients with bone metastasis from breast cancer receiving zoledronic acid from a previous clinical trial was analyzed. Five feature sets (FS) and seven algorithms were utilized to develop ML models to predict SREs within 18 months. The model was trained with ten-fold cross-validation, repeated three times, and was evaluated through four-fold external cross-validation. Model performances were assessed by multiple metrics and the ability to differentiate cumulative risks of SREs. The model was interpreted by Shapley Additive Explanation.

(shap) results: Four hundred sixty cases with bone metastatic breast cancer were incorporated for ML model development. The ML model that utilized six features selected by the Boruta method and random forest algorithm demonstrated the numerically highest performance. (F1 score of 0.70) The mean absolute SHAP values suggested performance status, history of SREs, and serum alkaline phosphatase were the most important features. The ML model differentiated the cases with a high risk and a low risk of SREs, with median time for the first SRE of 248 days and 867 days, respectively. (Hazard ratio: 2.43 and 95% confidence interval: 1.86-3.18) CONCLUSION: A machine learning model to predict SREs in patients with bone metastatic breast cancer demonstrated the features related to SRE risk and its ability to identify the population with a high risk of SREs.

目的：本研究的目的是建立一个机器学习（ML）模型来预测乳腺癌骨转移患者的骨骼相关事件（SREs）。患者和方法：对先前临床试验中接受唑来膦酸治疗的乳腺癌骨转移患者的公开数据进行了分析。利用5个特征集（FS）和7种算法开发ML模型来预测18个月内的SREs。模型经10次交叉验证训练，重复3次，并通过4次外部交叉验证进行评估。通过多种指标和区分SREs累积风险的能力来评估模型的性能。该模型由Shapley Additive Explanation解释。（图）结果：460例骨转移性乳腺癌纳入ML模型。利用Boruta方法和随机森林算法选择的六个特征的ML模型在数值上表现出最高的性能。（F1得分为0.70）平均绝对SHAP值提示运动能力状况、SREs病史和血清碱性磷酸酶是最重要的特征。ML模型区分SRE高风险和低风险的病例，第一次SRE的中位时间分别为248天和867天。（风险比：2.43,95%可信区间：1.86-3.18）结论：用于预测骨转移性乳腺癌患者SREs的机器学习模型显示出与SRE风险相关的特征，并能够识别SREs高危人群。

{"title":"Predicting Skeletal-Related Events in Bone Metastasis from Advanced Breast Cancer Using Machine Learning.","authors":"Hirotaka Miyashita, Ken Aoshima","doi":"10.1016/j.clbc.2026.01.005","DOIUrl":"https://doi.org/10.1016/j.clbc.2026.01.005","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to develop a machine learning (ML) model to predict skeletal-related events (SREs) in patients with bone metastasis from breast cancer.</p><p><strong>Patients and methods: </strong>Publicly available, patient-level data of patients with bone metastasis from breast cancer receiving zoledronic acid from a previous clinical trial was analyzed. Five feature sets (FS) and seven algorithms were utilized to develop ML models to predict SREs within 18 months. The model was trained with ten-fold cross-validation, repeated three times, and was evaluated through four-fold external cross-validation. Model performances were assessed by multiple metrics and the ability to differentiate cumulative risks of SREs. The model was interpreted by Shapley Additive Explanation.</p><p><strong>(shap) results: </strong>Four hundred sixty cases with bone metastatic breast cancer were incorporated for ML model development. The ML model that utilized six features selected by the Boruta method and random forest algorithm demonstrated the numerically highest performance. (F1 score of 0.70) The mean absolute SHAP values suggested performance status, history of SREs, and serum alkaline phosphatase were the most important features. The ML model differentiated the cases with a high risk and a low risk of SREs, with median time for the first SRE of 248 days and 867 days, respectively. (Hazard ratio: 2.43 and 95% confidence interval: 1.86-3.18) CONCLUSION: A machine learning model to predict SREs in patients with bone metastatic breast cancer demonstrated the features related to SRE risk and its ability to identify the population with a high risk of SREs.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257728","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

Diagnostic Heterogeneity and Healthcare Access Disparities: Latent Systemic Bias in Global Estimates of Male Breast Cancer Burden 诊断异质性和医疗可及性差异：全球男性乳腺癌负担估计的潜在系统性偏差

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2026-01-01 Epub Date: 2025-10-24 DOI: 10.1016/j.clbc.2025.10.013

Jiongjiong Zhang

引用次数: 0

SPON2 acts as a tumor promoter in HR-positive/HER2-negative breast cancer by regulating β-catenin signaling SPON2通过调节β-catenin信号传导，在hr阳性/ her2阴性乳腺癌中作为肿瘤启动子。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2026-01-01 Epub Date: 2025-08-07 DOI: 10.1016/j.clbc.2025.07.030

Gu-yue Liu, Dong-ping Huang, Can Ge, Xiao-yu Li, Fei Chen, Jia-shu Fan, Huan-ping Tu

Background

Spondin-2 (SPON2) expression is associated with various types of cancer, but its role in breast cancer (BC) remains ambiguous, especially in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) BC.

Methods

The expression of SPON2 in HR+/HER2− BC tissues and adjacent tissues was detected using immunohistochemical staining and western blotting. Cell proliferation and migration were assessed via CCK-8 assay, EdU assay, and transwell assay. Animal studies were performed to assess the effect of SPON2 knockdown on tumor growth.

Results

Herein, increased expression of SPON2 was found in HR+/HER2− BC, and silencing SPON2 suppressed cell proliferation, clonogenicity, and migration, whereas SPON2 overexpression had the opposite effects. Notably, SPON2 knockdown significantly suppressed tumor growth in a xenograft tumor assay. Mechanistically, a reduction in SPON2 expression inhibited β-catenin activation, whereas its overexpression promoted β-catenin-mediated proliferation and migration.

Conclusion

These data indicate that SPON2 plays oncogenic roles in HR+/HER2− BC via activating the β-catenin pathway, and may represent a potential therapeutic target for patients diagnosed with HR+/HER2- BC.

背景：Spondin-2 （SPON2）的表达与多种类型的癌症有关，但其在乳腺癌（BC）中的作用尚不清楚，特别是在激素受体阳性(HR+)/人表皮生长因子受体2阴性（HER2-） BC中。方法：采用免疫组化染色和western blotting检测SPON2在HR+/HER2- BC组织及癌旁组织中的表达。通过CCK-8法、EdU法和transwell法检测细胞增殖和迁移。通过动物实验来评估SPON2敲低对肿瘤生长的影响。结果：在HR+/HER2- BC中发现SPON2表达增加，沉默SPON2可抑制细胞增殖、克隆性和迁移，而过表达SPON2则具有相反的作用。值得注意的是，在异种移植肿瘤实验中，SPON2敲低显著抑制肿瘤生长。从机制上讲，SPON2表达的减少抑制了β-catenin的激活，而其过表达促进了β-catenin介导的增殖和迁移。结论：这些数据表明，SPON2通过激活β-catenin通路在HR+/HER2- BC中发挥致癌作用，可能是HR+/HER2- BC患者的潜在治疗靶点。

{"title":"SPON2 acts as a tumor promoter in HR-positive/HER2-negative breast cancer by regulating β-catenin signaling","authors":"Gu-yue Liu, Dong-ping Huang, Can Ge, Xiao-yu Li, Fei Chen, Jia-shu Fan, Huan-ping Tu","doi":"10.1016/j.clbc.2025.07.030","DOIUrl":"10.1016/j.clbc.2025.07.030","url":null,"abstract":"<div><h3>Background</h3><div>Spondin-2 (SPON2) expression is associated with various types of cancer, but its role in breast cancer (BC) remains ambiguous, especially in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) BC.</div></div><div><h3>Methods</h3><div>The expression of SPON2 in HR+/HER2− BC tissues and adjacent tissues was detected using immunohistochemical staining and western blotting. Cell proliferation and migration were assessed via CCK-8 assay, EdU assay, and transwell assay. Animal studies were performed to assess the effect of SPON2 knockdown on tumor growth.</div></div><div><h3>Results</h3><div>Herein, increased expression of SPON2 was found in HR+/HER2− BC, and silencing SPON2 suppressed cell proliferation, clonogenicity, and migration, whereas SPON2 overexpression had the opposite effects. Notably, SPON2 knockdown significantly suppressed tumor growth in a xenograft tumor assay. Mechanistically, a reduction in SPON2 expression inhibited β-catenin activation, whereas its overexpression promoted β-catenin-mediated proliferation and migration.</div></div><div><h3>Conclusion</h3><div>These data indicate that SPON2 plays oncogenic roles in HR+/HER2− BC via activating the β-catenin pathway, and may represent a potential therapeutic target for patients diagnosed with HR+/HER2- BC.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 298-305"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944859","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

Evaluation of Residual Axillary Lymph Node Metastases After Neoadjuvant Treatment in Breast Cancer 乳腺癌新辅助治疗后残留腋窝淋巴结转移的评价。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2026-01-01 Epub Date: 2025-07-12 DOI: 10.1016/j.clbc.2025.07.011

Rodrigo Vaz Reis , Paula Pinto , Bárbara Peleteiro , José Luís Fougo

Background

The present study aims to evaluate the volume of residual axillary nodal disease after neoadjuvant chemotherapy (NACT) in breast cancer.

Methods

Predictive factors for low-volume residual axillary nodal disease were analyzed in patients with histologically proven breast cancer (cT1-3 cN0-2) who were treated with NACT and surgery between 2015 and 2019.

Results

A total of 734 patients were analyzed. Breast pathological complete response (pCR) was achieved in 35.1%, with 31.5% showing no residual tumor in the breast or axillary lymph nodes (LNs). Breast and axillary pCR rates varied according to receptor subtype, with the highest rates found in HER2+ and hormone receptor (HR) negative tumors. Among 385 patients presenting with axillary metastases at diagnosis, 41.0% achieved axillary pCR, and 38.4% had 1–3 metastatic LNs. Predictive factors for axillary pCR included cN stage, HR status, ycN status, and breast pCR. For breast pCR patients with cN+ at presentation, the rate of axillary pCR was 81.1%. After NACT, 68.7% of patients with >2 metastatic LNs at diagnosis had 0-3 residual LNs.

Conclusion

We conclude that breast pCR, HER2+, HR negative breast cancer, <3 metastatic axillary LNs at diagnosis, and complete axillary imaging response after NACT were associated with axillary pCR rates and low probability of >3 positive LNs. Similarly, our study showed that axillary pCR in patients with more than 2 metastatic LNs was comparable to that of patients with 1-2 metastatic LNs highlighting an opportunity to tailor axillary surgery in this subgroup.

背景：本研究旨在评估乳腺癌新辅助化疗（NACT）后残留腋窝淋巴结的体积。方法：分析2015年至2019年期间经组织学证实的乳腺癌（cT1-3 cN0-2）接受NACT和手术治疗的小体积残留腋窝淋巴结病的预测因素。结果：共分析734例患者。35.1%的患者达到乳腺病理完全缓解（pCR）， 31.5%的患者乳腺或腋窝淋巴结（LNs）无残留肿瘤。乳腺和腋窝的pCR率因受体亚型而异，HER2+和激素受体（HR）阴性肿瘤的pCR率最高。在诊断时出现腋窝转移的385例患者中，41.0%的患者实现了腋窝pCR， 38.4%的患者有1-3个转移灶。腋窝pCR的预测因素包括cN分期、HR状态、ycN状态和乳腺pCR。在出现cN+的乳腺pCR患者中，腋窝pCR的检出率为81.1%。经NACT治疗后，68.7%诊断为bbbb2转移性LNs的患者有0-3个残留LNs。结论：乳腺癌pCR， HER2+， HR阴性乳腺癌，3个阳性LNs。同样，我们的研究表明，2个以上转移性LNs患者的腋窝pCR与1-2个转移性LNs患者的腋窝pCR相当，这表明该亚组有机会进行量身定制的腋窝手术。

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引用次数: 0

Effects of Resistance Training at Different Intensities on Preventing Breast Cancer-Related Lymphedema: A 1-Year Randomized Controlled Trial 不同强度的阻力训练对预防乳腺癌相关淋巴水肿的影响：一项为期1年的随机对照试验

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2026-01-01 Epub Date: 2025-07-14 DOI: 10.1016/j.clbc.2025.07.012

Yi-Jing Fan , Hui-Qian Xu , Hong Li , Zi-rui Zhang , Shu-Fang Zhang , Ai-Jun Du , Li-zhi Zhou , Yang Wang

Background

Breast cancer-related lymphedema (BCRL) is a relatively common and harmful complication after breast cancer surgery, and there is currently no effective cure. We hypothesized that, compared with the control group, 12 weeks of resistance exercise at different intensities could reduce the incidence of BCRL after axillary lymph node dissection.

Methods

114 breast cancer patients undergoing axillary lymph node dissection were randomly divided into a Control Group (CG), a Low-to-Moderate Intensity Exercise Group (L-MIEG, 40%-70% 1-RM) and a Moderate-to-High Intensity Exercise Group (M-HIEG, 60%-85% 1-RM).

Results

(1) The 12-month cumulative BCRL incidence was higher in the CG (16.3%, 6/37) than in the L-MIEG (8.3%, 3/36) and M-HIEG (5.5%, 2/37). (2) Postintervention and at 6-and 12- month follow-ups, both intervention groups had smaller interlimb differences than the CG (P < .05), and the M-HIEG had smaller differences at 6-month than the L-MIEG (P < .05). (3) InBody analysis showed both intervention groups outperformed CG in segmental water differences, extracellular water (ECW), and single-frequency bioelectrical impedance analysis (SFBIA) (P < .05), and the M-HIEG was better at 6-month (P < .05). (4) At 6-and 12-month follow-ups, both intervention groups improved grip strength more than CG (P < .05), and the M-HIEG was superior at 12 months (P < .05).

Conclusions

Different- intensity resistance exercises benefit BCRL prevention, with M-HIEG being more effective.

背景：乳腺癌相关淋巴水肿（Breast cancer-related lymphodema， BCRL）是乳腺癌手术后较为常见和有害的并发症，目前尚无有效的治疗方法。我们假设，与对照组相比，12周不同强度的阻力运动可以降低腋窝淋巴结清扫后BCRL的发生率。方法：114例行腋窝淋巴结清扫术的乳腺癌患者随机分为对照组（CG）、中低强度运动组（L-MIEG, 40% ~ 70% 1-RM）和中高强度运动组（M-HIEG, 60% ~ 85% 1-RM）。结果：(1)CG组12个月累积BCRL发生率（16.3%,6/37）高于L-MIEG组（8.3%,3/36）和M-HIEG组（5.5%,2/37）。(2)干预后及随访6、12个月时，两组患者肢间差异均小于对照组（P < 0.05），且6个月时M-HIEG差异小于L-MIEG （P < 0.05）。(3) InBody分析显示，两组在节段水差、细胞外水（ECW）和单频生物电阻抗分析（SFBIA）方面均优于CG (P < 0.05)，且M-HIEG在6个月时优于CG （P < 0.05）。(4)随访6个月和12个月时，两组握力的改善均优于对照组（P < 0.05）， 12个月时M-HIEG更优于对照组（P < 0.05）。结论：不同强度的阻力运动有利于预防BCRL，其中M-HIEG更有效。

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引用次数: 0

National Breast Cancer Surgery Snapshot Study: Breast Cancer Surgery after Neoadjuvant Systemic Therapy in Primary Breast Cancer (MANS Study) 全国乳腺癌手术快照研究：原发性乳腺癌新辅助全身治疗后的乳腺癌手术（MANS研究）

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2026-01-01 Epub Date: 2025-11-16 DOI: 10.1016/j.clbc.2025.10.019

Gaelle Kramer , José Volders , Femke den Haring , Roza Opperman , Pauline Spronk , Petrousjka van den Tol , Marie-Jeanne Vrancken Peeters

Introduction

The use of neoadjuvant systemic therapy (NST) in primary breast cancer has increased worldwide. This study provides real-time data of the reasons and variation in NST, conversion rate of mastectomy to BCS and conversion rate of ALND to radiation or omission of axillary treatment.

Methods

This is a Breast Cancer Surgery Snapshot study, multicenter prospective cross-sectional study in 70 breast cancer hospitals in the Netherlands. For 2 months the reason for NST is registered with patient- and tumor characteristics. The expectation of the surgical procedure in breast and axilla before and after NST is noted and the actual surgical outcome after NST is registered.

Results

Four hundred sixty seven patients receiving NST were registered. The 3 main reasons for NST were in 26% axillary down-staging, 25% a triple negative (TN) tumor and 25% HER2+. Before NST, 219 patients (47%) were eligible for BCS. In 210 patients (45%) initially assigned to receive a mastectomy, 99 patients (47%) underwent BCS. Triple negativity had the highest conversion rate with 68%. Of all mastectomy patients, 30% showed a pCR of the breast. Axillary conversion from ALND to axillary sparing surgery was achieved in 87% cN+ patients.

Conclusion

In the Netherlands the main reasons for NST were subtype (triple negative, HER2+) and axillary down staging. Additional reasons for NST focused more on down staging to convert to BCS and improve cosmetic outcomes. Real time data showed that NST lead to very high conversion rates from mastectomy to BCS as well as high rates of omission of ALND after NST.

新辅助全身治疗（NST）在原发性乳腺癌中的应用在世界范围内有所增加。本研究提供了NST的原因和变化、乳房切除术到BCS的转换率和ALND到放疗或遗漏腋窝治疗的转换率的实时数据。方法：这是一项针对荷兰70家乳腺癌医院的乳腺癌手术快照研究，多中心前瞻性横断面研究。2个月来，NST的原因与患者和肿瘤的特征有关。记录NST前后对乳房和腋窝手术的预期，记录NST后的实际手术结果。结果467例患者接受了NST治疗。发生NST的3个主要原因是腋窝分期下降26%，三阴性（TN）肿瘤25%，HER2+ 25%。在NST之前，219例患者（47%）符合BCS的条件。210名患者（45%）最初接受乳房切除术，99名患者（47%）接受了BCS。三重否定的转化率最高，达到68%。在所有乳房切除术患者中，30%的患者显示乳房的pCR。87%的cN+患者实现了腋窝从ALND到腋窝保留手术的转换。结论荷兰NST发生的主要原因是亚型（三阴性、HER2+）和腋窝下分期。NST的其他原因更多地关注于低分期转化为BCS和改善美容效果。实时数据显示，NST导致从乳房切除术到BCS的转换率非常高，并且NST后ALND的遗漏率也很高。

{"title":"National Breast Cancer Surgery Snapshot Study: Breast Cancer Surgery after Neoadjuvant Systemic Therapy in Primary Breast Cancer (MANS Study)","authors":"Gaelle Kramer , José Volders , Femke den Haring , Roza Opperman , Pauline Spronk , Petrousjka van den Tol , Marie-Jeanne Vrancken Peeters","doi":"10.1016/j.clbc.2025.10.019","DOIUrl":"10.1016/j.clbc.2025.10.019","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of neoadjuvant systemic therapy (NST) in primary breast cancer has increased worldwide. This study provides real-time data of the reasons and variation in NST, conversion rate of mastectomy to BCS and conversion rate of ALND to radiation or omission of axillary treatment.</div></div><div><h3>Methods</h3><div>This is a Breast Cancer Surgery Snapshot study, multicenter prospective cross-sectional study in 70 breast cancer hospitals in the Netherlands. For 2 months the reason for NST is registered with patient- and tumor characteristics. The expectation of the surgical procedure in breast and axilla before and after NST is noted and the actual surgical outcome after NST is registered.</div></div><div><h3>Results</h3><div>Four hundred sixty seven patients receiving NST were registered. The 3 main reasons for NST were in 26% axillary down-staging, 25% a triple negative (TN) tumor and 25% HER2+. Before NST, 219 patients (47%) were eligible for BCS. In 210 patients (45%) initially assigned to receive a mastectomy, 99 patients (47%) underwent BCS. Triple negativity had the highest conversion rate with 68%. Of all mastectomy patients, 30% showed a pCR of the breast. Axillary conversion from ALND to axillary sparing surgery was achieved in 87% cN+ patients.</div></div><div><h3>Conclusion</h3><div>In the Netherlands the main reasons for NST were subtype (triple negative, HER2+) and axillary down staging. Additional reasons for NST focused more on down staging to convert to BCS and improve cosmetic outcomes. Real time data showed that NST lead to very high conversion rates from mastectomy to BCS as well as high rates of omission of ALND after NST.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 64-72"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748415","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

Prognostic Impact of Real-World Immunohistochemical Changes in Breast Cancer Treated with Neoadjuvant Chemotherapy 乳腺癌新辅助化疗后真实世界免疫组织化学变化对预后的影响。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2026-01-01 Epub Date: 2025-07-30 DOI: 10.1016/j.clbc.2025.07.023

Marcelo Antonini , André Mattar , Marcelo Madeira , Letícia Xavier Félix , Julio Antonio Pereira de Araújo , Francisco Pimentel Cavalcante , Felipe Zerwes , Fabricio Palermo Brenelli , Antonio Luis Frasson , Eduardo Camargo Millen , Marina Diógenes Teixeira , Larissa Chrispim de Oliveira , Marcellus do Nascimento Moreira Ramos , Gil Facina , Rogério Fenile , Henrique Lima Couto , Sabrina Monteiro Rondelo , Leonardo Ribeiro Soares , Ruffo de Freitas Junior , Renata Arakelian , Luiz Henrique Gebrim

Purpose

To evaluate the rate and types of immunohistochemical (IHC) changes after neoadjuvant chemotherapy (NAC) and their influence on disease-free survival (DFS) and overall survival (OS) in breast cancer patients, with a focus on conversions such as HR+/HER-2+ to HR-/HER-2- and their implications for treatment adjustments.

Methods

This retrospective cohort study included 369 female patients aged 18 years or older with nonmetastatic breast cancer treated with NAC between January 2011 and January 2023. Patients who did not achieve complete pathological response were evaluated for changes in IHC profiles, including hormone receptor (HR) status, HER-2 expression, and Ki-67 index. Prognostic outcomes were assessed using Kaplan-Meier survival analysis and multivariate Cox regression models.

Results

IHC changes were observed in 41.7% of patients. Among those initially classified as HR-/HER-2-, 50.9% gained HR expression, and 14.1% acquired HER-2 expression. In HR+/HER-2+ cases, 70.8% experienced a loss of HER-2 expression. Patients with HER-2+ tumors exhibited more frequent IHC changes compared to HER-2- cases (P < .0001). After a median follow-up of 47.7 months, local recurrences occurred in 10.3% of patients, distant metastases in 29.5%, and 25.5% had died. Patients with IHC changes demonstrated significantly worse DFS and OS (P = .002), with the poorest outcomes associated with conversion to HR-/HER-2- (P < .001).

Conclusion

Post-NAC IHC changes are common and associated with poor prognosis, especially in patients losing HR and HER-2 expression. Monitoring IHC shifts is critical for guiding personalized treatment and improving prognostic evaluation.

目的：评估乳腺癌患者新辅助化疗（NAC）后免疫组化（IHC）变化的比率和类型及其对无病生存期（DFS）和总生存期（OS）的影响，重点关注HR+/HER-2+向HR-/HER-2-的转化及其对治疗调整的影响。方法：这项回顾性队列研究纳入了2011年1月至2023年1月期间369名18岁及以上接受NAC治疗的非转移性乳腺癌女性患者。未达到完全病理反应的患者评估IHC谱的变化，包括激素受体（HR）状态、HER-2表达和Ki-67指数。使用Kaplan-Meier生存分析和多变量Cox回归模型评估预后结果。结果：41.7%的患者出现免疫组化改变。在最初分类为HR-/HER-2-的患者中，50.9%获得HR表达，14.1%获得HER-2表达。在HR+/HER-2+病例中，70.8%的患者出现HER-2表达缺失。HER-2阳性肿瘤患者比HER-2阳性肿瘤患者表现出更频繁的免疫组化变化（P < 0.0001）。中位随访47.7个月后，10.3%的患者发生局部复发，29.5%的患者发生远处转移，25.5%的患者死亡。IHC改变的患者表现出更差的DFS和OS (P = 0.002)，与HR-/HER-2-转化相关的最差结果（P < 0.001）。结论：nac后IHC改变很常见，且与预后不良有关，尤其是HR和HER-2表达缺失的患者。监测免疫健康变化对于指导个性化治疗和改善预后评估至关重要。

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引用次数: 0