Clinical breast cancer最新文献_第8页

Survival Outcomes and Recurrence Patterns of Early-Stage HER2-Positive Breast Cancer Patients on Adjuvant T-DM1 Treatment: Turkish Oncology Group (TOG) Study 早期her2阳性乳腺癌患者接受辅助T-DM1治疗的生存结局和复发模式：土耳其肿瘤组（TOG）研究

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-12-01 DOI: 10.1016/j.clbc.2025.11.014

Alper Türkel , İlknur Deliktaş Onur , Anıl Karakayalı , Merve Bıyıklı Alemdar , Emine Türkmen , Ali Alkan , Sedat Yıldız , Nargiz Majidova , Gamze Emin , Ali Fuat Gürbüz , Elif Şahin , Teoman Şakalar , Özge Yalıcı , Atike Pınar Erdoğan , Ramazan Coşar , Elanur Karaman , Melek Karakurt Eryılmaz , Mutlu Doğan

Purpose

This study aimed to investigate the survival outcomes of adjuvant trastuzumab emtansine (T-DM1) in patients with early-stage HER2-positive breast cancer and the recurrence patterns in those who experienced recurrence.

Methods

This multicenter, retrospective study included 121 patients with early-stage HER2-positive breast cancer who underwent surgery following neoadjuvant chemotherapy and anti-HER2 therapy and received adjuvant T-DM1 for residual disease. Recurrence within the first 12 months of adjuvant T-DM1 was defined as ``early recurrence,'' while recurrence after 12 months (> 12 months) was defined as ``late recurrence.''

Results

With a median follow-up of 36 months, recurrence occurred in 23 patients (median time: 11 months). Twenty-two had distant metastases—most commonly lung (n = 14) and CNS (n = 6)—and one had local recurrence. The recurrent subgroup had higher Ki67, tumor grade, and HR-negativity rate (P = .015, P = .034, and P = .014, respectively). Among recurrences, 12 were early (≤ 12 months) and 11 were late recurrence (> 12 months). Patients with early recurrence were significantly younger (P = .007) and had a numerically higher median Ki67 (40% vs. 30%, P = .062). DFS rates at 12, 24, and 36 months were 93.3%, 75.2%, and 62.8%, respectively; OS rates were 100%, 98.3%, and 93.1%.

Conclusions

Younger patients with HR-negative, high-grade, high Ki67 tumors had significantly higher rates of recurrence. Defining patient subpopulations through biomarker identification is crucial for tailoring escalation and de-escalation strategies, thereby enabling more effective treatments and improved long-term survival. The mechanisms of T-DM1 resistance require investigation through larger trials and molecular profiling.

目的本研究旨在探讨曲妥珠单抗emtansine （T-DM1）辅助治疗早期her2阳性乳腺癌患者的生存结局以及复发患者的复发模式。方法本多中心回顾性研究纳入121例早期her2阳性乳腺癌患者，这些患者在新辅助化疗和抗her2治疗后接受手术，并对残留病变接受辅助T-DM1治疗。T-DM1辅助治疗前12个月内的复发定义为“早期复发”，12个月后（>； 12个月）的复发定义为“晚期复发”。结果中位随访36个月，23例患者出现复发（中位时间11个月）。22例远处转移-最常见的是肺（n = 14）和中枢神经系统(n = 6) - 1例局部复发。复发亚组Ki67、肿瘤分级、hr阴性率均高于复发亚组（P = 0.015、P = 0.034、P = 0.014）。早期复发（≤12个月）12例，晚期复发（≤12个月）11例。早期复发的患者明显更年轻（P = 0.007），并且Ki67的中位数更高（40%比30%，P = 0.062）。12、24、36个月的DFS率分别为93.3%、75.2%、62.8%；总有效率分别为100%、98.3%和93.1%。结论hr阴性、高级别、高Ki67肿瘤的低龄患者复发率明显增高。通过生物标志物识别来定义患者亚群对于调整升级和降级策略至关重要，从而实现更有效的治疗并提高长期生存率。T-DM1耐药机制需要通过更大规模的试验和分子谱分析来研究。

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引用次数: 0

From Mobility to Management: A Scoping Review on Exercise in Breast Cancer-Related Lymphedema 从活动能力到管理：乳腺癌相关淋巴水肿运动的范围综述

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-28 DOI: 10.1016/j.clbc.2025.11.011

Cansu Sahbaz Pirincci , Hasan Gercek , Emine Cihan , Elif Dilara Durmaz , Zübeyir Sari

Purpose

Breast cancer-related lymphedema (BCRL) is a prevalent complication that adversely affects survivors’ physical function and quality of life. Exercise is increasingly used in BCRL management, yet the diversity in exercise types and lack of standardization present challenges for clinical implementation. This scoping review aimed to systematically map and synthesize the available literature on exercise interventions for BCRL, focusing on the types of exercises used, their frequency and duration, and their effects on clinical and functional outcomes.

Methods

Studies were included if they were randomized or non-randomized controlled trials involving adult women with BCRL, evaluated at least one lymphedema-related outcome, and were published in English within the last 10 years. A comprehensive search was conducted in PubMed, Scopus, Web of Science, PEDro, and CINAHL databases using MeSH terms. Data were extracted on study design, sample size, exercise type, frequency and duration, and outcome measures.

Results

Out of 974 records, 21 studies met the inclusion criteria. Exercises examined included resistance, aerobic, aquatic, Pilates, and scapulothoracic stabilization. Most interventions were 6 to 12 weeks in duration and applied 2 to 5 times per week. Exercise was found to be effective in reducing edema volume and severity, improving range of motion, pain, function, and quality of life, both independently and alongside CDT.

Conclusion

Exercise is a safe and effective intervention for BCRL management. However, variability in exercise protocols highlights the need for standardized recommendations. Future studies should aim to determine optimal parameters to guide clinical decision-making.

目的乳腺癌相关淋巴水肿（BCRL）是一种普遍的并发症，对幸存者的身体功能和生活质量产生不利影响。运动在BCRL管理中的应用越来越多，但运动类型的多样性和缺乏标准化给临床实施带来挑战。本综述旨在系统地绘制和综合有关运动干预BCRL的现有文献，重点关注所使用的运动类型、频率和持续时间，以及它们对临床和功能结果的影响。方法纳入随机或非随机对照试验，涉及成年女性BCRL患者，评估至少一项淋巴水肿相关结局，并在过去10年内以英文发表。在PubMed、Scopus、Web of Science、PEDro和CINAHL数据库中使用MeSH词进行了全面的检索。从研究设计、样本量、运动类型、频率和持续时间以及结果测量中提取数据。结果974篇文献中有21篇符合纳入标准。检查的运动包括阻力、有氧、水上运动、普拉提和肩胸稳定。大多数干预持续时间为6至12周，每周应用2至5次。研究发现，运动在减少水肿体积和严重程度、改善活动范围、疼痛、功能和生活质量方面都是有效的，无论是独立的还是与CDT一起。结论运动是治疗BCRL安全有效的干预手段。然而，运动方案的可变性突出了标准化建议的必要性。未来的研究应旨在确定最佳参数来指导临床决策。

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引用次数: 0

Rethinking First-Line Therapy and Beyond: HER2-Positive and Hormone Receptor–Positive/HER2-Negative Metastatic Breast Cancer—Commentary Based on a Live Symposium Presented at the 2025 ESMO Congress in Berlin, Germany 重新思考一线治疗及以后：her2阳性和激素受体阳性/ her2阴性转移性乳腺癌——基于2025年德国柏林ESMO大会现场研讨会的评论

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-27 DOI: 10.1016/j.clbc.2025.11.009

Wolfgang Janni , Rebecca A. Dent , Peter Schmid

Recent advances in metastatic breast cancer have fundamentally altered treatment paradigms, offering new hope for patients while challenging clinicians to adapt their approaches to patient care. This article summarizes expert perspectives from a symposium presented at the 2025 European Society for Medical Oncology Congress, examining how emerging data in HER2-positive metastatic breast cancer and hormone receptor–positive metastatic breast cancer are reshaping clinical decision-making, patient selection strategies, and personalized approaches. Key developments include the evolution of antibody-drug conjugates in HER2-positive disease, biomarker-guided therapy selection using ESR1 mutation monitoring, and novel treatment strategies for patients with hormone-refractory disease. These advances necessitate understanding of patient selection criteria, toxicity management, and sequential therapy planning to optimize outcomes in this expanding therapeutic landscape.

转移性乳腺癌的最新进展从根本上改变了治疗模式，为患者提供了新的希望，同时也挑战了临床医生适应患者护理的方法。本文总结了专家在2025年欧洲肿瘤医学学会大会上发表的研讨会上的观点，研究了her2阳性转移性乳腺癌和激素受体阳性转移性乳腺癌的新数据如何重塑临床决策、患者选择策略和个性化方法。主要进展包括her2阳性疾病中抗体-药物偶联物的发展，使用ESR1突变监测的生物标志物引导治疗选择，以及激素难治性疾病患者的新治疗策略。这些进步需要了解患者选择标准、毒性管理和序贯治疗计划，以优化这一不断扩大的治疗领域的结果。

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引用次数: 0

How Can Online Resource Assessment Better Meet Patient Needs? 在线资源评估如何更好地满足患者需求？

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-26 DOI: 10.1016/j.clbc.2025.11.010

Yuning Tang , Ruotong Zhu

引用次数: 0

The Influence of Socioeconomic Status on Stage at Diagnosis and Survival in Young Breast Cancer Patients 社会经济地位对年轻乳腺癌患者诊断分期及生存的影响。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-24 DOI: 10.1016/j.clbc.2025.11.008

Alexandra Harris , Ryan Conrardy , Aniko Szabo , Lubna N. Chaudhary

Background

Breast cancer is the most common cancer in women. Women of low socioeconomic status (SES) are at increased risk for being diagnosed with later stage breast cancer and experience poorer survival. However, younger women, especially women under 40, are underrepresented in breast cancer research given screening mammography is not recommended until age 40. How SES impacts stage at diagnosis and survival rates in women under 40 diagnosed with breast cancer has not been addressed.

Methods

Data was obtained from the national Surveillance, Epidemiology, and End Results (SEER)*Stat Research Plus Census Tract Attributes Specialty Database, including 27 unique variables representing patient, tumor, and treatment characteristics. Proportional odds logistic regression models were used to assess the relationship between SES and stage at diagnosis and Kaplan–Meier curves along with Cox-proportional hazards models were used to assess the relationship between SES and survival months.

Results

In both women of all ages and in women under 40, lower SES was significantly associated with later stage at breast cancer diagnosis (P < .001), poorer five-year (P < .001), and ten-year (P < .001) overall and breast-cancer specific survival rates in an incremental fashion.

Conclusion

SES significantly impacts breast cancer stage at diagnosis and survival rates in a graded fashion, with lowering SES corresponding with later stage at breast cancer diagnosis and poorer five-year and ten-year survival rates across all age groups, including women under 40. Improving screening rates in low SES populations and initiating high risk screening strategies at an earlier age in women with low SES may help ameliorate these disparities.

背景：乳腺癌是女性中最常见的癌症。社会经济地位较低的妇女被诊断为晚期乳腺癌的风险增加，生存期也较差。然而，年轻女性，尤其是40岁以下的女性，在乳腺癌研究中的代表性不足，因为乳房x光检查在40岁之前是不推荐的。SES如何影响40岁以下诊断为乳腺癌的女性的诊断阶段和生存率尚未得到解决。方法：数据来自国家监测、流行病学和最终结果(SEER)*Stat Research +普查区属性专业数据库，包括27个代表患者、肿瘤和治疗特征的唯一变量。采用比例odds logistic回归模型评估SES与诊断阶段之间的关系，采用Kaplan-Meier曲线和cox比例风险模型评估SES与生存月之间的关系。结果：在所有年龄段的女性和40岁以下的女性中，较低的社会经济地位与乳腺癌诊断晚期（P < 0.001）、较差的5年（P < 0.001）和10年（P < 0.001）总体生存率和乳腺癌特异性生存率呈递增趋势显著相关。结论：社会经济地位对乳腺癌诊断分期和生存率有显著影响，社会经济地位越低，乳腺癌诊断阶段越晚，5年和10年生存率越低，包括40岁以下妇女。提高低社会经济地位人群的筛查率，并在低社会经济地位妇女早期启动高风险筛查策略，可能有助于改善这些差异。

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引用次数: 0

Operating Point Optimization for Efficient Mammogram Triage Using Only Highly Elevated Probability scores 仅使用高概率评分进行有效乳房x线检查分诊的操作点优化

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-21 DOI: 10.1016/j.clbc.2025.11.007

Mark Traill , Jensen Jantz , Blair Richards , Shokoufeh Khalatbari , Jeffrey Hoffmeister , Julie Shisler , Crystal Snyder

Backgroud

Using AI breast cancer detection scores to triage screening mammogram patients has been described in several studies. This type of triage could expedite a cancer diagnosis and significantly shorten the time from screening mammogram to treatment. However, the optimal operating point, or score value, above which patients should be triaged, has not been well defined. Identifying practical operating points is important because the Positive Predictive Value (PPV), sensitivity, specificity, and false-negative (FN) rate at different operating points can vary greatly.

Materials and Methond

Using patient datasets constructed from a clinical practice, the performance metrics of various AI scoring models were calculated at different operating point levels.

Results

Mathematical analysis of the very highest cancer detection case scores revealed that they are highly specific for the presence of breast cancer with few false positives. Therefore, if only the few highest case scores are used for clinical triage, the expectation is that most patients triaged will have cancer.

Conclusion

In clinical practice, this approach could be used to identify patients who would benefit from immediate diagnostic workup without overwhelming the clinic logistics with false-positive cases.

一些研究已经描述了使用人工智能乳腺癌检测评分来筛选乳房x光检查患者。这种类型的分诊可以加快癌症的诊断，并显著缩短从乳房x光检查到治疗的时间。然而，最佳手术点，或分值，在此之上的患者应该进行分类，并没有很好的定义。确定实际操作点很重要，因为不同操作点的阳性预测值（PPV）、灵敏度、特异性和假阴性（FN）率可能会有很大差异。材料和方法利用从临床实践中构建的患者数据集，在不同的操作点水平上计算各种AI评分模型的性能指标。结果对最高的癌症检测病例分数的数学分析表明，它们对乳腺癌的存在具有高度特异性，几乎没有假阳性。因此，如果只有少数得分最高的病例被用于临床分诊，预计大多数分诊的患者将患有癌症。结论在临床实践中，该方法可用于识别从即时诊断检查中获益的患者，而不会因假阳性病例而使临床后勤不堪重负。

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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 : 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。

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引用次数: 0

Do Not Rush to Omit Sentinel Lymph Node Biopsy for Early Breast Cancer Patients 早期乳腺癌患者不要急于忽略前哨淋巴结活检。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-14 DOI: 10.1016/j.clbc.2025.11.006

Níamh M. Smyth , Alexandra M. Zaborowski , Bukola V. Bolarinwa , Sandra Hembrecht , Rose Joyce Culhane , Abhi Narsiman , Clodagh T. Canavan , Jan Sørensen , Eithne Downey , Michael Allen , Abeeda Butt , Colm Power , Orla McArdle , Patrick G. Morris , Nuala Healy , Laura McKenna , Arnold D.K. Hill

Introduction

Recent data suggest that sentinel lymph node biopsy (SLNB) can be omitted in select patients with early breast cancer. The aim of this study was to determine the utility of SLNB for patients with early breast cancer.

Methods

A retrospective analysis of patients diagnosed with breast cancer in a Level IV hospital in Dublin, Ireland, between December 2013 and March 2024 was conducted. Inclusion criteria included: female patients ≥ 18 years, with cT1 disease and a negative preoperative axillary ultrasound, who underwent breast conserving surgery and a SLNB.

Results

In total, 334 patients were included. The median age was 59 years (26-91 years). The majority had invasive ductal carcinoma (261 patients, 78.1%) and were hormone receptor-postive and human epidermal growth factor receptor 2-negative (274 patients, 82%). Final N stage was N0 in 282 (84%) of patients. Fifty-two patients (16%) had a positive-SLNB, despite a negative preoperative axilla. Twenty-four patients underwent an axillary clearance, of which 7 (14%) were positive, with only 3 patients (12.5%) upstaged following axillary clearance. Eighty-four patients (25%) received chemotherapy due to positive-SLNB. In line with contemporary data, 9 patients (2.7%) were eligible for CDK4/6 inhibitors, 48 patients (14%) for escalation to nodal radiation, or 275 patients (82%) for de-escalation to partial breast radiation.

Conclusion

While SLNB may be safely omitted in specific contexts, its omission carries the risk of under- and over-treatment. Our findings demonstrate that SLNB continues to guide adjuvant therapy for breast cancer patients, and thus, support the ongoing use of SLNB.

简介：最近的数据表明，前哨淋巴结活检（SLNB）可以在选择早期乳腺癌患者中省略。本研究的目的是确定SLNB对早期乳腺癌患者的效用。方法：回顾性分析2013年12月至2024年3月在爱尔兰都柏林一家四级医院诊断为乳腺癌的患者。纳入标准：女性患者≥18岁，cT1病变，术前腋窝超声阴性，行保乳手术和SLNB。结果：共纳入334例患者。中位年龄为59岁（26-91岁）。大多数为浸润性导管癌（261例，78.1%），激素受体阳性，人表皮生长因子受体2阴性（274例，82%）。282例（84%）患者最终N期为0。52例（16%）患者的slnb阳性，尽管术前腋窝阴性。24例患者接受了腋窝清除率，其中7例（14%）阳性，只有3例（12.5%）患者在腋窝清除率后被抢镜。84例（25%）患者因slnb阳性接受化疗。与当代数据一致，9名患者（2.7%）符合CDK4/6抑制剂，48名患者（14%）符合升级到淋巴结放疗，275名患者（82%）符合降级到部分乳房放疗。结论：虽然在特定情况下可以安全地省略SLNB，但省略会带来治疗不足和过度治疗的风险。我们的研究结果表明，SLNB继续指导乳腺癌患者的辅助治疗，因此，支持SLNB的持续使用。

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引用次数: 0

Beyond BMI: Metabolic and Inflammatory Determinants of Recurrence After Neoadjuvant Therapy in Breast Cancer 超越BMI：乳腺癌新辅助治疗后复发的代谢和炎症决定因素。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-10 DOI: 10.1016/j.clbc.2025.11.004

Asim Armagan Aydin , Erkan Kayikcioglu

引用次数: 0

Response to “Cryotherapy in Taxane-Induced Peripheral Neuropathy: The Need for Objective Validation” 对“紫杉烷诱导的周围神经病变的冷冻治疗：需要客观验证”的反应。

IF 2.5 3区医学 Q2 ONCOLOGY

Clinical breast cancer

Pub Date : 2025-11-10 DOI: 10.1016/j.clbc.2025.11.005

Helya Kargar , Seyed Alireza Javadinia

引用次数: 0