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Histopathological Downgrading of Borderline Phyllodes Tumor in a Young Patient Following Chemotherapy: A Case Report. 化疗后一名年轻患者的边缘型鳞状上皮肿瘤组织病理学降级:病例报告
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.4048/jbc.2024.0159
Yuki Hara, Rin Yamaguchi, Ryota Otsubo, Ayako Fukushima, Eiko Inamasu, Momoko Akashi, Michi Morita, Sayaka Kuba, Susumu Eguchi, Keitaro Matsumoto

Phyllodes tumors (PT) are fibroepithelial neoplasms that are treated by complete surgical excision. The effectiveness of adjuvant therapies, including radiotherapy and chemotherapy, for PT remains unclear, and the use of neoadjuvant chemotherapy (NAC) is yet to be established. We report a case of a 15-year-old girl with acute lymphatic leukemia (ALL) who was incidentally diagnosed with a 50-mm borderline PT in the left breast using computed tomography, ultrasonography, and histological examination following needle biopsy. Lumpectomy was performed after administration of anthracycline-based chemotherapy for ALL, resulting in tumor size reduction. Histopathological examination of the excised specimen demonstrated decreased mitotic activity and stromal cellularity post-chemotherapy. To our knowledge, this is the first study to report the histopathological differences in pre- and post-chemotherapy borderline PT samples. Our findings suggest that NAC may induce changes in borderline PT, potentially affecting diagnosis and treatment decisions. Hence, further investigation is warranted in this regard.

鳞状上皮细胞瘤(PT)是一种纤维上皮肿瘤,治疗方法是通过手术完全切除。包括放疗和化疗在内的辅助疗法对PT的疗效尚不明确,新辅助化疗(NAC)的应用也尚未确立。我们报告了一例患有急性淋巴白血病(ALL)的15岁女孩的病例,她通过计算机断层扫描、超声波检查和针刺活检后的组织学检查,偶然被诊断出左侧乳房有一个50毫米的边界PT。该患者在接受蒽环类化疗治疗后进行了乳腺切除术,术后肿瘤缩小。切除标本的组织病理学检查显示,化疗后有丝分裂活性和基质细胞减少。据我们所知,这是第一项报告化疗前和化疗后边缘PT样本组织病理学差异的研究。我们的研究结果表明,NAC可能会诱导边缘型PT发生变化,从而可能影响诊断和治疗决策。因此,有必要在这方面开展进一步研究。
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引用次数: 0
Variability in Breast Density Estimation and Its Impact on Breast Cancer Risk Assessment. 乳房密度估算的变异性及其对乳腺癌风险评估的影响。
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-12 DOI: 10.4048/jbc.2024.0101
Hye Ji, Myoung-Jin Jang, Jung Min Chang

Breast density is an independent risk factor for breast cancer, although variability exists in measurements. This study sought to evaluate the agreement between radiologists and automated breast density assessment software and assess the impact of breast density measures on breast cancer risk estimates using the Breast Cancer Surveillance Consortium (BCSC) model (v.2). A retrospective database search identified women who had undergone mammography between December 2021 and June 2022. The Breast Imaging Reporting and Data System (BI-RADS) breast composition index assigned by a radiologist (R) was recorded and analyzed using three commercially available software programs (S1, S2, and S3). The agreement rate and Cohen's kappa (κ) were used to evaluate inter-rater agreements concerning breast density measures. The 5-year risk of invasive breast cancer in women was calculated using the BCSC model (v.2) with breast density inputs from various density estimation methods. Absolute differences in risk between various density measurements were evaluated. Overall, 1,949 women (mean age, 53.2 years) were included. The inter-rater agreement between R, S1, and S2 was 75.0-75.6%, while that between S3 and the others was 60.2%-63.3%. Kappa was substantial between R, S1, and S2 (0.66-0.68), and moderate (0.49-0.50) between S3 and the others. S3 placed fewer women in mammographic density d (14.9%) than R, S1, and S2 (40.5%-44.0%). In BCSC risk assessment (v.2), S3 assessed fewer women with a high 5-year risk of invasive breast cancer than the other methods, resulting in an absolute difference of 0% between R, S1, and S2 in 75.0%-75.6% of cases, whereas the difference between S3 and the other methods occurs in 60.2%-63.3% of cases. Breast density assessment using various methods showed moderate-to-substantial agreement, potentially affecting risk assessments. Precise and consistent breast density measurements may lead to personalized and effective strategies for breast cancer prevention.

乳腺密度是乳腺癌的一个独立风险因素,但测量结果存在差异。本研究旨在评估放射医师与自动乳腺密度评估软件之间的一致性,并使用乳腺癌监测联盟(BCSC)模型(v.2)评估乳腺密度测量对乳腺癌风险估计的影响。通过回顾性数据库搜索,确定了在2021年12月至2022年6月期间接受过乳腺X光检查的女性。放射科医生(R)分配的乳腺成像报告和数据系统(BI-RADS)乳腺成分指数被记录下来,并使用三种市售软件程序(S1、S2和S3)进行分析。采用一致率和科恩卡帕(κ)来评估评分者之间在乳腺密度测量方面的一致性。使用 BCSC 模型(v.2)计算妇女患浸润性乳腺癌的 5 年风险,并输入各种密度估算方法得出的乳腺密度。评估了不同密度测量方法之间风险的绝对差异。共纳入了 1,949 名女性(平均年龄 53.2 岁)。R、S1和S2之间的评分者间一致性为75.0%-75.6%,而S3和其他评分者之间的一致性为60.2%-63.3%。R、S1和S2之间的Kappa相当高(0.66-0.68),而S3和其他人之间的Kappa则适中(0.49-0.50)。与 R、S1 和 S2(40.5%-44.0%)相比,S3 将更少的妇女列入乳腺密度 d(14.9%)。在 BCSC 风险评估(v.2)中,S3 评估的 5 年浸润性乳腺癌高风险女性少于其他方法,在 75.0%-75.6% 的病例中,R、S1 和 S2 的绝对差异为 0%,而在 60.2%-63.3% 的病例中,S3 与其他方法的差异出现。使用不同方法进行的乳腺密度评估显示出中等至相当程度的一致性,这可能会影响风险评估。精确而一致的乳腺密度测量可为乳腺癌的预防提供个性化的有效策略。
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引用次数: 0
p27 Cell Cycle Inhibitor and Survival in Luminal-Type Breast Cancer: Gene Ontology, Machine Learning, and Drug Screening Analysis. p27细胞周期抑制剂与分叶型乳腺癌的存活率:基因本体、机器学习和药物筛选分析。
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-04 DOI: 10.4048/jbc.2024.0107
In Ah Park, Yung-Kyun Noh, Kyueng-Whan Min, Dong-Hoon Kim, Jeong-Yeon Lee, Byoung Kwan Son, Mi Jung Kwon, Myung-Hoon Han, Joon Young Hur, Jung Soo Pyo

Purpose: A widely distributed cell cycle inhibitor, p27, regulates cyclin-dependent kinase-cyclin complexes. Although the prognostic value of p27 has been established for various types of carcinomas, its role in luminal breast cancer remains poorly understood. This study aimed to explore the functional enrichment of p27 and identify potential drug targets in patients with luminal-type breast cancer.

Methods: Clinicopathological data were collected from 868 patients with luminal-type breast cancer. Additionally, publicly available data from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) dataset (1,500 patients) and the Gene Expression Omnibus database (855 patients) were included in the analysis. Immunohistochemical staining for p27, differential gene expression analysis, disease ontology analysis, survival prediction modeling using machine learning (ML), and in vitro drug screening were also performed.

Results: Low p27 expression correlated with younger age, advanced tumor stage, estrogen receptor/progesterone receptor negativity, decreased cluster of differentiation 8+ T cell count, and poorer survival outcomes in luminal-type breast cancer. The METABRIC data revealed that reduced cyclin-dependent kinase inhibitor 1B (CDKN1B) expression (encoding p27) was associated with cell proliferation-related pathways and epigenetic polycomb repressive complex 2. Using ML, p27 emerged as the second most significant survival factor after N stage, thereby enhancing survival model performance. Additionally, luminal-type breast cancer cell lines with low CDKN1B expression demonstrated increased sensitivity to specific anticancer drugs such as voxtalisib and serdemetan, implying a potential therapeutic synergy between CDKN1B-targeted approaches and these drugs.

Conclusion: The integration of ML and bioinformatic analyses of p27 has the potential to enhance risk stratification and facilitate personalized treatment strategies for patients with breast cancer.

目的:p27 是一种广泛分布的细胞周期抑制剂,可调节依赖细胞周期蛋白的激酶-细胞周期蛋白复合物。虽然 p27 对各种类型的癌症都有预后价值,但它在腔隙型乳腺癌中的作用仍鲜为人知。本研究旨在探索p27的功能富集,并确定管腔型乳腺癌患者的潜在药物靶点:方法:收集了868例腔隙型乳腺癌患者的临床病理数据。此外,来自国际乳腺癌分子分类联盟(METABRIC)数据集(1,500 名患者)和基因表达总库数据库(855 名患者)的公开数据也纳入了分析。此外,还进行了p27免疫组化染色、差异基因表达分析、疾病本体分析、使用机器学习(ML)的生存预测建模以及体外药物筛选:p27的低表达与管腔型乳腺癌患者的年龄较小、肿瘤分期较晚、雌激素受体/孕激素受体阴性、分化簇8+ T细胞数量减少以及较差的生存结果相关。METABRIC 数据显示,细胞周期蛋白依赖性激酶抑制剂 1B(CDKN1B)(编码 p27)表达的减少与细胞增殖相关途径和表观遗传多聚抑制复合体 2 有关。利用 ML,p27 成为仅次于 N 分期的第二大重要生存因素,从而提高了生存模型的性能。此外,CDKN1B表达量低的管腔型乳腺癌细胞系对特定抗癌药物(如voxtalisib和serdemetan)的敏感性增加,这意味着CDKN1B靶向方法与这些药物之间存在潜在的治疗协同作用:p27的ML和生物信息学分析的整合有望加强乳腺癌患者的风险分层并促进个性化治疗策略。
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引用次数: 0
Risk of Lymphedema After Sentinel Node Biopsy in Patients With Breast Cancer. 乳腺癌患者前哨节点活检后出现淋巴水肿的风险。
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 DOI: 10.4048/jbc.2024.0180
Jinyoung Byeon, Eunhye Kang, Ji-Jung Jung, Jong-Ho Cheun, Kwan Sik Seo, Hong-Kyu Kim, Han-Byoel Lee, Wonshik Han, Hyeong-Gon Moon

Purpose: Although numerous studies have identified potential risk factors for ipsilateral lymphedema development in patients with breast cancer following axillary node dissection, the risk factors for lymphedema in patients undergoing sentinel node biopsy without axillary dissection remain unclear. In this study, we aimed to determine the real-world incidence and risk factors for lymphedema in such patients.

Methods: We conducted a single-center, retrospective review of medical records of patients with breast cancer who underwent sentinel node biopsy alone. The development cohort (5,051 patients, January 2017-December 2020) was analyzed to identify predictors of lymphedema, and a predictive model was subsequently created. A validation cohort (1,627 patients, January 2014-December 2016) was used to validate the model.

Results: In the development cohort, 49 patients (0.9%) developed lymphedema over a median follow-up of 56 months, with most cases occurring within the first three years post-operation. Multivariate analysis revealed that a body mass index (BMI) of 30 kg/m² or above, radiation therapy (RTx), chemotherapy, and more than three harvested lymph nodes significantly predicted lymphedema. The predictive model showed an area under the curve of 0.824 for systemic chemotherapy, with the number of harvested lymph nodes being the most significant factor. Patients were stratified into four risk groups, showing lymphedema incidences of 3.3% in the highest-risk group and 0.1% in the lowest-risk group. In the validation cohort, the incidences were 1.7% and 0.2% for the highest and lowest risk groups, respectively.

Conclusion: The lymphedema prediction model identifies RTx, chemotherapy, BMI ≥ 30 kg/m², and more than three harvested lymph nodes as significant risk factors. Although the overall incidence is low, the risk is notably influenced by the extent of lymph node removal and systemic therapies. The model's high negative predictive value supports its application in designing tailored lymphedema surveillance programs for early intervention.

目的:尽管许多研究已经确定了乳腺癌患者在腋窝结节切除术后发生同侧淋巴水肿的潜在风险因素,但未进行腋窝结节切除术而接受前哨结节活检的患者发生淋巴水肿的风险因素仍不清楚。本研究旨在确定此类患者淋巴水肿的实际发生率和风险因素:我们对单独接受前哨节点活检的乳腺癌患者的病历进行了单中心回顾性分析。我们对发展队列(5,051 名患者,2017 年 1 月至 2020 年 12 月)进行了分析,以确定淋巴水肿的预测因素,随后建立了一个预测模型。验证队列(1627 名患者,2014 年 1 月至 2016 年 12 月)用于验证模型:在开发队列中,49名患者(0.9%)在中位56个月的随访期间出现了淋巴水肿,大多数病例发生在术后的前三年。多变量分析显示,体重指数(BMI)达到或超过30 kg/m²、接受过放疗(RTx)、化疗以及摘取的淋巴结超过3个可显著预测淋巴水肿的发生。预测模型显示,全身化疗的曲线下面积为 0.824,摘取淋巴结的数量是最重要的因素。患者被分为四个风险组,最高风险组淋巴水肿发生率为3.3%,最低风险组为0.1%。在验证队列中,最高风险组和最低风险组的发病率分别为1.7%和0.2%:淋巴水肿预测模型将RTx、化疗、体重指数≥30 kg/m²、摘取淋巴结超过3个确定为重要的风险因素。虽然总体发生率较低,但淋巴结切除范围和全身治疗对风险影响显著。该模型具有很高的阴性预测值,可用于设计有针对性的淋巴水肿监测计划,以进行早期干预。
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引用次数: 0
Targeted Inhibition of p21 Promotes the Growth of Breast Cancer Cells and Impairs the Tumor-Killing Effect of the Vaccinia Virus. 靶向抑制 p21 会促进乳腺癌细胞的生长并削弱疫苗病毒的杀瘤效果
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-09-02 DOI: 10.4048/jbc.2024.0063
Xiaoyuan Jia, Yujia Zhao, Qiang Li, Xiaming Lu, Xiaoyan Wang, Hui Wang, Ziyi Shi, Yipeng Xu, Biao Huang, Fang Huang, Yigang Wang

Purpose: Vaccinia virus is widely used as an oncolytic agent for human cancer therapy, and several versions of vaccinia virus have demonstrated robust antitumor effects in breast cancer. Most vaccinia viruses are modified by thymidine kinase (TK) deletion. The function of the cyclin-dependent kinase inhibitor p21 in breast cancer remains controversial. We explored the impact of p21 gene knockdown (KD) on breast cancer cells and whether p21 KD interferes with the antitumor effect of TK-negative vaccinia virus.

Methods: p21 KD MDA-MB-231 and p21 KD MCF-7 cells were prepared, and cell proliferation and migration rates were evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and scratch healing assays. The tumor growth of xenografts originating from p21KD MDA-MB-231 cells and control cells was compared in a mouse model. The colony formation and sphere-forming abilities of p21 KD breast cancer cells were also determined using low-melting agarose and serum-free culture. The tumor-killing effect of the vaccinia virus was determined in breast cancer cells and mouse models using an MTT assay and tumor cell xenografts.

Results: p21 KD increased the growth and migration of MDA-MB-231 and MCF-7 cells and promoted the cell growth of MDA-MB-231 cells in mice, while decreasing the colony formation and sphere formation abilities. Expression of TK was reduced in p21 KD MDA-MB-231 cells. Oncolytic effects of both wild-type and TK-deleted vaccinia viruses were attenuated in p21KD MDA-MB-231 cells. The tumor-killing effect of TK-deleted vaccinia virus was also weakened in xenografted mice bearing p21 KD MDA-MB-231 cells.

Conclusion: Targeted inhibition of p21 accelerates the proliferation and migration of breast cancer cells and impairs the tumor-killing effect of vaccinia virus, suggesting that p21 levels in cancer cells interfere with vaccinia virus oncolytic therapy.

目的:疫苗病毒被广泛用作人类癌症治疗的溶瘤剂,几种版本的疫苗病毒已在乳腺癌中显示出强大的抗肿瘤效果。大多数疫苗病毒都经过胸苷激酶(TK)缺失修饰。细胞周期蛋白依赖性激酶抑制剂 p21 在乳腺癌中的功能仍存在争议。方法:制备 p21 KD MDA-MB-231 和 p21 KD MCF-7 细胞,使用 3-(4,5-二甲基噻唑-2-基)-2,5-二苯基溴化四唑(MTT)和划痕愈合试验评估细胞增殖和迁移率。在小鼠模型中,比较了 p21KD MDA-MB-231 细胞和对照细胞异种移植的肿瘤生长情况。此外,还使用低熔琼脂糖和无血清培养法测定了 p21KD 乳腺癌细胞的集落形成和球形成能力。结果:p21 KD 增加了 MDA-MB-231 和 MCF-7 细胞的生长和迁移,促进了 MDA-MB-231 细胞在小鼠体内的生长,同时降低了集落形成和球形成能力。p21 KD MDA-MB-231 细胞中 TK 的表达减少。野生型和缺失 TK 的疫苗病毒在 p21KD MDA-MB-231 细胞中的溶瘤作用均减弱。TK缺失的疫苗病毒对携带p21 KD MDA-MB-231细胞的异种移植小鼠的肿瘤杀伤作用也有所减弱:结论:靶向抑制 p21 会加速乳腺癌细胞的增殖和迁移,并削弱疫苗病毒的杀瘤效果,这表明癌细胞中的 p21 水平会干扰疫苗病毒溶瘤疗法。
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引用次数: 0
Safety of Atypical Ductal Hyperplasia at the Nipple Margin in Nipple-Sparing Mastectomy. 乳头切除术中乳头边缘非典型导管增生的安全性
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-16 DOI: 10.4048/jbc.2024.0077
Meizhen Zhu, Jiefei Mao, Jun Fang, Daobao Chen

Purpose: Controversies persist regarding contraindications for nipple-sparing mastectomy (NSM). This study aimed to assess the accuracy of subareolar frozen section analysis and identify risk factors for nipple-areola complex (NAC) recurrence post NSM.

Methods: Consecutive cases of primary invasive breast cancer undergoing NSM at our single center from January 2015 to December 2020 were retrospectively reviewed.

Results: The nipples were retained in 126 patients (127 breasts), and the areola was retained with nipple excision for five breasts. Frozen section analysis demonstrated a sensitivity of 81.8% and specificity of 95.3%. The NAC recurrence rate was 4.3% over a median follow-up period of 48 (30-105) months. An atypical ductal hyperplasia (ADH) at the margin emerged as an independent factor for NAC recurrence in multivariate Cox regression analysis (hazard ratio, 25.464; 95% confidence interval, 1.841-352.145; p = 0.016). Kaplan-Meier survival analysis revealed no statistically significant reduction in overall survival rates (log-rank test, p = 0.660).

Conclusion: Frozen sections of subareolar tissue are reliable and re-excision may be necessary when ADH is detected at the nipple margin in NSM. The NAC recurrence rate was low, and the outcome was favorable following wide local excision.

目的:关于乳头保留乳房切除术(NSM)的禁忌症一直存在争议。本研究旨在评估乳晕下冰冻切片分析的准确性,并确定乳头乳晕复合体(NAC)在NSM术后复发的风险因素:方法:回顾性分析2015年1月至2020年12月在本中心接受NSM手术的原发性浸润性乳腺癌连续病例:结果:126 例患者(127 个乳房)保留了乳头,5 个乳房切除乳头后保留了乳晕。冷冻切片分析显示敏感性为 81.8%,特异性为 95.3%。中位随访期为 48 (30-105) 个月,NAC 复发率为 4.3%。在多变量考克斯回归分析中,边缘处的非典型导管增生(ADH)是导致 NAC 复发的独立因素(危险比为 25.464;95% 置信区间为 1.841-352.145;P = 0.016)。卡普兰-梅耶尔生存分析显示,总生存率在统计学上没有显著下降(对数秩检验,p = 0.660):结论:乳晕下组织的冷冻切片是可靠的,如果在 NSM 乳头边缘发现 ADH,可能需要再次切除。新乳头状瘤复发率较低,局部广泛切除后疗效良好。
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引用次数: 0
The Risk of Deep Vein Thrombosis and Optimal Timing of Breast Cancer Surgery After COVID-19 Infection. 感染 COVID-19 后深静脉血栓形成的风险和乳腺癌手术的最佳时间。
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.4048/jbc.2024.0122
Zhao Bi, Wei-Hao Cheng, Wei-Li Wang, Yong-Sheng Wang

Purpose: The aim of this study was to assess the risk of postoperative deep vein thrombosis (DVT) in breast cancer patients with coronavirus disease 2019 (COVID-19) to determine the optimal timing for surgery in the era of "post COVID-19 pandemic."

Methods: This prospective study included breast cancer patients who contracted COVID-19 and underwent surgery from December 20th, 2022, to March 20th, 2023 (n = 577). A control group comprised patients who underwent surgery from May 1st, 2019, to October 1st, 2019 (n = 327) and had not contracted COVID-19 prior to surgery. Patients were categorized based on the timing of their surgery relative to their COVID-19 infection. Data were analyzed using logistic regression.

Results: Patients with COVID-19 had a higher incidence of postoperative DVT compared to those without COVID-19 (3.64% vs. 1.21%). Multivariable logistic regression analysis indicated that the timing of surgery was significantly associated with the risk of DVT (odds ratio [OR], 2.795; 95% confidence interval [CI], 0.692-11.278; p = 0.024). Patients who underwent surgery within two weeks of COVID-19 infection experienced the highest DVT rates (OR, 10.556; 95% CI, 1.095-303.313; p = 0.003). However, the incidence decreased to 2.85% when surgery was delayed until two weeks or more after infection. The median follow-up period was 10 months, all patients with DVT after surgery were recovered without serious complications or death. There were no adverse effects on subsequent anti-tumor therapy.

Conclusion: Caution is advised when performing breast cancer surgery within two weeks after a COVID-19 infection. Although the risk of DVT remains somewhat elevated even after two weeks, surgery can be considered safe given the urgency of treatment, favorable complication outcomes, and lack of impact on subsequent adjuvant therapy.

目的:本研究旨在评估2019年冠状病毒病(COVID-19)乳腺癌患者术后深静脉血栓形成(DVT)的风险,以确定 "后COVID-19大流行 "时代的最佳手术时机:这项前瞻性研究纳入了2022年12月20日至2023年3月20日期间感染COVID-19并接受手术的乳腺癌患者(n = 577)。对照组包括在2019年5月1日至2019年10月1日期间接受手术的患者(n = 327),这些患者在手术前未感染COVID-19。患者根据手术时间与感染COVID-19的时间进行分类。数据采用逻辑回归法进行分析:结果:与未感染 COVID-19 的患者相比,感染 COVID-19 的患者术后深静脉血栓发生率更高(3.64% 对 1.21%)。多变量逻辑回归分析表明,手术时间与深静脉血栓风险显著相关(几率比 [OR],2.795;95% 置信区间 [CI],0.692-11.278;P = 0.024)。在感染 COVID-19 两周内接受手术的患者深静脉血栓发生率最高(OR,10.556;95% CI,1.095-303.313;P = 0.003)。然而,当手术推迟到感染后两周或两周以上时,发生率降至 2.85%。中位随访期为 10 个月,所有术后出现深静脉血栓的患者均已痊愈,未出现严重并发症或死亡。结论:进行乳腺癌手术时应谨慎:结论:在感染 COVID-19 后两周内进行乳腺癌手术应谨慎。结论:COVID-19 感染后两周内进行乳腺癌手术应谨慎,虽然深静脉血栓的风险在两周后仍有所升高,但考虑到治疗的紧迫性、良好的并发症结果以及对后续辅助治疗没有影响,手术是安全的。
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引用次数: 0
Palliative Radiotherapy for Symptomatic Primary Tumors in Patients With Locally Advanced Breast Cancer. 局部晚期乳腺癌患者无症状原发肿瘤的姑息放疗。
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-29 DOI: 10.4048/jbc.2024.0162
Jae Sik Kim, Jee Suk Chang, Kyubo Kim

Breast cancer remains a significant health concern for women, with a significant number of women facing unresectable, symptomatic, and advanced disease that severely affects their quality of life. Palliative radiotherapy (RT) is a well-established modality for managing such cases and alleviating symptoms. Recent advancements in systemic therapies and the resulting increase in long-term survival rates have not only heightened the need for retreatment in certain patients, but have also emphasized the importance of achieving durable local control. Additionally, inconsistencies in RT referral timing and variations in disease severity and extent contribute to diverse RT objectives and expected outcomes. The optimal dose fractionation for RT remains underexplored. Furthermore, a deeper understanding of breast radiobiology, along with the introduction of ultra- and moderately hypofractionated regimens and the widespread adoption of conformal techniques such as intensity-modulated RT, has diversified the approaches in RT dose and target volume. This review aimed to provides a comprehensive summary of the current evidence on the efficacy, outcomes, and toxicity profiles of palliative RT for symptomatic breast cancer. It highlights the need for more optimized regimens and further research to address the evolving treatment landscape and differing expectations of patients and physicians regarding RT.

乳腺癌仍然是妇女健康的一个重大问题,许多妇女面临着无法切除、无症状和严重影响生活质量的晚期疾病。姑息放射治疗(RT)是治疗此类病例和缓解症状的一种行之有效的方法。近年来全身疗法的进步以及由此带来的长期生存率的提高不仅增加了对某些患者进行再治疗的需求,还强调了实现持久局部控制的重要性。此外,RT 转诊时机的不一致以及疾病严重程度和范围的差异也导致了不同的 RT 目标和预期结果。乳腺放射治疗的最佳剂量分次仍未得到充分探索。此外,随着对乳腺放射生物学的深入了解,以及超低分量和中度低分量治疗方案的引入和适形技术(如强度调控 RT)的广泛采用,RT 剂量和靶体积的方法也变得多样化。本综述旨在全面总结姑息性 RT 治疗无症状乳腺癌的疗效、结果和毒性方面的现有证据。它强调了对更优化治疗方案和进一步研究的需求,以应对不断变化的治疗环境以及患者和医生对 RT 的不同期望。
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引用次数: 0
Effect of Interval Between Neoadjuvant Chemotherapy and Surgery on Oncological Outcomes in Poor Responders With Locally Advanced Breast Cancer. 新辅助化疗与手术之间的间隔时间对局部晚期乳腺癌不良反应患者肿瘤学结果的影响
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 Epub Date: 2024-07-22 DOI: 10.4048/jbc.2024.0084
Man Long, Chunxia Li, Keyu Mao, Zhenhui Li, Zhen Li, Guili Dong, Xia Zheng, Songliang Gao, Zhuolin Li, Guangjun Yang, Yu Xie

Purpose: The interval between neoadjuvant chemotherapy (NAC) and surgery for locally advanced breast cancer (LABC) remains controversial. At the same time, the prognostic effect of delayed surgery in patients with poor responses is currently unclear.

Methods: Data was collected from patients who had poor responses to NAC and underwent modified radical surgery from January 2013 to December 2018. The interval from completion of NAC to surgery was divided into two groups: a longer (greater than four weeks) or shorter (four weeks or less) interval. The associations of these interval groups with overall survival (OS) and recurrence-free survival (RFS) were evaluated by multivariable Cox models adjusting for the existing prognostic factors. Propensity score matching (PSM) was used to minimize election bias.

Results: A total of 1,229 patients (mean age, 47.2 ± 8.9 years; median follow-up duration, 32.67 [6.57-52.63] months) were included. The 5-year OS rates were 73.2% and 60.8% in the shorter (n = 171) and longer interval group (n = 1,058), respectively, while the 3-year RFS rates were 80.8% and 71.7%, respectively. In multivariate Cox analysis, the longer interval was associated with an increased risk of mortality (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.01-2.02; p = 0.046) and recurrence (HR, 1.50; 95% CI, 1.12-1.99; p = 0.006). There was an interaction between the molecular subtype and the surgery interval for OS (pinteraction = 0.014) and RFS (pinteraction = 0.027). After PSM, no significant difference in OS (p = 0.180) and RFS (p = 0.069) was observed between the two groups.

Conclusion: Among LABC patients with a poor response, those with a longer interval between NAC and surgery had worse OS and RFS. The results indicate that these patients should receive modified radical surgery timely, which may in turn improve their prognosis.

目的:局部晚期乳腺癌(LABC)新辅助化疗(NAC)与手术之间的间隔时间仍存在争议。同时,延迟手术对反应不佳患者的预后影响目前也不明确:收集了2013年1月至2018年12月期间对NAC反应不佳并接受改良根治术的患者数据。从完成 NAC 到手术的间隔时间分为两组:间隔时间较长(大于四周)或较短(四周或更短)。通过调整现有预后因素的多变量 Cox 模型评估了这些间隔组与总生存期(OS)和无复发生存期(RFS)的关系。采用倾向评分匹配法(PSM)最大限度地减少选举偏差:共纳入 1,229 名患者(平均年龄为 47.2 ± 8.9 岁;中位随访时间为 32.67 [6.57-52.63] 个月)。较短间隔组(n = 171)和较长间隔组(n = 1,058)的 5 年 OS 率分别为 73.2% 和 60.8%,3 年 RFS 率分别为 80.8% 和 71.7%。在多变量 Cox 分析中,较长的间隔与死亡率(危险比 [HR],1.43;95% 置信区间 [CI],1.01-2.02;P = 0.046)和复发(HR,1.50;95% 置信区间 [CI],1.12-1.99;P = 0.006)风险的增加有关。分子亚型与手术间隔对OS(pinteraction = 0.014)和RFS(pinteraction = 0.027)有交互作用。PSM后,两组患者的OS(p = 0.180)和RFS(p = 0.069)无明显差异:结论:在反应不佳的 LABC 患者中,NAC 与手术间隔时间较长的患者的 OS 和 RFS 较差。结果表明,这些患者应及时接受改良根治术,从而改善预后。
{"title":"Effect of Interval Between Neoadjuvant Chemotherapy and Surgery on Oncological Outcomes in Poor Responders With Locally Advanced Breast Cancer.","authors":"Man Long, Chunxia Li, Keyu Mao, Zhenhui Li, Zhen Li, Guili Dong, Xia Zheng, Songliang Gao, Zhuolin Li, Guangjun Yang, Yu Xie","doi":"10.4048/jbc.2024.0084","DOIUrl":"10.4048/jbc.2024.0084","url":null,"abstract":"<p><strong>Purpose: </strong>The interval between neoadjuvant chemotherapy (NAC) and surgery for locally advanced breast cancer (LABC) remains controversial. At the same time, the prognostic effect of delayed surgery in patients with poor responses is currently unclear.</p><p><strong>Methods: </strong>Data was collected from patients who had poor responses to NAC and underwent modified radical surgery from January 2013 to December 2018. The interval from completion of NAC to surgery was divided into two groups: a longer (greater than four weeks) or shorter (four weeks or less) interval. The associations of these interval groups with overall survival (OS) and recurrence-free survival (RFS) were evaluated by multivariable Cox models adjusting for the existing prognostic factors. Propensity score matching (PSM) was used to minimize election bias.</p><p><strong>Results: </strong>A total of 1,229 patients (mean age, 47.2 ± 8.9 years; median follow-up duration, 32.67 [6.57-52.63] months) were included. The 5-year OS rates were 73.2% and 60.8% in the shorter (n = 171) and longer interval group (n = 1,058), respectively, while the 3-year RFS rates were 80.8% and 71.7%, respectively. In multivariate Cox analysis, the longer interval was associated with an increased risk of mortality (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.01-2.02; <i>p</i> = 0.046) and recurrence (HR, 1.50; 95% CI, 1.12-1.99; <i>p</i> = 0.006). There was an interaction between the molecular subtype and the surgery interval for OS (<i>p</i><sub>interaction</sub> = 0.014) and RFS (<i>p</i><sub>interaction</sub> = 0.027). After PSM, no significant difference in OS (<i>p</i> = 0.180) and RFS (<i>p</i> = 0.069) was observed between the two groups.</p><p><strong>Conclusion: </strong>Among LABC patients with a poor response, those with a longer interval between NAC and surgery had worse OS and RFS. The results indicate that these patients should receive modified radical surgery timely, which may in turn improve their prognosis.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":" ","pages":"270-280"},"PeriodicalIF":2.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
Intensive Surveillance for Women With Breast Cancer: A Multicenter Retrospective Study in Korea. 乳腺癌妇女的强化监测:韩国多中心回顾性研究。
IF 2.2 4区 医学 Q3 ONCOLOGY Pub Date : 2024-08-01 DOI: 10.4048/jbc.2023.0234
Sungmin Park, Hyeong-Gon Moon, Jong Won Lee, Ku Sang Kim, Zisun Kim, So-Youn Jung, Jihyoun Lee, Se Kyung Lee, Byung Joo Chae, Sung Ui Jung, Jung Whan Chun, Jong-Ho Cheun, Hyun Jo Youn

Purpose: This study evaluated the effectiveness of different surveillance intensities on morbidity and mortality in women with breast cancer.

Methods: This retrospective study included patients who had undergone breast cancer surgery in the Republic of Korea between 2009 and 2011. The patients were divided into two groups based on the intensity of their postsurgical surveillance: intensive surveillance group (ISG) and less-intensive surveillance group. Surveillance intensity was measured based on the frequency and type of follow-up diagnostic tests conducted, including mammography, ultrasonography, computed tomography, magnetic resonance imaging, bone scans, and positron emission tomography scans.

Results: We included 1,356 patients with a median follow-up period of 121.2 months (range, 12.8-168.0 months). The analysis revealed no significant difference in the overall survival (OS) between the two groups within five years of surgery. However, patients with ISG exhibited significantly better breast cancer-specific survival (BCSS) and distant metastasis-free survival (DMFS) within the same period. Five years after surgery, the differences in survival outcomes between the groups were not statistically significant.

Conclusion: Intensive surveillance did not demonstrate a significant improvement in OS for patients with breast cancer beyond five years postoperatively. However, within the first five years, intensive surveillance was associated with better BCSS and DMFS. These findings suggest that personalized surveillance strategies may benefit specific patient subsets, particularly in the early years after treatment. Further nationwide randomized studies are warranted to refine surveillance guidelines and optimize outcomes in patients with breast cancer.

目的:本研究评估了不同监测强度对乳腺癌女性患者发病率和死亡率的影响:这项回顾性研究纳入了 2009 年至 2011 年期间在大韩民国接受乳腺癌手术的患者。根据术后监护强度将患者分为两组:强化监护组(ISG)和低强化监护组。监测强度根据随访诊断检查的频率和类型来衡量,包括乳腺放射摄影、超声波检查、计算机断层扫描、磁共振成像、骨扫描和正电子发射断层扫描:共纳入 1 356 名患者,中位随访时间为 121.2 个月(12.8-168.0 个月)。分析显示,两组患者在术后五年内的总生存率(OS)无明显差异。不过,ISG 患者在同一时期内的乳腺癌特异性生存期(BCSS)和无远处转移生存期(DMFS)明显更好。手术五年后,两组患者的生存结果差异无统计学意义:结论:术后五年后,强化监测并未显著改善乳腺癌患者的生存期。然而,在头五年内,强化监测与更好的 BCSS 和 DMFS 相关。这些研究结果表明,个性化监测策略可能会使特定的患者亚群受益,尤其是在治疗后的最初几年。有必要进一步开展全国范围的随机研究,以完善监测指南,优化乳腺癌患者的预后。
{"title":"Intensive Surveillance for Women With Breast Cancer: A Multicenter Retrospective Study in Korea.","authors":"Sungmin Park, Hyeong-Gon Moon, Jong Won Lee, Ku Sang Kim, Zisun Kim, So-Youn Jung, Jihyoun Lee, Se Kyung Lee, Byung Joo Chae, Sung Ui Jung, Jung Whan Chun, Jong-Ho Cheun, Hyun Jo Youn","doi":"10.4048/jbc.2023.0234","DOIUrl":"10.4048/jbc.2023.0234","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the effectiveness of different surveillance intensities on morbidity and mortality in women with breast cancer.</p><p><strong>Methods: </strong>This retrospective study included patients who had undergone breast cancer surgery in the Republic of Korea between 2009 and 2011. The patients were divided into two groups based on the intensity of their postsurgical surveillance: intensive surveillance group (ISG) and less-intensive surveillance group. Surveillance intensity was measured based on the frequency and type of follow-up diagnostic tests conducted, including mammography, ultrasonography, computed tomography, magnetic resonance imaging, bone scans, and positron emission tomography scans.</p><p><strong>Results: </strong>We included 1,356 patients with a median follow-up period of 121.2 months (range, 12.8-168.0 months). The analysis revealed no significant difference in the overall survival (OS) between the two groups within five years of surgery. However, patients with ISG exhibited significantly better breast cancer-specific survival (BCSS) and distant metastasis-free survival (DMFS) within the same period. Five years after surgery, the differences in survival outcomes between the groups were not statistically significant.</p><p><strong>Conclusion: </strong>Intensive surveillance did not demonstrate a significant improvement in OS for patients with breast cancer beyond five years postoperatively. However, within the first five years, intensive surveillance was associated with better BCSS and DMFS. These findings suggest that personalized surveillance strategies may benefit specific patient subsets, particularly in the early years after treatment. Further nationwide randomized studies are warranted to refine surveillance guidelines and optimize outcomes in patients with breast cancer.</p>","PeriodicalId":15206,"journal":{"name":"Journal of Breast Cancer","volume":"27 4","pages":"235-247"},"PeriodicalIF":2.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11377943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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
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Journal of Breast Cancer
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