Journal of Breast Cancer最新文献

Purpose: In hormone receptor (HR)-positive, human epidermal growth factor receptor 2-negative (HER2-) breast cancer, the omission of chemotherapy has become a viable option for select patients. However, when lymph node (LN) metastasis is suspected at diagnosis, the optimal initial treatment strategy (upfront surgery, neoadjuvant chemotherapy, or genomic testing) remains controversial. This study aimed to assess the preferences of multinational breast cancer specialists and to identify the factors influencing clinical decisions in this setting.

Methods: A cross-sectional survey was conducted among breast cancer specialists at two time points: November 2023 (via the Korean Breast Cancer Society) and April 2024 (following the Asian Breast Cancer Network meeting at Global Breast Cancer Conference 2024). The questionnaire presented 18 case scenarios that reflected varying patient ages, tumor sizes, nodal involvement, and pathological features. Respondents selected their preferred initial treatment strategy. Consensus was defined as ≥ 60% agreement. Univariate and multivariate logistic regression analyses were performed to identify the demographic factors associated with responses in the non-consensus scenarios.

Results: A total of 189 responses were analyzed. Consensus was consistently observed in postmenopausal patients and in cases involving small low-grade tumors with limited nodal suspicion. However, the responses varied between peri- and pre-menopausal patients, particularly in the intermediate-risk scenarios. Multivariate analysis revealed that clinician specialty, nationality, affiliation, and experience significantly influenced treatment choice. Notably, clinicians from other Asian countries and medical oncologists showed a greater preference for upfront surgery than for neoadjuvant chemotherapy in younger patients with aggressive tumor features.

Conclusion: The findings reveal both consensus and variability in clinical decision-making for HR+HER2- breast cancer with suspected LN involvement among multinational breast cancer specialists. This underscores the need for enhanced international collaboration and clear guidance in intermediate-risk settings. The incorporation of diagnostic tools such as multigene assays may further support individualized treatment decisions.

Purpose: The prevalence of immediate breast reconstruction (IBR) after mastectomy in patients with breast cancer is increasing. However, the applicability of IBR in cases of ipsilateral breast tumor recurrence (IBTR) remains limited. This study evaluated the oncological outcomes of total mastectomy (TM) alone and TM followed by IBR in patients with IBTR.

Methods: This retrospective analysis encompassed patients with IBTR who underwent TM, with or without subsequent IBR, between 2008 and 2018. The exclusion criteria were a third recurrence, delayed reconstruction, chest wall invasion, distant metastasis, supraclavicular or internal mammary lymph node metastasis, or bilateral breast cancer. The cohort was categorized into two groups: TM-only and TM with IBR.

Results: In total, 123 patients were included in this study (TM-only: n = 48, TM with IBR: n = 75). The median follow-up period were 52 and 51 months, respectively (p = 0.560). The clinicopathological characteristics were similar, except that advanced pathologic T stage at initial surgery was found more frequently in the TM-only group (p = 0.028). Locoregional recurrence, distant metastasis, and mortality rates were not significantly different between the groups (p = 0.535, p = 0.223, and p = 0.163, respectively). However, the TM with IBR group showed a significantly better overall survival (p = 0.040), but a higher rate of complications (p = 0.011).

Conclusion: Our results suggest that IBR after TM is a feasible treatment option for patients with IBTR from a prognostic perspective. Nonetheless, the selection of suitable candidates is crucial, considering the observed increase in complications and potential biases inherent in this study.

Purpose: Nipple-sparing mastectomy (NSM) with immediate reconstruction is one of the most widely selected approaches for total mastectomy in patients with breast cancer who desire breast reconstruction. With the introduction of endoscopic nipple-sparing mastectomy (EM) and robotic nipple-sparing mastectomy (RM), comparison of these techniques in terms of clinical outcomes, surgical efficiency, and cost-effectiveness has gained increasing attention. Here, we compared the EM and RM techniques.

Methods: This study included 110 patients who underwent RM (n = 29) or EM (n = 81) at Korea University Ansan Hospital between April 2019 and November 2024. Primary outcomes were surgical time, surgical cost, length of hospital stay, total drainage, and complication rates. Statistical analyses were performed to compare differences between the two groups.

Results: There were significant differences in both mastectomy operative time (RM: 170.7 ± 55.2 minutes, EM: 149.9 ± 40.2 minutes; p = 0.033) and reconstruction operative time (RM: 213.6 ± 110.1 minutes, EM: 119.2 ± 77.9 minutes; p < 0.001), resulting in a significantly longer total operative time for RM (RM: 384.3 ± 113.0 minutes, EM: 269.0 ± 89.0 minutes; p < 0.001). RM was also significantly more expensive than EM (RM: 31,338,659.0 ± 5,166,816.8 KRW, EM: 19,486,521.5 ± 6,074,413.6 KRW; p < 0.001). Length of hospital stay, complication rates, and short-term oncological outcomes did not differ significantly between the two groups.

Conclusion: EM is a more time-efficient and cost-effective surgical technique than RM. Our findings indicate no significant safety advantage of RM over EM, highlighting the need for individualized surgical decision-making.

Purpose: To evaluate the effect of radiation therapy (RT) boost sequences and doses to internal mammary (IM) lymph nodes (LNs) on oncologic outcomes and toxicity in patients with clinically IMLN-positive breast cancer.

Methods: Twenty-six patients with positive IMLNs at diagnosis who were treated between 2013 and 2022 were retrospectively evaluated. After systemic therapy and surgery, RT was applied to the whole breast or chest wall, including the axillary, supraclavicular, and IM lymphatics. An RT boost to the IMLNs was administered either sequentially or as a simultaneous integrated boost (SIB). Treatment outcomes, prognostic factors, and toxicity profiles were analyzed.

Results: A complete response (CR) and partial response (PR) in metastatic IMLNs were observed in 17 patients (65.4%) and 5 patients (19.2%) following systemic therapy, respectively. One patient (3.8%) had stable disease, while two patients (7.7%) experienced disease progression in the IMLNs.After a median follow-up of 67 months, regional recurrence, distant metastasis, or both occurred in 1 (3.8%), 1 (3.8%), and 2 (7.7%) patients, respectively. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 86.7% and 76.4%, respectively. The absence of extracapsular extension in axillary LNs was associated with improved OS and DFS. A CR or PR to systemic treatment in IMLNs was associated with improved DFS only. The boost sequence had no significant effect on survival, organ-at-risk doses, or cardiac toxicity.

Conclusion: An RT boost to IMLNs without surgical resection provides excellent oncologic outcomes with acceptable toxicity. While the SIB technique reduces the number of treatment fractions, it did not result in superior oncologic outcomes compared to the sequential boost. Further prospective studies are needed to investigate the role of RT boost sequencing to the IMLNs.

Purpose: CD39 (ENTPD1, ectonucleoside triphosphate diphosphohydrolase-1) and CD73 (NT5E, 5'-nucleotidase) are mediators of adenosine release in the tumor microenvironment (TME), and adenosine has the effect of overcoming anti-tumor immunity. This CD39-CD73-adenosine pathway is thought that play a role in immune suppression and promotion of tumor growth and infiltration. This study investigated the clinical and prognostic significance of CD39 and CD73 in breast cancer.

Methods: This study included 472 patients with primary invasive breast cancer who received surgical treatment at the Breast Cancer Clinic at Chung-Ang University Hospital from June 2010 to May 2017. Using a tissue microarray, biomarker immunostaining was performed for CD39 and CD73. We assessed the expression ratio of CD39 and CD73 in breast cancer subgroups, and investigated the association between disease-free survival (DFS) and the expression of CD39 and CD73.

Results: The expression ratio of CD39 and CD73 in breast cancer subgroups differed according to hormone receptor status and human epidermal growth factor receptor 2 (HER2) status. In the case of CD39, the high-level rate was increased in estrogen receptor (ER)/progesterone receptor (PR) positive (p = 0.001, p = 0.009), and HER2 negative (p < 0.001) breast cancer. In contrast, in the case of CD73 expressed in tumor-infiltrating lymphocyte (TIL), the expression rate was increased in ER/PR negative (p < 0.001), and HER2 positive (p < 0.001), breast cancer. High CD39 expression was significantly associated with lower stage (p < 0.001), but there was no relationship CD39 expression and survival. In patients with HER2-positive breast cancer, CD73 expression in TIL was associated with lower stage (p = 0.024), and better survival in DFS analysis (p = 0.015).

Conclusion: In conclusion, the expression ratio of CD39 and CD73 in breast cancer subgroups differed according to hormone receptor status and HER2 status, and CD73 expression in TILs associated with a trend toward favorable prognosis in HER2 positive breast cancer.

Purpose: Breast cancer (BC) is the most common cancer occurring during pregnancy. With delayed childbirth, pregnancy-associated breast cancer (PABC) incidence is expected to increase. It can be challenging for mothers undergoing cancer treatment and coping with disease progression to focus on parenting. The child may be affected by the mother's ongoing treatment both prenatally and postnatally. This study aims to investigate the biopsychosocial development of children born to patients with PABC, the emotional stress of patients.

Methods: This ambispective cohort study combines a retrospective analysis of previously collected data from January 2019 to December 2029 with the prospective recruitment and follow-up of new patients. Patients diagnosed with PABC within the past 5 years will be recruited from hospitals and patient associations. Recruitment and follow-up will occur from July 1, 2024, to December 31, 2029, with 80 participants targeted for both the subject and control groups.

Discussion: This study aims to provide long-term insights into the biopsychological development of children born to PABC patients, as well as the emotional states and QoL. The findings are expected to optimize biopsychosocial development, enhance family well-being, and guide breast cancer patients in making informed pregnancy decisions.

Trial registration: Clinical Research information Service Identifier: KCT0010225.

Purpose: Pectoral nerve (PECS) blocks have gained popularity for pain management in breast cancer surgery because of their ease of use and lower risk profile. However, their efficacy compared with that of paravertebral block (PVB) remains uncertain. This study aimed to evaluate the non-inferiority of the PECS block to PVB for postoperative analgesia.

Methods: This prospective, randomized, double-blind trial included adult patients (American Society of Anesthesiologists status 1-3) scheduled for elective breast cancer surgery. The patients were randomized to receive either a PECS block or PVB. The primary outcome was block success, defined as a Visual Analogue Scale pain score of < 30 at 30 minutes, 6 hours, and 24 hours postoperatively. The secondary outcomes included opioid consumption, block performance time, functional recovery, and patient satisfaction.

Results: Of the 42 patients, 23 received a PECS block and 19 received PVB. Successful blocks were achieved in 69.6%, 81.8%, and 77.3% of patients with PECS blocks and 63.2%, 68.4%, and 88.9% of patients with PVB at 30 minutes, 6 hours, and 24 hours, respectively. The non-inferiority of PECS was significant at 30 minutes and 6 hours but inconclusive at 24 hours. The PECS blocks were performed faster (7 vs. 14 minutes, p < 0.001). Opioid consumption, global satisfaction, and functional recovery were comparable with no reported complications.

Conclusion: Our study shows that the PECS block is non-inferior to the PVB in managing postoperative pain after breast surgery, offering advantages such as reduced administration time and a favorable safety profile. These findings support the integration of the PECS block into pain management strategies for breast cancer surgery.

Trial registration: ClinicalTrials.gov Identifier: NCT02645474.

Ribociclib combined with an aromatase inhibitor (AI) is widely used as first-line therapy for hormone receptor (HR)-positive, human epidermal growth factor receptor-2 (HER-2)-negative metastatic breast cancer. Desmoid-type fibromatosis (DTF) is a rare, locally invasive soft-tissue tumor that accounts for only 0.2% of all breast neoplasms and can mimic malignancy upon imaging. A 44-year-old premenopausal woman with HR-positive, HER2-negative bone-only metastatic breast cancer developed a rapidly growing breast mass after 30 cycles of ribociclib with an AI. Imaging suggested cancer progression, necessitating total mastectomy. However, postoperative pathology confirmed DTF, which is a rare occurrence that has not been previously reported. Appropriate therapeutic planning and follow-up for metastatic breast cancer should include histopathological diagnosis, when necessary, beyond clinical and imaging assessments.

Purpose: Multidisciplinary team (MDT) discussions are standard in cancer care; however, their effect on advanced breast cancer (ABC) prognosis is not well-documented. This study examined the impact of MDT intervention on ABC patient survival.

Methods: A retrospective analysis of ABC patients diagnosed 2018 to 2021 was conducted by dividing them into MDT and non-MDT groups. Kaplan-Meier analysis was used to compare progression-free survival (PFS) and overall survival (OS) between the groups. Prognostic factors were evaluated using multivariate Cox regression analysis with subgroup analysis and 1:1 propensity score matching (PSM) to control for confounders.

Results: Total 707 patients were included, with 72.8% (515/707) underwent MDT intervention. After a median follow-up of 43.73 months (interquartile range, 34.87-55.67 months), MDT intervention improved the median PFS (12.00 vs. 8.00 months; hazard ratio [HR], 0.75 [95% confidence interval {CI}, 0.63-0.89]; p = 0.001) and median OS (55.67 vs. 40.07 months; HR, 0.77 [95% CI, 0.61-0.97]; p = 0.030). Multivariate Cox analysis showed MDT as an independent factor for disease progression control (HR, 0.82 [95% CI, 0.68-0.98]; p = 0.041), but not for OS (HR, 0.88 [95% CI, 0.69-1.12]; p = 0.286). Subgroup analysis indicated that MDT benefited patients aged ≤ 39 years, those with disease status (de novo metastatic breast cancer), post-menopausal status, T4 stage, N3 stage, G3, visceral metastasis, > one organ metastasis and first-line systemic treatment, regardless of PFS or OS. After PSM, 172 matched patients were in the cohort. MDT still significantly controlled disease progression (12.00 vs. 8.00; HR, 0.74 [95% CI, 0.59-0.93]; p = 0.009) but did not significantly impact the OS (49.00 vs. 39.00; HR, 0.80 [95% CI, 0.59-1.08]; p = 0.121).

Conclusion: MDT effectively controlled the disease progression and improved OS in specific patient subgroups.