Journal of Breast Cancer最新文献

Purpose: Despite numerous previous studies, the relationship between hysterectomies and breast cancer risk remains unclear. This study aimed to assess whether hysterectomies are significantly associated with a reduced risk of breast cancer in Korean women using data from the National Health Insurance Service database of South Korea.

Methods: We conducted a retrospective cohort study of South Korean women aged 40-59 years who underwent hysterectomies for benign reasons or underwent a health check-up between 2003 and 2011. To minimize confounding factors, a 1:1 propensity score matching (PSM) was used to balance the groups based on key covariates. The participants were followed up until December 31, 2020. Stratified Cox proportional hazards regression analysis was performed to assess the association between hysterectomies and breast cancer risk.

Results: After 1:1 PSM, 13,148 women were assigned to the hysterectomy or non-hysterectomy groups. Breast cancer occurred in 242 (1.8%) and 233 (1.8%) women in the non-hysterectomy and hysterectomy groups, respectively (p = 0.711). After adjusting for confounders, hysterectomy with or without adnexal surgery was not significantly associated with breast cancer risk (hazard ratio [HR], 0.937; 95% confidence interval [CI], 0.775-1.132 for hysterectomy with/without adnexal surgery; HR, 0.957; 95% CI, 0.779-1.176 for hysterectomy without adnexal surgery; and HR, 0.833; 95% CI, 0.513-1.353 for hysterectomy with adnexal surgery). No significant association was found when analyzing surgical methods or age at natural menopause.

Conclusion: Our study found no association between hysterectomies and breast cancer risk, which is consistent with previous studies that reported a null association.

Purpose: Recent studies have shown that intermuscular adipose tissue (IMAT) is a significant prognostic factor for breast cancer. To date, no clinical studies have investigated whether IMAT can be used to predict chemotherapy toxicity in older adult patients with early-stage breast cancer.

Methods: We included 304 patients diagnosed with stage I-III breast cancer between January 2020 and December 2022 in Harbin Medical University Cancer Hospital. All patients were aged ≥ 65 years and treated with neoadjuvant or adjuvant chemotherapy. IMAT within the pectoralis muscle was measured using computed tomography imaging. Logistic regression analysis was used to identify independent predictors of chemotherapy toxicity. A nomogram was built, and the model performance was assessed using accuracy, discrimination, and clinical benefits. The net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to evaluate changes in model performance after the addition of adipose tissue.

Results: Of the 304 patients (184 in the training cohort and 120 in the validation cohort), 30.3% developed grade 3-5 chemotherapy toxicities. Three independent predictors were identified in the multivariate analysis: hemoglobin level, IMAT area, and primary prophylaxis with granulocyte colony-stimulating factor. The nomogram demonstrated area under the receiver operating characteristic curve values of 0.708 (95% confidence interval [CI], 0.616-0.801) and 0.751 (95% CI, 0.655-0.846) in the training and validation cohorts, respectively. The nomogram showed good calibration (Hosmer-Lemeshow test, p > 0.05), and incorporating IMAT improved nomogram performance in both cohorts (all NRI and IDI > 0, p < 0.05). Decision curve analysis revealed that the nomogram was clinically useful.

Conclusion: A nomogram including IMAT may be useful for predicting the individual probability of chemotherapy toxicity and guiding therapy in older adults with early-stage breast cancer.

Purpose: Since the last consensus statement on robotic nipple-sparing mastectomy (RNSM) in 2019, this technique has gained popularity, with accumulating evidence supporting its feasibility and patient satisfaction. However, concerns regarding the technical challenges and patient selection persist. This study aimed to provide an updated consensus on RNSM.

Methods: An international panel of 10 expert surgeons was convened to develop a consensus covering six domains: indications, contraindications, technical considerations, patient counseling, outcome measures, and training. The panel was asked to vote on statements via two rounds of online surveys and a final in-person meeting at the Global Breast Cancer Conference in conjunction with the International Endoscopic and Robotic Breast Surgery Symposium. Consensus was defined as 80% agreement with each statement.

Results: A total of 53 statements with at least 80% agreement were generated after three rounds of voting. Most statements were updated from previous consensus statement. All experts agreed that the consensus statement serves as a set of expert recommendations for the successful and safe practice of robotic mastectomy but are not mandatory actions.

Conclusion: Although still evolving, RNSM is a promising technique representing the future of minimally invasive breast surgery. This international consensus statement offers expert recommendations for safe and effective RNSM practices.

Purpose: In the tumor, node, metastasis staging system for metaplastic breast cancer (MBC), the T2 category, encompassing a border spectrum of tumor sizes than T1 category, curiously lacks subcategorization.

Methods: Using the Surveillance, Epidemiology, and End Results database, data of 767 women diagnosed as T2N0-2 MBC between 2004 and 2016 were analyzed. The optimal tumor size cutoff was determined using X-tile software to facilitate the subclassification of T2 tumors. A comparison of breast cancer-special survival (BCSS) was conducted across three subcategories, with a median follow-up duration of 44 months.

Results: Of 767 patients, 136 (17.7%) died. Based on Kaplan-Meier analysis, 30 mm and 40 mm were selected as the cutoff values. Ten-year BCSS rate was 90.2% in patients with breast tumors ≤ 30 mm (T2a), 80.2% in patients with breast tumors ≤ 40 mm (T2b), and 68.2% in patients with breast tumors ≤ 50 mm (T2c) (log-rank p = 0.001). T2b (p = 0.009) and T2c (p < 0.001) subcategory showed worse BCSS than T2a subcategory. By multivariate analysis, T2b (T2a as reference, hazard ratio [HR], 1.610, p = 0.020) and T2c (HR, 1.981, p = 0.002) subcategory were significant independent prognostic factors of BCSS. By subgroup multivariate analysis, patients receiving breast-conserving surgery (BCS) plus radiotherapy (RT) had a better prognosis than that receiving total mastectomy (TM) in T2a stage. However, the prognosis was worse in BCS + RT group than TM group in T2c stage, while there was no difference between two groups in T2b stage.

Conclusion: Further stratification within the T2 category could enhance the precision of prognostic predictions and facilitate the customization of adjuvant treatments.

Purpose: De-escalation of axillary lymph node (ALN) surgery in early breast cancer is increasingly common. This study aimed to identify patients suitable for this approach by comparing long-term survival based on preoperative axillary ultrasound (AUS).

Methods: Patients undergoing surgery at Yonsei University Severance Hospital between January 2010 and December 2017 were categorized into "no suspicion" and "low suspicion" groups based on AUS findings.

Results: Median follow-up duration was 92 months. The 10-year recurrence-free survival (RFS) and overall survival rates for the no suspicion and low suspicion groups were 94.2% and 90.1% (p < 0.001) and 93.1% and 93.0% (p = 0.177), respectively. The 10-year locoregional RFS rates were 96.8% and 96.1% (p = 0.060). Among node-positive patients, 19.9% in the no suspicion group had three or more metastatic ALNs compared with 23.0% in the low suspicion group (p = 0.012). Recurrence was associated with T stage, N stage, histologic grade, Ki-67, and subtype, whereas mortality was linked to age, T stage, N stage, histologic grade, and subtype.

Conclusion: The low suspicion and fine-needle aspiration biopsy-negative group had poorer prognostic biomarkers, leading to differences in recurrence but not in overall survival. The preoperative ALN status did not affect survival rates. Even in patients with cT2 and low suspicion of ALN, the rate of three or more metastatic ALNs was low, suggesting that further axillary surgery may not be necessary if two or fewer metastatic lymph nodes are found in the sentinel lymph node.

Purpose: Oncoplastic breast surgery (OPS) is a crucial component of breast cancer surgery that combines oncological safety with improved cosmetic outcomes. OPS is increasingly being adopted worldwide, although the techniques and concepts vary based on patient demographics and surgeons' expertise. This study aimed to evaluate the evolving OPS concept among Korean breast surgeons and assess the current trends in OPS techniques.

Methods: A web-based survey was conducted among members of the Korean Breast Cancer Society and Korean Oncoplastic Breast Surgery Study Group. The questionnaire included seven questions that explored opinions on the scope and practical trends of OPS. Respondents were stratified according to hospital type, position, and age. Data were analyzed to identify trends and differences based on demographic factors.

Results: A total of 122 surgeons responded, with a majority (78.7%) working in academic or tertiary hospitals. Most respondents (77.9%) considered OPS to include volume displacement/replacement and implant-based reconstruction, regardless of the resection volume. In addition, 70.5% agreed that robotic or endoscopic surgery fell within the scope of the OPS. Autologous reconstruction after a partial mastectomy is preferred for achieving excellent cosmetic results, particularly among younger surgeons. Notably, 59.0% of the surgeons reported using single- and dual-surgeon strategies.

Conclusion: OPS is widely practiced among Korean breast surgeons, with the increasing adoption of advanced techniques such as robotic-assisted and endoscopic surgery. Although preferences differ with the surgeon's age, the concept of OPS has expanded considerably, and a multidisciplinary approach remains critical. Understanding these trends is essential to optimize patient care and improve surgical training programs.

Existing artificial intelligence (AI) breast ultrasound solutions have limitations owing to their non-real-time detection and server dependency. However, novel real-time AI solutions enable on-device detection and differential diagnosis, aiding immediate decision-making. This study evaluated the feasibility of real-time artificial intelligence-based computer-aided detection/diagnosis (AI-CAD) for breast ultrasound in a clinical setting and assessed its preliminary efficacy in comparison with expert evaluations. A feasibility study was conducted from August to December 2023 at a tertiary medical center in Taiwan using a real-time AI solution (CadAI-B for Breast cancer). AI-CAD runs on a tablet PC and streams the display output from the ultrasound vendor's device via HDMI or DVI. Real-time AI-CAD was evaluated for detection and diagnostic performance based on sensitivity, specificity, and area under the curve (AUC). The analysis included 33 patients with 14 malignancies, 17 benign lesions, and 2 normal cases; 30 (90.9%) underwent biopsy. AI-CAD successfully identified all malignancies in real-time. As AUCs were calculated using the malignancy score and Breast Imaging Reporting and Data System (BI-RADS), the overall diagnostic performances were 0.835 and 0.850, respectively. The per-patient sensitivity and specificity were 100.0% and 52.6%, respectively. The BI-RADS distribution was the same between AI-CAD and experts in malignant cases. In benign cases, AI-CAD categorized nine (50.0%) as C4A or C4B, whereas experts classified 13 (72.2%), indicating the potential to reduce the need for biopsy. Real-time AI-CAD is feasible for supporting detection during breast ultrasound scanning, with potential efficacy in aiding differential diagnosis and reducing the risk of unnecessary biopsies.

Purpose: Exosomes, nanoscale vesicles with high biocompatibility, were engineered to express human epidermal growth factor receptor 2 (HER2)-binding peptides and carry miR-34a, targeting HER2 and programmed death-ligand 1 (PD-L1)-positive breast cancer cells.

Methods: An in vivo xenograft breast cancer model was established by subcutaneously injecting breast cancer cells of both HER2 and PD-L1 positivity (SK-BR3 cells) into the buttocks of BALB/c nude mice. miR-34a-loaded HER2-targeting exosomes, termed tEx[34a], were engineered by transfecting human adipose-derived mesenchymal stem cells with the pDisplay vector to express HER2-binding peptides (P51 peptide). Purified exosomes were then loaded with miR-34a, a tumor-suppressor miRNA, using the Exo-Fect transfection kit, creating tEx[34a] for targeted cancer therapy.

Results: Intravenous administration of miR-34a-loaded HER2-targeting exosomes, referred to as tEx[34a], demonstrated superior targetability compared to other materials, such as natural exosomes, miR-34a-loaded exosomes, and unloaded HER2-targeting exosomes. In vivo experiments using mouse breast cancer xenograft models revealed that the administration of tEx[34a] resulted in the smallest tumor size and lowest tumor weight when compared to all other groups. Notably, tEx[34a] treatment significantly reduced PD-L1 expression in breast cancer tissue compared to the other groups. Furthermore, tEx[34a] administration led to the highest upregulation of pro-apoptotic markers (Bax, PARP, and BIM) and the lowest downregulation of the anti-apoptotic marker Bcl-xL, as confirmed through various methods including RT-PCR, Western blot analysis, and immunofluorescence.

Conclusion: MiR-34a-loaded HER2-targeting exosomes demonstrate strong anticancer efficacy by selectively binding to HER2-positive breast cancer cells and effectively suppressing PD-L1 expression.

Purpose: Breast cancer (BC) is a predominant malignancy globally, surpassing lung cancer in terms of diagnostic frequency, with an escalating incidence rate in recent decades. Recent studies have investigated the role of protein kinase C zeta (PRKCZ) in diverse cellular processes in cancer biology. In this study, we evaluated the association between PRKCZ and deleterious outcomes in BC and elucidated the mechanisms underlying its expression in breast carcinoma.

Methods: The correlation between PRKCZ and survival rates of patients with BC was investigated using The Cancer Genome Atlas database. The methylation status of the PRKCZ promoter was analyzed using the UALCAN database. Furthermore, we investigated the mechanisms underlying PRKCZ inactivation in BC by treatment with transferase inhibitors, methylation-specific polymerase chain reaction (PCR) analysis, western blotting, and luciferase reporter gene assays. The degree of methylation and expression levels of PRKCZ, as regulated by DNA methyltransferase 1 (DNMT1), were quantified using quantitative PCR and western blotting.

Results: Our analysis revealed that decreased expression of PRKCZ in BC was significantly correlated with poor clinical prognosis. Furthermore, we observed that hypermethylation of the PRKCZ promoter contributed to its reduced expression in BC. Notably, DNMT1 has been identified as a critical regulator of PRKCZ methylation.

Conclusion: Our findings elucidate the tumor-suppressive function of PRKCZ and provide insights into the molecular mechanisms underlying its downregulation in BC.