Breast Cancer最新文献

Purpose: Multicatheter interstitial brachytherapy (MIB) is an established technique of partial breast irradiation (PBI). However, postoperative catheter implant is an invasive, inconvenient, and skillful procedure. In this study, local control and cosmesis of perioperative interstitial brachytherapy (PIB) by intraoperative catheter implant were evaluated by comparing with those of whole breast irradiation (WBI) following breast-conserving surgery (BCS).

Methods: Between October 2007 and August 2019, consequent patients who underwent either PIB or WBI following BCS were included. In general, additional indications for PIB to WBI included age ≥ 40 years, tumor ≤ 3 cm, and pN0 or pNmi. WBI was initiated with a total dose of 50 Gy in 25 fractions, whereas PBI was delivered immediately following BCS at 32 Gy in eight fractions. Local recurrence (LR) was the primary endpoint, and subjective and objective cosmetic outcomes at 5 years using the Harvard Cosmesis Scale and BCCT.core software, respectively, were the secondary endpoints.

Results: During the 10-year follow-up, the crude rate of LR was 3.8% (95% confidence interval [CI] 2.3-5.4) in 577 patients receiving PIB and 3.3% (95% CI 1.1-5.6) in 241 patients receiving WBI (P = 0.73). The 5- and 10-year LR-free survival rates in the PBI and WBI cohorts were 97.9% versus 97.9% and 95.4% versus 96.8%, respectively (P = 0.64). Multivariate analysis selected age < 50 years as an independent risk factor for LR. Excellent or good cosmesis in the PBI and WBI cohorts assessed by subjective and objective measures was 89.5% versus 84.5% (P = 0.26) and 83.7% versus 68.1% (P < 0.005), respectively.

Conclusions: Although this study was based on a retrospective chart review in a single institution, the largest series of data with a long follow-up suggested that acceptable local tumor control and cosmesis were achieved following PIB compared with WBI.

Background: Systemic therapy (ST) is essential for de novo stage IV breast cancer (BC). Stage IV BCs are highly heterogeneous, and it seems inappropriate to treat all de novo stage IV BCs equally. The survival benefit of surgery for primary sites in patients with de novo stage IV BC remains inconclusive.

Patients and methods: We investigated 220 patients with clinical de novo stage IV BC. The relationship between primary site surgery and overall survival (OS) was analyzed. Factors such as tumor subtype, timing of surgery, and efficacy of ST were also evaluated.

Results: The median follow-up time was 37.9 (0.5-201.7) months. In the total cohort, the median OS of the patients with and without primary site surgery was 70.5 months (95% confidence interval [CI] 58.4-107.3) and 42.7 months (95% CI 35.7-48.8), respectively. The OS was significantly longer in patients who underwent primary site surgery, especially in the hormone receptor (HR) + /HER2- and HER2 + subtypes, but not in the triple-negative subtype. OS prolongation was significant in patients who underwent surgery ≥ 24 months after the first diagnosis and in whom the first-line ST was effective for ≥ 24 months. Primary site surgery was a good prognostic factor in both univariate and multivariate analyses.

Conclusions: The OS was significantly longer in patients with de novo stage IV BC who underwent primary site surgery than in those who did not undergo surgery. Our results suggest that the tumor subtypes, efficacy of ST, and timing of surgery influenced the benefits of surgery.

Aims and objectives: Appropriately timed cessation of systemic anticancer treatments is an important part of a patient's quality of life (QoL). We aimed to determine the right time to discontinue systemic anticancer therapy (SACT) and switch to the best supportive care for patients with advanced breast cancer (BC) who are nearing the end of life.

Methods: We identified 200 BC patients who died within 30 days after palliative SACT. Laboratory parameters and Eastern Cooperative Oncology Group (ECOG) performance status (PS) were recorded when the patients received their last SACT and at the time of their penultimate treatment. The (Neutrophil-ECOG-LDH-Bilirubin) 'NELBI' score, created on the basis of the optimum cut-off points of ECOG PS, neutrophil count, bilirubin level, and lactate dehydrogenase (LDH) level, which can predict mortality within 30 days after SACT, was scored between 0 and 4. Patients were stratified on the basis of the NELBI score.

Results: A total of 4164 patients receiving palliative treatment for advanced BC were examined. A total of 4.8% of patients died within 30 days after SACT. The percentage of patients who died within 30 days after SACT among all deceased patients was 19.4%. The median time from the last systemic treatment to death was 19.5 ± 7.85 (95% CI 18.06-20.26) days, and the median time from the penultimate treatment to death was 43.0 ± 24.65 (95% CI 46.81-53.85) days. A total of 21.3%, 58.0%, 70.7%, and 88.9% of patients with NELBI scores of 0, 1, 2, and 3-4, respectively, died within 30 days after SACT. Compared with a NELBI score of 0, a NELBI score of 1 (OR = 5.095; 95% CI 2.654- 9.784; p < 0.001), a NELBI score of 2 (OR = 8.911; 95% CI 4.299-18.474; p < 0.001), and a NELBI score of 3-4 (OR = 29.500; 95% CI 6.135- 141.847; p < 0.001) was associated with significantly greater 30-day mortality. The AUC of the NELBI scoring for 30-day mortality prediction after SACT was 0.713.

Conclusions: The 'NELBI' scoring system has the potential to significantly improve patient care by guiding the appropriate discontinuation of SACTs in patients with BC.

Background: Circulating tumor DNA (ctDNA) enables non-invasive evaluation and is considered a promising tool for diagnosis, treatment selection, risk stratification, and disease monitoring. However, while the utility of ctDNA has been demonstrated in advanced-stage cancers, its detection in early breast cancer (EBC) remains limited. This study investigated the characteristics of EBC patients associated with higher ctDNA detectability.

Methods: A total of 101 patients with EBC were enrolled. Formalin-fixed paraffin-embedded samples (FFPEs) were obtained from biopsy tissue, and plasma samples were collected before and after neoadjuvant chemotherapy (NAC). Forty-seven breast cancer-related genes were analyzed using next-generation sequencing. The diagnostic performance of ctDNA was evaluated, and logistic regression analyses were conducted to assess the impact of clinical and molecular factors on ctDNA status.

Results: The most frequently identified gene was TP53 (FFPE, 66.7%; ctDNA, 46.4%), followed by PIK3CA (FFPE, 36.2%; ctDNA, 17.4%). The diagnostic performance of the three most common genes showed a sensitivity range of 11.1-58.7%, specificity of 78.3-100%, and diagnostic accuracy of 65.2-78.3%. The triple-negative breast cancer (TNBC) subtype exhibited the strongest association with ctDNA detection (odds ratio [OR] 209.50, p = 0.005) in multivariate analysis. Also, those who exhibited ctDNA clearance after NAC had a higher pathological complete response rate compared to those without clearance (38.5% vs. 11.1%, p = 0.238).

Conclusions: Our study highlights that ctDNA analysis can complement genetic testing from a single tissue biopsy in breast cancer patients. Furthermore, ctDNA analysis may be particularly important in patients with TNBC.

Antibody-drug conjugates (ADCs) are an emerging class of anticancer therapy that combines the specificity and long circulation half-life of monoclonal antibodies with the cytotoxic potency of the payload connected through a chemical linker. The optimal management of toxicities is crucial for improving quality of life in patients undergoing ADCs and for avoiding improper dose reductions or discontinuations. This article focuses on the characteristics and management of nausea and vomiting (NV) induced by three ADCs: trastuzumab deruxtecan (T-DXd), sacituzumab govitecan (SG), and datopotamab deruxtecan (Dato-DXd). We summarize the proposed mechanism of NV, clinical study data on NV, and recommendations from clinical guidelines. We also discuss three prospective studies evaluating prophylactic antiemetic therapy in patients receiving T-DXd, along with future perspectives.

Exosome markers, CD63 and CD81, belong to the tetraspanin family and are expressed in solid tumors. It has been reported that these tetraspanin family members are prognostic factors in some cancers. However, the expression of CD63 and CD81 in pathological breast cancer specimens has not been reported. It has been reported that CD63 promotes the proliferation of breast cancer cells in vitro through yes-associated protein (YAP). Therefore, in this study, the expression of tetraspanin family members, particularly CD63, CD81, and YAP were investigated in breast cancer tissue, by immunohistochemistry, to clarify the relationship between clinicopathological factors and prognosis. The number of CD63 and YAP double-positive breast cancer cells was significantly higher in patients with pathological T factor (pT) status (p = 0.030) and tended to be higher in patients with pathological N factor (pN) status (p = 0.054). Furthermore, the number of CD81 and YAP double-positive breast cancer cells was significantly higher in patients with histological grade (p = 0.015), pT status (p = 0.001), and Ki67 expression (p = 0.049), and tended to be higher in patients with pN status (p = 0.062) and TNM stage (p = 0.052). In addition, CD63 and YAP double-positive breast cancers and CD81 and YAP double-positive breast cancers were associated with shorter disease-free and breast cancer-specific survival, respectively. In conclusion, CD63 and YAP, and CD81 and YAP may serve as potential prognostic biomarkers in patients with breast cancer.

Purpose: The aim of this study was to examine the clinical utility of tumor-infiltrating lymphocytes (TILs) evaluated by "average" and "hot-spot" methods in breast cancer patients.

Methods: We examined 367 breast cancer patients without neoadjuvant chemotherapy (NAC) by average and hot-spot methods to determine the consistency of TIL scores between biopsy and surgical specimens. TIL scores before NAC were also compared with the pathological complete response (pCR) rate and clinical outcomes in 144 breast cancer patients that received NAC. TIL scores evaluated by the two methods were predicted from clinicopathological data using random forest regression.

Results: Surgical specimens showed higher TIL scores than biopsy specimens using the hot-spot method (p < 0.001), while biopsy and surgical specimens showed similar TIL scores using the average method. There was a linear relationship between the pCR rate and TIL scores determined using hot-spot (p < 0.001) and average methods (p = 0.001). Patients without pCR and low TILs by the average method had significantly worse overall survival compared to other patients (p = 0.02). The root mean squared errors of the predicted TIL score for the test set were 19.662 (hot-spot) and 10.955 (average).

Conclusion: The average method may have an advantage for breast cancer patients receiving NAC, since the TIL score using this method is more consistent between biopsy and surgical specimens, and it associates better with clinical outcomes. Our exploratory study showed that machine learning from clinicopathological data may better predict TIL scores assessed by the average, rather than hot-spot, method.

Background: The accuracy of mammography in breast cancer screening is influenced by different factors such as breast composition. However, previous studies did not evaluate the impact of breast size on examination accuracy. This study aimed to investigate the influence of breast size on the accuracy of mammography and ultrasonography in breast cancer screening using compressed breast thickness (CBT) on mammography as an indicator of breast size.

Methods: This study included Japanese women in their 40 s who underwent mammography alone (MG group) or mammography with adjunctive ultrasonography (MG + US group) at the Iwate Cancer Society (Iwate, Japan) in 2018 and 2019. Based on CBT, the participants were further divided into the L group (< 30 mm) and U group (≥ 30 mm). The recall rate, cancer detection rate, and positive predictive value of the L and U groups based on screening method and breast size were evaluated.

Results: Of 15,897 patients, 10,162 and 5735 underwent mammography alone and mammography with adjunctive ultrasonography, respectively. In the L group, the MG and MG + US groups did not significantly differ in terms of recall rate (1.9%, 95% CI 1.4-2.6 vs 1.9%, 1.2-2.9; p = 0.972). Moreover, the MG + US group had a higher cancer detection rate than the MG group. However, the difference was not significant (0.20%, 0.05-0.51 vs 0.63%, 0.25-1.29; p = 0.054). In the U group, the MG + US group had a significantly higher recall rate than the MG group (2.2%, 1.9-2.5 vs 2.9%, 2.5-3.4; p < 0.05). Nevertheless, there was no significant difference in the cancer detection rate (0.15%, 0.08-0.25 vs 0.28%, 0.15-0.48; p = 0.099).

Conclusions: To the best of our knowledge, this study first showed that breast size, in addition to breast composition, influences the accuracy of mammography and ultrasonography in breast cancer screening. Hence, screening methods tailored to individual breast characteristics should be considered.

Background: In Japan, biennial mammography screening has been recommended for the early detection of breast cancer (BC) in women aged 40 years or above since 2004 by the Ministry of Health, Labor and Welfare. The purpose of this study is to estimate the economic impact of BC screening on work productivity, using a new measure called the productivity-adjusted life-year (PALY).

Methods: We used a dynamic life table modeling approach to estimate the work productivity of female patients aged 40-64 years diagnosed with BC in 2019 over the year of diagnosis and the subsequent 5 years. Changes in life-years, PALYs, and gross domestic product (GDP) were assessed by changing the screening detection rate from the current (34.2%) to an ideal (100%) percentage. Each input for modeling was obtained from the most recent public database available.

Results: BC patients were estimated to lose 1903 in life-years, 3596 in PALYs, and US$281 million in GDP at the current screening detection rate compared with the ideal detection rate. On the other hand, the following gains are expected when the current screening detection rate was increased to 40-80%; life-years gain; 168-1325, PALYs gain; 317-2503, GDP gain: US$25-196 million.

Conclusion: This study has used modeling to show that detecting BC without screening is associated with a lower work productivity and an economic and life-years loss. Encouraging BC screening may be beneficial to maintaining work productivity after diagnosis.