Breast Cancer最新文献

Purpose: Different surgical options existed in the management of axilla among breast cancer patients who were initially node-positive and were converted node-negative after neoadjuvant systemic treatment (NST). De-escalation of axillary surgery was feasible, but previous studies focused on the false-negative rate (FNR) of respective procedures. The aim of this study is to evaluate the oncological outcomes of sentinel lymph-node biopsy (SLNB), MARI procedure, and targeted axillary dissection (TAD).

Patients and methods: PubMed, Embase, and the Cochrane library literature databases were searched systematically. Studies were eligible if they addressed the axillary recurrence rate of patients with nodal pathological complete response (pCR) and omission of axillary lymph-node dissection (ALND) after NST. Pooled analysis was performed using inverse variance methods for logit transformed proportions.

Results: Eleven retrospective studies and three prospective studies involving 4268 patients with node-positive breast cancers were included. A total of 1650 patients achieved nodal pCR and avoided ALND, 1382 patients with SLNB only and 268 patients with MARI/TAD. The pooled estimate of axillary recurrence was 2.1% (95%CI 1.4-3.2%) for patients with negative SLNB and 1.5% (95% CI 0.5-4.1%) for patients with negative MARI/TAD. There was no significant benefit of ALND over SLNB in patients with nodal pCR after NST. Pooled estimates of 5-year DFS, DDFS, and OS of SLNB alone were 0.87 (95% CI 0.83-0.90], 0.90 (95% CI 0.88-0.92), and 0.92 (95% CI 0.88-0.94), respectively.

Conclusion: Breast cancer patients who are converted node-negative after NST have extremely low nodal recurrence rate, irrespective of the choice of axillary surgery. Omission of ALND is oncologically safe in patients who have nodal pCR after NST.

Background: Recently, we reported the real-world effectiveness of palbociclib plus endocrine therapy (ET) in HR+/HER2- advanced breast cancer (ABC) in Japan (NCT05399329). However, median overall survival (OS) was not reached because of limited follow-up (36 months). Here, we present follow-up data from this study, including real-world clinical outcomes and treatment patterns.

Methods: The P-BRIDGE study was a multi-center, observational study evaluating the real-world effectiveness and treatment patterns of patients diagnosed with HR+/HER2- ABC who received palbociclib plus ET in first (1L) or second line (2L) in Japan. The primary endpoint was real-world progression-free survival (rwPFS); secondary endpoints included OS and chemotherapy-free survival (CFS).

Results: Of the 693 eligible patients, 426 and 267 patients received palbociclib with ET as 1L and 2L treatment, respectively. After a median follow-up of 48.1 months, the median rwPFS (95% CI) was 26.2 months (21.4-30.4) for 1L and 14.9 months (11.7-18.3) for 2L, respectively. Median OS (95% CI) was 68.2 months (60.8-NE) for 1L and 50.7 months (42.2-57.2) for 2L, respectively. OS analysis was also performed in the following subgroups: TFI < 12 months/TFI ≥ 12months/de novo metastatic median OS was 56.3 months (43.9-68.2), NR (NE-NE), NR (56.3-NE), visceral metastasis was 65.0 months (56.3-NE), liver metastasis was 46.4 months (37.2-NE), and bone only metastasis was NR (57.8-NE) in 1L, respectively.

Conclusions: The updated results from this study further confirm the real-world effectiveness of palbociclib plus ET in routine clinical practice in Japan. More than 5 years of median OS in 1L was observed, supporting the use of palbociclib plus ET as 1L standard of care for HR+/HER2- ABC.

Background: Observational studies have showed a strong association between bioavailable testosterone (BT) and breast cancer. However, the role of genetic factors in their comorbidity remains unknown.

Methods: Using large genome-wide association study (GWAS) data, we employed linkage disequilibrium score regression (LDSC) to identify the breast cancer subtype most genetically correlated with BT. We then constructed the shared genetic architecture between BT and this subtype by: (1) applied Heritability Estimation from Summary Statistics for local genetic correlations and stratified-LDSC for partitioned heritability; (2) performed a cross-trait GWAS meta-analysis to find novel single-nucleotide polymorphism (SNP) and validated through colocalization; (3) conducted both cross-tissue and single-tissue transcriptome-wide association studies (TWAS) and validated the candidate genes through Mendelian randomization (MR); (4) investigated SNP-heritability enrichment at the gene set, tissue, and cell levels using Multi-marker Analysis of GenoMic Annotation.

Results: Luminal A breast cancer (Luminal ABC) was selected as it is a common subtype of breast cancer and demonstrates a superior genetic correlation with BT. We identified strong local correlations in 132 distinct genomic regions and confirmed shared SNPs including rs1432679 and rs7175852. TWAS highlighted two pleiotropic genes, MICALL1 and TRIOBP, with TRIOBP validated by MR. We also found six shared pathways and luminal cells in mammary gland pregnancy shared between BT and Luminal ABC. For tissue-specific enrichment, BT was mainly found in the liver and adrenal gland, whereas Luminal ABC was found in the minor salivary gland.

Conclusions: This study sheds light on the genetic architecture of BT and Luminal ABC and suggests new avenues for research and therapy.

Background: The area of residual tumor (ART) is a quantitative method for assessing tumors after neoadjuvant chemotherapy (NAC). This study evaluated whether ART can identify a favorable prognosis group in patients with HER2-positive surgically resected breast cancer and residual tumors post-NAC.

Methods: We retrospectively reviewed patients with HER2-positive who underwent surgery after NAC, including trastuzumab, from 2005 to 2022 at our institution. ART was assessed at the maximum cut surface of the residual primary tumor using digital pathology images. Receiver operating characteristic curve analysis determined ART-Low and ART-High cutoffs, excluding ART-0 (0 mm²) patients.

Results: Of the 219 patients, 82 had ART greater than 0 mm². The median follow-up was 90.2 months. The number of patients in the ART-0, ART-Low (0 < ART ≤ 4.0 mm²), and ART-High (> 4.0 mm²) groups were 137, 39, and 43, respectively. The ART-Low group showed significantly shorter event-free survival compared to the ART-0 group (HR 3.50, 95% CI 1.52-8.06), and the ART-High group also tended toward poorer prognosis (HR 2.31, 95% CI 0.89-5.97). However, there was no significant difference in prognosis between the ART-Low and ART-High groups.

Conclusions: The current study suggests that even minimal residual tumor cells in the primary site can significantly impact on prognosis in HER2-positive early breast cancer.

Background: The standard approach for breast cancer-related lymphedema (BCRL) is Complex Decongestive Therapy. This therapy involves various components, including the use of compression bandages to reduce swelling. Among these, multilayer bandage is the most frequently applied bandage in these patients. Nevertheless, alternative bandaging methods may also be effective. The current systematic review and meta-analysis of randomized-controlled trials (RCTs) aimed to compare the effectiveness of different bandaging techniques in patients with BCRL.

Methods: A search was conducted in PubMed, Web of Science, and Scopus to identify RCTs that analyzed different bandaging techniques in patients with BCRL. The methodological quality of the RCTs was assessed using the Physiotherapy Evidence Database (PEDro). The meta-analysis was performed using RevMan 5.4 software, with standardized mean differences (SMDs) calculated by comparing change scores and standard deviations between intervention and control groups. This study was registered in PROSPERO (CRD42024597170).

Results: A total of 21 RCTs were included in the systematic review (n = 1122) and five could be meta-analyzed (n = 239). The meta-analysis did not reveal significant differences in the reduction of the affected arm volume among different bandaging techniques, including multilayer, kinesio-taping, cohesive, and alginate bandage [SMD = - 0.04, 95% confidence interval - 0.30 to 0.21; p = 0.750; I² = 0%].

Conclusions: The current scientific evidence does not suggest a clear advantage of one bandaging technique over another, including kinesio-taping and multilayer bandages. Further studies with larger sample sizes are warranted to better understand their potential benefits across the different stages and phases of BCRL management.

Background: This study evaluates the reproducibility of the IRSN-23 model, which classifies patients into highly chemotherapy-sensitive (Gp-R) or less-sensitive (Gp-NR) groups based on immune-related gene expression using DNA microarray analysis, and its impact on breast cancer subtype classification.

Methods: Tumor tissues from 146 breast cancer patients receiving neoadjuvant chemotherapy (paclitaxel-FEC) ± trastuzumab at Osaka University Hospital (OUH) were used to classify patients into Gp-R or Gp-NR using IRSN-23. The ability to predict a pathological complete response (pCR) was assessed and the results were validated with independent public datasets (N = 1282).

Results: In the OUH dataset, the pCR rate was significantly higher in the Gp-R group than in the Gp-NR group without trastuzumab (29 versus 1%, P = 1.70E-5). In all validation sets without anti-HER2 therapy, the pCR rate in the Gp-R group was significantly higher than that in the Gp-NR group. The pooled analysis of the validation set showed higher pCR rates in the Gp-R group than in the Gp-NR group, both without (N = 1103, 40 versus 12%, P = 2.02E-26) and with (N = 304, 49 versus 35%, P = 0.017) anti-HER2 therapy. Collaboration analyses of IRSN-23 and Oncotype Dx or PAM50 could identify highly chemotherapy-sensitive groups and refine breast cancer subtype classification based on the tumor microenvironment (offensive factor-PAM50 and defensive factor-IRSN-23), and the immune subtype was correlated with a better prognosis after NAC.

Conclusions: This study offers new validation analyses of IRSN-23 in predicting chemotherapy efficacy, showing high reproducibility. The findings indicate the clinical value of using IRSN-23 for refining breast cancer subtype classification, with implications for personalized treatment strategies and improved patient outcomes.

Purpose: The radiotherapy categorical anxiety scale (RCAS) was designed to evaluate the specific types of radiation therapy (RT)-related anxiety in cancer patients. We translated RCAS into Chinese, evaluated its reliability and validity in breast cancer (BC) patients, and used it to evaluate changes in specific types and levels of RT-related anxiety throughout RT.

Methods: This was a prospective, longitudinal study enrolling 504 Chinese BC patients receiving RT. The patients completed questionnaires assessing the specific types of RT-related anxiety (our Chinese version of RCAS), depression [Patient Health Questionnaire-9 (PHQ-9)], and anxiety [Generalized Anxiety Disorder-7 (GAD-7)] before, during, and after RT. Emotional distress (ED) was defined as a PHQ-9 or GAD-7 score of > 4. Generalized estimating equation was performed to evaluate changes in total and subscale scores on RCAS. Multivariable general linear models were used to explore independent predictors of baseline RCAS scores.

Results: Our Chinese version of RCAS demonstrated high internal consistency (Cronbach's α = 0.89-0.92). Our data demonstrated a Kaiser-Meyer-Olkin measure of 0.946 and P < 0.001 on the Bartlett sphericity test, indicating their suitability for subsequent confirmatory factor analysis (CFA). CFA further demonstrated its adequate convergent and discriminant validity. The levels of anxiety related to RT environment decreased over time, whereas those of anxiety related to RT treatment efficacy remained stable throughout the treatment. Patients demonstrated higher scores on items regarding side effects and treatment efficacy of RT than on other items. ED before RT independently predicted for higher baseline RCAS score.

Conclusions: Our Chinese version of the RCAS can be used to quantitatively evaluate specific types of RT-related anxiety in Chinese BC patients. Clinicians should pay more attention to anxiety regarding the side effects and treatment efficacy of RT reported by their patients, particularly those with baseline ED.