Breast Cancer最新文献

Background: For breast cancer patients, postoperative lymphedema and upper limb movement disorders are serious complications that absolutely reduce their quality of life (QOL). To evaluate this serious complication, we used "Quick Dash" or "FACT-B", which can assess a patient's physical, social, emotional, and functional health status. To evaluate their breast cancer surgery-related dysfunction correctly, "FACT-B + 4" was created by adding four questions about "arm swelling'' and "tenderness". We have translated it into Japanese according to international translation guidelines.

Methods: At the beginning, we contacted FACT headquarters that we would like to create a Japanese version of FACT-B + 4. They formed the FACIT Trans Team (FACIT) following international translation procedures, and then, we began translating according to them. The steps are 1: perform "Forward and Reverse translations" to create a "Preliminary Japanese version", 2: request the cooperation of 5 breast cancer patients and "conduct a pilot study" and "questionnaire survey", and 3: amendments and final approval based on pilot study results and clinical perspectives.

Result: In Step1, FACIT requested faithful translation of the words, verbs, and nouns from the original text. In Step2, patients reported that they felt uncomfortable with the Japanese version words such as "numb'' and "stiffness'' and felt that it might be difficult to describe their symptoms accurately. In Step3, we readjusted the translation to be more concise and closer to common Japanese language, and performed "Step1" again to ensure that the translation definitely retained the meaning of the original.

Conclusion: A Japanese version of FACT has existed until now, but there was no Japanese version of FACT-B + 4, which adds four additional items to evaluate swelling and pain in the upper limbs. This time, we have created a Japanese version that has been approved by FACT.

Background: Upper extremity impairments in patients with breast cancer persist after curative surgery. Although postoperative factors associated with upper extremity impairments have been reported, modifiable factors affecting these impairments preoperatively remain unclear. This study aimed to investigate the relationship between preoperative grip strength and postoperative upper extremity impairments in patients with breast cancer.

Methods: This retrospective cohort study included patients (age ≥ 18 years) with breast cancer who underwent mastectomy. Maximum grip strength was measured on the day before surgery. Upper extremity impairments were assessed 4-16 months after surgery using the Disabilities of the Arm, Shoulder and Hand (DASH) scale. Multiple linear regression analysis was used to evaluate the association between preoperative grip strength and postoperative upper extremity impairments.

Results: In total, 72 patients were included in the analysis. Multiple linear regression analysis showed that preoperative grip strength was significantly associated with the postoperative DASH score after adjusting for confounding factors (β = - 1.27, 95% confidence interval - 2.08 to - 0.48, p = 0.002).

Conclusions: This study showed that low preoperative grip strength is a risk factor for postoperative upper extremity impairments in patients with breast cancer. Providing prehabilitation to maintain and improve muscle strength immediately after diagnosis is important. Moreover, an individualized follow-up protocol according to preoperative screenings to prevent postoperative upper extremity impairments is necessary.

Background: Previous studies have indicated a connection between resilience and cognitive function, but critical gaps persist regarding limited data exploring the relationship between resilience profiles and cognition using person-centered methodologies, especially in the context of breast cancer patients.

Objectives: While the general correlation between resilience and cognitive function is known, how various resilience profiles impact cognitive function in breast cancer patients remains unclear. The study aimed to identify resilience profiles and explore the relationship with cognitive function in breast cancer (BC) patients.

Methods: This study was a cross-sectional study in descriptive research. BC patients (n = 425) from a tertiary oncology hospital completed the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scale and Connor-Davidson Resilience Scale (CD-RISC- 25). Latent profile analysis was adopted to identify subgroups of patients with distinct resilience profiles according to model fit indices. An ANOVA analysis and Chi-square test were also employed.

Results: Three profiles were identified, including Class 3, "High resilience-positive coping group" (n = 187, 44.7%), Class 2, "Medium resilience-effort regulation group" (n = 157, 37.6%), and Class 1, "Low resilience-negative coping" (n = 74, 17.7%). The results demonstrate that perceived cognitive impairment (CogPCI), other people's appraisal (CogOth), perceived cognitive ability (CogPCA), impact on quality of life (CogQOL), and FACT-Cog were significant differences in all three potential latent resilience profiles (P < 0.001). The CogPCI and FACT-Cog scores in Class 3 were the best, while Class 1 was the lowest.

Conclusion: The psychological resilience profile contains three classes, and the findings provide evidence that high resilience potentially serves as a crucial protective factor for cognitive function in BC patients. Healthcare providers should improve their ability to recognize and evaluate factors influencing resilience, including social support and physical activity, which will enable the development of precise nursing interventions to mitigate the long-term adverse effects of trauma and reduce the impact of cognitive impairment on BC patients.

Background: To enhance patient outcomes, we previously developed "Hibilog", an app that allows patients to report symptoms electronically. The paper-based Symptom Illustration Scale (SIS) was adapted using stickers and emojis to evaluate patient-reported outcomes (PROs). This study aimed to validate SIS within an electronic PRO monitoring environment for metastatic breast cancer patients undergoing chemotherapy.

Methods: The patients used the Electronic Patient-Reported Outcomes Monitoring (ePROM) "Hibilog" application to answer a questionnaire consisting of 18 items selected from the Patient-Reported Outcome-Common Terminology Criteria for Adverse Events (PRO-CTCAE), focusing on symptoms related to breast cancer treatment, along with the corresponding SIS questionnaire. Symptom monitoring began upon registration and continued every two weeks until the completion of the study. The primary outcome was the criterion-related validity of the SIS against PRO-CTCA using the ePROM. The secondary endpoints included the response rate, response time, and missing rates for each item.

Results: Patients (n = 75) were registered between September 2019 and March 2020. For criterion validity, the Spearman rank correlation coefficients between the PRO-CTCAE and SIS items showed high correlations (rs ≥ 0.41) for all 18 items. The κ correlation coefficient indicated a high correlation (κ > 0.41) in 11 of the 18 items (61.1%), unlike the correlation with continuous variables. In terms of response and missing rates, the SIS in ePROM demonstrated similarly high performance as our results. Additionally, the average response time was 3.0 min (SD 4.2) for SIS, with a substantially shorter response time.

Conclusion: We conclude that SIS is a useful tool in an ePROM environment for patients with MBC undergoing chemotherapy. The clinical utility of SIS in an ePRO environment needs to be validated to develop a more accurate scale for capturing patient symptoms.

Background: In recent years, the age range of patients undergoing breast reconstruction has expanded. Establishment of the influence of the age of a patient with breast cancer on the level of regret after breast reconstruction could assist in decision-making across age groups at the time of choice of options for breast cancer surgery.

Objectives: The objective of the study is to investigate the current age distribution of patients undergoing treatment for breast cancer in Japan through a multicenter collaborative study, and to examine the impact of age on post-surgical decision regret, analyzed by type of surgical procedure.

Methods: A multicenter observational retrospective study was conducted in 576 patients who were diagnosed with breast cancer pathologically and underwent mastectomy (Bt), breast-conserving surgery (Bc) or breast reconstruction (Br). Demographic and outcome data were collected and the level of regret concerning the surgical decision was surveyed using the Decision Regret Scale (DRS) across the different patient groups.

Results: The average age of the Bt group was significantly higher than those in the Bc and Br groups. The level of regret was slightly but significantly higher in the Br group compared to the other groups. Regression analysis of the relationship between age and DRS scores indicated that reconstruction is associated with an increase of about 5 points in the DRS score. This analysis also revealed that the DRS score slightly increases with advancing age, regardless of the surgical method.

Conclusions: In reconstruction cases, addition of new surgical procedures may lead to more complications, which might have slightly increased regret; however, the increase was not significant. Thus, although more cautious surgical criteria are desirable for older patients, age alone should not be a deterrent to opting for breast reconstruction.

Background: The Medical Imaging Projection System (MIPS) projects fluorescence ICG images on the surgical field. In this study, we aimed to assess sentinel lymph node (SLN) identification by the MIPS in patients with and without neoadjuvant chemotherapy (NAC) administration and compare the utility of the MIPS with the radioisotope (RI) method.

Methods: We retrospectively reviewed medical records of patients with primary breast cancer who underwent SLN biopsy using the MIPS at Kyoto University Hospital between April 2020 and December 2024. The primary endpoint was the identification rate of SLNs. The secondary endpoints included the number of positive SLNs and SLNs detected per patient.

Results: The analysis included 470 procedures (448 patients), of which 56 (11.9%) were conducted after NAC. The identification rate of SLNs by the MIPS was 99.6% (95% confidence interval [CI], 98.5-99.9) in all procedures and 98.2% (95% CI, 90.6-99.7) after NAC. The median number of SLNs identified per patient was 3 (range, 2-4) by the MIPS and 2 (range, 1-3) by the RI method (P < 0.001). No significant difference was observed in the number of SLNs between patients who received NAC and those who did not (3 vs 3, P = 0.84). Seventy-eight positive SLNs were excised, all of which were accurately identified by the MIPS.

Conclusions: This study suggested that the identification rate of SLNs by the MIPS was high regardless of the presence or absence of preceding systemic chemotherapy.

Background: Patients with early recurrence of hormone receptor (HR)-positive, HER2-negative (HR+/HER2-) breast cancer have a poor prognosis. We aimed to identify clinical and pathological risk factors for recurrence within three years after surgery of HR+/HER2- breast cancer.

Methods: We retrospectively reviewed clinical data of patients with stage II-III HR+/HER2- breast cancer who received adjuvant endocrine therapy from January 1, 2012 to January 1, 2017 at five institutions. Using univariable and multivariable analyses, we determined risk factors for invasive disease-free survival (IDFS). A nomogram was generated using variables from the multivariable analysis to predict 3-year IDFS rate.

Results: A total of 2732 patients were analyzed, with a median follow-up of 7.1 years. The 3-year IDFS rate was 92.1%. Multivariable analysis for IDFS revealed significant risk factors: age (40-69 vs. 20-39 years: HR 0.69, p = 0.011), nuclear grade (Grade 2 vs. Grade 1: HR 1.66, p < 0.001; Grade 3 vs. Grade 1: HR 1.64, p < 0.001), vascular invasion (Yes vs. No: HR 1.36, p = 0.027), pathological invasive tumor size (2-5 cm vs. < 2 cm: HR 1.75, p < 0.001; ≥ 5 cm vs. < 2 cm: HR 2.07, p < 0.001), number of positive lymph nodes (≥ 4 vs.0: HR 1.70, p < 0.001), and neoadjuvant chemotherapy (NAC) (Yes vs. No: HR 2.41, p < 0.001). The nomogram's concordance index was 0.68.

Conclusion: Younger age, nuclear grade, vascular invasion, tumor size and number of lymph node metastases were identified as independent risk factors for early recurrence. Patients whose physicians chose NAC had worse survival than those who did not.

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: ATPase copper transporting beta (ATP7B) functions as a copper-transporting ATPase that ejects copper from cells. Although high expression of ATP7B has been reported to increase cisplatin resistance, its role in breast cancer (BC) remains unclear. This study aimed to elucidate the function of ATP7B in BC cells and its significance in patients with BC.

Methods: The mRNA and protein expression levels of ATP7B were evaluated in BC and non-cancerous mammary cell lines. Polymerase chain reaction (PCR) array analysis was conducted to determine the correlation between ATP7B and 84 cancer-related genes. ATP7B knockdown was performed using small interfering RNA, and cell proliferation, invasiveness, and migration were analyzed. The associations between the mRNA and protein expression of ATP7B and clinicopathological factors were also investigated in 156 patients with BC.

Results: ATP7B was found to be highly expressed in estrogen receptor-positive and human epidermal growth factor receptor 2-positive BC cell lines. PCR array analysis revealed a significant correlation between the expression level of ATP7B and those of cadherin 1, estrogen receptor 1, and MET proto-oncogene. ATP7B knockdown significantly increased the proliferation, invasiveness, and migration of MDA-MB-361 and MDA-MB-415 cells. Patients with high ATP7B expression at the mRNA and protein levels experienced favorable prognoses. In addition, ATP7B expression level was identified as an independent prognostic factor in multivariate analysis.

Conclusions: ATP7B is involved in promoting anti-cancer activities of tumor suppressors in BC cells across different subtypes and is considered a prognostic marker for BC.