Breast Cancer最新文献

Background: Although the demand for care immediately after mastectomy is rising, and such medical services are referred to as post-acute care (PAC), there is limited evidence on the factors influencing PAC choices among these patients in Korea.

Methods: A total of 106,670 patients diagnosed with breast cancer and undergoing mastectomy were extracted from the Central Cancer Registry data from 2012 to 2019 using Public Cancer Library data of KCURE. PAC was defined as utilization of long-term care hospital (LTCH), hospital-based nursing care (HBNC), or HBC (hospital-based care) within 2 months post-surgery. Multinomial logistic regression was used to identify factors associated with different types of PAC utilization.

Results: The utilization patterns of different types of PAC within 2 months after mastectomy were associated with age, income, cancer severity, and particularly the region of residence (Metropolitan; HBNC, OR 0.16, 95% CI 0.10-0.26; LTCH, OR 2.35, 95% CI 2.21-2.50; HBC, OR 2.17, 95% CI 1.97-2.39), as well as the location (capital areas; HBNC, OR 12.46, 95% CI 4.97-31.25; LTCH, OR 1.21, 95% CI 1.15-1.28; HBC, OR 1.90, 95% CI 1.74-2.07) and type of the hospital (tertiary hospital; HBNC, OR 13.70, 95% CI 7.86-23.86; LTCH, OR 1.45, 95% CI 1.37-1.53; HBC, OR 3.38, 95% CI 3.00-3.80) where the surgery was performed.

Conclusion: In this study, we found the factors associated with PAC utilization on mastectomy patients. Our study found that middle-aged breast cancer patients, residents of metropolitan or rural areas, and those who underwent surgery at hospitals in capital area were particularly associated with higher utilization of inpatient-related PAC services. Breast cancer patients with higher income, older adults, metropolitan residents, patients who underwent breast cancer surgery at metropolitan hospitals, and those treated at tertiary hospitals were strongly associated with higher utilization of HBNC services. Identifying factors that determine the use of PAC has meaningful implications for patients and healthcare systems.

Aim: To establish the histological categorization of tumor‑associated stroma (TAS) that reflects the biological behavior of triple-negative breast cancer (TNBC).

Methods and results: One-hundred-and-twenty surgically resected cases of TNBC were examined. We histologically categorized the TAS in the invasive frontal region into two groups: mature stroma (MS) and immature stroma (IS). The designation of IS was applied for tumors in which the largest myxoid stroma filled a high-power magnification field. When there were no myxoid stroma that meet the criteria for IS, TAS was categorized as MS. The tumors with type MS were observed in 103 (85.8%) of patients, whereas 17 (14.2%) of patients had tumors with IS. In total, 72 out of 120 patients with TNBC exhibited high tumor-infiltrating lymphocytes (TILs) representing 60% of the cohort. The incidences of high TILs were 66% (68 out of 103) in the MS group but only 23.5% (4 of 17) in the IS group (p = 0.001). Progression-free survival (PFS) and overall survival (OS) curves were different between IS and MS groups (p < 0.001 each), and Cox multivariate regression analysis revealed that IS was an independent indicator for lower PFS and OS rates (p < 0.001; p = 0.008).

Conclusion: Our findings suggest that TAS characteristics, particularly the distinction between IS and MS, play a significant role in the prognosis of TNBC. The presence of IS, associated with poor prognosis and low TILs, contrasts with the favorable outcomes observed in cases with MS. Understanding these TAS dynamics could aid in identifying patients with varying prognostic outcomes in TNBC, necessitating further research into the mechanisms behind these observations.

Purpose: Understanding individuals at high risk of breast cancer, as well as patients and survivors, underscores the critical role of genetic counseling in the diagnosis and treatment of breast cancer.

Methods: This systematic review adhered to the guidelines outlined in the Reporting Items for Systematic Review and Meta-Analysis (PRISMA). The review process was managed using Covidence systematic review software, facilitating data extraction according to predefined eligibility criteria by two independent reviewers. Quality appraisal and narrative synthesis were conducted following data extraction.

Results: Out of 1089 articles screened, nineteen (19) studies met the inclusion criteria and were included in this review. These studies were categorized into categories based on their relevance to breast cancer genetic counseling. Rapid Genetic Counseling and Testing (RGCT): 3 studies (15.78%), racial differences: 2 studies (10.52%), limited health literacy: 4 studies (21.05%), breast cancer survivorship: 3 studies (15.78%), risk perceptions and cancer worry: 5 studies (26.31%) and telephone delivery and computer aid programs: 2 studies (10.52%) based on specific focus areas of each study in relation to breast cancer genetic counseling.

Conclusion: Genetic counseling has shown to improve client outcomes across the majority of reviewed studies, contributing to the advancement of evidence-based practice in this field. However, to further promote evidence-based advancements in breast cancer genetic counseling, it is imperative to pay close attention to potential sources of bias and uphold rigorous quality standards in future research endeavors.

Background: The gastrointestinal microbiota can modulate systemic estrogens, potentially influencing estrogen-induced breast neoplasia development. This study aimed to assess alterations in the gut microbiota in breast cancer patients.

Methods: A search strategy was developed using the terms: "Microbiota," "Gastrointestinal Microbiome," "Breast Cancer," and synonyms. Ten observational studies were included.

Results: The total sample was 1730 women (929 cases and 801 controls). The meta-analysis of alpha diversity, assessed by the Shannon index, displayed that in the breast cancer group, the diversity of the gut microbiota was reduced compared to controls, with a standardized mean difference (SMD) of - 0.34 (95% CI - 0.59, - 0.10, I² = 68%, p = 0.007). Regarding the premenopausal population, there was a significant reduction in the breast cancer group (SMD - 0.67, 95% CI - 1.06, - 0.28, I² = 77%, p = 0.0009). In women with a body mass index (BMI) between overweight or obesity, no statistically significant difference was observed (SMD - 0.20; 95% CI - 0.51, 0.11; I² 52%, p = 0.20). However, in women with a BMI greater than or equal to 18.5 and less than 25.0, there was lower diversity in women with breast cancer compared to controls (SMD - 0.49, 95% CI - 0.94, - 0.04; I² 78%, p = 0.03).

Conclusions: The study found a significant difference in gut microbiota diversity between women with breast cancer and controls, supporting the growing evidence that the gut microbiota may play a role in mammary carcinogenesis.

Background: Neoadjuvant pembrolizumab plus chemotherapy and adjuvant pembrolizumab have been established as the optimal systemic therapies for patients with early stage triple-negative breast cancer (TNBC); however, their efficacy and feasibility in the Japanese population remain unexplored.

Methods: This study included patients with early stage TNBC or low estrogen receptor (ER) positivity (1-9%) with human epidermal growth factor receptor type 2- (HER2-) negative breast cancer who received neoadjuvant pembrolizumab plus chemotherapy from October 2022 at Cancer Institute Hospital of Japanese Foundation for Cancer Research. Information regarding clinicopathological features, systemic therapy, treatment outcomes, and adverse events of patients who underwent surgery by February 2024 was retrospectively collected.

Results: Overall, 69 patients received neoadjuvant pembrolizumab plus carboplatin and paclitaxel therapy, and 46 underwent surgery by February 2024. The median age of the patients was 53.5 years, and 80.4% and 19.6% had stage II and III disease, respectively. TNBC and ER-low HER2-negative breast cancer accounted for 82.6% and 17.4% cases, respectively. Overall pathological complete response rate was 56.5%, with 87.5% in patients with ER-low HER2-negative tumors. The completion rates for neoadjuvant pembrolizumab, chemotherapy, and pembrolizumab plus chemotherapy were 65.2%, 56.5%, and 52.2%, respectively. Furthermore, 80.4% and 15.2% of patients experienced grade 3 or higher treatment-related adverse events and immune-related adverse events, respectively, and 34% experienced unexpected hospitalization during neoadjuvant treatment.

Conclusions: The efficacy and safety profiles of neoadjuvant pembrolizumab plus chemotherapy in the Japanese population are consistent with previous reports. This regimen may have therapeutic potential against ER-low HER2-negative tumors and TNBC.

Background: In Japan, despite 5 years since CGP tests were covered by insurance in 2019, low drug accessibility rates remain a critical issue. We evaluated drug accessibility in 3776 breast cancer from the C-CAT database using two criteria: the proportion first linked to PMDA-approved drugs with phase III trial evidence for breast cancer through CGP tests but not existing Companion diagnostics [CDx] (*), and the proportion first linked to PMDA-approved drugs including based on phase I and II trial evidence (**). Additionally, cases linked to investigational drugs for non-PMDA-approved drugs were counted.

Methods: We identified the top 100 genetic alterations in Japanese breast cancer via CGP tests, listing corresponding drugs from C-CAT reports. Drug accessibility was re-evaluated through simulations with updated evidence levels by a member of the expert panel at Osaka University (EP-EL in OUH).

Results: Results showed the proportion improved to 28.4% under the newest EP-EL in OUH, including 3.4% for HER2-negative cases eligible for HER2-targeted therapy due to ERBB2 amplification and 25.0% for ER-positive, HER2-negative cases eligible for capivasertib-fulvestrant therapy due to PIK3CA, AKT1, and PTEN alterations (*). However, in part, initial false negatives for HER2 status and practical difficulties in using CGP tests as a CDx for capivasertib exist. Including mutations like TMB-H, MSI-H, BRAF V600E mutation, and NTRK fusions raised the proportion to 37.9% (**), but lacking drugs with phase III trials evidence.

Conclusion: These findings highlight the ongoing difficulties in demonstrating clear clinical utility of CGP tests in Japan, emphasizing the need for broad discussions on its future direction.

Although the prognosis of breast cancer has significantly improved compared to other types of cancer, there are still some patients who expire due to recurrence or metastasis. Therefore, it is necessary to develop a method to identify patients with poor prognosis at the early stages of cancer. In the process of discovering new prognostic markers from genes of unknown function, we found that the expression of C1orf50 determines the prognosis of breast cancer patients, especially for those with Luminal A breast cancer. This study aims to elucidate the molecular role of C1orf50 in breast cancer progression. Bioinformatic analyses of the breast cancer dataset of TCGA, and in vitro analyses, reveal the molecular pathways influenced by C1orf50 expression. C1orf50 knockdown suppressed the cell cycle of breast cancer cells and weakened their ability to maintain the undifferentiated state and self-renewal capacity. Interestingly, upregulation of C1orf50 increased sensitivity to CDK4/6 inhibition. In addition, C1orf50 was found to be more abundant in breast cancer cells than in normal breast epithelium, suggesting C1orf50's involvement in breast cancer pathogenesis. Furthermore, the mRNA expression level of C1orf50 was positively correlated with the expression of PD-L1 and its related factors. These results suggest that C1orf50 promotes breast cancer progression through cell cycle upregulation, maintenance of cancer stemness, and immune evasion mechanisms. Our study uncovers the biological functions of C1orf50 in Luminal breast cancer progression, a finding not previously reported in any type of cancer.

Background: In ER + /HER2- early breast cancer (BC), 21-Gene Recurrence Score (RS) > 25 indicates high-risk of distant-recurrence and predicts benefit from adjuvant chemotherapy (aCT) regardless of tumor-size. However, T1a/b (≤ 1 cm) node-negative (N0) tumors, regarded as of low risk of recurrence, were under-represented in the RS trials. We therefore aimed to investigate the benefit of aCT in patients with T1a/bN0 BC, RS > 25, where clinical and genomic risk indicators are discordant.

Methods: This retrospective observational cohort study utilized Israel's national Oncotest database to identify Clalit Health Services (CHS) members, diagnosed with T1a/bN0 HR + /HER2- BC, who underwent RS testing between February 2006, and December 2019. Patients with RS > 25 who received aCT were matched 1:1 by propensity-scoring to similar patients receiving no aCT. Invasive disease-free survival (iDFS) and distant recurrence were the study endpoints. Patient demographic and clinical data were obtained from CHS's centralized database. Kaplan--Meier analysis with log-rank testing was used for comparing outcomes.

Results: During the study period, high-risk RS result (> 25) was identified in 156/9858 patients of the study cohort. aCT was administered to 74 (47.4%) and median follow-up was 121 months. Within the 148 matched-cases, eighteen iDFS-events occurred, nine (12.1%) in each group (χ² = 0.72, p = 0.39). Four (5.4%) of the aCT treated and three (4.0%) of the untreated patients were diagnosed with distant recurrence (χ² = 0.22, p = 0.64).

Conclusions: In this study cohort, patients with T1a/bN0 BC, RS > 25 that received aCT, did not have improved outcomes and the 21-Gene RS > 25 was not found to be predictive, possibly due to the low number of events observed.

Breast cancers (BCs) are frequently linked to an immunosuppressive microenvironment that facilitates tumor evasion of anti-cancer immunity. The cells that suppress the immune system such as regulatory B cells (Bregs), regulatory T cells (Tregs), tumor-associated macrophages (TAMs), tumor-associated neutrophils (TANs), myeloid-derived suppressor cells (MDSCs), play a crucial role in immune resistance. Also, tumor progression and immune evasion of cancers are facilitated by cytokines and factors released by tumor cells or immunosuppressive cells. Targeting these regulatory cells therapeutically, whether through elimination, inactivation, or reprogramming, has resulted in hopeful anti-tumor reactions. Yet, the substantial diversity and adaptability of these cells, both in terms of appearance and function, as well as their variation over time and depending on where they are in the body, have posed significant challenges for using them as reliable biomarkers and creating focused therapies that could target their creation, growth, and various tumor-promoting roles. The immunotherapy approaches in BC and their effectiveness in treating certain subtypes are still in their initial phases. In this review, we thoroughly outlined the characteristics, roles, and possible treatment options for these immune-suppressing cells in the tumor environment.

Background: In this study, we aimed to evaluate color differences of the skin paddle in autologous breast reconstruction performed using the deep inferior epigastric artery perforator (DIEP) flap and the profunda artery perforator (PAP) flap. The primary focus was to compare the color match between the reconstructed breast skin and the donor-site skin, to achieve optimal esthetic results.

Methods: A retrospective analysis was performed on patients who had undergone unilateral breast reconstruction with a DIEP flap or a PAP flap between January 2020 and December 2022. The colors were captured using a digital camera and analyzed using Adobe Photoshop 2024 software. The L*, a*, and b* coordinates were used. The International Commission on Illumination Delta E 2000 (CIEDE2000) score was used to quantify color differences, comparing skin tones of the unaffected breast, DIEP flap, PAP flap, abdomen, and medial thigh.

Results: A total of 125 patients were analyzed. The DIEP flap demonstrated a closer color match to the native breast skin compared with the PAP flap (CIEDE2000 scores, 5.29 vs. 8.69, p < 0.01). No significant difference in color deformity with time was found between the DIEP flap and the PAP flap (CIEDE2000 scores, 5.61 vs. 8.25, p = 0.17).

Conclusion: Our findings suggest that the DIEP flap results in a more favorable color match for breast reconstruction than the PAP flap, enhancing esthetic outcomes. These results underscore the importance of considering skin color matching in flap selection for breast reconstruction surgery.