Pub Date : 2026-02-01Epub Date: 2025-12-23DOI: 10.1016/j.breast.2025.104684
Manfred Welslau , Peter A. Fasching , Nicole Semmler-Lins , Lothar Mueller , Erik Belleville , Lorenz Rieger , Sabrina Uhrig , Mark-Oliver Zahn , Benno Lex , Christoph Uleer , Natalija Deuerling , Tobias Hesse , Dagmar Langanke , Lothar Häberle , Hans Tesch
Introduction
Therapy adherence is critical, particularly for patients with breast cancer undergoing oral endocrine therapies. The use of combination regimes, such as CDK4/6 inhibitors, has introduced additional side effects, which can affect adherence. A structured patient coaching and communication tool may positively affect therapy adherence.
Pub Date : 2026-02-01Epub Date: 2025-12-22DOI: 10.1016/j.breast.2025.104683
Michel Gabriel Cazenave , Leslie Elahi , Katia Mahiou , Claire Bonneau , Ornella Ammendola , Louise Benoit
Abemaciclib, a CDK4/6 inhibitor, has emerged as a pivotal therapy in hormone receptor–positive, HER2-negative breast cancer, including in the adjuvant setting for high-risk early disease. Its integration into long-term oncologic strategies poses new challenges for peri-operative management, particularly in the context of secondary breast reconstruction. Preclinical studies suggest impaired wound healing potential, while clinical data highlight an increased risk of venous thromboembolism. No study to date has specifically addressed surgical outcomes under abemaciclib therapy. We call for the need of a clinical trial in abemaciclib perioperative management and propose pragmatic peri-operative strategies to optimize patient safety without compromising oncologic benefit.
{"title":"How should we manage abemaciclib in the peri-operative period during secondary breast reconstruction: balancing oncologic benefit and surgical safety","authors":"Michel Gabriel Cazenave , Leslie Elahi , Katia Mahiou , Claire Bonneau , Ornella Ammendola , Louise Benoit","doi":"10.1016/j.breast.2025.104683","DOIUrl":"10.1016/j.breast.2025.104683","url":null,"abstract":"<div><div>Abemaciclib, a CDK4/6 inhibitor, has emerged as a pivotal therapy in hormone receptor–positive, HER2-negative breast cancer, including in the adjuvant setting for high-risk early disease. Its integration into long-term oncologic strategies poses new challenges for peri-operative management, particularly in the context of secondary breast reconstruction. Preclinical studies suggest impaired wound healing potential, while clinical data highlight an increased risk of venous thromboembolism. No study to date has specifically addressed surgical outcomes under abemaciclib therapy. We call for the need of a clinical trial in abemaciclib perioperative management and propose pragmatic peri-operative strategies to optimize patient safety without compromising oncologic benefit.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104683"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-22DOI: 10.1016/j.breast.2025.104679
Christian F. Singer , Franz Koenig , Stephanie Kacerovsky-Strobl , Sabine Danzinger , Christine Brunner , Christoph Suppan , Christine Deutschmann , Marija Balic , Richard Greil , Daniel Egle , Evandro de Azambuja , Serena Di Cosimo , Anup Choudhury , Michael Gnant
Purpose
In early breast cancer, HER2-directed therapies are approved for the treatment of patients with HER2-positive invasive breast cancer as defined by HER2 protein overexpression, or HER2 gene amplification with HER2/CEP17 ratios ≥2.2. Beyond this cut-off, however, it is unknown whether the efficacy of HER2-directed therapy improves with increasing HER2/CEP17 ratios. We evaluated whether quantitative assessment of the HER2/CEP17 ratio predicts pathological complete response (pCR) and event-free survival (EFS) in patients treated with neoadjuvant HER2-based regimen in the prospective phase III NeoALTTO trial.
Patients and methods
455 women with HER2-positive early breast cancer, who had received neoadjuvant trastuzumab and/or lapatinib, together with 12 cycles of weekly paclitaxel, were included in this analysis. The HER2/CEP17 ratio in the primary tumor samples was correlated with pCR and survival outcome.
Results
The median HER2/CEP17 ratio was 5.1 (range: 1.1–100.0), and ratios were not associated with age, hormone receptor (HR) status, or any other clinicopathological variable analyzed. The log HER2/CEP17 ratio significantly predicted pCR in both univariate (OR: 1.83; 95 % CI: 1.11–3.01, p = 0.0176) and multivariate analysis (OR: 1.79; 95 % CI: 1.07–2.99, p = 0.0257). Higher HER2/CEP17 ratios were, however, not associated with improved EFS (adjusted HR = 0.795; p = 0.3537). A pCR prediction model including HER2/CEP17 ratio, treatment arm, and HR status improved the predictive strength of treatment arm alone from a ROC AUC value of 0.60–0.69.
Conclusion
In patients treated with HER2-based neoadjuvant therapy, quantitative analysis of the readily available pretreatment HER2/CEP17 ratio by FISH is predictive of pCR.
目的：在早期乳腺癌中，HER2定向疗法被批准用于治疗HER2蛋白过表达或HER2基因扩增且HER2/CEP17比值≥2.2的HER2阳性浸润性乳腺癌患者。然而，在这个临界值之外，目前尚不清楚HER2/CEP17比值的增加是否会提高HER2定向治疗的疗效。在前瞻性III期NeoALTTO试验中，我们评估了HER2/CEP17比率的定量评估是否能预测基于HER2的新辅助方案治疗的患者的病理完全缓解（pCR）和无事件生存期（EFS）。患者和方法：455名her2阳性早期乳腺癌患者接受了新辅助曲妥珠单抗和/或拉帕替尼，以及每周12个周期的紫杉醇治疗，纳入本分析。原发肿瘤样本中HER2/CEP17比值与pCR和生存结局相关。结果：中位HER2/CEP17比值为5.1（范围：1.1-100.0），该比值与年龄、激素受体（HR）状态或任何其他临床病理变量分析无关。log HER2/CEP17比值在单因素分析（OR: 1.83; 95% CI: 1.11-3.01, p = 0.0176）和多因素分析（OR: 1.79; 95% CI: 1.07-2.99, p = 0.0257）中均显著预测pCR。然而，较高的HER2/CEP17比率与改善的EFS无关（调整后的HR = 0.795; p = 0.3537）。包含HER2/CEP17比值、治疗组和HR状态的pCR预测模型从0.60-0.69的ROC AUC值提高了单独治疗组的预测强度。结论：在接受基于HER2的新辅助治疗的患者中，通过FISH定量分析现成的预处理HER2/CEP17比值可预测pCR。
{"title":"HER2/CEP17 ratio is associated with pCR after HER2-directed neoadjuvant treatment in the phase III NeoALTTO trial","authors":"Christian F. Singer , Franz Koenig , Stephanie Kacerovsky-Strobl , Sabine Danzinger , Christine Brunner , Christoph Suppan , Christine Deutschmann , Marija Balic , Richard Greil , Daniel Egle , Evandro de Azambuja , Serena Di Cosimo , Anup Choudhury , Michael Gnant","doi":"10.1016/j.breast.2025.104679","DOIUrl":"10.1016/j.breast.2025.104679","url":null,"abstract":"<div><h3>Purpose</h3><div>In early breast cancer, HER2-directed therapies are approved for the treatment of patients with HER2-positive invasive breast cancer as defined by HER2 protein overexpression, or <em>HER2</em> gene amplification with <em>HER2/CEP17</em> ratios ≥2.2. Beyond this cut-off, however, it is unknown whether the efficacy of HER2-directed therapy improves with increasing <em>HER2/CEP17</em> ratios. We evaluated whether quantitative assessment of the <em>HER2/CEP17</em> ratio predicts pathological complete response (pCR) and event-free survival (EFS) in patients treated with neoadjuvant HER2-based regimen in the prospective phase III NeoALTTO trial.</div></div><div><h3>Patients and methods</h3><div>455 women with HER2-positive early breast cancer, who had received neoadjuvant trastuzumab and/or lapatinib, together with 12 cycles of weekly paclitaxel, were included in this analysis. The <em>HER2/CEP17</em> ratio in the primary tumor samples was correlated with pCR and survival outcome.</div></div><div><h3>Results</h3><div>The median <em>HER2/CEP17</em> ratio was 5.1 (range: 1.1–100.0), and ratios were not associated with age, hormone receptor (HR) status, or any other clinicopathological variable analyzed. The log <em>HER2/CEP17</em> ratio significantly predicted pCR in both univariate (OR: 1.83; 95 % CI: 1.11–3.01, p = 0.0176) and multivariate analysis (OR: 1.79; 95 % CI: 1.07–2.99, p = 0.0257). Higher <em>HER2/CEP17</em> ratios were, however, not associated with improved EFS (adjusted HR = 0.795; p = 0.3537). A pCR prediction model including <em>HER2/CEP17</em> ratio, treatment arm, and HR status improved the predictive strength of treatment arm alone from a ROC AUC value of 0.60–0.69.</div></div><div><h3>Conclusion</h3><div>In patients treated with HER2-based neoadjuvant therapy, quantitative analysis of the readily available pretreatment <em>HER2/CEP17</em> ratio by FISH is predictive of pCR<strong>.</strong></div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104679"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-06DOI: 10.1016/j.breast.2025.104669
Ayelet Shai , Hans Wildiers , Claudio Venieri , Katarzyna Pogoda , Barbro Linderholm , Matteo Lambertini , Leonor Matos , Eleonora De Maio D'Esposito , Nawale Hajjaji , Erika Matos , Lucía González Cortijo , Giuseppe Fotia , Ana Fortuna , Tal Sella , Helena Gouveia , Laurent Rosset , Anastasia Constantinidou , Eurydice Angeli , Irfan Cicin , Vivianne Tjan-Heijnen , Frederieke van Duijnhoven
Background
The benefit of adjuvant ovarian function suppression (OFS) and aromatase inhibitors (AI) in premenopausal patients with hormone receptor positive, HER2 positive (HR+/HER2+) breast cancer (BC) is unclear. We aimed to investigate this question in a retrospective cohort, stratified by timing (adjuvant or neoadjuvant) of chemotherapy and trastuzumab and by response to neoadjuvant therapy.
Methods
Patients aged <45Y at diagnosis, with stage I-III HR + HER2+ BC, treated with (neo)adjuvant chemotherapy and trastuzumab ( ± pertuzumab) and endocrine therapy were included. LHRH-agonists and oophorectomy were considered OFS. We compared distant disease-free survival (DDFS) with tamoxifen, OFS + tamoxifen and OFS + AI in three cohorts: neoadjuvant–pathologic complete response (pCR), neoadjuvant-residual disease (RD) and adjuvant. Endocrine therapy (ET) was modeled as a time dependent covariate in cox logistic regression analyses.
Results
The study included 1124 patients with median follow-up of 72.6 months (range:0–205 months). DDFS rates at 5 years were 83.9 %, 86.8 % and 92.1 % with tamoxifen, OFS + tamoxifen and OFS + AI respectively in the RD group, 94.3 %, 97.6 % and 96.5 % in the pCR group, and 94.3 %, 93.4 % and 98.6 % in the adjuvant group. OFS + AI was associated with better DDFS compared to tamoxifen in the RD group (n = 366) (multivariable weighted HR 0.28. 95 % CI 0.11-.069, p = 0.006), but associations of ET with DDFS in the pCR (n = 307, p = 0.59) and adjuvant (n = 451, p = 0.18) cohorts were not detected. Stage III was associated with worse DDFS in all groups.
Conclusion
OFS + AI were associated with better DDFS in patients with RD after neoadjuvant therapy. Our findings can assist shared decision-making on adjuvant endocrine therapy of these patients.
背景：辅助卵巢功能抑制（OFS）和芳香化酶抑制剂（AI）对激素受体阳性、HER2阳性（HR+/HER2+）乳腺癌（BC）绝经前患者的益处尚不清楚。我们的目的是在一个回顾性队列中调查这个问题，根据化疗和曲妥珠单抗的时间（辅助或新辅助）和对新辅助治疗的反应进行分层。结果：纳入1124例患者，中位随访72.6个月（范围：0 ~ 205个月）。RD组他莫昔芬、OFS +他莫昔芬和OFS + AI的5年DDFS率分别为83.9%、86.8%和92.1%，pCR组为94.3%、97.6%和96.5%，佐剂组为94.3%、93.4%和98.6%。与他莫昔芬相比，RD组OFS + AI与更好的DDFS相关（n = 366）（多变量加权HR 0.28）。95% CI 0.11- 0.069, p = 0.006)，但在pCR （n = 307, p = 0.59）和辅助（n = 451, p = 0.18）队列中未检测到ET与DDFS的相关性。所有组III期患者的DDFS均较差。结论：经新辅助治疗的RD患者，OFS + AI与较好的DDFS相关。我们的发现有助于这些患者辅助内分泌治疗的共同决策。
{"title":"Adjuvant ovarian function suppression and aromatase inhibitors in premenopausal patients with hormone receptor and HER2 positive breast cancer, by timing of chemotherapy and trastuzumab and response to neoadjuvant therapy","authors":"Ayelet Shai , Hans Wildiers , Claudio Venieri , Katarzyna Pogoda , Barbro Linderholm , Matteo Lambertini , Leonor Matos , Eleonora De Maio D'Esposito , Nawale Hajjaji , Erika Matos , Lucía González Cortijo , Giuseppe Fotia , Ana Fortuna , Tal Sella , Helena Gouveia , Laurent Rosset , Anastasia Constantinidou , Eurydice Angeli , Irfan Cicin , Vivianne Tjan-Heijnen , Frederieke van Duijnhoven","doi":"10.1016/j.breast.2025.104669","DOIUrl":"10.1016/j.breast.2025.104669","url":null,"abstract":"<div><h3>Background</h3><div>The benefit of adjuvant ovarian function suppression (OFS) and aromatase inhibitors (AI) in premenopausal patients with hormone receptor positive, HER2 positive (HR+/HER2+) breast cancer (BC) is unclear. We aimed to investigate this question in a retrospective cohort, stratified by timing (adjuvant or neoadjuvant) of chemotherapy and trastuzumab and by response to neoadjuvant therapy.</div></div><div><h3>Methods</h3><div>Patients aged <45Y at diagnosis, with stage I-III HR + HER2+ BC, treated with (neo)adjuvant chemotherapy and trastuzumab ( ± pertuzumab) and endocrine therapy were included. LHRH-agonists and oophorectomy were considered OFS. We compared distant disease-free survival (DDFS) with tamoxifen, OFS + tamoxifen and OFS + AI in three cohorts: neoadjuvant–pathologic complete response (pCR), neoadjuvant-residual disease (RD) and adjuvant. Endocrine therapy (ET) was modeled as a time dependent covariate in cox logistic regression analyses.</div></div><div><h3>Results</h3><div>The study included 1124 patients with median follow-up of 72.6 months (range:0–205 months). DDFS rates at 5 years were 83.9 %, 86.8 % and 92.1 % with tamoxifen, OFS + tamoxifen and OFS + AI respectively in the RD group, 94.3 %, 97.6 % and 96.5 % in the pCR group, and 94.3 %, 93.4 % and 98.6 % in the adjuvant group. OFS + AI was associated with better DDFS compared to tamoxifen in the RD group (n = 366) (multivariable weighted HR 0.28. 95 % CI 0.11-.069, p = 0.006), but associations of ET with DDFS in the pCR (n = 307, p = 0.59) and adjuvant (n = 451, p = 0.18) cohorts were not detected. Stage III was associated with worse DDFS in all groups.</div></div><div><h3>Conclusion</h3><div>OFS + AI were associated with better DDFS in patients with RD after neoadjuvant therapy. Our findings can assist shared decision-making on adjuvant endocrine therapy of these patients.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104669"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-03DOI: 10.1016/j.breast.2025.104670
Zhe Xu , Lu Cao , Wei-Xiang Qi , Gang Cai , Dan Ou , Cheng Xu , Rong Cai , Shu-Yan Li , Jia-Yi Chen
Purpose
To evaluate survival outcomes and prognostic factors in breast cancer patients with clinically positive internal mammary lymph nodes (cIMN+) after combined-modality therapy, and to identify indicators for internal mammary nodal boost irradiation.
Method
Consecutive cIMN + patients between January 2010 and April 2023 were retrospectively reviewed. According to nodal response to neoadjuvant therapy (NAT), patients were divided into three groups: no IMN clinical complete response (cCR) (Group A), IMN cCR without ALN pathological complete response (pCR) (Group B), both IMN cCR and ALN pCR (Group C).
Results
Among 141 eligible patients (median follow-up 49.5 months), the 5-year rates for overall survival (OS) and recurrence-free survival (RFS) were 85.7 % and 76.7 %, respectively. Multivariable analysis confirmed ALN pCR and IMN cCR as independent favorable prognostic factors. Patients in group C exhibited superior 5-year OS (97.4 % vs. 88.9 % vs. 71.0 %, p = 0.007) and RFS (93.9 % vs. 71.8 % vs. 61.4 %, p < 0.001), along with the lowest rate of distant metastasis (5.8 % vs. 22.7 % vs. 33.3 %, p = 0.003) compared to Groups B and A. In Group A patients, higher cumulative radiation dose (≥60 Gy) to IMN significantly improved both 5-year OS (71.0 % vs. 93.5 %, p = 0.009) and 5-year RFS (33.3 % vs. 69.3 %, p = 0.031).
Conclusion
The dual achievement of IMN cCR and ALN pCR after NAT predicts exceptional outcomes. For patients with persistent IMN involvement after NAT, IMN dose escalation to ≥60 Gy significantly improved OS and RFS. These findings support individualized radiotherapy strategies based on nodal response.
{"title":"Nodal response to neoadjuvant therapy predicts prognosis of breast cancer patients with clinically positive internal mammary nodes","authors":"Zhe Xu , Lu Cao , Wei-Xiang Qi , Gang Cai , Dan Ou , Cheng Xu , Rong Cai , Shu-Yan Li , Jia-Yi Chen","doi":"10.1016/j.breast.2025.104670","DOIUrl":"10.1016/j.breast.2025.104670","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate survival outcomes and prognostic factors in breast cancer patients with clinically positive internal mammary lymph nodes (cIMN+) after combined-modality therapy, and to identify indicators for internal mammary nodal boost irradiation.</div></div><div><h3>Method</h3><div>Consecutive cIMN + patients between January 2010 and April 2023 were retrospectively reviewed. According to nodal response to neoadjuvant therapy (NAT), patients were divided into three groups: no IMN clinical complete response (cCR) (Group A), IMN cCR without ALN pathological complete response (pCR) (Group B), both IMN cCR and ALN pCR (Group C).</div></div><div><h3>Results</h3><div>Among 141 eligible patients (median follow-up 49.5 months), the 5-year rates for overall survival (OS) and recurrence-free survival (RFS) were 85.7 % and 76.7 %, respectively. Multivariable analysis confirmed ALN pCR and IMN cCR as independent favorable prognostic factors. Patients in group C exhibited superior 5-year OS (97.4 % vs. 88.9 % vs. 71.0 %, p = 0.007) and RFS (93.9 % vs. 71.8 % vs. 61.4 %, p < 0.001), along with the lowest rate of distant metastasis (5.8 % vs. 22.7 % vs. 33.3 %, p = 0.003) compared to Groups B and A. In Group A patients, higher cumulative radiation dose (≥60 Gy) to IMN significantly improved both 5-year OS (71.0 % vs. 93.5 %, p = 0.009) and 5-year RFS (33.3 % vs. 69.3 %, p = 0.031).</div></div><div><h3>Conclusion</h3><div>The dual achievement of IMN cCR and ALN pCR after NAT predicts exceptional outcomes. For patients with persistent IMN involvement after NAT, IMN dose escalation to ≥60 Gy significantly improved OS and RFS. These findings support individualized radiotherapy strategies based on nodal response.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104670"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-08DOI: 10.1016/j.breast.2025.104689
Da Qian , Xuli Meng , Min Jia
Lymphatic microsurgical preventive healing approach (LyMPHA) is being adopted to prevent arm lymphedema after axillary lymph node dissection (ALND), but open questions remain over selection bias, non-standardized endpoints and variable surgical protocols before robust evidence is available.
{"title":"Short commentaries on data published by Yono et al. on avoiding breast cancer–related arm lymphedema with the lymphatic microsurgical preventive healing approach","authors":"Da Qian , Xuli Meng , Min Jia","doi":"10.1016/j.breast.2025.104689","DOIUrl":"10.1016/j.breast.2025.104689","url":null,"abstract":"<div><div>Lymphatic microsurgical preventive healing approach (LyMPHA) is being adopted to prevent arm lymphedema after axillary lymph node dissection (ALND), but open questions remain over selection bias, non-standardized endpoints and variable surgical protocols before robust evidence is available.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104689"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-04DOI: 10.1016/j.breast.2025.104671
Sandra Sinius Pouplier , Abhinav Sharma , Pekka Ruusuvuori , Johan Hartman , Maj-Britt Jensen , Bent Ejlertsen , Mattias Rantalainen , Anne-Vibeke Lænkholm
Background
Breast cancer prognostication is crucial for treatment decisions, and the Nottingham Histologic Grade (NHG) system is widely used. However, NHG suffers from interobserver variability, and its division into three risk groups leaves the intermediate group (comprising ∼50 % of patients) overrepresented, making individualized treatment planning challenging as prognosis within this group differ widely.
Objectives
This study aimed to validate the prognostic value of Stratipath's low and high-risk categories and five risk groups and compare NHG performance with the Stratipath deep-learning-based model.
Methods
We analyzed clinical data from 2466 postmenopausal, ER+/HER2-breast cancer patients who did not receive chemotherapy according to guidelines at that time. The NHG and Stratipath models were compared using concordance index and hazard ratios (HR) for distant recurrence (DR), with time to any recurrence (TR) and overall survival (OS) as secondary endpoints.
Results
The Stratipath five-risk group model showed similar performance to the NHG-system in predicting DR (c-index 0.71 vs. 0.72). HR for DR for Stratipath risk groups 2, 3, 4, and 5 were 1.91 (95 % CI: 1.17–3.13), 2.63 (95 % CI: 1.63–4.24), 3.18 (95 % CI: 2.00–5.07), and 3.25 (95 % CI: 2.00–5.28), respectively (p < 0.0001). In the NHG 2 subgroup, Stratipath Breast retained prognostic value for DR (HR for groups 3–5 vs. group 1: 1.73–1.85; p = 0.05), with a c-index of 0.71.
Conclusions
The Stratipath AI model performs similarly to the NHG system. Further prospective validation of the clinical benefits of differentiating Stratipath risk groups 2 and 3 in treatment strategies would be valuable.
{"title":"Validation of a deep learning-based AI model for breast cancer risk stratification in postmenopausal ER+/HER2-breast cancer patients","authors":"Sandra Sinius Pouplier , Abhinav Sharma , Pekka Ruusuvuori , Johan Hartman , Maj-Britt Jensen , Bent Ejlertsen , Mattias Rantalainen , Anne-Vibeke Lænkholm","doi":"10.1016/j.breast.2025.104671","DOIUrl":"10.1016/j.breast.2025.104671","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer prognostication is crucial for treatment decisions, and the Nottingham Histologic Grade (NHG) system is widely used. However, NHG suffers from interobserver variability, and its division into three risk groups leaves the intermediate group (comprising ∼50 % of patients) overrepresented, making individualized treatment planning challenging as prognosis within this group differ widely.</div></div><div><h3>Objectives</h3><div>This study aimed to validate the prognostic value of Stratipath's low and high-risk categories and five risk groups and compare NHG performance with the Stratipath deep-learning-based model.</div></div><div><h3>Methods</h3><div>We analyzed clinical data from 2466 postmenopausal, ER+/HER2-breast cancer patients who did not receive chemotherapy according to guidelines at that time. The NHG and Stratipath models were compared using concordance index and hazard ratios (HR) for distant recurrence (DR), with time to any recurrence (TR) and overall survival (OS) as secondary endpoints.</div></div><div><h3>Results</h3><div>The Stratipath five-risk group model showed similar performance to the NHG-system in predicting DR (c-index 0.71 vs. 0.72). HR for DR for Stratipath risk groups 2, 3, 4, and 5 were 1.91 (95 % CI: 1.17–3.13), 2.63 (95 % CI: 1.63–4.24), 3.18 (95 % CI: 2.00–5.07), and 3.25 (95 % CI: 2.00–5.28), respectively (p < 0.0001). In the NHG 2 subgroup, Stratipath Breast retained prognostic value for DR (HR for groups 3–5 vs. group 1: 1.73–1.85; p = 0.05), with a c-index of 0.71.</div></div><div><h3>Conclusions</h3><div>The Stratipath AI model performs similarly to the NHG system. Further prospective validation of the clinical benefits of differentiating Stratipath risk groups 2 and 3 in treatment strategies would be valuable.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104671"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-10-01DOI: 10.1016/j.breast.2025.104592
Fernanda Mesa-Chavez , Maria Grazia Razeti , Eva Blondeaux , Alejandra Platas , Virginia Delucchi , Alan Fonseca , Valeria Fontana , Marlid Cruz-Ramos , Paola Anserini , Manuel Rolando Gracía Garza , Edoardo Chiappe , Alejandro Mohar , Laura Orlando , Paula Cabrera-Galeana , Saverio Cinieri , Enrique Bargallo-Rocha , Lucia Del Mastro , Cynthia Villarreal-Garza , Matteo Lambertini
Background
Potential infertility and premature ovarian insufficiency represent notable concerns for young women with breast cancer (YWBC) undergoing chemotherapy. Cryopreservation techniques and temporary ovarian suppression with GnRH agonists (GnRHa) can be offered for fertility preservation (FP) and/or ovarian protection. This joint analysis of the Joven & Fuerte and PREFER multicenter prospective studies compared the uptake of these strategies and associated factors among Mexican and Italian YWBC.
Methods
Females ≤40 years diagnosed with non-metastatic BC from 2014 to 2019, who were offered FP strategies before (neo)adjuvant chemotherapy were included. Uptake of GnRHa for ovarian protection and cryopreservation procedures and reasons for their non-utilization were examined.
Results
Among 485 patients (74 % from Mexico; 26 % from Italy), cryopreservation techniques were used in 8 % of Mexican patients and 25 % of Italian patients (p < 0.001). Methods in Mexico and Italy, respectively, comprised oocyte (50 % and 87 %), embryo (53 % and 0 %), and ovarian tissue (0 % and 16 %) cryopreservation. GnRHa were used in 98 % of Italian patients and 6 % of Mexican patients. Cryopreservation uptake was associated with younger age (OR 1.2, 95 %CI 1.1–1.2), childlessness (OR 21.8, 95 %CI 10.0–47.6), stage I-II BC (OR 3.1, 95 %CI 1.5–6.3), private healthcare in Mexico (OR 3.0, 95 %CI 1.1–8.1), and unpartnered status in Italy (OR 5.4, 95 %CI 2.2–13.2).
Conclusion
FP and ovarian protection uptake were markedly higher in Italy than Mexico, possibly reflecting divergent social and healthcare contexts, though cryopreservation remained underutilized in both countries. Improved access to oncofertility services is warranted to provide comprehensive care aligned with the personal needs and life plans of YWBC.
{"title":"Fertility and ovarian function preservation in young women with breast cancer: A joint analysis of the Joven & Fuerte and PREFER prospective studies","authors":"Fernanda Mesa-Chavez , Maria Grazia Razeti , Eva Blondeaux , Alejandra Platas , Virginia Delucchi , Alan Fonseca , Valeria Fontana , Marlid Cruz-Ramos , Paola Anserini , Manuel Rolando Gracía Garza , Edoardo Chiappe , Alejandro Mohar , Laura Orlando , Paula Cabrera-Galeana , Saverio Cinieri , Enrique Bargallo-Rocha , Lucia Del Mastro , Cynthia Villarreal-Garza , Matteo Lambertini","doi":"10.1016/j.breast.2025.104592","DOIUrl":"10.1016/j.breast.2025.104592","url":null,"abstract":"<div><h3>Background</h3><div>Potential infertility and premature ovarian insufficiency represent notable concerns for young women with breast cancer (YWBC) undergoing chemotherapy. Cryopreservation techniques and temporary ovarian suppression with GnRH agonists (GnRHa) can be offered for fertility preservation (FP) and/or ovarian protection. This joint analysis of the Joven & Fuerte and PREFER multicenter prospective studies compared the uptake of these strategies and associated factors among Mexican and Italian YWBC.</div></div><div><h3>Methods</h3><div>Females ≤40 years diagnosed with non-metastatic BC from 2014 to 2019, who were offered FP strategies before (neo)adjuvant chemotherapy were included. Uptake of GnRHa for ovarian protection and cryopreservation procedures and reasons for their non-utilization were examined.</div></div><div><h3>Results</h3><div>Among 485 patients (74 % from Mexico; 26 % from Italy), cryopreservation techniques were used in 8 % of Mexican patients and 25 % of Italian patients (<em>p</em> < 0.001). Methods in Mexico and Italy, respectively, comprised oocyte (50 % and 87 %), embryo (53 % and 0 %), and ovarian tissue (0 % and 16 %) cryopreservation. GnRHa were used in 98 % of Italian patients and 6 % of Mexican patients. Cryopreservation uptake was associated with younger age (OR 1.2, 95 %CI 1.1–1.2), childlessness (OR 21.8, 95 %CI 10.0–47.6), stage I-II BC (OR 3.1, 95 %CI 1.5–6.3), private healthcare in Mexico (OR 3.0, 95 %CI 1.1–8.1), and unpartnered status in Italy (OR 5.4, 95 %CI 2.2–13.2).</div></div><div><h3>Conclusion</h3><div>FP and ovarian protection uptake were markedly higher in Italy than Mexico, possibly reflecting divergent social and healthcare contexts, though cryopreservation remained underutilized in both countries. Improved access to oncofertility services is warranted to provide comprehensive care aligned with the personal needs and life plans of YWBC.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104592"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-27DOI: 10.1016/j.breast.2025.104682
G. Curigliano , L. Marotti , C. Barrios , N.M.L. Battisti , K.L. Cheung , S. Chia , S.L. Graff , O.J. Hartmann , I. Rubio , D. Santini , F. Sardanelli , E. Senkus , P. van Dam , M. Walker , J. Wu , C. Aristei
Introduction
In breast cancer care multidisciplinary meetings (MDMs) are fundamental. Recently, the increasing number of patients, the complexity of cancer treatments, the shortages of specialists, and constrained hospital budgets have underscored the urgency of optimizing MDM processes to ensure that every patient benefits from thorough and timely multidisciplinary evaluation.
Material and methods
The European Society of Breast Cancer Specialists (EUSOMA) set up a multidisciplinary working group of international experts to develop consensus-based recommendations to optimize MDM management. To obtain insights into the current state of MDM organization and management within Europe and elsewhere, the experts designed and conducted an international survey.
Results
Briefly, the survey showed that most centres held a weekly MDM, either in person, online or combining the modalities, which lasted for 1−2 h. Discussion times for each case varied with its complexity. Some differences emerged between European and non- European breast cancer centres. The recommendations for improving MDM management focused on: i) timing, venue, logistics, administrative support; ii) technologies/equipment; iii) documentation; iv) planning and preparation; v) structure; vi) minutes/reporting; and viii) other issues.
Conclusion
Optimizing MDM ensures that each patient receives the most appropriate, guideline-aligned treatment, tailored to individual needs. With the present recommendations, EUSOMA wishes to support breast centres in improving and standardizing MDM management.
{"title":"Multidisciplinary meeting for breast cancer care: EUSOMA recommendations for optimization","authors":"G. Curigliano , L. Marotti , C. Barrios , N.M.L. Battisti , K.L. Cheung , S. Chia , S.L. Graff , O.J. Hartmann , I. Rubio , D. Santini , F. Sardanelli , E. Senkus , P. van Dam , M. Walker , J. Wu , C. Aristei","doi":"10.1016/j.breast.2025.104682","DOIUrl":"10.1016/j.breast.2025.104682","url":null,"abstract":"<div><h3>Introduction</h3><div>In breast cancer care multidisciplinary meetings (MDMs) are fundamental. Recently, the increasing number of patients, the complexity of cancer treatments, the shortages of specialists, and constrained hospital budgets have underscored the urgency of optimizing MDM processes to ensure that every patient benefits from thorough and timely multidisciplinary evaluation.</div></div><div><h3>Material and methods</h3><div>The European Society of Breast Cancer Specialists (EUSOMA) set up a multidisciplinary working group of international experts to develop consensus-based recommendations to optimize MDM management. To obtain insights into the current state of MDM organization and management within Europe and elsewhere, the experts designed and conducted an international survey.</div></div><div><h3>Results</h3><div>Briefly, the survey showed that most centres held a weekly MDM, either in person, online or combining the modalities, which lasted for 1−2 h. Discussion times for each case varied with its complexity. Some differences emerged between European and non- European breast cancer centres. The recommendations for improving MDM management focused on: i) timing, venue, logistics, administrative support; ii) technologies/equipment; iii) documentation; iv) planning and preparation; v) structure; vi) minutes/reporting; and viii) other issues.</div></div><div><h3>Conclusion</h3><div>Optimizing MDM ensures that each patient receives the most appropriate, guideline-aligned treatment, tailored to individual needs. With the present recommendations, EUSOMA wishes to support breast centres in improving and standardizing MDM management.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104682"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-23DOI: 10.1016/j.breast.2026.104702
Yirong Xiang , Jian Tie , Weihu Wang
{"title":"Response to \"Critical appraisal of a machine learning model for predicting internal mammary lymph node metastasis in breast cancer\"","authors":"Yirong Xiang , Jian Tie , Weihu Wang","doi":"10.1016/j.breast.2026.104702","DOIUrl":"10.1016/j.breast.2026.104702","url":null,"abstract":"","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104702"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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