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Zhang S, Yang H, Xu Y, Wang S. Do we need reshape rTNM staging system for ipsilateral breast tumor recurrence of breast cancer? A population-based, propensity score matched cohort study. Breast Cancer Res Treat 2024; 206:637-651. [PMID: 38727889 DOI: 10.1007/s10549-024-07340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/10/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND The aim of the study was to explore the role of recurrent TNM (rTNM) staging in predicting prognosis for ipsilateral breast tumor recurrence (IBTR) and determine the optimal treatment strategy for IBTR. METHOD IBTR cases were identified from the Surveillance, Epidemiology, and End Results (SEER) database spanning the years 2000-2018. Cox proportional hazards analysis was performed to examine factors associated with overall survival (OS) and breast cancer-specific survival (BCSS). Propensity score matching (PSM) was employed to match IBTR with primary early breast cancer (EBC) based on clinicopathological characteristics. Investigations into the impact of different therapies were also included. RESULTS Of the 4375 IBTR cases included in the study, the 5-year OS was 87.1%, 71.6% and 58.7% in rTNM stages I, II and III, respectively. After PSM, while IBTR patients had worse survival to primary EBC patients, prognosis of IBTR for different rTNM stage always closely aligned with the corresponding stage of primary EBC. Repeat breast-conserving surgery (BCS) with radiation therapy was equivalent to mastectomy with respect to OS and BCSS. Chemotherapy was favorable for OS and BCSS in estrogen receptor (ER)-negative IBTR or IBTR occurring within a 60-month interval. CONCLUSIONS rTNM staging system has an outstanding prognostic value for survival outcome of patients with IBTR, and IBTR and primary EBC may have potentially analogous features in the context of TNM staging. BCS plus radiation therapy may be an alternative. IBTR cases who have experienced recurrence with short intervals and with ER-negative tumors might benefit from chemotherapy.
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Affiliation(s)
- Shuwei Zhang
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China
| | - Houpu Yang
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China
| | - Yaqian Xu
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China
| | - Shu Wang
- Breast Center, Peking University People's Hospital, Xizhimen South Street No. 11, Xicheng District, Beijing, 100044, China.
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Giannakeas V, Lim DW, Narod SA. Bilateral Mastectomy and Breast Cancer Mortality. JAMA Oncol 2024:2821596. [PMID: 39052262 PMCID: PMC11273285 DOI: 10.1001/jamaoncol.2024.2212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/05/2024] [Indexed: 07/27/2024]
Abstract
Importance The benefit of bilateral mastectomy for women with unilateral breast cancer in terms of deaths from breast cancer has not been shown. Objectives To estimate the 20-year cumulative risk of breast cancer mortality among women with stage 0 to stage III unilateral breast cancer according to the type of initial surgery performed. Design, Settings, and Participants This cohort study used the Surveillance, Epidemiology, and End Results (SEER) Program registry database to identify women with unilateral breast cancer (invasive and ductal carcinoma in situ) who were diagnosed from 2000 to 2019. Three closely matched cohorts of equal size were generated using 1:1:1 matching according to surgical approach. The cohorts were followed up for 20 years for contralateral breast cancer and for breast cancer mortality. The analysis compared the 20-year cumulative risk of breast cancer mortality for women treated with lumpectomy vs unilateral mastectomy vs bilateral mastectomy. Data were analyzed from October 2023 to February 2024. Exposures Type of breast surgery performed (lumpectomy, unilateral mastectomy, or bilateral mastectomy). Main Outcomes and Measures Contralateral breast cancer or breast cancer mortality during the 20-year follow-up period among the groups treated with lumpectomy vs unilateral mastectomy vs bilateral mastectomy. Results The study sample included 661 270 women with unilateral breast cancer (mean [SD] age, 58.7 [11.3] years). After matching, there were 36 028 women in each of the 3 treatment groups. During the 20-year follow-up, there were 766 contralateral breast cancers observed in the lumpectomy group, 728 contralateral breast cancers in the unilateral mastectomy group, and 97 contralateral cancers in the bilateral mastectomy group. The 20-year risk of contralateral breast cancer was 6.9% (95% CI, 6.1%-7.9%) in the lumpectomy-unilateral mastectomy group. The cumulative breast cancer mortality was 32.1% at 15 years after developing a contralateral cancer and was 14.5% for those who did not develop a contralateral cancer (hazard ratio, 4.00; 95% CI, 3.52-4.54, using contralateral breast cancer as a time-dependent covariate). Deaths from breast cancer totaled 3077 women (8.54%) in the lumpectomy group, 3269 women (9.07%) in the unilateral mastectomy group, and 3062 women (8.50%) in the bilateral mastectomy group. Conclusions and Relevance This cohort study indicates that the risk of dying of breast cancer increases substantially after experiencing a contralateral breast cancer. Women with breast cancer treated with bilateral mastectomy had a greatly diminished risk of contralateral breast cancer; however, they experienced similar mortality rates as patients treated with lumpectomy or unilateral mastectomy.
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Affiliation(s)
- Vasily Giannakeas
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Women’s Age Lab, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David W. Lim
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Surgery, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Steven A. Narod
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Niu X, Ding X, Tong Q, Huang X, Ma X, Li Z, Wang Q, Wang Y. Myricetin inhibits 4 T1 breast tumor growth in mice via induction of Nrf-2/GPX4 pathway-mediated Ferroptosis. Toxicol Appl Pharmacol 2024; 488:116990. [PMID: 38838791 DOI: 10.1016/j.taap.2024.116990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/27/2024] [Accepted: 06/02/2024] [Indexed: 06/07/2024]
Abstract
Ferroptosis is a recently identified form of programmed cell death that is iron-dependent and closely involved in the pathogenesis of breast cancer. Past studies have identified myricetin as being able to inhibit breast cancer growth through its targeting of apoptotic mechanisms, but the precise mechanisms whereby it exerts its antitumoral effects in breast cancer remain to be characterized in detail. Here, the effects of myricetin on the induction of ferroptosis in breast cancer cells were investigated. It was found that myricetin was able to significantly inhibit 4 T1 tumor cell viability and colony forming activity, increasing the level of MDA, Fe2+, and ROS within these cells. From a mechanistic perspective, myricetin was found to induce ferroptotic 4 T1 cell death via downregulating Nrf-2 and GPX4. In vivo experimentation demonstrated that myricetin treatment was sufficient to reduce the growth of subcutaneous breast tumors in female mice as evidenced by decreases in tumor weight and volume, while significantly inhibiting Nrf-2 and GPX4 expression within the tumors of treated mice. Myricetin is capable of readily suppressing breast tumor growth in mice via the induction of ferroptotic activity through the Nrf-2/GPX4 pathway. Myricetin may thus offer utility as a therapeutic agent for the management of breast cancer in clinical settings.
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Affiliation(s)
- Xiaomin Niu
- First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China; Post Graduate School of Jinzhou Medical University, Jinzhou, Liaoning 121000, China; Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China
| | - Xuhao Ding
- Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China
| | - Qing Tong
- Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China.
| | - Xueru Huang
- Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China
| | - Xiaolan Ma
- Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China
| | - Ziping Li
- Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China
| | - Qian Wang
- First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China
| | - Yi Wang
- First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121000, China; Key Surgical Laboratory of Educational Administration of Liaoning Province, Jinzhou Medical University, Jinzhou, Liaoning 121000, China.
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Camps-Herrero J, Pijnappel R, Balleyguier C. MR-contrast enhanced mammography (CEM) for follow-up of breast cancer patients: a "pros and cons" debate. Eur Radiol 2024:10.1007/s00330-024-10684-w. [PMID: 38488968 DOI: 10.1007/s00330-024-10684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/07/2024] [Accepted: 02/03/2024] [Indexed: 03/17/2024]
Abstract
Women with a personal history of breast cancer (PHBC) are at an increased risk of either a local recurrence or a new primary breast cancer. Thus, surveillance is essential for the detection of recurrent disease at the earliest possible stage, allowing for prompt treatment, and potentially improving overall survival. Nowadays, mammography follow-up is the only surveillance imaging technique recommended by international guidelines. Nevertheless, sensitivity of mammography is lower after breast cancer treatment, particularly during the first 5 years, due to increased density or post-treatment changes. Contrast-enhanced breast imaging techniques, such as MRI or contrast-enhanced mammography (CEM), are very sensitive to detect malignant enhancement, especially in dense breasts. This Special Report will provide arguments in favor of and against breast cancer follow-up with MRI or CEM, in a debate style between experts in Breast Imaging. Finally, the scientific points of pros and cons arguments will be summarized to help objectively decide the best follow-up strategy for women with a personal history of breast cancer. CLINICAL RELEVANCE STATEMENT: A personalized approach to follow-up imaging after conservative breast cancer treatment could optimize patient outcomes, using mammography as a baseline for most patients, and MRI or CEM selectively in patients with higher risks for a recurrence. KEY POINTS: • Women with a personal history of breast cancer are at an increased risk of either a local recurrence or a new primary breast cancer. • Breast cancer survivors may benefit from additional imaging with MRI/CEM, in case of increased risk of a second breast cancer, with dense breasts or a cancer diagnosis before age 50 years. • As survival after local recurrence seems to depend on the initial stage at diagnosis, imaging should be more focused on detecting tumors in the earliest stages.
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Affiliation(s)
| | - Ruud Pijnappel
- Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Corinne Balleyguier
- Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France.
- BIOMAPS, UMR 1281, Université Paris-Saclay, 94800, Villejuif, France.
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5
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Xu C, Chen Y, Yu Q, Song J, Jin Y, Gao X. Compounds targeting ferroptosis in breast cancer: progress and their therapeutic potential. Front Pharmacol 2023; 14:1243286. [PMID: 37920209 PMCID: PMC10619677 DOI: 10.3389/fphar.2023.1243286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023] Open
Abstract
In recent years, there has been a significant increase in the incidence of Breast cancer (BC), making it the most common cancer among women and a major threat to women's health. Consequently, there is an urgent need to discover new and effective strategies for treating BC. Ferroptosis, a novel form of cell death characterized by the accumulation of iron-dependent lipid reactive oxygen species, has emerged as a distinct regulatory pathway separate from necrosis, apoptosis, and autophagy. It is widely recognized as a crucial factor in the development and progression of cancer, offering a promising avenue for BC treatment. While significant progress has been made in understanding the mechanisms of ferroptosis in BC, drug development is still in its early stages. Numerous compounds, including phytochemicals derived from dietary sources and medicinal plants, as well as synthetic drugs (both clinically approved medications and laboratory reagents), have shown the ability to induce ferroptosis in BC cells, effectively inhibiting tumor growth. This comprehensive review aims to examine in detail the compounds that target ferroptosis in BC and elucidate their potential mechanisms of action. Additionally, the challenges associated with the clinical application of ferroptosis-inducing drugs are discussed, offering valuable insights for the development of novel treatment strategies for BC.
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Affiliation(s)
- Chuchu Xu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Yian Chen
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Qinghong Yu
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Jiaqing Song
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Ying Jin
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Xiufei Gao
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
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Shahmirzalou P, Khaledi MJ, Khayamzadeh M, Rasekhi A. Survival analysis of recurrent breast cancer patients using mix Bayesian network. Heliyon 2023; 9:e20360. [PMID: 37780765 PMCID: PMC10539960 DOI: 10.1016/j.heliyon.2023.e20360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Breast cancer (BC) is the most common cancer among women. Iranians have an 11% BC recurrence rate, which lowers their survival rates. Few studies have investigated cancer recurrence survival rates. This study's major purpose is to use a mixed Bayesian network (BN) to analyze recurrent patients' survival. Material and methods This study aimed to evaluate the pathobiological features, age, gender, final status, and survival time of the patients. Bayesian imputation was used for missing data. The performance of BN was optimized through the utilization of a blacklist and prior probability. After structural and parametric learning, posterior conditional probabilities and mean survival periods for the node arcs were predicted. The hold-out technique based on the posterior classification error was used to investigate the model's validation. Results The study included 220 cancer recurrence patients. These patients averaged 47 years old. The BN with a blacklist and prior probability has a higher network score than other networks. The hold-out technique verified structural learning. The Directed Acyclic Graph showed a statistically significant relationship between cancer biomarkers (ER, PR, and HER2 receptors), cancer stage, and tumor grade and patient survival duration. Patient death was also significantly associated with education, ER, PR, HER2, and tumor grade. The BN reports that HER2 negative, ER positive, and PR positive patients had a higher survival rate. Conclusion Survival and death of relapsed patients depend on biomarkers. Based on the findings, patient survival can be predicted with their features.
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Affiliation(s)
- Parviz Shahmirzalou
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | | | - Maryam Khayamzadeh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aliakbar Rasekhi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Karavasiloglou N, Michalopoulou E, Limam M, Korol D, Wanner M, Rohrmann S. Net survival of women diagnosed with breast tumours: a population-based study in Switzerland. Swiss Med Wkly 2023; 153:40087. [PMID: 37769336 DOI: 10.57187/smw.2023.40087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
AIMS OF THE STUDY Although the incidence of breast carcinoma in situ has been increasing, the prognosis of breast carcinoma in situ patients has not been extensively investigated. Thus, we aimed to compare the characteristics of invasive breast tumours based on whether or not they were preceded by a breast carcinoma in situ and to estimate the 5-year net survival of patients diagnosed with different breast tumours. METHODS Data from women diagnosed with breast tumours between 2003 and 2016 were used in our analyses. Net survival analyses were performed using inverse probability of censoring weights (nonparametric Pohar Perme estimator). Under certain assumptions, differences in survival between the cancer population and the general population can be considered to be attributable to the cancer diagnosis (NS). RESULTS Descriptive observation of tumour characteristics indicated that invasive breast tumours following a breast carcinoma in situ were more frequently detected at an earlier stage and had less missing information in tumour-specific variables, compared to invasive breast tumours not preceded by a breast carcinoma in situ. Breast carcinoma in situ patients had a 5-year net survival of 1.02 (95% CI: 1.01-1.03), whereas patients diagnosed with invasive breast cancer without a recorded breast carcinoma in situ had a 5-year net survival of 0.89 (95% CI: 0.88-0.90). Patients diagnosed first with breast carcinoma in situ and then with invasive breast cancer had a 5-year net survival of 0.92 (95% CI: 0.85-1.01). CONCLUSION Invasive breast tumours that were preceded by a breast carcinoma in situ were detected more frequently at an earlier stage, compared to those that were not. The estimated 5-year net survival of patients with breast tumours was good.
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Affiliation(s)
- Nena Karavasiloglou
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen, and Schwyz, University Hospital Zurich, Zurich, Switzerland
- European Food Safety Authority, Parma, Italy
| | - Eleftheria Michalopoulou
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen, and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Manuela Limam
- Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen, and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Dimitri Korol
- Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen, and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Miriam Wanner
- Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen, and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Cancer Registry of the Cantons of Zurich, Zug, Schaffhausen, and Schwyz, University Hospital Zurich, Zurich, Switzerland
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Sopik V, Lim D, Sun P, Narod SA. Prognosis after Local Recurrence in Patients with Early-Stage Breast Cancer Treated without Chemotherapy. Curr Oncol 2023; 30:3829-3844. [PMID: 37185403 PMCID: PMC10136458 DOI: 10.3390/curroncol30040290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Many women with early-stage breast cancer are predicted to be at sufficiently low risk for recurrence that they may forego chemotherapy. Nevertheless, some low-risk women will experience a local recurrence, and for them the risk of death increases significantly thereafter. The utility of initiating chemotherapy at the time of local recurrence has not been adequately addressed. The purpose of this study is to identify, in a hospital-based series of patients with early-stage breast cancer who were not treated with chemotherapy, those factors which predict death post local recurrence. Methods: We identified 135 women who were diagnosed with early-stage breast cancer (node-negative, <5 cm) and who did not receive chemotherapy at diagnosis and who developed a local recurrence. They were diagnosed between 1987 and 2000 and treated at Women’s College Hospital. For each patient, we abstracted information on the initial cancer (age at diagnosis, tumour size, tumour grade, ER status, PR status, HER2 status, lympho-vascular invasion, type of surgery, use of radiotherapy, tamoxifen and chemotherapy), the time from initial diagnosis to local recurrence and treatment at recurrence. The Kaplan–Meier method was used to estimate the ten-year actuarial risk of breast cancer death post recurrence. A Cox proportional hazards model was used to estimate multivariate hazard ratios for the various factors. Results: Among the 135 women in the cohort, the mean time from initial diagnosis to local recurrence was 7.8 years (range: 0.3 to 22.6 years). A total of 38 of the 135 women (28.1%) died of breast cancer a mean of 5.3 years after experiencing the local recurrence (range: 0.3 to 17 years). The ten-year breast cancer survival post local recurrence was 71% and the 15-year survival was 65%. In a multivariate analysis, it was found that factors that were significantly associated with death after local recurrence were (1) PR-negative status, (2) young age at diagnosis (<40 years) and (3) time to local recurrence less than 2 years. Nine percent of women received chemotherapy at the time of local recurrence. Conclusions: For breast cancer patients with a low baseline risk of mortality, the risk of death after an isolated local recurrence is substantial. Systemic treatment at the time of local recurrence needs further study.
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Interactive exploration of a global clinical network from a large breast cancer cohort. NPJ Digit Med 2022; 5:113. [PMID: 35948579 PMCID: PMC9365762 DOI: 10.1038/s41746-022-00647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/27/2022] [Indexed: 11/08/2022] Open
Abstract
Despite unprecedented amount of information now available in medical records, health data remain underexploited due to their heterogeneity and complexity. Simple charts and hypothesis-driven statistics can no longer apprehend the content of information-rich clinical data. There is, therefore, a clear need for powerful interactive visualization tools enabling medical practitioners to perceive the patterns and insights gained by state-of-the-art machine learning algorithms. Here, we report an interactive graphical interface for use as the front end of a machine learning causal inference server (MIIC), to facilitate the visualization and comprehension by clinicians of relationships between clinically relevant variables. The widespread use of such tools, facilitating the interactive exploration of datasets, is crucial both for data visualization and for the generation of research hypotheses. We demonstrate the utility of the MIIC interactive interface, by exploring the clinical network of a large cohort of breast cancer patients treated with neoadjuvant chemotherapy (NAC). This example highlights, in particular, the direct and indirect links between post-NAC clinical responses and patient survival. The MIIC interactive graphical interface has the potential to help clinicians identify actionable nodes and edges in clinical networks, thereby ultimately improving the patient care pathway.
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10
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Narod SA, Sopik V. Countercurrents: DCIS or Cancer? Why All the Confusion? Curr Oncol 2022; 29:4936-4940. [PMID: 35877252 PMCID: PMC9316925 DOI: 10.3390/curroncol29070392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
At present, women with ductal carcinoma in situ are counseled that they have a pre-malignant condition which carries the possibility of progression to a fully malignant breast cancer. However, in most cases, the treatment of DCIS resembles that of a small invasive breast cancer and this is a source of confusion to many. In order to properly evaluate the benefit of radiotherapy, mastectomy and contralateral mastectomy, it is necessary to consider the risks of ipsilateral invasive cancer and of contralateral breast cancer in women with DCIS and with small invasive breast cancer. Several registry-based studies indicate that the risks of ipsilateral and contralateral cancer are similar in the two conditions and therefore a similar approach to treatment is rational.
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Affiliation(s)
- Steven A. Narod
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5S 1B2, Canada;
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Correspondence:
| | - Victoria Sopik
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5S 1B2, Canada;
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
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11
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Jia L, Li G, Ma N, Zhang A, Zhou Y, Ren L, Dong D. Soluble POSTN is a novel biomarker complementing CA153 and CEA for breast cancer diagnosis and metastasis prediction. BMC Cancer 2022; 22:760. [PMID: 35831854 PMCID: PMC9281047 DOI: 10.1186/s12885-022-09864-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/06/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Breast cancer (BCa) is the leading cause of cancer deaths among women. Reliable biomarkers for early diagnosis and metastasis prediction are essential to improve the prognosis of BCa. This study aimed to evaluate serum periostin (POSTN) as a novel biomarker complementing CA153 (carbohydrate antigen 153) and CEA (carcinoembryonic antigen) for BCa diagnosis and metastasis prediction. METHODS To assess the potential of soluble POSTN as a circulating biomarker, 242 participants, including 173 patients with different stages of BCa and 69 healthy individuals, were enrolled in this study. Soluble POSTN, together with CA153 and CEA, were determined in serum by enzyme linked immunosorbent assay (ELISA) or electrochemiluminescence immunoassays. RESULTS Serum POSTN levels in locoregional BCa patients were significantly higher than that in healthy controls. Receiver operating curve (ROC) analysis revealed that, to distinguish health controls from locoregional BCa, POSTN was observed with the highest AUC (area under curve) (AUCPOSTN = 0.72 [0.65 - 0.79], AUCCA153 = 0.57 [0.49 - 0.64], AUCCEA = 0.62 [0.55 - 0.69]), and both CA153 and CEA were observed with significantly improved AUCs by combination with POSTN (AUCPOSTN + CA153 = 0.74 [0.67 - 0.80], P < 0.001; AUCPOSTN + CEA = 0.77 [0.70 - 0.82], P < 0.001). Moreover, the performances of the POSTN were comparable with that of CA153 in predicting distant metastasis of BCa (AUCPOSTN = 0.78 [0.71 - 0.84], AUCCA153 = 0.82 [0.76 - 0.88]). Kaplan-Meier analysis indicated that elevated serum POSTN was associated with poor overall survival and progression-free survival. CONCLUSIONS This study suggested that soluble POSTN is a promising potential biomarker for diagnosis and metastasis prediction of BCa.
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Affiliation(s)
- Li Jia
- Department of Laboratory, Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
| | - Guanhua Li
- Department of Anesthesiology, Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, 100088, People's Republic of China
| | - Na Ma
- Cancer Biobank, Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
| | - Aimin Zhang
- Department of Laboratory, Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
| | - Yunli Zhou
- Department of Laboratory, Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China
| | - Li Ren
- Department of Laboratory, Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China.
| | - Dong Dong
- Department of Laboratory, Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, People's Republic of China.
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Patuleia SIS, Moelans CB, Koopman J, van Steenhoven JEC, van Dalen T, van der Pol CC, Jager A, Ausems MGEM, van Diest PJ, van der Wall E, Suijkerbuijk KPM. Patient-centered research: how do women tolerate nipple fluid aspiration as a potential screening tool for breast cancer? BMC Cancer 2022; 22:705. [PMID: 35761221 PMCID: PMC9235076 DOI: 10.1186/s12885-022-09795-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background Nipple fluid aspiration (NFA) is a technique to acquire nipple aspirate fluid (NAF), which is considered a rich source of breast-specific biomarkers. Originating directly from the mammary ducts, this liquid biopsy can offer insight into the process of carcinogenesis at its earliest stage and therefore could be of added value to the current imaging-based breast cancer screening tools. With that in mind, it is necessary to know how well NFA is tolerated. Aim To evaluate the participants’ tolerability of NFA compared to breast imaging screening methods and blood draws. Materials and methods Three cohorts of women underwent NFA: healthy women (n = 190), women diagnosed with breast cancer (n = 137) and women at high risk of developing breast cancer (n = 48). A 0–10 discomfort score of NFA, mammography, breast MRI and blood draws, was filled in at the study visits, which took place once or annually. Results The median discomfort rate of NFA was 1, which was significantly lower than the median discomfort of mammography and breast MRI (5 and 3, respectively, p < 0.001), but significantly higher than median discomfort for blood draws (0, p < 0.001). The great majority of women would undergo the procedure again (98%) and recommend it to others (97%). Conclusion This study shows that NFA was well tolerated by healthy women, women diagnosed with breast cancer and high-risk women. This makes NFA a feasible method to pursue as a potential future breast cancer early detection tool, based on resident biomarkers. Trial registration NL41845.041.12, NL57343.041.16 and NL11690.041.06 in trialregister.nl. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09795-8.
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Sheffield KM, Peachey JR, Method M, Grimes BR, Brown J, Saverno K, Sugihara T, Cui ZL, Lee KT. A real-world US study of recurrence risks using combined clinicopathological features in HR-positive, HER2-negative early breast cancer. Future Oncol 2022; 18:2667-2682. [PMID: 35611679 DOI: 10.2217/fon-2022-0310] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: To assess invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS) in hormone receptor-positive, HER2-negative early breast cancer with combined clinicopathological criteria from monarchE, a phase III study of abemaciclib. Methods: US electronic health records were used to compare outcomes between high-risk (≥4 lymph nodes, or 1-3 lymph nodes and grade 3, tumor ≥5 cm, or Ki-67 ≥20%) versus nonhigh-risk groups using Kaplan-Meier methods and Cox regression models. Results: The high-risk group (n = 557) was at higher risk for IDFS and DRFS events than the nonhigh-risk group (n = 3471). IDFS events (hazard ratio: 3.07; 95% CI: 2.45-3.83) and DRFS events (hazard ratio: 3.15; 95% CI: 2.49-3.97) were significantly higher for the high-risk group. Conclusion: Risk of recurrence was three-times greater in the high-risk group, highlighting the need for better therapies.
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Affiliation(s)
| | | | - Michael Method
- Eli Lilly and Company, Indianapolis, IN 46225, USA.,ImmunoGen, Waltham, MA 02451, USA
| | | | | | - Kim Saverno
- Eli Lilly and Company, Indianapolis, IN 46225, USA.,US Medical Affairs, Incyte Corporation, Wilmington, DE 19803, USA
| | | | | | - Kimberley T Lee
- Departments of Breast Oncology and Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Zhong YM, Tong F, Shen J. Lympho-vascular invasion impacts the prognosis in breast-conserving surgery: a systematic review and meta-analysis. BMC Cancer 2022; 22:102. [PMID: 35073848 PMCID: PMC8787911 DOI: 10.1186/s12885-022-09193-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023] Open
Abstract
Background It is estimated that breast cancer (BC) incidence, especially that of early-stage breast cancer cases continues to rise due to increased universal screening. Breast-conserving surgery (BCS) is the main intervention for early-stage BC. Lympho-vascular invasion (LVI) is reported to influence breast cancer prognosis but its prognostic value in breast-conserving treatment is controversial. Methods A search was conducted on the Cochrane library, PubMed, Web of Science, and EMBASE from inception to December 1st, 2021, without language restrictions, to identify studies that explored the prognosis of lympho-vascular invasion in breast-conserving surgery. Reviews of each study were conducted, and data extracted. The meta-analysis was performed with StataSE 16. Study quality assessment was evaluated using the Newcastle–Ottawa Scale. Results Overall, 15 studies with 21,704 patients deemed eligible for this study. Event-free survival (EFS), disease-free survival (DFS), overall survival (OS), distant metastases (DM), loco-regional recurrence (LRR), local recurrence (LR), breast recurrence (BR), disease specific survival (DSS), and breast cancer specific survival (BCSS), were extracted from each study. We found that LVI leads to poor OS (HR = 1.46, 95% CI: 1.17–1.83), DM (HR = 2.08, 95% CI: 1.66–2.60) and LR (HR = 2.00, 95% CI: 1.54–2.61). Conclusions We confirmed that early-stage BC patients with LVI-positive have poorer OS, DFS, LRR, BCSS, DM and LR following receiving BCS than those LVI-negative patients. Mastectomy, in combination with radical systemic therapies could be considered, especially in those requiring second surgery. How to change the impact of LVI on the local recurrence rate and long-term survival in patients who undergo BCS may be a valuable research direction in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09193-0.
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Lou SJ, Hou MF, Chang HT, Lee HH, Chiu CC, Yeh SCJ, Shi HY. Breast Cancer Surgery 10-Year Survival Prediction by Machine Learning: A Large Prospective Cohort Study. BIOLOGY 2021; 11:biology11010047. [PMID: 35053045 PMCID: PMC8773427 DOI: 10.3390/biology11010047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 02/07/2023]
Abstract
Machine learning algorithms have proven to be effective for predicting survival after surgery, but their use for predicting 10-year survival after breast cancer surgery has not yet been discussed. This study compares the accuracy of predicting 10-year survival after breast cancer surgery in the following five models: a deep neural network (DNN), K nearest neighbor (KNN), support vector machine (SVM), naive Bayes classifier (NBC) and Cox regression (COX), and to optimize the weighting of significant predictors. The subjects recruited for this study were breast cancer patients who had received breast cancer surgery (ICD-9 cm 174-174.9) at one of three southern Taiwan medical centers during the 3-year period from June 2007, to June 2010. The registry data for the patients were randomly allocated to three datasets, one for training (n = 824), one for testing (n = 177), and one for validation (n = 177). Prediction performance comparisons revealed that all performance indices for the DNN model were significantly (p < 0.001) higher than in the other forecasting models. Notably, the best predictor of 10-year survival after breast cancer surgery was the preoperative Physical Component Summary score on the SF-36. The next best predictors were the preoperative Mental Component Summary score on the SF-36, postoperative recurrence, and tumor stage. The deep-learning DNN model is the most clinically useful method to predict and to identify risk factors for 10-year survival after breast cancer surgery. Future research should explore designs for two-level or multi-level models that provide information on the contextual effects of the risk factors on breast cancer survival.
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Affiliation(s)
- Shi-Jer Lou
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan;
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Ming-Feng Hou
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Surgery, Division of Breast Oncology and Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Hong-Tai Chang
- Department of Surgery, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan;
| | - Hao-Hsien Lee
- Department of General Surgery, Chi Mei Medical Center, Liouying 73658, Taiwan;
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan;
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80420, Taiwan
| | - Hon-Yi Shi
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan;
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80420, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-7-3211101 (ext. 2648); Fax: +886-7-3137487
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Long-Term Results of Postoperative Hypofractionated Accelerated Breast and Lymph Node Radiotherapy (HypoAR) with Hypofractionated Boost. ACTA ACUST UNITED AC 2021; 28:3474-3487. [PMID: 34590607 PMCID: PMC8482084 DOI: 10.3390/curroncol28050300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/22/2021] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
We report long-term results (median follow-up 12 years) of hypofractionated accelerated radiotherapy (HypoAR) in patients treated with breast-conserving surgery. In total, 367 women were treated with HypoAR. Axillary and supraclavicular area (ASA) were treated in patients with involved nodes. In total, 290 patients (scheme A) received 3.5 Gy/day ×10 fractions (breast/ASA) followed by two 4 Gy fractions with electrons to the affected breast quadrant within 16 days. In total, 77 patients (Scheme B) received 2.7 Gy/day for 16 consecutive fractions (breast/ASA) within 22 days, while concurrently, the affected breast quadrant received an electron booster dose of 0.8 Gy for the first 13 fractions. Amifostine was offered to 252/367 patients. Early radiation toxicity was minimal. Regarding late toxicities, symptomatic breast edema was noted in 2.2%, asymptomatic breast fibrosis in 1.9%, and arm lymphedema in 3.7% of patients. Amifostine reduced early radiation dermatitis (p = 0.001). In total, 2.2% of patients developed contralateral breast and 1.6% other carcinomas. Locoregional recurrence (LR) occurred in 3.1% of patients (0% for in situ carcinomas). Positive margins after surgery, extracapsular node invasion, and HER2-enriched/triple-negative tumors were linked with significantly worse LR-free survival. The involvement of more than three nodes and luminal type other than A were independent prognostic variables of metastasis and death events. HypoAR delivering a biological dose of 50–52 Gy to the breast/ASA is a safe and effective therapy for patients treated with conservative surgery. The risk of carcinogenesis is low. Positive surgical margins, extracapsular node invasion, and HER2-enriched/triple-negative phenotypes appear as a cluster of features linked with a higher risk for locoregional relapse.
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Yang HY, Tu CW, Chen CC, Lee CY, Hsu YC. Sole adjuvant intraoperative breast radiotherapy in Taiwan: a single-center experience. Breast Cancer Res 2021; 23:43. [PMID: 33794958 PMCID: PMC8017735 DOI: 10.1186/s13058-021-01421-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/23/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Intraoperative radiotherapy (IORT) is more convenient than standard whole breast external beam radiotherapy (EBRT) as a sole adjuvant radiotherapy for breast cancer. The impact of age on breast cancer course and treatment strategy is still under investigation, and the peak age for breast cancer in Taiwan is much younger than that in Western countries. We aimed to review the oncological outcomes of sole IORT compared with standard EBRT in a country with younger breast cancer patients. Patients and methods We reviewed patients with invasive breast cancer who received breast-conserving surgery (BCS) from September 2014 to December 2016. The clinicopathologic characteristics and oncological outcomes of eligible patients who received EBRT or IORT as sole adjuvant radiotherapy after BCS were collected and reviewed. Results A total of 170 patients were enrolled with a mean follow-up time of 3.53 ± 0.82 years. The risk of locoregional recurrence was 2.44% for EBRT versus 10.64% for IORT (p = 0.024). IORT was a significant risk factor of locoregional recurrence (p = 0.005). The hazard ratios (HRs) for locoregional recurrence in the IORT group compared with the EBRT group were significantly higher in non-suitable risk group patients (HR = 7.02, p = 0.009) and in patients under 50 years old (HR = 10.42, p = 0.011). Conclusions Locoregional recurrence was significantly higher in patients who received IORT than in those who underwent EBRT. IORT should not be used alone in patients under 50 years old who do not belong to a suitable group.
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Affiliation(s)
- Hsin-Yi Yang
- Clinical Medicine Research Center, Ditmansion Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan, 60002
| | - Chi-Wen Tu
- Department of Surgery, Ditmansion Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chia-Yi City, Taiwan, 60002
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan, 60002.,Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan, 71710
| | - Cheng-Yen Lee
- Department of Radiation Therapy and Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan, 60002
| | - Yu-Chen Hsu
- Department of Surgery, Ditmansion Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East District, Chia-Yi City, Taiwan, 60002.
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18
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A Signature That May Be Predictive of Early Versus Late Recurrence After Radiation Treatment for Breast Cancer That May Inform the Biology of Early, Aggressive Recurrences. Int J Radiat Oncol Biol Phys 2020; 108:686-696. [DOI: 10.1016/j.ijrobp.2020.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 01/20/2023]
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Tsai CH, Hsieh HF, Lai TW, Kung PT, Kuo WY, Tsai WC. Effect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study. Breast 2020; 53:68-76. [PMID: 32652461 PMCID: PMC7375674 DOI: 10.1016/j.breast.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer has been the leading cause of death in the past decade in Taiwan, with breast cancer being the most common type of cancer in females. Very few studies looked at the risk of recurrence in patients who received multidisciplinary team (MDT) care. We analyzed the influence of MDT on the risk of recurrence and death in breast cancer patients. METHOD In this retrospective study, we included newly diagnosed patients from 2004 to 2010. The study included 9,266 breast cancer patients who were enrolled in MDT care and 9,266 patients who were not. The study used log-rank test to analyze patients' characteristics, hospital characteristics, cancer staging, and treatment methods to compare the recurrence rates in MDT care and non-MDT care participants. We used Cox proportional hazards model to examine the effect of MDT and associated factors on the risk of recurrence and mortality of breast cancer patients. RESULTS Relative risk of recurrence was lower for patients who received MDT care than for patients who did not (HR, 0.84; 95%CI: 0.70-0.99) after matching. The mortality risk for breast cancer patients with relapse was 8.48 times (95%CI: 7.53-9.54) than that for patients without relapse. CONCLUSIONS The relative risk of recurrence and death was significantly lower for breast cancer patients who received MDT care than for those who did not. We suggest that MDT care be implanted in the National Health Policy settings of breast cancer patients.
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Affiliation(s)
- Chang-Hung Tsai
- Miao-Li General Hospital, Ministry of Health and Welfare, Taiwan, ROC; Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC; Department of Public Health, China Medical University, Taichung, Taiwan, ROC
| | | | - Ting-Wei Lai
- Management Center, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Wei-Yin Kuo
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
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Cell-free DNA concentration in patients with clinical or mammographic suspicion of breast cancer. Sci Rep 2020; 10:14601. [PMID: 32884019 PMCID: PMC7471679 DOI: 10.1038/s41598-020-71357-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
Mammography has a crucial role in the detection of breast cancer (BC), yet it is not limitation-free. We hypothesized that the combination of mammography and cell-free DNA (cfDNA) levels may better discriminate patients with cancer. This prospective study included 259 participants suspected with BC before biopsy. Blood samples were taken before biopsy and from some patients during and at the end of treatment. cfDNA blood levels were measured using our simple fluorescent assay. The primary outcome was the pathologic diagnosis of BC, and the secondary aims were to correlate cfDNA to severity, response to treatments, and outcome. Median cfDNA blood levels were similar in patients with positive and negative biopsy: 577 vs. 564 ng/ml (p = 0.98). A significant decrease in cfDNA blood level was noted after the following treatments: surgery, surgery and radiation, neo-adjuvant chemotherapy and surgery, and at the end of all treatments. To conclude, the cfDNA level could not be used in suspected patients to discriminate BC. Reduction of tumor burden by surgery and chemotherapy is associated with reduction of cfDNA levels. In a minority of patients, an increase in post-treatment cfDNA blood level may indicate the presence of a residual tumor and higher risk. Further outcome assessment for a longer period is suggested.
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Impact of mammographic screening and advanced cancer definition on the percentage of advanced-stage cancers in a steady-state breast screening programme in the Netherlands. Br J Cancer 2020; 123:1191-1197. [PMID: 32641863 PMCID: PMC7524754 DOI: 10.1038/s41416-020-0968-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background To estimate the percentages of advanced-stage breast cancers (BCs) detected during the course of a steady-state screening programme when using different definitions of advanced BC. Methods Data of women aged 49–74 years, diagnosed with BC in 2006–2015, were selected from the Netherlands Cancer Registry and linked to the screening registry. BCs were classified as screen-detected, interval or non-screened. Three definitions of advanced BC were used for comparison: TNM stage (III–IV), NM stage (N+ and/or M+) and T size (invasive tumour ≥15 mm). Analyses were performed assuming a 10% overdiagnosis rate. In sensitivity analyses, this assumption varied from 0 to 30%. Results We included 46,734 screen-detected, 17,362 interval and 24,189 non-screened BCs. By TNM stage, 4.9% of screen-detected BCs were advanced, compared with 19.4% and 22.8% of interval and non-screened BCs, respectively (p < 0.001). Applying the other definitions led to higher percentages of advanced BC being detected. Depending on the definition interval, non-screened BCs had a 2–5-times risk of being advanced. Conclusion Irrespective of the definition, screen-detected BCs were less frequently in the advanced stage. These findings provide evidence of a stage shift to early detection and support the potential of mammographic screening to reduce treatment-related burdens and the mortality associated with BC.
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Kim J, Park EY, Kim O, Schilder JM, Coffey DM, Cho CH, Bast RC. Cell Origins of High-Grade Serous Ovarian Cancer. Cancers (Basel) 2018; 10:cancers10110433. [PMID: 30424539 PMCID: PMC6267333 DOI: 10.3390/cancers10110433] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 12/21/2022] Open
Abstract
High-grade serous ovarian cancer, also known as high-grade serous carcinoma (HGSC), is the most common and deadliest type of ovarian cancer. HGSC appears to arise from the ovary, fallopian tube, or peritoneum. As most HGSC cases present with widespread peritoneal metastases, it is often not clear where HGSC truly originates. Traditionally, the ovarian surface epithelium (OSE) was long believed to be the origin of HGSC. Since the late 1990s, the fallopian tube epithelium has emerged as a potential primary origin of HGSC. Particularly, serous tubal intraepithelial carcinoma (STIC), a noninvasive tumor lesion formed preferentially in the distal fallopian tube epithelium, was proposed as a precursor for HGSC. It was hypothesized that STIC lesions would progress, over time, to malignant and metastatic HGSC, arising from the fallopian tube or after implanting on the ovary or peritoneum. Many clinical studies and several mouse models support the fallopian tube STIC origin of HGSC. Current evidence indicates that STIC may serve as a precursor for HGSC in high-risk women carrying germline BRCA1 or 2 mutations. Yet not all STIC lesions appear to progress to clinical HGSCs, nor would all HGSCs arise from STIC lesions, even in high-risk women. Moreover, the clinical importance of STIC remains less clear in women in the general population, in which 85–90% of all HGSCs arise. Recently, increasing attention has been brought to the possibility that many potential precursor or premalignant lesions, though composed of microscopically—and genetically—cancerous cells, do not advance to malignant tumors or lethal malignancies. Hence, rigorous causal evidence would be crucial to establish that STIC is a bona fide premalignant lesion for metastatic HGSC. While not all STICs may transform into malignant tumors, these lesions are clearly associated with increased risk for HGSC. Identification of the molecular characteristics of STICs that predict their malignant potential and clinical behavior would bolster the clinical importance of STIC. Also, as STIC lesions alone cannot account for all HGSCs, other potential cellular origins of HGSC need to be investigated. The fallopian tube stroma in mice, for instance, has been shown to be capable of giving rise to metastatic HGSC, which faithfully recapitulates the clinical behavior and molecular aspect of human HGSC. Elucidating the precise cell(s) of origin of HGSC will be critical for improving the early detection and prevention of ovarian cancer, ultimately reducing ovarian cancer mortality.
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Affiliation(s)
- Jaeyeon Kim
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
- Indiana University Melvin & Bren Simon Cancer Center, Indianapolis, IN 46202, USA.
| | - Eun Young Park
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Olga Kim
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Jeanne M Schilder
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
- Indiana University Melvin & Bren Simon Cancer Center, Indianapolis, IN 46202, USA.
| | - Donna M Coffey
- Department of Pathology and Genomic Medicine, Houston Methodist and Weill Cornell Medical College, Houston, TX 77030, USA.
| | - Chi-Heum Cho
- Department of Obstetrics and Gynecology, School of Medicine, Keimyung University, Daegu 41931, Korea.
| | - Robert C Bast
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Affiliation(s)
- Gilbert H Daniels
- 1 Thyroid Unit, Cancer Center and Department of Medicine , Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Narod SA, Sopik V. Is invasion a necessary step for metastases in breast cancer? Breast Cancer Res Treat 2018; 169:9-23. [PMID: 29353366 PMCID: PMC5882625 DOI: 10.1007/s10549-017-4644-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 12/23/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To review the empirical evidence to support the conventional (sequential) model of breast cancer progression, which is based on the paradigm that cancer passes through several stages, including an in situ stage prior to an invasive stage, and thereafter (in some cases) disseminates to the lymph nodes and distant organs. METHODS We review the cancer literature of the last 50 years which relates to the prevention of invasive breast cancer (through radiotherapy or surgery) and reductions in the mortality for breast cancer. RESULTS For both invasive cancers and DCIS, the literature indicates that prevention of in-breast invasive recurrences does not prevent death from breast cancer. Moreover, the presence of residual cancer cells in the breast after breast-conserving surgery does not compromise the cure rate. CONCLUSION We propose an alternate (parallel) model of breast cancer wherein there is a small pool of cancer stem cells which have metastatic potential from their inception and which disseminate synchronously through several routes-to the breast stroma, to the lymph nodes and to distant organs. Cancer cells which disseminate to the breast give rise to cells which make up the bulk of the tumour mass but these are not the source of the distant metastases.
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Affiliation(s)
- Steven A Narod
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, M5S 1B2, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Victoria Sopik
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, M5S 1B2, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
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de Munck L, Fracheboud J, de Bock GH, den Heeten GJ, Siesling S, Broeders MJM. Is the incidence of advanced-stage breast cancer affected by whether women attend a steady-state screening program? Int J Cancer 2018; 143:842-850. [PMID: 29574967 DOI: 10.1002/ijc.31388] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 11/05/2022]
Abstract
In this cross-sectional population-based study, we assessed the incidence of advanced breast cancer based on screening attendance. Women from the Netherlands Cancer Registry were included if aged ≥49 years and diagnosed with breast cancer between 2006 and 2011, and data were linked with the screening program. Cancers were defined as screen-related (diagnosed <24 months after screening) or nonscreened (all other breast cancers). Two cut-offs were used to define advanced breast cancer: TNM-stage (III-IV vs 0-I-II) and T-stage alone (≥15 mm vs <15 mm or DCIS). The incidence rates were adjusted for age and logistic regression was used to compare groups. Of the 72,612 included women diagnosed with breast cancer, 44,246 (61%) had screen-related breast cancer. By TNM stage, advanced cancer was almost three times as likely to be at an advanced TNM stage in the nonscreened group compared with the screen-related group (38 and 94 per 100,000, respectively; OR: 2.86, 95%CI: 2.72-3.00). By T-stage, the incidence of advanced cancer was higher overall, and in nonscreened women was significantly higher than in screened women (210 and 169 per 100,000; OR: 1.85, 95%CI: 1.78-1.93). Data on actual screening attendance showed that the incidence of advanced breast cancer was significantly higher in nonscreened women than in screened women, supporting the expectation that screening would cause a stage shift to early detection. Despite critical evaluations of breast cancer screening programs, our data show that breast cancer screening is a valuable tool that can reduce the disease burden in women.
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Affiliation(s)
- Linda de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacques Fracheboud
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerard J den Heeten
- Dutch Reference Centre for Screening, Nijmegen, The Netherlands.,Department of Radiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Mireille J M Broeders
- Dutch Reference Centre for Screening, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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28
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Guo Q, Zhang L, Di Z, Ning C, Dong Z, Li Z, Wang D, Liu C, Zhao M, Tian J. Assessing Risk Category of Breast Cancer by Ultrasound Imaging Characteristics. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:815-824. [PMID: 29331358 DOI: 10.1016/j.ultrasmedbio.2017.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/03/2017] [Accepted: 12/03/2017] [Indexed: 06/07/2023]
Abstract
The purpose of our study was to assess the potential clinical value of ultrasound imaging in predicting risk category in patients with breast cancer. Three hundred thirty-six patients were enrolled and divided into a high-risk group (99, 29.5%) and mid- to low-risk group (237, 70.5%) according to the St. Gallen risk criteria. All data were retrospectively collected to analyze correlations between ultrasound features and risk category. The results revealed that the ultrasound features of irregular shape (p= 0.002), vertical growth orientation (p= 0.002), angular contour (p= 0.022) and high color Doppler flow imaging grade (p= 0.001) tended to be present in images of the high-risk group. Therefore, tumor ultrasound features should be recognized as an ideal option for determination of risk category in patients with breast cancer.
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Affiliation(s)
- Qiang Guo
- Department of Ultrasound Medicine, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China; Department of Ultrasound Medicine, Hospital of Harbin Medical University, Heilongjiang, China
| | - Lei Zhang
- Department of Ultrasound Medicine, Hospital of Harbin Medical University, Heilongjiang, China
| | - Zhixin Di
- Department of Ultrasound Medicine, Hospital of Harbin Medical University, Heilongjiang, China
| | - Chunping Ning
- Department of Ultrasound, Hospital of Qingdao University, Medical College, Qingdao, China
| | - Zhiwu Dong
- Department of Laboratory Medicine, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ziyao Li
- Department of Ultrasound Medicine, Hospital of Harbin Medical University, Heilongjiang, China
| | - Dongmo Wang
- Department of Ultrasound Medicine, Hospital of Harbin Medical University, Heilongjiang, China
| | - Chong Liu
- Department of Ultrasound Medicine, Hospital of Harbin Medical University, Heilongjiang, China
| | - Ming Zhao
- Department of Ultrasound Medicine, Hospital of Harbin Medical University, Heilongjiang, China
| | - Jiawei Tian
- Department of Ultrasound Medicine, Hospital of Harbin Medical University, Heilongjiang, China.
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29
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Outcomes of cancer surgery after inhalational and intravenous anesthesia: A systematic review. J Clin Anesth 2017; 42:19-25. [DOI: 10.1016/j.jclinane.2017.08.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/20/2017] [Accepted: 08/02/2017] [Indexed: 01/14/2023]
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30
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Wadsten C, Garmo H, Fredriksson I, Sund M, Wärnberg F. Risk of death from breast cancer after treatment for ductal carcinoma in situ. Br J Surg 2017; 104:1506-1513. [DOI: 10.1002/bjs.10589] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/25/2017] [Accepted: 04/06/2017] [Indexed: 01/18/2023]
Abstract
Abstract
Background
Studies to date have failed to demonstrate any survival benefit from preventing local recurrence after treatment for ductal breast carcinoma in situ (DCIS). Patient- and tumour-related risk factors for death from breast cancer in women with a primary DCIS were analysed here in a large case–control study.
Methods
A nested case–control study was conducted in a population-based cohort of women with primary DCIS between 1992 and 2012. Women who later died from breast cancer were identified. Four controls per case were selected randomly by incidence density sampling. Medical records and pathology reports were retrieved. Conditional logistic regression was used to calculate odds ratios (ORs) and 95 per cent confidence intervals for risk of death from breast cancer.
Results
From a cohort of 6964 women, 96 who died from breast cancer were identified and these were compared with a group of 318 controls. Tumour size over 25 mm or multifocal DCIS (OR 2·55, 95 per cent c.i. 1·53 to 4·25), a positive or uncertain margin status (OR 3·91, 1·59 to 9·61) and detection outside the screening programme (OR 2·12, 1·16 to 3·86) increased the risk of death from breast cancer. The risks were not affected by age or type of treatment. In the multivariable analysis, tumour size (OR 1·95, 1·06 to 3·67) and margin status (OR 2·69, 1·15 to 7·11) remained significant.
Conclusion
In the present study, large tumour size and positive or uncertain margin status were associated with a higher risk of death from breast cancer after treatment for primary DCIS. More extensive treatment was not associated with lower risk, which may be due to confounding by indication, or indicate that some DCIS has an inherent potential for metastatic spread.
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Affiliation(s)
- C Wadsten
- Department of Surgery, Sundsvall Hospital, Sundsvall, Sweden
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - H Garmo
- Regional Cancer Centre, Uppsala University/Uppsala University Hospital, Uppsala, Sweden
- Faculty of Life Sciences and Medicine, Section of Cancer Epidemiology and Population Health, King's College, London, UK
| | - I Fredriksson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Sund
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - F Wärnberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
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31
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Narod S, Ahmed H, Sopik V. Wherein the authors attempt to minimize the confusion generated by their study "Breast cancer mortality after a diagnosis of ductal carcinoma in situ" by several commentators who disagree with them and a few who don't: a qualitative study. Curr Oncol 2017; 24:e255-e260. [PMID: 28874895 PMCID: PMC5576464 DOI: 10.3747/co.24.3626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Various parties might wish to measure the impact of a given paper for the purpose of assigning merit to an author or institution [...]
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Affiliation(s)
- S.A. Narod
- Women’s College Research Institute
- Dalla Lana School of Public Health, University of Toronto; and
| | - H. Ahmed
- Women’s College Research Institute
- Institute of Medical Science, University of Toronto, Toronto; ON
| | - V. Sopik
- Women’s College Research Institute
- Institute of Medical Science, University of Toronto, Toronto; ON
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32
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Lazzeroni M, Dunn BK, Pruneri G, Jereczek-Fossa BA, Orecchia R, Bonanni B, DeCensi A. Adjuvant therapy in patients with ductal carcinoma in situ of the breast: The Pandora's box. Cancer Treat Rev 2017; 55:1-9. [PMID: 28262606 DOI: 10.1016/j.ctrv.2017.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 12/23/2022]
Abstract
Most patients with ductal carcinoma in situ of the breast (DCIS) are eligible for breast conservation treatment. The key management decision is whether to add radiotherapy and/or endocrine therapy to minimize the risk of a subsequent recurrence. Recent analyses indicating a lack of benefit in terms of breast cancer-associated mortality have suggested that more conservative approaches, omitting adjuvant therapy or even surgery, may be advisable in selected patients. These mortality observations are directly influenced by widespread use of mammographic screening which has opened a Pandora's box of subclinical DCIS and early invasive lesions. Confusion as to how aggressively such possibly indolent lesions should be treated has led to misunderstandings among patients and medical professionals. While awaiting further prospective evidence from clinical trials, we endorse an active treatment of DCIS as the standard of care. Our rationale is twofold: invasive recurrences are associated with an increase in breast cancer mortality, which is not the only relevant endpoint for DCIS. The benefit of complete surgical excision, adjuvant radiotherapy and endocrine treatment in preventing recurrence and invasive progression has been demonstrated in DCIS. The challenge now is how to identify DCIS patients who will not progress to invasive carcinoma even without complete excision and, at the other extreme, those patients at the highest risk who require mastectomy for local control. The current controversies over whether and which adjuvant therapy should be implemented can at least in part be addressed by developing effective doctor-patient communications that enable mutual understanding about the management of this biologically heterogeneous disease.
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Affiliation(s)
- Matteo Lazzeroni
- Divisions of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Barbara K Dunn
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA
| | - Giancarlo Pruneri
- Pathology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Roberto Orecchia
- Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Bernardo Bonanni
- Divisions of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Andrea DeCensi
- Divisions of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy; Division of Medical Oncology, E.O. Ospedali Galliera, Genoa, Italy; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom.
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33
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Fiskaa T, Knutsen E, Nikolaisen MA, Jørgensen TE, Johansen SD, Perander M, Seternes OM. Distinct Small RNA Signatures in Extracellular Vesicles Derived from Breast Cancer Cell Lines. PLoS One 2016; 11:e0161824. [PMID: 27579604 PMCID: PMC5006963 DOI: 10.1371/journal.pone.0161824] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 08/14/2016] [Indexed: 12/13/2022] Open
Abstract
Breast cancer is a heterogeneous disease, and different subtypes of breast cancer show distinct cellular morphology, gene expression, metabolism, motility, proliferation, and metastatic potential. Understanding the molecular features responsible for this heterogeneity is important for correct diagnosis and better treatment strategies. Extracellular vesicles (EVs) and their associated molecules have gained much attention as players in intercellular communication, ability to precondition specific organs for metastatic invasion, and for their potential role as circulating cancer biomarkers. EVs are released from the cells and contain proteins, DNA, and long and small RNA species. Here we show by high-throughput small RNA-sequencing that EVs from nine different breast cancer cell lines share common characteristics in terms of small RNA content that are distinct from their originating cells. Most strikingly, a highly abundant small RNA molecule derived from the nuclear 28S rRNA is vastly enriched in EVs. The miRNA profiles in EVs correlate with the cellular miRNA expression pattern, but with a few exceptions that includes miR-21. This cancer-associated miRNA is retained in breast cancer cell lines. Finally, we report that EVs from breast cancer cell lines cluster together based on their small RNA signature when compared to EVs derived from other cancer cell lines. Altogether, our data demonstrate that breast cancer cell lines manifest a specific small RNA signature in their released EVs. This opens up for further evaluation of EVs as breast cancer biomarkers.
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Affiliation(s)
- Tonje Fiskaa
- Department of Medical Biology, Faculty of Health Sciences, UiT–The Arctic University of Norway, MH-building Breivika, Tromsø, N-9037, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT–The Arctic University of Norway, MH-building Breivika, Tromsø, N-9037, Norway
- * E-mail:
| | - Erik Knutsen
- Department of Medical Biology, Faculty of Health Sciences, UiT–The Arctic University of Norway, MH-building Breivika, Tromsø, N-9037, Norway
| | - Marlen Aas Nikolaisen
- Department of Pharmacy, Faculty of Health Sciences, UiT–The Arctic University of Norway, MH-building Breivika, Tromsø, N-9037, Norway
| | - Tor Erik Jørgensen
- Marine Genomics group, Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
| | - Steinar Daae Johansen
- Department of Medical Biology, Faculty of Health Sciences, UiT–The Arctic University of Norway, MH-building Breivika, Tromsø, N-9037, Norway
- Marine Genomics group, Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
| | - Maria Perander
- Department of Medical Biology, Faculty of Health Sciences, UiT–The Arctic University of Norway, MH-building Breivika, Tromsø, N-9037, Norway
| | - Ole Morten Seternes
- Department of Pharmacy, Faculty of Health Sciences, UiT–The Arctic University of Norway, MH-building Breivika, Tromsø, N-9037, Norway
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34
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Sopik V, Iqbal J, Sun P, Narod SA. Impact of a prior diagnosis of DCIS on survival from invasive breast cancer. Breast Cancer Res Treat 2016; 158:385-93. [DOI: 10.1007/s10549-016-3894-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 11/28/2022]
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35
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Sopik V, Narod SA. Common genetic susceptibility to DCIS and invasive ductal carcinoma. Breast Cancer Res 2016; 18:60. [PMID: 27286830 PMCID: PMC4902925 DOI: 10.1186/s13058-016-0719-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- Victoria Sopik
- Women's College Research Institute, 76 Grenville Street, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, 76 Grenville Street, Toronto, Ontario, Canada.
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36
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Duffy SW. DCIS and invasive interval breast cancer - Author's reply. Lancet Oncol 2016; 17:e88-e89. [PMID: 26972861 DOI: 10.1016/s1470-2045(16)00104-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
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37
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Narod SA, Sopik V, Sun P. DCIS and invasive interval breast cancer. Lancet Oncol 2016; 17:e87-e88. [DOI: 10.1016/s1470-2045(16)00023-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/04/2016] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
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