1
|
Liu G, Xing Z, Guo C, Dai Q, Cheng H, Wang X, Tang Y, Wang Y. Identifying clinicopathological risk factors for regional lymph node metastasis in Chinese patients with T1 breast cancer: a population-based study. Front Oncol 2023; 13:1217869. [PMID: 37601676 PMCID: PMC10436470 DOI: 10.3389/fonc.2023.1217869] [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: 05/06/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Objectives To analyze clinicopathological risk factors and regular pattern of regional lymph node metastasis (LNM) in Chinese patients with T1 breast cancer and the effect on overall survival (OS) and disease-free survival (DFS). Materials and methods Between 1999 and 2020, breast cancer patients meeting inclusion criteria of unilateral, no distant metastatic site, and T1 invasive ductal carcinoma were reviewed. Clinical pathology characteristics were retrieved from medical records. Survival analysis was performed using Kaplan-Meier methods and an adjusted Cox proportional hazards model. Results We enrolled 11,407 eligible patients as a discovery cohort to explore risk factors for LNM and 3484 patients with stage T1N0 as a survival analysis cohort to identify the effect of those risk factors on OS and DFS. Compared with patients with N- status, patients with N+ status had a younger age, larger tumor size, higher Ki67 level, higher grade, higher HR+ and HER2+ percentages, and higher luminal B and HER2-positive subtype percentages. Logistic regression indicated that age was a protective factor and tumor size/higher grade/HR+ and HER2+ risk factors for LNM. Compared with limited LNM (N1) patients, extensive LNM (N2/3) patients had larger tumor sizes, higher Ki67 levels, higher grades, higher HR- and HER2+ percentages, and lower luminal A subtype percentages. Logistic regression indicated that HR+ was a protective factor and tumor size/higher grade/HER2+ risk factors for extensive LNM. Kaplan-Meier analysis indicated that grade was a predictor of both OS and DFS; HR was a predictor of OS but not DFS. Multivariate survival analysis using the Cox regression model demonstrated age and Ki67 level to be predictors of OS and grade and HER2 status of DFS in stage T1N0 patients. Conclusion In T1 breast cancer patients, there were several differences between N- and N+ patients, limited LNM and extensive LNM patients. Besides, HR+ plays a dual role in regional LNM. In patients without LNM, age and Ki67 level are predictors of OS, and grade and HER2 are predictors of DFS.
Collapse
Affiliation(s)
- Gang Liu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zeyu Xing
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changyuan Guo
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qichen Dai
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Cheng
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiang Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- GCP center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yipeng Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
2
|
Wu J, Liu Y, Huang H, Zhu M, Zhang X. Identification of a Risk Predictive Signature Based on Genes Associated with Tumor Size and Lymph Node Involvement in Breast Cancer. Genet Test Mol Biomarkers 2022; 26:532-542. [DOI: 10.1089/gtmb.2022.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Junqiang Wu
- Department of Breast Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yuqing Liu
- School of Life Sciences, Nanjing Normal University, Nanjing, China
| | - Hu Huang
- Department of Breast Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Mingjie Zhu
- Department of Breast Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xiufen Zhang
- Oncology Institute, Affiliated Hospital of Jiangnan University, Wuxi, China
| |
Collapse
|
3
|
Xu M, Tang Q, Li M, Liu Y, Li F. An analysis of Ki-67 expression in stage 1 invasive ductal breast carcinoma using apparent diffusion coefficient histograms. Quant Imaging Med Surg 2021; 11:1518-1531. [PMID: 33816188 DOI: 10.21037/qims-20-615] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background To investigate the value of apparent diffusion coefficient (ADC) histograms in differentiating Ki-67 expression in T1 stage invasive ductal breast carcinoma (IDC). Methods The records of 111 patients with pathologically confirmed T1 stage IDC who underwent magnetic resonance imaging prior to surgery were retrospectively reviewed. The expression of Ki-67 in tumor tissue samples from the patients was assessed using immunohistochemical (IHC) staining, with a cut-off value of 25% for high Ki-67 labeling index (LI). ADC images of the maximum lay of tumors were selected, and the region of interest (ROI) of each lay was delineated using the MaZda software and analyzed by histogram. The correlations between the histogram characteristic parameters and the Ki-67 LI were investigated. Additionally, the histogram characteristic parameters of the high Ki-67 group (n=54) and the low Ki-67 group (n=57) were statistically analyzed to determine the characteristic parameters with significant difference. Receiver operator characteristic (ROC) analyses were further performed for the significant parameters. Results The mean value, and the 1st, 10th, 50th, 90th, and 99th percentiles were found to be negatively correlated with the expression of Ki-67 (all P values <0.001), with a correlation coefficient of -0.624, -0.749, -0.717, -0.621, -0.500, and -0.410, respectively. In the high Ki-67 group, the mean value, and the 1st, 10th, 50th, 90th, and 99th percentiles extracted by the histogram were significantly lower (all P values <0.05) than that of the low Ki-67 group, with areas under the ROC curves ranging from 0.717-0.856. However, the variance, skewness, and kurtosis did not differ between the two groups (all P values >0.05). Conclusions Histogram-derived parameters for ADC images can serve as a reliable tool in the prediction of Ki-67 proliferation status in patients with T1 stage IDC. Among the significant ADC histogram values, the 1st and 10th percentiles showed the best predictive values.
Collapse
Affiliation(s)
- Maolin Xu
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Tang
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Manxiu Li
- Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yulin Liu
- Department of Radiology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Li
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
4
|
Alexander M, Lin J, Shriver CD, McGlynn KA, Zhu K. Tumour size and overall survival among surgically treated patients with non-metastatic colon cancer in the U.S. Military Health System. Colorectal Dis 2021; 23:192-199. [PMID: 32976668 PMCID: PMC8573790 DOI: 10.1111/codi.15381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/13/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022]
Abstract
AIM Larger tumour size and lymph node involvement traditionally predict poorer survival in colon cancer patients. However, it has been recently suggested that very small tumours (<5 mm) may be a predictor of poor prognosis in colon cancer patients when lymph nodes are involved. This study investigated whether node-positive colon cancer patients with small tumours had worse survival compared to those with larger tumours in the Department of Defense's (DoD) Military Health System (MHS), a universal health care system. METHODS Surgically treated colon cancer patients were identified from the DoD's Automated Central Tumour Registry (ACTUR). These patients were diagnosed with Stage I-III colon cancer between 1989 and 2010, had one or more lymph nodes examined, did not receive pre-operative radiotherapy and were followed through 2013 to determine vital status. Multivariable Cox models were used to examine survival differences according to tumour size, and data were stratified by lymph node status and age. RESULTS There were no differences in overall survival according to tumour size in the study population. These findings remained similar in analyses stratified by lymph node status and age. CONCLUSION In a universal healthcare system, small tumour size is not associated with worse prognosis in node-positive colon cancer patients.
Collapse
Affiliation(s)
- Melannie Alexander
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Jie Lin
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD,Departmentof Surgery, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD,Departmentof Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Craig D. Shriver
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD,Departmentof Surgery, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Department of Surgery, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD,Departmentof Surgery, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD,Departmentof Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD
| |
Collapse
|
5
|
Lim ST, Park CH, Kim SY, Nam SJ, Kang EY, Moon BI, Lee HJ, Jeon YW, Gwak H, Suh YJ. The effect of adjuvant chemotherapy on survival in Korean patients with node negative T1c, triple negative breast cancer. PLoS One 2018; 13:e0197523. [PMID: 29768496 PMCID: PMC5955535 DOI: 10.1371/journal.pone.0197523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/03/2018] [Indexed: 01/27/2023] Open
Abstract
Background The present study investigated the prognostic role of adjuvant systemic chemotherapy in patients with node negative, T1c triple negative breast cancer (TNBC) from a nationwide cohort. In addition, the prognostic effect between 3 different chemotherapy regimens were compared in node-negative T1c TNBC patients by subgroup analysis. Methods From the Korean breast cancer registry database, 1,151 T1c node negative TNBC patients were included in this study. Patients were categorized into four treatment groups according to chemotherapy regimen: (1) no chemotherapy, (2) adriamycin plus cyclophosphamide (AC), (3) adriamycin/epirubicin plus cyclophosphamide plus 5-FU (FAC/FEC), and (4) cyclophosphamide plus 5-FU plus methotrexate (CMF). Overall survival (OS) was evaluated between each patient group. Results Of the 1,151 T1c node negative TNBC patients, 1,006 received adjuvant chemotherapy, while 145 received no chemotherapy. Among the patients receiving adjuvant chemotherapy the distribution of regimens was: 586 AC, 168 FAC/FEC (126 FAC, 42 FEC), and 252 CMF. The mean follow-up time of the full study cohort was 87.98 ± 33.56 months (range = 6–192 months). Patients in the no chemotherapy group showed significantly worse OS compared to each chemotherapy regimen group. However, when OS was compared between each chemotherapy regimen, no significant difference was found. Conclusions This study showed that adjuvant systemic chemotherapy improved OS in T1c node negative TNBC patients, regardless of chemotherapy between AC, FAC/FEC, and CMF regimens.
Collapse
Affiliation(s)
- Seung Taek Lim
- Department of Surgery, Division of Breast & Thyroid Surgical Oncology, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yong Kim
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Seok Jin Nam
- Department of Surgery, Division of Breast and Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung-In Moon
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyouk Jin Lee
- Department of Surgery, Saegyaero Hospital, Busan, Republic of Korea
| | - Ye Won Jeon
- Department of Surgery, Division of Breast & Thyroid Surgical Oncology, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Hongki Gwak
- Department of Surgery, Division of Breast & Thyroid Surgical Oncology, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Young Jin Suh
- Department of Surgery, Division of Breast & Thyroid Surgical Oncology, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea
- * E-mail:
| |
Collapse
|
6
|
He Y, Peng L, Huang Y, Liu C, Zheng S, Wu K. Blood cadmium levels associated with short distant metastasis-free survival time in invasive breast cancer. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:28055-28064. [PMID: 28994009 DOI: 10.1007/s11356-017-0412-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/03/2017] [Indexed: 02/05/2023]
Abstract
Distant metastasis is strongly associated with poor prognosis of breast cancer. Cadmium (Cd) exposure was previously found associated with breast cancer incidence. We explored the associations of blood cadmium levels (BCLs) and clinicopathologic characteristics with invasive breast cancer distant metastasis. Blood samples were collected and analyzed for BCLs by graphite-furnace atomic absorption spectrometry. Clinicopathologic characteristics, including basic clinical information and tumor characteristics, were obtained from medical records. Breast cancer distant metastasis-free survival (DMFS) time was calculated at follow-up. The associations of BCLs and clinicopathologic characteristics with DMFS time were examined by Kaplan-Meier method and Cox regression analysis, and associations between BCLs and tumor characteristics were also explored. Blood Cd level was positively associated with distant metastasis, clinical stage, BMI, and age. On univariate analysis, older age at diagnosis, family history of breast cancer, high N classification and clinical stage, positivity for human epidermal growth factor receptor 2, and high BCLs were associated with short DMFS time. On multivariate analysis model, older age at diagnosis, family history of breast cancer, high N classification, and BCLs were predictors for breast cancer distant metastasis. BCLs were a risk factor for short DMFS time of invasive breast cancer. BCLs and some clinicopathologic factors affect breast cancer distant metastasis, which needs further epidemiological and experimental studies to confirm.
Collapse
Affiliation(s)
- Yuanfang He
- Department of Preventive Medicine, Shantou University Medical College, No.22, Xinling Rd., Shantou, Guangdong, 515041, China
| | - Lin Peng
- Clinical Laboratory, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Yanhong Huang
- Mental Health Center, Shantou University Medical College, North Taishan Road, Shantou, Guangdong Province, 515065, China
| | - Caixia Liu
- Department of Preventive Medicine, Shantou University Medical College, No.22, Xinling Rd., Shantou, Guangdong, 515041, China
| | - Shukai Zheng
- Department of Preventive Medicine, Shantou University Medical College, No.22, Xinling Rd., Shantou, Guangdong, 515041, China
| | - Kusheng Wu
- Department of Preventive Medicine, Shantou University Medical College, No.22, Xinling Rd., Shantou, Guangdong, 515041, China.
| |
Collapse
|