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Shao Z, Yu J, Cheng Y, Ma W, Liu P, Lu H. MR imaging phenotypes and features associated with pathogenic mutation to predict recurrence or metastasis in breast cancer. BMC Cancer 2023; 23:97. [PMID: 36707770 PMCID: PMC9883861 DOI: 10.1186/s12885-023-10555-5] [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: 01/24/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Distant metastasis remains the main cause of death in breast cancer. Breast cancer risk is strongly influenced by pathogenic mutation.This study was designed to develop a multiple-feature model using clinicopathological and imaging characteristics adding pathogenic mutations associated signs to predict recurrence or metastasis in breast cancers in high familial risk women. METHODS Genetic testing for breast-related gene mutations was performed in 54 patients with breast cancers. Breast MRI findings were retrospectively evaluated in 64 tumors of the 54 patients. The relationship between pathogenic mutation, clinicopathological and radiologic features was examined. The disease recurrence or metastasis were estimated. Multiple logistic regression analyses were performed to identify independent factors of pathogenic mutation and disease recurrence or metastasis. Based on significant factors from the regression models, a multivariate logistic regression was adopted to establish two models for predicting disease recurrence or metastasis in breast cancer using R software. RESULTS Of the 64 tumors in 54 patients, 17 tumors had pathogenic mutations and 47 tumors had no pathogenic mutations. The clinicopathogenic and imaging features associated with pathogenic mutation included six signs: biologic features (p = 0.000), nuclear grade (p = 0.045), breast density (p = 0.005), MRI lesion type (p = 0.000), internal enhancement pattern (p = 0.004), and spiculated margin (p = 0.049). Necrosis within the tumors was the only feature associated with increased disease recurrence or metastasis (p = 0.006). The developed modelIincluding clinico-pathologic and imaging factors showed good discrimination in predicting disease recurrence or metastasis. Comprehensive model II, which included parts of modelIand pathogenic mutations significantly associated signs, showed significantly more sensitivity and specificity for predicting disease recurrence or metastasis compared to Model I. CONCLUSIONS The incorporation of pathogenic mutations associated imaging and clinicopathological parameters significantly improved the sensitivity and specificity in predicting disease recurrence or metastasis. The constructed multi-feature fusion model may guide the implementation of prophylactic treatment for breast cancers at high familial risk women.
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Affiliation(s)
- Zhenzhen Shao
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 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, P. R. China
| | - Jinpu Yu
- Cancer Molecular Diagnostics Core, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 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, P. R. China
| | - Yanan Cheng
- Cancer Molecular Diagnostics Core, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 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, P. R. China
| | - Wenjuan Ma
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 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, P. R. China
| | - Peifang Liu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 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, P. R. China
| | - Hong Lu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 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, P. R. China
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Ma W, Wang X, Xu G, Liu Z, Yin Z, Xu Y, Wu H, Baklaushev VP, Peltzer K, Sun H, Kharchenko NV, Qi L, Mao M, Li Y, Liu P, Chekhonin VP, Zhang C. Distant metastasis prediction via a multi-feature fusion model in breast cancer. Aging (Albany NY) 2020; 12:18151-18162. [PMID: 32989175 PMCID: PMC7585122 DOI: 10.18632/aging.103630] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/22/2020] [Indexed: 01/24/2023]
Abstract
This study aimed to develop a model that fused multiple features (multi-feature fusion model) for predicting metachronous distant metastasis (DM) in breast cancer (BC) based on clinicopathological characteristics and magnetic resonance imaging (MRI). A nomogram based on clinicopathological features (clinicopathological-feature model) and a nomogram based on the multi-feature fusion model were constructed based on BC patients with DM (n=67) and matched patients (n=134) without DM. DM was diagnosed on average (17.31±13.12) months after diagnosis. The clinicopathological-feature model included seven features: reproductive history, lymph node metastasis, estrogen receptor status, progesterone receptor status, CA153, CEA, and endocrine therapy. The multi-feature fusion model included the same features and an additional three MRI features (multiple masses, fat-saturated T2WI signal, and mass size). The multi-feature fusion model was relatively better at predicting DM. The sensitivity, specificity, diagnostic accuracy and AUC of the multi-feature fusion model were 0.746 (95% CI: 0.623-0.841), 0.806 (0.727-0.867), 0.786 (0.723-0.841), and 0.854 (0.798-0.911), respectively. Both internal and external validations suggested good generalizability of the multi-feature fusion model to the clinic. The incorporation of MRI factors significantly improved the specificity and sensitivity of the nomogram. The constructed multi-feature fusion nomogram may guide DM screening and the implementation of prophylactic treatment for BC.
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Affiliation(s)
- Wenjuan Ma
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Guijun Xu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zheng Liu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhuming Yin
- Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, National 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’s Clinical Research Center for Cancer, Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin 300060, China
| | - Yao Xu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Haixiao Wu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Vladimir P. Baklaushev
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency of the Russian Federation, Moscow 115682, Russian Federation
| | - Karl Peltzer
- Department of Research and Innovation, University of Limpopo, Turfloop 0527, South Africa
| | - Henian Sun
- Department of Oncology, N.N. Blokhin National Medical Research Center of Oncology, Moscow 115478, Russian Federation
| | - Natalia V. Kharchenko
- Department of Oncology, Radiology and Nuclear Medicine, Medical Institute of Peoples’ Friendship University of Russia, Moscow 117198, Russian Federation
| | - Lisha Qi
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Min Mao
- Department of Pathology and Southwest Cancer Center, First Affiliated Hospital, Army Medical University, Chongqing 400038, China
| | - Yanbo Li
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Peifang Liu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Vladimir P. Chekhonin
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow 117997, Russian Federation
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
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Predictors of non-sentinel lymph node metastasis in clinical early stage (cT1-2N0) breast cancer patients with 1-2 metastatic sentinel lymph nodes. Asian J Surg 2019; 43:538-549. [PMID: 31519397 DOI: 10.1016/j.asjsur.2019.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/23/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the risk factors that caused non-sentinel lymph nodes (nonSLNs) metastasis by considering the clinicopathological characteristics of patients who have 1-2 sentinel lymph node (SLN) metastasis in the clinical early stage (T1-2, N0) breast cancer. METHODS The demographic and clinicopathological characteristics of the patients were recorded retrospectively. Among these, age, size of the primary breast tumor, tumor localization and multifocality/multicentricity status, preoperative serum Neutrophil/Lymphocyte rate (NLR), c-erbB2/HER2-neu status, Estrogen Receptor (ER) and Progesterone Receptor (PR) status, primary tumor proliferation index (Ki-67), histopathological grade, molecular subtypes, histopathological subtypes, nipple/areola infiltration, Lymphatic Invasion (LI), Vascular Invasion (VI), Perineural Invasion (PNI), number of metastatic SLN m(SLN), mSLN diameter, SLN Extranodal Extension (ENE) status, and number of metastatic nonSLNs were recorded. RESULTS According to the univariate analysis, the HER2 positivity, Ki-67≥%20, mSLN diameter, LI, VI, PNI, ENE and molecular subtypes were found to be significant. However, the age, tumor localization, multifocality/multicentricity, T stage, ER and PR status, tumor size, histopathological grade and subtypes, nipple/areola infiltration and NLR were not found to be significant. In the multivariate analysis, significant independent predictors in nonSLN metastasis development were found to be HER2 positivity, PNI, mSLN diameter ≥10,5 mm and ENE. CONCLUSION The HER2 positivity, ENE, PNI and mSLN diameter ≥10,5 mm were found to be very strong predictors in nonSLN metastasis development. The findings of this study have the potential to be a guideline for surgeons and oncologists when determining their patients' treatment plan. These components are candidates for inclusion among the clinicopathological factors that may be used in the new nomograms due to their higher sensitivity and specificity.
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Zhang J, Zhao B, Jin F. The assessment of 8th edition AJCC prognostic staging system and a simplified staging system for breast cancer: The analytic results from the SEER database. Breast J 2019; 25:838-847. [PMID: 31192530 DOI: 10.1111/tbj.13347] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/08/2018] [Accepted: 12/12/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Jingting Zhang
- Department of Breast Surgery First Affiliated Hospital of China Medical University Shenyang China
| | - Bochao Zhao
- Department of Surgical Oncology First Affiliated Hospital of China Medical University Shenyang China
| | - Feng Jin
- Department of Breast Surgery First Affiliated Hospital of China Medical University Shenyang China
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Zhou Y, Huang X, Mao F, Lin Y, Shen S, Guan J, Zhang X, Sun Q. Predictors of nonsentinel lymph node metastasis in patients with breast cancer with metastasis in the sentinel node. Medicine (Baltimore) 2019; 98:e13916. [PMID: 30608418 PMCID: PMC6344180 DOI: 10.1097/md.0000000000013916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
To predict the factors related to axillary nonsentinel lymph node (NSLN) metastasis in patients with positive sentinel lymph node (SLN) of early breast cancer.The retrospective data are collected from the patients with positive SLN who received further completion axillary lymph node dissection (cALND) in Peking Union Medical Hospital between March 2016 and December 2017. Univariate analysis was conducted on data with various clinicopathologic factors at first. Those factors with statistic significance (P < .05) in univariate analysis were then used to implement multivariate analysis and logistic regression.There were total of 734 patients who received SLN biopsy , among whom 153 cases were included in our study. About 39.22% (60/153) of 153 paitents with positive SLN had no NSLN metastasisted to SLN. Univariate analysis showed that 3 variables were significantly correlated with NSLN involvement: tumor size (X = 10.384, P = .001), SLN metastasis ratio (number of positive SLNs/number of SLNs removed × 100%) (X = 10.365, P = .001) and the number of negative sentinel nodes (X = 10.384, P = .006). In multivariate analysis and logistic regression, tumor size (odds ratio [OR] = 3.392, 95% confidence interval [CI]: 1.409-8.166, P = .006) and SLN metastasis ratio (OR = 3.514, 95% CI: 1.416-8.72, P = .007) were the independent risk factors. While the number of negative sentinel nodes (OR = 0.211, 95% CI: 0.063-0.709, P = .014) was the independent protective factor. The calculated risk resulted in an area under the curve of 0.746 (95% CI: 0.644-0.848), suggesting stable discriminative capability in Chinese population.For those patients with positive SLN, larger tumor burden and SLN metastasis ratio are independent risk factors for NSLN metastasis. However, the more of the detected negative SLN, the less possibility with NSLN involvement.
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Noda S, Onoda N, Asano Y, Kurata K, Tokumoto M, Morisaki T, Kashiwagi S, Takashima T, Hirakawa K. Predictive factors for the occurrence of four or more axillary lymph node metastases in ER-positive and HER2-negative breast cancer patients with positive sentinel node: A retrospective cohort study. Int J Surg 2015; 26:1-5. [PMID: 26700202 DOI: 10.1016/j.ijsu.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/16/2015] [Accepted: 12/04/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Patients with four or more axillary lymph node metastases have benefited from postmastectomy radiotherapy to the supraclavicular region. However, when metastatic sentinel nodes (SNs) are present, information regarding the total number of node metastases cannot be obtained if axillary lymph node dissection (ALND) is omitted from the treatment protocol. It is important to determine the indication for additional chemotherapy in ER-positive and HER2-negative breast cancer patients. We investigated the predictive factors for the occurrence of four or more metastases in patients with ER-positive and HER2-negative breast cancer in the presence of macrometastasis in the SNs. METHODS We reviewed 83 patients with ER-positive and HER2-negative breast cancer, who had macrometastasis in the SN and had undergone ALND. The clinicopathological findings and prognosis between patients with pN1 disease and those with pN2 disease were also compared. RESULTS Nineteen percent of patients had pN2-3 disease. The predictive factor for poor prognosis in these patients was the presence of pN2-3 disease. The independent predictive factors for pN2-3 disease were the T stage and the ratio of the number positive SNs to the number of removed SNs (SN ratio). Patients with both T2 tumors and a high SN ratio had a 50% risk of having pN2-3 disease. CONCLUSION The presence of four or more metastases was found to be the strongest prognostic factor in ER-positive and HER2-negative breast cancer patients with macrometastasis in the SN. The T stage and SN ratio determined before surgery or during surgery were useful in predicting pN2-3 disease in these patients.
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Affiliation(s)
- Satoru Noda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | - Naoyoshi Onoda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yuka Asano
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Kento Kurata
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Mao Tokumoto
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tamami Morisaki
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shinichiro Kashiwagi
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tsutomu Takashima
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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