Breast cancer in China

Predicting Overall Survival in Patients with Male Breast Cancer: Nomogram Development and External Validation Study

Background

Male breast cancer (MBC) is an uncommon disease. Few studies have discussed the prognosis of MBC due to its rarity.

Objective

This study aimed to develop a nomogram to predict the overall survival of patients with MBC and externally validate it using cases from China.

Methods

Based on the Surveillance, Epidemiology, and End Results (SEER) database, male patients who were diagnosed with breast cancer between January 2010, and December 2015, were enrolled. These patients were randomly assigned to either a training set (n=1610) or a validation set (n=713) in a 7:3 ratio. Additionally, 22 MBC cases diagnosed at the First Affiliated Hospital of Guangxi Medical University between January 2013 and June 2021 were used for external validation, with the follow-up endpoint being June 10, 2023. Cox regression analysis was performed to identify significant risk variables and construct a nomogram to predict the overall survival of patients with MBC. Information collected from the test set was applied to validate the model. The concordance index (C-index), receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and a Kaplan-Meier survival curve were used to evaluate the accuracy and reliability of the model.

Results

A total of 2301 patients with MBC in the SEER database and 22 patients with MBC from the study hospital were included. The predictive model included 7 variables: age (hazard ratio [HR] 1.89, 95% CI 1.50-2.38), surgery (HR 0.38, 95% CI 0.29-0.51), marital status (HR 0.75, 95% CI 0.63-0.89), tumor stage (HR 1.17, 95% CI 1.05-1.29), clinical stage (HR 1.41, 95% CI 1.15-1.74), chemotherapy (HR 0.62, 95% CI 0.50-0.75), and HER2 status (HR 2.68, 95% CI 1.20-5.98). The C-index was 0.72, 0.747, and 0.981 in the training set, internal validation set, and external validation set, respectively. The nomogram showed accurate calibration, and the ROC curve confirmed the advantage of the model in clinical validity. The DCA analysis indicated that the model had good clinical applicability. Furthermore, the nomogram classification allowed for more accurate differentiation of risk subgroups, and patients with low-risk MBC demonstrated substantially improved survival outcomes compared with medium- and high-risk patients (P<.001).

Conclusions

A survival prognosis prediction nomogram with 7 variables for patients with MBC was constructed in this study. The model can predict the survival outcome of these patients and provide a scientific basis for clinical diagnosis and treatment.

Extending breast cancer screening beyond age 45-64 years in China: A cost-effectiveness analysis

The optimal breast cancer (BC) screening age in China remains uncertain. In this study, we evaluated the benefits, harms, and cost-effectiveness of lowering the screening starting age from 45 to 35 years and extending the stopping age from 64 to 79 years in Chinese women at an average risk of progressing BC. Biennial screening showed a lower incremental cost-effectiveness ratio (ICER) compared to annual screening. Extending the screening age beyond 45-64 years in certain scenarios increased the number of false-positive results and each averted breast cancer deaths. Specifically, extending the starting age to 35 years reduced overdiagnosis rate to 10.8 % and had an incremental cost ratio of US$12,746 per quality-adjusted life year (QALY), falling below the cost-effectiveness threshold of US$18,346 per QALY. Regarding the ceasing age, the status quo (age 64 years) was found to be the optimal choice as it was proved to yield the majority of benefits with reduced harm and be the only option under the cost-effectiveness threshold. In summary, biennial screening for average-risk women aged 35-64 years is the most cost-effective approach strategy, aligning with The National Health Commission's screening program for cervical and breast cancer.

Efficacy and safety of trastuzumab deruxtecan in Chinese patients with HER2-positive and HER2-low advanced breast cancer: a multicenter, observational, real-world study

Objective

Limited real-world efficacy and safety data exist regarding the use of trastuzumab deruxtecan (T-DXd) in the Chinese population with human epidermal growth factor receptor (HER2)-positive and HER2-low advanced breast cancer (BC). This multicenter, observational, real-world study aimed to evaluate the efficacy and safety of T-DXd for the treatment of Chinese patients with HER2-positive and HER2-low advanced BC.

Methods

The medical records of 61 patients were collected from The Second Hospital of Dalian Medical University, Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing Jingxin Hospital, and Cancer Hospital of the Chinese Academy of Medical Sciences. The primary endpoint of the study was progression-free survival (PFS), and the secondary endpoints were overall survival (OS), objective response rate (ORR), disease control rate (DCR), time to response (TTR), and safety. PFS and OS were analyzed using the Kaplan-Meier method and log-rank test.

Results

The primary endpoint, PFS was 10.51 months (95% confidence interval (CI), 3.02-NE) in the HER2-low group and 10.18 months (95% CI, 3.88-NE) in the HER2-positive group. Regarding the secondary endpoints in the HER2-low and HER2-positive groups, OS data were immature, ORR rates were 37.93% and 62.50%, DCR rates were 79.31% and 87.50%, and the median TTR rates were 1.28 and 1.31 months, respectively. In the subgroup analysis, front-line treatment with T-DXd was associated with increased beneficial effects. The primary adverse events (AEs) related to T-DXd treatment were gastrointestinal reactions and bone marrow suppression, which were predominantly grades 1-2, with no severe grade 4/5 AEs reported, only one patient developed infectious pneumonia.

Conclusion

This study was the first multicenter, real-world study of T-DXd for advanced BC in China. The findings demonstrated that T-DXd may be an effective antitumor treatment with controllable adverse reactions in patients with advanced BC irrespective of HER2 expression levels.

Glycocalyx hyaluronan removal-induced increasing of cell stiffness delays breast cancer cells progression

Triple-negative breast cancer (TNBC) cells are rich in glycocalyx (GCX) that is closely correlated with the reorganization of cytoskeletal filaments. Most studies have focused on cell membrane glycoproteins in this context, but rarely on the significance of glycosaminoglycans, particularly the hyaluronan (HA)-associated GCX. Here, we reported that removal of GCX HA could significantly increase breast cancer cells (BCCs) stiffness, leading to impaired cell growth and decreased stem-like properties. Furthermore, we found that the delay of TNBC cells progression could be restored after the cells were re-softened. Meanwhile, in vivo studies revealed that hyaluronidase (HAase)-pretreated BCCs displayed reduced tumor growth and migration. Intriguingly, we identified that ZC3H12A, a zinc-finger RNA binding protein encoded gene, was significantly upregulated after the GCX HA impairment. Of note, knockdown of ZC3H12A could soften the HAase-treated TNBC cells, implying a GCX HA-ZC3H12A regulation on cell stiffening. Taken together, our findings suggested that the breakdown of pericellular HA coat could influence TNBC cells mechanical properties which might be helpful to the future breast cancer research.

Lifetime probabilities of developing and dying from cancer in China: comparison with Japan and the United States in 2022

The numbers of new cancer cases and deaths in China were the largest in the world, causing a huge social and economic burden. We attempt to use more intuitive indicators to measure the probabilities of being diagnosed of or dying from cancer in China and compare these probabilities with those in Japan and the United States (US). We obtained the cancer data from GLOBOCAN 2022 for China, Japan, and the US and the all-cause mortality and population data from the United Nations. The lifetime risks of developing and dying from cancer were estimated with adjusted actual life expectancy, multiple primaries, and death-competing risks from causes other than cancers. Approximately 27.61% of Chinese people developed cancer and 1 in 5 persons were likely to die from cancer. The highest-risk cancer among men and women was lung cancer in China, but in the US and Japan, prostate cancer among men and breast cancer among women posed the highest risk. Lung cancer presented the highest likelihood of death, but women in Japan had the highest likelihood of dying from colorectal cancer. China had a lower lifetime risk of developing cancer compared with Japan and the US, but a higher probability of dying from cancer than the US. Although the probability of developing cancer was not as high as that in Japan and the US, China was still faced with enormous pressure due to its huge population and contradictory cancer patterns. Estimating lifetime risks can provide essential information to formulate appropriate cancer prevention and control plans.

Breast cancer: pathogenesis and treatments

Breast cancer, characterized by unique epidemiological patterns and significant heterogeneity, remains one of the leading causes of malignancy-related deaths in women. The increasingly nuanced molecular subtypes of breast cancer have enhanced the comprehension and precision treatment of this disease. The mechanisms of tumorigenesis and progression of breast cancer have been central to scientific research, with investigations spanning various perspectives such as tumor stemness, intra-tumoral microbiota, and circadian rhythms. Technological advancements, particularly those integrated with artificial intelligence, have significantly improved the accuracy of breast cancer detection and diagnosis. The emergence of novel therapeutic concepts and drugs represents a paradigm shift towards personalized medicine. Evidence suggests that optimal diagnosis and treatment models tailored to individual patient risk and expected subtypes are crucial, supporting the era of precision oncology for breast cancer. Despite the rapid advancements in oncology and the increasing emphasis on the clinical precision treatment of breast cancer, a comprehensive update and summary of the panoramic knowledge related to this disease are needed. In this review, we provide a thorough overview of the global status of breast cancer, including its epidemiology, risk factors, pathophysiology, and molecular subtyping. Additionally, we elaborate on the latest research into mechanisms contributing to breast cancer progression, emerging treatment strategies, and long-term patient management. This review offers valuable insights into the latest advancements in Breast Cancer Research, thereby facilitating future progress in both basic research and clinical application.

PGAM1: a potential therapeutic target mediating Wnt/β-catenin signaling drives breast cancer progression

Phosphoglycerate mutase 1 (PGAM1) has been identified as a key player in the progression and metastasis of various human cancer types, including breast cancer (BC); however, its precise oncogenic mechanism remains unclear. The present study aimed to investigate the oncogenic mechanisms of PGAM1 and establish its potential as a therapeutic target. Comprehensive analyses from the Tumor Immune Estimation Resource 2.0 and The Cancer Genome Atlas databases revealed a significant upregulation of PGAM1 in BC, correlating with poor clinical outcomes. Additionally, elevated expression of PGAM1 was confirmed in clinical BC samples. Silencing PGAM1 with specific small hairpin RNA in BC cells resulted in a marked reduction in cell proliferation, invasiveness and migration, alongside increased apoptosis and cell cycle arrest. In vivo experiments using tumor-bearing nude mice demonstrated that PGAM1 knockdown significantly reduced tumor volume and weight, effectively inhibiting tumor growth. Mechanistic investigations suggested that PGAM1 promoted BC tumorigenesis through the activation of the Wnt/β-catenin signaling pathway, both in vitro and in vivo. Therefore, the upregulation of PGAM1 in BC enhances malignancy via the Wnt/β-catenin signaling pathway, highlighting PGAM1 as a promising therapeutic target for BC treatment.

Spatial proximity of CD8+ T cells to tumor cells predicts neoadjuvant therapy efficacy in breast cancer

The spatial proximity of CD8+ T cells to tumor cells critically influences the efficacy of neoadjuvant therapy (NAT) in breast cancer (BC). In this study, we evaluated whether the presence of CD8+ T cells and other immune cells near cancer cells predicts treatment outcomes across various BC subtypes. We analyzed pre- and post-NAT biopsies from 104 BC patients using multiplex immunofluorescence (mIF) and immunohistochemistry (IHC) to assess the distribution of immune markers, including CD8+ T cells, CD68+ macrophages, FoxP3+ regulatory T cells. Our findings revealed that a higher percentage of CD8+ T cells within 20 µm of cancer cells (N20-CD8+ T cells) was strongly correlated with improved pathological complete response (pCR), disease-free survival (DFS), and overall survival (OS), regardless of tumor subtype or NAT regimen. Moreover, a positive correlation between CXCL9 expression and N20-CD8+ T cells suggests that CXCL9 may facilitate the recruitment of CD8+ T cells to tumor cells. Our study emphasizes the link between immune cell composition and location, and patient outcomes with NAT. Focusing on the spatial dynamics of CD8+ T cells could significantly advance personalized treatment strategies and the development of targeted immunotherapies in BC.

Association among financial toxicity, depression and fear of cancer recurrence in young breast cancer patient-family caregiver dyads: an actor-partner interdependence mediation model

PURPOSE

This study aimed to investigate the depression situation and the mediating role of fear of cancer recurrence (FCR) in the relationship between financial toxicity and depression in young breast cancer (BC) patient-family caregiver dyads.

METHODS

A total of 196 young BC patient-family caregiver dyads at four hospitals in China were investigated. The Comprehensive scores for financial toxicity based on patient-reported outcome measures, the Hospital Anxiety and Depression Scale, and the FCR Inventory Short Form were assessed. The actor-partner interdependence mediation model using structural equation modelling in AMOS software was applied to examine the direct and indirect effects.

RESULTS

In this study, there were 196 pairs of patients and family caregivers. The findings indicated a significant correlation between financial toxicity and FCR in both young BC patients and their family caregivers. Two significant partner effects were observed: the family caregiver's financial toxicity significantly influenced the patient's FCR (β=-0.450, P < 0.001), and the patient's FCR influenced the family caregiver's depression (β = 0.570, P < 0.001). Furthermore, financial toxicity in both young BC patients and family caregivers markedly affected both the actor and partner effects on dyadic depression, primarily through the patients' FCR.

CONCLUSIONS

Depression in young BC patients was affected not only by themselves but also by their family caregivers. Emphasis should be placed on the interplay between financial toxicity and FCR of patients and family caregivers, with the aim of improving depression for young BC patients.

CLINICAL IMPLICATIONS

The study emphasized the importance of addressing the experiences of both patient and family caregivers in clinical interventions. By demonstrating how financial toxicity and FCR are interlinked with depression in both parties, the study supports the development of we offer empirical support for developing comprehensive intervention strategies to alleviate mental distress and enhance mental health for patients and family caregivers.

Predicting the likelihood of BRCA1/2 germline pathogenic variants in unselected patients with breast cancer: analysis of more than 10,000 individuals

BACKGROUND

Models for accurately predicting the likelihood of BRCA1/2 germline pathogenic variants (PVs) based on a large cohort of unselected patients with breast cancer are limited.

METHODS

A logistic regression model to predict the BRCA1/2 carrier probability, named PKCBRCA, was established and validated based on 10 167 unselected Chinese patients with breast cancer treated in Peking University Cancer Hospital between October 2003 and August 2020. All patients were tested for BRCA1/2 germline variants. The discrimination and calibration of the model were assessed.

RESULTS

A total of 601 (5.9%) patients carried BRCA1/2 germline PVs in the entire cohort of 10 167 unselected patients with breast cancer. The cohort was separated into a training set (n=6331; 387 (6.1%) BRCA1/2 carriers) and a validation set (n=3836; 214 (5.6%) BRCA1/2 carriers). Five variables strongly associated with BRCA1/2 carrier probability were incorporated in the establishment of PKCBRCA including age of diagnosis, bilateral breast cancer, family history of breast or ovarian cancer, hormone receptor and ERBB2. PKCBRCA showed a good ability to discriminate both in the training set (area under the receiver operating characteristic curve (AUC)=0.77) and in the validation set (AUC=0.77).

CONCLUSION

Our model provides a useful tool for accurately assessing the BRCA1/2 carrier probability for unselected patients with breast cancer.

TNIP1 Impacts Prognosis by Modulating the Immune Microenvironment in BRCA

Breast invasive carcinoma (BRCA) affects women worldwide, and despite advancements in diagnosis, prevention, and treatment, outcomes remain suboptimal. TNIP1, a novel target involved in multiple immune signaling pathways, influences tumor development and survival. However, the connection between BRCA and TNIP1 remains unclear. Analysis of data from the TCGA, GEO, Sangerbox, and Ualcan databases revealed that TNIP1 is underexpressed in BRCA tissues. This finding was corroborated by RT-PCR and immunohistochemistry. Furthermore, data from the TCGA and GEPIA2 databases, along with Sangerbox, identified TNIP1 as a marker of poor prognosis in BRCA patients. TNIP1 expression shows significant positive correlations with the BRCA Tumor Microenvironment (TME) StromalScore (R = 0.22), ImmuneScore (R = 0.25), and ESTIMATEScore (R = 0.27). Various algorithms have demonstrated a strong association between TNIP1 expression and BRCA tumor-infiltrating immune cells (TIICs). Further analysis using EPIC, TIMER, MCPCounter, QUANTISEQ, xCell, and other computational tools revealed that elevated TNIP1 expression is significantly associated with increased immune cell scores. TNIP1 expression in BRCA tumor tissues also shows a strong correlation with immune checkpoint markers. Data from the HAP database indicate that TNIP1 expression is predominantly involved in the normal skin microenvironment. Subsequent analysis using the TISCH platform with the BRCA single-cell dataset demonstrated that TNIP1 exhibits higher expression levels in immune cells compared to non-immune cells in BRCA patients. This expression is significantly positively correlated with inflammation (R = 0.25) and differentiation (R = 0.28) within the TME, while showing negative correlations with BRCA stemness (R = - 0.34) and invasion (R = - 0.22). Consequently, TNIP1 is proposed as a potential prognostic marker and therapeutic target for BRCA.

Preferences for breast cancer screening: Results of a discrete choice experiment

OBJECTIVES

This study aimed to assess the preferences of breast cancer patients in China for screening services using a discrete choice experiment (DCE) and latent class modeling (LCM). The findings are intended to inform the development of more patient-centered screening programs.

STUDY DESIGN

A cross-sectional, hospital-based survey employing discrete choice experiment methodology.

METHODS

A total of 278 breast cancer patients were recruited from the Department of Thyroid and Breast Surgery at a tertiary hospital in Guizhou Province. The study evaluated key attributes of screening services, including screening frequency, medical staff experience, referral sources, and out-of-pocket costs, through a DCE questionnaire. A mixed logit model was applied to assess overall patient preferences, while LCM was used to explore heterogeneity among patient subgroups. The development of the DCE questionnaire involved focus group discussions to ensure the relevance of attributes.

RESULTS

The analysis revealed that screening frequency, medical staff experience, and out-of-pocket costs were the most significant factors influencing patient preferences. Patients exhibited a strong preference for annual screenings (β = -1.622, p < 0.001) and for screening by experienced medical staff (β = 2.216, p < 0.001). Additionally, lower out-of-pocket costs significantly enhanced willingness to participate (β = -0.211, p < 0.05). LCM analysis identified two distinct patient subgroups: "process-driven" patients, who prioritized lower costs and multi-channel referral options, and "efficiency-driven" patients, who valued timely service and experienced staff.

CONCLUSION

This study emphasizes the diverse preferences of breast cancer patients for screening services and suggests that personalized screening programs could better meet the needs of different patient subgroups. Developing flexible, patient-centered screening programs will be essential to improving participation and satisfaction with breast cancer screening in China. Practical challenges in implementing such personalized approaches should be considered in future policy development.

MORF4L2 induces immunosuppressive microenvironment and immunotherapy resistance through GRHL2/MORF4L2/H4K12Ac/CSF1 axis in triple-negative breast cancer

BACKGROUND

Although immunotherapy has achieved great progress in advanced triple-negative breast cancer (TNBC), there are still numerous patients who do not benefit from immunotherapy. Therefore, identification of the key molecule that induces immune escape and clarification of its specific mechanism in TNBC are urgently needed.

METHODS

In this research, single cell sequencing and bulk sequencing were conducted for biomarker screening. Immunohistochemistry, multiplex immunofluorescence, and orthotopic TNBC tumor model were applied in identifying the key molecule driving immune escape. At the mechanical level, RNA sequencing, in vitro co-culturing system, flow cytometry, Western blotting, ELISA, and real-time qPCR were carried out.

RESULTS

Mortality factor 4 like 2 (MORF4L2) expression is significantly up-regulated among patients who developed anti-PD1 resistance. MORF4L2 enhances anti-PD1 resistance by inducing the chemotaxis of macrophage infiltration and promoting their polarization towards the alternative activation phenotype (M2), thus creating an immunosuppressive microenvironment. Mechanistically, MORF4L2 actes as part of NuA4 histone acetyltransferase (HAT) complex, contributes to to histone 4 lysine 12 acetylation (H4K12Ac) and activates the downstream transcription of macrophage colony-stimulating factor (CSF1). CSF1 is secreted by tumor cells and binds to the macrophage-surface CSF1 receptor (CSF1R), which chemotactically converted and polarized macrophages to the M2 phenotype. Furthermore, we revealed that grainyhead like transcription factor 2 (GRHL2) could promote MORF4L2 transcription by binding to the MORF4L2 enhancer region. Notably, BLZ549, an inhibitor of CSF1R, restored the anti-PD1 sensitivity by blocking the GRHL2/MORF4L2/H4K12Ac/CSF1 axis.

CONCLUSIONS

GRHL2/MORF4L2/H4K12Ac/CSF1 axis plays an important role in anti-PD1 resistance. CSF1R inhibitors can reverse GRHL2/MORF4L2-mediated anti-PD1 resistance.

Epidemiology of breast cancer in Chinese women from 1990 to 2021: a systematic analysis and comparison with the global burden

BACKGROUND

Breast cancer is a major global public health concern and a major cause of cancer-related mortality. In 2020, 8.3% of the total breast cancer deaths worldwide were reported from China, which highlighted the need to understand the epidemiological trends of breast cancer within the country. Therefore, this study aimed to analyse the trends in the breast cancer burden in China from 1990 to 2021 and compare them with global trends to provide insights for future prevention and control strategies.

METHODS

Data were sourced from the Global Burden of Disease database 2021, which includes comprehensive information on the disease burden across 204 countries from 1990 to 2021. We analysed six key indicators: the mortality, prevalence, incidence, disability-adjusted life years, years lived with disability, and years of life lost. Age-standardized rates were analysed using the global age structure as a reference. Joinpoint regression was employed to assess the annual percentage change and average annual percentage change.

RESULTS

In 2021, 3.75 million prevalent breast cancer cases, with 385,837 new breast cancer cases and 88,106 deaths due to breast cancer, were reported from China. The crude rates of the prevalence, incidence, mortality, disability-adjusted life years, years lived with disability, and years of life lost significantly increased in 2021 compared with 1990. The age-standardized rates per 100,000 women were 355.72 for prevalence (+ 103.22% from 1990), 37.00 for incidence (107.40%), 8.24 for mortality (-8.24%), 281.54 for disability-adjusted life years (-6.68%), 25.86 for years lived with disability (110.24%), and 255.69 for years of life lost (-11.62%). The burden of breast cancer has notably increased among the women above 40 years of age, peaking between the ages of 50 and 59 years, and the proportion of cases in women under 40 years has decreased.

CONCLUSIONS

The age-standardized rate of the mortality, disability-adjusted life years, and years of life lost of breast cancer decreased slightly in China; however, the age-standardized rate of the incidence, prevalence, and years lived with disability exhibited an upward trend between 1990 and 2021, thereby highlighting the need to improve treatment outcomes and formulate better policies for the prevention and control of breast cancer in China.

Automated Breast Ultrasound With Remote Reading for Primary Breast Cancer Screening: A Prospective Study Involving 46 Community Health Centers in China

BACKGROUND. China has faced barriers to implementation of a population-based mammographic screening program. Breast ultrasound provides an alternative screening modality to mammography in low-resource settings. OBJECTIVE. The purpose of this study was to evaluate the performance of automated breast ultrasound (ABUS) with remote reading as the primary screening modality for breast cancer. METHODS. This prospective study enrolled asymptomatic women 35-69 years old from 46 community health centers across 18 provinces representing all six regions of China from January 2021 to December 2021. Participants underwent screening ABUS as the sole breast cancer screening modality, with images acquired by a technologist at a community health center. The 3D volumetric data were transferred via cloud-based software to a single remote reading center, where examinations were interpreted independently in batches by two subspecialized breast radiologists using BI-RADS; a third radiologist at the remote reading center resolved discrepancies. Diagnostic reports were returned to the community centers, and patients sought follow-up care at local hospitals. The reference standard incorporated a combination of histopathology and 24-month follow-up. Outcome measures included cancer detection rate, abnormal interpretation rate (AIR), sensitivity, specificity, biopsy rate, and PPV. RESULTS. The final analysis included 5978 enrolled participants (median age, 46 years [IQR, 40-52 years]) who underwent screening ABUS at the community health centers with subsequent remote reading. A total of 24 ABUS-detected cancers and two interval cancers were diagnosed. The cancer detection rate was 4.0 per 1000 women (95% CI: 2.7-5.9), and the AIR was 11.9% (95% CI: 11.1-12.7%). A total of 95.8% (23/24) of ABUS-detected cancers were invasive. The 23 invasive cancers had a median diameter of 10.0 mm, and 73.9% (17/23) were node-negative. Sensitivity was 92.3% (95% CI: 75.9-97.9%), and specificity was 88.4% (95% CI: 87.6-89.2%). The biopsy rate was 1.7% (95% CI: 1.4-2.0%), and the PPV of biopsy was 24.0% (95% CI: 16.7-33.2%). CONCLUSION. ABUS screening with remote reading met benchmark performance for cancer detection in comparison with mammography, with infrequent interval cancers. CLINICAL IMPACT. ABUS with remote reading holds promise in enhancing access to breast cancer screening and early detection in low-resource settings or underserved regions where mammographic screening is not established. TRIAL REGISTRATION. ClinicalTrials.gov NCT04527510.

Blocking of SIRT7/FOXO3a axis by miR-152-3p enhances cisplatin sensitivity in breast cancer

BACKGROUND

Cisplatin-based chemoresistance is a major obstacle for the treatment breast cancer (BC) including Triple-negative breast cancer (TNBC). SIRT7 is reportedly involved in the progression of BC, the underlining mechanism in Cisplatin-based chemoresistance in BC remains unclear. This work is to elucidate effects of SIRT7 on cisplatin resistance in breast cancer regulated by miR-152-3p.

METHODS

The RNA expression of SIRT7 and miRNAs in breast cancer were available from TCGA database. SIRT7-targeted miRNAs were predicted by TargetScan, miRanda, miRDB databases. The association of SIRT7 expression with predicted miRNA was validated by Luciferase assay. Cell apoptosis was determined by Flow cytometry. Cell viability was detected by CCK8 assay. The mRNA expression was measured by quantitative real-time polymerase chain reaction (qRT-PCR) assay. Protein expression was determined by Western blotting assay.

RESULTS

SIRT7 mRNA levels were dramatically enhanced in BC tissues compared to para-carcinoma tissues, also increased in BC patients with Cisplatin-based chemotherapy containing TNBC compared with those without. The increase of SIRT7 expression was obviously relevant to shorter survival time of them. Importantly, SIRT7 inhibition facilitated Cisplatin-induced cell apoptosis of TNBC (MDA-MB-231 and MDA-MB-468) and non- TNBC (MCF-7). Notably, miR-152-3p was predicted as a negative regulator of SIRT7 by overlapping downregulated miRNAs in BC patients treated with Cisplatin-based chemotherapy and miRNAs to target SIRT7. Mechanically, miR-152-3p blocked SIRT7 to stimulate an activation of FOXO3a, cleaved PARP1 and Caspase-3, sensitizing Cisplatin-induced apoptosis of BC cells.

CONCLUSIONS

Inhibition of SIRT7 by miR-152-3p may be a promising strategy against the resistance to cisplatin-based chemotherapy in TNBC.

Cross-sectional study of hepatitis B virus infection in female breast cancer patients in China for the first time diagnosed

BACKGROUND

The correlation between breast cancer and hepatitis B virus (HBV) remains inconclusive. This study aims to explore the serological status of HBV infection and past infection in different age groups of female breast cancer patients, patients with benign breast diseases, and individuals undergoing routine physical examinations.

METHODS

Serum data on HBV serological markers were collected and analyzed from 6072 female breast cancer patients first diagnosed from September 2012 to July 2020 at the First Affiliated Hospital of Chongqing Medical University, along with 4019 women with benign breast diseases and 54,740 healthy females undergoing routine physical examinations in the same period. The data were stratified by age for comparison between groups.

RESULTS

The prevalence of HBV infection and past infection in the breast cancer group (7.9%, 55.1%) was higher than that in the benign breast disease group (6.5%, 39.1%) and the healthy females group(5.0%, 17.6%);the rate of only HBV surface antibody positivity (HBsAb ( +)) in the breast cancer group (10.3%) was lower than that in the benign breast disease group (26.9%) and the healthy females group (49.2%), with significant differences between the three groups (p < 0.05). Stratified by age, the prevalence of HBV infection in the breast cancer group (8%, 8.9%) and benign breast disease group (7.75%, 8.1%)was higher than that in the healthy females group (4.5%, 6.3%) in the 30-39 and 40-49 age group, respectively. The past infection rate of HBV in the breast cancer group (24.8%, 45.0%) was higher than that in the benign breast disease group (16.1%, 35.4%) in the ≤ 29 and 30-39 age group, respectively.. The past infection rate of HBV in the breast cancer group was higher than that in the healthy females group in all age groups, while the rate of only HBsAb ( +) in the breast cancer group was lower than that in the benign breast disease group and the routine physical examination group in all age groups.

CONCLUSIONS

Breast cancer women and women with benign breast diseases have higher rates of hepatitis B virus infection and previous infections, with more significant differences among middle-aged women. Breast cancer women and women with benign breast diseases have lower rates of only HBsAb ( +) for HBV.

Factors Associating with Bone-Only Metastasis in Chinese Breast Cancer Patients in the Absence of Anti-Human Epidermal Growth Factor Receptor 2-Targeted Therapy

INTRODUCTION

Bone-only metastasis (BOM) is a distinct clinical phenomenon in which cancer cells disseminate exclusively to the bones, without involvement of other distant organs. We investigated the factors associated with the BOM state versus other states of metastasis in breast cancer patients with bone metastasis (BM) at their first relapse. The results could help tailor the screening and preventive therapy strategies for BM in breast cancer.

METHODS

The study included 231 women who underwent mastectomy for primary unilateral non-metastatic breast cancer in 1997 or later and were subsequently diagnosed with BM at first relapse in 2008-2018 at the Fourth Hospital of Hebei Medical University in China. Factors such as patient age at primary breast cancer diagnosis, tumor clinicopathological characteristics, chemotherapy, radiotherapy, endocrine therapy (ET), time to progression (TTP), and others were analyzed. ET compliance was categorized from medication adherence. Multivariate logistic regressions were used to estimate the odds ratio (OR) and p value.

RESULTS

Only three (3.8%, 3/79) human epidermal growth factor receptor 2-positive (HER2+) breast cancer patients (n = 79) used anti-HER2-targeted agents in the adjuvant setting. After excluding them, the remaining 228 patients were analyzed. They had an average age of 47.3 years and median TTP 29.4 months at their first relapse. Overall, patients with BOM accounted for 26.8%. The BOM state was similarly presented in the hormone receptor-positive (HR+) patients (n = 182) and in the HR-negative (HR-) patients (n = 45) (28.6% vs. 17.8%, p = 0.142). However, it was significantly lower in the HER2+ patients (n = 76) than in the HER2-negative (HER2-) patients (n = 129) (13.2% vs. 31.8%, p = 0.003). Multivariate analyses showed that the BOM state was not associated with the HR+ (vs. HR-, OR 1.253, p = 0.723) and full ET compliance (vs. no/partial, OR 1.346, p = 0.545) status. Nonetheless, the BOM state was significantly associated with a lower chance in the HER2+ patients overall (OR 0.240, p = 0.008) and in the HR+ patients (OR 0.145, p = 0.005) but not in the HR- patients (OR 1.012, p = 0.991) than one in the HER2- patients. A lower chance of BOM state was also associated with TTP ≥24 months (p < 0.05). There were no other associated factors identified.

CONCLUSION

Differently from HR status and other clinicopathological factors, the HER2+ status is associated with a lower chance of the BOM state in breast cancer patients with first BM. Such association appears to be reflected in HR+ patients only.

INTRODUCTION

Bone-only metastasis (BOM) is a distinct clinical phenomenon in which cancer cells disseminate exclusively to the bones, without involvement of other distant organs. We investigated the factors associated with the BOM state versus other states of metastasis in breast cancer patients with bone metastasis (BM) at their first relapse. The results could help tailor the screening and preventive therapy strategies for BM in breast cancer.

METHODS

The study included 231 women who underwent mastectomy for primary unilateral non-metastatic breast cancer in 1997 or later and were subsequently diagnosed with BM at first relapse in 2008-2018 at the Fourth Hospital of Hebei Medical University in China. Factors such as patient age at primary breast cancer diagnosis, tumor clinicopathological characteristics, chemotherapy, radiotherapy, endocrine therapy (ET), time to progression (TTP), and others were analyzed. ET compliance was categorized from medication adherence. Multivariate logistic regressions were used to estimate the odds ratio (OR) and p value.

RESULTS

Only three (3.8%, 3/79) human epidermal growth factor receptor 2-positive (HER2+) breast cancer patients (n = 79) used anti-HER2-targeted agents in the adjuvant setting. After excluding them, the remaining 228 patients were analyzed. They had an average age of 47.3 years and median TTP 29.4 months at their first relapse. Overall, patients with BOM accounted for 26.8%. The BOM state was similarly presented in the hormone receptor-positive (HR+) patients (n = 182) and in the HR-negative (HR-) patients (n = 45) (28.6% vs. 17.8%, p = 0.142). However, it was significantly lower in the HER2+ patients (n = 76) than in the HER2-negative (HER2-) patients (n = 129) (13.2% vs. 31.8%, p = 0.003). Multivariate analyses showed that the BOM state was not associated with the HR+ (vs. HR-, OR 1.253, p = 0.723) and full ET compliance (vs. no/partial, OR 1.346, p = 0.545) status. Nonetheless, the BOM state was significantly associated with a lower chance in the HER2+ patients overall (OR 0.240, p = 0.008) and in the HR+ patients (OR 0.145, p = 0.005) but not in the HR- patients (OR 1.012, p = 0.991) than one in the HER2- patients. A lower chance of BOM state was also associated with TTP ≥24 months (p < 0.05). There were no other associated factors identified.

CONCLUSION

Differently from HR status and other clinicopathological factors, the HER2+ status is associated with a lower chance of the BOM state in breast cancer patients with first BM. Such association appears to be reflected in HR+ patients only.

Risk factors and prediction model for sub-threshold depression in young and middle-aged breast cancer patients

OBJECTIVE

To explore the current status of subthreshold depression in young and middle-aged breast cancer patients and its influencing factors, in order to guide early identification and intervention in clinical settings.

METHODS

The study included 385 young and middle-aged cancer patients treated at the First Affiliated Hospital of Xinjiang Medical University from June 2023 to June 2024. Standardized scales were used to evaluate sub-threshold depression, psychological resilience, and self-perceived burden. Multivariate linear regression analysis was performed to identify risk factors, and ROC analysis was utilized to assess the predictive performance of the model.

RESULTS

The sub-threshold depression score for 385 patients was 104.23±19.36, with an average item score of 3.58±0.59. Statistically significant differences in sub-threshold depression scores were observed across age groups, family relationships, economic burdens due to the illness, prior contact with patients having the same disease, subjective feelings about the illness, clinical stages, and whether patients had received radiotherapy or chemotherapy (all P < 0.05). No statistically significant differences were found in other variables (all P > 0.05). Significant risk factors for sub-threshold depression included age ≥ 31 years, poor family relationships, severe subjective perception of the illness, heavy economic burden due to the disease, clinical stage III, psychological resilience, self-perceived burden, and receiving radiotherapy or chemotherapy (all P < 0.05). ROC analysis revealed that the area under the curve (AUC) for the predictive model was 0.956.

CONCLUSION

The prediction model developed in this study provides a theoretical basis for screening sub-threshold depression in young and middle-aged breast cancer patients. It also offers a reference for clinical healthcare professionals to adopt preventive measures and care strategies for patients at risk of sub-threshold depression.

Trends in the Disease Burden and Risk Factors of Women's Cancers in China From 1990 to 2019

Objectives

To examine age-specific trends and risk factors in the burden of women's cancers (WCs) in China from 1990 to 2019 to inform strategies.

Methods

Data were sourced from the Global Burden of Disease 2019 and World Population Prospects 2019. Time trends, age differences, and key factors for breast, cervical, and ovarian cancers (BC, CC, and OC) were analyzed based on age-standardized incidence rate (ASIR) and disability-adjusted life years (DALYs) rate.

Results

ASIRs for BC and CC increased over the study period, with a slower growth rate for CC after 2005, likely due to targeted HPV prevention. OC showed the highest ASIR and DALY increases, indicating a growing concern. Peak ASIR for BC and CC was in women aged 50-55, while OC showed a higher burden in women aged 70-79. Lower DALYs in women born after 1985 suggest improved healthcare access.

Conclusion

This study highlights significant trends in cancer burden among Chinese women, driven by age and reproductive health policies. Future efforts should enhance screening, health literacy, and age-targeted risk reduction for specific cancer types.

Cohort profile: Guangzhou breast cancer study (GBCS)

The Guangzhou Breast Cancer Study (GBCS) is a patient-based prospective cohort study designed to identify risk factors and underlying mechanisms for breast cancer (BC) incidence and prognosis, specifically addressing the need for individualized prevention in South China, where BC incidence is notably high. Based in Guangzhou, China, the GBCS began recruitment in 2008, comprises three complementary studies: the Guangzhou breast cancer cohort with 5471 breast cancer patients, a case-control study with 1551 cases and 1605 controls, and an immunohistochemistry (IHC) cohort with 1063 breast cancer patients. Participants are primarily aged 41-60 years. Cohort follow-up is conducted every three months in the first year, every six months in the second and third years, and annually thereafter. High follow-up rates have been achieved until 2023, with 73.5% for the Guangzhou breast cancer cohort and 98.6% for the IHC cohort still active. Baseline data collection included demographic characteristics and breast cancer risk factors, while follow-up data included survival, treatment details, disease history, occupational history, post-diagnostic lifestyle, and laboratory measures, including genetic markers, proteins, and environmental exposures. The study encourages global collaborations and invites interested researchers to contact the corresponding author at xulin27@ mail.sysu.edu.cn with specific research ideas or proposals.

Breast Modular Resection (BMR) in Nipple-Sparing Mastectomy (NSM) With Intraoperative Laser Speckle Contrast Imaging (LSCI) Monitoring Improved Surgical Training Outcome Among Fellows

BACKGROUND

Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are challenging for surgical training among fellow trainees. We developed a surgical training course with novel concept of breast modular resection (BMR) for NSM/SSM procedure, and performed this study to investigate whether BMR could improve surgical outcomes compared to classical procedure resection (CPR).

METHODS

The records of 105 breast cancer patients undergoing NSM/SSM with immediate reconstruction performed by fellow trainees were reviewed. Clinicopathological characteristics and surgical outcomes were compared between 2 groups. Laser speckle contrast imaging (LSCI) was performed to intraoperatively evaluate the blood supply of the NAC, and the absolute perfusion unit (PU) values and relative perfusion unit (rPU) values were further compared.

RESULTS

Surgical training outcomes of BMR group (N = 52) were insignificantly improved compared to CPR group (N = 53). The rates of NAC necrosis, flap necrosis and implant removal all reduced respectively. Among the 60 NSM patients, the blood loss (P = .011) and surgery time (P < .001) was significantly reduced in BMR group (N = 30) and all the other outcomes were insignificantly improved. Both the absolute PU values and rPU values were significantly higher among patients without NAC necrosis (P < .001). The absolute PU values were significantly higher in BMR group (P = .002).

CONCLUSION

Compared to CPR, the BMR-based surgical training course for NSM demonstrated the reduction in complications and operating time, offering a potential streamlined, efficient, and safe method for NSM procedure. LSCI was effective for intraoperative visualized evaluation of NAC blood supply and could provide effective real-time feedback for fellow trainees.

Baseline Performance of Ultrasound-Based Strategies in Breast Cancer Screening Among Chinese Women

RATIONALE AND OBJECTIVE

There is a notable absence of robust evidence on the efficacy of ultrasound-based breast cancer screening strategies, particularly in populations with a high prevalence of dense breasts. Our study addresses this gap by evaluating the effectiveness of such strategies in Chinese women, thereby enriching the evidence base for identifying the most efficacious screening approaches for women with dense breast tissue.

METHODS

Conducted from October 2018 to August 2022 in Central China, this prospective cohort study enrolled 8996 women aged 35-64 years, divided into two age groups (35-44 and 45-64 years). Participants were screened for breast cancer using hand-held ultrasound (HHUS) and automated breast ultrasound system (ABUS), with the older age group also receiving full-field digital mammography (FFDM). The Breast Imaging Reporting and Data System (BI-RADS) was employed for image interpretation, with abnormal results indicated by BI-RADS 4/5, necessitating a biopsy; BI-RADS 3 required follow-up within 6-12 months by primary screening strategies; and BI-RADS 1/2 were classified as negative.

RESULTS

Among the screened women, 29 cases of breast cancer were identified, with 4 (1.3‰) in the 35-44 years age group and 25 (4.2‰) in the 45-64 years age group. In the younger age group, HHUS and ABUS performed equally well, with no significant difference in their AUC values (0.8678 vs. 0.8679, P > 0.05). For the older age group, ABUS as a standalone strategy (AUC 0.9935) and both supplemental screening methods (HHUS with FFDM, AUC 0.9920; ABUS with FFDM, AUC 0.9928) outperformed FFDM alone (AUC 0.8983, P < 0.05). However, there was no significant difference between HHUS alone and FFDM alone (AUC 0.9529 vs. 0.8983, P > 0.05).

CONCLUSION

The findings indicate that both HHUS and ABUS exhibit strong performance as independent breast cancer screening strategies, with ABUS demonstrating superior potential. However, the integration of FFDM with these ultrasound techniques did not confer a substantial improvement in the overall effectiveness of the screening process.

Navigating the implementation gap for Trastuzumab's journey from health insurance to patient access: a preliminary study in a hospital in China

BACKGROUND

Trastuzumab, a monoclonal antibody for breast cancer, faces global accessibility challenges, primarily due to high costs. This study examines how changes in medical insurance policies and price adjustments influence Trastuzumab utilization in China, focusing on implementation challenges and their impact on drug accessibility and affordability.

METHODS

This retrospective study investigated Trastuzumab utilization among HER2-positive breast cancer patients at a tertiary hospital from May 2013 to December 2022 in JX, a prefecture-level city in eastern China. Patients were stratified based on their CerbB2 indicator, because those with a 2 + CerbB2 status require further FISH testing to confirm Trastuzumab eligibility. We analyzed the utilization rates of both FISH test and Trastuzumab using logistic regressions, identifying factors that influence their usage.

RESULTS

766 patients were included. The utilization rate of Trastuzumab among patients with CerbB2 3+ rose from 40.40 to 77.94% in September 2017 following the expansion of insurance coverage, and further increased to 90.41% after a price reduction in 2020. The FISH test was not covered by health insurance, and it was not available in the local hospital until Trastuzumab became available in JX city. For patients with CerbB2 2+, the proportion undergoing the FISH test increased dramatically from 8.89 to 82.08% after the price reduction in 2020. The mere inclusion into basic medical insurance, regardless of insurance types, significantly increased the utilization of Trastuzumab and the FISH test. However, rural patients in JX city are still facing financial burdens with Trastuzumab's out-of-pocket cost accounting for 62.9% of their annual disposable income in 2020.

CONCLUSIONS

Our findings indicate that insurance coverage and price reduction significantly increased Trastuzumab utilization. However, failure to improve the accessibility of the FISH test can pose challenges in enhancing the uptake of Trastuzumab among eligible patients. With the expiration of Trastuzumab's patent and the development of affordable biosimilars, there are now greater opportunities to enhance treatment access globally. These insights can inform policy makers of implementation guidance about providing financial support for breast cancer patients in other LMICs.

Diagnostic value of 5 miRNAs combined detection for breast cancer

Background

Breast cancer (BC) is the prevailing malignant tumor, with its prevalence and death rate steadily rising over time. BC often does not show obvious symptoms in its early stages and is difficult to distinguish from benign breast disease. We aimed to find a distinct group of miRNAs utilizing serum as a non-invasive biomarker for early BC diagnosis.

Methods

Herein, we mainly include the screening stage, testing stage, and verification stage. In the screening stage, 8 miRNAs associated with BC were selected and analyzed via literature reading, and the expression of the above miRNAs in BC was further verified by bioinformatics and included in the research analysis. In the testing phase, quantitative reverse transcription polymerase chain reaction (qRT-PCR) was deployed to select the five miRNAs with the most significant expression differences in 15 BC patients and 15 benign breast controls to proceed to the next stage. In a subsequent validation phase, the five miRNAs obtained from serum samples from an additional 75 BC patients and 50 benign control patients were evaluated using RT-qPCR. The diagnostic capacity, specificity, and sensitivity of candidate miRNAs were estimated with the receiver operating characteristic (ROC) curve and area under the curve (AUC). Finally, the optimal diagnostic combination model with high sensitivity and strong specificity was constructed by using the above 5 miRNAs.

Results

The BC patients reported a significant decline in mir-10b-5p, mir-133a-3p, mir-195-5p, and mir-155-3p levels in serum levels contrasted with those in benign controls. Additionally, BC patients experienced elevated mir-195-3p levels than in benign controls. We implemented ROC analysis to evaluate its diagnostic capacity for BC. We demonstrated that all five miRNAs had robust diagnostic capability, with an AUC above 0.8. We developed a conclusive diagnostic combination model consisting of these 5 miRNAs in order to enhance the diagnosis accuracy. This model demonstrated a high diagnostic value, as shown by an AUC of 0.948.

Conclusion

The serum biomarker panels composed of five miRNAs identified in this study (mir-10b-5p, mir-133a-3p, mir-195-5p, mir-195-3p, and mir-155-3p) provide hope for early, non-invasive, and accurate diagnosis of BC.

Development and feasibility of an mHealth intervention for psychoeducational support of Nigerian women diagnosed with breast cancer undergoing chemotherapy: A pilot randomized controlled trial

BACKGROUND

Breast cancer (BC) remains a significant health burden globally, with high incidence and mortality rates, particularly in Nigeria. Chemotherapy, a common treatment modality for BC, often leads to various physical and psychological side effects, impacting patients' quality of life. Despite the growing use of mobile health (mHealth) interventions to provide psychoeducational support, there is a paucity of evidence regarding their feasibility and acceptability among Nigerian women with BC.

OBJECTIVE

To develop and investigate the feasibility and acceptability of a mHealth psychoeducational intervention (mPEI) named the ChEmo Nurse Breast cancer Application (CENBA) programme.

METHODS

A multi-centre, assessor-blinded, parallel-group pilot randomised controlled trial (RCT) was conducted at Lagos State University Teaching Hospital (LASUTH) and Lagos University Teaching Hospital (LUTH). Thirty women newly diagnosed with BC and undergoing chemotherapy were randomly assigned to an intervention or a control group. The intervention group received the CENBA programme, which included BC education, coping skills training, a discussion forum, and nurse-led consultations, delivered via a mobile application and phone calls over six weeks. The control group received standard care. Feasibility was assessed through consent, attrition, and completion rates, while acceptability was explored via qualitative interviews.

RESULTS

The completion rate was 93.3%. Qualitative data indicated that participants found the intervention beneficial, particularly appreciating the educational content and the emotional support provided through the discussion forum and nurse consultations.

CONCLUSION

The CENBA programme was perceived as a feasible and acceptable mHealth intervention for providing psychoeducational support to Nigerian women with BC undergoing chemotherapy. These findings suggest that the CENBA programme could be a valuable tool in addressing the psychoeducational needs of this population, warranting further investigation in a full-scale RCT.

TRIAL REGISTRATION

This manuscript reports a feasibility study preceding the full trial, which was registered with the United States Clinical Trials registry (number NCT05489354).

Unfavorable Prognostic Impact of HER2 2+/FISH-Negativity in Older Patients with HER2-Negative and High-Risk Breast Cancer

Purpose

Human epidermal growth factor receptor 2 (HER2)-low breast cancer, consisted of carcinomas with HER2 protein 1+ or 2+ without gene amplification, has been considered a biologically heterogeneous disease. Limited research separately investigated the prognostic significance of HER2 2+ without gene amplification, and no evidence can be identified in older patients. In this dedicated cohort of older patients with HER2-negative and high-risk breast cancer, we analyzed the real-world prognosis after standard adjuvant chemotherapy, and investigated the associations of survival with HER2 2+ without gene amplification.

Patients and Methods

From January 2016 to December 2021, older patients (≥65 years) with breast cancer were reviewed, and HER2-negative/high-risk disease receiving standard adjuvant chemotherapy was included. HER2-negativity was defined as immunohistochemistry (IHC) score 0, 1+ or 2+ without gene amplification by fluorescent in situ hybridization (FISH). Cox proportional hazards regression analyses were performed to assess the associations of HER2 2+/FISH-negativity with disease-free survival (DFS), which was estimated by the Kaplan-Meier method and compared by the Log rank test.

Results

This cohort consisted of 121 consecutive older patients. With a median follow-up of 46 months, 12 patients had a DFS event. By univariate and multivariate analyses, HER2 2+/FISH-negativity was the only independent predictor for worse DFS (hazard ratio 5.56; P=0.046). Patients with HER2 2+/FISH-negativity had significantly poorer DFS compared with those with HER2 0 or 1+ (Log rank test, P=0.029). In both hormone receptor (HR)-positive (Log rank test, P=0.052) and HR-negative (Log rank test, P=0.125) subgroups, HER2 2+/FISH-negativity showed a marginally significant adverse influence on DFS.

Conclusion

In older patients with HER2-negative/high-risk breast cancer undergoing standard adjuvant chemotherapy, our findings suggest that HER2 2+/FISH-negativity has an independent negative impact on prognosis.

Transcriptomic era of cancers in females: new epigenetic perspectives and therapeutic prospects

In the era of transcriptomics, the role of epigenetics in the study of cancers in females has gained increasing recognition. This article explores the impact of epigenetic modifications, such as DNA methylation, histone modification, and non-coding RNA, on cancers in females, including breast, cervical, and ovarian cancers (1). Our findings suggest that these epigenetic markers not only influence tumor onset, progression, and metastasis but also present novel targets for therapeutic intervention. Detailed analyses of DNA methylation patterns have revealed aberrant events in cancer cells, particularly promoter region hypermethylation, which may lead to silencing of tumor suppressor genes. Furthermore, we examined the complex roles of histone modifications and long non-coding RNAs in regulating the expression of cancer-related genes, thereby providing a scientific basis for developing targeted epigenetic therapies. Our research emphasizes the importance of understanding the functions and mechanisms of epigenetics in cancers in females to develop effective treatment strategies. Future therapeutic approaches may include drugs targeting specific epigenetic markers, which could not only improve therapeutic outcomes but also enhance patient survival and quality of life. Through these efforts, we aim to offer new perspectives and hope for the prevention, diagnosis, and treatment of cancers in females.

Rising incidence of obesity-related cancers among younger adults in China: A population-based analysis (2007-2021)

BACKGROUND

Developing countries face an "obesity epidemic," particularly affecting children and younger adults. While obesity is a known risk factor for 12 types of cancer, primarily affecting older populations, its impact on younger generations is understudied.

METHODS

This study analyzed data from a population-based cancer registry covering 14.14 million individuals in China (2007-2021). We compared the incidence of obesity- and non-obesity-related cancers and applied an age-period-cohort model to estimate their impacts.

FINDINGS

Among 651,342 cancer cases, 48.47% were obesity related. The age-standardized incidence rates (ASRs) of the 12 obesity-related cancers increased annually by 3.6% (p < 0.001), while ASRs for non-obesity-related cancers remained stable. Obesity-related cancers surged among younger adults, with rates rising across successive generations. The annual percentage of change decreased with age, from 15.28% for ages 25-29 years to 1.55% for ages 60-64 years. The incidence rate ratio for obesity-related cancer was higher in younger generations compared to those born in 1962-1966. We predict that the ASR for obesity-related cancers will nearly double in the next decade.

CONCLUSIONS

The rising incidence of obesity-related cancers among young adults poses a significant public health concern. The increasing cancer burden underscores the need for targeted interventions to address the obesity epidemic.

FUNDING

This work was supported by the National Natural Science Foundation of China (81930019, 82341076) to J.-K.Y.

The association of preoperative serum free fatty acid levels with survival in breast cancer patients

BACKGROUND AND OBJECTIVES

Serum free fatty acids (FFA) are associated with various types of cancer. However, the prognostic value of preoperative serum FFA levels and breast cancer (BC) remains unclear. This study aimed to elucidate the specific relationship between FFA levels and BC outcomes.

METHODS

A retrospective review was conducted on 4133 patients with BC admitted to Sun Yat-sen Memorial Hospital from January 2015 to October 2021. Preoperative serum FFA levels were detected by the enzymatic endpoint method. The relationship between serum FFA levels and clinical characteristics was analyzed based on FFA interquartile range. Restricted cubic splines and multivariate Cox regression analyses were used to assess the relationship between preoperative serum FFA levels and overall survival (OS) in patients with BC. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated.

RESULTS

According to the FFA interquartile range, FFA levels were significantly correlated with OS (years) (p < 0.001). Restricted cubic spline analysis might reveal a U-shaped relationship between preoperative serum FFA levels and OS, after adjusting for other variables. According to the cutoff points for FFAs, multivariate Cox regression analyses showed that patients with low FFA levels (≤ 250 µmol/L) had higher rates of all-cause mortality and cancer-specific mortality than those with high FFA levels (530-700 µmol/L) in the total population and patients with a BMI of 18.5-24.0 kg/m2. A trend was observed indicating that elevated FFA levels (≥ 715 µmol/L) were associated with worse prognosis; however, this association failed to reach statistical significance.

CONCLUSIONS

There might be a nonlinear U-shaped relationship between preoperative serum FFA levels and survival in breast cancer patients, with lower FFA levels associated with worse OS. The effect of elevated FFA levels on prognosis requires further investigation.

Trends in hospitalization for female breast and gynecological cancer in China from 2004 to 2020

Breast and gynecological cancers are common cancers with high mortality and have profound effects on the various physical functions of women. This study assessed trends in the number of hospitalizations, in-hospital mortality, length of stay (LOS), and hospital charges for female breast and gynecological cancer from 2004 to 2020. The data for this study come from the China Health Statistics Yearbook. Time trends of categorical variables were assessed with the Cochran-Armitage Test. The linear model was used to test for the trend of continuous variables. The hospitalizations for breast cancer increased from 15,204 to 276,387 (P for trend < 0.001) and gynecological cancer increased from 12,418 to 214,956 (P for trend < 0.001). The in-hospital mortality rate due to breast cancer decreased from 1.70 to 1.07% (P for trend < 0.001). Hospitalizations for both breast and gynecological cancer increased clearly, whether in urban or rural. The gap between urban and rural has narrowed. The average cost per hospitalization for breast cancer significantly increased. However, the average LOS for breast cancer gradually decreased (from 17.0 to 10.7 days, P for trend < 0.001). The average cost per hospitalization for gynecological cancer increased significantly. However, this steady downward trend was observed in the average LOS for gynecological cancer (from 10.34 to 6.69 days, P for trend = 0.003). The increase in hospitalizations and medical expenses for breast and gynecological cancer should encourage healthcare policymakers and healthcare system stakeholders to develop more cost-effective approaches to women's cancer management.

Biomimetic Modification of siRNA/Chemo Drug Nanoassemblies for Targeted Combination Therapy in Breast Cancer

The development and progression of tumors are characterized by intricate biological processes. Monotherapy not only struggles to achieve effective treatment but also tends to precipitate a series of issues, including multidrug resistance and limited antitumor effect. Consequently, it is imperative to adopt a synergistic multitherapy approach to enhance the efficacy of tumor treatment. The integration of chemotherapy drug with oligonucleotide drug for combinational treatment has shown significant promise in improving tumor therapeutic efficiency. However, the effective in vivo codelivery of oligonucleotide drugs and chemotherapy drugs faces substantial challenges such as poor stability of oligonucleotide drugs during the circulation time, limited tumor accumulation, and uncertain delivery ratios of different payloads. To overcome these obstacles, we have engineered cyclic Arg-Gly-Asp (cRGD)-modified red blood cell membrane (RBCm)-coated multidrug nanocomplexes, which were self-assembled from the Polo-like kinase 1 siRNA (siPlk1) and an irreversible tyrosine kinase inhibitor neratinib targeted to human epidermal growth factor receptor 2 (HER2) overexpressed in breast cancer. Through electrostatic and amphiphilic interactions between the positively charged neratinib and negatively charged siPlk1, we have successfully fabricated uniform multidrug nanoparticles. The cRGD-modified red blood cell membranes coated on the surface of the multidrug nanoparticles could enhance drug stability in circulation and tumor accumulation. This targeted combinational therapy significantly enhanced the antitumor efficiency in HER2-positive breast cancer in vitro and in vivo.

High chromosomal instability is associated with higher 10-year risks of recurrence for hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer patients: clinical evidence from a large-scale, multiple-site, retrospective study

Long-term survival varies among hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-) breast cancer patients and is seriously impaired by metastasis. Chromosomal instability (CIN) was one of the key drivers of breast cancer metastasis. Here we evaluate CIN and 10-year invasive disease-free survival (iDFS) and overall survival (OS) in HR+/HER2-- breast cancer. In this large-scale, multiple-site, retrospective study, 354 HR+/HER2- breast cancer patients were recruited. Of these, 204 patients were used for internal training, 70 for external validation, and 80 for cross-validation. All medical records were carefully reviewed to obtain the disease recurrence information. Formalin-fixed paraffin-embedded tissue samples were collected, followed by low-pass whole-genome sequencing with a median genome coverage of 1.86X using minimal 1 ng DNA input. CIN was then assessed using a customized bioinformatics workflow. Three or more instances of CIN per sample was defined as high CIN and the frequency was 42.2% (86/204) in the internal cohort. High CIN correlated significantly with increased lymph node metastasis, vascular invasion, progesterone receptor negative status, HER2 low, worse pathological type, and performed as an independent prognostic factor for HR+/- breast cancer. Patients with high CIN had shorter iDFS and OS than those with low CIN [10-year iDFS 11.1% versus 82.2%, hazard ratio (HR) = 11.12, p < 0.01; 10-year OS 45.7% versus 94.3%, HR = 14.17, p < 0.01]. These findings were validated in two external cohorts with 70 breast cancer patients. Moreover, high CIN could predict the prognosis more accurately than Adjuvant! Online score (10-year iDFS 11.1% versus 48.6%, HR = 2.71, p < 0.01). Cross-validation analysis found that high consistency (83.8%) was observed between CIN and MammaPrint score, while only 45% between CIN and Adjuvant! Online score. In conclusion, high CIN is an independent prognostic indicator for HR+/HER2- breast cancer with shorter iDFS and OS and holds promise for predicting recurrence and metastasis.

Preoperative plasma fibrinogen level is a risk factor for the long-term survival of postmenopausal women after surgery for breast cancer

BACKGROUND

Studies have indicated an association between fibrinogen levels and the prognosis of breast cancer patients. However, fibrinogen levels are notably susceptible to fluctuations due to the menstrual cycle. This study explored the relationship between preoperative plasma fibrinogen levels and the prognosis of postmenopausal breast cancer women after surgery.

METHOD

855 patients with postmenopausal breast cancer were monitored for 10 years. Cox proportional hazards regression models were used to perform univariate and multivariate analyses to identify factors that are of substantial prognostic value.

RESULTS

The median follow-up was 77 months (51-105 months), and the maximum 142 months. Over the follow-up period, 65 deaths (7.6 %) were recorded. Multivariate Cox regression results show that preoperative plasma fibrinogen level (hazard ratio [HR] =1.615, 95 % confidence interval [CI]: 1.233-2.115) and age (HR = 1.626, 95%CI: 1.250-2.116) were independent risk factors for 10-year overall survival after surgery in postmenopausal breast cancer patients, while endocrine therapy (HR = 0.414, 95%CI: 0.202-0.846) was an independent protective factor. Multivariate Cox regression results also show preoperative plasma fibrinogen level was an independent risk factor for 10-year disease-free survival (HR = 1.398, 95 % CI: 1.137-1.719) and 10-year distant metastasis-free survival (HR = 1.436, 95%CI: 1.153-1.787).

CONCLUSION

Elevated pretreatment plasma fibrinogen levels are associated with a poorer long-term prognosis in postmenopausal breast cancer patients following surgical treatment.

Survival outcomes of young-age female patients with early breast cancer: an international multicenter cohort study

BACKGROUND

The incidence of breast cancer among young Asian women is increasing, yet they remain underrepresented in global data. We analyzed the epidemiology and outcomes of Asian patients with breast cancer <40 years old across different subtypes to identify their clinical unmet needs.

PATIENTS AND METHODS

Female patients aged ≥20 years diagnosed with early breast cancer were analyzed from the prospective cohort of the Asian Breast Cancer Cooperative Group (ABCCG). For comparison, data from the Surveillance, Epidemiology, and End Results Program (SEER) cancer registry were used. Patients were categorized into three age groups: young (<40 years), alleged premenopausal mid-age (40-49 years), and alleged postmenopausal (aged ≥50 years). Multivariable Cox proportional hazards models for survival were adjusted for subtypes, histologic grade, T stage, nodal status, and study centers.

RESULTS

A total of 45 021 patients with breast cancer from Asian study centers, 496 332 SEER-White patients, and 18 279 SEER-Asian patients were included in the analysis. The median age at diagnosis was younger in the Asian cohort (51 years) compared with SEER-Whites (62 years) and SEER-Asians (58 years; P < 0.0001). In the young-age group, hormone receptor-positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer was more prevalent among Asians and SEER-Asians compared with SEER-Whites (61.2% and 59.8% versus 54.7%). In the Asian population, young patients with HR+/HER2- breast cancer exhibited significantly inferior overall survival than the mid-age group (6-year overall survival 94.4% versus 96.6%; mid-age to young-age group hazard ratio 0.62; P < 0.001). Similarly, young patients in SEER-Whites showed an earlier decline in survival compared with the mid-age group (89.1% versus 94.0%; P < 0.001).

CONCLUSION

ABCCG-Asian patients with breast cancer <40 years old with HR+/HER2- subtypes were more likely to have worse survival outcomes than their mid-age counterparts. Our study highlights the poorer prognosis of young patients and underscores the need for a tailored therapeutic approach, such as ovarian function suppression, particularly considering ethnic factors.

Single-cell omics and machine learning integration to develop a polyamine metabolism-based risk score model in breast cancer patients

BACKGROUND

Breast cancer remains the leading malignant neoplasm among women globally, posing significant challenges in terms of treatment and prognostic evaluation. The metabolic pathway of polyamines is crucial in breast cancer progression, with a strong association to the increased capabilities of tumor cells for proliferation, invasion, and metastasis.

METHODS

We used a multi-omics approach combining bulk RNA sequencing and single-cell RNA sequencing (scRNA-seq) to study polyamine metabolism. Data from The Cancer Genome Atlas, Gene Expression Omnibus, and Genotype-Tissue Expression identified 286 differentially expressed genes linked to polyamine pathways in breast cancer. These genes were analyzed using univariate COX and machine learning algorithms to develop a prognostic scoring algorithm. Single-cell RNA sequencing validated the model by examining gene expression heterogeneity at the cellular level.

RESULTS

Our single-cell analyses revealed distinct subpopulations with different expressions of genes related to polyamine metabolism, highlighting the heterogeneity of the tumor microenvironment. The SuperPC model (a constructed risk score) demonstrated high accuracy when predicting patient outcomes. The immune profiling and functional enrichment analyses revealed that the genes identified play a crucial role in cell cycle control and immune modulation. Single-cell validation confirmed that polyamine metabolism genes were present in specific cell clusters. This highlights their potential as therapeutic targets.

CONCLUSIONS

This study integrates single cell omics with machine-learning to develop a robust scoring model for breast cancer based on polyamine metabolic pathways. Our findings offer new insights into tumor heterogeneity, and a novel framework to personalize prognosis. Single-cell technologies are being used in this context to enhance our understanding of the complex molecular terrain of breast cancer and support more effective clinical management.

Global, reginal, national burden and risk factors in female breast cancer from 1990 to 2021

This study was to assess the burden, trends, and risk factors associated with female breast cancer from 1990 to 2021 based on the Global Burden of Disease (GBD) 2021 study. In 2021, there were 20.32 million prevalent cases, 2.08 million incident cases, 0.66 million death cases, and 20.26 million disability-adjusted life years (DALYs). It presented an ascending trend in the age-standardized rates of prevalence and incidence over the past 32 years. The age-standardized DALYs rate (ASDR) increased slightly during 2012-2021. The DALYs increase was primarily driven by population aging and growth. High red meat intake accounted for the highest proportion of ASDR. Breast cancer burden attributed to metabolic risks increased, especially in the regions with low social-development index (SDI) and limited health systems. Dietary, behavior, and metabolic risk factors should be controlled to diminish breast cancer burden, especially in countries with lower SDI.

Post-Treatment Experiences of Reproductive Concerns Among Young Breast Cancer Survivors: A Descriptive Phenomenological Study

PURPOSE

The long-term fertility impact of cancer treatments is a significant concern for young breast cancer survivors. These reproductive concerns often become a persistent source of stress, negatively affecting their quality of life. This study aims to explore the reproductive concerns experienced by young breast cancer survivors post-treatment and the factors influencing their perceptions.

METHODS

This phenomenological study utilized semi-structured interviews to collect data. Eighteen participants were recruited from a tertiary hospital in Mainland China. The interviews were transcribed verbatim and analyzed using Colaizzi's method.

RESULTS

Data analysis revealed five themes and fourteen subthemes: (1) multiple emotional burdens interwoven with concerns about fertility; (2) concerns about risks associated with reproduction; (3) dilemma of childrearing; (4) the significance of reproduction; (5) support needs from family, peers, and professionals.

CONCLUSION

Young breast cancer survivors in China face significant challenges related to reproductive issues. Reproductive health is a crucial aspect of breast cancer survivorship care. Healthcare providers must be attentive to the reproductive concerns of survivors, recognize the importance of multidimensional support for positive adaptation, and offer tailored and ongoing interventions to manage reproductive health in young breast cancer survivors.

Global, regional, and national trends in the burden of breast cancer among individuals aged 70 years and older from 1990 to 2021: an analysis based on the global burden of disease study 2021

BACKGROUND

Breast cancer poses a substantial health challenge for the world's over-70 population. However, data on the impact and epidemiology of breast cancer in this age group are limited. We aimed to evaluate global, regional, and national breast cancer trends among those aged 70 and older between 1990 and 2021.

METHODS

In this trend analysis based on the 2021 Global Burden of Diseases (GBD), we report on the incidence rates and Global Burden of Diseases (GBD) disability-adjusted life years (DALYs) counts, as well as the incidence rates per 100,000 individuals and average annual percentage changes (AAPCs) for breast cancer among individuals aged 70 and above at the global, regional, and national levels. We analyzed these global trends by age, sex, and socio-developmental index (SDI). Joinpoint regression elucidates pivotal trend shifts.

RESULTS

From 1990 to 2021, the global incidence of breast cancer in the over-70 population modestly increased from 104 to 107 per 100,000, with significant trend changes in 1995, 2005, and 2018. Regionally, High-income North America had the highest incidence in 2021, while North Africa and the Middle East saw the steepest rise in incidence and DALYs. The only decrease was in the High SDI quintile. The 70-74 age group experienced the largest increase globally, with rates rising from 86.3 to 90 per 100,000 (AAPC 0.27).

CONCLUSION

From 1990 to 2021, global breast cancer incidence in the over-70 population saw a slight uptick, contrasted by a significant reduction in DALYs, likely due to progress in endocrine and targeted therapies. This underscores the critical need for enhanced screening and personalized treatments for older patients.

Pterostilbene Induces Pyroptosis in Breast Cancer Cells through Pyruvate Kinase 2/Caspase-8/Gasdermin C Signaling Pathway

The incidence and mortality of breast cancer increase year by year, and it is urgent to find high-efficiency and low-toxicity anti-cancer drugs. Pterostilbene (PTE) is a natural product with antitumor activity, but the specific antitumor mechanism is not very clear. Aerobic glycolysis is the main energy supply for cancer cells. Pyroptosis is an inflammatory, programmed cell death. The aim of this study was to investigate the effect of PTE on glycolysis and pyroptosis in EMT6 and 4T1 cells and the specific mechanism, and to elucidate the role of pyruvate kinase 2 (PKM2), a key enzyme in glycolysis, in the antitumor role of PTE. Our study suggested that PTE induced pyroptosis by inhibiting tumor glycolysis. PKM2 played an important role in both the inhibition of glycolysis and the induction of pyroptosis by PTE.

Analysis of clinicopathological characteristics and prognostic factors in 54 metaplastic breast carcinoma patients from northwest China

Objective

Metaplastic breast carcinoma (MBC) is a special type of morphologically heterogeneous and aggressively invasive breast cancer. MBC is characterized by the transformation of tumor epithelium into squamous epithelium and/or mesenchymal components, including differentiation into spindle cells, chondrocytes, and osteocytes. Due to its rarity and invasiveness, there is a paucity of research on MBC prognosis. Furthermore, there are currently no treatment guidelines for MBC. This study analyzed the clinicopathological characteristics, immunophenotype, and prognostic features of MBC. Our aim was to better characterize MBC, thereby identifying potential prognostic factors and new treatment methods. Moreover, we also describe an MBC case treated experimentally with anti-vascular targeted therapy.

Material and Methods

We retrospectively analyzed clinical pathological data on 54 female patients with MBC from Shaanxi Provincial People's Hospital and the XiJing Hospital of Air Force Medical University. These cases were diagnosed with MBC between January 1st, 2013, and October 1st, 2018. All patients were from the northwest region of China. The gross morphological, histological, and immunohistochemical features of MBC were analyzed. Kaplan-Meier analysis was used to calculate the survival rate, and univariate analysis was performed to identify significant prognostic factors. In addition, the treatment of an MBC patient with anti-angiogenic therapy was described, and a relevant literature review was conducted.

Results

MBC was diagnosed in 32 left breasts and 22 right breasts from 54 women aged 21-76 years (median age of 57 years). The maximum tumor diameter ranged from 0.6 to 14 cm (average of 4.1 cm). Of the 54 patients, 47 underwent surgical treatment, with lymph node metastasis found in 17.0% (8/47). According to the World Health Organization classification criteria for breast tumors, the study cohort consisted of 15 cases of squamous cell carcinoma, ten cases of spindle cell carcinoma, nine cases of carcinoma with associated stromal differentiation, 18 cases of mixed carcinoma, and two cases of adenocarcinoma with squamous differentiation. Based on the American Joint Committee on Cancer clinical staging criteria, the patients were classified as Stage I (10 cases, 18.5%), Stage II (26 cases, 48.1%), Stage III (11 cases, 20.4%), and Stage IV (7 cases, 13.0%). Immunohistochemical analysis revealed that 94.4% of patients had triple-negative breast cancer (TNBC), 47 cases showed mutant tumor protein 53 (TP53) expression, 29 cases showed positive epidermal growth factor receptor (EGFR) expression, 43 cases showed positive E-cadherin expression, and 37 cases showed positive Cluster of Differentiation 24 expression. The Ki-67 index ranged from 20% to 90%. Univariate analysis showed that the Ki-67 index was not significantly associated with either progression-free survival (PFS) or overall survival (OS) in MBC patients. Patients with negative axillary lymph nodes had significantly better PFS and OS than those with positive nodes (P < 0.05), and patients with clinical stage I-II disease had better PFS and OS than those with stage III-IV disease (P < 0.05). Patients treated with anthracycline-containing chemotherapy had significantly better PFS than those who did not receive chemotherapy. Univariate analysis revealed that the high expression of EGFR correlated with worse PFS (P < 0.05). The type of surgical approach employed did not affect the prognosis of MBC patients. Following the application of anti-angiogenic therapy, a rapid partial response was observed in an MBC patient with carcinoma and associated stromal differentiation. This patient subsequently underwent surgery and radiation therapy and has now achieved over 6 years of PFS.

Conclusion

MBC is a heterogeneous group of tumors with high malignancy and poor prognosis. The large majority is TNBC and exhibits unique immune phenotypes. The poor PFS of MBC patients may be related to EGFR expression, which could become a potential therapeutic target in these patients. Surgery remains the primary treatment method for MBC. The present study found that sentinel lymph node biopsy was feasible in appropriate patients, and that chemotherapy regimens incorporating anthracycline-class drugs did not appear to improve OS. Anti-angiogenic therapy holds promise as a potentially effective treatment approach for MBC, and the optimization of systemic treatment strategies should be a priority in the management of these patients.

LINC01503 promotes the cell proliferation, migration and invasion of triple-negative breast cancer as a ceRNA to elevate SPNS2 expression by sponging miR-335-5p

Objective

Triple-negative breast cancer (TNBC) is a common cancer with high aggressiveness and high mortality in women. Recently, a plenty of studies have indicated that long non-coding RNAs (lncRNAs) exert the crucial function in human cancers, TNBC is included. The carcinogenicity of lncRNA long intergenic non-protein coding RNA 1503 (LINC01503) has been confirmed in several cancers, nevertheless, its function in TNBC still unclear. Therefore, our study aimed to reveal the underlying mechanism of LINC01503 in TNBC.

Methods

In our study, RT-qPCR was performed to detect the expression of LINC01503 in TNBC cells. The proliferative, invasive, migratory and apoptotic abilities of TNBC cells were detected by functional assay such as CCK-8, clone formation, EdU staining, transwell, and flow cytometry. RIP, RNA pull down, and luciferase assay revealed interactions between LINC01503, miR-335-5p, and sphingolipid transporter protein 2 (SPNS2). Finally, rescue experiments were performed to validate the previous results.

Results

LINC01503 expression was singularly high in TNBC cells. LINC01503 knockdown could restrain cell proliferation, invasion and migration, but accelerated cell apoptosis in TNBC. What's more, miR-335-5p could be sponged by LINC01503 in TNBC. We also found that overexpressed miR-335-5p could inhibit cell proliferation, migration and invasion and facilitates cell apoptosis. Moreover, SPNS2 was the target gene of miR-335-5p and it functioned as an oncogene in TNBC cells. Finally, we found that overexpressed SPNS2 or inhibited miR-335-5p could reverse the suppressive function of silencing LINC01503 on TNBC progression.

Conclusion

LINC01503 could facilitate cell proliferation, migration and invasion of TNBC by sponging miR-335-5p to elevate SPNS2 expression.

Genome-wide characterization of dynamic DNA 5-hydroxymethylcytosine and TET2-related DNA demethylation during breast tumorigenesis

BACKGROUND

Breast tumorigenesis is a complex and multistep process accompanied by both genetic and epigenetic dysregulation. In contrast to the extensive studies on DNA epigenetic modifications 5-hydroxymethylcytosine (5hmC) and 5-methylcytosine (5mC) in malignant breast tumors, their roles in the early phases of breast tumorigenesis remain ambiguous.

RESULTS

DNA 5hmC and 5mC exhibited a consistent and significant decrease from usual ductal hyperplasia to atypical ductal hyperplasia and subsequently to ductal carcinoma in situ (DCIS). However, 5hmC showed a modest increase in invasive ductal breast cancer compared to DCIS. Genomic analyses showed that the changes in 5hmC and 5mC levels occurred around the transcription start sites (TSSs), and the modification levels were strongly correlated with gene expression levels. Meanwhile, it was found that differentially hydroxymethylated regions (DhMRs) and differentially methylated regions (DMRs) were overlapped in the early phases and accompanied by the enrichment of active histone marks. In addition, TET2-related DNA demethylation was found to be involved in breast tumorigenesis, and four transcription factor binding sites (TFs: ESR1, FOXA1, GATA3, FOS) were enriched in TET2-related DhMRs/DMRs. Intriguingly, we also identified a certain number of common DhMRs between tumor samples and cell-free DNA (cfDNA).

CONCLUSIONS

Our study reveals that dynamic changes in DNA 5hmC and 5mC play a vital role in propelling breast tumorigenesis. Both TFs and active histone marks are involved in TET2-related DNA demethylation. Concurrent changes in 5hmC signals in primary breast tumors and cfDNA may play a promising role in breast cancer screening.

LncRNA AFAP1-AS1 mediates breast cancer cell proliferation and migration through the miR-21/PTEN axis

LncRNAs play various effects, mostly by sponging with miRNAs. Based on public databases integrating bioinformatics analyses and further validation in breast cancer (BC) tissue and cell lines, the effect of lncRNA AFAP1-AS1 on breast cancer cell proliferation and migration was verified. It might work via the miR-21/PTEN axis. The expression of AFAP1-AS1, which was significantly upregulated in BC tissues and cell lines, was correlated with old age and lymph node metastasis of patients with BC. Knockdown of AFAP1-AS1 inhibited the proliferation and migration of BC cells in vitro and in vivo. And downregulated miR-21 expression and upregulated PTEN expression additionally. Mechanistically, the knockdown of lncRNA AFAP1-AS1 upregulated PTEN expression and consequently attenuated miR-21-mediated enhanced BC cell proliferation and migration. LncRNA AFAP1-AS1 is a potential prognostic biomarker for BC patients.

Age‑integrated breast imaging reporting and data system assessment model to improve the accuracy of breast cancer diagnosis

Early diagnosis is an effective strategy for decreasing breast cancer mortality. Ultrasonography is one of the most predominant imaging modalities for breast cancer owing to its convenience and non-invasiveness. The present study aimed to develop a model that integrates age with Breast Imaging Reporting and Data System (BI-RADS) lexicon to improve diagnostic accuracy of ultrasonography in breast cancer. This retrospective study comprised two cohorts: A training cohort with 975 female patients from Renmin Hospital of Wuhan University (Wuhan, China) and a validation cohort with 500 female patients from Maternal and Child Health Hospital of Hubei Province (Wuhan, China). Logistic regression was used to construct a model combining BI-RADS score with age and to determine the age-based prevalence of breast cancer to predict a cut-off age. The model that integrated age with BI-RADS scores demonstrated the best performance compared with models based solely on age or BI-RADS scores, with an area under the curve (AUC) of 0.872 (95% CI: 0.850-0.894, P<0.001). Furthermore, among participants aged <30 years, the prevalence of breast cancer was lower than the lower limit of the reference range (2%) for BI-RADS subcategory 4A lesions but within the reference range for BI-RADS category 3 lesions, as indicated by linear regression analysis. Therefore, it is recommended that management for this subset of participants are categorized as BI-RADS category 3, meaning that biopsies typically indicated could be replaced with short-term follow-up. In conclusion, the integrated assessment model based on age and BI-RADS may enhance accuracy of ultrasonography in diagnosing breast lesions and young patients with BI-RADS subcategory 4A lesions may be exempted from biopsy.

Recent advances in caspase-3, breast cancer, and traditional Chinese medicine: a review

Caspases (cysteinyl aspartate-specific proteinases) are a group of structurally similar proteases in the cytoplasm that can be involved in cell differentiation, programmed death, proliferation, and inflammatory generation. Experts have found that caspase-3 can serve as a terminal splicing enzyme in apoptosis and participate in the mechanism by which cytotoxic drugs kill cancer cells. Breast cancer (BC) has become the most common cancer among women worldwide, posing a severe threat to their lives. Finding new therapeutic targets for BC is the primary task of contemporary physicians. Numerous studies have revealed the close association between caspase-3 expression and BC. Caspase-3 is essential in BC's occurrence, invasion, and metastasis. In addition, Caspase-3 exerts anticancer effects by regulating cell death mechanisms. Traditional Chinese medicine acting through caspase-3 expression is increasingly used in clinical treatment. This review summarizes the biological mechanism of caspase-3 and research progress on BC. It introduces a variety of traditional Chinese medicine related to caspase-3 to provide new ideas for the clinical treatment of BC.

Effects of exosomes and inflammatory response on tumor: a bibliometrics study and visualization analysis via CiteSpace and VOSviewer

BACKGROUND

Tumor is a new organism formed by abnormal hyperplasia of local tissue cells under the action of various tumorigenic factors. Inflammation plays a decisive role in inducing tumorigenesis, promoting tumor development, invasion and migration. More and more evidence indicate that exosomes are involved in regulating the formation of tumor microenvironment in the process of proinflammatory carcinogenesis, leading to the stimulation of anti-tumor immune response or systemic immunosuppression, and exosomes play a crucial role in the development of tumor.

METHODS

The articles on tumor-derived exosomes and inflammatory responses from January 2005 to January 2024 were collected through Web of Science (WOS), and the inclusion criteria were "Article", "Review Article" and "Early Access". Articles obtained after excluding "Book Chapters", "Editorial Material", "Proceeding Paper", "Meeting Abstract" and "Retracted Publication". Bibliometrics and visualization analysis were carried out on the obtained articles using CiteSpace6.2.R6 and VOSviewer1.6.20.

RESULTS

Total of 703 articles were included. The number of published documents showed a fluctuating growth trend year by year. A total of 61 countries have participated in the research on the effects of exosomes and inflammatory responses on tumors, among which China and the United States have the largest influence in this field. The obtained articles have been published in 60 journals around the world, among which PLOS ONE and NAT REV IMMUNOL are the journals with the most published articles and the highest co-citations respectively. The article from French author THERY C was cited the most (202 times). As a major researcher on the basic function of exosomes, THERY C established the gold standard for extraction, separation and identification of exosomes, and found that exosomes promote tumor metastasis through direct regulation of miRNA. Her research has had a huge impact on the field. Keyword co-occurrence analysis indicate that extracellular vesicles, inflammation, cancer, miRNAs, mesenchymal stem cells, drug delivery, gastric cancer and circulating endothelial microparticles are the research hotspot at present stage. The main keywords of the cluster analysis show that extracellular vesicles, human papilloma virus, myeloid cells, tumor macro-environment are the current research hotspots and frontier. The research hotspots have developed over time from the time chart of keywords and clustering, especially after 2016, exosomes have established extensive links with drug delivery, cancer treatment, inflammatory response and other fields. Tumor-derived exosomes stimulate receptor cells to secrete pro-inflammatory cytokines and growth factors, enabling immune and inflammatory cells to perceive the intracellular environment of cancer cells even when cancer cells do not express any tumor-specific antigens. For example, in anoxic environment, cancer cells can secrete exosomes containing pro-inflammatory factors to promote the invasion and metastasis of cancer cells. In the complex tumor microenvironment, both tumor cells and various stromal cells will secrete specific exosomes, and promote the development of tumors through various ways, so that tumor cells have drug resistance, and bring adverse effects on the clinical treatment of tumor patients. MicroRNAs and long noncoding RNA as hot keywords play important roles in regulating and mediating tumor development, and their specificity makes them important biomarkers for cancer prediction and diagnosis. Highlighting word analysis shows that microRNAs secreted by leukemia patients can effectively promote the proliferation of malignant cells and the development of cardiovascular diseases. At the same time, exosomes can induce the secretion of some microRNAs in patients, leading to cardiac repair and regeneration. Therefore, the detection and screening of microRNAs plays a crucial role in predicting the incidence of cardiovascular diseases in patients.

CONCLUSION

Exosomes have attracted increasing attention due to their significant heterogeneity and ability to regulate the tumor immune microenvironment. However, tumor cell-derived exosomes accelerate tumor progression by enhancing immunosuppression and inflammation, increasing oxidative stress, and promoting angiogenesis, which may lead to poor prognosis.

GFPT1 accelerates immune escape in breast cancer by modifying PD-L1 via O-glycosylation

BACKGROUND

Immune escape is one of the causes of poor prognosis in breast cancer (BC). Glutamine-fructose-6-phosphate transaminase 1 (GFPT1) is the first speed-limiting enzyme of the hexosamine biosynthesis pathway (HBP) and is essential for the progression of BC. Nevertheless, the mechanism of the influence of GFPT1 in BC immune escape is not clear.

METHODS

First, the level of GFPT1 in BC was analyzed by starbase, and GFPT1 expression in BC tissues was measured by qRT-PCR, western blot and IHC. Then, the O-GlcNAc levels were detected by western blot. Thereafter, Co-IP was applied to examine the relationship between GFPT1 and PD-L1. At last, a mouse model was constructed for validation in vivo.

RESULTS

Firstly, we discovered that GFPT1 was obviously strengthened in BC. Knockdown or introduction of GFPT1 correspondingly degraded and elevated O-GlcNAc levels in cells. Further researches revealed that there was a reciprocal relationship between GFPT1 and PD-L1. Mechanistically, we disclosed that GFPT1 enhanced PD-L1 protein stability through O-glycosylation. More interestingly, GFPT1 accelerated BC cell immune escape via upregulation of O-glycosylation-modified PD-L1. In vivo, silencing of GFPT1 attenuated immune escape of BC cells by reducing PD-L1 levels.

CONCLUSION

GFPT1 promoted BC progression and immune escape via O-glycosylation-modified PD-L1. GFPT1 may be a potential target for BC therapy.

Targeted FT-NIR and SERS Detection of Breast Cancer HER-II Biomarkers in Blood Serum Using PCB-Based Plasmonic Active Nanostructured Thin Film Label-Free Immunosensor Immobilized with Directional GNU-Conjugated Antibody

This work describes our recent PCB-based plasmonic nanostructured platform patent (US 11,828,747B2) for the detection of biomarkers in breast cancer serum (BCS). A 50 nm thin gold film (TGF) was immersion-coated on PCB (i.e., PCB-TGF) and immobilized covalently with gold nanourchin (GNU) via a 1,6-Hexanedithiol (HDT) linkage to produce a plasmonic activated nanostructured thin film (PANTF) platform. A label-free SERS immunosensor was fabricated by conjugating the platform with monoclonal HER-II antibodies (mAb) in a directional orientation via adipic acid dihydrazide (ADH) to provide higher accessibility to overexpressed HER-II biomarkers (i.e., 2+ (early), 3+ (locally advanced), and positive (meta) in BCS. An enhancement factor (EF) of 0.3 × 105 was achieved for PANTF using Rhodamine (R6G), and the morphology was studied by scanning electron microscopy (SEM) and atomic force microscope (AFM). UV-vis spectroscopy showed the peaks at 222, 231, and 213 nm corresponding to ADH, mAb, and HER-II biomarkers, respectively. The functionalization and conjugation were investigated by Fourier Transform Near Infrared (FT-NIR) where the most dominant overlapped spectra of 2+, 3+, and Pos correspond to OH-combination of carbohydrate, RNH2 1st overtone, and aromatic CH 1st overtone of mAb, respectively. SERS data were filtered using the filtfilt filter from scipy.signals, baseline corrected using the Improved Asymmetric Least Squares (isals) function from the pybaselines.Whittaker library. The results showed the common peaks at 867, 1312, 2894, 3026, and 3258 cm-1 corresponding to glycine, alanine ν (C-N-C) assigned to the symmetric C-N-C stretch mode; tryptophan and α helix; C-H antisymmetric and symmetric stretching; NH3+ in amino acids; and N-H stretch primary amide, respectively, with the intensity of Pos > 3+ > 2+. This trend is justifiable considering the stage of each sample. Principal Component Analysis (PCA) and Linear Discrimination Analysis (LDA) were employed for the statistical analysis of data.

Construction and validation of a ubiquitination-related prognostic risk score signature in breast cancer

Background

Breast cancer (BC) is a highly common form of cancer that occurs in many parts of the world. However, early -stage BC is curable. Many patients with BC have poor prognostic outcomes owing to ineffective diagnostic and therapeutic tools. The ubiquitination system and associated proteins were found influencing the outcome of individuals with cancer. Therefore, developing a biomarker associated with ubiquitination genes to forecast BC patient outcomes is a feasible strategy.

Objective

The primary goal of this work was to develop a novel risk score signature capable of accurately estimate the future outcome of patients with BC by targeting ubiquitinated genes.

Methods

Univariate Cox regression analysis was conducted utilizing the E1, E2, and E3 ubiquitination-related genes in the GSE20685 dataset. Genes with p < 0.01 were screened again using the Non-negative Matrix Factorization (NMF) algorithm, and the resulting hub genes were composed of a risk score signature. Patients were categorized into two risk groups, and the predictive effect was tested using Kaplan-Meier (KM) and Receiver Operating Characteristic (ROC) curves. This risk score signature was later validated using multiple external datasets, namely TCGA-BRAC, GSE1456, GSE16446, GSE20711, GSE58812 and GSE96058. Immuno-microenvironmental, single-cell, and microbial analyses were also performed.

Results

The selected gene signature comprising six ubiquitination-related genes (ATG5, FBXL20, DTX4, BIRC3, TRIM45, and WDR78) showed good prognostic power in patients with BC. It was validated using multiple externally validated datasets, with KM curves showing significant differences in survival (p < 0.05). The KM curves also demonstrated superior predictive ability compared to traditional clinical indicators. Single-cell analysis revealed that Vd2 gd T cells were less abundantin the low-risk group, whereas patients in the high-risk group lacked myeloid dendritic cells. Tumor microbiological analysis revealed a notable variation in microorganism diversity between the high- and low-risk groups.

Conclusion

This study established an risk score signature consisting of six ubiquitination genes, that can accurately forecast the outcome of patients with BC using multiple datasets. It can provide personalized and targeted assistance to provide the evaluation and therapy of individuals having BC.