1
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McDonald ES, Scheel JR, Lewin AA, Weinstein SP, Dodelzon K, Dogan BE, Fitzpatrick A, Kuzmiak CM, Newell MS, Paulis LV, Pilewskie M, Salkowski LR, Silva HC, Sharpe RE, Specht JM, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Imaging of Invasive Breast Cancer. J Am Coll Radiol 2024; 21:S168-S202. [PMID: 38823943 DOI: 10.1016/j.jacr.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
As the proportion of women diagnosed with invasive breast cancer increases, the role of imaging for staging and surveillance purposes should be determined based on evidence-based guidelines. It is important to understand the indications for extent of disease evaluation and staging, as unnecessary imaging can delay care and even result in adverse outcomes. In asymptomatic patients that received treatment for curative intent, there is no role for imaging to screen for distant recurrence. Routine surveillance with an annual 2-D mammogram and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women with a history of breast cancer, and MRI is increasingly used as an additional screening tool in this population, especially in women with dense breasts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Elizabeth S McDonald
- Research Author, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John R Scheel
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Alana A Lewin
- Panel Chair, New York University Grossman School of Medicine, New York, New York
| | - Susan P Weinstein
- Panel Vice Chair, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Basak E Dogan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amy Fitzpatrick
- Boston Medical Center, Boston, Massachusetts, Primary care physician
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | | | - Melissa Pilewskie
- University of Michigan, Ann Arbor, Michigan; Society of Surgical Oncology
| | - Lonie R Salkowski
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - H Colleen Silva
- The University of Texas Medical Branch, Galveston, Texas; American College of Surgeons
| | | | - Jennifer M Specht
- University of Washington, Seattle, Washington; American Society of Clinical Oncology
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California; University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
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2
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Mehta TS, Lourenco AP, Niell BL, Bennett DL, Brown A, Chetlen A, Freer P, Ivansco LK, Jochelson MS, Klein KA, Malak SF, McCrary M, Mullins D, Neal CH, Newell MS, Ulaner GA, Moy L. ACR Appropriateness Criteria® Imaging After Breast Surgery. J Am Coll Radiol 2022; 19:S341-S356. [PMID: 36436961 DOI: 10.1016/j.jacr.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Given that 20% to 40% of women who have percutaneous breast biopsy subsequently undergo breast surgery, knowledge of imaging women with a history of benign (including high-risk) disease or breast cancer is important. For women who had surgery for nonmalignant pathology, the surveillance recommendations are determined by their overall risk. Higher-than-average risk women with a history of benign surgery may require screening mammography starting at an earlier age before 40 and may benefit from screening MRI. For women with breast cancer who have undergone initial excision and have positive margins, imaging with diagnostic mammography or MRI can sometimes guide additional surgical planning. Women who have completed breast conservation therapy for cancer should get annual mammography and may benefit from the addition of MRI or ultrasound to their surveillance regimen. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Tejas S Mehta
- Director of Diversity, Equity Inclusion and Population Health in Radiology, UMass Memorial Medical Center, Worchester, Massachusetts.
| | - Ana P Lourenco
- Panel Chair; Residency Program Director, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Bethany L Niell
- Panel Vice-Chair; Section Chief of Breast Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Commission Government Relations Chair
| | - Debbie L Bennett
- Section Chief - Breast Imaging, Mallinckrodt Institute of Radiology/Washington University School of Medicine, Saint Louis, Missouri
| | - Ann Brown
- Assistant Section Chief, University of Cincinnati, Cincinnati, Ohio
| | - Alison Chetlen
- Vice Chair of Education, Division Chief Breast Imaging, Penn State Health Hershey Medical Center, Hershey, Pennsylvania
| | - Phoebe Freer
- Section Chief, Breast Imaging, University of Utah/Huntsman Cancer Institute, Salt Lake City, Utah; ACR/SCBI Screening Leadership Group Inaugural Class
| | - Lillian K Ivansco
- Assistant Chief, Department of Radiology, Section Chief for Breast Imaging and Quality, Co-Chair, Breast Imaging Sourcing and Standards Team, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Maxine S Jochelson
- Chief of the Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Marion McCrary
- Associate Director of Duke GME Coaching, Duke Signature Care, Durham, North Carolina; American College of Physicians; Governor-Elect, American College of Physicians, North Carolina Chapter
| | - David Mullins
- Chief of Staff, Princeton Community Hospital, Princeton, West Virginia; American College of Surgeons
| | | | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; RADS Committee
| | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California and University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York
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3
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Zhang G, Song W. Long non-coding RNA LSINCT5 inactivates Wnt/β-catenin pathway to regulate MCF-7 cell proliferation and motility through targeting the miR-30a. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1635. [PMID: 33490147 PMCID: PMC7812233 DOI: 10.21037/atm-20-7253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Breast cancer (BC) is the most common malignant tumor among women. Earlier studies showed that long stress-induced non-coding transcript 5 (LSINCT5) was implicated in BC. However, the potential mechanisms of LSINCT5 in BC is still elusive. Methods Relative expression of LSINCT5 in BC tissues and cells were quantified by quantitative real-time reverse transcription PCR (qRT-PCR). shRNA was employed to specifically knockdown endogenous LSINCT5 in BC cells. Cell growth and invasion activity of BC cells was assessed by colony formation and transwell migration assay, respectively. The association between LSINCT5 and miR-30a was conducted by luciferase reporter assay. Subcutaneous injection of sh-LSINCT5 transfected MCF-7 cells into the ventral regions of mice to form tumors. Mice were divided into three groups (n=10): control group, sh-NC group, sh-LSINCT5 group (sh-NC or sh-LSINCT5 transfected MCF-7 cells injected into mice). Tumor weight was checked after 30 days post-injection. Results LSINCT5 was significantly up-regulated in BC tissues and cells. LSINCT5 knockdown suppressed proliferation, invasion, and epithelial-mesenchymal transition (EMT) in vitro and in vivo. LSINCT5 acted as a sponge molecule and targeted miR-30a in BC cells. Further mechanistic study exhibited that overexpression of LSINCT5 promoted the expression of Wnt/β-catenin-related proteins (β-catenin, TCF4, and c-Myc). In vivo, xenograft nude mice experiment indicated sh-LSINCT5 inhibited tumor growth and motility by targeting miR-30a through modulating Wnt/β-catenin pathway. Conclusions The present results uncovered that LSINCT5 knockdown suppressed BC growth and metastasis via the miR-30a/Wnt/β-catenin axis, and it served as a potential therapeutic target for early diagnosis and treatment of BC patients..
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Affiliation(s)
- Guizhi Zhang
- Department of Radiology, The Eighth Affiliated Hospital Sun Yat-sen University, Shenzhen, China
| | - Wenbo Song
- Department of Oncology, Jiangdu People's Hospital Affiliated to Medical College of Yangzhou University, Yangzhou, China
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4
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Zhong H, Yang J, Zhang B, Wang X, Pei L, Zhang L, Lin Z, Wang Y, Wang C. LncRNA GACAT3 predicts poor prognosis and promotes cell proliferation in breast cancer through regulation of miR-497/CCND2. Cancer Biomark 2018; 22:787-797. [PMID: 29945347 DOI: 10.3233/cbm-181354] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common malignancy in women which increases gradually all over the world. LncRNA GACAT3 has been found to be increased in gastric cancer and associated with tumor malignancy. However, whether GACAT3 plays a role in the regulation of breast cancer is not known. In the present study, we found that GACAT3 expression was increased in breast cancer tissues and cells compared with adjacent normal tissues and normal cells. High GACAT3 expression was correlated with the poor prognosis of breast cancer patients. GACAT3 and cyclin D2 (CCND2) contained a binding site of miR-497. miR-497 was decreased in breast cancer tissues and cells compared with adjacent normal tissues and normal cells. Low miR-497 expression was correlated with the poor prognosis of breast cancer patients. In breast cancer tissues, the expression of miR-497 was negatively correlated with GACAT3. Downregulation of GACAT3 increased miR-497 expression. miR-497 mimic reduced the luciferase of GACAT3 and CCND2. Anti-miR-497 reversed the effects of GACAT3 downregulation. We also found that GACAT3 may act as a ceRNA for miR-497, enhancing the expression of CCND2. In conclusion, GACAT3 promotes breast cancer malignancy by sponging miR-497, leading to the enhancement of its endogenous target CCND2. These results suggest that GACAT3/miR-497/CCND2 is a potential therapeutic target and biomarker for breast cancer.
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Affiliation(s)
- Hua Zhong
- Department of Clinical Laboratory, Chinese PLA General Hospital, Beijing 100853, China.,Department of Clinical Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, China
| | - Jun Yang
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, China
| | - Bin Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, China
| | - Xiaofang Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, China
| | - Lihong Pei
- Department of Clinical Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, China
| | - Lei Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, China
| | - Zhiqiang Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, China
| | - Yanan Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, China
| | - Chengbin Wang
- Department of Clinical Laboratory, Chinese PLA General Hospital, Beijing 100853, China
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5
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Takeuchi H, Abe M, Takumi Y, Hashimoto T, Kobayashi R, Osoegawa A, Miyawaki M, Okamoto T, Sugio K. The prognostic impact of the platelet distribution width-to-platelet count ratio in patients with breast cancer. PLoS One 2017; 12:e0189166. [PMID: 29216259 PMCID: PMC5720724 DOI: 10.1371/journal.pone.0189166] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022] Open
Abstract
Activated platelets promote tumor cell growth, angiogenesis, and invasion. Platelet activity can be inferred by platelet volume indices (PVIs), which include platelet distribution width (PDW), mean platelet volume (MPV), platelet distribution width-to-platelet count ratio (PDW/P), and mean platelet volume-to-platelet count ratio. Platelets and platelet-related markers, such as the platelet-to-lymphocyte ratio, have been found to be significant prognostic factors in patients with breast cancer. However, the role of PVIs for predicting survival in breast cancer remains unknown; hence, we performed this retrospective analysis of 275 patients with breast cancer. PVIs were compared with clinicopathological variables, and were assessed to identify independent indicators associated with disease-free survival (DFS) using the Cox proportional hazards model. An elevated PDW/P significantly correlated with age and HER2 status. Univariate analysis revealed that elevated PDW, MPV, and PDW/P as well as tumor size, nuclear grade, and lymph node involvement were significantly associated with inferior DFS rates (tumor size: p<0.01; nuclear grade, lymph node involvement, PDW, MPV, and PDW/P: p<0.05). On multivariate analysis, a large tumor size and elevated PDW/P were significant prognostic factors for DFS, with hazard ratios of 3.24 (95% confidence interval [CI]: 1.24-8.47) and 2.99 (95% CI: 1.18-7.57), respectively (p<0.05). Our study is the first to reveal that an elevated PDW/P significantly reduces DFS in patients with breast carcinoma. Measuring the PDW/P is simple, relatively inexpensive, and almost universally available using routine blood counts; this makes it an attractive biomarker for improved risk assessment.
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Affiliation(s)
- Hideya Takeuchi
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
- * E-mail:
| | - Miyuki Abe
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yohei Takumi
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takafumi Hashimoto
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Ryoji Kobayashi
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Atsushi Osoegawa
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Michiyo Miyawaki
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Tatsuro Okamoto
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
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6
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Zhang M, Huang XZ, Song YX, Gao P, Sun JX, Wang ZN. High Platelet-to-Lymphocyte Ratio Predicts Poor Prognosis and Clinicopathological Characteristics in Patients with Breast Cancer: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9503025. [PMID: 29082257 PMCID: PMC5610825 DOI: 10.1155/2017/9503025] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/10/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to evaluate the correlation of platelet-to-lymphocyte ratio (PLR) with prognosis and clinicopathological characteristics of breast cancer. METHODS The PubMed and Embase databases were searched. Hazard ratio (HR) with 95% confidence interval (CI) was used to summarize disease-free survival (DFS) and overall survival (OS). Odds ratio (OR) was used to summarize tumor clinicopathological characteristics. RESULTS High PLR was associated with poor DFS and OS (DFS: HR = 1.47, 95% CI = 1.16-1.85, and Tau2 = 0.070; OS: HR = 1.88, 95% CI = 1.27-2.80, and Tau2 = 0.192). A Galbraith plot indicated that the studies by Allan et al. and Cihan et al. contributed the heterogeneity of DFS and OS, respectively. There were significant differences in the incidence of high PLR between stage II-IV and stage I groups (OR = 1.86, 95% CI = 1.20-2.90, and Tau2 < 0.001), between lymph node-positive and lymph node-negative groups (OR = 1.52, 95% CI = 1.22-1.91, and Tau2 =0.014), and between metastasis-positive and metastasis-negative groups (OR = 4.24, 95% CI = 2.73-6.59, and Tau2 < 0.001). CONCLUSIONS Our results indicated that PLR was associated with poor prognosis of breast cancer and adequately predicted clinicopathological characteristics.
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Affiliation(s)
- Miao Zhang
- Department of Oncology, The Air Force General Hospital of Chinese PLA, No. 30 Fucheng Road, Haidian District, Beijing City 100142, China
| | - Xuan-zhang Huang
- Department of Chemotherapy and Radiotherapy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Lucheng District, Wenzhou City 325027, China
| | - Yong-xi Song
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City 110001, China
| | - Peng Gao
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City 110001, China
| | - Jing-xu Sun
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City 110001, China
| | - Zhen-ning Wang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City 110001, China
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7
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Follow-Up of Patients with Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Liu C, Huang Z, Wang Q, Sun B, Ding L, Meng X, Wu S. Usefulness of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in hormone-receptor-negative breast cancer. Onco Targets Ther 2016; 9:4653-60. [PMID: 27536129 PMCID: PMC4973777 DOI: 10.2147/ott.s106017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose We aimed to investigate the relationship between pretreatment neutrophil-to-lymphocyte ratio (NLR)/platelet-to-lymphocyte ratio (PLR) and the estimation of hormone-receptor-negative (HR−) breast cancer patients’ survival in a Chinese cohort. Patients and methods Of 434 consecutive HR− nonmetastatic breast cancer patients treated between 2004 and 2010 in the Affiliated Hospital of Academy of Military Medical Sciences, 318 eligible cases with complete data were included in the present study. Kaplan–Meier analysis was performed to determine the overall survival (OS) and disease-free survival (DFS). Univariate and multivariate Cox proportional hazards models were used to test the usefulness of NLR and PLR. Results Univariate analysis indicated that both elevated NLR and PLR (both P<0.001) were associated with poor OS. The utility of NLR remained in the multivariate analysis (P<0.001), but not PLR (P=0.104). The analysis results for DFS were almost the same as OS. Subgroup analysis revealed a significant association between increased NLR and PLR (P<0.001 and P=0.011) and poor survival in triple-negative breast cancer. However, for human epidermal growth factor receptor 2-positive breast cancer, only NLR was significantly associated with OS in the multivariate analysis (P=0.001). Conclusion The present study indicates that both increased NLR and PLR are associated with poor survival in HR−breast cancer patients. Meanwhile, NLR is independently correlated with OS and DFS, but PLR is not.
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Affiliation(s)
- Chao Liu
- Department of Radiation Oncology, Affiliated Hospital of Academy of Military Medical Sciences; Department of Radiation Oncology, 307 Hospital of PLA, 307 Clinical College, Anhui Medical University, Beijing, People's Republic of China
| | - Zhou Huang
- Department of Radiation Oncology, Affiliated Hospital of Academy of Military Medical Sciences
| | - Qiusheng Wang
- Department of Radiation Oncology, Affiliated Hospital of Academy of Military Medical Sciences
| | - Bing Sun
- Department of Radiation Oncology, Affiliated Hospital of Academy of Military Medical Sciences
| | - Lijuan Ding
- Department of Radiation Oncology, Affiliated Hospital of Academy of Military Medical Sciences
| | - Xiangying Meng
- Department of Radiation Oncology, Affiliated Hospital of Academy of Military Medical Sciences
| | - Shikai Wu
- Department of Radiation Oncology, Affiliated Hospital of Academy of Military Medical Sciences; Department of Radiation Oncology, 307 Hospital of PLA, 307 Clinical College, Anhui Medical University, Beijing, People's Republic of China
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9
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Sammour T, Macleod A, Chittleborough TJ, Chandra R, Shedda SM, Hastie IA, Jones IT, Hayes IP. Total caseload of a colorectal surgical unit: baseline measurement and identification of areas for efficiency gains. Int J Colorectal Dis 2016; 31:1141-8. [PMID: 26979980 DOI: 10.1007/s00384-016-2556-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Resource limitations are a concern in most modern public hospital systems. The aim of this study is to prospectively quantify the total caseload of a tertiary colorectal surgery unit to identify areas of redundancy. METHODS Data was collected prospectively at all points of clinical care (outpatient clinic, inpatient referrals, operating theatre and endoscopy) between March 2014 and March 2015 using specifically designed templates. The final data was analysed using descriptive statistics. RESULTS During the study period, 4012 patient episodes were recorded: 2871 in outpatient clinic, 186 as emergency patient referrals, 541 at colonoscopy and 414 at surgery. The largest component of the caseload was made up primarily of colonoscopy results follow-up, protocol review for previous cancer or polyps and post-operative review. Sixty-eight percent of these episodes did not result in any active intervention such as further tests or surgery. Most new outpatient referrals were undifferentiated, with the most common indications being minor rectal bleeding, non-specific gastrointestinal symptoms, and minor non-bleeding anorectal problems. Of the new referrals, 56 % were booked for a colonoscopy, and only 13.3 % were booked directly for elective surgery. CONCLUSION A large component of the caseload of a tertiary colorectal surgery unit is made up of post-colonoscopy, post-operative, and surveillance protocol follow-up, with a significant proportion of patients not requiring any active intervention. The majority of new referrals are undifferentiated and result in a low rate of direct booking for operative intervention. Rationalisation of this resource using evidence-based methods could reduce redundancy, workload, and cost.
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Affiliation(s)
- Tarik Sammour
- Colorectal Unit, Department of Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, Australia.
| | - Andrew Macleod
- Colorectal Unit, Department of Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, Australia
| | - Tim J Chittleborough
- Colorectal Unit, Department of Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, Australia
| | - Raaj Chandra
- Colorectal Unit, Department of Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, Australia
| | - Susan M Shedda
- Colorectal Unit, Department of Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, Australia
| | - Ian A Hastie
- Colorectal Unit, Department of Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, Australia
| | - Ian T Jones
- Colorectal Unit, Department of Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, Australia.,Department of Surgery, University of Melbourne, Parkville, VIC, Australia
| | - Ian P Hayes
- Colorectal Unit, Department of Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, Australia.,Department of Surgery, University of Melbourne, Parkville, VIC, Australia
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10
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Krenn-Pilko S, Langsenlehner U, Stojakovic T, Pichler M, Gerger A, Kapp KS, Langsenlehner T. The elevated preoperative derived neutrophil-to-lymphocyte ratio predicts poor clinical outcome in breast cancer patients. Tumour Biol 2015. [PMID: 26219894 DOI: 10.1007/s13277-015-3805-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Existing preclinical and clinical data suggest that the presence of a systemic inflammatory response plays a critical role in the progression of several solid tumors. The derived neutrophil-to-lymphocyte ratio (dNLR) represents an easily determinable marker of systemic inflammation and has been proposed as a potential prognostic marker. The present study was performed to validate and further clarify the prognostic relevance of an elevated pre-treatment dNLR in a large cohort of European breast cancer patients. Data from 762 consecutive female breast cancer patients treated from 1999 to 2004 were evaluated. Disease-free survival (DFS) and overall survival (OS) were assessed using the Kaplan-Meier method. To evaluate the prognostic relevance, univariate and multivariate Cox regression models were performed for each endpoint. Applying receiver operating characteristics (ROC) analysis, the optimal cutoff level for the dNLR was 3. In univariate analysis, a dNLR ≥3 was associated with poor DFS (hazard ratio (HR) 1.87, 95 % confidence interval (CI) 1.28-2.73, p = 0.001) and OS (HR 1.67, 95 % CI 1.07-2.63, p = 0.025). Multivariate analysis revealed a significant association between the elevated dNLR and poor DFS (hazard ratio (HR) 1.70, 95 % CI 1.09-2.65, p = 0.018) but did not show a significant association between the dNLR and OS (HR 1.54, 95 % CI 0.91-2.59, p = 0.106). The present study shows that the pre-treatment dNLR is an independent prognostic factor that could be useful for future individual risk assessment in breast cancer patients.
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Affiliation(s)
- Sabine Krenn-Pilko
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Uwe Langsenlehner
- Division of Internal Medicine, Outpatient Department Graz, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Internal Medicine, Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology, Department of Internal Medicine, Comprehensive Cancer Center, Medical University of Graz, Graz, Austria
| | - Karin S Kapp
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Tanja Langsenlehner
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria.
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11
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Ugras S, Stempel M, Patil S, Morrow M. Estrogen receptor, progesterone receptor, and HER2 status predict lymphovascular invasion and lymph node involvement. Ann Surg Oncol 2014; 21:3780-6. [PMID: 24952028 DOI: 10.1245/s10434-014-3851-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The ACOSOG Z0011 trial demonstrated that axillary dissection (ALND) is not necessary for local control or survival in women with T1/2cN0 cancer undergoing breast-conserving therapy. There is concern about applying these results to triple-negative (TN) cancers secondary to their high local-recurrence (LR) rate. We examined the frequency of lymphovascular invasion (LVI) and nodal metastases in TN cancers to determine whether ALND can be safely avoided in this subtype. METHODS Data were obtained from a database of patients with invasive breast cancer treated at Memorial Sloan Kettering Cancer Center from January 1998 to December 2010. A total of 11,596 tumors were classifiable into clinical surrogates for molecular subtype by immunohistochemical analysis: hormone receptor (HR)+/HER2+, HR+/HER2-, HR-/HER2+, and TN (HR-/HER2-). Multivariable logistic regression analysis (MVA) was used to determine associations between clinicopathologic variables and subtype. RESULTS There were differences in age, tumor size, LVI, grade, and nodal involvement among groups. On MVA controlling for size, grade, and age, ER, PR, and HER2 status were significantly associated with LVI (p < 0.0001). Relative to TN tumors, HR+/HER2-, HR+/HER2+, and HR-/HER2+ tumors had higher odds of demonstrating LVI of 1.8 (odds ratio 1.8; 95 % confidence interval 1.6-2.1), 2.5 (2.5; 2.0-3.0), and 1.7 (1.7; 1.4-2.1), respectively. On MVA adjusting for size, grade, LVI, and age, TN tumors had the lowest odds of having any or high-volume nodal involvement (≥4 nodes, p < 0.0001). CONCLUSIONS LVI and nodal metastases were least frequent in TN cancers compared with other subtypes, despite the uniformly worse prognosis and increased LR rate in TN tumors. This suggests TN cancers spread via lymphatics less frequently than other subtypes and ALND may be avoided in TN patients meeting Z0011 eligibility criteria.
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Affiliation(s)
- Stacy Ugras
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Krenn-Pilko S, Langsenlehner U, Thurner EM, Stojakovic T, Pichler M, Gerger A, Kapp KS, Langsenlehner T. The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients. Br J Cancer 2014; 110:2524-30. [PMID: 24675383 PMCID: PMC4021515 DOI: 10.1038/bjc.2014.163] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/01/2014] [Accepted: 03/04/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The elevation of the platelet-to-lymphocyte ratio (PLR), an easily applicable blood test based on platelet and lymphocyte counts has been associated with poor prognosis in patients with different types of cancer. The present study was aimed to investigate the prognostic significance of the preoperative PLR in a large cohort of breast cancer patients. METHODS Data from 793 consecutive non-metastatic breast cancer patients, treated between 1999 and 2004, were evaluated retrospectively. The optimal cutoff values for the PLR were calculated using receiver operating curve analysis. Cancer-specific survival (CSS), overall survival (OS) as well as distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method. To evaluate the independent prognostic significance of PLR, multivariable Cox regression models were applied for all three different end points. RESULTS Univariable analysis revealed a significant association between the elevated preoperative PLR and CSS (hazard ratio (HR): 2.75, 95% confidence interval (CI): 1.57-4.83, P<0.001) that remained statistically significant in multivariable analysis (HR: 2.03, 95% CI: 1.03-4.02, P=0.042). An increased PLR was also significantly associated with decreased OS in univariable (HR: 2.45, 95% CI: 1.43-4.20, P=0.001) and in multivariable analysis (HR: 1.92, 95% CI: 1.01-3.67, P=0.047). Furthermore, univariable analysis showed a significant impact of increased PLR on DMFS (HR: 2.02, 95% CI: 1.18-3.44, P=0.010). Subgroup analysis revealed significant associations of the elevated PLR on the primary end point CSS for all breast cancer subtypes. This association retained its significance in multivariable analysis in patients with luminal B tumours (HR: 2.538, 95% CI: 1.043-6.177, P=0.040). CONCLUSIONS In this study, we identified the preoperative PLR as an independent prognostic marker for survival in breast cancer patients. Independent validation of our findings is needed.
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Affiliation(s)
- S Krenn-Pilko
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036 Graz, Austria
| | - U Langsenlehner
- Division of Internal Medicine, Outpatient Department Graz, Graz, Austria
| | - E-M Thurner
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036 Graz, Austria
| | - T Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - M Pichler
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Gerger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - K S Kapp
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036 Graz, Austria
| | - T Langsenlehner
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036 Graz, Austria
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