Differences in clinicopathological characteristics, treatment, and survival outcomes between older and younger breast cancer patients

A nomogram model for predicting the risk of axillary lymph node metastasis in patients with early breast cancer and cN0 status

Axillary staging is commonly performed via sentinel lymph node biopsy for patients with early breast cancer (EBC) presenting with clinically negative axillary lymph nodes (cN0). The present study aimed to investigate the association between axillary lymph node metastasis (ALNM), clinicopathological characteristics of tumors and results from axillary ultrasound (US) scanning. Moreover, a nomogram model was developed to predict the risk for ALNM based on relevant factors. Data from 998 patients who met the inclusion criteria were retrospectively reviewed. These patients were then randomly divided into a training and validation group in a 7:3 ratio. In the training group, receiver operating characteristic curve analysis was used to identify the cutoff values for continuous measurement data. R software was used to identify independent ALNM risk variables in the training group using univariate and multivariate logistic regression analysis. The selected independent risk factors were incorporated into a nomogram. The model differentiation was assessed using the area under the curve (AUC), while calibration was evaluated through calibration charts and the Hosmer-Lemeshow test. To assess clinical applicability, a decision curve analysis (DCA) was conducted. Internal verification was performed via 1000 rounds of bootstrap resampling. Among the 998 patients with EBC, 228 (22.84%) developed ALNM. Multivariate logistic analysis identified lymphovascular invasion, axillary US findings, maximum diameter and molecular subtype as independent risk factors for ALNM. The Akaike Information Criterion served as the basis for both nomogram development and model selection. Robust differentiation was shown by the AUC values of 0.855 (95% CI, 0.817-0.892) and 0.793 (95% CI, 0.725-0.857) for the training and validation groups, respectively. The Hosmer-Lemeshow test yielded P-values of 0.869 and 0.847 for the training and validation groups, respectively, and the calibration chart aligned closely with the ideal curve, affirming excellent calibration. DCA showed that the net benefit from the nomogram significantly outweighed both the 'no intervention' and the 'full intervention' approaches, falling within the threshold probability interval of 12-97% for the training group and 17-82% for the validation group. This underscores the robust clinical utility of the model. A nomogram model was successfully constructed and validated to predict the risk of ALNM in patients with EBC and cN0 status. The model demonstrated favorable differentiation, calibration and clinical applicability, offering valuable guidance for assessing axillary lymph node status in this population.

Age-Related Clusters and Favorable Immune Phenotypes in Breast Cancer of the Young Patients

Breast cancer (BC) patients aged <40 years at diagnosis experience aggressive disease and poorer survival compared with women diagnosed with BC at 40 to 49 years, but the age-related biology is described to little extent. Here, we explored transcriptional alterations in BC to gain better understanding of age-related tumor biology. We studied a subset of the Bergen in-house cohort (n = 127; age range, 26-49 years) and used the NanoString Breast Cancer 360 expression panel on formalin-fixed paraffin-embedded BC tissue, and publicly available global BC messenger RNA expression data (n = 204, age range, 22-49 years), to explore differentially expressed genes between the young (age <40 years) and older (age 40-49 years) patients. Unsupervised hierarchical clustering was applied to identify gene expression-based patient clusters. We applied established computational approaches to define the PAM50 subtypes, risk of recurrence scores (ROR), and risk groups and to infer the proportions of 22 immune cell types from bulk gene expression profiles of patients aged <50 years at BC diagnosis. Differentially expressed genes and gene sets were investigated using OncoEnrichR and g:Profiler to describe functional profiles and pathway enrichment. We identified 4 age-related patient clusters presenting distinct characteristics of PAM50 subtypes and ROR profiles, which demonstrated independent prognostic value when adjusted for traditional clinicopathologic variables and the known molecular subtypes. Our findings showed better survival than expected in the basal-enriched cluster 2 and in triple-negative and basal-like BC. Deconvolution analyses of immunophenotypes indicated higher levels of M0 and M1 macrophages than M2 macrophages in subsets of young BC. Our approach identifies age-based patient clusters with distinct clinicopathologic profiles, to a large extent overlapping with the PAM50 subtypes, although with independent prognostic values in multivariate survival analyses. The patient clusters provided new insight in the immune cell distribution across tumor subtypes, potentially contributing to survival differences between the clusters and the molecular subtypes and indicating age-related mechanisms improving outcome. Our study confirms the applicability of ROR as a valid prognosticator also in a young BC cohort.

HER2/neu 655 polymorphism, trastuzumab-induced cardiotoxicity, and survival in HER2-positive breast cancer patients

PURPOSE

HER2 overexpression in breast cancer correlates with poor outcomes. The incorporation of Trastuzumab into the treatment regimen has notably improved patient prognoses. However, cardiotoxicity emerges in approximately 20% of patients treated with the drug. This study aims to investigate the association between the HER2 655 A > G polymorphism, Trastuzumab-induced cardiotoxicity, and patient survival.

METHODS

The study involved 88 patients treated with Trastuzumab. Cardiotoxicity, defined as a reduction in left ventricular ejection fraction (LVEF) from baseline or the emergence of clinical signs of congestive heart failure, was identified during treatment follow-up. Genotyping of HER2 655 A > G employed TaqMan SNP technology.

RESULTS

Genotype frequencies of HER2/neu 655 (53 AA, 32 AG, and 3 GG) were consistent with Hardy-Weinberg equilibrium. No significant differences were observed in mean baseline LVEF between patients who developed cardiotoxicity and those who did not. Within these groups, neither AA nor AG genotypes showed an association with changes in mean baseline or reduced LVEF levels. Logistic regression analysis, adjusted for hormonal status and anthracycline treatment, revealed that AG genotype carriers face a significantly higher risk of cardiotoxicity compared to AA carriers (OR = 4.42; p = 0.037). No association was found between the HER2/neu 655 A > G polymorphism and disease-free or overall survival, regardless of whether the data was adjusted for stage or not.

CONCLUSION

HER2 655 A > G polymorphism is significantly linked to an increased risk of Trastuzumab-induced cardiotoxicity but does not correlate with variations in disease-free survival or overall survival rates.

Assessment of breast cytoarchitecture and its associated axillary lymph node status under normal and pathological conditions in Egyptian women

OBJECTIVE

Herein, we compare the features of neoplastic cancer cells in invasive ductal carcinoma (IDC) grade II and III patients to their corresponding normal cells both in breast and axillary lymph node (ALN) tissues.

METHODS

A retrospective cohort of 70 female breast cancer patients enrolled between 2018 and 2020 at Medical Research Institute, Alexandria University, Egypt, was analyzed for clinicopathological features presentation. Fresh tiny pieces of breast tissue and its associated ALN tissues were then processed to investigate the morphological appearance by scanning electron microscopy. Moreover, the histological architecture of tissue sections stained with hematoxylin and eosin was studied by light microscope, while the characterization of the ultrastructure features of breast and ALN tissues was analyzed by transmission electron microscopy.

RESULTS

Clinicopathological presentation of patients revealed that the Egyptian female breast cancer population adhered to the global trends of breast cancer disease with elevated incidence rate among postmenopausal women (61.3%), high frequency of IDC (95.7%), and increased ALN metastasis (65.7%). The percentage of estrogen receptor alpha (ERα) and human epidermal growth factor receptor 2 (HER2) expression, as key indicators for carcinogenesis and disease progression was 87.1% and 55.8%, respectively. The present study points to the observed discrepancies among the investigated variables in the diagnostic separation between IDC grade II and grade III. Ductal epithelial cells organization, nuclei size and irregularity, chromatin amount and uniformity, mitochondrial abundance and dysfunction were differentially manifested in IDC grades. Moreover, aberrations in the cellular organelles like lysosomes, endoplasmic reticulum, and lipid droplets vary according to the grade of IDC and the aggressiveness of the invasive breast cancer.

CONCLUSIONS

To sum up, this study emphasizes the importance of accurate specimen evaluation for treatment choice and decision.

Young Filipino breast cancer patients have worse survival outcomes

Background

In the 2020 GLOBOCAN report, breast cancer is the 3rd most common cause of cancer-related mortality in the Philippines. The incidence of breast cancer in the young (≤40 years) was reported to be higher in the Philippines compared to other Asian countries. Several studies have consistently demonstrated poor survival outcomes in this age group due to its aggressiveness and unique tumour biology. However, data on survival outcomes of young Filipino breast cancer patients remains unknown in the Philippines.

Methods

A retrospective study was performed involving patients with stage I-III breast cancer who underwent definitive surgery from January 2010 to December 2015 at a single-tertiary institution. Patients were grouped according to age (≤40 and >40 years old). Their clinicopathological characteristics, treatment profile and 5-year survival outcomes were analyzed.

Results

A total of 524 Filipino patients (15.1% aged ≤40 years) were included. Younger patients were diagnosed at a higher stage and pathologic grade. A negative hormone receptor, high Ki67 status, and triple negative breast cancer (TNBC) subtypes were also more common among younger patients. The overall breast-conserving surgery rate was low at 8.9%. The use of adjuvant chemoradiotherapy was more common and both 5-year overall survival (OS) and disease-free survival (DFS) were lower (61.1% versus 77.1% and 31.1% versus 66.8%, respectively) in the ≤40-year-old group. In the multivariate analysis, age group, tumour size, and nodal status were significant predictors for DFS. However, only tumour size was significant for OS.

Conclusion

Young Filipino breast cancer patients have demonstrated unique pathologic characteristics with associated lower survival outcomes similar to the published literature. Increasing awareness of cancer screening practices among young women, provision of equitable access to healthcare, and prompt management of breast cancer in the young are crucial.

Age has a U-shaped relationship with breast cancer outcomes in women: a cohort study

Background and Objectives

Age is a significant determinant of susceptibility to breast cancer. Currently, the available evidence regarding the non-linear correlation between the age of diagnosis and the prognosis of breast cancer patients is contradictory. Insufficient data currently exist regarding the influence of age at diagnosis on the prognosis of breast cancer. The objective of our investigation was to examine the relationship between age at diagnosis and overall survival (OS), breast cancer-specific survival (BCSS), and disease-free survival (DFS).

Methods

This retrospective cohort study included 1054 patients diagnosed with breast cancer between March 7, 2013 and December 31, 2019. The hazard ratios (HRs) and 95% confidence interval (CI) for OS, BCSS, DFS were assessed using Cox proportional hazard ratio models and restricted cubic splines (RCS).

Results

The study included 1054 breast cancer patients who met the criteria. With a median follow-up of 4.86 years, 71 patients (6.74%) died and 144 patients (13.66%) relapsed. After multivariable adjustment, age showed a U-shaped association with OS, BCSS, and DFS, with significantly higher risk at two ends, with age inflection points of 44, 44, and 41 years for OS, BCSS, and DFS, respectively. For OS, Quartile 1 (HR, 2.09; 95% CI: 0.90-4.84), Quartile 3 (HR, 2.44; 95% CI: 1.05-5.65) and Quartile 4 (HR, 3.38; 95% CI: 1.51-7.54) had poorer OS compared with Quartile 2. Similar results were found for BCSS and DFS.

Conclusions

This study confirmed a U-shaped association between age at diagnosis and breast cancer outcome.

Characteristics and prognosis of young breast cancer patients treated in a public comprehensive cancer centre in Brazil: A retrospective cohort study

BACKGROUND

The incidence of breast cancer among women under 41 years old varies worldwide, with higher rates observed in developing countries. These young women often face later-stage diagnoses. In this study, we examine a cohort of young women who were treated for breast cancer in São Paulo, Brazil.

METHODS

We conducted a retrospective cohort study involving women under 41 years old. Our objective was to describe patient and treatment characteristics, with the main outcomes being overall and disease-free survival. Our analysis explored the associations between age of menarche, history of breastfeeding, use of hormonal contraceptives, and age at diagnosis.

RESULTS

Our study included 493 patients with a mean follow-up of 62.8 months. The mean age of the patients was 34.6 (SD=4.19). Of the patients, 68% presented with locally advanced disease, and 19.27% were metastatic at the time of diagnosis. We observed significant associations between age of menarche and age at diagnosis (p = 0.0096), as well as age at diagnosis and breastfeeding (p = 0.0232). Chemotherapy was administered to 92.91% of the patients as part of their treatment, while 27.2% were eligible for breast-conserving surgery. During the follow-up period, 153 patients died, with disease progression being the cause of death in 73.2% of cases. The median survival time for the entire cohort is still under review, while the metastatic patients at diagnosis had a median survival time of 28.64 months (95%CI 20.21-40.89).

CONCLUSION

Our findings highlight significant associations between late-stage diagnosis and overall and disease-free survival in this patient age group. Given that the majority of patients present with locally advanced breast cancer, it is crucial to implement strategies that promote early-stage diagnosis and improve survival rates.

Clinicopathological Features of Invasive Breast Cancer: A Five-Year Retrospective Study in Southern and South-Western Ethiopia

Background: Breast cancer (BC) is the most common type of cancer in Ethiopia. The incidence of BC is also rising, but the exact figure is still poorly known. Therefore, this study was conducted to address the gap in epidemiological data on BC in southern and southwestern Ethiopia. Materials and Methods: This is a five-year (2015-2019) retrospective study. The demographic and clinicopathological data were collected from biopsy reports of different kinds of breast carcinomas in the pathology department of Jimma University Specialized Hospital and Hawassa University Specialized Referral Hospital. Histopathological grades and stages were conducted using Nottingham grading and TNM staging system, respectively. Collected data were entered and analyzed using SPSS Version-20 software. Results: The mean age of patients at diagnosis was 42.27 (SD = 13.57) years. The pathological stage of most BC patients was stage III, and most of them had tumor sizes greater than 5 cm. Most patients had moderately differentiated tumor grade, and mastectomy was the most common type of surgery at the time of diagnosis. Invasive ductal carcinoma was the most common histological type of BC, followed by invasive lobular carcinoma. Lymph node involvement was seen in 60.5% of cases. Lymph node involvement was associated with tumor size (χ² = 8.55, p = 0.033) and type of surgery (χ² = 39.69, p < 0.001). Conclusions: This study showed that BC patients in southern and southwestern Ethiopia displayed advanced pathological stages, relatively young age at diagnosis, and predominant invasive ductal carcinoma histological patterns.

Clinical features and prognostic factors of breast cancer in young women: a retrospective single-center study

PURPOSE

This research aims to characterize the differences in clinical features and prognostic factors between younger and older breast cancer (BC) patients in China.

METHODS

All patients who were recently diagnosed with BC between January 1, 2015 and December 31, 2016 at Shanxi Province Cancer Hospital were recruited. We collected the epidemiological and clinical data as well as the follow-up information.

RESULTS

Out of the 1968 BC patients who met the criteria for analysis, 227 (11.53%) were under 40 years of age with a median age of 34 years at diagnosis. All patients were classified into the age < 40, age 40-59, and age ≥ 60 groups. There were significant differences in the histology, tumor size, T stage, grade, and human epidermal growth factor receptor-2 (HER-2) levels among the three groups (all P < 0.05). The 5-year overall survival (OS) rates were 86.34%, 89.58%, and 84.84% for the age < 40, age 40-59, and age ≥ 60 groups, respectively. The TNM stage was the only predictor of clinical outcome in all BC patients. The prognostic value of intrinsic subtypes for OS was different among the three groups.

CONCLUSION

Our study helped identify an age-related prognostic indicator of adverse events in BC patients and showed that young women with BC exhibited more aggressive clinical and pathological features. Our findings may facilitate clinical management and therapeutic interventions in young BC patients, especially in young women with a history of exposure to risk factors and age < 40 years.

Effect of adjuvant chemotherapy on the survival outcomes of elderly breast cancer: A retrospective cohort study based on SEER database

BACKGROUND

Currently, the proportion of standard chemotherapy for elderly patients is much lower than that for young patients, with little evidence from clinical trials supporting the use of chemotherapy for elderly patients. The effectiveness of chemotherapy for the elderly suffering from breast cancer remains to be further verified.

METHODS

A total of 75,525 female breast cancer patients aged 70 years or older were hereby identified, all from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010 to December 31, 2016. Kaplan-Meier analysis and multivariable Cox proportional model were performed to evaluate the effectiveness of chemotherapy on overall survival (OS) and breast cancer-specific survival (BCSS). Propensity score matching (PSM) (PSM ratio: 1:1, caliper: 0.2 standard deviation of propensity score) was applied to construct balanced cohorts with or without chemotherapy based on demographic and pathophysiological characteristics.

RESULTS

A total of 33,177 eligible patients were included, with 5273 (15.89%) receiving chemotherapy. Through PSM, 8360 patients were successfully matched, and balances between groups were almost reached. In the matched data set, multivariable Cox analysis reveals that chemotherapy was associated with a 36% and 21% risk reduction on OS (HR = 0.64, 95% CI 0.58 to 0.71) and BCSS (HR = 0.79, 95% CI 0.69 to 0.91), respectively. Furthermore, subgroups with more adjacent lymph nodes involved by tumor, or nonluminal A, were inclined to benefit more from chemotherapy. Moreover, chemotherapy did not increase the chances of dying from heart disease.

CONCLUSIONS

The present study provided evidence that chemotherapy may improve the prognosis of elderly breast cancer, especially for those subpopulations that benefit more from chemotherapy treatment.

Ultrasonography and clinicopathological features of breast cancer in predicting axillary lymph node metastases

Background

Early identification of axillary lymph node metastasis (ALNM) in breast cancer (BC) is still a clinical difficulty. There is still no good method to replace sentinel lymph node biopsy (SLNB). The purpose of our study was to develop and validate a nomogram to predict the probability of ALNM preoperatively based on ultrasonography (US) and clinicopathological features of primary tumors.

Methods

From September 2019 to April 2022, the preoperative US) and clinicopathological data of 1076 T1-T2 BC patients underwent surgical treatment were collected. Patients were divided into a training set (875 patients from September 2019 to October 2021) and a validation set (201 patients from November 2021 to April 2022). Patients were divided into positive and negative axillary lymph node (ALN) group according pathology of axillary surgery. Compared the US and clinicopathological features between the two groups. The risk factors for ALNM were determined using multivariate logistic regression analysis, and a nomogram was constructed. AUC and calibration were used to assess its performance.

Results

By univariate and multivariate logistic regression analysis, age (p = 0.009), histologic grades (p = 0.000), molecular subtypes (p = 0.000), tumor location (p = 0.000), maximum diameter (p = 0.000), spiculated margin (p = 0.000) and distance from the skin (p = 0.000) were independent risk factors of ALNM. Then a nomogram was developed. The model was good discriminating with an AUC of 0.705 and 0.745 for the training and validation set, respectively. And the calibration curves demonstrated high agreement. However, in further predicting a heavy nodal disease burden (> 2 nodes), none of the variables were significant.

Conclusion

This nomogram based on the US and clinicopathological data can predict the presence of ALNM good in T1-T2 BC patients. But it cannot effectively predict a heavy nodal disease burden (> 2 nodes).

Increased morbidity evaluated on hospital contacts and prescriptions among 100,834 Danish breast cancer survivors

BACKGROUND

Cardiovascular disease competes with breast cancer (BC) as the leading cause of death for females diagnosed with breast cancer. Not much is known concerning morbidity and medicine use in the short and long term after a BC diagnosis.

AIM

The aim of this study was to determine acute and long-term morbidity in Danish women treated for BC.

METHOD

A nationwide registry-based cohort study of 100,834 BC patients identified in the clinical database of Danish Breast Cancer Cooperative Group (DBCG) and 1,100,320 (10 per patient) age-matched Danish women without BC, serving as controls. Morbidity was studied using complete data on hospital contacts and medicinal use.

RESULTS

The risk of hospital contacts was significantly increased in BC survivors compared with controls evaluated both by means of Cox regression and negative binomial regression analysis both during and after cessation of breast cancer treatment. Young age at breast cancer diagnosis was associated with the most pronounced increase in risk of hospital contacts, both during and after cessation of BC treatment. Medicinal use was significantly increased among BC patients compared to controls, both during (HR 1.27 (1.26-1.28), p < 0.0001) and after BC treatment (HR 1.18 (1.17-1.19), p < 0.0001, and present for all subgroups of medicine.

CONCLUSION

Overall, BC survivors have a pronounced increase in hospital contacts and medicinal use compared to women without BC. Premenopausal status at BC diagnosis was associated with an overall higher excess morbidity and a higher burden both during and after treatment.