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Li C, Wang Y, Liu M, Qu J, Zhang S. Time for detailed clinical management of Paget's disease of the breast. Int J Surg 2024; 110:1266-1267. [PMID: 37889547 PMCID: PMC10871616 DOI: 10.1097/js9.0000000000000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Affiliation(s)
| | - Yusheng Wang
- Department of Otolaryngology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
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Qu J, Li C, Liu M, Wang Y, Sun S, Feng Z, Wu F, Zhang S, Zhao X. A novel web-based prognostic nomogram and the features influencing the curative effect of chemotherapy and radiotherapy for Paget's disease with invasive ductal carcinoma. Am J Cancer Res 2023; 13:4508-4530. [PMID: 37970339 PMCID: PMC10636690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/09/2023] [Indexed: 11/17/2023] Open
Abstract
Paget's disease (PD) of the breast is a rare underlying malignant tumor. Approximately 50% to 60% of patients with mammary PD are concurrently diagnosed with invasive ductal carcinoma (PD-IDC), a condition associated with a worse prognosis than IDC without PD. Thus far, there has been a lack of an accurate and efficient prognostic model for PD-IDC, and the factors influencing the effectiveness of chemotherapy and radiotherapy for these patients remain unknown. In this study, we developed a web-based nomogram based on the data from the Surveillance Epidemiology and End Results (SEER) database. We subjected the model to a series of validation methods, including area under the curve (AUC) values, receiver operating characteristic curve (ROC) analysis, calibration curves, and decision curve analysis (DCA). Our results demonstrated that our model exhibited high discrimination, accuracy, and clinical applicability in predicting the overall survival (OS) of patients with PD-IDC (testing set: three- and five-year AUCs, 0.831 and 0.841, respectively). To further validate our nomogram, we used external data from both our institution and sister hospitals (external data: three- and five-year AUCs, 0.892 and 0.914, respectively). Multivariable Cox regression analysis identified several independent unfavorable prognostic factors for the OS of patients with PD-IDC, including increasing age, high grade, widowed status, higher T stages, and the presence of bone metastases. Furthermore, propensity score matching (PSM)-adjusted analysis was conducted, revealing that chemotherapy did not significantly improve the survival of patients with PD-IDC across molecular subtypes, except for those in the grade III/IV group, where it improved both OS and breast cancer-specific survival (BCSS). Additionally, our findings indicated that only patients with PD-IDC with T4 and N3 stages benefited from radiotherapy, leading to improvements in both OS and BCSS. In conclusion, we have comprehensively analyzed the clinical characteristics and prognosis of patients with PD-IDC, culminating in the development of a user-friendly web-based nomogram for predicting their survival. Our predictive model is not only highly accurate but also offers simplicity, making it accessible for healthcare providers and patients. Furthermore, our stratified analysis highlights that the pathological grade, rather than the molecular subtype, plays a pivotal role in determining the efficacy of chemotherapy in improving the prognosis for patients with PD-IDC, while radiotherapy confers survival benefits to patients with PD-IDC in T4 and N3 stages.
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Affiliation(s)
- Jingkun Qu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Chaofan Li
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Mengjie Liu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Yusheng Wang
- Department of Otolaryngology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Shiyu Sun
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Zeyao Feng
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Fei Wu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Shuqun Zhang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
| | - Xixi Zhao
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University157 West Fifth Street, Xi’an, Shaanxi, P. R. China
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Lv CY, Cheng XK, Guo ZY, Liu L, Cai J, Lei T, Tang Y. Mammary Paget's Disease of Young Females: Case Reports and Comparison With Middle-Aged and Elderly Patients. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2023; 16:2632010X231162700. [PMID: 37050911 PMCID: PMC10084577 DOI: 10.1177/2632010x231162700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 02/21/2023] [Indexed: 04/14/2023]
Abstract
Purpose Mammary Paget's disease (PD) in young women has seldom been reported. The aim of this study was to improve the knowledge of the clinicopathological characteristics in young patients with PD to provide a basis for the precise treatment of young patients. Methods The medical records and pathological slides of 8 young patients (younger than 40 years old) with PD were reviewed. The data of 20 patients over 40 years old within the same period were used as controls. Results The average age was 32.00 ± 3.96 years for the young patient group, with the youngest aged 27 years. The first symptom, physical examination, Paget cell morphology, and immunohistochemical marks were the same in different age groups. But young patients have varied tumor distribution patterns, fewer interstitial inflammatory cells, and advanced pathological local lymphatic metastasis than older patients in the same period. Conclusions PD in young women has unique histopathological features. These manifestations seem to provide personalized treatment for PD treatment in young patients. More research is needed to clarify the significance of this research.
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Affiliation(s)
- Chun-yan Lv
- Basic Medical School, Chengdu University, Chengdu, China
- Chun-yan Lv, Basic Medical School, Chengdu University, 2025, Chengluo Avenue, Chengdu 610106, China.
| | - Xian-kui Cheng
- Department of Pathology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhong-Yue Guo
- Department of Medicine, North Sichuan Medical College, Nanchong, China
| | - Li Liu
- Affiliated Hospital of Chengdu University of T. C. M./Clinical Medical College, Chengdu University of T. C. M., Chengdu, China
| | - Jian Cai
- Affiliated Hospital of Chengdu University of T. C. M./Clinical Medical College, Chengdu University of T. C. M., Chengdu, China
| | - Tao Lei
- Basic Medical School, Chengdu University, Chengdu, China
| | - Yan Tang
- Department of Pathology, Chengdu Third People’s Hospital, Chengdu, China
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Mammary Paget’s Disease: An Update. Cancers (Basel) 2022; 14:cancers14102422. [PMID: 35626023 PMCID: PMC9139704 DOI: 10.3390/cancers14102422] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Mammary Paget’s disease of the breast is an uncommon and often misdiagnosed breast malignancy. The review discusses the diagnosis, work-up, treatment, and prognosis of mammary Paget’s disease. Abstract Mammary Paget’s Disease is a non-invasive cutaneous malignancy of the breast involving the nipple-areolar complex that is commonly mistaken for benign breast conditions, leading to delay in diagnosis. This review article discusses Paget’s disease etiology, clinical presentation, differential diagnosis, diagnostic work-up, natural history and prognosis. This article also discusses evolving strategies for the surgical and non-surgical management of Paget’s disease.
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Okonofua D, Soh CL, Tafazal H. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac106. [PMID: 35422998 PMCID: PMC9004590 DOI: 10.1093/jscr/rjac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/03/2022] [Indexed: 11/14/2022] Open
Abstract
Mammary Paget’s disease is a rare form of breast cancer present in ~0.5–2.8% of breast cancers. The patients have a poorer prognosis, and usually, the appropriate therapy is based on the pathologic findings of the mass and axillary staging. This report adds the outcomes of Paget’s disease following neoadjuvant chemotherapy to the literature by description of a case of a 48-year-old patient with Paget’s disease who had a complete pathological response to Paget’s disease of the breast following neoadjuvant chemotherapy.
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Affiliation(s)
- Daisy Okonofua
- North West Anglia NHS Foundation Trust, Breast Unit, Peterborough City Hospital, Peterborough UK
| | - Chien Lin Soh
- Correspondence address. 112 Hobart Road, Cambridge CB13PT, UK. Tel: +44-7548017779; E-mail:
| | - Habib Tafazal
- North West Anglia NHS Foundation Trust, Breast Unit, Peterborough City Hospital, Peterborough UK
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Anwar SL, Cahyono R, Avanti WS, Budiman HY, Harahap WA, Aryandono T. Pre-treatment neutrophil-lymphocyte and platelet-lymphocyte ratios as additional markers for breast cancer progression: A retrospective cohort study. Ann Med Surg (Lond) 2021; 63:102144. [PMID: 33659054 PMCID: PMC7890158 DOI: 10.1016/j.amsu.2021.01.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
Background Breast cancer is the most prevalent cancer that causes significant morbidity and loss of productivity. Around a third of all breast cancer patients are potentially develop distant metastases albeit the current implementation of multidisciplinary treatment. A simple but effective marker to predict the risks of cancer progression is very important for clinicians to improve treatment and surveillance. Methods We recruited 1083 non-metastatic patients and analyzed the ratios of neutrophil to lymphocyte (NLR) and platelet to lymphocyte (PLR) in relation to progression-free survivals (PFS) and risks of distant metastases. Results Baseline clinicopathological variables were not significantly different in the pretreatment NLR and PLRs. Using maximum points of sensitivity and specificity of the Receiver Operating Characteristic (ROC) curve, cut-off values were determined 2.8 for NLR and 170 for PLR. Higher NLR was associated with skin and chest wall cancer infiltration (T4, P = 0.0001). Elevated PLR was associated with more advanced stages at diagnosis (P = 0.03). High NLR values were significantly associated with risks of disease progression (OR 1.555, 95% CI: 1.206–2.005, P = 0.001). Patients with high NLR had shorter PFS (34.9 vs 53.5 months, Log-rank test = 0.001) and shorter time to develop recurrent distant metastatic disease (66.6 vs 104.6 months, Log-rank test = 0.027). Conclusion High NLR is significantly associated with higher risk of disease progression and shorter time to develop metastases particularly among breast cancer patients diagnosed in the advanced stages. Elevated NLR is associated with higher risks of breast cancer disease progression. High NLR is associated with shorter time to develop distant metastases. NLR might be useful as an additional prognostic marker in breast cancer.
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Affiliation(s)
- Sumadi Lukman Anwar
- Division of Surgical Oncology - Department of Surgery, Dr Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Roby Cahyono
- Division of Surgical Oncology - Department of Surgery, Dr Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Widya Surya Avanti
- Department of Radiology, Dr Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Heru Yudhanto Budiman
- Division of Surgical Oncology - Department of Surgery, Dr Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Wirsma Arif Harahap
- Division of Surgical Oncology - Department of Surgery, Dr M Jamil Hospital / Faculty of Medicine Universitas Andalas, Padang, 25127, Indonesia
| | - Teguh Aryandono
- Division of Surgical Oncology - Department of Surgery, Dr Sardjito Hospital / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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Anwar SL, Prabowo D, Avanti WS, Dwianingsih EK, Harahap WA, Aryandono T. Clinical characteristics and the associated risk factors of the development of bilateral breast cancers: A case-control study. Ann Med Surg (Lond) 2020; 60:285-292. [PMID: 33204419 PMCID: PMC7649582 DOI: 10.1016/j.amsu.2020.10.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
Background The clinical impacts of bilateralism on prognosis and clinical decision-making remain contradictory particularly in areas with low incidence and delayed diagnosis of primary breast cancer. Identification of women at risk of bilateral breast cancer is required to improve patient management and to design the appropriate surveillance. Methods A total of 1083 women were enrolled and analyzed for the presence of synchronous and metachronous bilateral breast cancer as cases and unilateral breast cancer as controls during the median follow-up of 4.8 years. Results The incidence of bilateral breast cancer was 7.5% (81 of 1083). In comparison with unilateral breast cancers, bilateral cases were significantly diagnosed in younger women (P = 0.037, mean age was 35.6 years) who had a larger tumor size (P = 0.012, mean tumor size was 8 cm in diameter). Histological type of lobular cancer was identified as one of the risk factors for the development of contralateral breast cancer (OR 5.564, 95% CI: 3.219-9.620) and synchronous bilateral breast cancer (OR 2.561, 95% CI: 1.182-5.550). Bilateral breast cancer had significantly shorter progression-free survival (Mean survival was 26.6 vs 52.5 months for bilateral and unilateral breast cancers, respectively; P = 0.001) and shorter time to develop distant metastasis (Mean survival was 41.7 vs 104 months for bilateral and unilateral breast cancers, respectively; P = 0.001). Conclusion Patients with first primary breast tumors with lobular histological type and advanced stages were observed to have higher risks for the development of contralateral breast cancers.
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Affiliation(s)
- Sumadi Lukman Anwar
- Division of Surgical Oncology, Department of Surgery, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Dayat Prabowo
- Division of Surgical Oncology, Department of Surgery, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Widya Surya Avanti
- Department of Radiology, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Ery Kus Dwianingsih
- Department of Anatomical Pathology, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Wirsma Arif Harahap
- Division of Surgical Oncology, Department of Surgery, Dr M Jamil Hospital/Faculty of Medicine Universitas Andalas, Padang, 25127, Indonesia
| | - Teguh Aryandono
- Division of Surgical Oncology, Department of Surgery, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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