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Li W, Li Y, Gao S, Huang N, Kojima I, Kusama T, Ou Y, Iikubo M, Niu X. Integrating lipid metabolite analysis with MRI-based transformer and radiomics for early and late stage prediction of oral squamous cell carcinoma. BMC Cancer 2024; 24:795. [PMID: 38961418 PMCID: PMC11221018 DOI: 10.1186/s12885-024-12533-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Oral Squamous Cell Carcinoma (OSCC) presents significant diagnostic challenges in its early and late stages. This study aims to utilize preoperative MRI and biochemical indicators of OSCC patients to predict the stage of tumors. METHODS This study involved 198 patients from two medical centers. A detailed analysis of contrast-enhanced T1-weighted (ceT1W) and T2-weighted (T2W) MRI were conducted, integrating these with biochemical indicators for a comprehensive evaluation. Initially, 42 clinical biochemical indicators were selected for consideration. Through univariate analysis and multivariate analysis, only those indicators with p-values less than 0.05 were retained for model development. To extract imaging features, machine learning algorithms in conjunction with Vision Transformer (ViT) techniques were utilized. These features were integrated with biochemical indicators for predictive modeling. The performance of model was evaluated using the Receiver Operating Characteristic (ROC) curve. RESULTS After rigorously screening biochemical indicators, four key markers were selected for the model: cholesterol, triglyceride, very low-density lipoprotein cholesterol and chloride. The model, developed using radiomics and deep learning for feature extraction from ceT1W and T2W images, showed a lower Area Under the Curve (AUC) of 0.85 in the validation cohort when using these imaging modalities alone. However, integrating these biochemical indicators improved the model's performance, increasing the validation cohort AUC to 0.87. CONCLUSION In this study, the performance of the model significantly improved following multimodal fusion, outperforming the single-modality approach. CLINICAL RELEVANCE STATEMENT This integration of radiomics, ViT models, and lipid metabolite analysis, presents a promising non-invasive technique for predicting the staging of OSCC.
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Affiliation(s)
- Wen Li
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yang Li
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Shiyu Gao
- School of Mathematics and Statistics, Huazhong University of Science and Technology, Wuhan, China
| | - Nengwen Huang
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Ikuho Kojima
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Taro Kusama
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yanjing Ou
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Masahiro Iikubo
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan.
| | - Xuegang Niu
- Department of Neurosurgey, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
- Department of Neurosurgey, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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Zhou W, Yu G, Liu L, Gao Q, Feng L, Wang Y. Primary diffuse large B-cell lymphoma of the breast: A retrospective study of outcomes and insulin resistance. Saudi Med J 2023; 44:38-44. [PMID: 36634942 PMCID: PMC9987672 DOI: 10.15537/smj.2023.44.1.20220677] [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: 09/19/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To investigate the clinicopathological features, insulin resistance (IR) status, and the outcomes of populations with diffuse large B-cell lymphoma (DLBCL) of the breast. METHODS This study was carried out at Department of Haematology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China, that included 32 patients treated form January 2009 to June 2020. The primary endpoints of the study were their survival time. RESULTS There were 32 patients in the study. A total of 18 (56.2%) patients had IR. In terms of treatment, 31.2% were treated with surgery, most (93.8%) received chemotherapy, and 25% received radiotherapy and intrathecal therapy. Univariate analysis indicated the patients with stages III-IV, B symptoms, tumour recurrence, PAX5 positivity, and c-MYC positivity showed a shorter survival time (p<0.05). The overall survival and progression-free survival (PFS) rates in IR group were shorter than those without IR, but there was no statistical difference (p>0.05). Multivariate analysis indicated that tumour recurrence shortened the 5-year PFS of the patients (p=0.037). CONCLUSION Primary DLBCL of the breast was very rare; more than half of the cases had IR, but IR did not affect their survival.
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Affiliation(s)
- Weiling Zhou
- From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
| | - Guodong Yu
- From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
| | - Lihong Liu
- From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
| | - Qian Gao
- From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
| | - Lei Feng
- From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
| | - Yuan Wang
- From the Department of Endocrine and Metabolic Diseases (Zhou, Gao, Feng, Wang), from the Department of Hematology (Liu), The Fourth Hospital of Hebei Medical University, Shijiazhuang, and from the Department of Hepatobiliary Surgery (Yu), Affiliated Hospital of Hebei University, Baoding, China.
- Address correspondence and reprint request to: Dr. Yuan Wang, Department of Endocrine and Metabolic Diseases, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China. E-mail: ORCID ID: https://orcid.org/0000-0003-1657-1484
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Lee H, Chien RN, Pao LH, Kuo CJ, Huang PH, Chang ML. Decoupled Glucose and Lipid Metabolic Recovery after Viral Clearance in Direct-Acting Antiviral-Treated HCV Patients: A 3-Year Prospective Cohort Study. Cells 2021; 10:2934. [PMID: 34831156 PMCID: PMC8616092 DOI: 10.3390/cells10112934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/AIM The recovery pattern of hepatitis C virus (HCV)-associated metabolic alteration after sustained virological response (SVR) following direct-acting antivirals (DAAs) remains elusive. METHODS A prospective cohort study of chronic HCV-infected (CHC) patients (n = 415) receiving DAAs (n = 365) was conducted. Metabolic profiles were examined in SVR patients (n = 360) every 3-6 months after therapy and compared with those of sex- and age-matched controls (n = 470). RESULTS At baseline, of 415, 168 (40.5%) had insulin resistance (IR). The following were associated: levels of high-density lipoprotein cholesterol (HDL-C), triglycerides (TGs), HCV RNA, fibrosis-4 score, and interferon-λ3-rs12979860 genotype with total cholesterol (TC) levels; and TG levels and BMI with HOMA-IR. Over a 3-year follow-up, in SVR patients, BMI and TC levels and TG/HDL-C ratios increased from baseline, while HOMA-IR trended downward by 72 weeks after therapy and then increased. The increased HDL-C levels began to decrease after 72 weeks after therapy. TC and HOMA-IR were negatively associated with each other until 24 weeks after therapy. Earlier increases in BMI and decreases in HOMA-IR were noted in SVR patients with than in those without baseline IR. Compared with controls, in the subgroup without baseline IR, SVR patients had increased BMI and HOMA-IR levels. Metabolic profiles were similar between SVR patients and controls in the subgroup with baseline IR. CONCLUSIONS In SVR patients treated with DAAs, the recovery of altered lipid and glucose metabolism was not coupled until 72-week post-therapy, when HOMA-IR reached its nadir. SVR patients with baseline IR recovered from HCV-associated metabolic alterations earlier than those without baseline IR.
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Affiliation(s)
- Heng Lee
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (H.L.); (R.-N.C.); (C.-J.K.); (P.-H.H.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Rong-Nan Chien
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (H.L.); (R.-N.C.); (C.-J.K.); (P.-H.H.)
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
| | - Li-Heng Pao
- Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan;
- Research Center for Food and Cosmetic Safety and Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
| | - Chia-Jung Kuo
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (H.L.); (R.-N.C.); (C.-J.K.); (P.-H.H.)
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
| | - Po-Han Huang
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (H.L.); (R.-N.C.); (C.-J.K.); (P.-H.H.)
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
| | - Ming-Ling Chang
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (H.L.); (R.-N.C.); (C.-J.K.); (P.-H.H.)
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
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Leng W, Pu D, Jiang J, Lei X, Wu Q, Chen B. Effect of Metformin on Breast Density in Overweight/Obese Premenopausal Women. Diabetes Metab Syndr Obes 2021; 14:4423-4432. [PMID: 34764661 PMCID: PMC8572728 DOI: 10.2147/dmso.s330625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study investigated the effects of metformin on breast density in overweight/obese premenopausal women. METHODS Overweight/obese premenopausal women (n=120) were randomly assigned to the metformin or placebo group, and all women received lifestyle interventions. The outcomes included weight, BMI, FPG, FIN, glucose, HOMA-IR, LDL-C, HDL-C, TG, TC, SBP, DBP, FSH, E, AD, and the BIRADS grade, and the incidence of breast cancer was assessed by pathological biopsy and BIRADS grade greater than 4. RESULTS In total, 120 overweight/obese women completed the 1-year trial. Seven patients had a BIRADS grade greater than 4, including 5 patients who were biopsy positive, in the control group, and 2 patients had a BIRADS grade greater than 4, including 1 patient who was biopsy positive, in the metformin group. Compared with those in the control group, the body weight, BMI, FIN, FPG, HOMA-IR, TC, BIRADS grade and positive pathological biopsy rate in the metformin group were significantly decreased (P<0.05), while AD was significantly increased (P<0.05). The correlation analysis indicated that the BIRADS grade was significantly correlated with weight, BMI, FPG, FIN, HOMA-IR, SBP, AD and the positive pathological biopsy rate, and the positive pathological biopsy rate was significantly correlated with weight, BMI, HOMA-IR, SBP, AD and BIRADS grade. The logistic regression analysis revealed that the BIRADS grade was significantly correlated with the positive pathological biopsy rate and AD and that the positive pathological biopsy rate was significantly correlated with the BIRADS grade. CONCLUSION As adjunctive therapy, the combination of lifestyle changes and metformin was found to be a safe strategy for improving related metabolic markers and increasing adiponectin. The BIRADS grade was significantly correlated with the positive pathological biopsy rate and AD, and the positive pathological biopsy rate was significantly correlated with the BIRADS grade.
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Affiliation(s)
- Weiling Leng
- Endocrinology Department, The First Affiliated Hospital of the Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Danlan Pu
- Endocrinology and Nephrology Department, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Juan Jiang
- Endocrinology and Nephrology Department, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Xiaotian Lei
- Endocrinology Department, The First Affiliated Hospital of the Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
| | - Qinan Wu
- Endocrinology Department, Chongqing Medical University Affiliated Dazu Hospital, Dazu District People’s Hospital, Chongqing, People’s Republic of China
- Correspondence: Qinan Wu; Bing Chen Email ;
| | - Bing Chen
- Endocrinology Department, The First Affiliated Hospital of the Third Military Medical University (Army Medical University), Chongqing, People’s Republic of China
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Kumie G, Melak T, Wondifraw Baynes H. The Association of Serum Lipid Levels with Breast Cancer Risks Among Women with Breast Cancer at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. BREAST CANCER-TARGETS AND THERAPY 2020; 12:279-287. [PMID: 33363407 PMCID: PMC7753895 DOI: 10.2147/bctt.s279291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/30/2020] [Indexed: 12/24/2022]
Abstract
Background Breast cancer is a malignant condition affecting about 2.1 million women worldwide. Cancer cells have increased the level of cholesterol and facilitate lipid biosynthesis and metabolism. Therefore, there is a need for assessment of serum lipid and its association with breast cancer risks. Methods A comparative cross-sectional study was conducted among women with breast cancer (n=23), benign breast lump (n=68) and apparently healthy control (n=91) at Felege Hiwot Comprehensive Specialized Hospital, from January to May, 2020. A convenient sampling technique and an interviewer-administered questionnaires were used to collect data. Five milliliter of fasting blood sample was collected for lipid level analysis using enzymatic colorimetric method. Data entry and analysis were done using Epi Info version 7 and SPSS version 20. One way ANOVA and logistic regression were the tools used for analysis, and a p-value of <0.05 was considered as statistically significant. Results The mean age of healthy control, benign and malignant breast cancer was 32.51±9.44, 33.34±10.664 and 37.65±14.345 years, respectively. The mean serum value of TG among controls, benign and malignant women was 168.67±41.616, 170.1±59.018 and 211.7±82.924 (p<0.001), respectively. The mean serum concentration of HDL-c was significantly different between the three groups (47.61±9.122, 44.69±14.479 and 38.26±7.442: p=0.004) among controls, benign and malignant, respectively. Low serum HDL-c level was significantly associated with age at parity (AOR=3.353; 95% CI=1.33, 8.436), the habit of drinking alcohol (AOR=2.125; 95% CI=1.065, 4.241) and BMI (AOR=3.555; 95% CI=1.13, 11.184). In addition, BMI (AOR: 4.54; 95% CI: 1.45, 14.21) was statistically associated with high LDL-c level. Conclusion The overall prevalence of dyslipidemia was high in breast cancer patients. Age at first parity, alcohol consumption and BMI were significantly associated with low serum HDL-c level.
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Affiliation(s)
- Getinet Kumie
- University of Gondar, College of Medicine & Health Sciences, School of Biomedical & Laboratory Sciences, Department of Clinical Chemistry, Gondar, Ethiopia
| | - Tadele Melak
- University of Gondar, College of Medicine & Health Sciences, School of Biomedical & Laboratory Sciences, Department of Clinical Chemistry, Gondar, Ethiopia
| | - Habtamu Wondifraw Baynes
- University of Gondar, College of Medicine & Health Sciences, School of Biomedical & Laboratory Sciences, Department of Clinical Chemistry, Gondar, Ethiopia
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Li M, Song L, Yuan J, Zhang D, Zhang C, Liu Y, Lin Q, Wang H, Su K, Li Y, Ma Z, Liu D, Dong J. Association Between Serum Insulin and C-Peptide Levels and Breast Cancer: An Updated Systematic Review and Meta-Analysis. Front Oncol 2020; 10:553332. [PMID: 33194614 PMCID: PMC7658676 DOI: 10.3389/fonc.2020.553332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/08/2020] [Indexed: 01/07/2023] Open
Abstract
Background Several studies have reported that hyperinsulinemia plays a part in the etiology of breast cancer. However, no consensus has been reached. Therefore, we conducted a meta-analysis to explore the role of insulin and C-peptide in breast cancer. Methods A systematic search in PubMed, Embase, and The Cochrane Library was conducted up to September, 2020. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to measure effect sizes. Publication bias was assessed using the Egger test. Stability of these results was evaluated using sensitivity analyses. Results Fourteen articles including 27,084 cases and five articles including 2,513 cases were extracted for serum insulin levels and C-peptide levels. We found that C-peptide levels were positively associated with breast cancer with overall SMD = 0.37 (95% CI = 0.09–0.65, I2 = 89.1%). Subgroup analysis by control source illustrated a positive relationship between breast cancer and C-peptide levels in population-based control. Subgroup analysis by C-peptide level indicated a positive correlation between breast cancer and C-peptide levels no matter C-peptide levels in case group is ≤3 ng/ml or >3 ng/ml. Subgroup analysis by age showed that C-peptide level positively correlated to breast cancer in women between the ages of 50 and 60. However, we did not identify any relationship between breast cancer and insulin levels (SMD = 0.22, 95% CI = −0.06–0.50, I2 = 97.3%). Conclusion This meta-analysis demonstrated that C-peptide levels were positively related to breast cancer in women, and no relationship between insulin levels and breast cancer was found.
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Affiliation(s)
- Manwen Li
- Special Medicine Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Limin Song
- Special Medicine Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Junhua Yuan
- Special Medicine Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Di Zhang
- Special Medicine Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Caishun Zhang
- Special Medicine Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Yuan Liu
- Special Medicine Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Qian Lin
- Special Medicine Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Haidan Wang
- Special Medicine Department, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Kaizhen Su
- Clinical Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Yanrun Li
- Clinical Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Zhengye Ma
- Clinical Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Defeng Liu
- Clinical Medicine Department, Medical College, Qingdao University, Qingdao, China
| | - Jing Dong
- Special Medicine Department, School of Basic Medicine, Qingdao University, Qingdao, China.,Physiology Department, Medical College, Qingdao University, Qingdao, China
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Effectiveness of a Global Multidisciplinary Supportive and Educational Intervention in Thermal Resort on Anthropometric and Biological Parameters, and the Disease-Free Survival after Breast Cancer Treatment Completion (PACThe). JOURNAL OF ONCOLOGY 2020; 2020:4181850. [PMID: 32454823 PMCID: PMC7222596 DOI: 10.1155/2020/4181850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/06/2019] [Accepted: 02/07/2020] [Indexed: 11/18/2022]
Abstract
A growing knowledge highlights the strong benefit of regular physical activity in the management of breast cancer patients, but few studies have considered biological parameters in their outcomes. In the prospective randomised trial after breast cancer treatment completion “PACThe,” we determined the effects of physical activity and nutritional intervention on the biological and anthropometric status of patients after one year of follow-up, and clarified the link between biomarkers at allocation and disease-free survival. 113 patients from the population of the “PACThe” study (n = 251) were analysed for biological parameters. Patients were randomized after chemotherapy in two arms: the intervention “SPA” receiving a 2-week session of physical training, dietary education, and physiotherapy (n = 57), and the control “CTR” (n = 56). Diet questionnaire, anthropometric measures, and blood parameters were determined at allocation and one year later. Survival and recurrence were checked over 7 years. Data were considered as a function of BMI, i.e., ≤25 for normal, 25–30 for overweight, and >30 for obese patients. At allocation, the large standard deviation for nutrient-intake values reflected an unbalanced diet for some patients in the three groups. At one-year follow-up, we noticed an increase in glucose (p < 10−6), insulin (p < 10−7), and adiponectin (p < 0.022) plasma levels for both intervention arms, which were more accentuated for the >30 groups. Using the Cox model, we demonstrated that the highest testosterone plasma values were linked to an increase of the recurrence risk (HR [CI–95%] = 5.06 [1.66–15.41]; p=0.004). One-year after a global multidisciplinary supportive and educational intervention, we found few anthropometric and biological changes, mainly related to the patient's initial BMI. We highlighted the importance of plasma testosterone in the evaluation of patient's recurrence risk. Future studies would help better understand the mechanisms by which such multidisciplinary interventions could interact with breast cancer recurrence and define the most effective modalities.
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