Body Mass Index and Hormone Receptor Status Influence Recurrence Risk in HER2-Positive Early Breast Cancer Patients

IntroductionA reliable risk stratification on the basis of tumor biology and host factors of HER2-positive (HER2⁺) early breast cancer (eBC) patients is needed. The aim of our study was to assess the prognostic role of body mass index (BMI) and hormone receptor (HR) expression in this setting.Patients and MethodsWe retrospectively evaluated 238 women with stage I to III HER2⁺ breast cancer who completed adjuvant chemotherapy (CHT) and 1 year of treatment with trastuzumab. The end point was 3-year distant disease-free survival (3yDDFS). Survival analysis was evaluated using the Kaplan–Meier method. Multivariate analysis was performed using Cox proportional-hazards model adjusting for HR status, BMI, tumor staging, size, nodal status, and type of adjuvant CHT. Association among categorical variables was assessed using χ² test.ResultsThe early recurrence rate after 3 years resulted as 4.2% (40% HR⁺ patients and 60% HR⁻ patients). Neither HR status nor BMI alone showed an association with 3yDDFS in multivariate analysis. However, the hazard ratios for patients with HR⁻ tumors who had also BMI ≥25 (3yDDFS 86.9%; 95% confidence interval [CI], 75.0%-97.7%) were amplified compared with patients with HR⁺ tumors and with BMI <25 (3yDDFS 98%; 95% CI, 94.8%-100.0%) and other subgroups (P = .003). This observation was confirmed in multivariate analysis (hazard ratio, 1.79; 95% CI, 1.04-3.07; P = .03).ConclusionOur real-life data highlight a different risk of eBC recurrence after grouping patients according to HR status and BMI. These results might help clinicians to identify correct treatment strategies. Patients who are HR⁻ and have BMI ≥25 might benefit from escalation approaches, whereas those who are HR⁺ and have BMI <25 might be eligible for a shorter duration of adjuvant treatment with anti-HER2 agents.     

甲状旁腺切除术用于难治性肾性继发性甲状旁腺功能亢进的安全性及近远疗效

背景与目的:甲状旁腺切除术(PTX)是治疗药物不能控制的难治性肾性继发性甲状旁腺功能亢进症(SHPT)的重要手段,但PTX术后仍有可能发生永久性甲状旁腺功能减退,无动力性骨病或难治性骨软化症,且国内尚缺乏对PTX术后远期的疗效观察的研究。本研究进一步评价PTX治疗难治性肾性SHPT的安全性与近远期疗效。方法:纳入2011年1月—2014年12月在安徽医科大学第二附属医院行PTX治疗的139例伴有难治性肾性SHPT的维持性透析患者。收集患者术前及术后3 d、6个月及1、2、3年的临床资料、血全段甲状旁腺激素(iPTH)、血钙、血磷、血红蛋白(Hb)及红细胞压积(Hct)等,观察并记录术后症状缓解情况、术后并发症和随访情况。结果:139例患者的PTX手术成功率为95.7%(133/139),术中共计切除甲状旁腺腺体537枚,平均切除3.86枚/例。12例(8.6%)术后发生一过性喉返神经损伤,其中声音嘶哑9例(6.5%),饮水呛咳3例(2.2%),未予处理术后3个月内均自行好转。术后低钙血症或缺乏维生素D者120例(86.3%),给予西那卡塞、补钙及补充活性维生素D治疗后得到有效控制。全组未发生切口感染、出血、窒息及甲状腺功能减退等外科并发症。患者的贫血状况均有不同程度地改善,Hb和Hct术后6个月明显升高并在随访期间保持稳定;术后iPTH明显降低,术后3 d的血钙、磷、钙磷乘积水平最低,随访3年仍低于手术前,所有变化与术前均有统计学差异(均P0.05)。随访期间无死亡病例。患者术前的骨痛、顽固性皮肤瘙痒、失眠、异位钙化、肌无力伴萎缩症状在术后1 d即明显缓解;身高缩短、骨骼畸形患者随访期间无进行性加重;纳差、全身营养状况及自理能力术后3个月内不同程度地改善。11例(7.9%)持续性SHPT,包括4例(2.9%)术中未完全切除甲状旁腺腺体,1例(0.7%)术中1枚腺体较小而未切除完全,6例(4.3%)术后检查存在纵隔异位甲状旁腺。随访期间,5例(3.5%)腺体未切除完全者的iPTH均800 pg/mL,肌无力及顽固性皮肤瘙痒临床症状明显,再次行PTX;6例(4.3%)存在异位甲状旁腺腺体者,因手术风险较大患者拒绝再次手术,予以药物治疗;8例(5.8%)术后复发,其中6例(4.3%)系前臂移植物复发所致,均在局麻下行前臂皮下移植物切除;2例(1.4%)系颈部原位残留腺体过度增生,予以二次手术,术后症状缓解。所有进行二次手术的患者在随访结束时无明显的临床症状,均未复发。结论:PTX可改善难治性肾性SHPT患者临床症状、贫血及钙磷代谢,且近远期疗效均较好,是治疗难治性SHPT的安全有效方法。     

Effects of pomegranate supplement on menopausal symptoms and quality of life in menopausal women: A double-blind randomized placebo-controlled trial

BackgroundMenopausal symptoms have negative effects on the aspects of quality of life and impose a high cost on the health system. In traditional Persian medicine, pomegranate is recommended to alleviate menopausal symptoms.Material and methodsA randomized double-blind placebo-controlled trial was performed among 78 healthy women. Participants were interviewed three times: Before receiving the supplement/placebo, after completing the treatment, and after 3 weeks with no intervention. They filled out the demographic information sheet, modified-Kupperman index, and Menopause-Specific Quality of Life (MENQOL) questionnaires.ResultsThe mean scores of the modified-Kupperman index and MENQOL characteristics before and after the treatment and after the follow-up period were significantly different between pomegranate and placebo groups in both modified-Kupperman and MENQOL scores (p < 0.001).ConclusionThis study demonstrated that 4 weeks' treatment with the pomegranate supplement significantly ameliorates the irritating symptoms of menopause and improves the quality of life in menopausal women even after 4 weeks' medicine deprivation.     

Hormone exposure and its suppressive effect on risk of high-grade gliomas among patients with breast cancer

BackgroundPrior reports demonstrate the expression of estrogen and progesterone receptors in high-grade gliomas (HGGs), but the relationship between hormone receptor-positive disease and risk of HHGs in patients with breast cancer (BC) remains uncharacterized.MethodsUsing the SEER 18 registries (2000–2017), we examined the temporal trend of the incidence of HGGs and BC. The standardized incidence ratio was calculated to assess the risk of subsequent HGG in BC patients.ResultsDuring the study period, the incidence of BC and HGGs remained comparable for men and women. Among 976,134 patients with BC, we found a decreased incidence of HGGs in females, but not in males. Female BC patients with hormone receptor-positive disease were at a lower risk of developing glioblastoma and anaplastic astrocytoma.ConclusionOur study findings allude to the protective role of hormone exposure in the development of HGGs, which may lead to the development of therapies targeting hormonal pathways.     

Control oncológico en cáncer de próstata de alto riesgo tras prostatectomía radical y radioterapia de rescate en comparación con radioterapia más hormonoterapia primaria

Introduction

In patients with high-risk localized prostate cancer (HRPCa), multimodal treatment plays a fundamental role.

The Undervalued Effects of Polychlorinated Biphenyl Exposure on Breast Cancer

The incidence of breast cancer across the world has been on the rise in recent decades. Because identified risk factors can only explain a relatively small portion of the cases, environmental exposure to organic pollutants is suspected to play a role in breast cancer etiology. Polychlorinated biphenyls (PCBs) are among the most abundant pollutants, and the impact of their exposure on breast cancer risk has been extensively studied in recent decades. However, the results of most epidemiologic studies do not support an association between PCB exposure and breast cancer risk. We hypothesized that the effects of PCBs on breast cancer might have been undervalued for reasons such as insufficient recognition of the confounding effects of several factors and lack of attention on the innate heterogeneity of PCB mixtures or breast cancer. After reviewing the evidence in the existing literature, we concluded that early life exposure, known risk factors of breast cancer, and impact of exposure to other pollutants are the main sources of confounding effects and have potentially masked the associations between PCBs and breast cancer. Because PCBs are mixtures of congeners with varied properties, and because breast cancers of different subtypes are etiologically distinct diseases, the absence of stratified subgroup analysis on individual PCBs and patients with specific biological subtypes and insufficient attention paid to the results of these subgroup analyses may result in an underestimation of the correlations between PCBs and breast cancer. In future studies, these factors must be taken into consideration when exploring the effect of PCB exposure on breast cancer risk.     

A Phase II Open Label Study of Everolimus in Combination With Endocrine Therapy in Resistant Hormone Receptor-Positive HER2-Negative Advanced Breast Cancer

BackgroundTherapies targeting estrogen receptor signaling are standard for patients with hormone receptor (HR)-positive (HR⁺) metastatic breast cancer (MBC). Dysregulation of the phosphoinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway is associated with treatment resistance. Addition of the mTOR inhibitor, everolimus, to exemestane doubled progression-free survival (PFS) in HR⁺/HER2⁻ MBC patients whose disease had previously progressed during endocrine therapy. In this phase II study, we used everolimus in addition to the most recent endocrine therapy during which a patient's disease progressed, in an attempt to restore and extend the benefit of the antiestrogen therapy in patients with HR⁺/HER2⁻ MBC.Patients and MethodsPatients with HR⁺ MBC who progressed on antiestrogen therapy received everolimus (10 mg orally daily) in combination with the antiestrogen therapy most recently administered. Treatment was administered in 4-week cycles and continued until disease progression or unacceptable toxicity. Blood and archival tumor specimens were collected for VeriStrat (Biodesix, Inc) and Foundation One (Foundation Medicine) assays, respectively. Accrual of 42 evaluable patients allowed detection of improvement in median PFS from 2.8 months (expected with hormonal treatment alone) to 5 months (power 80%, α = 5%).ResultsForty-seven patients were enrolled and treated. After a median follow-up of 22.2 months, median PFS was 6.6 months. Secondary efficacy end points included: overall response rate, 6%; clinical benefit rate, 40%; and median overall survival, 21.1 months. No unexpected toxicity was observed. Efficacy could not be correlated with PI3K/AKT/mTOR alterations or VeriStrat (Biodesix, Inc) prognostic signatures.ConclusionAfter progression during antiestrogen therapy, the addition of everolimus, without changing the hormonal therapy, resulted in a median PFS of 6.6 months, suggesting efficacy in patients with HR⁺/HER2⁻ MBC.