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1.
Maureen O’Donnell 《Current breast cancer reports》2018,10(2):91-97
Purpose of review
Accurate estimates of contralateral breast cancer (CBC) risk are necessary around the time a first breast cancer is diagnosed to aid surgical decision-making. This review will discuss the known risk factors for contralateral breast cancer (CBC) and present methods for calculating CBC risk that can be utilized when breast surgeons counsel patients.Recent findings
In addition to the well-known factors that impact contralateral breast cancer risk, such as BRCA1/BRCA2 mutation carrier status and history of chest wall radiation, other factors that affect CBC risk are being better defined. Recent studies that take into account important covariates in contralateral breast cancer risk, such as BRCA1 and BRCA2 mutation carrier status, family history, and systemic treatment, are further improving estimates of contralateral risk. Recent studies show family history, especially of breast cancer in a young relative or of bilateral breast cancer, hormone receptor status, lobular histology, and breast density are important in accurately estimating contralateral breast cancer risk. The Manchester formula, a pen and paper calculation for contralateral breast cancer risk estimation, and CBCRisk, a recently developed online CBC risk calculator, are two tools now available to clinicians.Summary
Despite a decreasing incidence of contralateral breast cancer over the last few decades, there has been a steady increase in the number of women undergoing contralateral prophylactic mastectomy (CPM). The reasons for this are multifactorial, but fear of a contralateral breast cancer and a tendency to overestimate the risk of a contralateral breast cancer are two factors. Therefore, a critical element in decision-making for women considering CPM is having an accurate estimate of contralateral breast cancer risk. Models for estimating contralateral breast cancer risk are not widely used, but are available.2.
Rati Chkheidze Mary Ann G. Sanders Barbara Haley A. Marilyn Leitch Sunati Sahoo 《Clinical breast cancer》2018,18(4):298-304
Background
Breast cancer metastases to an ipsilateral supraclavicular lymph node is assigned a N3 status in the TNM system and thus classified as stage III disease in the American Joint Commission on Cancer staging manual. Breast cancer metastatic to contralateral axillary lymph node (CAM) without metastases to any other distant organ is currently assigned M1 status (stage IV) instead of N3 (stage III).Patients and Methods
We retrospectively reviewed the medical records of breast cancer patients diagnosed with CAM for their clinical presentation, pathologic diagnoses, treatment, and follow-up data. Patients who had distant metastases at the time of CAM diagnosis were excluded from the study.Results
We report 12 breast cancer patients who developed CAM but no evidence of metastases in any other distant organ documented with extensive imaging workup. Imaging studies and thorough pathologic evaluation of the prophylactic total mastectomy specimen did not reveal a primary in the breast to account for the metastases in the axillary node.Conclusion
Findings of our study as well as previous studies support that lymph node metastases in the contralateral axilla represents a locoregional spread of the tumor from the index breast via lymphatics rather than hematogenous spread. Therefore, isolated CAM in breast cancer patients should not be classified as stage IV disease. 相似文献3.
Hannah Lui Park Jenny Chang Gagandeep Lal Krustina Lal Argyrios Ziogas Hoda Anton-Culver 《Clinical breast cancer》2018,18(2):e179-e185
Background
Although it is known that the risk of a second breast cancer event among young women diagnosed with ductal carcinoma in situ (DCIS) is higher than in older women, the effect of current treatment options on long-term outcomes in this subgroup of women remains poorly defined. We aimed to evaluate national treatment trends and determine their effect on second breast cancer risk and overall survival among young women diagnosed with DCIS.Materials and Methods
Surveillance, Epidemiology, and End Results data from 1998 to 2011 were used to analyze 3648 DCIS patients younger than age 40 years.Results
Among all treatment options, breast-conserving surgery (BCS) with radiation therapy (BCS + RT) was the most prevalent (36.1%) followed by mastectomy (MTX) without contralateral prophylactic MTX (CPM; 25.8%), BCS alone (22.2%), and MTX with CPM (15.8%). Risk of a second ipsilateral event was > 5-fold and > 2-fold lower within 2 years and 5 years of initial DCIS diagnosis, respectively, in women who received BCS + RT compared with BCS alone; and overall survival was 3-fold higher in women who received BCS + RT. However, MTX with or without CPM did not show an increase in overall survival compared with BCS + RT. In addition, although the percentage of young women who receive MTX with CPM has increased in recent years, MTX with CPM did not show an increased benefit in survival compared with MTX without CPM.Conclusion
The results of our study suggest that more aggressive treatments do not offer survival benefits over BCS + RT; thus, clinical treatment options in young women with DCIS should be carefully considered. 相似文献4.
Robabeh Taheripanah Firoozeh Balash Robab Anbiaee Mohammedreza Mahmoodi Azadeh Akbari Sene 《Clinical breast cancer》2018,18(5):395-399
Background
This study was performed to determine whether the use of ovulation induction drugs in treatment of infertility have a significant effect on the risk of breast cancer.Patients and Methods
This case control study (928 cases, 928 controls), was performed in the gynecology and oncology clinics of Shahid Beheshti University of Medical Sciences between 2011 and 2013. Data were collected via in-person interviews using a questionnaire, which included demographic and gynecologic information. Statistical analysis was performed using SPSS statistics software version 20 (IBM Corp).Results
The use of ovulation induction drugs was not significantly associated with an increased risk of breast cancer (odds ratio [OR], 1.13; 95% confidence interval [CI], 0.7-1.855) among women with infertility (OR, 1.28; 95% CI, 0.8-1.95).Conclusion
We observed no statistically significant relationship between infertility and ovulation induction drugs with the risk of breast cancer, except for significant increases in the risk of breast cancer among patients who had used fertility drugs for >6 months. 相似文献5.
Gustavo Nader Marta Philip Poortmans Alfredo C. de Barros José Roberto Filassi Ruffo Freitas Junior Riccardo A. Audisio Max Senna Mano Sarkis Meterissian Sarah M. DeSnyder Thomas A. Buchholz Tarek Hijal 《European journal of surgical oncology》2017,43(11):2036-2043
Purpose/Objective(s)
Skin sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) have entered routine surgical practice for breast cancer, though their oncologic safety has not been established in randomized controlled trials. The aim of this study was to evaluate and compare radiation oncologists' and breast surgeons' opinions concerning the indications of post-operative radiation therapy (PORT) after SSM and NSM.Materials/Methods
Radiation oncologists and breast surgeons from North America, South America and Europe were invited to contribute in this study. A 22-question survey was used to evaluate their opinions.Results
A total of 550 physicians (298 radiation oncologists and 252 breast surgeons) answered the survey. The majority of responders affirmed that PORT should be performed in early-stage (stages I and II) breast cancer for patients who present with risk factors for relapse after SSM and NSM. They considered age, lymph node involvement, tumor size, extracapsular extension, involved surgical margins, lymphovascular invasion, triple negative receptor status and multicentric presentation as major risk factors. Considering that after SSM and NSM, residual breast tissue can be left behind, the residual tissue considered as acceptable in the context of an oncologic surgery were 1–5 mm for breast surgeons. There is no consensus for the necessity of evaluating residual breast tissue through breast imaging.Conclusion
Although the indications of PORT after SSM and NSM vary among practitioners, standard risk factors for relapse are considered as important by radiation oncologists and breast surgeons. 相似文献6.
Sunil W. Dutta Daniel M. Trifiletti Surbhi Grover Kara D. Romano Einsley-Marie Janowski Shayna L. Showalter 《Clinical breast cancer》2018,18(2):121-127
Background
There is an established relationship between hormone receptor (HR; estrogen and/or progesterone receptors) status, HER2 status, and locoregional recurrence. The purpose of this study was to analyze how HR and HER2 receptor status have influenced the surgical management trends among patients with early stage breast cancer.Patients and Methods
The National Cancer Database was queried for patients with cT1 to cT3, cN0, and cM0 breast carcinoma from 2004 to 2012. Patients were grouped on the basis of receptor status and surgical management (mastectomy or breast-conserving surgery [BCS]). Multivariable analyses were performed to investigate factors associated with increased odds of receiving mastectomy over BCS. Among a subgroup of patients who underwent ipsilateral mastectomy, analyses were performed to determine any association between contralateral prophylactic mastectomy (CPM) and receptor status.Results
We found 280,241 patients who met inclusion criteria for analyzing mastectomy or BCS surgical decision. Patients with HER2-positive (HER2+) tumors (HR+/HER+ and HR?/HER2+) were the most likely to undergo mastectomy (odds ratio [OR], 1.212 and 1.499 respectively, compared with HR+/HER2? patients, each P < .001). HR status alone did not affect ipsilateral surgical management as patients with HR+/HER2? and HR?/HER2? tumors demonstrated similar mastectomy rates (P = .391). Among the 108,018 who underwent mastectomy, 20% underwent CPM. After adjustment, patients with HR+/HER2+, HR?/HER2+, and HR?/HER2? were all more likely to undergo CPM (OR 1.356, 1.608, and 1.358, respectively compared with HR+/HER2? patients, each P < .001).Conclusion
This analysis indicates that patients with early stage breast cancer are more likely to undergo a mastectomy and CPM if they have HER2+ tumors. 相似文献7.
P. Zhang C.-Z. Li C.-T. Wu G.-M. Jiao F. Yan H.-C. Zhu X.-P. Zhang 《European journal of surgical oncology》2017,43(2):285-293
Background
The purpose of this study was to compare patient outcomes between immediate breast reconstruction (IBR) after mastectomy and mastectomy alone.Methods
We conducted a comprehensive literature search of PUBMED, EMBASE, Web of Science, and Cochrane Library. The primary outcomes evaluated in this review were overall survival, disease-free survival and local recurrence. Secondary outcome was the incidence of surgical site infection. All data were analyzed using Review Manager 5.3.Results
Thirty-one studies, involving of 139,894 participants were included in this paper. Pooled data demonstrated that women who had IBR after mastectomy were more likely to experience surgical site infection than those treated with mastectomy alone (risk ratios 1.51, 95% CI: 1.22–1.87; p = 0.0001). There were no significant differences in overall survival (hazard ratios 0.92, 95% CI: 0.80–1.06; p = 0.25) and disease-free survival (hazard ratios 0.96, 95% CI: 0.84–1.10; p = 0.54) between IBR after mastectomy and mastectomy alone. No significant difference was found in local recurrence between two groups (risk ratios 0.92, 95% CI: 0.75–1.13; p = 0.41).Conclusions
Our study demonstrates that IBR after mastectomy does not affect the overall survival and disease-free survival of breast cancer. Besides, no evidence shows that IBR after mastectomy increases the frequency of local recurrence. 相似文献8.
Jae Hoon Jeong Bomi Choi Sam Yeol Chang Eun-Kyu Kim Eunyoung Kang Chan Yeong Heo Yujin Myung 《Clinical breast cancer》2018,18(3):214-219
Background
Long-term posture change after unilateral mastectomy in breast cancer patients can affect spinal alignment during the postoperative period. We evaluated the effect of immediate breast reconstruction on body posture after surgery by analyzing spinal alignment with radiographic studies.Materials and Methods
Preoperative and 2-year postoperative chest radiographs of 116 patients who received immediate breast reconstruction with unilateral mastectomy and 250 patients who underwent unilateral mastectomy without reconstruction were retrospectively reviewed. Cobb angle, the direction of spinal curvature, upper and lower ends of the thoracic curve, and curve length were measured and compared between both groups. Additional patient information including age, height, weight, body mass index, and side of surgery were collected via chart review.Results
There was a significant difference in the Cobb angle between the preoperative and 2-year postoperative chest radiographs between the immediate breast reconstruction group and mastectomy group. Without considering curvature change, the difference was ?0.593° in the reconstruction group and 2.698° in the mastectomy-alone group (P = .02), and considering curvature change, the difference was 0.335° and 3.972° in the reconstruction and mastectomy-alone group, respectively (P < .01).Conclusion
The amount of change in postoperative spinal alignment was significantly smaller in the immediate breast reconstruction group compared with patients who received only unilateral mastectomy without reconstruction. We suggest that immediate breast reconstruction positively affects spinal alignment, leading to better posture and physical function. 相似文献9.
Andrea Prochowski Iamurri Martina Ponziani Marco Macchini Marco Fogante Mirco Pistelli Mariagrazia De Lisa Rossana Berardi Gian Marco Giuseppetti 《Clinical breast cancer》2018,18(2):e231-e235
Introduction
The purpose of this study was to evaluate whether diagnostic performance of breast magnetic resonance imaging (MRI) for detection of multifocality and multicentricity (MFMC) of breast cancer (BC) can be influenced by different histotypes or immunophenotypes in newly diagnosed patients with breast cancer.Materials and Methods
In this institutional review board-approved retrospective study, 289 patients who underwent both preoperative breast MRI and radical or modified mastectomy in our institution because of primary BCs were selected. Patients were stratified based on the pathologic report in 2 main histotypes and 5 immunophenotypes. By matching the radiologic report with the corresponding pathologic report for each patient, breast MRI performance for detection of MFMC were obtained in each histotype and immunophenotype and subsequently compared.Results
Overall breast MRI sensitivity for MFMC detection was 88.1%, specificity was 80.0%, positive predictive value 82.1%, negative predictive value 85.8%, diagnostic accuracy 83.7%, and area under the curve 0.835. Breast MRI sensitivity for MFMC detection in triple-negative BC was 84.6% (P = .88), specificity 70.8% (P = .63), positive predictive value 61.1% (P = .02), negative predictive value 89.5% (P = .20), diagnostic accuracy 75.7% (P = .65), and area under the curve 0.777 (P = .87).Conclusion
Performance of breast MRI for the detection of MFMC are not influenced by the BC histotypes, in accordance with published literature. Conversely, the triple-negative immunophenotypes demonstrated lower performance, statistically significant only for positive predictive value (P = .02), for the detection of MFMC. 相似文献10.
Background
The influence of stress on breast cancer risk remains unknown. The goal of the present study was to determine the effect of stress in the form of salient positive and negative valence life events (LEs) on primary invasive breast cancer risk. We hypothesized that salient negative LEs would increase breast cancer risk and salient positive LEs would attenuate this increased risk.Patients and Methods
We used a case-control design with 664 cases identified through the Cancer Surveillance Program of Orange County and 203 population-based controls. Participants completed a risk factor questionnaire, which included a LE section. Fourteen salient LEs of positive or negative valence were used to quantify stress exposure. A baseline model was constructed, and odds ratios (ORs) were calculated using multivariate unconditional logistic regression.Results
Negative LEs were associated with increased breast cancer risk. The OR for ≥ 4 negative LEs showed a 2.81-fold increase in breast cancer risk (OR, 2.81; 95% confidence interval [CI], 1.47-5.36). A significant dose–response relationship between lifetime negative valence LEs and breast cancer risk was found. Previous personal illness increased breast cancer risk by 3.6-fold (OR, 3.60; 95% CI, 2.50-5.20). In contrast, abortion was associated with a 45% decrease in breast cancer risk (OR, 0.55; 95% CI, 0.34-0.89). Salient positive LEs did not have a significant effect on breast cancer risk. However, they seemed to buffer the adverse effect of salient negative LEs on breast cancer risk.Conclusion
The findings from the present study support the role of salient negative LEs in promoting breast cancer development, with a possible buffering effect of salient positive LEs. 相似文献11.
Hongliang Chen Mingdi Zhang Maoli Wang Peng Zhang Fang Bai Kejin Wu 《Clinical breast cancer》2019,19(1):e135-e141
Background
Controversy exists regarding the appropriateness of immediate breast reconstruction (IBR) in patients with metastatic breast cancer (MBC).Patients and Methods
By using the Surveillance, Epidemiology, and End Results (SEER) database, data of patients with de novo MBC undergoing mastectomy with or without IBR were assessed. The trend of IBR in de novo MBC was explored. Comparisons of the distribution of clinicopathologic characteristics were evaluated by chi-square and Fisher exact tests. The predictors of IBR in de novo MBC were evaluated by multivariate logistic regression. The survival outcomes were compared by Cox hazards models adjusting for known clinicopathologic variables in both the entire population and in the matched cohorts.Results
Between 1998 and 2015, 5.2% of patients with de novo MBC undergoing mastectomy received IBR. The rate of IBR increased significantly, from 6.3% in 1998 to 16.8% in 2015. Patients undergoing IBR were younger and had smaller tumor size, fewer positive lymph nodes, lower proportion of hormone receptor–negative disease and lung metastasis, and better economic status. They were also more likely to receive radiotherapy and chemotherapy. Although IBR was an independent favorable prognostic factor for breast cancer–specific survival and overall survival in the whole population, there were no statistically significant differences between IBR and mastectomy for breast cancer–specific survival (P = .892) and overall survival (P = .708) in the well-matched analysis.Conclusion
IBR in selected de novo MBC could be an acceptable practice when balancing quality of life, underlying health care burden, and oncologic risks. 相似文献12.
Seo Hee Choi Jun Won Kim Jinhyun Choi Joohyuk Sohn Seung Il Kim Seho Park Hyung Seok Park Joon Jeong Chang-Ok Suh Ki Chang Keum Yong Bae Kim Ik Jae Lee 《Clinical breast cancer》2018,18(2):e167-e178
Background
The aim of this study was to assess the outcomes of patients with de novo stage IV breast cancer after locoregional treatment (LRT) of primary site.Patients and Methods
We studied 245 patients diagnosed with de novo stage IV breast cancer. LRT of the primary tumor (+ systemic therapy) was performed in 82 (34%) patients (surgery, 27; surgery + radiotherapy (RT), 46; and RT, 9). Among those undergoing surgery, 64 (88%) patients underwent mastectomy, and 9 (12%) patients underwent breast-conserving surgery (BCS). Local recurrence-free survival (LRFS) and overall survival (OS) were investigated, and propensity score matching was used to balance patient distributions.Results
The 5-year LRFS and OS rates were 27% and 50%, respectively. Advanced T stage (T4), liver or brain metastasis, ≥ 5 metastatic sites, and absence of hormone therapy were significant adverse factors for LRFS, whereas T4 stage and absence of hormone therapy were significant for OS. The LRT group demonstrated significantly more favorable outcomes (5-year LRFS, 61%; 5-year OS, 71%), especially after surgery. After matching, survival rates remained significantly higher for patients who received LRT (5-year LRFS, 62% vs. 20%; P < .001; 5-year OS, 73% vs. 45%; P = .02). BCS + RT was superior to mastectomy ± RT, which can be attributed to more patients with a low tumor burden undergoing BCS + RT. Outcomes were better with post-mastectomy RT in selected patients (≥ N2, ≥ T3, or T2N1).Conclusions
Upfront LRT including RT is an important option together with systemic therapies for de novo stage IV breast cancer. 相似文献13.
Loïc Lelièvre Philippe Clézardin Laurent Magaud Laurent Roche Nicole Tubiana-Mathieu Jean-Dominique Tigaud Delphine Topart Nadia Raban Marie-Ange Mouret-Reynier Patrice Mathevet 《Clinical breast cancer》2018,18(6):e1311-e1321
Introduction
Neoadjuvant chemotherapy has become the treatment of choice for locally advanced breast cancer. Zoledronic acid (ZA) is a bisphosphonate initially used in the treatment of bone metastases because of its antibone resorption effect. Antitumor effects of ZA, including the inhibition of cell adhesion to mineralized bone or the antiangiogenic effect, have been demonstrated. However, the clinical significance of these effects remains to be determined.Materials and Methods
We undertook a multicenter open-label randomized trial to analyze the value of adding ZA to neoadjuvant chemotherapy for TNM clinical stage T2/T3 breast cancer. The primary endpoint was the evolution of serum VEGF.Results
The data from 24 patients were included in the ZA group and 26 in the control group. The evolution of serum VEGF was slightly in favor of ZA at 5.5 months (?0.7% vs. +7.5%), without reaching statistical significance (P = .52). The secondary endpoints were the breast conservation rate (higher with ZA; 83.3% vs. 65.4%; P = NS), pathologic complete response (no effect), and circulating tumor cells (odds ratio, 0.68 in favor of ZA; 95% confidence interval, 0.02-24.36). No cases of jaw necrosis or severe renal failure were observed in either group.Conclusion
ZA is an antitumor drug of interest because of its multiple effects on tumor biology. Larger trials with longer follow-up that include additional endpoints such as relapse and survival rates would be of interest. 相似文献14.
Toshikazu Ito Shoji Oura Shinji Nagamine Masato Takahashi Naohito Yamamoto Noboru Yamamichi Mitsuharu Earashi Hiroyoshi Doihara Shigeru Imoto Shoshu Mitsuyama Kohei Akazawa 《Clinical breast cancer》2018,18(4):e495-e500
Purpose
To validate the safety and efficacy of percutaneous radiofrequency ablation (RFA) of breast carcinomas.Methods
This retrospective study was conducted by the Breast Cancer Society for Minimally Invasive Therapy following approval from institutional review boards, and with the written informed consent of patients. A total of 386 patients with breast cancer treated with RFA at 10 institutions between July 2003 and June 2009 were identified and included in the analysis. Patients underwent a standard RFA procedure with ultrasound guidance and were followed up every 6 to 12 months. In this study, feasibility of RFA procedure and related safety and ipsilateral breast tumor recurrence (IBTR) were examined. Fisher exact or χ2 test evaluated associations between clinicopathological factors and IBTR, and local recurrence-free survival was estimated using the Kaplan-Meier method.Results
RFA-related adverse events included local pain in 9 patients, skin burns in 15, and nipple retraction in 7. Patients were followed for a median of 50 months. IBTR was more frequently observed in patients with initial tumor sizes > 2 cm (3 of 30, 10%) than in those with initial tumors ≤ 2 cm (8 of 355, 2.3%; P = .015). IBTR-free rates 5 years after RFA were 97%, 94%, and 87% in patients with initial tumor sizes ≤ 1.0 cm, 1.1 to 2.0 cm, and > 2.0 cm, respectively.Conclusions
RFA in breast cancer is a safe and promising minimally invasive treatment for tumors ≤ 2 cm in diameter. Further studies are needed to optimize the technique and evaluate its future role as local therapy. 相似文献15.
Patrick G. Morris Selene Rota Karen Cadoo Stephen Zamora Sujata Patil Gabriella D&#x;Andrea Theresa Gilewski Jacqueline Bromberg Chau Dang Maura Dickler Shanu Modi Andrew D. Seidman Nancy Sklarin Larry Norton Clifford A. Hudis Monica N. Fornier 《Clinical breast cancer》2018,18(5):387-394
Background
Overexpression and activation of tyrosine kinase Src has been linked to breast carcinogenesis and bone metastases. We showed the feasibility of combining the SRC inhibitor dasatinib with weekly paclitaxel in patients with metastatic breast cancer (MBC) and herein report the subsequent phase II trial.Patients and Methods
Patients had received ≤ 2 chemotherapy regimens for measurable, HER2-negative MBC. Patients received paclitaxel and dasatinib (120 mg daily) and were assessed according to Response Evaluation Criteria in Solid Tumors for overall response rate (ORR), the primary end point. Secondary end points included progression-free survival (PFS) and overall survival (OS). A 30% ORR (n = 55) was deemed worthy of further investigation. Exploratory biomarkers included N-telopeptide (NTX) and plasma vascular epidermal growth factor (VEGF) receptor 2 as predictors of clinical benefit.Results
From March 2010 to March 2014, 40 patients, including 2 men enrolled. The study was stopped early because of slow accrual. Overall, 32 patients (80%) had estrogen receptor-positive tumors and 23 (58%) had previously received taxanes. Of the 35 assessable patients, 1 (3%) had complete response and 7 (20%) partial response, resulting in an ORR of 23%. The median PFS and OS was 5.2 (95% confidence interval [CI], 2.9-9.9) and 20.6 (95% CI, 12.9-25.2) months, respectively. As expected, fatigue (75%), neuropathy (65%), and diarrhea (50%) were common side effects, but were generally low-grade. Median baseline NTX was similar in patients who had clinical benefit (8.2 nmol BCE) and no clinical benefit (10.9 nmol BCE). Similarly, median baseline VEGF levels were similar between the 2 groups; 93.0 pg/mL versus 83.0 pg/mL.Conclusion
This phase II study of dasatinib and paclitaxel was stopped early because of slow accrual but showed some clinical activity. Further study is not planned. 相似文献16.
Tina J. Hieken Brittany L. Murphy Judy C. Boughey Amy C. Degnim Katrina N. Glazebrook Tanya L. Hoskin 《Clinical breast cancer》2018,18(4):e501-e506
Background
Few data exist on the influence of tumor biologic subtype on treatment response and outcomes for inflammatory breast cancer (IBC). We examined a contemporary cohort of IBC patients treated with current targeted systemic therapies, selected on the basis of tumor biologic subtype, to evaluate pathologic treatment response and cancer outcomes across biologic subtypes.Patients and Methods
We studied 57 clinical stage T4dM0 IBC patients operated on at our institution from October 2008 to July 2015. Comparisons across biologic subtypes were performed by Wilcoxon rank-sum or chi-square tests; Kaplan-Meier and log-rank tests were used to analyze survival outcomes.Results
All patients received neoadjuvant systemic therapy; 54 (95%) completed postmastectomy radiation. Ninety-one percent (52/57) had clinically node-positive disease at presentation. Pathologic complete response (pCR) rates in the breast and axilla differed significantly by approximated biologic subtype, defined as estrogen receptor (ER) positive/human epidermal growth factor receptor 2 (HER-2) negative; and HER-2 positive and ER negative/HER-2 negative (all P < .001). After 50 months' median follow-up, 20 patients experienced disease recurrence. Site of first relapse was distant in 80% (16/20). Disease-free survival (DFS) and breast cancer-specific survival (BCSS) differed significantly by biologic subtype. Five-year DFS was 46% for patients with ER-positive/HER-2–negative tumors, 82% for HER-2–positive tumors, and 33% for ER-negative/HER-2–negative tumors (P < .001), while 5-year BCSS was 76%, 100%, and 57%, respectively (P = .02)—notably better than historic reports.Conclusion
Our data show that both treatment response and outcomes vary significantly across IBC biologic subtypes. Multimodal treatment and modern systemic therapies have markedly improved DFS and BCSS. These data provide further evidence to suggest that IBC is not a distinct biologic entity transcending standard breast tumor marker subclassification. 相似文献17.
Background
Despite the psychological benefits and oncologic safety of postmastectomy breast reconstruction, most breast cancer patients do not undergo reconstruction. To better understand the patterns of breast reconstruction usage, it is important to identify the clinicopathologic factors associated with immediate breast reconstruction (IBR), and whether modification of the reconstruction incidence when stratified by patient- or cancer-related factors exists in the breast cancer population. The primary objectives were to determine whether the incidence of immediate postmastectomy breast reconstruction varies across age, and whether the tumor grade or radiation therapy modify the effect of age on the incidence of immediate breast reconstruction.Materials and Methods
Using the Surveillance, Epidemiology, and End Results database, we identified women who had undergone mastectomy for breast cancer from 2000 to 2014. Inverse probability of treatment-weighted log-binomial regression was used to estimate the effect of age on IBR after accounting for potential confounding by patient demographic data and cancer characteristics. Potential effect measure modification by tumor grade and radiation therapy on the age–IBR relationship was also assessed.Results
Of 321,206 women, 77,798 (24.2%) had undergone IBR. Age was significantly associated with IBR prevalence (P < .0001), with younger women more likely to undergo IBR. Both tumor grade (P < .0001) and radiation therapy (P < .0001) modified the effect of age on IBR.Conclusion
Compared with their older counterparts, younger breast cancer patients were more likely to undergo IBR, and both tumor grade and radiation therapy were differentially associated with the likelihood of IBR across patient age. 相似文献18.
Ishrat Rasool Dil Afroze Khursheed Alam Wani Adfar Yousuf Imtiyaz Ahmad Bhat Bilal Rah Sheeraz Un Nazir Showket Hussain Shweta Dubey 《Clinical breast cancer》2018,18(4):e671-e676
Introduction
Survivin is an apoptosis inhibitor and plays a primary role in cancer development and progression. One of the most common polymorphism of the survivin promoter -31G/C (rs9904341) influences its expression and is associated with the risk of cancer development. This study was conducted to explore survivin promoter gene -31G/C (rs9904341) polymorphism and the risk of breast cancer.Patients and Methods
The study group included 190 pathologically confirmed breast cancer patients, in addition to 200 distinct cancer-free controls from Jammu and Kashmir region of India, where breast cancer is the most common cancer in women. Single nucleotide polymorphism genotyping for -31G/C polymorphism in the survivin promoter region was done using a polymerase chain reaction-restriction fragment length polymorphism method.Results
The variant genotype/allele was found in 54.1% of the cases compared with 46.5% of controls. The combined prevalence of genotype GC+CC was significantly higher in patients compared with the control group (P = .02). Analyses of odds ratios (ORs) in the patient and control groups indicated that the presence of homozygous CC genotype was associated with increased risk for development of breast cancer (OR, 2.04; 95% confidence interval [CI], 1.07-2.98). The gene frequencies for G and C alleles were statistically different between patient and control groups (OR, 1.37; 95% CI, 1.03-1.84).Conclusion
The results suggest the association of -31G/C survivin polymorphism at a genotypic and allelic level in breast cancer. 相似文献19.
Jianyang Wang Shulian Wang Yu Tang Hao Jing Guangyi Sun Jing Jin Yueping Liu Yongwen Song Weihu Wang Hui Fang Hua Ren Zihao Yu Yexiong Li 《Clinical breast cancer》2018,18(5):e975-e984
Background
To investigate the superiority of breast-conserving surgery (BCS) plus radiotherapy (RT) compared with mastectomy alone for patients with stage I breast cancer in a real-world setting.Patients and Methods
The data from patients with histologically confirmed stage I breast cancer treated from 1999 to 2014 were retrospectively reviewed. The association of outcomes with the choice of treatment (BCS plus RT vs. mastectomy) was evaluated using multivariable proportional hazards regression and further confirmed using propensity score matching methods.Results
Of 6137 eligible patients in the present study, 1296 underwent BCS plus RT and 4841 underwent mastectomy plus axillary lymph node dissection without RT (mastectomy group). Multivariate analysis revealed that BCS plus RT was related to similar locoregional recurrence-free survival but greater distant metastasis-free survival (P = .003) and overall survival (P = .036) compared with mastectomy. For the 1252 pairs of patients matched using propensity score matching, the BCS plus RT groups enjoyed significantly greater 5-year overall survival (99.1% vs. 96.1%; P = .001), distant metastasis-free survival (97.0% vs. 92.2%; P < .001), and disease-free survival (95.3% vs. 90.2%; P = .001) compared with the mastectomy group.Conclusion
BCS plus RT provided better outcomes than mastectomy for eligible patients with stage I breast cancer and should be offered as a preferred treatment option. 相似文献20.
Hong Pan Kai Zhang Ming Wang Lijun Ling Wenbin Zhou Shui Wang 《Clinical breast cancer》2019,19(1):e247-e260