Breast cancer: emerging principles of metastasis, adjuvant and neoadjuvant treatment from cancer registry data

Prolonged time to breast cancer surgery and the risk of metastasis: an explorative simulation analysis using epidemiological data from Germany and the USA

PURPOSE

Growing breast cancer is associated with an inherent risk of metastasis. If surgical treatment of breast cancer is delayed, the prognosis worsens with increasing tumor size. This justifies the search for a safe time interval between diagnosis and surgery.

METHODS

The 2022 population-based data on incidence and the time interval to initial surgery for the United States (U.S.) and Germany are used. Tumor growth and initiation of metastases can be calculated using public data on hormone receptor status, volume doubling time, and tumor size-dependent relative survival. Our assumptions are based on an initial 19.8 mm mean tumor size. 15-year BC-specific mortality in both countries is assumed to be 19.6% without surgical delay. Volume doubling time stratified by hormone receptor status, assumed to be continuous may differ by a factor of 2.4.

RESULTS

The U.S. and Germany report 287,850/71,375 new breast cancers for the year 2022 and 2019. If tumor removal is delayed by 8 weeks, mortality rate increases by 2.25/4.79% (HR + /HR-) as estimated by our model. The currently reported mean delay in the U.S. and Germany of 33.7/26.0 days or 4.8/3.7 weeks, respectively, would lead to an estimated 4,676/918 additional BC deaths or a 1.6/1.2% rise in the 15-year BC-specific mortality rate.

CONCLUSIONS

This study offers reasonable evidence that confirmed cases of breast cancer should be prioritized and treated according to hormone receptor status and tumor size as soon as possible. Effective screening measures should be followed by timely treatment.

Prognostic Insights in Feline Mammary Carcinomas: Clinicopathological Factors and the Proposal of a New Staging System

Feline mammary carcinoma (FMC) is an aggressive neoplasm with a poor prognosis. Clinical staging is crucial for risk assessment, yet the current WHO system lacks granularity, particularly in Stage III. Aligning this system with human breast cancer staging has the potential to improve prognostic accuracy. Additionally, prognostic factors such as tumor size, ulceration, lymph node metastasis, and lymphovascular invasion require further evaluation. This study retrospectively analyzed 75 female cats with FMC to assess the prognostic impact of clinicopathological factors and evaluate a novel staging system (new staging) adapted from the AJCC Cancer Staging Manual. Survival analyses included disease-free interval (DFI), and overall survival (OS). Tumor size >3 cm (p < 0.001), ulceration (p = 0.010), lymphovascular invasion (p < 0.001), lymph node metastasis (p < 0.001), WHO and new staging (p < 0.001) were significantly associated with shorter survival. The new staging refined Stage III into IIIA (T3N0M0), IIIB (T4N0M0), and IIIC (AnyTN1M0), improved prognostic differentiation. Stage IIIC cases had the worst survival (p < 0.001). Multivariate survival analysis identified lymphovascular invasion (HR = 2.834, 95% CI: 1.546-5.195, p = 0.001), histological Grade II (HR = 5.013, 95% CI: 1.122-22.397, p = 0.035) and III (HR = 9.894, 95% CI: 2.195-44.594, p = 0.003) and skin ulceration (HR = 2.462, 95% CI: 1.256-4.825, p = 0.009). These findings support the prognostic relevance of key clinicopathological factors in FMC and highlight the advantages of a refined TNM-based staging system, which may enhance risk stratification and therapeutic decision-making in veterinary oncology.

Overexpression of malic enzyme is involved in breast cancer growth and is correlated with poor prognosis

Malic enzyme (ME) genes are key functional metabolic enzymes playing a crucial role in carcinogenesis. However, the detailed effects of ME gene expression on breast cancer progression remain unclear. Here, our results revealed ME1 expression was significantly upregulated in breast cancer, especially in patients with oestrogen receptor/progesterone receptor-negative and human epidermal growth factor receptor 2-positive breast cancer. Furthermore, upregulation of ME1 was significantly associated with more advanced pathological stages (p < 0.001), pT stage (p < 0.001) and tumour grade (p < 0.001). Kaplan-Meier analysis revealed ME1 upregulation was associated with poor disease-specific survival (DSS: p = 0.002) and disease-free survival (DFS: p = 0.003). Multivariate Cox regression analysis revealed ME1 upregulation was significantly correlated with poor DSS (adjusted hazard ratio [AHR] = 1.65; 95% CI: 1.08-2.52; p = 0.021) and DFS (AHR, 1.57; 95% CI: 1.03-2.41; p = 0.038). Stratification analysis indicated ME1 upregulation was significantly associated with poor DSS (p = 0.039) and DFS (p = 0.038) in patients with non-triple-negative breast cancer (TNBC). However, ME1 expression did not affect the DSS of patients with TNBC. Biological function analysis revealed ME1 knockdown could significantly suppress the growth of breast cancer cells and influence its migration ability. Furthermore, the infiltration of immune cells was significantly reduced when they were co-cultured with breast cancer cells with ME1 knockdown. In summary, ME1 plays an oncogenic role in the growth of breast cancer; it may serve as a potential biomarker of progression and constitute a therapeutic target in patients with breast cancer.