Prognostic impact of postoperative radiotherapy in patients with breast cancer and with pT1-2 and 1-3 lymph node metastases: A retrospective cohort study based on the Japanese Breast Cancer Registry

Annual report of National Clinical Database-Breast Cancer Registry in 2021: characteristics categorized by body mass index and menopause status

The Japanese Breast Cancer Society initiated the breast cancer registry in 1975 and migrated the registry to the National Clinical Database-Breast Cancer Registry (NCD-BCR) in 2012. This annual report presents 2021 data on the NCD-BCR. We analyzed data from 98,540 breast cancer (BC) cases registered in 2021. In 2021, 99.4% of BC cases were females with a median age of 61. Most (57.5%) were diagnosed at early stages (Stage 0 or I). Breast-conserving surgery was performed in 42.8% of cases. Sentinel lymph node biopsy was performed in 67.8%, followed by radiotherapy in 71.0% of those post-conserving surgery. Regarding postoperative systemic therapy, 63.1% received endocrine therapy, 28.2% received chemotherapy, and 14.9% received molecular-targeted therapy. ER positivity was observed in 75.2%, HER2 in 13.6%, and Ki67 ≥30% in 29.1% of cases. The median age of premenopausal cases was 46 (interquartile range, 42-49) years and the median BMI was 21.5 (19.7-24.2) kg/m2 whereas the median age of postmenopausal cases was 69 (61-76) years and the median BMI was 23.0 (20.6-25.9) kg/m2. In premenopausal cases, cases with normal BMI were more likely to be found at checkups without subjective symptoms and in the early stage than those with high BMI. The tendency of ER, PgR, HER2, and Ki67 status on BMI differed by menopause status; premenopausal cases with a lower BMI showed higher proportions of ER- and PgR-positive cancer and lower proportions of cancer with high Ki67. These nationwide descriptive statistics would help clinical explanation and further research on breast cancer.

Breast cancer statistics for Japan in 2022: annual report of the national clinical database-breast cancer registry-clinical implications including chemosensitivity of breast cancer with low estrogen receptor expression

This is an annual report by the Japanese Breast Cancer Society, which provides statistics on the clinical data on breast cancer in Japan, extracted from the National Clinical Database-Breast Cancer Registry (NCD-BCR). This report includes an update of 102,453 breast cancer cases at 1339 institutions registered in the NCD-BCR in 2022. Among the 101,793 female patients, the median age at cancer diagnosis was 62 years (interquartile range, 50-73 years), and 29.4% of the patients were premenopausal. Of these patients, 15,437 (15.2%) and 42,936 (42.2%) were diagnosed with stage 0 and I disease, respectively. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) were positive in 78.7%, 69.4%, and 12.8% of the patients, respectively. Of the 97,154 patients without distant metastasis, 40,521 (41.7%) underwent breast-conserving surgery, and 5780 (5.9%) patients underwent some form of breast reconstruction procedures at the time of mastectomy. A total of 66,894 (68.9%) patients were treated with sentinel lymph node biopsy and 7155 (7.4%) patients were treated with sentinel lymph node biopsy followed by axillary node dissection. In the group of patients treated with breast-conserving surgery (n = 40,521), 29,500 (72.8%) received whole-breast irradiation. In the group of patients who underwent mastectomy (n = 54,476), 6226 (11.4%) received radiation therapy to the chest wall. Of the 13,950 patients receiving preoperative chemotherapy with or without molecular targeted therapy, 4308 (30.9%) achieved a pathological complete response, with the highest rate of 60.5% in patients with the hormone receptor-negative/HER2-positive subtype.

Clinical treatment score Post-5 Years (CTS5) predicts the benefit of postmastectomy radiotherapy in patients with T1-2N1 luminal breast cancer

PURPOSE

To investigate the clinical value of Clinical Treatment Score Post-5 Years (CTS5) to predict the survival benefits of postmastectomy radiotherapy (PMRT) of patients with T1-2N1 luminal breast cancer (BC).

METHODS

Patients who were diagnosed with T1-2N1 luminal BC between 2010 and 2015 were included in the Surveillance, Epidemiology, and End Results database. The chi-square test, binomial logistic regression, Kaplan-Meier analysis, and multivariable Cox proportional hazard model were used for statistical analyses.

RESULTS

A total of 11190 patients were included with a median follow-up time of 76 months. Regarding the CTS5 classification, 1641 (14.7 %), 3915 (35.0 %), and 5633 (50.3 %) patients had low-risk, intermediate-risk, and high-risk diseases, respectively. Patients with younger age, T2 stage, higher tumor grade, a higher number of positive lymph nodes, infiltrating lobular carcinoma subtype, and receipt of chemotherapy were associated with the receipt of PMRT (all P < 0.05). The multivariate analysis showed that the receipt of PMRT was the independent prognostic factor associated with better BCSS (P = 0.005) and OS (P < 0.001). The sensitivity analysis showed that PMRT did not improve BCSS (low-risk, P = 0.932; intermediate-risk, P = 0.952) and OS (low-risk, P = 0.637; intermediate-risk, P = 0.825) compared to those without PMRT in the low-risk and intermediate-risk groups. However, PMRT improved BCSS (P = 0.003) and OS (P < 0.001) in those with high-risk groups compared to those without PMRT.

CONCLUSIONS

CTS5 is an innovative model that could predict the survival benefit of PMRT for T1-2N1 luminal BC patients.

The impact of bolus on clinical outcomes for post-mastectomy breast cancer patients treated with IMRT: data from China

PURPOSE

This study aims to investigate the effects of chest wall bolus in intensity-modulated radiotherapy (IMRT) technology on clinical outcomes for post-mastectomy breast cancer patients.

MATERIALS AND METHODS

This retrospective study included patients with invasive carcinoma ((y)pT0-4, (y)pN0-3) who received photon IMRT after mastectomy at the Affiliated Hospital of Qingdao University from 2014 to 2019. The patients were divided into two groups based on whether they received daily bolus application or not, and the baseline characteristics were matched using propensity score matching (PSM). Cumulative incidence (CI) of local recurrence (LR), locoregional recurrence (LRR), overall survival (OS) and disease-free survival (DFS) were evaluated with a log-rank test. Acute skin toxicity and late radiation pneumonia was analyzed using chi-square test.

RESULTS

A total of 529 patients were included in this study, among whom 254 (48%) patients received bolus application. The median follow-up time was 60 months. After matching, 175 well-paired patients were selected. The adjusted 5-year outcomes (95% confidence interval) in patients treated with and without bolus were, respectively: CI of LR 2.42% (0.04-4.74) versus 2.38% (0.05-4.65), CI of LRR 2.42% (0.04-4.74) versus 3.59% (0.73-6.37), DFS 88.12% (83.35-93.18) versus 84.69% (79.42-90.30), OS 94.21% (90.79-97.76) versus 95.86% (92.91-98.91). No correlation between bolus application and skin toxicity (P = 0.555) and late pneumonia (P = 0.333) was observed.

CONCLUSIONS

The study revealed a low recurrence rate using IMRT technology. The daily used 5 mm chest wall bolus was not associated with improved clinical outcomes.

Perioperative treatments for and postoperative activity of daily living of patients with early-stage breast cancer according to age group: A retrospective observational study

INTRODUCTION

The number of older patients with breast cancer is increasing worldwide. However, no studies have clarified to what extent activities of daily living (ADL) decline in older patients after surgery. This study aimed to identify perioperative treatments and the proportion of patients with a postoperative decline in ADL among those with early-stage breast cancer, according to age groups (<65, 65-74, ≥75 years).

MATERIALS AND METHODS

This retrospective study used healthcare utilization data of women aged ≥40 years who were diagnosed with breast cancer in 431 Japanese hospitals. Patients who underwent breast conserving surgery and mastectomy at clinical stages 0-III were included. ADL were assessed using the Barthel index (100 points indicated independent ADL).

RESULTS

Overall, 37,161 patients were analyzed, including 17,313 undergoing a breast conserving surgery and 19,848 undergoing a mastectomy. The difference in the proportion of patients with a postoperative decline in ADL between those in the <65-year and ≥75-year group who underwent mastectomy was approximately 1%. In each age group, a higher proportion of patients received adjuvant chemotherapy (9.4-27.5% for breast conserving surgery; 15.6-40.3% for mastectomy) than neoadjuvant chemotherapy (breast conserving surgery, 2.1-12.0%; mastectomy, 3.0-18.1%). A lower proportion of patients in the ≥75-year group underwent radiotherapy than that in the <65-year group.

CONCLUSION

Physical burden of surgery was low in both younger and older patients. Low proportions of patients in the ≥75-year group who underwent surgery received neoadjuvant and adjuvant chemotherapy and adjuvant radiotherapy. Healthcare providers should inform this to patients.

Developing prompts from large language model for extracting clinical information from pathology and ultrasound reports in breast cancer

PURPOSE

We aimed to evaluate the time and cost of developing prompts using large language model (LLM), tailored to extract clinical factors in breast cancer patients and their accuracy.

MATERIALS AND METHODS

We collected data from reports of surgical pathology and ultrasound from breast cancer patients who underwent radiotherapy from 2020 to 2022. We extracted the information using the Generative Pre-trained Transformer (GPT) for Sheets and Docs extension plugin and termed this the "LLM" method. The time and cost of developing the prompts with LLM methods were assessed and compared with those spent on collecting information with "full manual" and "LLM-assisted manual" methods. To assess accuracy, 340 patients were randomly selected, and the extracted information by LLM method were compared with those collected by "full manual" method.

RESULTS

Data from 2,931 patients were collected. We developed 12 prompts for Extract function and 12 for Format function to extract and standardize the information. The overall accuracy was 87.7%. For lymphovascular invasion, it was 98.2%. Developing and processing the prompts took 3.5 hours and 15 minutes, respectively. Utilizing the ChatGPT application programming interface cost US $65.8 and when factoring in the estimated wage, the total cost was US $95.4. In an estimated comparison, "LLM-assisted manual" and "LLM" methods were time- and cost-efficient compared to the "full manual" method.

CONCLUSION

Developing and facilitating prompts for LLM to derive clinical factors was efficient to extract crucial information from huge medical records. This study demonstrated the potential of the application of natural language processing using LLM model in breast cancer patients. Prompts from the current study can be re-used for other research to collect clinical information.

Development and validation of nomograms for predicting survival outcomes in patients with T1-2N1 breast cancer to identify those who could not benefit from postmastectomy radiotherapy

Purpose

In this study, we aimed to develop and validate nomograms for predicting the survival outcomes in patients with T1-2N1 breast cancer to identify the patients who could not benefit from postmastectomy radiotherapy (PMRT).

Methods

Data from 10191 patients with T1-2N1 breast cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Of them, 6542 patients who had not received PMRT formed the training set. Concurrently, we retrospectively enrolled 419 patients from the Affiliated Hospital of North Sichuan Medical College (NSMC), and 286 patients who did not undergo PMRT formed the external validation set. The least absolute shrinkage and selection operator (LASSO) and multivariate Cox regression analyses were used for selecting prognostic factors in the training set. Using the selected factors, two prognostic nomograms were constructed. The nomograms’ performance was assessed using the concordance index (C-index), calibration curves, decision curve analysis (DCA), and risk subgroup classification. The stabilized inverse probability of treatment weights (IPTWs) was used to balance the baseline characteristics of the different risk groups. Finally, the survival outcomes and effectiveness of PMRT after IPTW adjustment were evaluated using adjusted Kaplan–Meier curves and Cox regression models.

Results

The 8-year overall survival (OS) and breast cancer-specific survival (BCSS) rates for the SEER cohort were 84.3% and 90.1%, with a median follow-up time of 76 months, while those for the NSMC cohort were 84.1% and 86.9%, with a median follow-up time of 73 months. Moreover, significant differences were observed in the survival curves for the different risk subgroups (P &lt; 0.001) in both SEER and NSMC cohorts. The subgroup analysis after adjustment by IPTW revealed that PMRT was significantly associated with improved OS and BCSS in the intermediate- (hazard ratio [HR] = 0.72, 95% confidence interval [CI]: 0.59–0.88, P=0.001; HR = 0.77, 95% CI: 0.62–0.95, P = 0.015) and high- (HR=0.66, 95% CI: 0.52–0.83, P&lt;0.001; HR=0.74, 95% CI: 0.56–0.99, P=0.039) risk groups. However, PMRT had no significant effects on patients in the low-risk groups.

Conclusion

According to the prognostic nomogram, we performed risk subgroup classification and found that patients in the low-risk group did not benefit from PMRT.

Integrated profiling uncovers prognostic, immunological, and pharmacogenomic features of ferroptosis in triple-negative breast cancer

Objective

Ferroptosis is an iron-dependent type of regulated cell death triggered by the toxic buildup of lipid peroxides on cell membranes. Nonetheless, the implication of ferroptosis in triple-negative breast cancer (TNBC), which is the most aggressive subtype of breast carcinoma, remains unexplored.

Methods

Three TNBC cohorts-TCGA-TNBC, GSE58812, and METABRIC-were adopted. Consensus molecular subtyping on prognostic ferroptosis-related genes was implemented across TNBC. Ferroptosis classification-relevant genes were selected through weighted co-expression network analysis (WGCNA), and a ferroptosis-relevant scoring system was proposed through the LASSO approach. Prognostic and immunological traits, transcriptional and post-transcriptional modulation, therapeutic response, and prediction of potential small-molecule agents were conducted.

Results

Three disparate ferroptosis patterns were identified across TNBC, with prognostic and immunological traits in each pattern. The ferroptosis-relevant scoring system was proposed, with poorer overall survival in high-risk patients. This risk score was strongly linked to transcriptional and post-transcriptional mechanisms. The high-risk group had a higher response to anti-PD-1 blockade or sunitinib, and the low-risk group had higher sensitivity to cisplatin. High relationships of risk score with immunological features were observed across pan-cancer. Two Cancer Therapeutics Response Portal (CTRP)-derived agents (SNX-2112 and brefeldin A) and PRISM-derived agents (MEK162, PD-0325901, PD-318088, Ro-4987655, and SAR131675) were predicted, which were intended for high-risk patients.

Conclusion

Altogether, our findings unveil prognostic, immunological, and pharmacogenomic features of ferroptosis in TNBC, highlighting the potential clinical utility of ferroptosis in TNBC therapy.