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Li S, Li C, Shao W, Liu X, Sun L, Yu Z. Survival analysis and prognosis of patients with breast cancer with pleural metastasis. Front Oncol 2023; 13:1104246. [PMID: 37197429 PMCID: PMC10183576 DOI: 10.3389/fonc.2023.1104246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/19/2023] [Indexed: 05/19/2023] Open
Abstract
Background Breast cancer (BC) is the most common malignant cancer. The prognosis of patients differs according to the location of distant metastasis, with pleura being a common metastatic site in BC. Nonetheless, clinical data of patients with pleural metastasis (PM) as the only distant metastatic site at initial diagnosis of metastatic BC (MBC) are limited. Patient cohort and methods The medical records of patients who were hospitalized in Shandong Cancer Hospital between January 1, 2012 and December 31, 2021 were reviewed, and patients eligible for the study were selected. Survival analysis was conducted using Kaplan-Meier (KM) method. Univariate and multivariate Cox proportional-hazards models were used to identify prognostic factors. Finally, based on these selected factors, a nomogram was constructed and validated. Results In total, 182 patients were included; 58 (group A), 81 (group B), and 43 (group C) patients presented with only PM, only lung metastasis (LM), and PM combined with LM, respectively. The KM curves revealed no significant difference in overall survival (OS) among the three groups. However, in terms of survival after distant metastasis (M-OS), the difference was significant: patients with only PM exhibited the best prognosis, whereas those with PM combined with LM exhibited the worst prognosis (median M-OS: 65.9, 40.5, and 32.4 months, respectively; P = 0.0067). For patients with LM in groups A and C, those with malignant pleural effusion (MPE) exhibited significantly worse M-OS than those without MPE. Univariate and multivariate analyses indicated that primary cancer site, T stage, N stage, location of PM, and MPE were independent prognostic factors for patients with PM without other distant metastasis. A nomogram prediction model incorporating these variables was created. According to the C-index (0.776), the AUC values of the 3-, 5-, and 8-year M-OS (0.86, 0.86, and 0.90, respectively), and calibration curves, the predicted and actual M-OS were in good agreement. Conclusion BC patients with PM only at the first diagnosis of MBC exhibited a better prognosis than those with LM only or PM combined with LM. We identified five independent prognostic factors associated with M-OS in this subset of patients, and a nomogram model with good predictive efficacy was established.
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Affiliation(s)
- Sumei Li
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Chao Li
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Wenna Shao
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaoyu Liu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Luhao Sun
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhiyong Yu
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Zhiyong Yu,
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Zhu Z, Li S, Wu D, Ren H, Ni C, Wang C, Xiang N, Ni Z. High-throughput and label-free enrichment of malignant tumor cells and clusters from pleural and peritoneal effusions using inertial microfluidics. LAB ON A CHIP 2022; 22:2097-2106. [PMID: 35441644 DOI: 10.1039/d2lc00082b] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Accurate and rapid diagnosis of malignant pleural and peritoneal effusions is critical due to potential association with advanced disease stages or progression. Traditional cytodiagnosis suffers from low efficiency and has difficulties in finding malignant tumor cells (MTCs) from a mass of exfoliated cells. Hence, a polymer microfluidic chip with a slanted spiral channel was employed for high-throughput and label-free enrichment of MTCs and MTC clusters from clinical malignant pleural and peritoneal effusions. The slanted spiral channel with trapezoidal cross-sections was fabricated by assembling two patterned polymer films of different thicknesses within one flow channel layer. After systematically exploring the effects of the particle size, effusion concentration, and flow rate on separation performance of the device, we realized the enrichment of MTCs from abundant blood cells in 2-fold diluted effusions. The results indicated that approximately 85% of the spiked tumor cells (A549 and MCF-7 cell lines) were recovered with high purities of over 37% at a high throughput of 2000 μL min-1. In clinical applications, we successfully enriched 24-2691 MTCs per mL from the diluted malignant pleural and peritoneal effusions collected from four types of cancer patients (n = 22). More importantly, the MTC clusters were further purified from single MTCs using a higher flow rate of 3000 μL min-1. Finally, we performed the rapid drug sensitivity test by coupling the microfluidic enrichment with CCK-8 assay. Our approach may serve as valuable assistance to accelerate cancer diagnosis and guide the selection of treatment medications.
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Affiliation(s)
- Zhixian Zhu
- School of Mechanical Engineering, and, Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing, 211189, China.
| | - Shuang Li
- Department of Oncology, Zhongda Hospital, Southeast University, Nanjing, 210009, China.
| | - Dan Wu
- Department of Oncology, Jiangyin People's Hospital, Jiangyin, 214400, China
| | - Hui Ren
- School of Mechanical Engineering, and, Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing, 211189, China.
| | - Chen Ni
- School of Mechanical Engineering, and, Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing, 211189, China.
| | - Cailian Wang
- Department of Oncology, Zhongda Hospital, Southeast University, Nanjing, 210009, China.
| | - Nan Xiang
- School of Mechanical Engineering, and, Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing, 211189, China.
| | - Zhonghua Ni
- School of Mechanical Engineering, and, Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing, 211189, China.
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Pericardial and Pleural Metastases: Clinical, Histologic, and Molecular Differences. Ann Thorac Surg 2018; 106:872-879. [DOI: 10.1016/j.athoracsur.2018.04.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 11/22/2022]
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dos Santos GT, Camillo ND, Berto MD, Prolla JC, da Cruz IBM, Roehe AV, Brackmann RL, Reiter KC, Bica CG. Impact of Her-2 Overexpression on Survival of Patients with Metastatic Breast Cancer. Asian Pac J Cancer Prev 2017; 18:2673-2678. [PMID: 29072390 PMCID: PMC5747388 DOI: 10.22034/apjcp.2017.18.10.2673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Breast cancer is a complex and heterogeneous disease which is increasingly important as a public
health problem. In Brazil, 57,960 new cases have been estimated to be the burden in 2016 and 2017. Despite advances
in early diagnosis and therapy, approximately 20-30% of patients, even with early stage lesions, will develop distant
metastatic disease. Tumors with similar clinical and pathological presentations may have differing behavior, so it
is important to understand specific biological characteristics. Objective: To investigate tumor markers of primary
tumors featuring pleural metastasis to identify organ-specific characteristics of metastatic breast cancer. Methods:
In a historical cohort study, immunohistochemistry was performed on cell blocks of neoplastic pleural effusions and
results were compared with clinicopathological data. Results: The median survival time with Her-2 overexpression
in malignant pleural effusions was 2.2 months, whereas cases without overexpression survived, on average, for seven
months (p = 0.02). Conclusions: We emphasize that metastases may behave independently of primary tumors, but the
present results indicate that therapeutic agents targeting Her-2 overexpression could increase survival in metastatic
breast cancer cases.
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Emergencies in Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Camillo ND, Dos Santos GT, Prolla JC, Flôres ERDS, Introíni GO, Brackmann RL, da Cruz IBM, Bica CG. Impact of cell arrangement of pleural effusion in survival of patients with breast cancer. Acta Cytol 2014; 58:446-52. [PMID: 25377597 DOI: 10.1159/000367919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study was performed to evaluate the potential influence of cytological differences between pleural effusions on the survival of women with metastatic breast cancer during 30 months of follow-up. STUDY DESIGN A hospital-based cohort study was performed. Pleural fluid cytology slides from patients with breast cancer were examined. Cases were grouped according to the pattern of tumor cells (spheroid and isolated), in order to access their prognostic value. RESULTS The study comprised 87 patients. An isolated cell pattern was associated with higher mortality 30 months after the pleural effusion when compared to a spheroid pattern (p = 0.038). Patients with an isolated cell pattern showed higher risk of dying than patients with spheroid formations. The relative risk after adjustment of intervening variables was 5.336 (95% CI 1.054-27.020). The presence of a triple-negative immunohistochemical pattern significantly increased the risk of mortality before 30 months. CONCLUSION Pleural effusion with isolated malignant cells is associated with worse prognosis after 30 months of follow-up.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/genetics
- Breast Neoplasms/diagnosis
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/genetics
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Cell Shape
- Female
- Follow-Up Studies
- Gene Expression
- Humans
- Middle Aged
- Neoplasm Proteins/genetics
- Neoplastic Cells, Circulating/metabolism
- Neoplastic Cells, Circulating/pathology
- Pleural Effusion, Malignant/diagnosis
- Pleural Effusion, Malignant/genetics
- Pleural Effusion, Malignant/mortality
- Pleural Effusion, Malignant/pathology
- Prognosis
- Risk
- Spheroids, Cellular/metabolism
- Spheroids, Cellular/pathology
- Survival Analysis
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Affiliation(s)
- Natália Dressler Camillo
- Postgraduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Ikeda H, Kikawa Y, Nakamoto Y, Takeo M, Yamamoto M. A patient with recurrent breast cancer showing long-term survival after developing pericardial effusion and cardiac tamponade caused by carcinomatous pericarditis. ACTA ACUST UNITED AC 2014; 8:71-3. [PMID: 24715847 DOI: 10.1159/000346831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Malignant pericardial effusion caused by carcinomatous pericarditis is a complication of advanced malignancy. Breast cancer is the second most important cause of malignant pericardial effusion. Malignant pericardial effusion is the end stage of breast cancer, and the prognosis is very poor. Pericardial effusion may cause cardiac tamponade and sudden death if it is not controlled properly. There is a debate on which is the best method to control pericardial effusion. CASE REPORT We describe the clinical course of a 55-year-old woman with recurrent breast cancer, pericardial effusion, and cardiac tamponade caused by carcinomatous pericarditis. Thoracoscopic pericardial window was performed to control the pericardial effusion. The patient survived for about 5 years after being diagnosed with pericardial metastases. CONCLUSION The observed long-term survival in such a patient with the development of pericardial effusions and cardiac tamponade caused by carcinomatous pericarditis attributable to breast cancer is rare. Thoracoscopic pericardial window was effective in controlling the pericardial effusion.
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Affiliation(s)
- Hirokuni Ikeda
- Department of Surgery, Kobe City Hospital Organization Kobe City Center West Hospital, Kobe Nagata-ku, Hyogo, Japan
| | - Yuichiro Kikawa
- Department of Surgery, Kobe City Hospital Organization Kobe City Center West Hospital, Kobe Nagata-ku, Hyogo, Japan
| | - Yoshihiko Nakamoto
- Department of Surgery, Kobe City Hospital Organization Kobe City Center West Hospital, Kobe Nagata-ku, Hyogo, Japan
| | - Masahiko Takeo
- Department of Surgery, Kobe City Hospital Organization Kobe City Center West Hospital, Kobe Nagata-ku, Hyogo, Japan
| | - Mistuo Yamamoto
- Department of Surgery, Kobe City Hospital Organization Kobe City Center West Hospital, Kobe Nagata-ku, Hyogo, Japan
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Santos GTD, Prolla JC, Camillo ND, Zavalhia LS, Ranzi AD, Bica CG. Fatores clínicos e anatomopatológicos que influenciam a sobrevida de pacientes com câncer de mama e derrame pleural neoplásico. J Bras Pneumol 2012; 38:487-93. [DOI: 10.1590/s1806-37132012000400011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 06/13/2012] [Indexed: 03/15/2023] Open
Abstract
OBJETIVO: O objetivo deste estudo foi identificar os fatores clínicos e anatomopatológicos que possam influenciar o prognóstico de pacientes com câncer de mama e sintomas clínicos de derrame pleural neoplásico. MÉTODOS: Trata-se de um estudo clínico de coorte, no qual foram analisados os prontuários médicos de pacientes que receberam diagnóstico de derrame pleural neoplásico entre 2006 e 2010. Por meio da análise dos prontuários, identificamos as pacientes com história de câncer de mama. Para essas pacientes, coletamos dados anatomopatológicos relacionados ao tumor primário e dados citopatológicos relacionados à metástase pleural. RESULTADOS: Das 145 pacientes avaliadas, 87 (60%) apresentaram, no exame citológico, resultado positivo para células neoplásicas no líquido pleural; além disso, 119 (82%) apresentaram tipo histológico ductal. O fenótipo triplo-negativo foi observado em 25 pacientes (17%), as quais apresentaram o pior prognóstico, com queda acentuada na curva de sobrevida. Das 25 pacientes, 20 (80%) evoluíram a óbito durante o período de seguimento (até junho de 2011). A sobrevida média após a identificação de derrame pleural neoplásico foi de 6 meses. CONCLUSÕES: Em pacientes com câncer de mama triplo-negativo e exame citológico com resultado positivo para células neoplásicas no líquido pleural, o prognóstico é ruim e a sobrevida é menor.
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Powell G, Roche H, Roche WR. Expression of calretinin by breast carcinoma and the potential for misdiagnosis of mesothelioma. Histopathology 2011; 59:950-6. [PMID: 22092406 DOI: 10.1111/j.1365-2559.2011.04031.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- George Powell
- School of Medicine, University of Southampton, Southampton, UK
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Takei T, Otsubo S, Uchida K, Matsugami K, Mimuro T, Kabaya T, Akiba T, Nitta K. Effects of sevelamer on the progression of vascular calcification in patients on chronic haemodialysis. Nephron Clin Pract 2008; 108:c278-83. [PMID: 18434749 DOI: 10.1159/000127361] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Accepted: 10/29/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Vascular calcification is thought to be associated with a high cardiovascular mortality rate in patients with end-stage renal disease. Control of hyperphosphataemia is important for the treatment of the vascular calcification. The aim of the present study was to evaluate the effects of sevelamer hydrochloride on the progression of aortic calcification in haemodialysis (HD) patients. METHODS 42 HD patients were studied in this study and divided into two groups (sevelamer vs. calcium). Sevelamer was added and titrated up to achieve serum P control for 6 months. The estimations of aortic calcification index (ACI) by abdominal computed tomography scans were performed twice in each patient. We compared the changes in serum calcium, phosphorus, intact parathyroid hormone, and lipids in two groups. RESULTS Serum phosphorus levels decreased significantly from 6.7 +/- 0.7 to 6.2 +/- 0.5 mg/dl with no changes in serum intact parathyroid hormone levels in the sevelamer group (p < 0.01), and increased from 6.5 +/- 1.0 to 6.7 +/- 1.1 mg/dl in the calcium group (p < 0.05). Serum calcium levels did not change in the sevelamer group and calcium group. The serum levels of total cholesterol decreased significantly from 158.5 +/- 20.7 to 146.2 +/- 24.1 mg/dl (p = 0.024) and the low-density lipoprotein cholesterol level from 65.3 +/- 14.4 to 54.7 +/- 11.6 mg/dl (p = 0.014) in the sevelamer group. Serum C-reactive protein decreased significantly from 0.14 +/- 0.13 to 0.08 +/- 0.11 mg/dl in the sevelamer group (p = 0.038) and significantly increased (0.18 +/- 0.09 vs. 0.22 +/- 0.12 mg/dl) in the calcium group (p = 0.042). The mean changes in ACI (DeltaACI) were 3.6 +/- 1.5% in the sevelamer group and 8.2 +/- 3.1% in the calcium group. CONCLUSIONS Sevelamer allows a better serum phosphorus control compared with calcium-based phosphate binder and suppresses the progression of aortic calcification in HD patients.
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Affiliation(s)
- Takashi Takei
- Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
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