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Rahurkar S, Jonnalagadda P, Stover D, Andersen B, Handley D, Elsaid MI, Chen JC, Obeng-Gyasi S. Identifying and Treating Those at Risk: Disparities in Rapid Relapse Among TNBC Patients in the National Cancer Database. Ann Surg Oncol 2024:10.1245/s10434-024-15507-2. [PMID: 38872045 DOI: 10.1245/s10434-024-15507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/09/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE This study was designed to characterize features of rapid relapse TNBC (rrTNBC), an aggressive, poor prognosis breast cancer subset using the National Cancer Database (NCDB). METHODS Patients diagnosed with TNBC between 2010 and 2019 within NCDB were included in analyses. rrTNBC was defined as all-cause mortality ≤24 months from diagnosis. Patient demographic, tumor, and treatment association with rrTNBC were evaluated in univariate, bivariate analyses, and multiple logistic regression models. Two-part models are used to compare receipt of treatment (i.e., receipt of both chemotherapy and breast surgery) versus not in its relationship with rrTNBC. RESULTS Overall, 14.5% of patients were categorized as rrTNBC. Age older than 75 years (-41.3%), Black race (-1.4%), Medicare (-2.6%), and Charlson-Deyo score ≥2 (-4.9%) were associated with a lower probability of receiving both chemotherapy and breast surgery. Not receiving both treatments (vs. receiving both chemotherapy and breast surgery) was associated with a two-to-three-fold higher probability of rrTNBC among patients aged older than 75 years (16.6% vs. 6%), having Medicare (3.6% vs. 1.6%), and Charlson-Deyo score ≥2 (16.6% vs. 5.9%). CONCLUSIONS Age, insurance, and comorbidity were related to a lower likelihood of treatment; yet receiving treatment reduced the risk of rrTNBC threefold for each. These findings might be valuable to inform clinical care delivery, as well as future research that examines treatment protocols among diverse patients.
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Affiliation(s)
- Saurabh Rahurkar
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, OH, USA.
| | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, OH, USA
| | - Daniel Stover
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Barbara Andersen
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Demond Handley
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus, OH, USA
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
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Piedra-Delgado L, Chambergo-Michilot D, Morante Z, Fairen C, Jerves-Coello F, Luque-Benavides R, Casas F, Bustamante E, Razuri-Bustamante C, Torres-Roman JS, Fuentes H, Gomez H, Narvaez-Rojas A, De la Cruz-Ku G, Araujo J. Survival according to the site of metastasis in triple-negative breast cancer patients: The Peruvian experience. PLoS One 2024; 19:e0293833. [PMID: 38300959 PMCID: PMC10833533 DOI: 10.1371/journal.pone.0293833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/19/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Evidence regarding differences in survival associated with the site of metastasis in triple-negative breast cancer (TNBC) remains limited. Our aim was to analyze the overall survival (OS), distant relapse free survival (DRFS), and survival since the diagnosis of the relapse (MS), according to the side of metastasis. METHODS This was a retrospective study of TNBC patients with distant metastases at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru) from 2000 to 2014. Prognostic factors were determined by multivariate Cox regression analysis. RESULTS In total, 309 patients were included. Regarding the type of metastasis, visceral metastasis accounted for 41% and the lung was the most frequent first site of metastasis (33.3%). With a median follow-up of 10.2 years, the 5-year DRFS and OS were 10% and 26%, respectively. N staging (N2-N3 vs. N0, HR = 1.49, 95%CI: 1.04-2.14), metastasis in visceral sites (vs. bone; HR = 1.55, 95%CI: 0.94-2.56), the central nervous system (vs. bone; HR = 1.88, 95% CI: 1.10-3.22), and multiple sites (vs. bone; HR = 2.55, 95%CI:1.53-4.25) were prognostic factors of OS whereas multiple metastasis (HR = 2.30, 95% CI: 1.42-3.72) was a predictor of MS. In terms of DRFS, there were no differences according to metastasis type or solid organ. CONCLUSION TNBC patients with multiple metastasis and CNS metastasis have an increased risk of death compared to those with bone metastasis in terms of OS and MS.
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Affiliation(s)
| | | | - Zaida Morante
- Departamento de Oncología Médica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Carlos Fairen
- Boston Medical Center, Boston, Massachusetts, United States of America
| | | | | | - Fresia Casas
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | - Hugo Fuentes
- Departamento de Oncología Médica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Henry Gomez
- Departamento de Oncología Médica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Alexis Narvaez-Rojas
- Department of Surgical Oncology, Miller School of Medicine, University Of Miami, Miami, Florida, United States of America
| | | | - Jhajaira Araujo
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Chorrillos, Lima, Peru
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Lakkad M, Martin B, Li C, Harrington S, Dayer L, Painter JT. Factors Associated With Guideline-Concordant Pharmacological Treatment for Neuropathic Pain Among Breast Cancer Survivors. Clin Breast Cancer 2023:S1526-8209(23)00107-6. [PMID: 37328334 DOI: 10.1016/j.clbc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To identify factors associated with receiving guideline-concordant treatment among breast cancer survivors with neuropathic pain. MATERIALS AND METHODS A retrospective case-control study was conducted using the SEER-Medicare linked database. We included female breast cancer survivors diagnosed with non-metastatic breast cancer (stages 0-III) between 2007 and 2015 who developed treatment-related neuropathic pain during their survivorship period. Guideline-concordant treatment was defined based on NCCN guidelines. Factors associated with receiving guideline-concordant treatment were assessed using multivariable logistic regression and backward selection was used to identify potential associated factors. RESULTS Around 16.7% of breast cancer survivors in the study developed a neuropathic pain condition. The mean time to develop neuropathic pain was 1.4 years after beginning adjuvant treatment. On average, patients who developed neuropathic pain and received guideline-concordant treatment did so at 2.4 months after their neuropathic pain diagnosis. We found that survivors that are black and of other races were less likely to receive guideline-concordant treatment for breast cancer treatment-related neuropathic pain. Whereas survivors with diabetes, mental health disorders, hemiplegia, prior continuous opioid use, benzodiazepine use, nonbenzodiazepine CNS depressant use, or antipsychotic medication use were less likely to receive guideline-concordant treatment. CONCLUSION This study suggests that minority races, prior medication use, and comorbid conditions are associated with guideline-concordant treatment among breast cancer survivors with neuropathic pain. These findings warrant attention towards minority races to prescribe them guideline-concordant treatment as well as caution when prescribing concurrent pain medications to survivors with comorbidities and prior medication use.
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Affiliation(s)
- Mrinmayee Lakkad
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, College of Pharmacy, Little Rock, AR
| | - Bradley Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, College of Pharmacy, Little Rock, AR
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, College of Pharmacy, Little Rock, AR
| | - Sarah Harrington
- University of Arkansas for Medical Sciences, Winthrop P. Rockefeller Cancer Institute, Little Rock, AR
| | - Lindsey Dayer
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, College of Pharmacy, Little Rock, AR
| | - Jacob T Painter
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, College of Pharmacy, Little Rock, AR.
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Abraham A, Barcenas CH, Bleicher RJ, Cohen AL, Javid SH, Levine EG, Lin NU, Moy B, Niland JC, Wolff AC, Hassett MJ, Asad S, Stover DG. Clinicopathologic and sociodemographic factors associated with late relapse triple negative breast cancer in a multivariable logistic model: A multi-institution cohort study. Breast 2023; 67:89-93. [PMID: 36681001 PMCID: PMC9982264 DOI: 10.1016/j.breast.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Most metastatic recurrences of triple negative breast cancer (TNBC) occur within five years of diagnosis, yet late relapses of TNBC (lrTNBC) do occur. Our objective was to develop a risk prediction model of lrTNBC using readily available clinicopathologic and sociodemographic features. METHODS We included patients diagnosed with stage I-III TNBC between 1998 and 2012 at ten academic cancer centers. lrTNBC was defined as relapse or mortality greater than 5 years from diagnosis. Features associated with lrTNBC were included in a multivariable logistic model using backward elimination with a p < 0.10 criterion, with a final multivariable model applied to training (70%) and independent validation (30%) cohorts. RESULTS A total 2210 TNBC patients with at least five years follow-up and no relapse before 5 years were included. In final multivariable model, lrTNBC was significantly associated with higher stage at diagnosis (adjusted Odds Ratio [aOR] for stage III vs I, 10.9; 95% Confidence Interval [CI], 7.5-15.9; p < 0.0001) and BMI (aOR for obese vs normal weight, 1.4; 95% CI, 1.0-1.8; p = 0.03). Final model performance was consistent between training (70%) and validation (30%) cohorts. CONCLUSIONS A risk prediction model incorporating stage, BMI, and age at diagnosis offers potential utility for identification of patients at risk of development of lrTNBC and warrants further investigation.
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Affiliation(s)
- Adith Abraham
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | | | | | | | | | - Beverly Moy
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Sarah Asad
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel G. Stover
- Ohio State University Wexner Medical Center, Columbus, OH, USA,Corresponding author. Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984 Columbus, OH, 43210, USA.
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5
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Wang Z, Deng H, Jin Y, Luo M, Huang J, Wang J, Zhang K, Wang L, Zhou J. Circular RNAs: biology and clinical significance of breast cancer. RNA Biol 2023; 20:859-874. [PMID: 37882644 PMCID: PMC10730165 DOI: 10.1080/15476286.2023.2272468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 10/27/2023] Open
Abstract
Circular RNAs (circRNAs) are novel noncoding RNAs with covalently closed-loop structures that can regulate eukaryotic gene expression. Due to their stable structure, circRNAs are widely distributed in the cytoplasm and have important biological functions, including as microRNA sponges, RNA-binding protein conjugates, transcription regulators, and translation templates. Breast cancer is among the most common malignant cancers diagnosed in women worldwide. Despite the development of comprehensive treatments, breast cancer still has high mortality rates. Recent studies have unmasked critical roles for circRNAs in breast cancer as regulators of tumour initiation, progression, and metastasis. Further, research has revealed that some circRNAs have the potential for use as diagnostic and prognostic biomarkers in clinical practice. Herein, we review the biogenesis and biological functions of circRNAs, as well as their roles in different breast cancer subtypes. Moreover, we provide a comprehensive summary of the clinical significance of circRNAs in breast cancer. CircRNAs are believed to be a hot focus in basic and clinical research of breast cancer, and innovative future research directions of circRNAs could be used as biomarkers, therapeutic targets, or novel drugs.Abbreviations: CeRNA: Competitive endogenous RNA; ciRNA: Circular intronic RNA; circRNA: Circular RNA; EIciRNA: Exon-intron circRNA; EMT: Epithelial-mesenchymal transition; IRES: Internal ribosome entry site; lncRNA: Long non-coding RNA; miRNA: MicroRNA; MRE: MiRNA response element; ncRNA: Non-coding RNA; RBP: RNA-binding protein; RNA-seq: RNA sequencing; RT-PCR: Reverse transcription-polymerase chain reaction.
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Affiliation(s)
- Zhanwei Wang
- Department of Breast Surgery, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Hao Deng
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Jin
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Meng Luo
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia Huang
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Wang
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kun Zhang
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Wang
- Department of Emergency, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaojiao Zhou
- The Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Zhejiang University School of Medicine, Hangzhou, China
- Department of Breast Surgery and Oncology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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6
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Cai SL, Liu JJ, Liu YX, Yu SH, Liu X, Lin XQ, Chen HD, Fang X, Ma T, Li YQ, Li Y, Li CY, Zhang S, Chen XG, Guo XJ, Zhang J. Characteristics of recurrence, predictors for relapse and prognosis of rapid relapse triple-negative breast cancer. Front Oncol 2023; 13:1119611. [PMID: 36874102 PMCID: PMC9978400 DOI: 10.3389/fonc.2023.1119611] [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: 12/09/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023] Open
Abstract
Background Triple-negative breast cancer (TNBC) patients who recur at different times are associated with distinct biological characteristics and prognoses. Research on rapid-relapse TNBC (RR-TNBC) is sparse. In this study, we aimed to describe the characteristics of recurrence, predictors for relapse, and prognosis in rrTNBC patients. Methods Clinicopathological data of 1584 TNBC patients from 2014 to 2016 were retrospectively reviewed. The characteristics of recurrence were compared between patients with RR-TNBC and slow relapse TNBC(SR-TNBC). All TNBC patients were randomly divided into a training set and a validation set to find predictors for rapid relapse. The multivariate logistic regression model was used to analyze the data of the training set. C-index and brier score analysis for predicting rapid relapse in the validation set was used to evaluate the discrimination and accuracy of the multivariate logistic model. Prognostic measurements were analyzed in all TNBC patients. Results Compared with SR-TNBC patients, RR-TNBC patients tended to have a higher T staging, N staging, TNM staging, and low expression of stromal tumor-infiltrating lymphocytes (sTILs). The recurring characteristics were prone to appear as distant metastasis at the first relapse. The first metastatic site was apt to visceral metastasis and less likely to have chest wall or regional lymph node metastasis. Six predictors (postmenopausal status, metaplastic breast cancer,≥pT3 staging,≥pN1 staging, sTIL intermediate/high expression, and Her2 [1+]) were used to construct the predictive model of rapid relapse in TNBC patients. The C-index and brier score in the validation set was 0.861 and 0.095, respectively. This suggested that the predictive model had high discrimination and accuracy. The prognostic data for all TNBC patients showed that RR-TNBC patients had the worst prognosis, followed by SR-TNBC patients. Conclusion RR-TNBC patients were associated with unique biological characteristics and worse outcomes compared to non-RR-TNBC patients.
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Affiliation(s)
- Shuang-Long Cai
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Jing-Jing Liu
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Ying-Xue Liu
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Shao-Hong Yu
- College of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Xu Liu
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Xiu-Quan Lin
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Hong-Dan Chen
- First Department of Cadre Clinic, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xuan Fang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Tao Ma
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Ya-Qing Li
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Department of Oncological Surgery, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Ying Li
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Chun-Yan Li
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Sheng Zhang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
| | - Xiao-Geng Chen
- Department of Oncological Surgery, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiao-Jing Guo
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jin Zhang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
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7
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Li Y, Ma R, Chen H, Pu S, Xie P, He J, Zhang H. A Novel Risk-Scoring System to Identify the Potential Population Benefiting From Adjuvant Chemotherapy for Node-Negative TNBC Patients With Tumor Size Less Than 1 cm. Front Oncol 2022; 12:788883. [PMID: 35814418 PMCID: PMC9260021 DOI: 10.3389/fonc.2022.788883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 05/25/2022] [Indexed: 12/31/2022] Open
Abstract
Background and ObjectivesWhether chemotherapy is needed in node-negative triple-negative breast cancer (TNBC) patients with tumor size less than 1 cm is still controversial. In our research, we constructed a novel risk-scoring system to identify the potential TNBC patients benefiting from adjuvant chemotherapy in T1miN0M0, T1aN0M0, and T1bN0M0 stages.MethodsRelevant data were extracted from the SEER database. We applied Kaplan-Meier curves and the Cox hazards model for survival analysis and developed a nomogram of overall survival. The X-tile software was used for risk stratification. The information of TNBC patients treated in the First Affiliated Hospital of Xi’an Jiaotong University was used for the application of the model.ResultsA total of 4266 patients who met the criteria of our study were included. T stage, age, race, surgery, and radiotherapy state were used to create the nomogram of overall survival. According to the total risk score, the patients were divided into high-risk (score g 73), median-risk (38 ≤ score < 73), and low-risk (score <38) groups. Chemotherapy can prolong the overall survival of patients in the median-risk and high-risk groups, while patients in the low-risk group can be exempted from chemotherapy. In addition, we also used the risk-scoring system in real-world patients as application and verification.ConclusionWe constructed a novel risk-scoring system that can be used as a chemotherapy decision-making tool for node-negative TNBC patients with tumor size less than 1 cm. Tumor size should not be the only criterion for chemotherapy treatment decision-making.
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Affiliation(s)
- Yijun Li
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Rulan Ma
- Department of Surgical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Heyan Chen
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shengyu Pu
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Peiling Xie
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jianjun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Jianjun He, ; Huimin Zhang,
| | - Huimin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Jianjun He, ; Huimin Zhang,
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8
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Hjorth CF, Damkier P, Ejlertsen B, Lash T, Sørensen HT, Cronin-Fenton D. Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark. BMC Med 2021; 19:235. [PMID: 34587961 PMCID: PMC8482675 DOI: 10.1186/s12916-021-02108-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To investigate how socioeconomic position (SEP) influences the effectiveness of cancer-directed treatment in premenopausal breast cancer patients in terms of breast cancer recurrence and mortality. METHODS We conducted a cohort study nested in the ProBeCaRe (Predictors of Breast Cancer Recurrence) cohort (n = 5959). We identified all premenopausal women aged 18-55 years diagnosed with non-metastatic breast cancer and prescribed docetaxel-based chemotherapy in Denmark during 2007-2011. Population-based administrative registries provided data on SEP: marital status (married including registered partnership or single including divorced or widowed), cohabitation (cohabiting or living alone), education (low, intermediate, or high), income (low, medium, or high), and employment status (employed, unemployed, or health-related absenteeism). For each SEP measure, we computed incidence rates, cumulative incidence proportions (CIPs), and used Poisson regression to compute incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of recurrence and death. We stratified on estrogen receptor (ER) status/tamoxifen to evaluate interaction. RESULTS Our study cohort included 2616 women; 286 (CIP 13%) experienced recurrence and 223 (CIP 11%) died during follow-up (median 6.6 and 7.2 years, respectively). Single women had both increased 5-year risks of recurrence (IRR 1.45, 95% CI 1.11-1.89) and mortality (IRR 1.83, 95% CI 1.32-2.52). Furthermore, we observed increased 5-year mortality in women with low education (IRR 1.49, 95% CI 0.95-2.33), low income (IRR 1.37, 95% CI 0.83-2.28), unemployment (IRR 1.61, 95% CI 0.83-3.13), or health-related work absenteeism (IRR 1.80, 95% CI 1.14-2.82), but smaller or no increased risk of recurrence. These findings were especially evident among women with ER+ tumors prescribed tamoxifen. Overall analyses (follow-up max. 10 years) provided similar results. CONCLUSIONS Low SEP in premenopausal women with non-metastatic breast cancer was associated with increased mortality, but not always recurrence. This suggests underdetection of recurrences in certain groups. Poor prognosis in women with low SEP, especially single women, may partly be explained by tamoxifen adherence.
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Affiliation(s)
- Cathrine Fonnesbech Hjorth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, J.B. Winsløvs vej 4, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, Winsløwparken 19, University of Southern Denmark, 5000, Odense, Denmark
| | - Bent Ejlertsen
- Danish Breast Cancer Group, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Oncology, University of Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark
| | - Timothy Lash
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
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Zhang Y, Asad S, Weber Z, Tallman D, Nock W, Wyse M, Bey JF, Dean KL, Adams EJ, Stockard S, Singh J, Winer EP, Lin NU, Jiang YZ, Ma D, Wang P, Shi L, Huang W, Shao ZM, Cherian M, Lustberg MB, Ramaswamy B, Sardesai S, VanDeusen J, Williams N, Wesolowski R, Obeng-Gyasi S, Sizemore GM, Sizemore ST, Verschraegen C, Stover DG. Genomic features of rapid versus late relapse in triple negative breast cancer. BMC Cancer 2021; 21:568. [PMID: 34006255 PMCID: PMC8130400 DOI: 10.1186/s12885-021-08320-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
Background Triple-negative breast cancer (TNBC) is a heterogeneous disease and we have previously shown that rapid relapse of TNBC is associated with distinct sociodemographic features. We hypothesized that rapid versus late relapse in TNBC is also defined by distinct clinical and genomic features of primary tumors. Methods Using three publicly-available datasets, we identified 453 patients diagnosed with primary TNBC with adequate follow-up to be characterized as ‘rapid relapse’ (rrTNBC; distant relapse or death ≤2 years of diagnosis), ‘late relapse’ (lrTNBC; > 2 years) or ‘no relapse’ (nrTNBC: > 5 years no relapse/death). We explored basic clinical and primary tumor multi-omic data, including whole transcriptome (n = 453), and whole genome copy number and mutation data for 171 cancer-related genes (n = 317). Association of rapid relapse with clinical and genomic features were assessed using Pearson chi-squared tests, t-tests, ANOVA, and Fisher exact tests. We evaluated logistic regression models of clinical features with subtype versus two models that integrated significant genomic features. Results Relative to nrTNBC, both rrTNBC and lrTNBC had significantly lower immune signatures and immune signatures were highly correlated to anti-tumor CD8 T-cell, M1 macrophage, and gamma-delta T-cell CIBERSORT inferred immune subsets. Intriguingly, lrTNBCs were enriched for luminal signatures. There was no difference in tumor mutation burden or percent genome altered across groups. Logistic regression mModels that incorporate genomic features significantly outperformed standard clinical/subtype models in training (n = 63 patients), testing (n = 63) and independent validation (n = 34) cohorts, although performance of all models were overall modest. Conclusions We identify clinical and genomic features associated with rapid relapse TNBC for further study of this aggressive TNBC subset. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08320-7.
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Affiliation(s)
- Yiqing Zhang
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Sarah Asad
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Zachary Weber
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - David Tallman
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - William Nock
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Meghan Wyse
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Jerome F Bey
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Kristin L Dean
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Elizabeth J Adams
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Sinclair Stockard
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Jasneet Singh
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Eric P Winer
- Department of Medical Oncology, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nancy U Lin
- Department of Medical Oncology, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Yi-Zhou Jiang
- Department of Breast Surgery, Precision Cancer Medicine Center, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, P.R. China
| | - Ding Ma
- Department of Breast Surgery, Precision Cancer Medicine Center, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, P.R. China
| | - Peng Wang
- Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai, 200031, P.R. China
| | - Leming Shi
- State Key Laboratory of Genetic Engineering, School of Life Sciences and Human Phenome Institute, Fudan University, 2005 Songhu Road, Shanghai, 200438, P.R. China
| | - Wei Huang
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai (CHGC) and Shanghai Industrial Technology Institute (SITI), 250 Bibo Road, Shanghai, 201203, P.R. China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Precision Cancer Medicine Center, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, P.R. China
| | - Mathew Cherian
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Maryam B Lustberg
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Bhuvaneswari Ramaswamy
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Sagar Sardesai
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Jeffrey VanDeusen
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Nicole Williams
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Robert Wesolowski
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Samilia Obeng-Gyasi
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Gina M Sizemore
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Steven T Sizemore
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Claire Verschraegen
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Daniel G Stover
- Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA. .,Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, 460 W 10th Ave, Columbus, OH, 43210, USA. .,Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA. .,Stefanie Spielman Comprehensive Breast Center, 1145 Olentangy River Rd, Columbus, OH, 43212, USA. .,Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 512, Columbus, OH, 43210, USA.
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