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Plichta JK, Thomas SM, Wang X, McDuff SGR, Kimmick G, Hwang ES. Survival among patients with untreated metastatic breast cancer: "What if I do nothing?". Breast Cancer Res Treat 2024; 205:333-347. [PMID: 38438700 PMCID: PMC11102301 DOI: 10.1007/s10549-024-07265-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/19/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE We sought to assess survival outcomes of patients with de novo metastatic breast cancer (dnMBC) who did not receive treatment irrespective of the reason. METHODS Adults with dnMBC were selected from the NCDB (2010-2016) and stratified based on receipt of treatment (treated = received at least one treatment and untreated = received no treatments). Overall survival (OS) was estimated using the Kaplan-Meier method, and groups were compared. Cox proportional hazards models were used to identify factors associated with OS. RESULTS Of the 53,240 patients with dnMBC, 92.1% received at least one treatment (treated), and 7.9% had no documented treatments, irrespective of the reason (untreated). Untreated patients were more likely to be older (median 68 y vs 61 y, p < 0.001), have higher comorbidity scores (p < 0.001), have triple-negative disease (17.8% vs 12.6%), and a higher disease burden (≥ 2 metastatic sites: 38.2% untreated vs 29.2% treated, p < 0.001). The median unadjusted OS in the untreated subgroup was 2.5 mo versus 36.4 mo in the treated subgroup (p < 0.001). After adjustment, variables associated with a worse OS in the untreated cohort included older age, higher comorbidity scores, higher tumor grade, and triple-negative (vs HR + /HER2-) subtype (all p < 0.05), while the number of metastatic sites was not associated with survival. CONCLUSIONS Patients with dnMBC who do not receive treatment are more likely to be older, present with comorbid conditions, and have clinically aggressive disease. Similar to those who do receive treatment, survival in an untreated population is associated with select patient and disease characteristics. However, the prognosis for untreated dnMBC is dismal.
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Affiliation(s)
- Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, DUMC 3513, Durham, NC, 27710, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Durham, NC, USA.
| | - Samantha M Thomas
- Duke Cancer Institute, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Xuanji Wang
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Susan G R McDuff
- Duke Cancer Institute, Durham, NC, USA
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Gretchen Kimmick
- Duke Cancer Institute, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, DUMC 3513, Durham, NC, 27710, USA
- Duke Cancer Institute, Durham, NC, USA
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Watt KD, Rolak S, Foley DP, Plichta JK, Pruthi S, Farr D, Zwald FO, Carvajal RD, Dudek AZ, Sanger CB, Rocco R, Chang GJ, Dizon DS, Langstraat CL, Teoh D, Agarwal PK, Al-Qaoud T, Eggener S, Kennedy CC, D'Cunha J, Mohindra NA, Stewart S, Habermann TH, Schuster S, Lunning M, Shah NN, Gertz MA, Mehta J, Suvannasankha A, Verna E, Farr M, Blosser CD, Hammel L, Al-Adra DP. Cancer Surveillance in Solid Organ Transplant Recipients With a Pretransplant History of Malignancy: Multidisciplinary Collaborative Expert Opinion. Transplantation 2024:00007890-990000000-00757. [PMID: 38771067 DOI: 10.1097/tp.0000000000005056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
With improved medical treatments, the prognosis for many malignancies has improved, and more patients are presenting for transplant evaluation with a history of treated cancer. Solid organ transplant (SOT) recipients with a prior malignancy are at higher risk of posttransplant recurrence or de novo malignancy, and they may require a cancer surveillance program that is individualized to their specific needs. There is a dearth of literature on optimal surveillance strategies specific to SOT recipients. A working group of transplant physicians and cancer-specific specialists met to provide expert opinion recommendations on optimal cancer surveillance after transplantation for patients with a history of malignancy. Surveillance strategies provided are mainly based on general population recurrence risk data, immunosuppression effects, and limited transplant-specific data and should be considered expert opinion based on current knowledge. Prospective studies of cancer-specific surveillance models in SOT recipients should be supported to inform posttransplant management of this high-risk population.
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Affiliation(s)
| | - Stacey Rolak
- Department of Medicine, Mayo Clinic, Rochester, MN
| | - David P Foley
- Department of Surgery, University of Wisconsin, Madison, WI
| | | | | | - Deborah Farr
- Department of Surgery, University of Texas Southwestern, Dallas, TX
| | - Fiona O Zwald
- Department of Dermatology, Colorado University School of Medicine, Aurora, CO
| | - Richard D Carvajal
- Department of Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | | | - Cristina B Sanger
- Department of Surgery, University of Wisconsin, Madison, WI
- Department of Surgery, William S.Middleton Memorial Veteran's Hospital, Madison, WI
| | - Ricciardi Rocco
- Department of Surgery, Massachusetts General Hospital, Boston MA
| | - George J Chang
- Department of Colon and Rectal Surgery, University of Texas, MD Anderson Cancer Center, Dallas, TX
| | - Don S Dizon
- Department of Medicine, Lifespan Cancer Institute and Brown University, Providence, RI
| | | | - Deanna Teoh
- Department of Obstetrics and Gynecology and Women's Health, University of Minnesota, Minneapolis, MN
| | - Piyush K Agarwal
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL
| | - Talal Al-Qaoud
- Department of Surgery, Medstar Georgetown Transplant Institute, Georgetown University Hospital, Washington DC
| | - Scott Eggener
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL
| | | | | | - Nisha A Mohindra
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shelby Stewart
- Department of Thoracic Surgery, University of Maryland, Baltimore, MD
| | | | - Stephen Schuster
- Department of Medicine, Lymphoma Program, Abraham Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Matthew Lunning
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Nirav N Shah
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Jayesh Mehta
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Attaya Suvannasankha
- Department of Medicine, Indiana University School of Medicine and Roudebush VAMC, Indianapolis, IN
| | | | - Maryjane Farr
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christopher D Blosser
- Department of Medicine, University of Washington and Seattle Children's Hospital, Seattle WA
| | - Laura Hammel
- Department of Anesthesiology, University of Wisconsin, Madison, WI
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Woriax HE, Thomas SM, Plichta JK, Rosenberger LH, Botty van den Bruele A, Chiba A, Hwang ES, DiNome ML. Racial/Ethnic Disparities in Pathologic Complete Response and Overall Survival in Patients With Triple-Negative Breast Cancer Treated With Neoadjuvant Chemotherapy. J Clin Oncol 2024; 42:1635-1645. [PMID: 38394476 PMCID: PMC11095870 DOI: 10.1200/jco.23.01199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 12/03/2023] [Accepted: 12/15/2023] [Indexed: 02/25/2024] Open
Abstract
PURPOSE Black women have higher rates of death from triple-negative breast cancer (TNBC) than White women. We hypothesized that pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) and overall survival (OS) may vary by race/ethnicity in patients with TNBC. METHODS We identified women 18 years and older with stage I-III TNBC who received NAC followed by surgery from the National Cancer Database (2010-2019). We excluded patients without race/ethnicity or pathology data. Primary outcomes were pCR rates and OS on the basis of race/ethnicity. RESULTS Forty thousand eight hundred ninety women with TNBC met inclusion criteria (median age [IQR], 53 [44-61] years): 26,150 Non-Hispanic White (64%, NHW), 9,672 Non-Hispanic Black (23.7%, NHB), 3,267 Hispanic (8%), 1,368 Non-Hispanic Asian (3.3%, NHA), and 433 Non-Hispanic Other (1.1%, NHO) patients. Overall, 29.8% demonstrated pCR (NHW: 30.5%, NHB: 27%, Hispanic: 32.6%, NHA: 28.8%, NHO: 29.8%). Unadjusted OS was significantly higher for those with pCR compared with those with residual disease (5-year OS, 0.917 [95% CI, 0.911 to 0.923] v 0.667 [95% CI, 0.661 to 0.673], log-rank P < .001), and this association persisted after adjustment for demographic and tumor factors. The effect of achieving pCR on OS did not differ by race/ethnicity (interaction P = .10). However, NHB patients were less likely (odds ratio [OR], 0.89 [95% CI, 0.83 to 0.95], P = .001) and Hispanic patients were more likely (OR, 1.19 [95% CI, 1.08 to 1.31], P = .001) to achieve pCR than NHW patients. After adjustment for patient and disease factors, including achievement of pCR, Hispanic (hazard ratio [HR], 0.76 [95% CI, 0.69 to 0.85], P < .001) and NHA (HR, 0.64 [95% CI, 0.55 to 0.75], P < .001) race/ethnicity remained associated with OS. CONCLUSION Odds of achieving pCR and OS in patients with TNBC appear to be associated with race/ethnicity. Additional research is necessary to understand how race/ethnicity is associated with rates of pCR and OS, whether related to socioeconomic factors or biologic variables, or both.
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Affiliation(s)
- Hannah E. Woriax
- Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - Samantha M. Thomas
- Duke Cancer Institute, Durham, NC
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Jennifer K. Plichta
- Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - Laura H. Rosenberger
- Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - Astrid Botty van den Bruele
- Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - Akiko Chiba
- Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - E. Shelley Hwang
- Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - Maggie L. DiNome
- Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC
- Duke Cancer Institute, Durham, NC
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Dalton JC, Plichta JK. Paget's disease of the breast: Insights from imaging to guide surgical management. Am J Surg 2024; 231:16-17. [PMID: 38521673 DOI: 10.1016/j.amjsurg.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/09/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Juliet C Dalton
- Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27707, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27707, USA; Duke Cancer Institute, Duke University, 10 Bryan Searle Drive, Durham, NC, 27710, USA; Department of Population Health Sciences, Duke University Medical Center, 215 Morris St, Durham, NC, 27701, USA.
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Record SM, Thomas SM, Tian WM, van den Bruele AB, Chiba A, DiLalla G, DiNome ML, Kimmick G, Rosenberger LH, Woriax HE, Hwang ES, Plichta JK. Anatomy Versus Biology: What Guides Chemotherapy Decisions in Older Patients With Breast Cancer? J Surg Res 2024; 296:654-664. [PMID: 38359680 PMCID: PMC10947834 DOI: 10.1016/j.jss.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION With the increasing utilization of genomic assays, such as the Oncotype DX recurrence score (RS), the relevance of anatomic staging has been questioned for select older patients with breast cancer. We sought to evaluate differences in chemotherapy receipt and/or survival among older patients based on RS and sentinel lymph node biopsy (SLNB) receipt/result. METHODS Patients aged ≥ 65 diagnosed with pT1-2/cN0/M0 hormone-receptor-positive (HR+)/HER2-breast cancer (2010-2019) were selected from the National Cancer Database. Logistic regression was used to identify factors associated with chemotherapy receipt. Cox proportional hazards models were used to estimate the association of RS/SLNB group with overall survival. A cost-benefit study was also performed. RESULTS Of the 75,428 patients included, the majority had an intermediate RS (58.2% versus 27.9% low, 13.8% high) and were SLNB- (85.1% versus 11.6% SLNB+, 3.3% none). Chemotherapy was recommended for 13,442 patients (17.8%). After adjustment, chemotherapy receipt was more likely with higher RS and SLNB+. After adjustment, SLNB receipt/result was only associated with overall survival among those with an intermediate RS. However, returning to the OR for SLNB is not cost-effective. CONCLUSIONS SLNB receipt/result was associated with survival for those with an intermediate RS, but not a low or high RS, suggesting that an SLNB may indeed be unnecessary for select older patients with breast cancer.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, North Carolina; Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - William M Tian
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Astrid Botty van den Bruele
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Gayle DiLalla
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Maggie L DiNome
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Gretchen Kimmick
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Hannah E Woriax
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina.
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Singh P, Agnese D, Amin M, Barrio AV, Botty Van den Bruele A, Burke E, Danforth DN, Dirbas FM, Eladoumikdachi F, Kantor O, Kumar S, Lee MC, Matsen C, Nguyen TT, Ozmen T, Park KU, Plichta JK, Reyna C, Showalter SL, Styblo T, Tranakas N, Weiss A, Laronga C, Boughey J. Society of Surgical Oncology Breast Disease Site Working Group Statement on Contralateral Mastectomy: Indications, Outcomes, and Risks. Ann Surg Oncol 2024; 31:2212-2223. [PMID: 38261126 DOI: 10.1245/s10434-024-14893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
Rates of contralateral mastectomy (CM) among patients with unilateral breast cancer have been increasing in the United States. In this Society of Surgical Oncology position statement, we review the literature addressing the indications, risks, and benefits of CM since the society's 2017 statement. We held a virtual meeting to outline key topics and then conducted a literature search using PubMed to identify relevant articles. We reviewed the articles and made recommendations based on group consensus. Patients consider CM for many reasons, including concerns regarding the risk of contralateral breast cancer (CBC), desire for improved cosmesis and symmetry, and preferences to avoid ongoing screening, whereas surgeons primarily consider CBC risk when making a recommendation for CM. For patients with a high risk of CBC, CM reduces the risk of new breast cancer, however it is not known to convey an overall survival benefit. Studies evaluating patient satisfaction with CM and reconstruction have yielded mixed results. Imaging with mammography within 12 months before CM is recommended, but routine preoperative breast magnetic resonance imaging is not; there is also no evidence to support routine postmastectomy imaging surveillance. Because the likelihood of identifying an occult malignancy during CM is low, routine sentinel lymph node surgery is not recommended. Data on the rates of postoperative complications are conflicting, and such complications may not be directly related to CM. Adjuvant therapy delays due to complications have not been reported. Surgeons can reduce CM rates by encouraging shared decision making and informed discussions incorporating patient preferences.
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Affiliation(s)
- Puneet Singh
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | | | - Andrea V Barrio
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | - Erin Burke
- University of Kentucky, Lexington, KY, USA
| | | | | | | | - Olga Kantor
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Shicha Kumar
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | | | - Tolga Ozmen
- Massachusetts General Hospital, Boston, MA, USA
| | - Ko Un Park
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Anna Weiss
- University of Rochester Medical Center, Rochester, NY, USA
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Ntowe KW, Lee MS, Plichta JK. Clinical genetics in breast cancer. J Surg Oncol 2024. [PMID: 38557982 DOI: 10.1002/jso.27630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
As genetic testing becomes increasingly more accessible and more applicable with a broader range of clinical implications, it may also become more challenging for breast cancer providers to remain up-to-date. This review outlines some of the current clinical guidelines and recent literature surrounding germline genetic testing, as well as genomic testing, in the screening, prevention, diagnosis, and treatment of breast cancer, while identifying potential areas of further research.
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Affiliation(s)
- Koumani W Ntowe
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael S Lee
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Kirsch EP, Kunte SA, Wu KA, Kaplan S, Hwang ES, Plichta JK, Lad SP. Digital Health Platforms for Breast Cancer Care: A Scoping Review. J Clin Med 2024; 13:1937. [PMID: 38610702 PMCID: PMC11012307 DOI: 10.3390/jcm13071937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
Breast cancer is a significant global health concern affecting millions of women each year. Digital health platforms are an easily accessible intervention that can improve patient care, though their efficacy in breast cancer care is unknown. This scoping review aims to provide an overview of existing research on the utilization of digital health platforms for breast cancer care and identify key trends and gaps in the literature. A comprehensive literature search was conducted across electronic databases, including Ovid MEDLINE, Elsevier EMBASE, and Elsevier Scopus databases. The search strategy incorporated keywords related to "digital health platforms", "breast cancer care", and associated terminologies. After screening for eligibility, a total of 25 articles were included in this scoping review. The identified studies comprised mobile applications and web-based interventions. These platforms demonstrated various functionalities, including patient education, symptom monitoring, treatment adherence, and psychosocial support. The findings indicate the potential of digital health platforms in improving breast cancer care and patients' overall experiences. The positive impact on patient outcomes, including improved quality of life and reduced psychological distress, underscores the importance of incorporating digital health solutions into breast cancer management. Additional research is necessary to validate the effectiveness of these platforms in diverse patient populations and assess their impact on healthcare-resource utilization.
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Affiliation(s)
- Elayna P. Kirsch
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Sameer A. Kunte
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Kevin A. Wu
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Samantha Kaplan
- Medical Center Library & Archives, Duke University School of Medicine, Durham, NC 27710, USA
| | - E. Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA (J.K.P.)
| | - Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA (J.K.P.)
| | - Shivanand P. Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
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Bedrosian I, Somerfield MR, Achatz MI, Boughey JC, Curigliano G, Friedman S, Kohlmann WK, Kurian AW, Laronga C, Lynce F, Norquist BS, Plichta JK, Rodriguez P, Shah PD, Tischkowitz M, Wood M, Yadav S, Yao K, Robson ME. Germline Testing in Patients With Breast Cancer: ASCO-Society of Surgical Oncology Guideline. J Clin Oncol 2024; 42:584-604. [PMID: 38175972 DOI: 10.1200/jco.23.02225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE To develop recommendations for germline mutation testing for patients with breast cancer. METHODS An ASCO-Society of Surgical Oncology (SSO) panel convened to develop recommendations based on a systematic review and formal consensus process. RESULTS Forty-seven articles met eligibility criteria for the germline mutation testing recommendations; 18 for the genetic counseling recommendations. RECOMMENDATIONS BRCA1/2 mutation testing should be offered to all newly diagnosed patients with breast cancer ≤65 years and select patients >65 years based on personal history, family history, ancestry, or eligibility for poly(ADP-ribose) polymerase (PARP) inhibitor therapy. All patients with recurrent breast cancer who are candidates for PARP inhibitor therapy should be offered BRCA1/2 testing, regardless of family history. BRCA1/2 testing should be offered to women who develop a second primary cancer in the ipsilateral or contralateral breast. For patients with prior history of breast cancer and without active disease, testing should be offered to patients diagnosed ≤65 years and selectively in patients diagnosed after 65 years, if it will inform personal and family risk. Testing for high-penetrance cancer susceptibility genes beyond BRCA1/2 should be offered to those with supportive family histories; testing for moderate-penetrance genes may be offered if necessary to inform personal and family cancer risk. Patients should be provided enough pretest information for informed consent; those with pathogenic variants should receive individualized post-test counseling. Variants of uncertain significance should not impact management, and patients with such variants should be followed for reclassification. Referral to providers experienced in clinical cancer genetics may help facilitate patient selection and interpretation of expanded testing, and provide counseling of individuals without pathogenic germline variants but with significant family history.Additional information is available at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
| | | | | | | | - Giuseppe Curigliano
- University of Milan, Italy
- European Institute of Oncology, IRCCS, Milano, Italy
| | - Sue Friedman
- FORCE (Facing Our Risk of Cancer Empowered), Tampa, FL
| | - Wendy K Kohlmann
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT
| | | | | | | | | | | | - Patricia Rodriguez
- Hereditary Cancer Risk Assessment Program, Virginia Cancer Specialists, Arlington, VA
| | - Payal D Shah
- Basser Center for BRCA & Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Katherine Yao
- Division of Surgical Oncology at NorthShore University Health System, Evanston, IL
| | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, NY
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10
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Botty van den Bruele A, Paul MA, Thomas SM, Sammons SL, DiNome ML, Plichta JK, Record SM, Woriax H, Chiba A, Rosenberger LH, Hwang ES. Axillary nodal disease burden is not associated with an elevated 21-gene recurrence score in post-menopausal women presenting with a clinically negative axilla. Am J Surg 2024:S0002-9610(24)00067-9. [PMID: 38350748 DOI: 10.1016/j.amjsurg.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The predictive and prognostic value of the recurrence score (RS) has emphasized the importance of tumor biology and has reduced the prognostic implications of limited nodal burden in post-menopausal women with HR+/HER2-invasive breast cancer (IBC). It is unclear whether routine axillary staging has a continued role in the management of small, clinically node negative (cN0) HR+/HER2- IBC. We sought to estimate the association of RS with pN stage. METHODS Patients >50yo diagnosed with cN0, HR+/HER2- IBC (2015-2019) with an available RS were identified from the National Cancer Database. The clinicopathologic characteristics and rates of pN-stage (pN0, pN1, pN2/3) were compared for RS of ≤25 vs. >25. RESULTS The median patient age was 64.1 (IQR 58-69) and the majority (75%) of tumors displayed ductal histology. Most (81.6%) were cT1 on presentation and pT1 (74.7%) on final pathology. There were 130,568 (86.2%) with a RS ≤ 25 and 20,879 (13.8%) with a RS > 25. On final pathology, 128,995 (85.2%) were pN0 and 21,991 (14.5%) pN1. Of the pN1, 2699 (12.3%) yielded a RS > 25. There were 461 (0.3%) patients with pN2-pN3 disease. Of those, 57 (12.4%) had RS > 25. CONCLUSION In our analysis, pN0 and pN1 tumors are biologically similar by gene expression assay in postmenopausal patients with similar proportions of high RS. These data support the notion that tumor biology examined via RS may have more prognostic and predictive value than metastatic dissemination to limited lymph nodes. These findings support the ongoing evaluation of routine axillary staging in postmenopausal patients with HR+/HER2- IBC.
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Affiliation(s)
- Astrid Botty van den Bruele
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA.
| | - Morgan A Paul
- Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Sarah L Sammons
- Department of Medicine, Dana Farber Cancer Institute, Boston, MA, USA
| | - Maggie L DiNome
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Sydney M Record
- Department of Surgery, Duke University, Durham, NC, USA; Department of Medicine, Dana Farber Cancer Institute, Boston, MA, USA
| | - Hannah Woriax
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Akiko Chiba
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
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11
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Weaver ML, Drudi LM, Adams AM, Faria I, Feldman HA, Gudmundsdottir H, Marmor H, Miles MVP, Ochoa B, Ruff SM, Sundland R, Tonelli C, Altieri MS, Cannada LK, Dewan K, Etkin Y, Marmor R, Plichta JK, Reyna C, Tatebe LC, Hicks CW. Implementation of a novel peer review academy by Surgery and the Association of Women Surgeons. Surgery 2024; 175:323-330. [PMID: 37953152 PMCID: PMC10842028 DOI: 10.1016/j.surg.2023.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/28/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND A novel Peer Review Academy was developed as a collaborative effort between the Association of Women Surgeons and the journal Surgery to provide formal training in peer review. We aimed to describe the outcomes of this initiative using a mixed methods approach. METHODS We developed a year-long curriculum with monthly online didactic sessions. Women surgical trainee mentees were paired 1:1 with rotating women surgical faculty mentors for 3 formal peer review opportunities. We analyzed pre-course and post-course surveys to evaluate mentee perceptions of the academy and assessed changes in mentee review quality over time with blinded scoring of unedited reviews. Semi-structured interviews were conducted upon course completion. RESULTS Ten women surgical faculty mentors and 10 women surgical trainees from across the United States and Canada successfully completed the Peer Review Academy. There were improvements in the mentees' confidence for all domains of peer review evaluated, including overall confidence in peer review, study novelty, study design, analytic approach, and review formatting (all, P ≤ .02). The mean score of peer review quality increased over time (59.2 ± 10.8 vs 76.5 ± 9.4; P = .02). In semi-structured interviews, important elements were emphasized across the Innovation, Implementation Process, and Individuals Domains, including the values of (1) a comprehensive approach to formal peer review education; (2) mentoring relationships between women faculty and resident surgeons; and (3) increasing diversity in the scientific peer review process. CONCLUSION Our novel Peer Review Academy was feasible on a national scale, resulting in significant qualitative and quantitative improvements in women surgical trainee skillsets, and has the potential to grow and diversify the existing peer review pool.
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Affiliation(s)
- M Libby Weaver
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Isabella Faria
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Hope A Feldman
- Department of General Surgery, Geisinger Medical Center, Danville, PA
| | | | - Hannah Marmor
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY
| | - M Victoria P Miles
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brielle Ochoa
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Samantha M Ruff
- Division of Surgical Oncology, The Ohio State University, Columbus, OH
| | | | - Celsa Tonelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA
| | - Lisa K Cannada
- Novant Health Fracture Clinic, University of North Carolina-Charlotte School of Medicine, Charlotte, NC
| | - Karuna Dewan
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University, New Orleans, LA
| | - Yana Etkin
- Division of Vascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Rebecca Marmor
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Chantal Reyna
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Leah C Tatebe
- Department of Surgery, Northwestern University, Chicago, IL
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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12
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Li H, Plichta JK, Li K, Jin Y, Thomas SM, Ma F, Tang L, Wei Q, He YW, Chen Q, Guo Y, Liu Y, Zhang J, Luo S. Impact of HER2-low status for patients with early-stage breast cancer and non-pCR after neoadjuvant chemotherapy: a National Cancer Database Analysis. Breast Cancer Res Treat 2024; 204:89-105. [PMID: 38066250 DOI: 10.1007/s10549-023-07171-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/02/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE To investigate potential differences in pathological complete response (pCR) rates and overall survival (OS) between HER2-low and HER2-zero patients with early-stage hormone receptor (HR)-positive and triple-negative breast cancer (TNBC), in the neoadjuvant chemotherapy setting. METHODS We identified early-stage invasive HER2-negative BC patients who received neoadjuvant chemotherapy diagnosed between 2010 and 2018 in the National Cancer Database. HER2-low was defined by immunohistochemistry (IHC) 1+ or 2+ with negative in situ hybridization, and HER2-zero by IHC0. All the methods were applied separately in the HR-positive and TNBC cohorts. Logistic regression was used to estimate the association of HER2 status with pCR (i.e. ypT0/Tis and ypN0). Kaplan-Meier method and Cox proportional hazards model were applied to estimate the association of HER2 status with OS. Inverse probability weighting and/or multivariable regression were applied to all analyses. RESULTS For HR-positive patients, 70.9% (n = 17,934) were HER2-low, whereas 51.1% (n = 10,238) of TNBC patients were HER2-low. For both HR-positive and TNBC cohorts, HER2-low status was significantly associated with lower pCR rates [HR-positive: 5.0% vs. 6.7%; weighted odds ratio (OR) = 0.81 (95% CI: 0.72-0.91), p < 0.001; TNBC: 21.6% vs. 24.4%; weighted OR = 0.91 (95% CI: 0.85-0.98), p = 0.007] and improved OS [HR-positive: weighted hazard ratio = 0.85 (95% CI: 0.79-0.91), p < 0.001; TNBC: weighted hazard ratio = 0.91 (95% CI: 0.86-0.96), p < 0.001]. HER2-low status was associated with favorable OS among patients not achieving pCR [HR-positive: adjusted hazard ratio = 0.83 (95% CI: 0.77-0.89), p < 0.001; TNBC: adjusted hazard ratio = 0.88 (95% CI 0.83-0.94), p < 0.001], while no significant difference in OS was observed in patients who achieved pCR [HR-positive: adjusted hazard ratio = 1.00 (95% CI: 0.61-1.63), p > 0.99; TNBC: adjusted hazard ratio = 1.11 (95% CI: 0.85-1.45), p = 0.44]. CONCLUSION In both early-stage HR-positive and TNBC patients, HER2-low status was associated with lower pCR rates. HER2-zero status might be considered an adverse prognostic factor for OS in patients not achieving pCR.
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Affiliation(s)
- Huiyue Li
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Jennifer K Plichta
- Duke Cancer Institute, Duke University, Durham, NC, 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Kan Li
- Merck & Co., Inc., Rahway, NJ, USA
| | - Yizi Jin
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Department of Phase I Clinical Trial Center, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Shanghai, 200032, China
| | - Samantha M Thomas
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA
- Duke Cancer Institute, Duke University, Durham, NC, 27710, USA
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Tang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Qingyi Wei
- Duke Cancer Institute, Duke University, Durham, NC, 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - You-Wen He
- Department of Integrative Immunobiology, Duke University School of Medicine, Durham, NC, USA
| | - Qichen Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanyuan Guo
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Yueping Liu
- Department of Pathology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jian Zhang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Department of Phase I Clinical Trial Center, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Shanghai, 200032, China.
| | - Sheng Luo
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA.
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13
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Dalton JC, Chiba A, Plichta JK. The Evolving Era of Breast Cancer Risk Assessment in Benign Breast Disease. JAMA Surg 2024; 159:201-202. [PMID: 38091019 DOI: 10.1001/jamasurg.2023.6389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Juliet C Dalton
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina
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14
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Record SM, Thomas SM, Ntowe K, Chiba A, Plichta JK. BRCA1/2 mutation carriers & risk reducing mastectomy: Who undergoes surgery and potential benefits. Am J Surg 2024; 227:146-152. [PMID: 37827871 PMCID: PMC10842097 DOI: 10.1016/j.amjsurg.2023.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/29/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Risk-reducing mastectomy (RRM) is the most effective breast cancer risk-reduction strategy in BRCA1/2 mutation carriers. We examined factors associated with RRM and its relationship with overall survival (OS). METHODS Patients aged 18-80y at diagnosis of their BRCA1/2 mutation were selected from our institutional database and stratified by RRM receipt. Differences were tested; unadjusted OS was estimated. RESULTS Of the 306 patients, median age was 43y; median follow-up was 41.6mo. Patients undergoing RRM were more often married with a history of pregnancy (both p ≤ 0.05). Of female patients, 23.1% underwent RRM. Two patients had malignancy detected at RRM, and one developed breast cancer after RRM. Higher unadjusted OS was observed with RRM (p = 0.02). CONCLUSIONS Our analyses suggest that family-structure may play a role in a patient's decision to undergo RRM. We also demonstrated RRM is likely associated with improved survival, potentially underscoring the importance of this option for BRCA1/2 mutation carriers.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA; Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Koumani Ntowe
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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15
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Plichta JK, Greenup RA. Expanding Endocrine Therapy Options for Patients With Ductal Carcinoma In Situ-More Work to Do. JAMA Surg 2023; 158:1274. [PMID: 37870941 DOI: 10.1001/jamasurg.2023.5111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Affiliation(s)
- Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina
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16
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Nash AL, Bloom DL, Chapman BM, Wheeler SB, McGuire KP, Lee CN, Weinfurt K, Rosenstein DL, Plichta JK, Vann JCJ, Hwang ES. ASO Visual Abstract: Contralateral Prophylactic Mastectomy Decision Making-The Partners' Perspective. Ann Surg Oncol 2023; 30:8481-8482. [PMID: 37718338 DOI: 10.1245/s10434-023-14184-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Amanda L Nash
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Diane L Bloom
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Brittany M Chapman
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Clara N Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Division of Health Services Management and Policy, College of Public Health, OSU Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Kevin Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Julie C Jacobson Vann
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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17
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Moris D, Barfield R, Chan C, Chasse S, Stempora L, Xie J, Plichta JK, Thacker J, Harpole DH, Purves T, Lagoo-Deenadayalan S, Hwang ESS, Kirk AD. Immune Phenotype and Postoperative Complications After Elective Surgery. Ann Surg 2023; 278:873-882. [PMID: 37051915 DOI: 10.1097/sla.0000000000005864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To characterize and quantify accumulating immunologic alterations, pre and postoperatively in patients undergoing elective surgical procedures. BACKGROUND Elective surgery is an anticipatable, controlled human injury. Although the human response to injury is generally stereotyped, individual variability exists. This makes surgical outcomes less predictable, even after standardized procedures, and may provoke complications in patients unable to compensate for their injury. One potential source of variation is found in immune cell maturation, with phenotypic changes dependent on an individual's unique, lifelong response to environmental antigens. METHODS We enrolled 248 patients in a prospective trial facilitating comprehensive biospecimen and clinical data collection in patients scheduled to undergo elective surgery. Peripheral blood was collected preoperatively, and immediately on return to the postanesthesia care unit. Postoperative complications that occurred within 30 days after surgery were captured. RESULTS As this was an elective surgical cohort, outcomes were generally favorable. With a median follow-up of 6 months, the overall survival at 30 days was 100%. However, 20.5% of the cohort experienced a postoperative complication (infection, readmission, or system dysfunction). We identified substantial heterogeneity of immune senescence and terminal differentiation phenotypes in surgical patients. More importantly, phenotypes indicating increased T-cell maturation and senescence were associated with postoperative complications and were evident preoperatively. CONCLUSIONS The baseline immune repertoire may define an immune signature of resilience to surgical injury and help predict risk for surgical complications.
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Affiliation(s)
| | - Richard Barfield
- Department of Biostatistics and Bioinformatics, Duke University; Durham, NC
- Duke Center for Genomic and Computational Biology, Duke University; Durham, NC
| | - Cliburn Chan
- Department of Biostatistics and Bioinformatics, Duke University; Durham, NC
- Duke Center for Genomic and Computational Biology, Duke University; Durham, NC
| | - Scott Chasse
- Department of Surgery, Duke University; Durham, NC
| | | | - Jichun Xie
- Department of Biostatistics and Bioinformatics, Duke University; Durham, NC
- Duke Center for Genomic and Computational Biology, Duke University; Durham, NC
| | | | | | | | - Todd Purves
- Department of Surgery, Duke University; Durham, NC
| | | | | | - Allan D Kirk
- Department of Surgery, Duke University; Durham, NC
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18
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Record SM, Chanenchuk T, Altieri M, Cannada L, Guetter CR, Joseph KA, Maxwell J, Reyna C, Sumra H, Tan S, Tasnim S, Yu YR, Plichta JK. One step ahead: Finding mentors at all stages of a surgical career. Am J Surg 2023; 226:729-731. [PMID: 37414608 DOI: 10.1016/j.amjsurg.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University School of Medicine, DUMC Box 3704, 2301 Erwin Rd., Durham, NC, 27710, USA.
| | - Tori Chanenchuk
- Department of Surgery, Duke University School of Medicine, DUMC Box 3704, 2301 Erwin Rd., Durham, NC, 27710, USA.
| | - Maria Altieri
- Department of Surgery, Penn Medicine, 3400 Spruce St, Philadelphia, PA, 19104, USA.
| | - Lisa Cannada
- Department of Orthopedic Surgery, Charlotte Novant Health, University of North Carolina School of Medicine, 1901 Randolph Road, Charlotte, NC, 28207, USA.
| | - Camila R Guetter
- Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis St., Boston, MA, 02215, USA.
| | - Kathie-Ann Joseph
- Department of Surgery, NYU Grossman School of Medicine, 424 East 34th Street, New York, NY, 10016, USA; NYU Langone Health Institute of Health Equity, 180 Madison Avenue, New York, NY, 10016, USA.
| | - Jessica Maxwell
- Department of Surgery, University of Nebraska Medical Center, 620 S 42nd St, Omaha, NE, 68105, USA.
| | - Chantal Reyna
- Department of Surgery, Crozer Health System, 1 Medical Center Blvd, Upland, PA, 19013, USA.
| | - Hibba Sumra
- Department of Surgery, Advocate Aurora Health, 2535 S Martin Luther King Dr, Chicago, IL, 60616, USA.
| | - Sanda Tan
- Department of Surgery, HCA Florida Healthcare 2130 E Johnson Ave Suite 130-A, Pensacola, FL, 32514, USA.
| | - Sadia Tasnim
- Department of Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Yangyang R Yu
- Department of Surgery, University of California Irvine, Gillespie Neuroscience Research Facility, #2226, Irvine, CA, 92617, USA.
| | - Jennifer K Plichta
- Department of Surgery, Duke University School of Medicine, DUMC Box 3704, 2301 Erwin Rd., Durham, NC, 27710, USA; Duke Cancer Institute, Duke University Medical Center, 20 Duke Medicine Cir, Durham, NC, 27710, USA; Department of Population Health Sciences, Duke University Medical Center, 215 Morris St, Durham, NC, 27701, USA.
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19
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Nash AL, Bloom DL, Chapman BM, Wheeler SB, McGuire KP, Lee CN, Weinfurt K, Rosenstein DL, Plichta JK, Vann JCJ, Hwang ES. Contralateral Prophylactic Mastectomy Decision-Making: The Partners' Perspective. Ann Surg Oncol 2023; 30:6268-6274. [PMID: 37573282 DOI: 10.1245/s10434-023-14022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/14/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND The rate of contralateral prophylactic mastectomy (CPM) continues to rise despite no improvement in survival, an increased risk of surgical complications, and negative effects on quality of life. This study explored the experiences of the partners of women who undergo CPM. METHODS This study was part of an investigation into the factors motivating women with early-stage unilateral breast cancer and low genetic risk to opt for contralateral prophylactic mastectomy (CPM). Participating women were asked for permission to invite their partners to take part in interviews. In-depth interviews with partners were conducted using a semi-structured topic guide. A thematic analysis of the data was performed RESULTS: Of 35 partners, all men, 15 agreed to be interviewed. Most perceived their role to be strong and logical. Some hoped their wives would choose a bilateral mastectomy. All felt strongly that the final decision was up to their partners. The partners often framed the decision for CPM as one of life or death. Thus, any aesthetic effects were unimportant by comparison. The male partners had difficulty grasping the physical and emotional changes inherent in mastectomy, which made communicating about sexuality and intimacy very challenging for the couples. In the early recovery period, some noted the stress of managing home life. CONCLUSIONS The experiences of the male partners provide insight into how couples navigate complex treatment decision-making, both together and separately. There may be a benefit to including partners in pre- and post-surgical counseling to mitigate miscommunication regarding the expected oncologic and emotional outcomes related to CPM.
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Affiliation(s)
- Amanda L Nash
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Diane L Bloom
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Brittany M Chapman
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Clara N Lee
- Division of Health Services Management and Policy, Department of Plastic and Reconstructive Surgery, OSU Comprehensive Cancer Center, College of Medicine, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Kevin Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Julie C Jacobson Vann
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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20
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Miller KN, Thomas SM, Record SM, Rosenberger LH, DiNome ML, DiLalla G, Force JM, Hwang ES, Plichta JK. ASO Visual Abstract: Neoadjuvant Chemotherapy and Endocrine Therapy for Older Patients with Estrogen Receptor Positive Breast Cancer-Comparison of Approaches. Ann Surg Oncol 2023; 30:6151. [PMID: 37516728 DOI: 10.1245/s10434-023-14010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Affiliation(s)
- Krislyn N Miller
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Maggie L DiNome
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Gayle DiLalla
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jeremy M Force
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Record SM, Thomas SM, Chanenchuk T, Baker JA, Grimm LJ, Plichta JK. Breast Cancer Risk Assessment and Screening Practices Reported Via an Online Survey. Ann Surg Oncol 2023; 30:6219-6229. [PMID: 37460738 PMCID: PMC10528282 DOI: 10.1245/s10434-023-13903-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Breast cancer screening guidelines differ between organizations, and significant variations in practice patterns exist. Previous evidence suggests that provider-level factors are the greatest contributors to risk assessment and screening practice variability. This study aimed to characterize provider factors associated with breast cancer risk assessment and screening practice patterns, and to assess perceived barriers to providing risk assessment. METHODS An online survey was distributed to providers at a single academic institution and to providers publicly via social media (January to August 2022). Respondents in the United States who care for adult women at risk for the development of breast cancer were included. RESULTS Most of the respondents in the 143 completed surveys were white/Caucasian (79%) females (90%) age 50 years or younger (79%), and whereas 97% discuss breast cancer screening with their patients, only 90% order screening mammograms. Risk factor assessment was common (93%), typically performed at the first visit (51%). Additional training in genetics or risk assessment was uncommon (17%), although the majority were interested but did not have the time or resources (55%). Although most (64%) did not perceive barriers to providing risk assessment or appropriate screening, the most common barriers were time (77%) and education (55%). Barriers were more common among family practice or obstetrics and gynecology (OB/GYN) providers and those who worked in an academic setting (all p < 0.05). CONCLUSIONS Breast cancer risk assessment and screening practices are highly variable. Although time is the major barrier to providing risk assessment, providers also need education. Primary care organizations could partner with breast cancer-focused societies for additional resources.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Tori Chanenchuk
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay A Baker
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Lars J Grimm
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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22
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Record SM, Thomas SM, Tori Chanenchuk, Baker JA, Grimm LJ, Plichta JK. ASO Visual Abstract: Breast Cancer Risk Assessment and Screening Practices Reported via an Online Survey. Ann Surg Oncol 2023; 30:6230-6231. [PMID: 37537486 DOI: 10.1245/s10434-023-14043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Tori Chanenchuk
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay A Baker
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Lars J Grimm
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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23
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Miller KN, Thomas SM, Record SM, Rosenberger LH, DiNome ML, DiLalla G, Force JM, Hwang ES, Plichta JK. Neoadjuvant Chemotherapy and Endocrine Therapy for Older Patients with Estrogen Receptor Positive Breast Cancer: Comparison of Approaches. Ann Surg Oncol 2023; 30:6141-6150. [PMID: 37466869 PMCID: PMC10529791 DOI: 10.1245/s10434-023-13880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Benefits of a pathologic complete response (pCR) following neoadjuvant therapy are well established, yet outcomes for older women are understudied. We sought to examine the pCR and overall survival (OS) rates of women with estrogen receptor (ER) positive breast cancer across age groups. METHODS Women diagnosed with cT1-4, N0-3, M0, ER+/HER2- breast cancer (2010-2018) who underwent neoadjuvant chemotherapy (NACT) or neoadjuvant endocrine therapy (NET) followed by surgery were selected from the National Cancer Database and categorized by age. Differences were tested, and Cox proportional hazards models were used to estimate the association of response with OS after adjustment for covariates. RESULTS In the 43,009-patient cohort, 84.8% received NACT and 15.2% received NET. Of those aged ≥ 70 (N = 5623), 51.0% received NACT, and 49.0% received NET. Compared with younger women receiving NACT, older women were less likely to have a breast or nodal pCR [no pCR by age: 85.1% (≥ 70 years) vs 82.2% (50-69 years) vs 77.7% (< 50 years), p < 0.001]. Rates of pCR were similarly low for all women receiving NET [no pCR by age: 95.6% (≥ 70 years) vs 95% (50-69 years) vs 96% (< 50 years), p = 0.06]. After adjustment, pCR after NACT was not associated with OS for older patients, but better survival outcomes were noted for older patients achieving pCR after NET. CONCLUSION For women with ER+/HER2- breast cancer, pCR rates after NACT are lower in older women compared with younger women, and are equally low after NET for all women. However, pCR after NET is associated with improved OS among older women, unlike pCR after NACT.
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Affiliation(s)
- Krislyn N Miller
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Sydney M Record
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Maggie L DiNome
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Gayle DiLalla
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jeremy M Force
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center (DUMC), Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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24
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Bevers TB, Niell BL, Baker JL, Bennett DL, Bonaccio E, Camp MS, Chikarmane S, Conant EF, Eghtedari M, Flanagan MR, Hawley J, Helvie M, Hodgkiss L, Hoyt TL, Ivanovich J, Jochelson MS, Kulkarni S, Lancaster RB, Mauer C, Maxwell J, Patel BK, Pearlman M, Philpotts L, Plecha D, Plichta JK, Shakeri S, Smith ML, Streibert CL, Strigel RM, Tumyan L, Winkler NS, Wolverton DE, Bergman MA, Kumar R, Stehman K. NCCN Guidelines® Insights: Breast Cancer Screening and Diagnosis, Version 1.2023. J Natl Compr Canc Netw 2023; 21:900-909. [PMID: 37673117 DOI: 10.6004/jnccn.2023.0046] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
The NCCN Guidelines for Breast Cancer Screening and Diagnosis provide health care providers with a practical, consistent framework for screening and evaluating a spectrum of clinical presentations and breast lesions. The NCCN Breast Cancer Screening and Diagnosis Panel is composed of a multidisciplinary team of experts in the field, including representation from medical oncology, gynecologic oncology, surgical oncology, internal medicine, family practice, preventive medicine, pathology, diagnostic and interventional radiology, as well as patient advocacy. The NCCN Breast Cancer Screening and Diagnosis Panel meets at least annually to review emerging data and comments from reviewers within their institutions to guide updates to existing recommendations. These NCCN Guidelines Insights summarize the panel's decision-making and discussion surrounding the most recent updates to the guideline's screening recommendations.
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Affiliation(s)
| | | | | | - Debbie L Bennett
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | - Melissa S Camp
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Emily F Conant
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Jeffrey Hawley
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Linda Hodgkiss
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | - Swati Kulkarni
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | - Donna Plecha
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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25
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Record SM, Chanenchuk T, Parrish KM, Kaplan SJ, Kimmick G, Plichta JK. Prognostic Tools for Older Women with Breast Cancer: A Systematic Review. Medicina (Kaunas) 2023; 59:1576. [PMID: 37763695 PMCID: PMC10534323 DOI: 10.3390/medicina59091576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background: Breast cancer is the most common cancer in women, and older patients comprise an increasing proportion of patients with this disease. The older breast cancer population is heterogenous with unique factors affecting clinical decision making. While many models have been developed and tested for breast cancer patients of all ages, tools specifically developed for older patients with breast cancer have not been recently reviewed. We systematically reviewed prognostic models developed and/or validated for older patients with breast cancer. Methods: We conducted a systematic search in 3 electronic databases. We identified original studies that were published prior to 8 November 2022 and presented the development and/or validation of models based mainly on clinico-pathological factors to predict response to treatment, recurrence, and/or mortality in older patients with breast cancer. The PROBAST was used to assess the ROB and applicability of each included tool. Results: We screened titles and abstracts of 7316 records. This generated 126 studies for a full text review. We identified 17 eligible articles, all of which presented tool development. The models were developed between 1996 and 2022, mostly using national registry data. The prognostic models were mainly developed in the United States (n = 7; 41%). For the derivation cohorts, the median sample size was 213 (interquartile range, 81-845). For the 17 included modes, the median number of predictive factors was 7 (4.5-10). Conclusions: There have been several studies focused on developing prognostic tools specifically for older patients with breast cancer, and the predictions made by these tools vary widely to include response to treatment, recurrence, and mortality. While external validation was rare, we found that it was typically concordant with interval validation results. Studies that were not validated or only internally validated still require external validation. However, most of the models presented in this review represent promising tools for clinical application in the care of older patients with breast cancer.
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Affiliation(s)
- Sydney M. Record
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Tori Chanenchuk
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Kendra M. Parrish
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Gretchen Kimmick
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC 27710, USA
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26
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Record SM, Plichta JK. De-Escalation of Axillary Surgery for Older Patients with Breast Cancer: Supporting Data Continue to Accumulate. Ann Surg Oncol 2023; 30:3882-3884. [PMID: 36820936 PMCID: PMC10441034 DOI: 10.1245/s10434-023-13299-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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27
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Plichta JK, Thomas SM, Hayes DF, Chavez-MacGregor M, Allison K, de los Santos J, Fowler AM, Giuliano AE, Sharma P, Smith BD, van Eycken E, Edge SB, Hortobagyi GN. Novel Prognostic Staging System for Patients With De Novo Metastatic Breast Cancer. J Clin Oncol 2023; 41:2546-2560. [PMID: 36944149 PMCID: PMC10414698 DOI: 10.1200/jco.22.02222] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/22/2023] [Accepted: 02/13/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE Given the heterogeneity and improvement in outcomes for metastatic breast cancer (MBC), we developed a staging system that refines prognostic estimates for patients with metastatic cancer at the time of initial diagnosis, de novo MBC (dnMBC), on the basis of survival outcomes and disease-related variables. METHODS Patients with dnMBC (2010-2016) were selected from the National Cancer Database (NCDB). Recursive partitioning analysis (RPA) was used to group patients with similar overall survival (OS) on the basis of clinical T category, grade, estrogen receptor (ER), progesterone receptor, human epidermal growth factor receptor 2, histology, organ system site of metastases (bone-only, brain-only, visceral), and number of organ systems involved. Three-year OS rates were used to assign a final stage: IVA: >70%, IVB: 50%-70%, IVC: 25 to <50%, and IVD: <25%. Bootstrapping was applied with 1,000 iterations, and final stage assignments were made based on the most commonly occurring assignment. Unadjusted OS was estimated. Validation analyses were conducted using SEER and NCDB. RESULTS At a median follow-up of 52.9 months, the median OS of the original cohort (N = 42,467) was 35.4 months (95% CI, 34.8 to 35.9). RPA stratified patients into 53 groups with 3-year OS rates ranging from 73.5% to 5.7%; these groups were amalgamated into four stage groups: 3-year OS, A = 73.2%, B = 61.9%, C = 40.1%, and D = 17% (log-rank P < .001). After bootstrapping, the survival outcomes for the four stages remained significantly different (log-rank P < .001). This staging system was then validated using SEER data (N = 20,469) and a separate cohort from the NCDB (N = 7,645) (both log-rank P < .001). CONCLUSION Our findings regarding the heterogeneity in outcomes for patients with dnMBC could guide future revisions of the current American Joint Committee on Cancer staging guidelines for patients with newly diagnosed stage IV disease. Our findings should be independently confirmed.
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Affiliation(s)
- Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - Samantha M. Thomas
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC
- Duke University, Department of Biostatistics & Bioinformatics, Durham, NC
| | - Daniel F. Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kimberly Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | | | - Amy M. Fowler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Armando E. Giuliano
- Cedars-Sinai Medical Center, University of California—Los Angeles, Los Angeles, CA
| | - Priyanka Sharma
- Department of Internal Medicine, Division of Medical Oncology, University of Kansas Medical Center, Westwood, KS
| | - Benjamin D. Smith
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Stephen B. Edge
- Department of Surgical Oncology and Cancer Prevention and Control, University at Buffalo, Buffalo, NY
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Gabriel N. Hortobagyi
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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28
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Nash AL, Ren Y, Plichta JK, Rosenberger LH, van den Bruele AMB, DiNome ML, Westbrook K, Hwang ES. ASO Visual Abstract: Survival Benefit of Chemotherapy According to 21-Gene Recurrence Score in Young Women with Breast Cancer. Ann Surg Oncol 2023; 30:2140-2141. [PMID: 36697997 DOI: 10.1245/s10434-022-12885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- A L Nash
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Y Ren
- Duke Cancer Institute, Biostatistics Shared Resources, Durham, NC, USA
| | - J K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - L H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - A M B van den Bruele
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - M L DiNome
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - K Westbrook
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
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29
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Nash AL, Ren Y, Plichta JK, Rosenberger LH, van den Bruele AMB, DiNome ML, Westbrook K, Hwang ES. Survival Benefit of Chemotherapy According to 21-Gene Recurrence Score in Young Women with Breast Cancer. Ann Surg Oncol 2023; 30:2130-2139. [PMID: 36611067 DOI: 10.1245/s10434-022-12699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/05/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Initial trials evaluating Oncotype DX, reported as a recurrence score (RS) from 0 to 100, were not powered to evaluate overall survival, and premenopausal women were underrepresented. The purpose of this study was to explore the benefit of chemotherapy according to RS among younger women eligible for oncotype testing. METHODS Women aged 40-50, diagnosed with HR-positive, HER2-negative breast cancer between 2010 and 2017 were selected from the National Cancer Database (NCBD). Patients were grouped by age, RS, nodal status, and chemotherapy receipt. Kaplan-Meier curves were used to compare unadjusted overall survival (OS) between the groups, and log-rank tests were used to test for a difference between groups. Cox proportional hazards models were used to examine the association between select factors and OS. RESULTS A total of 15,422 patients met inclusion criteria, 45.3% of whom received chemotherapy. Median follow-up time was 66.4 (50.6-86.6) months. Patients who received chemotherapy were more likely to have higher-stage and higher-grade tumors, tumors that were PR-negative, and have higher RS (p < 0.001 for all). RS was prognostic for OS regardless of nodal status. After adjustment, chemotherapy was associated with a significant improvement in OS only in the pN1 RS 31-50 subgroup (p = 0.02). CONCLUSIONS RS retains its prognostic value in younger patients with early stage HR-positive, HER2-negative breast cancer. Chemotherapy survival benefit was limited to patients aged 40-50 with pN1 disease and RS of 31-50. Therefore, chemotherapy decision-making should be especially preference-sensitive in women aged 40-50 with intermediate RS, where it may not provide a survival benefit for many women.
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Affiliation(s)
- A L Nash
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Y Ren
- Duke Cancer Institute Biostatistics Shared Resources, Durham, NC, USA
| | - J K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - L H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - A M B van den Bruele
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - M L DiNome
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - K Westbrook
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
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30
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Tan HS, Plichta JK, Kong A, Tan CW, Hwang S, Sultana R, Wright MC, Sia ATH, Sng BL, Habib AS. Risk factors for persistent pain after breast cancer surgery: a multicentre prospective cohort study. Anaesthesia 2023; 78:432-441. [PMID: 36639918 DOI: 10.1111/anae.15958] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/15/2023]
Abstract
Identifying factors associated with persistent pain after breast cancer surgery may facilitate risk stratification and individualised management. Single-population studies have limited generalisability as socio-economic and genetic factors contribute to persistent pain development. Therefore, this prospective multicentre cohort study aimed to develop a predictive model from a sample of Asian and American women. We enrolled women undergoing elective breast cancer surgery at KK Women's and Children's Hospital and Duke University Medical Center. Pre-operative patient and clinical characteristics and EQ-5D-3L health status were recorded. Pain catastrophising scale; central sensitisation inventory; coping strategies questionnaire-revised; brief symptom inventory-18; perceived stress scale; mechanical temporal summation; and pressure-pain threshold assessments were performed. Persistent pain was defined as pain score ≥ 3 or pain affecting activities of daily living 4 months after surgery. Univariate associations were generated using generalised estimating equations. Enrolment site was forced into the multivariable model, and risk factors with p < 0.2 in univariate analyses were considered for backwards selection. Of 210 patients, 135 (64.3%) developed persistent pain. The multivariable model attained AUC = 0.807, with five independent associations: age (OR 0.85 95%CI 0.74-0.98 per 5 years); diabetes (OR 4.68, 95%CI 1.03-21.22); pre-operative pain score at sites other than the breast (OR 1.48, 95%CI 1.11-1.96); previous mastitis (OR 4.90, 95%CI 1.31-18.34); and perceived stress scale (OR 1.35, 95%CI 1.01-1.80 per 5 points), after adjusting for: enrolment site; pre-operative pain score at the breast; pre-operative overall pain score at rest; postoperative non-steroidal anti-inflammatory drug use; and pain catastrophising scale. Future research should validate this model and evaluate pre-emptive interventions to reduce persistent pain risk.
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Affiliation(s)
- H S Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - J K Plichta
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A Kong
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - C W Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - S Hwang
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - R Sultana
- Centre for Quantitative Medicine, Singapore
| | - M C Wright
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - A T H Sia
- KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - B L Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - A S Habib
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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31
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van den Bruele AB, Paul M, Thomas SM, Sammons SL, DiNome ML, Plichta JK, Chiba A, Rosenberger LH, Hwang ES. Abstract P3-05-20: Low 21-Gene Recurrence Score Is Not Associated with a High Axillary Nodal Burden in Post-Menopausal Women Presenting with a Clinically Negative Axilla. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-05-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: The predictive and prognostic value of the 21-gene recurrence score (RS) has emphasized the importance of tumor biology and minimized the credence of a limited (1-3 positive) nodal burden. The practice changing results of RxPonder demonstrated that post-menopausal women with 1-3 positive lymph nodes (pN1) and a RS of ≤25 did not necessarily benefit from adjuvant chemotherapy. Given that RS influences adjuvant therapy decision-making more significantly than nodal status, it is unclear whether axillary staging with sentinel lymph node biopsy (SLNB) has a continued role in the surgical care of post-menopausal patients otherwise presenting with early stage, clinically node negative (cN0) hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) invasive breast cancer. In this context, the de-escalation of axillary staging, especially in the presence of a low RS, is an area of active investigation. To help elucidate this further, we sought to estimate the association of RS with pathologic nodal stage.
Methods: Using the 2004-2019 National Cancer Database (NCDB) Patient User File (2022 release), we evaluated the association of RS with the incidence of pN0, pN1 and pN2-3 disease. Only female patients diagnosed who were age 50 and older with HR+/HER2- invasive breast cancer were eligible, and only those presenting with cT1-T2N0 who underwent upfront surgery with a SLNB comprised our study population. Those with Oncotype DX testing performed with an available RS were included. Given the limitations within the dataset, age 50 and over was selected as a surrogate for post-menopausal status. Categorical variables were compared between RS groups (≤25 vs. >25) using chi-square tests and continuous variables were compared using t-tests. A logistic regression analysis was performed to estimate the association between RS (≤25 vs. >25) and nodal burden (pN2-3 vs pN0-1).
Results: There were 151,447 patients with an invasive breast cancer diagnosis between 2015 and 2019 who met inclusion criteria. The average age at diagnosis was 64.1 (IQR 58-69) and almost 75% of tumors displayed ductal histology. There were 130,568 (86.2%) patients with a RS≤25 and 20,879 (13.8%) with a RS >25. On final pathology, 85.2% were pN0 and 14.8% were pN1-3. For those with a RS ≤25, 84.9% were pN0, 14.8% were pN1 and 0.3% were pN2-3. For those with a RS >25, 86.8% were pN0, 12.9% were pN1 and 0.3% were pN2-3. Overall, 14.5% demonstrated pN1 disease, of which 12.3% yielded a RS >25. Of the 461 patients with pN2-3 disease for whom RS was available, 12.4% (57 patients) had RS >25. After adjustment, RS >25 was associated with reduced incidence of pN2-3 compared to pN0-1 (OR=0.64, 95% CI 0.47-0.87, p=0.004).
Conclusion: In this population of post-menopausal patients with cT1-T2N0, HR+/HER2- invasive breast cancer and an available RS, almost 86% displayed pN0 or pN1 disease in conjunction with a RS ≤25. Based on the current available literature, less than 5% of cT1-2N0 patients are thought to harbor >pN1 disease. These data add further support, suggesting that this patient population is unlikely to harbor a higher than limited nodal burden given a clinically negative axilla. Though less than 0.5% of the studied patient population demonstrated pN2-3 disease, an important caveat to make is that these patients would not have met criteria for RS, and it’s likely this low number reflects the absence of testing. Given that RS has not been validated for this higher nodal stage, we cannot make recommendations to omit axillary surgery in this cohort of patients. The data presented here provides further rationale for the two large prospective studies addressing whether SLNB could be eliminated in patients with otherwise small HR+/HER2- tumors which are currently ongoing.
Table 1: Pathologic Nodal Staging Based on Recurrence Score
Citation Format: Astrid Botty van den Bruele, Morgan Paul, Samantha M. Thomas, Sarah L. Sammons, Maggie L. DiNome, Jennifer K. Plichta, Akiko Chiba, Laura H. Rosenberger, E Shelley Hwang. Low 21-Gene Recurrence Score Is Not Associated with a High Axillary Nodal Burden in Post-Menopausal Women Presenting with a Clinically Negative Axilla [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-20.
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Affiliation(s)
| | | | | | | | | | | | - Akiko Chiba
- 7Duke University Medical Center, Durham, North Carolina
| | - Laura H. Rosenberger
- 8Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Woriax HE, Thomas SM, Plichta JK, Rosenberger LH, van de bruele AB, Chiba A, DiLalla G, Menendez C, Hwang ES, DiNome ML. Abstract P1-06-02: The effect of race on pathologic complete response rates and overall survival in patients with triple negative breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p1-06-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Introduction: Despite the recent overall improvement in survival for patients with breast cancer, racial disparities in outcomes persist. While studies have demonstrated that socioeconomic factors and access to treatment play a role, differences in tumor biology may also contribute. Black women are significantly more likely to develop triple negative breast cancer (TNBC), the deadliest of the breast cancer subtypes, with more TNBC patients progressing to incurable, metastatic disease than patients with any other breast cancer subtype. Studies have demonstrated that TNBC patients who achieve a pathologic complete response (pCR), defined as no residual invasive cancer in the breast or lymph nodes after neoadjuvant chemotherapy (NAC), have improved survival. We hypothesize that rates of pCR and overall survival (OS) in patients with TNBC may differ by race/ethnicity, which may account in part for the disparities in outcomes observed. Methods: Adult female patients with stage I-III TNBC diagnosed in 2010-2019 who received NAC followed by surgery were identified from the National Cancer Database (NCDB). Race/ethnicity was defined as Hispanic (H), Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Non-Hispanic Asian (NHA), and Non-Hispanic Other (NHO). pCR was defined as no invasive cancer in either the breast or axilla (ypT0/is,N0) at surgery. Logistic regression was used to estimate the association of race/ethnicity with achievement of pCR after adjustment for covariates. Unadjusted OS was estimated using the Kaplan-Meier method, and the log-rank test was used to compare groups. Cox Proportional Hazards models were used to estimate the association of race/ethnicity and achievement of pCR with OS after adjustment for covariates. Additional interaction and subgroup analyses were also conducted. Results: Of the 40,890 patients identified, 29.8% (n=12,173) demonstrated pCR after NAC. The unadjusted 5-year OS rates for those who achieved pCR were significantly higher compared to patients with no pCR (0.917, 95% CI 0.911-0.923 vs 0.667, 95% CI 0.661-0.673, log-rank p< 0.001). Hispanic patients were more likely to achieve pCR (OR 1.19, 95% CI 1.08-1.31, p=0.001), and NHB patients were less likely to achieve pCR (OR 0.89, 95% CI 0.83-0.95, p=0.001) compared to NHW, even after adjustment. Unadjusted OS was also notably lower for NHB patients compared to every other race group (5-year OS rate: NHB 0.709 vs NHW 0.746 vs NHO 0.771 vs H 0.772 vs NHA 0.816, log-rank p< 0.001); however, this difference did not persist after adjustment for patient and disease factors, including achievement of pCR. Interval from diagnosis to start of chemotherapy (OR 0.95, 95% CI 0.94-0.96, p< 0.001) and duration after chemotherapy start to surgery (OR 1.02, 95% CI 1.02-1.03, p< 0.001) were associated with the odds of achieving pCR. Overall, the effect of achieving pCR on OS did not differ by race/ethnicity (interaction p=0.10). Discussion: Achieving pCR after NAC in patients with TNBC is associated with a significant improvement in OS. Yet, rates of pCR appear to differ based on race/ethnicity, with NHB patients demonstrating significantly lower rates of pCR than NHW patients, which may contribute to the disparities in survival outcomes observed. In addition to addressing socioeconomic factors and access to treatment, further research examining whether biological differences exist based on race that influence response of TNBC to current standard therapies is essential for improving survival outcomes for this disproportionately affected patient population.
Citation Format: Hannah E. Woriax, Samantha M. Thomas, Jennifer K. Plichta, Laura H. Rosenberger, Astrid Botty van de bruele, Akiko Chiba, Gayle DiLalla, Carolyn Menendez, E Shelley Hwang, Maggie L. DiNome. The effect of race on pathologic complete response rates and overall survival in patients with triple negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-06-02.
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Affiliation(s)
| | | | | | | | | | - Akiko Chiba
- 6Duke University Medical Center, Durham, North Carolina
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Green MF, Watson CH, Tait S, He J, Pavlick DC, Frampton G, Riedel J, Plichta JK, Armstrong AJ, Previs RA, Kauff N, Strickler JH, Datto MB, Berchuck A, Menendez CS. Concordance Between Genomic Alterations Detected by Tumor and Germline Sequencing: Results from a Tertiary Care Academic Center Molecular Tumor Board. Oncologist 2023; 28:33-39. [PMID: 35962742 PMCID: PMC9847540 DOI: 10.1093/oncolo/oyac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/15/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The majority of tumor sequencing currently performed on cancer patients does not include a matched normal control, and in cases where germline testing is performed, it is usually run independently of tumor testing. The rates of concordance between variants identified via germline and tumor testing in this context are poorly understood. We compared tumor and germline sequencing results in patients with breast, ovarian, pancreatic, and prostate cancer who were found to harbor alterations in genes associated with homologous recombination deficiency (HRD) and increased hereditary cancer risk. We then evaluated the potential for a computational somatic-germline-zygosity (SGZ) modeling algorithm to predict germline status based on tumor-only comprehensive genomic profiling (CGP) results. METHODS A retrospective chart review was performed using an academic cancer center's databases of somatic and germline sequencing tests, and concordance between tumor and germline results was assessed. SGZ modeling from tumor-only CGP was compared to germline results to assess this method's accuracy in determining germline mutation status. RESULTS A total of 115 patients with 146 total alterations were identified. Concordance rates between somatic and germline alterations ranged from 0% to 85.7% depending on the gene and variant classification. After correcting for differences in variant classification and filtering practices, SGZ modeling was found to have 97.2% sensitivity and 90.3% specificity for the prediction of somatic versus germline origin. CONCLUSIONS Mutations in HRD genes identified by tumor-only sequencing are frequently germline. Providers should be aware that technical differences related to assay design, variant filtering, and variant classification can contribute to discordance between tumor-only and germline sequencing test results. In addition, SGZ modeling had high predictive power to distinguish between mutations of somatic and germline origin without the need for a matched normal control, and could potentially be considered to inform clinical decision-making.
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Affiliation(s)
- Michelle F Green
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Catherine H Watson
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Sarah Tait
- Duke University, School of Medicine, Durham, NC, USA
| | - Jie He
- Foundation Medicine, Inc., Cambridge, MA, USA
| | | | | | - Jinny Riedel
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Andrew J Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham NCUSA
| | - Rebecca A Previs
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Noah Kauff
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - John H Strickler
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA,Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michael B Datto
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Carolyn S Menendez
- Corresponding author: Carolyn S. Menendez, MD, Duke Cancer Center, 216 Ashville Ave Ste 20, Cary, NC 27518, USA. E-mail:
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Plichta JK, Rushing CN, Lewis HC, Rooney MM, Blazer DG, Thomas SM, Hwang ES, Greenup RA. Implications of missing data on reported breast cancer mortality. Breast Cancer Res Treat 2023; 197:177-187. [PMID: 36334190 PMCID: PMC9912364 DOI: 10.1007/s10549-022-06764-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND National cancer registries are valuable tools to analyze patterns of care and clinical outcomes; yet, missing data may impact the accuracy and generalizability of these data. We sought to evaluate the association between missing data and overall survival (OS). METHODS Using the NCDB (National Cancer Database) and SEER (Surveillance, Epidemiology, End Results Program), we assessed data missingness among patients diagnosed with invasive breast cancer from 2010 to 2014. Key variables included demographic (age, race, ethnicity, insurance, education, income), tumor (grade, ER, PR, HER2, TNM stages), and treatment (surgery in both databases; chemotherapy and radiation in NCDB). OS was compared between those with and without missing data using Cox proportional hazards models. RESULTS Overall, 775,996 patients in the NCDB and 263,016 in SEER were identified; missing at least 1 key variable occurred for 29% and 13%, respectively. Of those, the overwhelming majority (NCDB 80%; SEER 88%) were missing tumor variables. When compared to patients with complete data, missingness was associated with a greater risk of death: NCDB HR 1.23 (99% CI 1.21-1.25) and SEER HR 2.11 (99% CI 2.05-2.18). Patients with complete tumor data had higher unadjusted OS estimates than that of the entire sample: NCDB 82.7% vs 81.8% and SEER 83.5% vs 81.7% for 5-year OS. CONCLUSIONS Missingness of select variables is not uncommon within large national cancer registries and is associated with a worse OS. Exclusion of patients with missing variables may introduce unintended bias into analyses and result in findings that underestimate breast cancer mortality.
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Affiliation(s)
- Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, DUMC 351327710, USA.
- Duke Cancer Institute, Durham, NC, USA.
| | - Christel N Rushing
- Duke Cancer Institute, Durham, NC, USA
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA
| | - Holly C Lewis
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
| | - Marguerite M Rooney
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
| | - Dan G Blazer
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Durham, NC, USA
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Duke Cancer Institute, Durham, NC, USA
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Rooney MM, Thomas SM, Taskindoust M, Greenup RA, Rosenberger LH, Hwang ES, Plichta JK. The role of tumor phenotype in the surgical treatment of early-stage breast cancer. Am J Surg 2023; 225:84-92. [PMID: 36180300 PMCID: PMC9912362 DOI: 10.1016/j.amjsurg.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/10/2022] [Accepted: 09/18/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND We investigated whether tumor phenotype influences surgical decision-making, and how that may impact overall survival (OS) for early-stage breast cancer. METHODS Women aged 18-69 with cT0-2/cN0/cM0 breast cancer in the National Cancer Database (2010-2017) were included. A generalized logistic model was used to identify factors associated with surgery type. A Kaplan-Meier curve was used to visualize unadjusted OS, and the log-rank test was used to test for differences in OS between surgery types. RESULTS Of 597,149 patients, 58% underwent lumpectomy with radiation (BCT), 25% unilateral mastectomy (UM), and 17% bilateral mastectomy (BM). After adjustment, HER2+ and triple-negative (TN) tumors were less likely to undergo UM than BCT, versus hormone receptor-positive tumors (OR = 0.881, 95% CI = 0.860-0.903; OR = 0.485, 95% CI = 0.470-0.501). UM and BM had worse 5-year OS versus BCT (UM: 0.926, vs BM: 0.952, vs BCT: 0.960). CONCLUSIONS BCT is increasingly used to treat HER2+ and TN tumors. More extensive surgery is not associated with better survival outcomes, regardless of tumor phenotype.
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Affiliation(s)
| | - Samantha M Thomas
- Duke Cancer Institute, Durham, NC, USA; Duke University, Department of Biostatistics & Bioinformatics, Durham, NC, USA
| | | | | | - Laura H Rosenberger
- Duke Cancer Institute, Durham, NC, USA; Duke University Medical Center, Department of Surgery, Durham, NC, USA
| | - E Shelley Hwang
- Duke Cancer Institute, Durham, NC, USA; Duke University Medical Center, Department of Surgery, Durham, NC, USA
| | - Jennifer K Plichta
- Duke Cancer Institute, Durham, NC, USA; Duke University Medical Center, Department of Surgery, Durham, NC, USA; Duke University Medical Center, Department of Population Health Sciences, New Haven, NC, USA.
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Weaver ML, Sundland R, Adams AM, Faria I, Feldman HA, Gudmundsdottir H, Marmor H, Miles V, Ochoa B, Ruff SM, Tonelli C, Altieri MS, Cannada L, Dewan K, Etkin Y, Marmor R, Plichta JK, Reyna C, Tatebe L, Drudi LM, Hicks CW. The art of peer review: Guidelines to become a credible and constructive peer reviewer. Semin Vasc Surg 2022; 35:470-478. [PMID: 36414364 PMCID: PMC9833278 DOI: 10.1053/j.semvascsurg.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
Peer review is a learned skill set that requires knowledge of study design, review construct, ethical considerations, and general expertise in a field of study. Participating in peer review is a rewarding and valuable experience in which all academic physicians are encouraged to partake. However, formal training opportunities in peer review are limited. In 2021, the Association of Women Surgeons and the journal Surgery collaborated to develop a Peer Review Academy. This academy is a 1-year longitudinal course that offers a select group of young women surgical trainees across all specialties a curriculum of monthly lectures and multiple formal mentored peer review opportunities to assist them in developing the foundation necessary to transition to independent peer review. The trainees and faculty mentors participating in the Association of Women Surgeons-Surgery Peer Review Academy compiled a summary of best peer review practices, which is intended to outline the elements of the skill set necessary to become a proficient peer reviewer.
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Affiliation(s)
- M Libby Weaver
- Division of Vascular and Endovascular Surgery, University of Virginia, 1215 Lee Street, PO Box 800679, Charlottesville, VA, 22908-0679.
| | | | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Isabella Faria
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Hope A Feldman
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Hannah Marmor
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Victoria Miles
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN
| | - Brielle Ochoa
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Samantha M Ruff
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Celsa Tonelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA
| | - Lisa Cannada
- Department of Orthopaedics, University of North Carolina, Charlotte, NC
| | - Karuna Dewan
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University, New Orleans, LA
| | - Yana Etkin
- Division of Vascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Rebecca Marmor
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Chantal Reyna
- Department of Surgery, Crozer Health System, Upland, PA
| | - Leah Tatebe
- Department of Surgery, Northwestern University, Chicago, IL
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospital de L'Université de Montréal, Montreal, Quebec, Canada
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Rooney MM, Miller KN, Plichta JK. Genetics of Breast Cancer. Surg Clin North Am 2022; 103:35-47. [DOI: 10.1016/j.suc.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Miller KN, Thomas SM, Sergesketter AR, Rosenberger LH, DiLalla G, van den Bruele AB, Hwang ES, Plichta JK. ASO Visual Abstract: The Influence of BMI on the Histopathology and Outcomes of Patients with a Diagnosis of Atypical Breast Lesions. Ann Surg Oncol 2022; 29:6495. [PMID: 36002701 DOI: 10.1245/s10434-022-12445-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Krislyn N Miller
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | | | - Amanda R Sergesketter
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Gayle DiLalla
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Astrid Botty van den Bruele
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Miller KN, Thomas SM, Sergesketter AR, Rosenberger LH, DiLalla G, van den Bruele AB, Hwang ES, Plichta JK. The Influence of Body Mass Index on the Histopathology and Outcomes of Patients Diagnosed with Atypical Breast Lesions. Ann Surg Oncol 2022; 29:6484-6494. [PMID: 35951136 PMCID: PMC9942245 DOI: 10.1245/s10434-022-12313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/14/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Multiple studies have demonstrated a link between obesity and breast cancer; however, the potential association between obesity and atypical high-risk breast lesions has not been well characterized. We sought to evaluate the characteristics and clinical outcomes of patients with breast atypia based on a woman's body mass index (BMI). METHODS We retrospectively identified adult women diagnosed with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and/or lobular carcinoma in situ (LCIS) at a single institution from 2008 to 2017. BMI groups were defined as a BMI 18.5 to < 30 or BMI ≥ 30 (obese). Adjusted logistic regression was used to estimate the association of BMI group with the odds of (1) upstage to cancer after atypia on needle biopsy, and (2) subsequent diagnosis of breast cancer. RESULTS Breast atypia was identified in 503 patients (most advanced atypia: 74.8% ADH, 4.6% ALH, 20.7% LCIS), and 41% of these patients were classified as obese. After adjustment, BMI group was not associated with upstage to breast cancer at surgical excision following needle biopsy (p = 0.16) or development of a subsequent breast cancer (p = 0.08). For those upstaged to breast cancer at the time of surgical excision, or those who developed a subsequent malignancy, tumor subtype, grade and stage were not associated with BMI group (p > 0.05). CONCLUSION In a large cohort of patients diagnosed with atypical breast histology, the risk of upstaging and/or subsequent progression to a breast malignancy was not associated with BMI. Factors other than obesity may influence breast cancer risk.
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Affiliation(s)
- Krislyn N Miller
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | | | - Amanda R Sergesketter
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Laura H Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Gayle DiLalla
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Astrid Botty van den Bruele
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Neely B, Shahsahebi M, Marks CE, Power S, Kanter A, Howell C, Hyslop T, Plichta JK. Design and Evaluation of a Computational Phenotype to Identify Patients With Metastatic Breast Cancer Within the Electronic Health Record. JCO Clin Cancer Inform 2022; 6:e2200056. [PMID: 36179272 PMCID: PMC9848550 DOI: 10.1200/cci.22.00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/15/2022] [Accepted: 08/30/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Outcomes for patients with metastatic breast cancer (MBC) are continually improving as more effective treatments become available. Granular data sets of this unique population are lacking, and the standard method for data collection relies largely on chart review. Therefore, using electronic health records (EHR) collected at a tertiary hospital system, we developed and evaluated a computational phenotype designed to identify all patients with MBC, and we compared the effectiveness of this algorithm against the gold standard, clinical chart review. METHODS A cohort of patients with breast cancer were identified according to International Classification of Diseases codes, the institutional tumor registry, and SNOMED codes. Chart review was performed to determine whether distant metastases had occurred. We developed a computational phenotype, on the basis of SNOMED concept IDs, which was applied to the EHR to identify patients with MBC. Contingency tables were used to aggregate and compare results. RESULTS A total of 1,741 patients with breast cancer were identified using data from International Classification of Diseases codes, the tumor registry, and/or SNOMED concept identifiers. Chart review of all patients classified each patient as having MBC (n = 416; 23.9%) versus not (n = 1,325; 75.9%). The final computational phenotype successfully classified 1,646 patients (95% accuracy; 82% sensitivity; 99% specificity). CONCLUSION Hospital systems with robust EHRs and reliable mapping to SNOMED have the ability to use standard codes to derive computational phenotypes. These algorithms perform reasonably well and have the added ability to be run at disparate health care facilities. Better tooling to navigate the polyhierarchical structure of SNOMED ontology could yield better-performing computational phenotypes.
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Affiliation(s)
| | - Mohammad Shahsahebi
- Duke Cancer Institute, Durham, NC
- Department of Family Medicine and Community Health, Duke University, Durham, NC
| | - Caitlin E. Marks
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | | | | | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Jennifer K. Plichta
- Duke Cancer Institute, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
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Affiliation(s)
- Caitlin W. Hicks
- Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe
Street - Halsted 668, Baltimore, MD, 21287, USA
| | - Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, DUMC 3513
919.681.9156, Durham, NC, 27710, USA
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Plichta JK. Circulating Tumor Cells and Breast Cancer: The Long and Winding Road Behind and Before Us. Ann Surg Oncol 2022; 29:2747-2749. [PMID: 34984567 DOI: 10.1245/s10434-021-11301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA. .,Duke Cancer Institute, Durham, NC, USA. .,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Champion CD, Thomas SM, Plichta JK, Parrilla Castellar E, Rosenberger LH, Greenup RA, Hyslop T, Hwang ES, Fayanju OM. Disparities at the Intersection of Race and Ethnicity: Examining Trends and Outcomes in Hispanic Women With Breast Cancer. JCO Oncol Pract 2022; 18:e827-e838. [PMID: 33026950 PMCID: PMC9797230 DOI: 10.1200/op.20.00381] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE We sought to examine tumor subtype, stage at diagnosis, time to surgery (TTS), and overall survival (OS) among Hispanic patients of different races and among Hispanic and non-Hispanic (NH) women of the same race. METHODS Women 18 years of age or older who had been diagnosed with stage 0-IV breast cancer and who had undergone lumpectomy or mastectomy were identified in the National Cancer Database (2004-2014). Tumor subtype and stage at diagnosis were compared by race/ethnicity. Multivariable linear regression and Cox proportional hazards modeling were used to estimate associations between race/ethnicity and adjusted TTS and OS, respectively. RESULTS A total of 44,374 Hispanic (American Indian [AI]: 79 [0.2%]; Black: 1,011 [2.3%]; White: 41,126 [92.7%]; Other: 2,158 [4.9%]) and 858,634 NH women (AI: 2,319 [0.3%]; Black: 97,206 [11.3%]; White: 727,270 [84.7%]; Other: 31,839 [3.7%]) were included. Hispanic Black women had lower rates of triple-negative disease (16.2%) than did NH Black women (23.5%) but higher rates than did Hispanic White women (13.9%; P < .001). Hispanic White women had higher rates of node-positive disease (23.2%) versus NH White women (14.4%) but slightly lower rates than Hispanic (24.6%) and NH Black women (24.5%; P < .001). Hispanic White women had longer TTS versus NH White women regardless of treatment sequence (adjusted means: adjuvant chemotherapy, 42.71 v 38.60 days; neoadjuvant chemotherapy, 208.55 v 201.14 days; both P < .001), but there were no significant racial differences in TTS among Hispanic patients. After adjustment, Hispanic White women (hazard ratio, 0.77 [95% CI, 0.74 to 0.81]) and Black women (hazard ratio, 0.75 [95% CI, 0.58 to 0.96]) had improved OS versus NH White women (reference) and Black women (hazard ratio, 1.15 [95% CI, 1.12 to 1.18]; all P < .05). CONCLUSION Hispanic women had improved OS versus NH women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.
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Affiliation(s)
- Cosette D. Champion
- Department of Medicine, Washington University School of Medicine, St Louis, MO,Oluwadamilola M. Fayanju, MD, MA, MPHS, DUMC 3513, Durham, NC 27710; e-mail:
| | - Samantha M. Thomas
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC,Women’s Cancer Program, Duke Cancer Institute, Durham, NC
| | - Edgardo Parrilla Castellar
- Women’s Cancer Program, Duke Cancer Institute, Durham, NC,Department of Pathology, Duke University Medical Center, Durham, NC
| | - Laura H. Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, NC,Women’s Cancer Program, Duke Cancer Institute, Durham, NC
| | - Rachel A. Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC,Women’s Cancer Program, Duke Cancer Institute, Durham, NC,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Terry Hyslop
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - E. Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC,Women’s Cancer Program, Duke Cancer Institute, Durham, NC
| | - Oluwadamilola M. Fayanju
- Department of Surgery, Duke University Medical Center, Durham, NC,Women’s Cancer Program, Duke Cancer Institute, Durham, NC,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC,Duke Forge, Duke University, Durham, NC,Department of Surgery, Durham VA Medical Center, Durham, NC,Oluwadamilola M. Fayanju, MD, MA, MPHS, DUMC 3513, Durham, NC 27710; e-mail:
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Rooney MM, Miller KN, Rosenberger LH, Plichta JK. Surgical Treatment of de novo Metastatic Breast Cancer. Curr Breast Cancer Rep 2022. [DOI: 10.1007/s12609-022-00448-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Plichta JK, Thomas SM, Sergesketter AR, Greenup RA, Rosenberger LH, Fayanju OM, Kimmick G, Force J, Hyslop T, Hwang ES. A Novel Staging System for De Novo Metastatic Breast Cancer Refines Prognostic Estimates. Ann Surg 2022; 275:784-792. [PMID: 32657941 PMCID: PMC7794098 DOI: 10.1097/sla.0000000000004231] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We aim to identify prognostic groups within a de novo metastatic cohort, incorporating both anatomic and biologic factors. BACKGROUND Staging for breast cancer now includes anatomic and biologic factors, although the guidelines for stage IV disease do not account for how these factors may influence outcomes. METHODS Adults with de novo metastatic breast cancer were selected from the National Cancer DataBase (2010-2013). Recursive partitioning analysis was used to group patients with similar overall survival (OS) based on clinical T/N stage, tumor grade, ER, PR, HER2, number of metastatic sites, and presence of bone-only metastases. Categories were created by amalgamating homogeneous groups based on 3-year OS rates (stage IVA: >50%, stage IVB: 30%-50%, stage IVC: <30%). RESULTS 16,187 patients were identified; median follow-up was 32 months. 65.2% had 1 site of distant metastasis, and 42.9% had bone-only metastases. Recursive partitioning analysis identified the number of metastatic sites (1 vs >1) as the first stratification point, and ER status as the second stratification point for both resulting groups. Additional divisions were made based on HER2 status, PR status, cT stage, tumor grade, and presence of bone-only metastases. After bootstrapping, significant differences in 3-year OS were noted between the 3 groups [stage IVB vs IVA: HR 1.58 (95% confidence interval 1.50-1.67), stage IVC vs IVA: HR 3.54 (95% confidence interval 3.33-3.77)]. CONCLUSIONS Both anatomic and biologic factors yielded reliable and reproducible prognostic estimates among patients with metastatic disease. These findings support formal stratification of de novo stage IV breast cancer into 3 distinct prognosis groups.
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Affiliation(s)
- Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
| | - Samantha M. Thomas
- Duke Cancer Institute, Durham, North Carolina
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | | | - Rachel A. Greenup
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
| | - Laura H. Rosenberger
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
| | - Oluwadamilola M. Fayanju
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
| | - Gretchen Kimmick
- Duke Cancer Institute, Durham, North Carolina
- Department of Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - Jeremy Force
- Duke Cancer Institute, Durham, North Carolina
- Department of Medical Oncology, Duke University Medical Center, Durham, North Carolina
| | - Terry Hyslop
- Duke Cancer Institute, Durham, North Carolina
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | - E. Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
- Duke Cancer Institute, Durham, North Carolina
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Grimm LJ, Plichta JK, Hwang ES. More Than Incremental: Harnessing Machine Learning to Predict Breast Cancer Risk. J Clin Oncol 2022; 40:1713-1717. [PMID: 35245093 DOI: 10.1200/jco.21.02733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University, Durham, NC
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Yu AYL, Thomas SM, DiLalla GD, Greenup RA, Hwang ES, Hyslop T, Menendez CS, Plichta JK, Tolnitch LA, Fayanju OM. Disease characteristics and mortality among Asian women with breast cancer. Cancer 2022; 128:1024-1037. [PMID: 34792814 PMCID: PMC8837687 DOI: 10.1002/cncr.34015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Asian women with breast cancer are often studied in aggregate, belying significant intragroup diversity. The authors sought to examine differences in breast cancer characteristics and outcomes among Asian women. METHODS Asian, non-Hispanic Black, Hispanic, and non-Hispanic White women aged 18 years and older who were diagnosed with breast cancer from 1990 to 2016 were identified in the Surveillance, Epidemiology, and End Results 18 database. Asian patients were subclassified as Chinese, Japanese, Korean, Filipino, Vietnamese, South Asian (Asian Indian or Pakistani), Southeast Asian (SEA, i.e., Cambodian, Laotian, Hmong, or Thai), or other Asian. Unadjusted overall survival (OS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to estimate adjusted OS and CSS. RESULTS In total, 910,415 women were included (Asian, n = 63,405; Black, n = 92,226; Hispanic, n = 84,451; White, n = 670,333). Asian women had higher rates of human epidermal growth factor receptor 2 (HER2)-positive disease compared with White women (18.7% vs 13.8%) and had the highest 10-year unadjusted OS and CSS among all racial/ethnic groups (all P < .001). SEA women had the highest rates of stage IV disease at presentation, whereas Japanese women had the lowest rates (5.9% vs 2.7%; P < .001). Japanese women had the highest 10-year unadjusted CSS (89.4%; 95% confidence interval, 88.7%-90.1%) of any distinct Asian group, whereas SEA women had the worst unadjusted CSS (78%; 95% confidence interval, 74.1%-81.3%; P < .001). After adjustment, SEA women had the worst OS of any Asian group and were the only Asian group without improved OS compared with White women (reference category; P = .08). CONCLUSIONS Breast cancer characteristics and outcomes vary significantly among Asian women. Future research should consider disaggregation by country or region of origin to identify subgroups that are at risk for worse outcomes than aggregated data may suggest. LAY SUMMARY Asian women with breast cancer are frequently studied as a single entity. However, Asian ethnic groups differ greatly by country of origin, genetic ancestry, disease frequency, socioeconomic status, patterns of immigration, as well as dietary and cultural practices. Women of different Asian ethnicities vary significantly with regard to cancer characteristics, such as mortality and tumor subtype. Future research should disaggregate these populations to better understand, treat, and counsel Asian patients with breast cancer.
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Affiliation(s)
| | - Samantha M Thomas
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.,Duke Cancer Institute, Durham, North Carolina
| | - Gayle D DiLalla
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Rachel A Greenup
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - E Shelley Hwang
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.,Duke Cancer Institute, Durham, North Carolina
| | - Carolyn S Menendez
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer K Plichta
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lisa A Tolnitch
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Oluwadamilola M Fayanju
- Duke Cancer Institute, Durham, North Carolina.,Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Surgery, Durham Veterans Affairs Medical Center, Durham, North Carolina
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Gutnik L, Ren Y, Thomas SM, Plichta JK, Greenup RA, Fayanju OM, Hwang ES, Rosenberger LH. Malignant phyllodes tumor and primary breast sarcoma; distinct rare tumors of the breast. J Surg Oncol 2022; 125:947-957. [PMID: 35179788 PMCID: PMC8995353 DOI: 10.1002/jso.26820] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Malignant phyllodes (MP) and primary breast sarcomas (PBS) are rare neoplasms with overlapping histopathologic features. We compared overall survival (OS) and estimated the association of surgery and therapies with OS. METHODS We utilized the National Cancer Database (2004-2016). Patients without surgery, unknown surgery, or margins, or Stage IV disease were excluded. Kaplan-Meier curves and Cox proportional hazards models were used to estimate unadjusted and adjusted OS, respectively. RESULTS A total of 3209 (59.5%) MP, and 2185 (40.5%) PBS were identified. Despite a larger median tumor size in MP (46 vs. 40 mm PBS, p < 0.001), lumpectomy rate was higher for MP (52.9% vs. 27.0% PBS, p < 0.001). Compared to MP, PBS patients more frequently received radiation (28.9% vs. 24%), and chemotherapy (28.1% vs. 4%), both p < 0.001. Unadjusted OS was lower for PBS (57% vs. 85% MP, log-rank p < 0.001). PBS (vs. MP) had persistently worse survival (hazard ratio [HR]: 1.98, 95% confidence interval [CI]: 1.69-2.31) after adjustment. Receipt of adjuvant therapies was not associated with OS (either neoplasm); however, lumpectomy was associated with improved OS (vs. mastectomy) for both PBS (HR: 0.59, 95% CI: 0.50-0.75) and MP (HR: 0.65, 95% CI: 0.53-0.81). Positive margins had no association with OS for MP (HR: 1.09, 95% CI: 0.75-1.60), but was associated with worse survival for PBS (HR: 2.35, 95% CI: 1.82-3.02). DISCUSSION We found significant survival differences between MP and PBS, with PBS having a consistently worse OS. Our findings support surgery as the mainstay of treatment for both tumor types and suggest that lumpectomy may be a reasonable option for select patients without compromising outcomes.
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Affiliation(s)
- Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yi Ren
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Jennifer K Plichta
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Rachel A Greenup
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - E Shelley Hwang
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Laura H Rosenberger
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Prakash I, Neely NB, Thomas SM, Sammons S, Blitzblau RC, DiLalla GA, Hyslop T, Menendez CS, Plichta JK, Rosenberger LH, Fayanju OM, Hwang ES, Greenup RA. Utilization of neoadjuvant chemotherapy in high-risk, node-negative early breast cancer. Cancer Med 2022; 11:1099-1108. [PMID: 34989142 PMCID: PMC8855910 DOI: 10.1002/cam4.4517] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/02/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Controversy exists regarding the optimal sequence of chemotherapy among women with operable node‐negative breast cancers with high‐risk tumor biology. We evaluated national patterns of neoadjuvant chemotherapy (NACT) use among women with early‐stage HER2+, triple‐negative (TNBC), and high‐risk hormone receptor‐positive (HR+) invasive breast cancers. Methods Women ≥18 years with cT1‐2/cN0 HER2+, TNBC, or high recurrence risk score (≥31) HR+ invasive breast cancers who received chemotherapy were identified in the National Cancer Database (2010–2016). Cochran‐Armitage and logistic regression examined temporal trends and likelihood of undergoing NACT versus adjuvant chemotherapy based on patient age and molecular subtype. Results Overall, 96,622 patients met study criteria; 25% received NACT and 75% underwent surgery first, with comparable 5‐year estimates of overall survival (0.90, 95% CI 0.892–0.905 vs 0.91, 95% CI 0.907–0.913). During the study period, utilization of NACT increased from 14% to 36% and varied according to molecular subtype (year*molecular subtype p < 0.001, p‐corrected < 0.001). Women with HER2+ (OR 4.17, 95% CI 3.70–4.60, p < 0.001, p‐corrected < 0.001) and TNBC (OR 3.81, 95% CI 3.38–4.31, p < 0.001, p‐corrected < 0.001) were more likely to receive NACT over time, without a change in use among those with HR+ disease (OR 1.58, 95% CI 0.88–2.87, p = 0.13, p‐corrected = 0.17). Conclusion Among women with early‐stage triple‐negative and HER2+ breast cancers, utilization of NACT increased over time, a trend that correlates with previously reported improved rates of pCR and options post‐neoadjuvant treatment with residual disease. Future research is needed to better understand multidisciplinary decisions for NACT and implications for breast cancer patients.
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Affiliation(s)
- Ipshita Prakash
- Department of Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - N Ben Neely
- Duke Department of Biostatistics & Bioinformatics, Durham, North Carolina, USA
| | - Samantha M Thomas
- Duke Department of Biostatistics & Bioinformatics, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA
| | - Sarah Sammons
- Duke Cancer Institute, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel C Blitzblau
- Duke Cancer Institute, Durham, North Carolina, USA.,Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gayle A DiLalla
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Terry Hyslop
- Duke Department of Biostatistics & Bioinformatics, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA
| | - Carolyn S Menendez
- Duke Cancer Institute, Durham, North Carolina, USA.,Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer K Plichta
- Duke Cancer Institute, Durham, North Carolina, USA.,Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura H Rosenberger
- Duke Cancer Institute, Durham, North Carolina, USA.,Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwadamilola M Fayanju
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Rena Rowan Breast Center, Abramson Cancer Center, Philadelphia, Pennsylvania, USA.,Yale Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - E Shelley Hwang
- Duke Cancer Institute, Durham, North Carolina, USA.,Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel A Greenup
- Yale Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.,Yale Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut, USA
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Marks CE, Thomas SM, Fayanju OM, DiLalla G, Sammons S, Hwang ES, Plichta JK. Metastatic breast cancer: Who benefits from surgery? Am J Surg 2022; 223:81-93. [PMID: 34325907 PMCID: PMC8688223 DOI: 10.1016/j.amjsurg.2021.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND We sought to identify characteristics of metastatic breast cancer (MBC) patients who may benefit most from primary tumor resection. METHODS Recursive partitioning analysis (RPA) was used to categorize non-surgical patients with de novo MBC in the NCDB (2010-2015) into 3 groups (I/II/III) based on 3-year overall survival (OS). After bootstrapping (BS), group-level profiles were applied, and the association of surgery with OS was estimated using Cox proportional hazards models. RESULTS All patients benefitted from surgery (median OS, surgery vs no surgery): 72.7 vs 42.9 months, 47.3 vs 30.4 months, 23.8 vs 14.4 months (all p < 0.001) in BS-groups I, II, and III, respectively. After adjustment, surgery remained associated with improved OS (HR 0.52, 95% CI 0.50-0.55). The effect of surgery on OS differed quantitatively across groups. CONCLUSION Prognostic groups may inform the degree of benefit from surgery, with the greatest benefit seen in those with the most favorable survival.
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Affiliation(s)
- Caitlin E. Marks
- Duke University Medical Center, Department of Surgery. Durham, NC
| | - Samantha M. Thomas
- Duke Cancer Institute. Durham, NC.,Biostatistics Shared Resource, Duke Cancer Institute. Durham, NC.,Duke University, Department of Biostatistics & Bioinformatics. Durham, NC
| | - Oluwadamilola M. Fayanju
- Duke University Medical Center, Department of Surgery. Durham, NC.,Duke Cancer Institute. Durham, NC.,Duke University Medical Center, Department of Population Health Sciences. Durham, NC.,Durham VA Medical Center, Department of Surgery. Durham, NC
| | - Gayle DiLalla
- Duke University Medical Center, Department of Surgery. Durham, NC.,Duke Women’s Cancer Care Raleigh. Raleigh, NC
| | - Sarah Sammons
- Duke Cancer Institute. Durham, NC.,Duke University Medical Center, Department of Medicine. Durham, NC
| | - E. Shelley Hwang
- Duke University Medical Center, Department of Surgery. Durham, NC.,Duke Cancer Institute. Durham, NC
| | - Jennifer K. Plichta
- Duke University Medical Center, Department of Surgery. Durham, NC.,Duke Cancer Institute. Durham, NC.,Duke University Medical Center, Department of Population Health Sciences. Durham, NC
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