Objective： A previous study demonstrated that non-anthracycline-containing docetaxel plus cyclophosphamide（TC） regimen was inferior to docetaxel, anthracycline and cyclophosphamide（TAC） in neoadjuvant treatment o...Objective： A previous study demonstrated that non-anthracycline-containing docetaxel plus cyclophosphamide（TC） regimen was inferior to docetaxel, anthracycline and cyclophosphamide（TAC） in neoadjuvant treatment of triple-negative breast cancer（TNBC） and human epidermal growth factor receptor-2-（HER2）-positive breast cancer in a short-term follow-up. Herein, long-term follow-up survival outcomes have been investigated.Methods： TNBC or HER2-positive patients were randomized to receive 6 cycles of TC or TAC neoadjuvant treatment. The primary endpoint was pathological complete remission（p CR）. Secondary endpoints included clinical response rate, event-free survival（EFS）, and overall survival（OS）.Results： A cohort of 96 patients consisted of 45 in TC and 51 in TAC arm. With a median follow-up period of53（range, 8-76） months, the patients achieving p CR post neoadjuvant chemotherapy exhibited superior EFS and OS than patients without p CR（P〈0.05）. TAC treatment resulted in consistently better EFS than TC treatment：the estimated 5-year EFS was 66.1% vs. 29.8%（P=0.002）. Moreover, the estimated 5-year OS was also in favor of TAC： 88.4% vs. 51.6%（P〈0.001）. Multivariable analysis demonstrated that the treatment regimen was an independent prognostic factor, and patients treated with TAC had a superior EFS [hazard ratio（HR）, 0.48; 95%confidence interval（95% CI）, 0.26-0.90; P=0.021] and OS（HR, 0.20; 95% CI, 0.08-0.60; P=0.003）.Conclusions： The updated long-term follow-up data demonstrated a sustained benefit in EFS and OS from anthracycline-containing TAC treatment, indicating that anthracycline is an essential and effective drug in this clinical trial.展开更多
Objective： The indication of adjuvant chemotherapy recommendation（ACR） in breast cancer patients with intermediate recurrence score（RS） is controversial. This study investigated the relationship between routine c...Objective： The indication of adjuvant chemotherapy recommendation（ACR） in breast cancer patients with intermediate recurrence score（RS） is controversial. This study investigated the relationship between routine clinicopathological indicators and ACR, and established a nomogram for predicting the probability of ACR in this subset of patients.Methods： Data for a total of 504 consecutive patients with intermediate RS from January 2014 to December2016 were retrospectively reviewed. A nomogram was constructed using a multivariate logistic regression model based on data from a training set（378 cases） and validated in an independent validation set（126 cases）. A Youdenderived cut-off value was assigned to the nomogram for accuracy evaluation.Results： The multivariate logistic regression analysis identified that age, histological grade, tumor size, lymph node（LN） status, molecular subtype, and RS were independent predictors of ACR. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.286. The area under the curve（AUC） values were 0.905 [95% confidence interval（95% CI）： 0.876–0.934] and 0.883（95%CI： 0.824–0.942） in the training and validation sets, respectively. The accuracies of the nomogram for ACR were84.4% in the training set and 82.1% in the validation set.Conclusions： We developed a nomogram to predict the probability of ACR in breast cancer patients with intermediate RS. This model may aid the individual risk assessment and guide treatment decisions in clinical practice.展开更多
MRI provides a highly sensitive technique for early detection of abnormal breast tissue. It is useful for identifying a status of proliferation, angiogenesis, and microvascular permeability, which may indicate early b...MRI provides a highly sensitive technique for early detection of abnormal breast tissue. It is useful for identifying a status of proliferation, angiogenesis, and microvascular permeability, which may indicate early breast neoplasm formation. We retrospectively studied 2005 breast MRI images from Taiwan Residents women and classified them as either healthy or unhealthy according to BI-RADS categories. A subgroup of our study patients had received estrogen supplements, containing estrogen components or phytoestrogen, for at least 3 months. These patients’ images were also classified into the healthy and unhealthy groups. These two groups were compared and a significant difference was found between them (P < 0.002). Comparison of the MRI images also identified certain cases that demonstrated a typical estrogen/phytoestrogen effect or a withdrawal effect. The overuse of estrogen or phytoestrogen supplements can increase breast glandular tissue proliferation, as reflected on MRI images. Such proliferation may increase the patient’s risk of future breast cancer.展开更多
p53 is mutated in half of cancer cases.However,no p53-targeting drugs have been approved.Here,we reposition decitabine for triple-negative breast cancer(TNBC),a subtype with frequent p53 mutations and extremely poor p...p53 is mutated in half of cancer cases.However,no p53-targeting drugs have been approved.Here,we reposition decitabine for triple-negative breast cancer(TNBC),a subtype with frequent p53 mutations and extremely poor prognosis.In a retrospective study on tissue microarrays with 132 TNBC cases,DNMT1 overexpression was associated with p53 mutations(P=0.037)and poor overall survival(OS)(P=0.010).In a prospective DEciTabinE and Carboplatin in TNBC(DETECT)trial(NCT03295552),decitabine with carboplatin produced an objective response rate(ORR)of 42%in 12 patients with stage IV TNBC.Among the 9 trialed patients with available TP53 sequencing results,the 6 patients with p53 mutations had higher ORR(3/6 vs.0/3)and better OS(16.0 vs.4.0 months)than the patients with wild-type p53.In a mechanistic study,isogenic TNBC cell lines harboring DETECT-derived p53 mutations exhibited higher DNMT1 expression and decitabine sensitivity than the cell line with wild-type p53.In the DETECT trial,decitabine induced strong immune responses featuring the striking upregulation of the innate immune player IRF7 in the p53-mutated TNBC cell line(upregulation by 16-fold)and the most responsive patient with TNBC.Our integrative studies reveal the potential of repurposing decitabine for the treatment of p53-mutated TNBC and suggest IRF7 as a potential biomarker for decitabine-based treatments.展开更多
目的分析内分泌治疗期间年轻乳腺癌患者女性性功能障碍(female sexual dysfunction,FSD)的发生状况及其影响因素。方法选取2021年1月至2021年7月于上海交通大学医学院附属瑞金医院进行术后辅助内分泌治疗的189例年轻女性乳腺癌患者为研...目的分析内分泌治疗期间年轻乳腺癌患者女性性功能障碍(female sexual dysfunction,FSD)的发生状况及其影响因素。方法选取2021年1月至2021年7月于上海交通大学医学院附属瑞金医院进行术后辅助内分泌治疗的189例年轻女性乳腺癌患者为研究对象,采用一般资料调查表、女性性功能指数量表、乳腺癌患者身体意象量表、医院焦虑抑郁量表、社会支持评定量表及修订版婚姻调适量表进行调查。采用logistic回归分析FSD的影响因素。结果在189例年轻女性乳腺癌患者中,FSD发生率为81.0%(153/189)。多因素分析结果显示,乳房重建术相比乳房切除术可以降低FSD的发生风险(OR=0.243,95%CI:0.076~0.779,P=0.017);术后身体意象评分≥8分是FSD的保护因素(OR=0.176,95%CI:0.059~0.526,P=0.002);而曾接受化疗(OR=5.250,95%CI:2.065~13.347,P<0.001)、存在焦虑症状(OR=6.348,95%CI:1.985~20.299,P=0.002)是FSD的独立危险因素。结论年轻女性乳腺癌患者在内分泌治疗期间的FSD发生率较高,尤其是曾接受化疗、存在焦虑症状、身体意象状况较差的患者,需重视患者的性健康问题并加强性功能评估,以便进行针对性干预。展开更多
基金supported in part by the grants from the National Natural Science Foundation of China (Grant No. 81472462)Medical Guidance Foundation of Shanghai Municipal Science and Technology Commission (Grant No. 15411966400)Technology Innovation Act Plan of Shanghai Municipal Science and Technology Commission (Grant No. 14411950200, 14411950201) and Sanofi
文摘Objective： A previous study demonstrated that non-anthracycline-containing docetaxel plus cyclophosphamide（TC） regimen was inferior to docetaxel, anthracycline and cyclophosphamide（TAC） in neoadjuvant treatment of triple-negative breast cancer（TNBC） and human epidermal growth factor receptor-2-（HER2）-positive breast cancer in a short-term follow-up. Herein, long-term follow-up survival outcomes have been investigated.Methods： TNBC or HER2-positive patients were randomized to receive 6 cycles of TC or TAC neoadjuvant treatment. The primary endpoint was pathological complete remission（p CR）. Secondary endpoints included clinical response rate, event-free survival（EFS）, and overall survival（OS）.Results： A cohort of 96 patients consisted of 45 in TC and 51 in TAC arm. With a median follow-up period of53（range, 8-76） months, the patients achieving p CR post neoadjuvant chemotherapy exhibited superior EFS and OS than patients without p CR（P〈0.05）. TAC treatment resulted in consistently better EFS than TC treatment：the estimated 5-year EFS was 66.1% vs. 29.8%（P=0.002）. Moreover, the estimated 5-year OS was also in favor of TAC： 88.4% vs. 51.6%（P〈0.001）. Multivariable analysis demonstrated that the treatment regimen was an independent prognostic factor, and patients treated with TAC had a superior EFS [hazard ratio（HR）, 0.48; 95%confidence interval（95% CI）, 0.26-0.90; P=0.021] and OS（HR, 0.20; 95% CI, 0.08-0.60; P=0.003）.Conclusions： The updated long-term follow-up data demonstrated a sustained benefit in EFS and OS from anthracycline-containing TAC treatment, indicating that anthracycline is an essential and effective drug in this clinical trial.
文摘Objective： The indication of adjuvant chemotherapy recommendation（ACR） in breast cancer patients with intermediate recurrence score（RS） is controversial. This study investigated the relationship between routine clinicopathological indicators and ACR, and established a nomogram for predicting the probability of ACR in this subset of patients.Methods： Data for a total of 504 consecutive patients with intermediate RS from January 2014 to December2016 were retrospectively reviewed. A nomogram was constructed using a multivariate logistic regression model based on data from a training set（378 cases） and validated in an independent validation set（126 cases）. A Youdenderived cut-off value was assigned to the nomogram for accuracy evaluation.Results： The multivariate logistic regression analysis identified that age, histological grade, tumor size, lymph node（LN） status, molecular subtype, and RS were independent predictors of ACR. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.286. The area under the curve（AUC） values were 0.905 [95% confidence interval（95% CI）： 0.876–0.934] and 0.883（95%CI： 0.824–0.942） in the training and validation sets, respectively. The accuracies of the nomogram for ACR were84.4% in the training set and 82.1% in the validation set.Conclusions： We developed a nomogram to predict the probability of ACR in breast cancer patients with intermediate RS. This model may aid the individual risk assessment and guide treatment decisions in clinical practice.
文摘MRI provides a highly sensitive technique for early detection of abnormal breast tissue. It is useful for identifying a status of proliferation, angiogenesis, and microvascular permeability, which may indicate early breast neoplasm formation. We retrospectively studied 2005 breast MRI images from Taiwan Residents women and classified them as either healthy or unhealthy according to BI-RADS categories. A subgroup of our study patients had received estrogen supplements, containing estrogen components or phytoestrogen, for at least 3 months. These patients’ images were also classified into the healthy and unhealthy groups. These two groups were compared and a significant difference was found between them (P < 0.002). Comparison of the MRI images also identified certain cases that demonstrated a typical estrogen/phytoestrogen effect or a withdrawal effect. The overuse of estrogen or phytoestrogen supplements can increase breast glandular tissue proliferation, as reflected on MRI images. Such proliferation may increase the patient’s risk of future breast cancer.
基金supported by the National Natural Science Foundation of China(No.82130075 to Min Lu,No.82073292 to Min Lu,No.81772797 to Xiaosong Chen,No.82072937 to Xiaosong Chen,No.82072897 to Kunwei Shen,No.82002773 to Zheng Wang,No.81900157 to Ying Liang)SJTU Transmed Awards Research(to Min Lu),Shanghai Municipal Education Commission-Gaofeng Clinical Medicine(No.828318 to Min Lu and No.20172007 to Xiaosong Chen)+4 种基金Shanghai Excellent Youth Academic Leader(No.20XD1422700 to Min Lu)Program of Shanghai Science and Technology Committee(No.21S11900100 to Min Lu)Dawn Program of Shanghai Education Commission(No.21SG18 to Min Lu)Samuel Waxman Cancer Research Foundation(to Min Lu)Foundation of National Facility for Translational Medicine(Shanghai)(No.NRCTM(SH)-2021-08).
文摘p53 is mutated in half of cancer cases.However,no p53-targeting drugs have been approved.Here,we reposition decitabine for triple-negative breast cancer(TNBC),a subtype with frequent p53 mutations and extremely poor prognosis.In a retrospective study on tissue microarrays with 132 TNBC cases,DNMT1 overexpression was associated with p53 mutations(P=0.037)and poor overall survival(OS)(P=0.010).In a prospective DEciTabinE and Carboplatin in TNBC(DETECT)trial(NCT03295552),decitabine with carboplatin produced an objective response rate(ORR)of 42%in 12 patients with stage IV TNBC.Among the 9 trialed patients with available TP53 sequencing results,the 6 patients with p53 mutations had higher ORR(3/6 vs.0/3)and better OS(16.0 vs.4.0 months)than the patients with wild-type p53.In a mechanistic study,isogenic TNBC cell lines harboring DETECT-derived p53 mutations exhibited higher DNMT1 expression and decitabine sensitivity than the cell line with wild-type p53.In the DETECT trial,decitabine induced strong immune responses featuring the striking upregulation of the innate immune player IRF7 in the p53-mutated TNBC cell line(upregulation by 16-fold)and the most responsive patient with TNBC.Our integrative studies reveal the potential of repurposing decitabine for the treatment of p53-mutated TNBC and suggest IRF7 as a potential biomarker for decitabine-based treatments.
文摘目的:分析绝经前乳腺癌不同年龄段病人的临床病理特征及辅助治疗方案选择的差异。方法 :回顾性分析2009年1月至2016年12月就诊的571例绝经前乳腺癌病人,收集其临床病理资料以及辅助治疗方案。根据年龄,分为≤35岁(44例)、36～40岁(86例)和>40岁(441例)三组,比较组间临床病理特征以及治疗方案的差异。结果:分析显示,体质量指数(body mass index, BMI)以及HER2阳性率在三组间具有显著差异(P<0.05)。进一步两两比较发现,BMI>25的比例在≤35岁组显著低于其他两组;≤35岁组的HER2阳性率为20.45%,显著高于36～40岁组(12.79%)和>40岁组(15.87%)。在外科治疗方面,≤35岁组较多选择保乳手术(22.73%)和前哨淋巴结手术(43.18%);而在术后辅助化疗、放疗、内分泌治疗和靶向治疗方面,三组间无统计学差异。>40岁组卵巢功能抑制应用少于其他两组(P<0.001)。结论:在绝经前乳腺癌病人中,≤35岁组BMI较低,HER2阳性率较高,较多接受保乳手术和前哨淋巴结手术。
文摘目的分析内分泌治疗期间年轻乳腺癌患者女性性功能障碍(female sexual dysfunction,FSD)的发生状况及其影响因素。方法选取2021年1月至2021年7月于上海交通大学医学院附属瑞金医院进行术后辅助内分泌治疗的189例年轻女性乳腺癌患者为研究对象,采用一般资料调查表、女性性功能指数量表、乳腺癌患者身体意象量表、医院焦虑抑郁量表、社会支持评定量表及修订版婚姻调适量表进行调查。采用logistic回归分析FSD的影响因素。结果在189例年轻女性乳腺癌患者中,FSD发生率为81.0%(153/189)。多因素分析结果显示,乳房重建术相比乳房切除术可以降低FSD的发生风险(OR=0.243,95%CI:0.076~0.779,P=0.017);术后身体意象评分≥8分是FSD的保护因素(OR=0.176,95%CI:0.059~0.526,P=0.002);而曾接受化疗(OR=5.250,95%CI:2.065~13.347,P<0.001)、存在焦虑症状(OR=6.348,95%CI:1.985~20.299,P=0.002)是FSD的独立危险因素。结论年轻女性乳腺癌患者在内分泌治疗期间的FSD发生率较高,尤其是曾接受化疗、存在焦虑症状、身体意象状况较差的患者,需重视患者的性健康问题并加强性功能评估,以便进行针对性干预。
