Development and validation of a nomogram for predicting internal mammary sentinel node metastasis in breast cancer patients.

OBJECTIVE: Internal mammary nodes are important in breast cancer prognosis, but their diagnosis is often missed in clinical practice, leading to inaccurate staging and treatment. We developed a validated nomogram to predict the presence of internal mammary sentinel nodes (IMSN) metastasis. METHODS: A total of 864 sequential IMSN biopsy procedures from a prospective studies database of 1505 cases were used for model development and validation. Multivariable logistic regression was performed on 519 sequential IMSN biopsy procedures from multi-center data between August 2018 and July 2022 to predict the presence of IMSN metastasis. A nomogram was developed based on the logistic regression model and subsequently applied to 345 sequential IMSN biopsy procedures from single-center data between November 2011 and July 2018. The model's discrimination was assessed using the area under the receiver operating characteristic curve. RESULTS: The overall frequency of IMSN metastasis was 17.0% in our study. A predictive model for IMSN metastasis was constructed using tumor size, tumor location, lymphovascular invasion, the number of positive axillary nodes (P < 0.05 for all variables in multivariate analysis), and histological grade (P < 0.05 only in univariate analysis). The nomogram was accurate, with a concordance index of 0.84 in the bootstrapping analysis and an area under the receiver operating characteristic curve of 0.80 in the validation population. CONCLUSION: Our nomogram provides an accurate and validated multivariable predictive model for estimating the individual likelihood of having IMSN metastasis. This may be useful for personalized treatment decisions regarding internal mammary radiotherapy in breast cancer patients.

Lower subcutaneous fat index predicts bone metastasis in breast cancer.

BACKGROUND: Bone metastases affect 50% to 70% of breast cancer (BC) patients and have a high mortality rate. Adipose tissue loss plays a pivotal role in the progression of cancer. OBJECTIVE: This study aims to evaluate the prognostic value of adipose tissue for bone metastasis in BC patients. METHODS: 517 BC patients were studied retrospectively. Patients' characteristics before the surgery were collected. Quantitative measurements of the subcutaneous fat index (SFI) were performed at the level of the eleventh thoracic vertebra. In order to adjust for the heterogeneity between the low SFI and high SFI groups, propensity score matching (PSM) was used. The Kaplan-Meier method was used to estimate the 5-year bone metastatic incidence. The prognostic analysis was performed with the Cox regression models. RESULTS: Compared with the patients without bone metastasis, the patients with bone metastasis had reduced SFI levels. In addition, Kaplan-Meier analysis revealed that patients with low SFI were more likely to develop bone metastases. The independent predictive value of SFI for bone metastases was confirmed by Cox regression analysis. The survival analysis was repeated after PSM with a 1:1 ratio, yielding similar results (P< 0.05). CONCLUSIONS: SFI is an independent predictor of bone metastasis in BC patients.

Breast cancer-derived exosomes regulate cell invasion and metastasis in breast cancer via miR-146a to activate cancer associated fibroblasts in tumor microenvironment.

OBJECTIVE: To explore the effects of breast cancer (BC)-derived exosomes on invasion and migration of BC cells. METHODS: Exosomes (Exo-MA, Exo-M7, Exo-M1) were extracted from normal breast epithelial cells (MCF-10A), BC cells (MCF-7/MDA-MB-231) and BC cells with miR-146a overexpression or knockdown using multi-step differential centrifugation. Morphologies and sizes of exosomes were observed by transmission electron microscope (TEM) and particle size analysis respectively. BC mouse models were injected with DIR labeled Exo-MA, Exo-M7 or Exo-M1. The epithelial-mesenchymal transition (EMT) in BC cells was determined by PCR and Western blot. PKH67 labeled Exo-MA, Exo-M7 and Exo-M1 were incubated with NFs or MCF-7 to measure the activation of CAFs. Cell invasion and migration abilities were determined by scratch test and Transwell assay. RESULTS: Exo-MA, Exo-M7, Exo-M1 were successfully extracted with positive expressions of Alix, CD63 and TSG101. Contents of Ki67, N-cadherin, Vimentin and Snail-1 were increased but E-cadherin was decreased, compared to Exo-MA group. Exo-M7 or Exo-M1 could increase BC cell proliferation and enhance EMT in nude mouse. Exo-M7 and Exo-M1 could accelerate the transformation of NFs into CAFs and promote the recruitment of CAFs in MCF-7. Transfection of miR-146a could promote the transformation of NFs into CAFs and promote cell invasion and migration of MCF-7 cells. As a target gene of miR-146a, TXNIP could inhibit the activation of CAFs. miR-146a overexpression or TXNIP silence enhance the activation of Wnt signal pathway. CONCLUSION: BC-derived exosomes promote the activation of CAFs through miR-146a/TXNIP axis to activate Wnt pathway, which in turn enhances invasion and metastasis of BC cells.

Preoperative mean platelet volume predicts survival in breast cancer patients with type 2 diabetes.

PURPOSE: Patients with type 2 diabetes mellitus (T2DM) have an increased risk of breast cancer (BC). Furthermore, growing evidence suggests that activated platelets play a crucial role in tumor and T2DM. Mean platelet volume (MPV) is a platelet index and is altered in patients with malignancies. The aim of this study was to determine whether preoperative MPV could predict survival in BC patients with T2DM. METHODS: The clinical data of 266 female BC patients with T2DM and 264 female BC patients without T2DM between January 2011 and December 2011 in our center were retrospectively analyzed. Survival analysis was performed using the log-rank test and Cox proportional hazards regression analysis. RESULTS: The patients with T2DM had higher MPV levels than the patients without T2DM. Furthermore, MPV was found to be significantly associated with differentiation T2DM from non-T2DM. In addition, survival analysis revealed that the disease-specific survival and overall survival of patients with MPV ≤ 8.0 fL were significantly shorter than that of those with MPV > 8.0 fL in diabetic patients. Multivariate analysis identified MPV as an independent poor prognostic factor for survival only in patients with T2DM not in patients without T2DM. CONCLUSIONS: Our study first established a connection between MPV and BC patients with T2DM, suggesting that MPV was an independent prognostic factor and could be the biomarker for prognosis.

Preoperative platelet distribution width predicts breast cancer survival.

BACKGROUND: Breast cancer is one of the most commonly diagnosed cancers, and the fourth leading cause of cancer deaths in females worldwide. Activated platelets play a key role in tumor growth and tumor metastasis. Platelet distribution width (PDW) is a platelet index, and is altered in patients with malignancies. The aim of this study was to explore whether PDW can effectively predict death outcome of breast cancer patients. STUDY DESIGN: The clinical data of 271 breast cancer patients in our hospital between January 2009 and December 2009 were retrospectively analyzed. Survival analysis was performed using the log-rank test and Cox proportional hazards regression analysis. RESULT: There were significant correlations between increased PDW and tumor size, molecular subtype, differentiation grade, and cancer stages (T, N, or TNM). Moreover, survival analysis revealed that the overall survival of patients with PDW > 16.8%, which was significantly shorter than those with PDW ⩽ 16.8%. Multivariate analysis indicated that PDW > 16.8% predicts a poor overall survival of breast cancer patients. CONCLUSIONS: Elevated PDW may serve as a marker of adverse prognosis in breast cancer. However, these data are preliminary and should be interpreted with caution pending validation by additional clinical and molecular/genomics studies in various populations.

Prognostic significance of HOXD13 expression in human breast cancer.

Homeobox protein Hox-D13 has been recognized as a tumor suppressor in pancreatic cancer. To evaluate the function of HOXD13 in invasive breast cancer pathogenesis, we examined HOXD13 expression in 434 breast cancer tissues and 230 their counterpart normal breast tissues by immunohistochemistry using a tissue microarray (TMA). The association between HOXD13 expression and clinicopathological factors was analyzed by use of Chi-square test. Kaplan-Meier survival curves and log-rank tests were applied to analyze the survival status. Cox regression was applied for multivariate analysis of prognosis. We found that low HOXD13 expression accounts for 84.3% in breast cancer tissues. Low HOXD13 expression was significantly associated with large tumor size (P=0.038) and positive lymph node metastasis (LNM) (P=0.026). In Kaplan-Meier survival curves and log-rank tests, the patients with HOXD13-negative breast cancer showed significantly poorer outcomes (69.867 ± 1.058 months) in terms of overall survival (OS) than positive-HOXD13-expression patients (76.248 ± 1.069 months) (P=0.003). And in multivariate analysis, low level of HOXD13 expression was a significant unfavorable prognostic factor. So we conclude that down-regulation of HOXD13 might be a potentially useful prognostic marker for patients with breast cancer.