Artificial intelligence for predicting five-year survival in stage IV metastatic breast cancer patients: A focus on sarcopenia and other host factors.

We developed an artificial intelligence (AI) model that can predict five-year survival in patients with stage IV metastatic breast cancer, mainly based on host factors and sarcopenia. From a prospectively built breast cancer registry, a total of 210 metastatic breast cancer patients were selected in a consecutive manner using inclusion/exclusion criteria. The patients' data were divided into two categories: a group that survived for more than 5 years and a group that did not survive for 5 years. For the AI model input, 11 features were considered, including age, body mass index, skeletal muscle area (SMA), height-relative SMA (H-SMI), height square-relative SMA (H2-SMA), weight-relative SMA (W-SMA), muscle mass, anticancer chemotherapy, radiation therapy, and comorbid diseases such as hypertension and mellitus. For the feature importance analysis, we compared classifiers using six different machine learning algorithms and found that extreme gradient boosting (XGBoost) provided the best accuracy. Subsequently, we performed the feature importance analysis based on XGBoost and proposed a 4-layer deep neural network, which considered the top 10 ranked features. Our proposed 4-layer deep neural network provided high sensitivity (75.00%), specificity (78.94%), accuracy (78.57%), balanced accuracy (76.97%), and an area under receiver operating characteristics of 0.90. We generated a web application for anyone to easily access and use this AI model to predict five-year survival. We expect this web application to be helpful for patients to understand the importance of host factors and sarcopenia and achieve survival gain.

A Randomized Controlled Trial for Doing vs. Omitting Intraoperative Frozen Section Biopsy for Resection Margin Status in Selected Patients Undergoing Breast-Conserving Surgery (OFF-MAP Trial).

PURPOSE: Intraoperative frozen section biopsy is used to reduce the margin positive rate and re-excision rate and has been reported to have high diagnostic accuracy. A majority of breast surgeons in the Republic of Korea routinely perform frozen section biopsy to assess margins intraoperatively, despite its long turnaround time and high resource requirements. This study aims to determine whether omitting frozen section biopsy for intraoperative margin evaluation in selected patients is non-inferior to performing frozen section biopsy in terms of resection margin positivity rate. METHODS: This study is a phase III, randomized controlled, parallel-group, multicenter non-inferiority clinical trial. Patients meeting the inclusion criteria and providing written informed consent will be randomized to the "frozen section biopsy" or "frozen section biopsy omission" group after lumpectomy. Patients with clinical stage T1-T3 disease who are diagnosed with invasive breast cancer by core-needle biopsy and plan to undergo breast-conserving surgery will be included in this study. If a daughter nodule, non-mass enhancement, or microcalcification is identified on preoperative imaging, these features must be within 1 cm of the main mass for inclusion in the trial. The target sample size is 646 patients per arm. The primary endpoint will be the resection margin positive rate, and the secondary endpoints include the reoperation rate, operating time, residual cancer after reoperation, residual cancer after re-excision according to the frozen section biopsy result, resection volume, patient quality of life, and cost-effectiveness. DISCUSSION: This is the first randomized clinical trial utilizing frozen section biopsy for intraoperative margin evaluation and aims to determine the non-inferiority of omitting frozen section biopsy in selected patients compared to performing frozen section biopsy. We expect that this trial will help surgeons perform the procedure more efficiently while ensuring patient safety. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03975179; Clinical Research Information Service Identifier: KCT0004606.

Five-Year Overall Survival of Interval Breast Cancers is Better than Non- Interval Cancers from Korean Breast Cancer Registry.

Objective: Interval breast cancer (IC) is a limitation of breast cancer screening. We investigated data from a large scaled breast cancer dataset of patients with breast cancer who underwent breast cancer screening in order to recapitulate the overall survival (OS) of patients with ICs compared to those with non-ICs. Methods: A total of 27,141 patients in the Korean breast cancer registry with breast cancer who had ever participated in biannual national breast cancer screening programs between 2009 and 2013 were enrolled. We compared the social, pregnancy-associated, and pathologic characteristics between the IC and non-IC groups and identified the significant prognostic factors for OS. Results: The proportion of ICs was 1.3% (370/27,141) in this study population. ICs were correlated with age 45-55 years at diagnosis, higher levels of education, early menopause (<50 years), hormone replacement therapy, specific provinces (Kangwon, Kyungnam, Jeju, and Dae-jeon), and family history of breast cancer. Low-to-intermediate nuclear grade, early stage (stage 0-I), and low Ki-67 level were also correlated with IC proportion. Non-ICs were associated with an increased risk of five-year mortality (hazard ratio [HR] 7.4; 95% confidence interval [CI]:1.85-29.66; p = 0.005) compared to ICs. Lymph node metastasis, residence (Kyung-nam province), low education status, high histologic grade, and asymptomatic cancers increased the HR of five-year OS. Conclusion: ICs occurred unequally in specific province and relatively high-educated women in Korea. They were also diagnosed with early-stage breast cancer with a favorable recurrence risk, and their outcome was better than those of patients with other breast cancers in breast cancer screening.

Familial history of non-medullary thyroid cancer is an independent prognostic factor for tumor recurrence in younger patients with conventional papillary thyroid carcinoma.

BACKGROUND: It is not clear whether familial non-medullary thyroid cancer (FNMTC) is more aggressive and has a poorer prognosis, than sporadic carcinoma. Therefore, the optimal clinical approach for FNMTC is yet to be established. In this study, we investigated the biological behavior and prognosis of FNMTC compared with its sporadic counterpart. METHODS: Between 1996 and 2004, 1,262 patients underwent a total thyroidectomy for conventional PTC at Asan Medical Center and 113 (9.0%) were diagnosed with FNMTC. We compared the clinico-pathologic characteristics, treatment modalities, and prognosis between familial and sporadic NMTC. RESULTS: FNMTC was significantly more multi-centric than sporadic. We also found that family history itself was an independent risk factor for recurrence. Moreover, disease-free survival in the familial group was significantly shorter than in the sporadic group in the subgroups in which age was <45 years, and in which the tumors were multi-centric, bilateral, and of N1b node status. CONCLUSION: FNMTC may be considered as a separate clinical entity with a higher rate of recurrence and worse DFS than its sporadic counterpart. Furthermore, familial history of NMTC is an independent risk factor for recurrence, especially in younger patients with conventional PTC.

Surgical outcomes of robotic thyroid surgery using a double incision gasless transaxillary approach: analysis of 400 cases treated by the same surgeon.

BACKGROUND: The purpose of this study was to evaluate the surgical outcomes of 400 cases of robotic thyroid surgery using a double incision gasless transaxillary approach. METHODS: We analyzed 400 patients who underwent a robot-assisted thyroidectomy performed by a single surgeon. RESULTS: All patients underwent successful operations without conversion to open surgery. Transient hypoparathyroidism was the most common complication (51.7%) and permanent hypoparathyroidism occurred in only 2 patients (1.4%). The mean number of retrieved central lymph nodes was 6.5 ± 4.4 for ipsilateral central compartment node dissection and 8.4 ± 5.1 for bilateral central compartment node dissection. The proportion of patients with stimulated thyroglobulin (sTg) levels at the time of remnant ablation <10 ng/mL and sTg levels 6 to 12 months after the first ablation <1 ng/mL was 84.9% and 88.3%, respectively. CONCLUSION: Robotic thyroid surgery is technically safe and may be a surgical option for patients with well-differentiated thyroid cancer.

Technical and oncologic safety of robotic thyroid surgery.

BACKGROUND: The aim of this study was to evaluate the surgical outcomes of a double-incision robot-assisted gasless transaxillary thyroidectomy procedure compared with conventional open thyroid surgery. METHODS: We enrolled and analyzed 521 female patients with classic papillary thyroid carcinoma (PTC) who underwent a total thyroidectomy with central compartment node dissection (CCND) at the Asan Medical Center in Seoul, Korea from December 2008 to December 2010. These patients were classified into robotic (N = 98) or open (N = 423) groups and were compared with respect to clinicopathologic characteristics, complications, and stimulated thyroglobulin (sTg) levels at the time of immediate postoperative radioactive iodine remnant ablation (ablation sTg) and at 6-12 months after the first ablation (control sTg). RESULTS: The rate of perioperative complications was also similar, except for transient hypoparathyroidism in the robotic group. The median ablation sTg levels (0.39 vs 0.50 ng/mL, P = 0.215) and the proportion of patients with ablation sTg levels <10 ng/mL (94.5 vs 98.0 %, P = 0.103) were also comparable between the robotic and open groups. In addition, the proportion of patients with control sTg levels <1 ng/mL in both robotic and open groups (91.3 vs 95.6 %, P = 0.079) did not show a significant difference. CONCLUSIONS: Robotic thyroid surgery using a double-incision gasless transaxillary approach is technically safe and may provide a feasible option for a complete thyroid resection and adequate lymph node dissection in patients with PTC.