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1.
Breast Cancer Res Treat ; 182(3): 515-521, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32529409

RESUMEN

PURPOSE: Cryoablation is a minimally-invasive percutaneous procedure that is capable of reducing the psychosocial burden of surgical delay while also decreasing the morbidity of breast cancer therapy. The purpose of this editorial is to discuss the potential role of cryoablation for reducing the psychosocial burden of surgical delay during the COVID-19 pandemic by expediting the management of breast cancer while also lessening demand on limited healthcare resources. METHODS: This editorial critiques current expert opinion recommendations that aim to reduce viral transmission and preserve healthcare resources during the COVID-19 pandemic by advocating delay of elective breast cancer surgery. RESULTS: The editorial summarizes the current state of the evidence that supports the selective use of cryoablation as a definite or stopgap measure in the management of breast cancer during the COVID-19 pandemic or when healthcare resources are limited. CONCLUSIONS: As an office-based procedure performed under local anesthesia, cryoablation eliminates the need for operating room personnel and equipment while also reducing the psychosocial impact of delayed breast cancer surgery. By reducing the number of patient and healthcare provider interactions, cryoablation not only decreases the risk of viral transmission but also the need for personal protective devices during resource-limited times.


Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Ansiedad/psicología , Neoplasias de la Mama/terapia , Infecciones por Coronavirus/epidemiología , Criocirugia/métodos , Mastectomía , Terapia Neoadyuvante , Neumonía Viral/epidemiología , Tiempo de Tratamiento , Procedimientos Quirúrgicos Ambulatorios , Betacoronavirus , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Neoplasias de la Mama/psicología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Mastectomía Segmentaria , Estadificación de Neoplasias , Pandemias/prevención & control , Equipo de Protección Personal/provisión & distribución , Neumonía Viral/prevención & control , Medición de Riesgo
2.
Breast Cancer Res Treat ; 182(3): 527-530, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32556796

RESUMEN

PURPOSE: The Coronavirus pandemic has exposed substantial racial and ethnic health and healthcare disparities. Black breast cancer patients face significant disparities in stage of presentation, surgical management, and mortality. The objective of this editorial is to examine the possible implications of the surgical delay imposed by the pandemic on black breast cancer patients. METHODS: The American College of Surgeons, the Society of Surgical Oncology, and the American Society of Breast Surgeons recommendations for surgical delay during the Coronavirus Disease 2019 (COVID-19) were evaluated and discussed. RESULTS: Guidelines by major surgical organizations on surgical delay for breast cancer patients may inadvertently exacerbate disparities in time to surgery for black breast cancer patients. Our recommendations to better characterize the impact of these guidelines on surgical delay among vulnerable populations include the following: (1) track time from biopsy-proven diagnosis to surgery by race and ethnicity, (2) document patient and institution-related reasons for surgical delay, (3) record patient and disease-related variables/reasons for the selection of breast conservation surgery, mastectomy, and reconstruction by race and ethnicity, and (4) collect data on impactful social determinants of health such as financial reserve, housing conditions, stress, and transportation. CONCLUSIONS: The COVID-19 pandemic may exacerbate delays in time to surgery among black breast cancer patients. Surgeons should incorporate collection of social determinants of health into their clinical practice to better understand the impact of COVID-19 on racial and ethnic disparities in surgical management.


Asunto(s)
Afroamericanos , Neoplasias de la Mama/cirugía , Infecciones por Coronavirus/epidemiología , Disparidades en Atención de Salud/etnología , Mastectomía , Neumonía Viral/epidemiología , Determinantes Sociales de la Salud/etnología , Tiempo de Tratamiento , Betacoronavirus , Neoplasias de la Mama/patología , Femenino , Humanos , Mamoplastia , Mastectomía Segmentaria , Mortalidad , Estadificación de Neoplasias , Pandemias , Estados Unidos/epidemiología
3.
Lancet ; 395(10237): 1613-1626, 2020 05 23.
Artículo en Inglés | MEDLINE | ID: mdl-32580883

RESUMEN

BACKGROUND: We aimed to identify a five-fraction schedule of adjuvant radiotherapy (radiation therapy) delivered in 1 week that is non-inferior in terms of local cancer control and is as safe as an international standard 15-fraction regimen after primary surgery for early breast cancer. Here, we present 5-year results of the FAST-Forward trial. METHODS: FAST-Forward is a multicentre, phase 3, randomised, non-inferiority trial done at 97 hospitals (47 radiotherapy centres and 50 referring hospitals) in the UK. Patients aged at least 18 years with invasive carcinoma of the breast (pT1-3, pN0-1, M0) after breast conservation surgery or mastectomy were eligible. We randomly allocated patients to either 40 Gy in 15 fractions (over 3 weeks), 27 Gy in five fractions (over 1 week), or 26 Gy in five fractions (over 1 week) to the whole breast or chest wall. Allocation was not masked because of the nature of the intervention. The primary endpoint was ipsilateral breast tumour relapse; assuming a 2% 5-year incidence for 40 Gy, non-inferiority was predefined as ≤1·6% excess for five-fraction schedules (critical hazard ratio [HR] of 1·81). Normal tissue effects were assessed by clinicians, patients, and from photographs. This trial is registered at isrctn.com, ISRCTN19906132. FINDINGS: Between Nov 24, 2011, and June 19, 2014, we recruited and obtained consent from 4096 patients from 97 UK centres, of whom 1361 were assigned to the 40 Gy schedule, 1367 to the 27 Gy schedule, and 1368 to the 26 Gy schedule. At a median follow-up of 71·5 months (IQR 71·3 to 71·7), the primary endpoint event occurred in 79 patients (31 in the 40 Gy group, 27 in the 27 Gy group, and 21 in the 26 Gy group); HRs versus 40 Gy in 15 fractions were 0·86 (95% CI 0·51 to 1·44) for 27 Gy in five fractions and 0·67 (0·38 to 1·16) for 26 Gy in five fractions. 5-year incidence of ipsilateral breast tumour relapse after 40 Gy was 2·1% (1·4 to 3·1); estimated absolute differences versus 40 Gy in 15 fractions were -0·3% (-1·0 to 0·9) for 27 Gy in five fractions (probability of incorrectly accepting an inferior five-fraction schedule: p=0·0022 vs 40 Gy in 15 fractions) and -0·7% (-1·3 to 0·3) for 26 Gy in five fractions (p=0·00019 vs 40 Gy in 15 fractions). At 5 years, any moderate or marked clinician-assessed normal tissue effects in the breast or chest wall was reported for 98 of 986 (9·9%) 40 Gy patients, 155 (15·4%) of 1005 27 Gy patients, and 121 of 1020 (11·9%) 26 Gy patients. Across all clinician assessments from 1-5 years, odds ratios versus 40 Gy in 15 fractions were 1·55 (95% CI 1·32 to 1·83, p<0·0001) for 27 Gy in five fractions and 1·12 (0·94 to 1·34, p=0·20) for 26 Gy in five fractions. Patient and photographic assessments showed higher normal tissue effect risk for 27 Gy versus 40 Gy but not for 26 Gy versus 40 Gy. INTERPRETATION: 26 Gy in five fractions over 1 week is non-inferior to the standard of 40 Gy in 15 fractions over 3 weeks for local tumour control, and is as safe in terms of normal tissue effects up to 5 years for patients prescribed adjuvant local radiotherapy after primary surgery for early-stage breast cancer. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Asunto(s)
Neoplasias de la Mama/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Mastectomía/métodos , Persona de Mediana Edad , Clasificación del Tumor , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia/epidemiología , Estadificación de Neoplasias , Hipofraccionamiento de la Dosis de Radiación , Traumatismos por Radiación/epidemiología , Traumatismos por Radiación/etiología , Radioterapia Ayuvante/efectos adversos , Radioterapia Ayuvante/métodos , Medición de Riesgo/métodos , Resultado del Tratamiento , Reino Unido/epidemiología
4.
Anticancer Res ; 40(6): 3395-3400, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32487636

RESUMEN

AIM: To investigate whether tumor-infiltrating lymphocyte (TIL) scoring based on 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) can predict the pathological response to neoadjuvant chemotherapy. PATIENTS AND METHODS: A total of 261 patients with breast cancer underwent complete resection after neoadjuvant chemotherapy. PET-TIL score was calculated using tumor size, Ki-67 labeling index, and maximum standardized uptake value (SUVmax) on FDG PET/CT. The efficacy of the PET-TIL score in predicting the pathological complete response (pCR) was retrospectively evaluated. RESULTS: pCR rates were 11.4%, 58.6%, and 38.8% in luminal, human epidermal growth factor receptor 2 (HER2)-positive, and triple-negative breast cancer, respectively. The corresponding median PET-TIL scores were 28, 37, and 45. pCR rates were 20.0% and 44.2% in the low and high PET-TIL score groups, respectively (p<0.001). HER2-positive and triple-negative subtypes and high PET-TIL score were independent predictors for pCR. CONCLUSION: PET-TIL score can predict pCR after neoadjuvant chemotherapy in breast cancer.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Fluorodesoxiglucosa F18 , Linfocitos Infiltrantes de Tumor/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/mortalidad , Femenino , Humanos , Linfocitos Infiltrantes de Tumor/metabolismo , Persona de Mediana Edad , Terapia Neoadyuvante , Clasificación del Tumor , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Pronóstico , Curva ROC , Resultado del Tratamiento , Microambiente Tumoral , Adulto Joven
5.
Anticancer Res ; 40(6): 3491-3497, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32487649

RESUMEN

AIM: To investigate the usefulness of classification of ring-type dedicated breast positron-emission tomography (dbPET) findings in detection of breast cancer. PATIENTS AND METHODS: A total of 709 patients with breast cancer underwent dbPET before treatment. Each finding was morphologically categorized as a focus (uptake size ≤5 mm), mass (>5 mm), or non-mass (multiple uptakes not belonging to a three-dimensional mass or without distinct mass features). Non-mass uptakes were additionally classified as linear, focal, segmental, regional, or diffuse distributions. Lesion-to-background ratios were calculated. RESULTS: Among 910 abnormal findings, 700 (76.9%) were malignant and 210 (23.1%) were benign. Morphologically, 198 (21.8%) lesions were foci, 431 (47.4%) were masses, and 281 (30.9%) were non-masses. In multivariate analysis, mass, focal and segmental distributions of non-mass lesions and high lesion-to-background ratio were significantly related to breast cancer (all p<0.001). CONCLUSION: Classification of abnormal findings on dbPET using morphology and lesion-to-background ratio were useful to detect breast cancer.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Tomografía de Emisión de Positrones , Femenino , Fluorodesoxiglucosa F18 , Humanos , Imagen por Resonancia Magnética , Mamografía , Clasificación del Tumor , Estadificación de Neoplasias , Tomografía de Emisión de Positrones/métodos , Curva ROC , Radiofármacos , Estudios Retrospectivos , Ultrasonografía
6.
Anticancer Res ; 40(6): 3543-3550, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32487656

RESUMEN

BACKGROUND/AIM: A retrospective study was performed in 246 breast cancer patients to define whether tumor-to-nipple distance (TND) assessment by breast MRI may select patients eligible to nipple-sparing mastectomy (NSM) as compared to permanent section assessment of retroareolar margin. PATIENTS AND METHODS: Pre- and post-operative parameters including imaging data, histology of the primary tumor, biologic prognostic factors, and adjuvant regimens were retrieved; patients with close/positive retroareolar margins underwent nipple or NAC excision. The primary endpoint was loco-regional recurrence (LRR). RESULTS: Patients with TND ≤2 cm had a significantly higher rate of invasive ductal carcinoma (p<0.003) and excision margins less than 2 mm (p<0.000). Eleven retroareolar specimens were positive at definitive pathology; final re-excision specimen examination showed residual disease in seven patients (63.6%). At a median follow-up of 31 to 33 months, no NAC recurrence did occur; disease-free survival was more than 96%, and LRR was homogeneously distributed among TND subgroups. CONCLUSION: Therapeutic NSM is a safe procedure independently of TND assessed at preoperative breast MRI. Permanent section assessment of retroareolar tissue is more accurate and cost-effective than frozen section. Furthermore, delayed nipple and/or NAC excision did not impair local disease control.


Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Márgenes de Escisión , Adulto , Anciano , Neoplasias de la Mama/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Mamoplastia/métodos , Mastectomía/métodos , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Pezones/cirugía , Recurrencia , Carga Tumoral
7.
Tumour Biol ; 42(6): 1010428320925301, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32489146

RESUMEN

A key tool for monitoring breast cancer patients under neoadjuvant treatment is the identification of reliable predictive markers. Ki67 has been identified as a prognostic and predictive marker in ER-positive breast cancer. Ninety ER-positive, HER2 negative locally advanced breast cancer patients received letrozole (2.5 mg daily) and cyclophosphamide (50 mg daily) with/without Sorafenib (400 mg/bid daily) for 6 months before undergoing surgery. Ki67 expression and tumor size measured with caliber were determined at baseline, after 30 days of treatment and at the end of treatment. Patients were assigned to a clinical response category according to Response Evaluation Criteria in Solid Tumors, both at 30 days and before surgery and further classified as high-responder and low-responder according to the median variation of Ki67 values between biopsy and 30 days and between biopsy and surgery time. The predictive role of Ki67 and its changes with regard to clinical response and survival was analyzed. No differences in terms of survival outcomes emerged between the arms of treatment, while we observed a higher percentage of women with progression or stable disease in arm with the combination containing Sorafenib (20.5% vs 7.1%, p = 0.06). Clinical complete responders experienced a greater overall variation in Ki67 when compared with partial responders and patients with progressive/stable disease (66.7% vs 30.7%, p = 0.009). High responders showed a better outcome than low responders in terms of both disease-free survival (p = 0.009) and overall survival (p = 0.002). ΔKi67 score evaluated between basal and residual tumor at definitive surgery showed to be highly predictive of clinical complete response, and a potential parameter to be used for predicting disease-free survival and overall survival in luminal breast cancer treated with neoadjuvant endocrine-based therapy.


Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Antígeno Ki-67/genética , Letrozol/administración & dosificación , Pronóstico , Anciano , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Linaje de la Célula/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Supervivencia sin Enfermedad , Relación Dosis-Respuesta a Droga , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Humanos , Letrozol/efectos adversos , Terapia Neoadyuvante , Sorafenib/administración & dosificación , Sorafenib/efectos adversos , Resultado del Tratamiento
8.
Anticancer Res ; 40(6): 3091-3096, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32487603

RESUMEN

BACKGROUND/AIM: Exosomes are produced by normal and cancer cells. Exosomes are found in the serum of cancer patients and have been used for diagnosis and prognosis. Recently tears from non-cancer patients have been found to contain exosomes. In the present report we describe tears from advanced breast-cancer patients. MATERIALS AND METHODS: We found oncogenic miRNAs in the exosomes isolated from tear fluids obtained from five patients with metastatic breast cancer and compared them with tear exosomes form eight healthy volunteers. RESULTS: Tear exosomes had a significantly higher quantity of exosome markers than serum exosomes (CD9, CD63). Tear exosomes were subjected to quantitative reverse-transcription polymerase reaction (qRT-PCR), and western blot analysis to elucidate the status of miRNAs, previously reported in serum from patients with metastatic breast cancer. qRT-PCR and western-blot analysis revealed that breast-cancer-specific miR-21 and miR-200c were highly expressed in tear exosomes from metastatic breast cancer patients in contrast to tear exosomes from healthy volunteers. CONCLUSION: Tear exosomes can be a potential source of diagnostic and prognostic biomarkers for metastatic breast cancer, and possibly other cancers or diseases.


Asunto(s)
Neoplasias de la Mama/genética , Carcinogénesis/genética , Exosomas/genética , MicroARNs/metabolismo , Adulto , Anciano , Neoplasias de la Mama/patología , Femenino , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia
9.
Medicine (Baltimore) ; 99(24): e20396, 2020 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-32541460

RESUMEN

RATIONALE: Patients with, or who develop, metastatic breast cancer have a 5-year relative survival of about 25%. Endocrine therapy clearly improves outcomes in patients with estrogen receptor-positive breast cancer. In the metastatic setting, the primary goal of treatment is to maintain long-term disease control with good quality of life. Rarely, exceptional responders achieve durable disease control, and potential cures cannot be ruled out. PATIENT CONCERNS: We report the case of a 39-year-old woman with primary breast cancer and associated synchronous bone metastases, who experienced a disease response of 12 years with hormonal therapy as maintenance after first line chemotherapy, with a good toxicity profile. DIAGNOSIS: The patient was diagnosed with estrogen receptor + human epidermal growth factor receptor 2 (HER2)- metastatic breast cancer with synchronous bone metastases. INTERVENTIONS: This patient was treated with chemotherapy for 6 cycles as a first-line therapy following by endocrine treatment given as a maintenance therapy. OUTCOMES: Our patient experienced a progression-free survival >12 years with an exceptionally good quality of life. LESSONS: Our anecdotal experience highlights the existence of exceptional responders among patients with hormone receptor-positive metastatic breast cancer, who achieve clinical remission and durable disease control with endocrine therapy. Being able to identify these patients could help in the selection of the best treatment option among the many available.


Asunto(s)
Neoplasias Óseas/secundario , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Adulto , Antineoplásicos/uso terapéutico , Antineoplásicos Hormonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/tratamiento farmacológico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/psicología , Femenino , Humanos , Supervivencia sin Progresión , Calidad de Vida , Receptor ErbB-2/genética , Receptores Estrogénicos/genética , Resultado del Tratamiento
10.
Medicine (Baltimore) ; 99(22): e20346, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32481414

RESUMEN

The immune system plays a fundamental role in the response to neoadjuvant chemotherapy (NAC) of locally advanced breast cancer (LABC) patients. Patients with pathological complete response (pCR) after NAC have a higher survival rate. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are peripheral blood indicators of inflammatory response. This investigates the correlation between NLR, PLR, LMR, and other clinicopathological features of breast cancer patients before receiving NAC and pCR.Data of LABC patients who underwent NAC between 2009 and 2018 were retrospectively reviewed. Each patient's peripheral complete blood count was recorded before starting NAC. The cut-off values for neutrophils, lymphocytes, monocytes, and platelets in the peripheral blood and NLR, PLR, and LMR were determined by receiver operating characteristic curve analyses.The records of 131 patients were analyzed and divided into two groups, pCR (+ve) and pCR (-ve), and their clinicopathological features and laboratory findings were compared. pCR was achieved in 23.6% of patients. The cut-off values of neutrophils, lymphocytes, monocytes, and platelets at the time of diagnosis and NLR, PLR, and LMR were, respectively, 4150 µL, 2000 µL, 635 µL, 271 × 10 µL, 1.95, 119, and 3.35. The pCR rate was higher in patients with low neutrophil count, low NLR, and high lymphocyte count (P = .002, <.001, and .040, respectively).As per the findings of multivariate logistic regression analysis, the independent predictive factors of pCR were clinical tumor size T1 and T2, grade 3, ER negativity, and low NLR (P = .015, .001, .020, .022, and .001, respectively).While NLR was found to be an independent predictive factor of pCR in LABC patients receiving NAC, a similar result was not observed for PLR and LMR. NLR can be a useful biomarker for predicting the response of patients receiving NAC.


Asunto(s)
Neoplasias de la Mama/sangre , Neoplasias de la Mama/patología , Mediadores de Inflamación/sangre , Adulto , Anciano , Biomarcadores de Tumor , Plaquetas/metabolismo , Quimioterapia Adyuvante , Femenino , Humanos , Mediadores de Inflamación/metabolismo , Linfocitos/metabolismo , Persona de Mediana Edad , Monocitos/metabolismo , Neutrófilos/metabolismo , Estudios Retrospectivos , Análisis de Supervivencia
11.
Zhonghua Zhong Liu Za Zhi ; 42(5): 353-361, 2020 May 23.
Artículo en Chino | MEDLINE | ID: mdl-32482023

RESUMEN

Objective: Breast cancer is a kind of malignant tumor which seriously endangers women's health. With the development of molecular biology technology and the further understanding of pathogenesis, the treatment of breast cancer has entered a new era of molecular targeted therapy, and has been making new progress. At present, molecular targeted drugs for the treatment of breast cancer keep emerging, mainly including endocrine therapy targeting estrogen and progesterone receptor (ER/PR), targeted drugs treatment for epidermal growth factor receptor-2 (HER-2); phosphatidylinositol 3 kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway inhibitors, anti-angiogenic drugs, poly (ADP-ribose) polymerase (PARP) inhibitors for BRCA1/2 mutations, cyclin-dependent kinases (CDK) 4/6 inhibitors, etc. Because some signal pathway abnormalities may occur in different molecular types of breast cancer, the same targeted drugs are cross-used in different types.


Asunto(s)
Antineoplásicos/administración & dosificación , Neoplasias de la Mama/tratamiento farmacológico , Terapia Molecular Dirigida , Neoplasias de la Mama/patología , Femenino , Humanos , Fosfatidilinositol 3-Quinasas , Proteínas Proto-Oncogénicas c-akt , Receptor ErbB-2/metabolismo , Receptores Estrogénicos , Serina-Treonina Quinasas TOR/metabolismo
12.
Medicine (Baltimore) ; 99(22): e20438, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32481447

RESUMEN

BACKGROUND: Hyaluronic acid (HA) may be a novel prognostic biomarker of breast cancer. However, the available evidence is controversial. Therefore, we performed a meta-analysis to determine the prognostic role of HA in breast cancer. METHODS: The data were extracted from seven articles by searching the databases of PubMed, EMBASE, Web of Science, the Chinese National Knowledge Infrastructure and Wanfang data for the prognostic role of HA in breast cancer. In reference to survival outcomes, the pooled hazard ratios (HRs) of HA were calculated given a 95% confidence interval (CI). RESULTS: A total of seven articles were included in our study involving 2664 cases. The result of meta-analysis showed that a high HA level predicts poor overall survival (OS) (HR = 1.86, 95% CI: 1.28-2.71, P = .001) and shortened disease-free or recurrence-free survival or progression free survival (DFS/RFS/PFS) (HR = 1.63, 95% CI: 1.14-2.33, P = .007) in breast cancer patients. Moreover, a high HA level in stroma (HR = 1.63, 95% CI: 1.06-2.51, P = .025) and plasma (HR = 3.26, 95% CI: 2.25-4.73, P < .001) significantly predicted poor OS. Besides, a tendency shows that HA was significantly correlated with lymph node metastasis (HR = 1.55, 95% CI: 0.96-2.49, P = .070) and tumor grade (HR = 2.10, 95% CI: 0.89-4.96, P = .089) on the clinical characteristics of patients. CONCLUSION: These results suggested that HA has a potential to be prognostic biomarker in breast cancer patients, especially location in stroma and plasma.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Ácido Hialurónico/metabolismo , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto , Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Humanos , Pronóstico
13.
In Vivo ; 34(3 Suppl): 1651-1659, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32503825

RESUMEN

BACKGROUND/AIM: Coronavirus-19 (COVID-19) pandemic outbreak is currently having a huge impact on medical resource allocation. Breast Cancer (BC) patients are concerned both with BC treatment and COVID-19. This study aimed to estimate the impact of anxiety among patients, caused by the spreading of COVID-19. PATIENTS AND METHODS: Between the 16th of January and the 20th of March 2020, we retrospectively enrolled 160 patients. Eighty-two patients with a suspected breast lesion (SBL) were divided into two groups: PRE-COVID-19-SBL and POST-COVID-19-SBL. Seventy-eight BC patients were divided into PRE-COVID-19-BC and POST-COVID-19-BC. Patient characteristics including age, marital status, SBL/BC diameter, personal and family history of BC, clinical stage and molecular subtype were recorded. Procedure Refusal (PR) and Surgical Refusal (SR) were also recorded with their reason. RESULTS: BC and SBL analysis showed no difference in pre-treatment characteristics (p>0.05). Both POST-COVID-19-SBL and POST-COVID-19-BC groups showed higher rates of PR and SR (p=0.0208, p=0.0065 respectively). Infection risk represented primary reason for refusal among POST-COVID-19 patients. CONCLUSION: COVID-19-related anxiety could affect patients' decision-making process.


Asunto(s)
Ansiedad/psicología , Biopsia con Aguja Gruesa/psicología , Neoplasias de la Mama/psicología , Infecciones por Coronavirus/psicología , Toma de Decisiones , Procedimientos Quirúrgicos Electivos/psicología , Miedo/psicología , Mastectomía/psicología , Neumonía Viral/psicología , Negativa del Paciente al Tratamiento/psicología , Anciano , Anciano de 80 o más Años , Ansiedad/etiología , Actitud Frente a la Salud , Biopsia con Aguja Gruesa/métodos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Italia , Mamografía , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Factores Socioeconómicos , Ultrasonografía Mamaria , Vacio
14.
Mol Biol Rep ; 47(6): 4857-4860, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32388698

RESUMEN

The first person-to-person transmission of the 2019-novel coronavirus in Italy on 21 February 2020 led to an infection chain that represents one of the largest known COVID-19 outbreaks outside Asia. Hospitals have been forced to reorganized their units in response to prepare for an unforeseen healthcare emergency. In this context, our laboratory (Molecular and Genomic Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS) re-modulated its priorities by temporarily interrupting most of the molecular tests guaranteeing only those considered "urgent" and not postponable. In particular, this paper details changes regarding the execution of germline BRCA (gBRCA) testing in our laboratory. A substantial reduction in gBRCA testing (about 60%) compared to the first 2 months of the current year was registered, but the requests have not been reset. The requesting physicians were mainly gynaecologists and oncologists. These evidences further emphasize the new era of gBRCA testing in the management of cancer patients and confirms definitively the integration of gBRCA testing/Next Generation Sequencing (NGS) into clinical oncology. Finally, a re-organization of gBRCA testing in our Unit, mainly related to delayed and reduced arrival of tests was necessary, ensuring, however, a high-quality standard and reliability, mandatory for gBRCA testing in a clinical setting.


Asunto(s)
Proteína BRCA2/genética , Neoplasias de la Mama/diagnóstico , Infecciones por Coronavirus/epidemiología , Detección Precoz del Cáncer/estadística & datos numéricos , Neoplasias Ováricas/diagnóstico , Pandemias , Neumonía Viral/epidemiología , Betacoronavirus/genética , Betacoronavirus/patogenicidad , Biomarcadores de Tumor/genética , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/patología , Detección Precoz del Cáncer/métodos , Diagnóstico Precoz , Femenino , Genómica/métodos , Secuenciación de Nucleótidos de Alto Rendimiento/estadística & datos numéricos , Humanos , Italia/epidemiología , Mutación , Neoplasias Ováricas/genética , Neoplasias Ováricas/patología , Neumonía Viral/sangre , Neumonía Viral/diagnóstico , Neumonía Viral/patología , Derivación y Consulta/estadística & datos numéricos
16.
Medicine (Baltimore) ; 99(19): e20158, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384506

RESUMEN

BACKGROUND: A consensus has not been achieved regarding the treatment of small nonpalpable breast lesions, and the purpose of this study was to prospectively investigate nonpalpable lesions less than 1.0 cm in diameter to explore the risk factors for such lesions and determine appropriate treatment of such kind of lesions. METHODS: A total of 1039 patients with small lesions less than 1.0 cm in diameter who underwent mammography and ultrasound from 2009 to 2010 in our institution were prospectively enrolled. Among them, 80 patients underwent biopsy, whose lesions grew by more than 30% of its original size, with an unclear boundary or irregular shape. All patients were followed-up for an average of 24 months, and lesions identified as high-risk types, such as cancer or atypical hyperplasia, of tumors on pathological examination were labeled "meaningful lesions." Then relevant factors affecting the detection of meaningful lesions were analyzed. RESULTS: In total, 40 meaningful lesions including 2 breast cancers were detected, accounting for 3.8% and 0.2% of all patients, respectively. Univariate analysis identified smoking (P = .030), irregular shape (P = .018), unclear boundary (P = .024), and vascularization (P = .023) as risk factors for the detection of meaningful lesions (P < .05). On multivariate analysis, smoking and irregular shape were further identified as independent risk factors for the detection of meaningful lesions. CONCLUSION: The overall incidence of cancer among nonpalpable lesions with a diameter less than 1.0 cm is low. Biopsies are strongly recommended for patients who are smokers or who have small lesions with an irregular shape, whereas regular follow-up observation is likely safe for other patients with small, non-palpable breast lesions.


Asunto(s)
Neoplasias de la Mama/patología , Adulto , Anciano , Mama/patología , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/epidemiología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Femenino , Humanos , Japón , Mamografía , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Fumar/epidemiología , Ultrasonografía Mamaria
17.
Life Sci ; 253: 117733, 2020 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-32360127

RESUMEN

AIMS: Aldehyde dehydrogenase-1 (ALDH-1) is considered a signature of breast cancer stem cells and is linked to poor outcomes in breast cancer patients. This study aimed at investigating the effect of vitamin D3 on enhancing the tumor responsiveness to different conventional chemotherapeutic agents, viz., cisplatin, methotrexate, and doxorubicin. MAIN METHODS: In vitro and in vivo experiments were performed using combinations of vitamin D3 and chemotherapeutic agents. Cell cycle analysis and apoptosis assays were performed. Moreover, ALDH-1 expression levels were estimated in cancer cell lines and solid tumors. For solid tumors, tumor volume and histopathological necrotic indices were estimated. Leukocyte presence was also evaluated in tumors using leukocyte common antigen (LCA). KEY FINDINGS: Results showed a synergistic interaction between vitamin D3 and each of the chemotherapeutic agents on breast cancer cell lines as well as cell cycle arrest at G2/M phase. A decrease in ALDH-1 levels was reported in both breast cancer cells and in tumor tissues. Reductions in tumor volume were also observed in the groups which received the combination therapy. An influence on necrosis rather than apoptosis was also reported, as evidenced by necrotic indices and Bcl-2 expression in tumor sections, respectively. Increased local leukocytes in tumors was also evident, as indicated by increased expression of leukocyte common antigen (LCA). SIGNIFICANCE: Overall, the present study shows that vitamin D3 has an impact on resistance to different chemotherapeutic agents which could be due to the inhibition of ALDH-1, suggesting its use as an adjuvant therapy in cancer patients receiving chemotherapy.


Asunto(s)
Antineoplásicos/farmacología , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma de Ehrlich/tratamiento farmacológico , Colecalciferol/farmacología , Aldehído Deshidrogenasa 1/antagonistas & inhibidores , Animales , Antineoplásicos/administración & dosificación , Apoptosis/efectos de los fármacos , Neoplasias de la Mama/patología , Carcinoma de Ehrlich/patología , Línea Celular Tumoral , Colecalciferol/administración & dosificación , Cisplatino/administración & dosificación , Cisplatino/farmacología , Doxorrubicina/administración & dosificación , Doxorrubicina/farmacología , Resistencia a Antineoplásicos/efectos de los fármacos , Sinergismo Farmacológico , Femenino , Humanos , Antígenos Comunes de Leucocito , Metotrexato/administración & dosificación , Metotrexato/farmacología , Ratones , Células Madre Neoplásicas/enzimología
18.
Life Sci ; 253: 117736, 2020 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-32360571

RESUMEN

AIMS: Recently, studies indicated that inflammation could exacerbate the development of BC. Karyopherin α-2 (KPNA2) is a molecule which modulates nucleocytoplasmic transport and is involved in malignant cellular behavior and carcinogenesis. Our study aims to elucidate the role of KPNA2 in BC pathogenesis and explore the mechanism of KPNA2 in regulating inflammation-induced BC exacerbations. MAIN METHODS: We measured the expression of KPNA2 in BC cells. Through loss-of-function experiments, the functional role of KPNA2 in MCF-7 and MDA-MB-468 cells was evaluated. SK-BR-3 cells were treated with IL-6 as an inflammatory in vitro model of BC. ELISA determination exhibited the contents of cytokines. RANKL and leptomycin B treatments activated NF-κB signaling and inhibited the nuclear translocation of c-Myc, respectively. KEY FINDINGS: The results showed that KPNA2 was significantly up-regulated in BC and silencing KPNA2 inhibited the proliferation, migration and invasion of BC cells, while the cycle arrest was induced, via blocking NF-κB signaling and c-Myc nuclear translocation. IL-6 stimulated the secretions of IL-8 and IL-17 in BC cells, and elevated KPNA2 expression. However, KPNA2 knockdown suppressed the inflammatory responses and malignant progression of BC induced by IL-6. SIGNIFICANCE: In conclusion, our study illustrated that KPNA2 regulated BC development, as well as IL-6-induced inflammation and exacerbation, via NF-κB signaling and c-Myc nuclear translocation. This may provide a novel target for BC therapy.


Asunto(s)
Neoplasias de la Mama/patología , Inflamación/patología , Interleucina-6/metabolismo , alfa Carioferinas/genética , Neoplasias de la Mama/genética , Línea Celular , Línea Celular Tumoral , Núcleo Celular/metabolismo , Proliferación Celular/genética , Femenino , Técnicas de Silenciamiento del Gen , Silenciador del Gen , Humanos , Células MCF-7 , FN-kappa B/metabolismo , Proteínas Proto-Oncogénicas c-myc/genética , Proteínas Proto-Oncogénicas c-myc/metabolismo , Transducción de Señal , Regulación hacia Arriba
19.
BMJ ; 369: m1570, 2020 05 27.
Artículo en Inglés | MEDLINE | ID: mdl-32461218

RESUMEN

OBJECTIVE: To evaluate the long term risks of invasive breast cancer and death from breast cancer after ductal carcinoma in situ (DCIS) diagnosed through breast screening. DESIGN: Population based observational cohort study. SETTING: Data from the NHS Breast Screening Programme and the National Cancer Registration and Analysis Service. PARTICIPANTS: All 35 024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014. MAIN OUTCOME MEASURES: Incident invasive breast cancer and death from breast cancer. RESULTS: By December 2014, 13 606 women had been followed for up to five years, 10 998 for five to nine years, 6861 for 10-14 years, 2620 for 15-19 years, and 939 for at least 20 years. Among these women, 2076 developed invasive breast cancer, corresponding to an incidence rate of 8.82 (95% confidence interval 8.45 to 9.21) per 1000 women per year and more than double that expected from national cancer incidence rates (ratio of observed rate to expected rate 2.52, 95% confidence interval 2.41 to 2.63). The increase started in the second year after diagnosis of DCIS and continued until the end of follow-up. In the same group of women, 310 died from breast cancer, corresponding to a death rate of 1.26 (1.13 to 1.41) per 1000 women per year and 70% higher than that expected from national breast cancer mortality rates (observed:expected ratio 1.70, 1.52 to 1.90). During the first five years after diagnosis of DCIS, the breast cancer death rate was similar to that expected from national mortality rates (observed:expected ratio 0.87, 0.69 to 1.10), but it then increased, with values of 1.98 (1.65 to 2.37), 2.99 (2.41 to 3.70), and 2.77 (2.01 to 3.80) in years five to nine, 10-14, and 15 or more after DCIS diagnosis. Among 29 044 women with unilateral DCIS undergoing surgery, those who had more intensive treatment (mastectomy, radiotherapy for women who had breast conserving surgery, and endocrine treatment in oestrogen receptor positive disease) and those with larger final surgical margins had lower rates of invasive breast cancer. CONCLUSIONS: To date, women with DCIS detected by screening have, on average, experienced higher long term risks of invasive breast cancer and death from breast cancer than women in the general population during a period of at least two decades after their diagnosis. More intensive treatment and larger final surgical margins were associated with lower risks of invasive breast cancer.


Asunto(s)
Neoplasias de la Mama/mortalidad , Carcinoma Intraductal no Infiltrante/patología , Tamizaje Masivo/estadística & datos numéricos , Anciano , Antineoplásicos Hormonales/uso terapéutico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/epidemiología , Carcinoma Intraductal no Infiltrante/radioterapia , Carcinoma Intraductal no Infiltrante/terapia , Estudios de Cohortes , Inglaterra/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Mamografía/métodos , Márgenes de Escisión , Tamizaje Masivo/tendencias , Mastectomía/métodos , Mastectomía Segmentaria/métodos , Persona de Mediana Edad , Mortalidad/tendencias , Riesgo
20.
Cancer Invest ; 38(5): 300-309, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32378982

RESUMEN

Centrosome amplification leads to aberrant mitosis, giving rise to aneuploidy and it has been associated with poor prognosis in human cancers. This study aimed to evaluate the relationship between polyploidy, centrosome abnormalities, and response to endocrine treatment in progestin-induced mouse mammary carcinomas. We found cells with three or more centrosomes in the polyploid tumors. The endocrine unresponsive tumors showed a higher average number of centrosomes per cell than the responsive tumors. The results suggest an association between polyploidy and centrosome amplification with the resistance to endocrine therapy in this luminal breast cancer model.


Asunto(s)
Neoplasias de la Mama/patología , Carcinoma/patología , Centrosoma/patología , Hormonas/metabolismo , Aneuploidia , Animales , Neoplasias de la Mama/metabolismo , Carcinoma/metabolismo , Línea Celular Tumoral , Centrosoma/metabolismo , Femenino , Amplificación de Genes/fisiología , Humanos , Células MCF-7 , Ratones , Ratones Endogámicos BALB C , Mitosis/fisiología , Poliploidía
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