Clinical breast cancer最新文献

{"title":"Association of Regional Anesthesia With Reduced Post-discharge Opioid Prescriptions Following Immediate Autologous Breast Reconstruction: An ACS-NSQIP Analysis","authors":"Dylan K. Kim,&nbsp;Millicent M. Warner,&nbsp;Ashley Zhang,&nbsp;Jarrod T. Bogue","doi":"10.1016/j.clbc.2026.07.008","DOIUrl":"10.1016/j.clbc.2026.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pain may be significant following mastectomy and immediate autologous breast reconstruction, and pain management regimens must be balanced with opioid stewardship. Regional anesthesia has been associated with reduced opioid consumption in smaller studies and may represent a promising method of acute pain management. This study evaluates rates of opioid prescription and renewal following immediate autologous reconstruction depending on receipt of regional anesthesia.</div></div><div><h3>Methods</h3><div>All adult female patients who underwent immediate autologous breast reconstruction in the 2024 National Surgical Quality Improvement Program dataset were identified. Patient cohorts who did and did not receive regional anesthesia were propensity score-matched in a 1:2 ratio. Rates of post-discharge opioid prescriptions and subsequent renewals were compared between cohorts (<em>P</em> &lt; .05).</div></div><div><h3>Results</h3><div>The final cohort included 1103 patients. Regional anesthesia was utilized in 231 (20.9%) cases, and the rate of post-discharge opioid prescription was 60.8% (671 patients). After matching on covariates like body mass index, operative time, and local anesthesia utilization (<em>n</em> = 684), regional anesthesia usage was associated with significantly lower rates of opioid prescriptions (57.0% vs. 66.4%; <em>P</em> = .020) and conferred lower odds of opioid prescription in multivariable analysis (OR: 0.71, 95% CI: 0.51-0.99; <em>P</em> = .041). Among patients who were prescribed opioids, the rate of renewal was similar between matched cohorts (6.6% vs. 6.2%; <em>P</em> = 1.00).</div></div><div><h3>Conclusion</h3><div>Regional anesthesia was associated with reduced post-discharge opioid prescriptions and similar rates of prescription renewal following immediate autologous breast reconstruction. These findings support the further investigation and possible integration of regional anesthesia within pain management regimens for autologous breast reconstruction.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 8","pages":"Pages 145-151"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-excision in Ductal Carcinoma In Situ Is Not Associated With Improved Local Control: A Retrospective Cohort Study","authors":"Paulina Dorten,&nbsp;Sina Windgaßen,&nbsp;Isabel Radke,&nbsp;Carl Opitz,&nbsp;Ariana Plasger,&nbsp;Ludwig Kiesel,&nbsp;Lars Hanker,&nbsp;Joke Tio,&nbsp;Marie-Kristin von Wahlde","doi":"10.1016/j.clbc.2026.07.009","DOIUrl":"10.1016/j.clbc.2026.07.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Ductal carcinoma in situ (DCIS) is a non-invasive precursor of invasive breast cancer and is primarily treated surgically. Re-excision is commonly performed to achieve clear margins; however, its impact on local recurrence remains controversial. This study evaluated whether re-excision influences the risk of ipsilateral breast tumor recurrence in patients with DCIS.</div></div><div><h3>Methods</h3><div>In this retrospective single-center cohort study, all patients treated for DCIS at the University Hospital Münster between 2003 and 2015 were included. Clinical and pathological parameters, including age, menopausal status, tumor size, nuclear grade, re-excision, and adjuvant radiotherapy were analyzed. Follow-up data were obtained from the German cancer registry. The association between re-excision and local recurrence was analyzed using log-rank testing, and multivariate Cox regression was performed to identify independent risk factors.</div></div><div><h3>Results</h3><div>A total of 425 patients were treated for DCIS between 2003 and 2015, with follow-up data available for 247 patients (mean follow-up: 4.4 years). Re-excision was performed in 119 patients (48.2%). Local recurrence occurred in 8 patients (6.7%) with re-excision and in 9 patients (7.1%) without. The 5-year local recurrence rate was 2.9% with re-excision versus 6.0% without (<em>P</em> = .33). Multivariate analysis identified younger age (<em>P</em> = .03) and premenopausal status (<em>P</em> = .02) as significant risk factors, while adjuvant radiotherapy showed a protective effect (<em>P</em> = .01).</div></div><div><h3>Conclusion</h3><div>Re-excision was not associated with a significantly different risk of local recurrence. Younger age and premenopausal status were associated with increased recurrence risk, whereas adjuvant radiotherapy was associated with improved local control.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 8","pages":"Pages 152-157"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Xpert Breast Cancer Insight Test Predicts Distant Recurrence and Overall Survival in ER-Positive, HER2-Negative Early Breast Cancer","authors":"Martin Filipits,&nbsp;Viktoria Gruber,&nbsp;Christian F. Singer,&nbsp;Florian Fitzal,&nbsp;Zsuzsanna Bago-Horvath,&nbsp;Richard Greil,&nbsp;Marija Balic,&nbsp;Peter Regitnig,&nbsp;Nancy Toro-Bauer,&nbsp;Wolfgang Hulla,&nbsp;Daniel Egle,&nbsp;Daneida Lizarraga,&nbsp;Alice Baker,&nbsp;Rajesh Kaldate,&nbsp;Malini Satya,&nbsp;Jodi Weidler,&nbsp;Michael Bates,&nbsp;Scott Campbell,&nbsp;Dominik Hlauschek,&nbsp;Peter Dubsky,&nbsp;Michael Gnant","doi":"10.1016/j.clbc.2026.06.012","DOIUrl":"10.1016/j.clbc.2026.06.012","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to validate the Xpert Breast Cancer Insight (BC Insight) test. BC Insight is a multigene assay consisting of three target genes and three reference genes.</div></div><div><h3>Materials and Methods</h3><div>We studied the BC Insight test in 1278 formalin-fixed, paraffin-embedded surgical specimens from postmenopausal women with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative primary breast cancer with 0-3 involved lymph nodes. Time to distant recurrence (DR) and overall survival (OS) were analyzed using Cox models.</div></div><div><h3>Results</h3><div>The BC Insight test categorized 764 of 1089 (70.2%) evaluable patients as “low risk”. The Xpert BC Insight Risk Score (XRS) was prognostic for DR (hazard ratio (HR) 1.93, 95% confidence interval (CI) 1.58 to 2.35, <em>P</em>&lt;0.0001; C-index 0.73) and OS (HR 1.45, 95% CI 1.26 to 1.67, <em>P</em>&lt;0.0001; C-index 0.65). At 10 years, 95.3% of Xpert BC Insight Risk Category (XRC) low-risk patients were metastasis-free and 89.6% were alive, compared with 85.6% and 77.1% of XRC high-risk patients, respectively (absolute DR risk difference 9.7%, <em>P</em>&lt;0.0001; absolute risk of death difference 12.5%, <em>P</em>&lt;0.0001).</div></div><div><h3>Conclusions</h3><div>XRS and XRC are prognostic for DR in postmenopausal women with ER-positive, HER2-negative primary breast cancer. Furthermore, the BC Insight test accurately predicted OS in these patients, particularly in patients with 1-3 involved lymph nodes.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 8","pages":"Pages 112-120"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterozygous BRCA1 SNPs in the Central Functional Region are Associated With Increased Sensitivity to PARP Inhibition in Breast Cancer Cells","authors":"Ming-Hsin Yeh,&nbsp;Chang-Wei Li,&nbsp;Ling Chen,&nbsp;Ting-Ying Shih,&nbsp;Ya-Chi Kang,&nbsp;Yu-Di Chang","doi":"10.1016/j.clbc.2026.06.016","DOIUrl":"10.1016/j.clbc.2026.06.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Poly (ADP-ribose) polymerase (PARP) inhibitors demonstrate efficacy in breast cancer patients harboring pathogenic BRCA1/2 mutations. However, certain BRCA1 single nucleotide polymorphisms may alter protein function without complete loss of activity. This study investigates whether specific heterozygous BRCA1 single nucleotide polymorphisms within the central functional region of BRCA1 affect cellular sensitivity to PARP inhibition and explores the underlying transcriptomic mechanisms.</div></div><div><h3>Materials and Methods</h3><div>Two breast cancer cell lines were employed: CAMA-1, carrying heterozygous BRCA1 SNPs (rs799917, rs16941, rs16942, and rs1799966), and T47D, harboring wild-type BRCA1. Cell viability following olaparib treatment was assessed using the MTT assay at multiple concentrations and time points. Whole-transcriptome sequencing was subsequently performed, followed by functional enrichment and pathway analyses to characterize differential gene expression between the 2 cell lines under PARP inhibition stress.</div></div><div><h3>Results</h3><div>CAMA-1 cells exhibited significantly enhanced olaparib sensitivity compared to T47D cells, with viability reduced to 45% versus 75% at 50 μM after 72 hours (<em>P</em> &lt; .001). Transcriptome analysis identified 6978 differentially expressed genes, with significant enrichment in pathways related to DNA binding, transcriptional regulation, and cellular degradation, a pattern consistent with a model of conditional haploinsufficiency, though this interpretation requires direct experimental validation.</div></div><div><h3>Conclusion</h3><div>Heterozygous BRCA1 SNPs in the central functional region of BRCA1 are associated with increased PARP inhibitor sensitivity in the absence of pathogenic mutations. These preliminary findings identify these variants as candidates warranting further investigation as potential predictive biomarkers for PARP inhibitor response.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 8","pages":"Pages 121-130"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Clinicopathological Features and Survival Between Distant Lymph Node Metastasis and Distant Micrometastasis in Breast Cancer","authors":"Simin Luo,&nbsp;Hongna Lai,&nbsp;Jianli Zhao,&nbsp;Yinduo Zeng,&nbsp;Linxiaoxiao Ding,&nbsp;Wenjing Wu,&nbsp;Ying Wang,&nbsp;Song Tang,&nbsp;Herui Yao","doi":"10.1016/j.clbc.2026.07.005","DOIUrl":"10.1016/j.clbc.2026.07.005","url":null,"abstract":"<div><h3>Background</h3><div>The clinical value of distant lymph node (DLN) metastasis for breast cancer prognosis still lacks consensus, and scholars dispute whether it should be categorized as M1 stage disease. Similarly, distant micrometastasis [M0(i+)] has been associated with adverse outcomes despite being staged as M0. This study compared the clinicopathological characteristics and survival outcomes of DLN metastasis and M0(i+) breast cancer to clarify the prognostic significance of DLN metastasis.</div></div><div><h3>Method</h3><div>We extracted data of female breast cancer cases diagnosed during 2018 to 2022 from the SEER database. Cases with isolated DLN metastasis or M0(i+) were enrolled. Baseline indicators were compared using chi-square test and t-test. After 1:1 propensity score matching, survival differences were analyzed. Kaplan–Meier curves and Cox models were used for OS analysis, while cumulative incidence functions and Fine–Gray models were applied to assess BCSM.</div></div><div><h3>Result</h3><div>Among 345,138 original cases, 1,315 patients were finally enrolled (DLN: n = 731; M0(i+): n = 584). DLN metastasis was linked to larger tumors, higher histologic grade, more ER/PR negativity, more HER2 positivity, increased triple-negative subtype, and higher T/N stage (all <em>P</em> &lt; .001). Following matching, patients with DLN metastasis presented notably inferior OS and BCSM compared with those with M0(i+) status (all <em>P</em> &lt; .001). Multivariate regression verified that DLN metastasis was an independent risk factor for poor prognosis, with HR of 3.82 (CI: 2.20-6.64) for OS and 3.76 (95% CI, 2.06-6.85) for BCSM.</div></div><div><h3>Conclusion</h3><div>DLN metastasis indicates more aggressive tumor characteristics and inferior prognosis relative to M0(i+). These findings provide evidence supporting the consideration of DLN metastasis as M1 stage disease.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 8","pages":"Pages 137-144"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Radiation Treatment in Breast Cancer Patients on the Subsequent Development of Adhesive Capsulitis","authors":"Eujung Park,&nbsp;Seth Eilfer,&nbsp;Katja Klosterman,&nbsp;Stanna Calderon-Tellez,&nbsp;Karina Shah,&nbsp;Rafael Buerba,&nbsp;Anup Shah","doi":"10.1016/j.clbc.2026.07.007","DOIUrl":"10.1016/j.clbc.2026.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Adhesive capsulitis (AC) is a disabling condition associated with shoulder pain and restricted range of motion. Although breast cancer treatment has been linked to increased AC risk, the independent contribution of radiation therapy remains unclear.</div></div><div><h3>Patients and Methods</h3><div>A retrospective cohort study was performed using the PearlDiver MARINER database (2014-2023). Female patients with a primary diagnosis of breast cancer and ≥ 2 years of follow-up were included. Patients with prior shoulder pathology were excluded. Cohorts were stratified by radiation exposure and surgical treatment. Propensity score matching was conducted based on age and Charlson Comorbidity Index (CCI). Outcomes were compared using chi-square tests and odds ratios (ORs).</div></div><div><h3>Results</h3><div>A total of 1,672,952 patients met inclusion criteria, of whom 22,964 (1.37%) developed AC. Radiation therapy was associated with an increased risk of AC compared with no radiation (OR 1.292, 95% confidence interval 1.251-1.334; <em>P</em> &lt; .001). This association persisted in surgical patients (OR 1.364, <em>P</em> &lt; .001) and across surgical subgroups, including breast-conserving surgery, mastectomy, and mastectomy with reconstruction. Radiation exposure was also associated with increased AC risk in nonsurgical patients (OR 1.172, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>Radiation therapy is independently associated with an increased risk of adhesive capsulitis following breast cancer diagnosis. These findings underscore the importance of recognizing treatment-related shoulder morbidity and may inform surveillance and early intervention strategies in breast cancer survivorship care.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 8","pages":"Pages 196-200"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Feasibility Assessment of Short-Course Preoperative Endocrine Therapy Using the Ki67 Biomarker in an Australian Cohort of Patients With Estrogen Receptor–Positive Early Breast Cancer","authors":"Oliver J. Nilsen,&nbsp;David S. Williams,&nbsp;Chang-Hao S. Tsao,&nbsp;Shane White,&nbsp;Belinda Yeo","doi":"10.1016/j.clbc.2026.07.011","DOIUrl":"10.1016/j.clbc.2026.07.011","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative endocrine therapy (ET) can be used in the lead-up to surgery in estrogen receptor positive (ER+) early breast cancer (eBC), without delaying surgery. Preoperative ET (pET) may not yield clinically significant tumor shrinkage, unlike conventional neoadjuvant treatment. However, dynamic Ki67 changes with pET can provide biological tumor response information, akin to genomic recurrence assays, in post- and pre/perimenopausal patients. We aimed to assess pET feasibility in an Australian ER+/HER2- eBC cohort.</div></div><div><h3>Patients and Methods</h3><div>Single-center retrospective study of ER+/HER2- eBC patients who received pET from December 2022 to June 2025. Demographic, oncological, and pathological data were collected. pET response was defined as surgical excisional Ki67_low ≤ 10%.</div></div><div><h3>Results</h3><div>Overall, 102 patients (85.3% postmenopausal) were prescribed pET, median age 65 years (interquartile range [IQR] 58.3-73.8). Thirty-nine patients (38.2%) underwent mastectomy, and 36 patients (33.6%) had node positive disease. Median time between pET commencement and surgery was 29 days (IQR 16.3-42.0). Eighty-six patients (84.3%) demonstrated excisional Ki67_low ≤ 10% on pET, including 12 pre-menopausal patients (80.0%). Importantly, 45 pET responders (47.4%) demonstrated conversion from core biopsy (CBx) Ki67_high &gt; 10% to surgical Ki67_low ≤ 10%. Median Ki67 value from baseline CBx to surgery declined on pET (15.0% vs. 5.0%). Most patients (<em>n</em> = 76, 74.5%) received adjuvant ET alone.</div></div><div><h3>Conclusion</h3><div>The majority of patients in this cohort were endocrine sensitive. A significant proportion of the cohort demonstrated Ki67_high to Ki67_low conversion, which may be a clinically meaningful measure of endocrine response on pET. Prospective validation is required to link pET response to clinical outcomes and adjuvant treatment decisions.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 8","pages":"Pages 158-164"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Estrogen Receptors Versus Progesterone Receptors in Early Breast Cancer: An Analysis of Clinical and Translational Data (2004-2026)","authors":"Noureddine Samai,&nbsp;Aymen Berremdani","doi":"10.1016/j.clbc.2026.07.006","DOIUrl":"10.1016/j.clbc.2026.07.006","url":null,"abstract":"<div><div>The accurate determination of hormone-receptor status is foundational to risk stratification and therapeutic decision-making in breast oncology. While the estrogen receptor (ER) is universally recognized as the primary predictive biomarker for a tumor's response to endocrine therapy, the independent prognostic value of the progesterone receptor (PR) remains a subject of ongoing clinical debate. This study evaluates the relative prognostic weight of PR expression compared to ER expression in early-stage breast cancer, clarifies the biological mechanisms driving PR loss, and assesses the diagnostic reproducibility of single hormone receptor-positive phenotypes using primary clinical and translational data synthesized from 2004 to 2026. A systematic assessment of primary scientific literature was conducted to isolate original clinical validation cohorts and translational molecular studies published from 2004 to 2026. Eligible studies were required to evaluate original data from primary operable, non-metastatic early-stage invasive breast cancer (Stage I to IIIA). Studies were categorized by methodology into clinical cohorts or mechanistic investigations. Methodological variations in immunohistochemical percentage cutoffs across different cohorts were evaluated via prespecified sensitivity analyses. The data tracking protocol was registered under the PROSPERO identifier CRD420251274985. The systematic literature search identified a cohesive pool of 18 eligible original studies published between 2004 and 2026 for quantitative synthesis and structural categorization. Within the synthesized clinical cohorts, higher PR expression was generally associated with improved disease-free survival (DFS) and significantly lower late recurrence rates in multivariate testing. Conversely, the loss of PR expression, resulting in the ER-positive/PR-negative (ER+/PR-) phenotype, was generally associated with endocrine resistance and a more aggressive clinical course. Furthermore, interassay reproducibility analyses revealed that the ER-negative/PR-positive (ER-/PR+) subtype is highly unstable, as a substantial proportion of cases were reclassified on secondary central pathology review, indicating that this phenotype frequently reflects an immunohistochemical technical artifact rather than a distinct biological entity. PR expression is not merely a surrogate marker for ER activity; it functions as a critical independent prognostic indicator and a molecular modulator in early breast cancer. The quantitative assessment of PR expression levels is essential for accurate risk stratification, particularly within luminal-like disease. Single hormone receptor-positive tumors, particularly the ER-/PR+ phenotype, require highly cautious clinical interpretation and validation via repeat immunohistochemical testing to prevent suboptimal treatment allocation.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 8","pages":"Pages 165-171"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Clinical Outcomes and Cost-Utility Analysis of Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction Following Nipple-Sparing Mastectomy: A Multicenter Retrospective Cohort Study","authors":"Federica Grieco,&nbsp;Marco Driutti,&nbsp;Emma Zanin,&nbsp;Eleonora Bassi,&nbsp;Elena Galvano,&nbsp;Luigi Castriotta,&nbsp;Stefano Ivan Coppola,&nbsp;Pier Camillo Parodi,&nbsp;Nicola Zingaretti","doi":"10.1016/j.clbc.2026.06.009","DOIUrl":"10.1016/j.clbc.2026.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Immediate direct-to-implant (DTI) reconstruction after nipple-sparing mastectomy (NSM) can be performed prepectorally or subpectorally, with variable use of implant-supporting mesh. We compared long-term clinical outcomes and cost-utility of 3 DTI strategies.</div></div><div><h3>Methods</h3><div>Consecutive adult women undergoing NSM with immediate DTI at 2 tertiary centers in northeastern Italy (January 1, 2011-Decmeber 31, 2024) were included. Cohorts: prepectoral DTI with mesh, dual-plane subpectoral DTI with mesh, and subpectoral DTI without mesh. Primary outcome: cumulative reconstruction-related reoperation. Secondary outcomes: early (≤ 90 days) and late (&gt; 90 days) complications. EQ-5D-5L utilities were collected prospectively; Quality-Adjusted Life Years (QALYs) were estimated by trapezoidal integration. Hospital/provider costs were captured and standardized to 2024 €; base-case horizon 10 years with 3.5% annual discounting. Probabilistic sensitivity analysis (PSA) (10,000 iterations) quantified uncertainty.</div></div><div><h3>Results</h3><div>Of 416 patients (501 reconstructions): prepectoral + mesh n = 215 (42.9%), subpectoral + mesh n = 144 (28.7%), subpectoral no mesh n = 142 (28.3%). Median follow-up 5.9 years. Cumulative reoperation: 13.95% (prepectoral + mesh), 27.08% (subpectoral + mesh), 21.83% (subpectoral no mesh) (<em>P</em> = .008). Mean observed total cost per patient: €8798.50 (prepectoral + mesh), €5235.28 (subpectoral + mesh), €3227.17 (subpectoral no mesh) (<em>P</em> &lt; .001). Time-weighted mean EQ-5D-5L utilities ≈0.830 (prepectoral) versus ≈0.801 (pooled subpectoral). Ten-year discounted base-case: incremental cost ≈€4567 and incremental cost-utility ratio (ICUR) ≈€17,566/QALY for prepectoral versus pooled subpectoral. PSA: ≈68% probability prepectoral is cost-effective at €20,000/QALY.</div></div><div><h3>Conclusions</h3><div>Prepectoral DTI with mesh was associated with fewer late complications and reoperations and higher QALYs, at higher upfront cost; some mesh techniques showed increased early seroma/infection rates.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 8","pages":"Pages 82-89"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tracking Utilization of Neoadjuvant Endocrine Therapy (NET) and Neoadjuvant Chemotherapy (NCT) for Hormone Receptor-Positive Breast Cancer (HR + BC) in the U.S.A. Over Time – A TriNetX Database Study","authors":"Jubin K. Lim,&nbsp;Anna E. Gibson,&nbsp;Jian He,&nbsp;Alexis Antonucci,&nbsp;Harry D. Bear","doi":"10.1016/j.clbc.2026.05.008","DOIUrl":"10.1016/j.clbc.2026.05.008","url":null,"abstract":"<div><h3>Purpose</h3><div>Hormone receptor-positive breast cancer (HR + BC) responds well to neoadjuvant endocrine therapy (NET), increasing chances for breast conserving surgery with less toxicity than neoadjuvant chemotherapy (NCT). A National Cancer Database study found that NET use increased by only 0.5% between 2004 and 2012. We investigated the utilization of NET, NCT, and no neoadjuvant therapy (no NT) from 2005 to 2023.</div></div><div><h3>Methods</h3><div>We queried the TriNetX database for patients with HR + BC (stages I-III, ER+, PR+, ERBB2-) who underwent mastectomies in the US and evaluated utilization of NET, NCT, or no NT. We trended each use by all ages, age ≤ 50 years, or ≥ 51 years across roughly 5-year increments. NET cases were less than 10 for 2005-2009, and rounding obscured the exact count, so this period was excluded from the trend analysis.</div></div><div><h3>Results</h3><div>The use of NET remained below 1%, while NCT utilization was approximately 11%, and breast conserving surgery was achieved more frequently with NET than NCT (p &lt; .0001). Both therapy types were used more frequently with advanced cancer stage (p &lt; .0001), and NCT use was higher than NET in both age groups (p &lt; .0001). NET and NCT use did not show significant trends when all ages were combined (p = .39). However, age-stratified analyses revealed significant declines in NCT use within each age group, with similar NET patterns and increasing no NT (p &lt; .0001), indicating that overall results may mask weighted subgroup trends.</div></div><div><h3>Conclusions</h3><div>This study highlights underutilization of NET, despite its low toxicity and efficacy in improving patient outcomes. Increased efforts are needed to address this gap and consider NET as an option for HR + BC.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 7","pages":"Pages 39-45"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}