Breast最新文献

{"title":"Improving medication adherence to endocrine therapy in breast cancer patients: a mixed-methods systematic review of effective communication strategies for healthcare providers","authors":"M.A.A. Smits , L.H. Mammatas , L. Schoonhoven , S.C.J.M. Vervoort","doi":"10.1016/j.breast.2025.104510","DOIUrl":"10.1016/j.breast.2025.104510","url":null,"abstract":"","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104510"},"PeriodicalIF":5.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between intrinsic breast cancer subtypes, mammography screening and prognosis: a large population-based real world cohort study","authors":"Santeri Palmi ,&nbsp;Teemu J Murtola ,&nbsp;Mika Murto ,&nbsp;Heini Huhtala ,&nbsp;Otso Arponen ,&nbsp;Arja Jukkola","doi":"10.1016/j.breast.2025.104507","DOIUrl":"10.1016/j.breast.2025.104507","url":null,"abstract":"<div><h3>Introduction</h3><div>Breast cancer (BC) as a heterogeneous disease is routinely managed according to its intrinsic subtypes. Mammographic BC screening reduces overall mortality in females. Our aim was to analyze the association between different intrinsic subtypes and mammography screening coverage (pre-screening-aged, screening-aged vs. post-screening-aged), attendance (attendance vs. non-attendance), and means of detection (screen-detected vs. interval BC) and BC survival.</div></div><div><h3>Materials and methods</h3><div>We used a subpopulation of a registry including all patients diagnosed with invasive BC in Finland between 1995 and 2013. We collected screening results, information on biological characteristics and survival from national registries.</div></div><div><h3>Results</h3><div>We included 7389 patients with early-stage BC. Compared to luminal A-like subtype, patients with triple-negative BC had the highest risks of death (HR: 1.81, 95 % CI: 1.52–2.15) and BC-related death (HR: 3.16, 95 % CI: 2.43–4.10). The majority of triple-negative BCs were diagnosed after the screening age. HER2-positive (non-luminal) tumors were most likely interval tumors, while the rest of the subtypes were most likely screen-detected. The risk of death was higher in patients with interval cancers compared to screen-detected cases (HR 1.40, 95 % CI: 1.18–1.68) and even higher among patients not attending screening (HR 2.17, 95 % CI: 1.75–2.68); this association was also detected in major subtypes.</div></div><div><h3>Conclusion</h3><div>In this real-world dataset, triple-negative tumors had the highest risk of death and majority of these tumors were found after the screening age. In screening-aged females, patients with screen-detected tumors had the best survival, while patients with interval tumors and patients not attending screening had the worst prognosis.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104507"},"PeriodicalIF":5.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144137930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenia in patients with metastatic breast cancer: A systematic review and meta-analysis","authors":"Min Kyeong Jang ,&nbsp;Sungwon Park ,&nbsp;Chang Park ,&nbsp;Rebecca Raszewski ,&nbsp;Seho Park ,&nbsp;Sue Kim","doi":"10.1016/j.breast.2025.104508","DOIUrl":"10.1016/j.breast.2025.104508","url":null,"abstract":"<div><h3>Background</h3><div>Sarcopenia is associated with poor treatment outcomes and survival in early breast cancer and other cancer types. This systematic review and meta-analysis evaluated sarcopenia's prevalence and clinical implications for metastatic breast cancer—an area that remains underexplored.</div></div><div><h3>Methods</h3><div>A systematic literature review searched CINAHL, Cochrane Library, Embase, and Ovid MEDLINE for studies published before October 2024. A meta-analysis using a random- or fixed-effects model calculated mean differences in skeletal muscle index (SMI) and assessed the association with progression-free and overall survival. The study protocol was registered on PROSPERO (CRD42024557390).</div></div><div><h3>Results</h3><div>Fourteen studies involving 1472 participants with metastatic breast cancer were included. The pooled overall sarcopenia prevalence was 41.6 % (95 % CI 35.4 %–48.7 %), with variability driven by differing SMI cutoffs (38–41 cm²/m²). The pooled mean SMI was 41.01 cm²/m² (95 % CI 38.81–43.21, <em>p</em> &lt; .001), with significant heterogeneity <em>(I</em>² = 95.3 %). Subgroup analysis revealed that patients treated with cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors as first-line treatment had an SMI of 42.08 cm²/m². Our synthesized review showed heterogeneous association between sarcopenia and poor treatment outcomes. Sarcopenia's impact on progression-free survival (hazard ratio = 1.17, 95 % CI 0.43–1.91) and overall survival (hazard ratio = 0.99, 95 % CI 0.96–1.01) was not statistically significant.</div></div><div><h3>Conclusions</h3><div>Sarcopenia is prevalent and clinically meaningful in metastatic breast cancer. While its direct role in survival remains inconclusive, early assessment of sarcopenia by molecular subtype and treatment timing is crucial for optimizing care.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104508"},"PeriodicalIF":5.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical genome sequencing in patients with hereditary breast and ovarian cancer: Concept, implementation and benefits","authors":"Dennis Witt ,&nbsp;Marc Sturm ,&nbsp;Antje Stäbler ,&nbsp;Benita Menden ,&nbsp;Lisa Ruisinger ,&nbsp;Kristin Bosse ,&nbsp;Ines Gruber ,&nbsp;Andreas Hartkopf ,&nbsp;Silja Gauß ,&nbsp;German Demidov ,&nbsp;Nicolas Casadei ,&nbsp;Elena Buena Atienza ,&nbsp;Kira Mehnert ,&nbsp;Janna Witt ,&nbsp;Caspar Gross ,&nbsp;Leon Schütz ,&nbsp;Christopher Schroeder ,&nbsp;Stephan Ossowski ,&nbsp;Andreas Dufke ,&nbsp;Tobias B. Haack ,&nbsp;Ulrike Faust","doi":"10.1016/j.breast.2025.104505","DOIUrl":"10.1016/j.breast.2025.104505","url":null,"abstract":"<div><div>Hereditary breast and ovarian cancer (HBOC) is one of the most frequent genetic cancer predisposition syndromes. Individuals at risk are identified mainly by family history and histopathological criteria. The current standard genetic testing is exome or panel sequencing. However, many high-risk families remain genetically unexplained. Genome sequencing has the potential to increase the diagnostic yield. This single-center real-world study aims to evaluate advantages of short-read genome sequencing (GS) in HBOC families. We report genome sequencing results of 818 index patients, who fulfilled clinical criteria for genetic testing. Data analysis showed less sequencing gaps and a more uniform coverage compared to a large cohort of in-house exomes. Samples were sequenced at an average depth of 41.2x for the HBOC core genes. Pathogenic variants were found in 9 of 13 core genes in 12.2 % of the patients. GS allowed the classification of a <em>BRCA1</em> duplication and detected a whole-exon inversion in <em>BARD1,</em> as well as a deep intronic <em>CHEK2</em> variant. Furthermore, we successfully used the BRIDGES-PRS in our HBOC cohort and found a significant effect size compared to the control cohort (p = 4.804⁻¹⁴, Cohen's-D: 0.476), proving the transferability to a German cohort. GS offers a wealth of information, including the improved detection of structural variants, copy number variants, and parallel detection of complex genetic markers. This has the potential for future analyses, including intronic and intergenic regions. Finally, it also allows for a more streamlined process by converging several tests into one. The approach presented will give guidance for the implementation of GS in HBOC diagnostics.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104505"},"PeriodicalIF":5.7,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of Denosumab and Zoledronic acid in advanced breast cancer patients receiving CDK4/6 inhibitors","authors":"Roberta Scafetta ,&nbsp;Marco Donato ,&nbsp;Carla Gullotta ,&nbsp;Alessandra Guarino ,&nbsp;Cristina Fiore ,&nbsp;Luisana Sisca ,&nbsp;Elena Speziale ,&nbsp;Raffaella Troiano ,&nbsp;Simone Foderaro ,&nbsp;Valentina Ricozzi ,&nbsp;Michele Iuliani ,&nbsp;Sonia Simonetti ,&nbsp;Silvia Cavaliere ,&nbsp;Alessio Cortellini ,&nbsp;Andrea Botticelli ,&nbsp;Simone Scagnoli ,&nbsp;Simona Pisegna ,&nbsp;Carmen Criscitiello ,&nbsp;Rebecca Pedersini ,&nbsp;Caterina Sposetti ,&nbsp;Francesco Pantano","doi":"10.1016/j.breast.2025.104502","DOIUrl":"10.1016/j.breast.2025.104502","url":null,"abstract":"<div><div>A comparative analysis of Denosumab (DMAB) and Zoledronic Acid (ZA) was conducted in a real-world cohort of 864 patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer with bone metastases, who were undergoing CDK4/6 inhibitors plus endocrine therapy. We evaluated the time to first skeletal-related events (SREs), progression-free survival (PFS), and overall survival (OS). To adjust for confounding variables, we utilized propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) methodologies. In the unadjusted cohort, ZA was associated with a longer time to first SRE compared to DMAB (HR = 0.77, 95 % CI: 0.61–0.98, p = 0.031). Similar results were obtained in both the PSM (HR = 0.69, 95 % CI: 0.52–0.92, p = 0.011) and IPTW cohorts (HR = 0.74, 95 % CI: 0.63–0.87, p &lt; 0.001), with ZA-treated patients showing an extended time to first SRE compared to those treated with DMAB. No differences in PFS and OS were observed between the two cohorts.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104502"},"PeriodicalIF":5.7,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tall Cell Carcinoma with Reversed Polarity of the breast: Clinicopathological insights, molecular profile, and future therapeutic directions","authors":"Ye Lu ,&nbsp;Xiangyi Kong ,&nbsp;Wenxiang Zhang ,&nbsp;Xiangyu Wang ,&nbsp;Shengbin Pei ,&nbsp;Yi Fang ,&nbsp;Jidong Gao ,&nbsp;Jing Wang","doi":"10.1016/j.breast.2025.104501","DOIUrl":"10.1016/j.breast.2025.104501","url":null,"abstract":"<div><div>Tall Cell Carcinoma with Reversed Polarity (TCCRP) is a rare and distinct subtype of invasive breast carcinoma, first described in 2003. It is histologically characterized by tall columnar epithelial cells with reversed nuclear polarity and shares morphological features with papillary thyroid carcinoma (PTC). However, its unique molecular signature, including <em>IDH2</em> and <em>PIK3CA</em> mutations, differentiates it from other breast cancer subtypes. A retrospective systematic study of 91 published cases of TCCRP was conducted, including two cases from our institution. Clinical, pathological, molecular, and treatment-related data were collected and analyzed. Descriptive statistics and Kaplan-Meier survival analysis were employed to evaluate disease-free survival (DFS) and overall survival (OS). Subgroup analyses explored associations between clinical features, molecular markers, and outcomes. The median age at diagnosis was 64 years, with a predominance of small tumors (mean size: 10.4 mm, T1 stage). Histologically, hallmark features included reversed nuclear polarity (100 %), nuclear grooves, and intranuclear pseudoinclusions. Immunohistochemical analysis confirmed a triple-negative profile (ER-/PR-/HER2-) in most cases, with consistent breast-specific marker expression (GATA3, CK7). Molecular testing revealed frequent <em>IDH2 R172</em> (84.6 %) and <em>PIK3CA</em> (72.5 %) mutations. Surgical management, predominantly breast-conserving surgery (BCS), was the primary treatment, with adjuvant therapies rarely utilized. At a median follow-up of 35.8 months, recurrence occurred in only 2.2 % of cases, and the overall survival rate was 100 %. TCCRP is a rare, low-grade breast cancer subtype with a favorable prognosis and low recurrence risk based on currently available data, but longer follow-up studies are needed to confirm this observation. Its distinct histological and molecular features enable accurate diagnosis and differentiation from other breast cancers and metastatic thyroid carcinoma. Given its indolent nature, conservative treatment strategies, including BCS, are effective, and adjuvant therapies can be minimized. Future research should explore targeted therapies for <em>IDH2</em> and <em>PIK3CA</em> mutations to expand treatment options for this unique subtype.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104501"},"PeriodicalIF":5.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide real-world practice pattern and clinical data of palbociclib in HR (+), HER2 (−) metastatic breast cancer patients in Korea (KCSG BR21-15)","authors":"Jieun Lee ,&nbsp;Dae-Won Lee ,&nbsp;Min Hwan Kim ,&nbsp;Jee Hung Kim ,&nbsp;Ju Won Kim ,&nbsp;Jae-Ho Byun ,&nbsp;Kyoung Eun Lee ,&nbsp;Myoung Joo Kang ,&nbsp;Su-Jin Koh ,&nbsp;Soojung Hong ,&nbsp;Hye Sung Won ,&nbsp;Han Jo Kim ,&nbsp;In Hae Park ,&nbsp;Seong Hoon Shin ,&nbsp;Sun Kyung Baek ,&nbsp;Seul-Gi Kim ,&nbsp;Sung Ae Koh ,&nbsp;Joo Young Jung ,&nbsp;Ji-Yeon Kim ,&nbsp;Gun Min Kim ,&nbsp;Yeon Hee Park","doi":"10.1016/j.breast.2025.104500","DOIUrl":"10.1016/j.breast.2025.104500","url":null,"abstract":"<div><h3>Background</h3><div>Cyclin-dependent kinase (CDK) 4/6 inhibitors have remarkably improved the survival outcome in hormone-receptor-positive (HR+)/human epidermal growth factor-2-negative (HER2-) metastatic breast cancer (mBC). Although PALOMA-2 has met its primary outcome, overall survival (OS) was relatively shorter compared to ribociclib and abemaciclib. In Korea, use of palbociclib + aromatase inhibitor (AI) + gonadotropin-releasing hormone agonist (GnRHa) in premenopausal women is limited, and bilateral salpingo-oophorectomy (BSO) is necessary before treatment. We analyzed the real-world clinical outcome and patient characteristics of letrozole + palbociclib in Korea.</div></div><div><h3>Methods</h3><div>Between August 2016 and December 2022, 1017 HR+/HER2-postmenopausal women treated with first-line letrozole + palbociclib were enrolled. Primary endpoints were real-world progression-free survival (rwPFS) in total population and survival differences according to menopausal status (natural or induced menopause via BSO).</div></div><div><h3>Results</h3><div>Patients’ median age was 56 (range 27–92) years. Median rwPFS, real-world OS (rwOS) were 28.0 months (95 % confidence interval [CI] 25.5–32.1) and 61.8 months (95 % CI 57.7–70.5), with a median follow-up of 45.1 (IQR, 31.0–56.6) months. BSO group demonstrated similar median rwPFS compared to natural menopause group. Adjuvant tamoxifen ± GnRHa was most frequently prescribed (73.3 %). Primary endocrine resistant mBC patients showed inferior median rwPFS compared to secondary resistant mBC (14.6 vs. 27.1 months, <em>p</em> = 0.0063). Overall response rate was 47.5 %, with a disease control rate of 89.6 %.</div></div><div><h3>Conclusion</h3><div>This is the largest country-based real-world study on palbociclib + letrozole in Asia. Palbociclib demonstrated median rwOS over 60 months, comparable to other pivotal trials.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104500"},"PeriodicalIF":5.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing breast cancer therapy in the era of molecular diagnostics","authors":"Maria Grazia Carnevale ,&nbsp;Riccardo Ray Colciago ,&nbsp;Maria Carmen De Santis ,&nbsp;Laura Cortesi ,&nbsp;Cinzia De Marco ,&nbsp;Antonio Marra ,&nbsp;Andrea Vingiani ,&nbsp;Franco Nolè ,&nbsp;Giuseppe Curigliano ,&nbsp;Giancarlo Pruneri ,&nbsp;Antonio Llombart-Cussac ,&nbsp;Serena Di Cosimo ,&nbsp;Javier Cortes","doi":"10.1016/j.breast.2025.104488","DOIUrl":"10.1016/j.breast.2025.104488","url":null,"abstract":"<div><div>Advances in cancer biology and drug development now enable treatments tailored to individual tumor profile. Targeting specific molecular alterations marked a significant step forward in cancer care, including breast cancer. Access to these therapies is improving thanks to the implementation of molecular tumor boards and efforts to provide molecular diagnostics at sustainable costs for all. In this context, we highlight recent progress in breast cancer therapy, focusing on biomarker-driven approaches, immunotherapy, and precision medicine paving the way for increasingly personalized and effective options.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104488"},"PeriodicalIF":5.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple dimensions of the quality of life among Asian American breast cancer survivors: The impact of a technology-based program","authors":"Eun-Ok Im ,&nbsp;Wonshik Chee ,&nbsp;Sudeshna Paul ,&nbsp;Seo Yun Kim ,&nbsp;Mi-Young Choi ,&nbsp;Jun J. Mao ,&nbsp;Giang T. Nguyen ,&nbsp;Marilyn M. Schapira ,&nbsp;Connie M. Ulrich ,&nbsp;SeonAe Yeo ,&nbsp;Janet A. Deatrick ,&nbsp;Jillian Inouye ,&nbsp;Grace Ma ,&nbsp;Salimah Meghani ,&nbsp;David Shin ,&nbsp;Ting Bao","doi":"10.1016/j.breast.2025.104490","DOIUrl":"10.1016/j.breast.2025.104490","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to examine if a technology-based information and coaching/support program could improve the quality of life of Asian American breast cancer survivors and determine the factors that influenced the changes in the women's quality of life by the technology-based program.</div></div><div><h3>Methods</h3><div>This was a randomized controlled trial with 199 Asian American breast cancer survivors (104 in the intervention group and 95 in the control group). Multiple instruments including the Functional Assessment of Cancer Therapy Scale-Breast Cancer (FACT-B) were used to assess background factors, disease factors, and the quality of life. The data were analyzed using intent-to-treat general linear models.</div></div><div><h3>Results</h3><div>The FACT-B total and subscale scores of the intervention group increased from pre-test (T0) to post 3-months (T2), while those of the control group decreased. Significant interaction between time and group were found only in physical well-being (<em>β</em> = 0.84, <em>p</em> = .025) from T0 to T1 (post 1-month) and social well-being (<em>β</em> = 1.05, <em>p</em> = .006) from T0 to T2 within the mixed-effect model with AR1. The PRQ scores mediated the effect of the technology-based intervention on the Breast Cancer Subscale scores (<em>p</em> &lt; .05) over one month (T0 to T1).</div></div><div><h3>Conclusion</h3><div>The technology-based program improved physical and social well-being among Asian American breast cancer survivors. Social support mediated the impact of the program on the quality of life. Future studies are needed on different dimensions of the quality of life with diverse groups of survivors. NCT02803593.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104490"},"PeriodicalIF":5.7,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization of guidelines for Risk Of Recurrence/Prosigna testing using a machine learning model: a Swedish multicenter study","authors":"Una Kjällquist ,&nbsp;Nikos Tsiknakis ,&nbsp;Balazs Acs ,&nbsp;Sara Margolin ,&nbsp;Luisa Edman Kessler ,&nbsp;Scarlett Levy ,&nbsp;Maria Ekholm ,&nbsp;Christine Lundgren ,&nbsp;Erik Olsson ,&nbsp;Henrik Lindman ,&nbsp;Antonios Valachis ,&nbsp;Johan Hartman ,&nbsp;Theodoros Foukakis ,&nbsp;Alexios Matikas","doi":"10.1016/j.breast.2025.104489","DOIUrl":"10.1016/j.breast.2025.104489","url":null,"abstract":"<div><h3>Purpose</h3><div>Gene expression profiles are used for decision making in the adjuvant setting in hormone receptor-positive, HER2-negative (HR+/HER2-) breast cancer. While algorithms to optimize testing exist for RS/Oncotype Dx, no such efforts have focused on ROR/Prosigna. This study aims to enhance pre-selection of patients for testing using machine learning.</div></div><div><h3>Methods</h3><div>We included 348 postmenopausal women with resected HR+/HER2-node-negative breast cancer tested with ROR/Prosigna across four Swedish regions. We developed a machine learning model using simple prognostic factors (size, progesterone receptor expression, grade, and Ki67) to predict ROR/Prosigna output and compared the performance regarding over- and undertreatment with commonly employed risk stratification schemes.</div></div><div><h3>Results</h3><div>Previous classifications resulted in significant undertreatment or large intermediate groups needing gene expression profiling. The machine learning model achieved AUC under ROC of 0.77 in training and 0.83 in validation cohorts for prediction of indication for adjuvant chemotherapy according to ROR/Prosigna. By setting and validating upper and lower cut-offs corresponding to low, intermediate and high-risk disease, we improved risk stratification accuracy and reduced the proportion of patients needing ROR/Prosigna testing compared to current risk stratification.</div></div><div><h3>Conclusion</h3><div>Machine learning algorithms can enhance patient selection for gene expression profiling, though further external validation is needed.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104489"},"PeriodicalIF":5.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}