Breast最新文献

{"title":"Partial breast irradiation after sentinel lymph node biopsy omission: Is it a valid alternative to whole breast Irradiation? Analysis of the dose to the sentinel lymph node region during whole breast irradiation vs. partial breast irradiation","authors":"Sophie T. Behzadi ,&nbsp;Rebecca Moser ,&nbsp;Mathias Düsberg ,&nbsp;Maximilian Aigner ,&nbsp;Jana Nano ,&nbsp;Sophia Kiesl ,&nbsp;Jacqueline Lammert ,&nbsp;Evelyn Klein ,&nbsp;Georg P. Schmidt ,&nbsp;Marion Kiechle ,&nbsp;Thomas Huber ,&nbsp;Stefanie Corradini ,&nbsp;Stephanie E. Combs ,&nbsp;Kai J. Borm","doi":"10.1016/j.breast.2025.104523","DOIUrl":"10.1016/j.breast.2025.104523","url":null,"abstract":"<div><h3>Background</h3><div>Sentinel lymph node biopsy (SLNB) can be safely omitted in selected early-stage, clinically node-negative breast cancer (BC) patients. While these patients are also candidates for partial breast irradiation (PBI), the dosimetric effects of PBI on the sentinel lymph node region (SLNs) and axillary levels remain unclear.</div></div><div><h3>Methods</h3><div>In this study, SLNs were identified and contoured in 100 BC patients using pre- and postoperative imaging. Axillary levels were contoured following ESTRO guidelines. Dose distribution to the SLN (n = 9000 data points) and axillary levels (n = 270 data points) were analyzed for whole breast irradiation (WBI) and PBI across different techniques (3D-conformal radiation therapy [3D-CRT] vs. volumetric modulated arc therapy [VMAT]), deep inspiration breath-hold [DIBH] vs. free breathing [FB]), and anatomical variations (breast size, tumor site, and upper breast border).</div></div><div><h3>Results</h3><div>WBI provided full therapeutic dose coverage (&gt;95 % of the prescribed dose) to 65 % of SLNs, compared to only 10 % (3D-CRT) and 3 % (VMAT) with PBI. DIBH significantly reduced dose distribution to SLN and axillary levels compared to FB. Lower incidental dose coverage was also observed in patients with medial/central tumors, smaller breasts, and lower upper breast borders.</div></div><div><h3>Conclusion</h3><div>These results demonstrate that PBI delivers substantially lower incidental dose to the SLN than WBI. Since patients in the INSEMA and SOUND trials were predominantly treated with WBI, combining SLNB omission with PBI should not be considered a standard approach and warrants further investigation.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104523"},"PeriodicalIF":5.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524311","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 effects of adjuvant endocrine therapy on long-term outcomes from ductal carcinoma in situ: a systematic review and meta-analysis","authors":"Qian Chen ,&nbsp;Ian Campbell ,&nbsp;Mark Elwood ,&nbsp;Alana Cavadino ,&nbsp;Phyu Sin Aye ,&nbsp;Sandar Tin Tin","doi":"10.1016/j.breast.2025.104521","DOIUrl":"10.1016/j.breast.2025.104521","url":null,"abstract":"<div><h3>Background</h3><div>Although adjuvant endocrine therapy (ET) is a standard treatment for hormone receptor positive ductal carcinoma in situ (DCIS), its use is variably recommended by clinicians. This paper reviewed the effects of ET in relation to recurrence and survival across diverse populations.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Web of Science, and Cochrane were searched for studies that reported outcomes of DCIS treated with ET versus no ET.</div></div><div><h3>Results</h3><div>Three randomised trials and 42 cohort studies were included. In the trials, tamoxifen significantly reduced the risk of in-breast recurrence with a pooled hazard ratio (HR) of 0.69 (95 % CI: 0.60, 0.80). In the cohort studies, ET was associated with lower risks of any recurrence (HR 0.67; 95 % CI: 0.55, 0.83), ipsilateral breast tumour recurrence (HR 0.59; 0.51, 0.69), loco-regional recurrence (HR 0.74; 0.53, 1.02) and contralateral breast cancer (HR 0.70; 0.49, 1.00), and improved overall survival (HR 0.85; 0.79, 0.90). No significant association between ET and breast cancer specific survival was observed in either trials or cohort studies. Subgroup analyses within the cohort studies showed no significant differences in the pooled HRs for recurrence and survival by follow-up length, confounding adjustment or treatment type.</div></div><div><h3>Conclusions</h3><div>The use of adjuvant ET reduces the risk of recurrence in patients with DCIS in clinical trials, as well as in the real-world setting. Survival benefits, however, warrant further study.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104521"},"PeriodicalIF":5.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322471","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":"High impact of chemotherapy on ovarian reserve in breast cancer survivors of reproductive age: A systematic review and meta-analysis","authors":"Susanna Weidlinger ,&nbsp;Magdalena Weidlinger ,&nbsp;Rose-Maria Schramm ,&nbsp;Angela Vidal ,&nbsp;Janna Pape ,&nbsp;Tanya Karrer ,&nbsp;Manuela Rabaglio ,&nbsp;Michael von Wolff","doi":"10.1016/j.breast.2025.104514","DOIUrl":"10.1016/j.breast.2025.104514","url":null,"abstract":"<div><h3>Introduction</h3><div>The risk of infertility following breast cancer (BC) treatment is critical for women of reproductive age. Accurate risk assessment is essential for fertility counseling and preservation. Amenorrhoea as an infertility marker is unreliable due to endocrine therapies. Anti-Mullerian hormone (AMH) is a reliable fertility marker, but its role in assessing chemotherapy-induced loss of ovarian reserve in BC survivors remains underexplored.</div></div><div><h3>Objective</h3><div>This systematic review and meta-analysis evaluates AMH decline and the prevalence of low (AMH &lt;1 ng/mL) and very low (&lt;0.5 ng/mL) ovarian reserve in BC survivors &lt;40 years old, 12–24 months post-chemotherapy, to quantify the gonadotoxic impact of BC treatments.</div></div><div><h3>Methods</h3><div>A systematic literature search of PubMed, Embase, and the Cochrane Library identified studies with AMH levels before and 12–24 months after chemotherapy in BC patients &lt;40 years of age. Data on AMH levels were pooled using random-effects meta-analysis. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. This study is part of the FertiTOX project (<span><span>www.fertitox.com</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>Ten studies (860 BC survivors) were included. Mean AMH decline was −1.61 (95 % CI: -2.31; −0.91) post-chemotherapy. The pooled prevalence of AMH &lt;1 ng/mL and &lt;0.5 ng/mL was 58 % (46–70 %) and 53 % (41–64 %), respectively. High heterogeneity was observed (I² &gt;80 %).</div></div><div><h3>Conclusions</h3><div>More than half of BC survivors have severely reduced ovarian reserve after chemotherapy, which is associated with a shortened fertile window and an increased risk of premature ovarian insufficiency. These findings highlight the need for pre-treatment fertility counseling and post-treatment ovarian insufficiency surveillance in routine oncology care.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104514"},"PeriodicalIF":5.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330815","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":"Hyaluronic acid 0.2 % cream for preventing radiation dermatitis in breast cancer patients treated with postoperative radiotherapy: A randomized, double-blind, placebo-controlled study","authors":"Letizia Deantonio ,&nbsp;Giulia Borgonovo ,&nbsp;Serena Caverzasio ,&nbsp;Maria Antonietta Piliero ,&nbsp;Paola Canino ,&nbsp;Andrea Puliatti ,&nbsp;Thomas Zilli ,&nbsp;Maria Carla Valli ,&nbsp;Antonella Richetti","doi":"10.1016/j.breast.2025.104513","DOIUrl":"10.1016/j.breast.2025.104513","url":null,"abstract":"<div><h3>Introduction</h3><div>This randomized trial evaluated the efficacy and safety of the prophylactic use of a hyaluronic acid (HA) 0.2 %-containing cream to reduce acute radiodermatitis in breast cancer patients undergoing adjuvant radiotherapy (RT).</div></div><div><h3>Methods</h3><div>Candidates for conventionally-fractionated or hypofractionated adjuvant RT for unilateral stage I-III breast cancer were randomized 1:1 to the HA cream or neutral comparator applied twice daily from 14 days before starting until 14 days after completing local RT. The primary endpoint was the development of acute skin dermatitis of grade ≥2 according to RTOG scale at the end of RT.</div></div><div><h3>Results</h3><div>The study closed early after 86 of the planned 120 patients were enrolled because of an unexpectedly low frequency of acute skin toxicity. Cumulative acute grade ≥2 radiodermatitis was lower with the HA cream (21.1 %) than the comparator group (35.3 %) but did not reach statistical significance in the primary endpoint (p = 0.3). At the end of RT, acute dermatitis grade ≥1 occurred in 92 % of patients undergoing conventionally-fractionated RT and 50 % in the hypofractionation subgroup. Physician-based RTOG grading scale and quantitative assessment with skin reflectance spectrophotometry (SRS) measures were comparable in detecting skin toxicity. However, an increase in SRS values was detectable a week before the first signs of radiodermatitis were depicted using RTOG scores.</div></div><div><h3>Conclusion</h3><div>Compared to physician-based grading, SRS enabled earlier detection of skin toxicity and may be used as a valid and effective tool for assessing radiodermatitis. Prophylactic topical HA may help mitigate this toxicity; however adequately powered prospective trials are needed.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104513"},"PeriodicalIF":5.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314584","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":"Outcomes, indications and predictive factors for complications in postmastectomy prepectoral reconstructions with polyurethane foam-coated implants","authors":"Andrea Lisa ,&nbsp;Francesca Riccardi ,&nbsp;Mario Alessandri-Bonetti ,&nbsp;Luca Mazzocconi ,&nbsp;Manuela Bottoni ,&nbsp;Benedetta Barbieri ,&nbsp;Alessandra Gottardi ,&nbsp;Marco Palmesano ,&nbsp;Valerio Cervelli ,&nbsp;Vincenzo Bagnardi ,&nbsp;Eleonora Pagan ,&nbsp;Paolo Veronesi ,&nbsp;Francesca De Lorenzi ,&nbsp;Mario Rietjens","doi":"10.1016/j.breast.2025.104520","DOIUrl":"10.1016/j.breast.2025.104520","url":null,"abstract":"<div><h3>Background</h3><div>Implant-based reconstruction (IBR) is the most common reconstructive strategy following mastectomy. Advancements in surgical techniques and materials have led to improvement in perfusion and thickness of mastectomy skin flaps and they have renewed interest in prepectoral breast reconstruction (PBR).</div><div>The aim of this study was to analyze the surgical outcomes of skin or nipple-sparing mastectomies with direct-to-implant (DTI) reconstructions with prepectoral polyurethane foam–coated implants.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on consecutive patients undergoing postmastectomy IBR-DTI with prepectoral polyurethane foam-coated implants between 2020 and 2022. Inclusion criteria were a preoperative pinch test &gt;0.8 cm and well-perfused mastectomy flaps. Preoperative radiation therapy was not an exclusion criterium. Complications were classified as “major” if they required urgent re-intervention, and as “minor” if they required only outpatient management.</div></div><div><h3>Results</h3><div>A total of 250 patients and 317 breast reconstructions were included. The mean (±SD) age was 50.5 ± 10.9 years with a mean BMI of 23.8 ± 4.0. The mean follow-up was 12.2 ± 1.2 months. The overall rate of major complications was 6.3 %, being infection the most common major complication (2.5 %), followed by mastectomy flap necrosis (1.6 %), bleeding (1.6 %), and wound dehiscence (0.6 %). The overall minor complications rate was 27.8 %. Across minor complications, rippling was recorded as the most common (14.5 %), followed by capsular contracture (7.6 %), seroma formation (2.5 %), skin necrosis (2.2 %), hematoma (0.6 %) and wound dehiscence (0.3 %).</div></div><div><h3>Conclusion</h3><div>In our cohort, DTI-PBR with PU implants had a 6.3 % risk of major complications requiring urgent re-intervention. Hypothyroidism, diabetes, and overweight have been identified as risk factors associated with higher risk of complications.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"83 ","pages":"Article 104520"},"PeriodicalIF":5.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672596","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":"Tumor site, stage, and receptor-specific efficacy of radiation therapy in Asian breast cancer patients aged 60 years and older: A SEER database survival analysis incorporating clinicopathological features and nomograms","authors":"Qixin Mao ,&nbsp;Haonan Han ,&nbsp;Lianfang Li ,&nbsp;Shanqing Liu ,&nbsp;Yong Li ,&nbsp;Yan Shen ,&nbsp;Leiming Guo ,&nbsp;Liming Xu","doi":"10.1016/j.breast.2025.104518","DOIUrl":"10.1016/j.breast.2025.104518","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the survival benefits of radiation therapy (RT) in elderly (≥60 years) Asian breast cancer patients focusing on tumor site, stage, and receptor status using SEER data. And aims to provide a nuanced understanding of how RT impacts survival outcomes in this demographic, particularly across varying tumor stages and receptor statuses.</div></div><div><h3>Methods</h3><div>We analyzed 47,868 elderly (≥60 years) Asian patients from the SEER database (2000–2021). Survival outcomes were assessed using Kaplan-Meier analysis, Cox regression models, and nomograms. Multivariate analyses quantified RT efficacy across tumor sites (central, axillary tail), hormone receptor status (ER/PR, HER2), and stages (I–IV).</div></div><div><h3>Results</h3><div>RT improved median overall survival (OS) (17.5 <em>vs.</em> 13.4 years; hazard ratio [HR] = 0.54, <em>p</em> &lt; 0.001), with consistent benefits across delivery methods. Axillary tail tumors showed the greatest survival gain (64.2 % OS improvement, HR = 0.36). ER/PR-positive patients derived significant benefit (HR = 0.48), unlike HER2-positive cases (<em>p</em> = 0.12). Stage III patients experienced maximal survival improvement (HR = 0.41), while stage IV showed marginal benefits (HR = 0.89). Age-stratified analyses confirmed benefits across all groups (60–69, 70–79, ≥80 years).</div></div><div><h3>Conclusion</h3><div>RT confers significant survival benefits in elderly (≥60 years) Asian breast cancer patients, with pronounced efficacy observed in axillary tail tumors and stage III disease. ER/PR-positive tumors exhibit enhanced treatment responsiveness, while HER2 status remains non-predictive of therapeutic outcomes. However, limited efficacy in stage IV disease underscores the necessity for alternative management strategies in advanced-stage settings. These findings emphasized personalizing RT guided by tumor biology and staging, while carefully considering comorbidities and treatment-related toxicities in geriatric oncology populations.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104518"},"PeriodicalIF":5.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314509","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":"Navigating discrepancies: The assessment of residual lymphovascular invasion in breast carcinoma after neoadjuvant treatment","authors":"Anikó Kovács ,&nbsp;Åsa Rundgren-Sellei ,&nbsp;Gunilla Rask ,&nbsp;Annette Bauer ,&nbsp;Anna Bodén ,&nbsp;Johannes van Brakel ,&nbsp;Eugenia Colón-Cervantes ,&nbsp;Anna Ehinger ,&nbsp;Johan Hartman ,&nbsp;Balazs Acs","doi":"10.1016/j.breast.2025.104519","DOIUrl":"10.1016/j.breast.2025.104519","url":null,"abstract":"<div><div>The assessment of residual lymphovascular invasion (LVI) in breast cancer patients undergoing neoadjuvant therapy may be a critical factor influencing prognosis and treatment decisions. However, there is a notable discrepancy between the RCB, UICC/AJCC, and ICCR guidelines regarding how LVI should be evaluated and reported in this context. ICCR recommends including LVI in the invasive tumor size for neoadjuvant treated patients with only residual LVI affecting the Residual Cancer Burden (RCB) score. AJCC suggests that LVI should not be evaluated as invasive cancer. However, they do not recommend that such cases are considered as complete response. The RCB method does not address the LVI question at all. This editorial aims to explore the implications of these differing recommendations, highlighting the challenges in clinical practice. Even though there is limited evidence in the literature on this subject, leaving this discrepancy unaddressed leads to high variability in the staging of neoadjuvant-treated breast cancer patients among pathologists. This, in turn, may cause confusion in the clinical decision-making for these patients. The recommendation of the Swedish Breast Pathology Expert Group (KVAST breast) based on current evidence, is to report LVI as a separate prognostic biomarker in neoadjuvant setting and reporting it separately from the RCB treatment response criteria. For breast cancer patients with only LVI as residual disease in the breast without any lymph node metastasis after NACT, the Swedish Breast Pathology Expert Group recommends the following staging: RCB-0, pPR, ypT0, ypN0, L1.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104519"},"PeriodicalIF":5.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254587","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":"Explainable machine learning model for predicting internal mammary node metastasis in breast cancer: Multi-method development and cross-cohort validation","authors":"Yirong Xiang ,&nbsp;Jian Tie ,&nbsp;Siyuan Zhang ,&nbsp;Chen Shi ,&nbsp;Changkuo Guo ,&nbsp;Yushuo Peng ,&nbsp;Zhaoqing Fan ,&nbsp;Weihu Wang","doi":"10.1016/j.breast.2025.104517","DOIUrl":"10.1016/j.breast.2025.104517","url":null,"abstract":"<div><h3>Background</h3><div>This study developed an explainable machine learning model for baseline internal mammary lymph node metastasis (IMNM) in breast cancer patients.</div></div><div><h3>Materials and methods</h3><div>This study included three cohorts: a derivation cohort (n = 1997) from Peking University Cancer Hospital, a temporal testing cohort (n = 633) from the same center, and a SEER cohort (n = 51,420). Multiple machine learning strategies were conducted: Least Absolute Shrinkage and Selection Operator (LASSO), Boruta, backward stepwise regression, and best subset for feature selection, and logistic regression (LR), support vector machines (SVM), k-nearest neighbors (KNN), and extreme gradient boosting (XGBoost) for model construction. The best-performing model was validated across internal and temporal testing cohorts. Shapley Additive Explanations (SHAP) analysis was conducted to improve interpretability.</div></div><div><h3>Results</h3><div>Six clinical features (clinical N stage, size, stage, classification, grade and location) were used to construct the final predictive model with SVM. The model achieved robust performance, with AUCs of 0·811 (0·790–0·843), 0.806 (0·760-0·857) and 0·864 (0·830–0·926) in the training, internal testing and temporal testing cohort, respectively. High-risk patients exhibited significantly worse outcomes with DFS (HR 2·776, 95 % CI: 1·897–4·064, p &lt; 0·001) and OS (HR of 1·962, 95 % CI: 1·853–2·077, p &lt; 0·001). An online prediction tool was established that allows users to input key clinical variables and obtain model-predicted probabilities along with SHAP-based explanations.</div></div><div><h3>Conclusion</h3><div>This validated and explainable machine learning model offers a practical tool for early risk stratification, aiding clinicians in appropriate baseline imaging selection and adjuvant treatment planning.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104517"},"PeriodicalIF":5.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144272025","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":"Body mass index and progesterone receptor in postmenopausal ER-positive/HER2-negative breast cancer: A nation-wide study in Korean breast cancer society and the multi-institutional cohort","authors":"Janghee Lee ,&nbsp;Soong June Bae ,&nbsp;Hong Kyu Kim ,&nbsp;Seok Jin Nam ,&nbsp;Hee Jeong Kim ,&nbsp;Soo Youn Bae ,&nbsp;Ho Yong Park ,&nbsp;Byung Kyun Ko ,&nbsp;Jung Ho Park ,&nbsp;Yeonjoo Kwon ,&nbsp;Youri Park ,&nbsp;Seung Ho Baek ,&nbsp;Yoowon Kook ,&nbsp;Sanghwa Kim ,&nbsp;Young Ah Lim ,&nbsp;Hee-Joon Kang ,&nbsp;Doyil Kim ,&nbsp;Joon Jeong ,&nbsp;Sung Gwe Ahn","doi":"10.1016/j.breast.2025.104515","DOIUrl":"10.1016/j.breast.2025.104515","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a risk factor for breast cancer and associated with increased estrogen levels that stimulate the progesterone receptor (PgR). Understanding interplay between obesity, PgR, and prognosis in estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer (ER+/HER2-) is crucial. This study aimed to investigate the association between body mass index (BMI) and the prognostic value of PgR.</div></div><div><h3>Methods</h3><div>Study included 10,125 postmenopausal patients with ER+/HER2-breast cancer between January 1991 to December 2019. Patients were categorized according to BMI (cutoff: 25 kg/m²) and PgR (positive/negative). The primary outcomes were the 6-year overall survival (OS) in the Korean Breast Cancer Registry (KBCR) cohort and 6-year recurrence-free survival (RFS) in the multi-institutional cohort.</div></div><div><h3>Results</h3><div>In both cohorts, a greater proportion of patients with high BMI were PgR-positive, and the mean BMI was higher in the PgR-positive group. PgR-negativity was associated with worse 6-year OS in the KBCR cohort among patients with BMI ≥25 kg/m² (hazard ratio [HR], 1.45; 95 % confidence intervals [CI], 1.06–1.97; <em>P</em> = .02), but not in those with BMI &lt;25 kg/m². Similarly, in the multi-institutional cohort, PgR-negativity was associated with worse 6-year RFS only in patients with BMI ≥25 kg/m² (HR, 2.93; 95 % CI, 1.29–6.69; <em>P</em> = .01). The mean 21-gene recurrence score was higher in the PgR-negative group, regardless of the BMI.</div></div><div><h3>Conclusions</h3><div>In postmenopausal patients with ER+/HER2-breast cancer, the prognostic impact of PgR is modified by BMI. PgR-negativity is a strong predictor of poor outcomes in obese patients but not in non-obese patients.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104515"},"PeriodicalIF":5.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290828","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":"Prognostic significance of receptor conversion following neoadjuvant therapy in breast cancer: a systematic review & meta-analysis","authors":"Gavin P. Dowling ,&nbsp;Gordon R. Daly ,&nbsp;Cian M. Hehir ,&nbsp;Maen M. AlRawasdeh ,&nbsp;Gavin G. Calpin ,&nbsp;Sami Almasri ,&nbsp;Sinead Toomey ,&nbsp;Leonie S. Young ,&nbsp;Bryan T. Hennessey ,&nbsp;Arnold D.K. Hill","doi":"10.1016/j.breast.2025.104516","DOIUrl":"10.1016/j.breast.2025.104516","url":null,"abstract":"<div><h3>Purpose</h3><div>Receptor conversion following neoadjuvant therapy in breast cancer may influence prognosis and adjuvant treatment decisions. This systematic review and meta-analysis evaluated the prognostic significance of changes in hormone receptor (HR) and HER2 status after neoadjuvant therapy.</div></div><div><h3>Methods</h3><div>This study was performed in accordance with PRISMA guidelines. A systematic search of the literature was conducted to identify studies assessing the prognostic effect of receptor conversion after neoadjuvant treatment in breast cancer. Studies reporting receptor status before and after neoadjuvant therapy, with associated survival outcomes, were included. Pooled hazard ratios (HRs) for disease-free survival (DFS) and overall survival (OS) were calculated using random-effects models.</div></div><div><h3>Results</h3><div>Twenty-two studies (n = 5370) were included in this meta-analysis. HR gain demonstrated significantly improved DFS (HR 0.49, 95 % CI 0.25–0.97; <em>p</em> = 0.04), but no OS benefit. HR loss was associated with both significantly worse DFS (HR 3.42, 95 % CI 1.93–6.08; <em>p</em> &lt; 0.001) and OS (HR 1.99, 95 % CI 1.04–3.84; <em>p</em> = 0.04). HER2 gain had a negative impact on DFS (HR 1.89, 95 % CI 1.00–3.58; <em>p</em> = 0.05), with no significant effect on OS. HER2 loss was associated with significantly poorer DFS (HR 1.92, 95 % CI 1.51–2.43; <em>p</em> &lt; 0.001) and OS (HR 2.20, 95 % CI 1.44–3.38; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>This systematic review and meta-analysis demonstrates that receptor conversion following neoadjuvant therapy in breast cancer significantly impacts survival outcomes. Specifically, gaining HR positivity is associated with improved DFS, while losing HR positivity correlates with worse DFS and OS. With regards to HER2, gaining positivity is associated with worse DFS, and losing positivity is associated with worse DFS and OS, compared to patients who maintain their initial status. These findings underscore the potential importance of reassessing receptor status after neoadjuvant therapy to tailor subsequent treatment decisions accurately.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"82 ","pages":"Article 104516"},"PeriodicalIF":5.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262810","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}