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{"title":"Early Ki67 change predicts prognosis and supports response-adapted therapy in breast cancer treated with neoadjuvant chemotherapy","authors":"Ying Zhang ,&nbsp;Siyu Wu ,&nbsp;Liang Xue ,&nbsp;Yifan Xie ,&nbsp;Juping Shen ,&nbsp;Zhimin Shao ,&nbsp;Guangyu Liu","doi":"10.1016/j.breast.2025.104649","DOIUrl":"10.1016/j.breast.2025.104649","url":null,"abstract":"<div><h3>Background</h3><div>Early prediction of response to neoadjuvant chemotherapy (NACT) in breast cancer is critical for optimizing treatment strategies and improving outcomes. This study assessed the prognostic value of early Ki67 change (ΔKi67 %) via on-treatment core needle biopsy (CNB) in stratifying event-free survival (EFS) and informing potential treatment escalation.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, 1388 breast cancer patients treated from 2013 to 2021 were randomly divided into training and validation sets (7:3 ratio). ΔKi67 % was calculated as the percentage change from baseline to on-treatment CNB after a median of two NACT cycles. K-means clustering determined an optimal 40 % cutoff classifying patients as poor (≤40 %) or good responders (&gt;40 %). EFS was analyzed using Kaplan-Meier estimates, multivariable Cox models, and restricted mean survival time (RMST).</div></div><div><h3>Results</h3><div>Good responders had significantly superior 5-year EFS compared to poor responders in both training (78.8 % versus 62.4 %, p &lt; 0.001) and validation (78.6 % versus 60.9 %, p = 0.001) sets. ΔKi67 % showed stronger stratification than imaging-based metrics in RMST analysis and remained an independent predictor after adjustment. Subgroup analyses suggested poor responders in the ER-negative/HER2-negative subgroup derived a 32.0 % 3-year EFS benefit from chemotherapy intensification. The 3-year survival benefit was 14.1 % in poor responders in the HER2-positive subtype with dual HER2 blockade, though these findings require further validation.</div></div><div><h3>Conclusion</h3><div>Early ΔKi67 % change using a 40 % cutoff via on-treatment CNB is a reliable prognostic predictor supporting response-adapted treatment tailoring, particularly in ER-negative/HER2-negative and HER2-positive populations.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104649"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556338","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 trajectory of fatigue over time in breast cancer patients treated with chemotherapy: exploring the effect of anthracycline-based chemotherapy","authors":"Anneke Kastelein ,&nbsp;Laura Kervezee ,&nbsp;Dieuwke R. Mink van der Molen ,&nbsp;Daniel J. Evers ,&nbsp;Carmen C. van der Pol ,&nbsp;Annemiek Doeksen ,&nbsp;N.H. Chavannes ,&nbsp;Hans Gelderblom ,&nbsp;Jacques Neefjes ,&nbsp;Helena M. Verkooijen ,&nbsp;Anne M. May","doi":"10.1016/j.breast.2026.104700","DOIUrl":"10.1016/j.breast.2026.104700","url":null,"abstract":"<div><h3>Background</h3><div>Cancer-related fatigue is a common and profound side effect of cancer treatment. The specific impacts of different classes of chemotherapy remains understudied. This study aimed to compare the trajectory of fatigue between breast cancer patients treated with anthracycline-based versus non-anthracycline-based regimens over a period of 4 years.</div></div><div><h3>Methods</h3><div>Data were obtained from the Dutch UMBRELLA cohort. Included were breast cancer patients treated with (neo)adjuvant chemotherapy, categorized as anthracycline-containing vs. non-anthracycline-containing. Fatigue was measured using the Multidimensional Fatigue Inventory-20 and the fatigue scale of the EORTC QLQ-C30. A total of 1155 patients were included: 971 received anthracycline-based chemotherapy, and 184 received non-anthracycline-based chemotherapy. Linear mixed-effects models were employed to analyse time-by-treatment interactions for different dimensions of fatigue.</div></div><div><h3>Results</h3><div>The fatigue trajectories differed significantly between treatment groups for general and physical fatigue. Pairwise comparisons indicate that anthracycline-treated patients reported higher levels of general fatigue and physical fatigue as well as reduced activity in the first six months after start of treatment. Notably, patients treated with non-anthracycline-based regimens reported better recovery over time, with significantly lower fatigue levels at 42–48 months compared to anthracyclines-treated patients, as measured by both the MFI-20 and the fatigue scale of the EORTC QLQ-C30.</div></div><div><h3>Conclusion</h3><div>These observations suggest that (neo)adjuvant anthracycline-based chemotherapy in breast cancer patients is associated with higher levels of fatigue during treatment as well as a prolonged burden of fatigue. Treatment tailored fatigue management strategies may be particularly useful for patients undergoing anthracycline-based chemotherapy.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104700"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008930","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":"Divergence of DNA tumor mutations in cerebrospinal fluid in metastatic breast cancer patients with leptomeningeal metastases","authors":"Peter H. Wessels ,&nbsp;Sten Cornellisen ,&nbsp;Kim Monkhorst ,&nbsp;Gabe S. Sonke ,&nbsp;Annegien Broeks ,&nbsp;Dorothe Linders ,&nbsp;Daan van den Broek ,&nbsp;Mirjam C. Boelens ,&nbsp;Dieta Brandsma","doi":"10.1016/j.breast.2025.104674","DOIUrl":"10.1016/j.breast.2025.104674","url":null,"abstract":"<div><h3>Purpose</h3><div>To study differences in genetic alterations between primary breast cancer, systemic metastases, and cerebrospinal fluid (CSF) in patients with leptomeningeal metastases (LM).</div></div><div><h3>Material and methods</h3><div>Breast cancer patients with confirmed or probable LM and available primary tumor tissue were selected from a CSF-biobank study of the Netherlands Cancer Institute. Genetic analysis of cell-free DNA (cfDNA) in CSF and tissue from the primary tumor and/or systemic metastases was performed using Next Generation Sequencing (NGS). In patients with HR+/HER2-breast cancer, CSF and tumor tissues were also tested for ESR1 mutations with Sanger sequencing.</div></div><div><h3>Results</h3><div>27 breast cancer patients with LM (n = 23 confirmed LM; n = 4 probable LM) were included in the study. Fourteen patients had triple negative (TN), 11 HR+/HER2-and 3 HER2+ breast cancer. CSF-only genetic alterations were observed in 5 (20 %) of 25 evaluable patients. The majority of these genetic alterations were found in the PTEN-PI3K-AKT pathway, which were present in 3 of 14 evaluable patients with a TN breast cancer subtype (21 %) and in one patient wit HER2+ breastcancer. In one HR+/HER2+ patient, an ESR1 mutation was present in both CSF and systemic metastases, while it was absent in the primary tumor. All genetic alterations that were observed in either the primary tumor or systemic metastases were also observed in the CSF.</div></div><div><h3>Conclusion</h3><div>In 20 % of breast cancer patients with LM, genetic alterations in the CSF were discordant from the primary tumor and/or systemic metastases. These genetic alterations involved in particular the PTEN-PI3K-AKT pathway in TN breast cancer. No ESR1 mutation limited to CSF only was found in HR+/HER2-breast cancer. Divergence of genetic alterations in LM from breast cancer must be considered for optimization of future target treatment strategy.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104674"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910427","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":"Standardized patient coaching improves therapy persistence in patients with hormone receptor–positive, HER2–negative advanced/metastatic breast cancer treated with abemaciclib","authors":"Manfred Welslau ,&nbsp;Peter A. Fasching ,&nbsp;Nicole Semmler-Lins ,&nbsp;Lothar Mueller ,&nbsp;Erik Belleville ,&nbsp;Lorenz Rieger ,&nbsp;Sabrina Uhrig ,&nbsp;Mark-Oliver Zahn ,&nbsp;Benno Lex ,&nbsp;Christoph Uleer ,&nbsp;Natalija Deuerling ,&nbsp;Tobias Hesse ,&nbsp;Dagmar Langanke ,&nbsp;Lothar Häberle ,&nbsp;Hans Tesch","doi":"10.1016/j.breast.2025.104684","DOIUrl":"10.1016/j.breast.2025.104684","url":null,"abstract":"<div><h3>Introduction</h3><div>Therapy adherence is critical, particularly for patients with breast cancer undergoing oral endocrine therapies. The use of combination regimes, such as CDK4/6 inhibitors, has introduced additional side effects, which can affect adherence. A structured patient coaching and communication tool may positively affect therapy adherence.</div></div><div><h3>Methods</h3><div>The IMPACT study (NCT04030728) was a randomized trial including patients with advanced breast cancer (aBC) receiving abemaciclib as part of routine clinical care. The study examined the influence of structured coaching on patient adherence. Participants were randomized to receive therapy management incorporating the Multinational Association of Supportive Care in Cancer (MASCC) Oral Agent Teaching Tool (MOATT©) or local standard of care practice (LSOC). The primary endpoint was the persistence rate at week 24 (PR24). Secondary endpoints included time to therapy discontinuation (TTD) and quality of life.</div></div><div><h3>Results</h3><div>A total of 201 patients were randomized and initiated abemaciclib therapy. By week 24, 22 (10.9 %) patients had permanently discontinued abemaciclib for reasons other than progression or death: 14 (14.1 %) in the LSOC arm and 8 (7.8 %) in the MOATT© arm. PR24 was 68.9 % (95 % CI: 58.3–78.2) in the LSOC arm and 81.6 % (95 % CI: 72.5–88.7) in the MOATT© arm, yielding an odds ratio of 2.01 (95 % CI: 1.02–3.96; <em>P</em> = 0.04). TTD showed a hazard ratio of 0.59 (95 % CI: 0.32–1.07), favoring the MOATT© arm. No significant differences in quality of life between study arms were observed.</div></div><div><h3>Conclusion</h3><div>Individual patient coaching based on MOATT© demonstrated improved PR24 for patients undergoing abemaciclib treatment for aBC.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104684"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973282","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":"How should we manage abemaciclib in the peri-operative period during secondary breast reconstruction: balancing oncologic benefit and surgical safety","authors":"Michel Gabriel Cazenave ,&nbsp;Leslie Elahi ,&nbsp;Katia Mahiou ,&nbsp;Claire Bonneau ,&nbsp;Ornella Ammendola ,&nbsp;Louise Benoit","doi":"10.1016/j.breast.2025.104683","DOIUrl":"10.1016/j.breast.2025.104683","url":null,"abstract":"<div><div>Abemaciclib, a CDK4/6 inhibitor, has emerged as a pivotal therapy in hormone receptor–positive, HER2-negative breast cancer, including in the adjuvant setting for high-risk early disease. Its integration into long-term oncologic strategies poses new challenges for peri-operative management, particularly in the context of secondary breast reconstruction. Preclinical studies suggest impaired wound healing potential, while clinical data highlight an increased risk of venous thromboembolism. No study to date has specifically addressed surgical outcomes under abemaciclib therapy. We call for the need of a clinical trial in abemaciclib perioperative management and propose pragmatic peri-operative strategies to optimize patient safety without compromising oncologic benefit.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104683"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910400","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":"HER2/CEP17 ratio is associated with pCR after HER2-directed neoadjuvant treatment in the phase III NeoALTTO trial","authors":"Christian F. Singer ,&nbsp;Franz Koenig ,&nbsp;Stephanie Kacerovsky-Strobl ,&nbsp;Sabine Danzinger ,&nbsp;Christine Brunner ,&nbsp;Christoph Suppan ,&nbsp;Christine Deutschmann ,&nbsp;Marija Balic ,&nbsp;Richard Greil ,&nbsp;Daniel Egle ,&nbsp;Evandro de Azambuja ,&nbsp;Serena Di Cosimo ,&nbsp;Anup Choudhury ,&nbsp;Michael Gnant","doi":"10.1016/j.breast.2025.104679","DOIUrl":"10.1016/j.breast.2025.104679","url":null,"abstract":"<div><h3>Purpose</h3><div>In early breast cancer, HER2-directed therapies are approved for the treatment of patients with HER2-positive invasive breast cancer as defined by HER2 protein overexpression, or <em>HER2</em> gene amplification with <em>HER2/CEP17</em> ratios ≥2.2. Beyond this cut-off, however, it is unknown whether the efficacy of HER2-directed therapy improves with increasing <em>HER2/CEP17</em> ratios. We evaluated whether quantitative assessment of the <em>HER2/CEP17</em> ratio predicts pathological complete response (pCR) and event-free survival (EFS) in patients treated with neoadjuvant HER2-based regimen in the prospective phase III NeoALTTO trial.</div></div><div><h3>Patients and methods</h3><div>455 women with HER2-positive early breast cancer, who had received neoadjuvant trastuzumab and/or lapatinib, together with 12 cycles of weekly paclitaxel, were included in this analysis. The <em>HER2/CEP17</em> ratio in the primary tumor samples was correlated with pCR and survival outcome.</div></div><div><h3>Results</h3><div>The median <em>HER2/CEP17</em> ratio was 5.1 (range: 1.1–100.0), and ratios were not associated with age, hormone receptor (HR) status, or any other clinicopathological variable analyzed. The log <em>HER2/CEP17</em> ratio significantly predicted pCR in both univariate (OR: 1.83; 95 % CI: 1.11–3.01, p = 0.0176) and multivariate analysis (OR: 1.79; 95 % CI: 1.07–2.99, p = 0.0257). Higher <em>HER2/CEP17</em> ratios were, however, not associated with improved EFS (adjusted HR = 0.795; p = 0.3537). A pCR prediction model including <em>HER2/CEP17</em> ratio, treatment arm, and HR status improved the predictive strength of treatment arm alone from a ROC AUC value of 0.60–0.69.</div></div><div><h3>Conclusion</h3><div>In patients treated with HER2-based neoadjuvant therapy, quantitative analysis of the readily available pretreatment <em>HER2/CEP17</em> ratio by FISH is predictive of pCR<strong>.</strong></div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104679"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910479","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":"Nodal response to neoadjuvant therapy predicts prognosis of breast cancer patients with clinically positive internal mammary nodes","authors":"Zhe Xu ,&nbsp;Lu Cao ,&nbsp;Wei-Xiang Qi ,&nbsp;Gang Cai ,&nbsp;Dan Ou ,&nbsp;Cheng Xu ,&nbsp;Rong Cai ,&nbsp;Shu-Yan Li ,&nbsp;Jia-Yi Chen","doi":"10.1016/j.breast.2025.104670","DOIUrl":"10.1016/j.breast.2025.104670","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate survival outcomes and prognostic factors in breast cancer patients with clinically positive internal mammary lymph nodes (cIMN+) after combined-modality therapy, and to identify indicators for internal mammary nodal boost irradiation.</div></div><div><h3>Method</h3><div>Consecutive cIMN + patients between January 2010 and April 2023 were retrospectively reviewed. According to nodal response to neoadjuvant therapy (NAT), patients were divided into three groups: no IMN clinical complete response (cCR) (Group A), IMN cCR without ALN pathological complete response (pCR) (Group B), both IMN cCR and ALN pCR (Group C).</div></div><div><h3>Results</h3><div>Among 141 eligible patients (median follow-up 49.5 months), the 5-year rates for overall survival (OS) and recurrence-free survival (RFS) were 85.7 % and 76.7 %, respectively. Multivariable analysis confirmed ALN pCR and IMN cCR as independent favorable prognostic factors. Patients in group C exhibited superior 5-year OS (97.4 % vs. 88.9 % vs. 71.0 %, p = 0.007) and RFS (93.9 % vs. 71.8 % vs. 61.4 %, p &lt; 0.001), along with the lowest rate of distant metastasis (5.8 % vs. 22.7 % vs. 33.3 %, p = 0.003) compared to Groups B and A. In Group A patients, higher cumulative radiation dose (≥60 Gy) to IMN significantly improved both 5-year OS (71.0 % vs. 93.5 %, p = 0.009) and 5-year RFS (33.3 % vs. 69.3 %, p = 0.031).</div></div><div><h3>Conclusion</h3><div>The dual achievement of IMN cCR and ALN pCR after NAT predicts exceptional outcomes. For patients with persistent IMN involvement after NAT, IMN dose escalation to ≥60 Gy significantly improved OS and RFS. These findings support individualized radiotherapy strategies based on nodal response.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104670"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681868","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":"Short commentaries on data published by Yono et al. on avoiding breast cancer–related arm lymphedema with the lymphatic microsurgical preventive healing approach","authors":"Da Qian ,&nbsp;Xuli Meng ,&nbsp;Min Jia","doi":"10.1016/j.breast.2025.104689","DOIUrl":"10.1016/j.breast.2025.104689","url":null,"abstract":"<div><div>Lymphatic microsurgical preventive healing approach (LyMPHA) is being adopted to prevent arm lymphedema after axillary lymph node dissection (ALND), but open questions remain over selection bias, non-standardized endpoints and variable surgical protocols before robust evidence is available.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104689"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951510","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":"Adjuvant ovarian function suppression and aromatase inhibitors in premenopausal patients with hormone receptor and HER2 positive breast cancer, by timing of chemotherapy and trastuzumab and response to neoadjuvant therapy","authors":"Ayelet Shai ,&nbsp;Hans Wildiers ,&nbsp;Claudio Venieri ,&nbsp;Katarzyna Pogoda ,&nbsp;Barbro Linderholm ,&nbsp;Matteo Lambertini ,&nbsp;Leonor Matos ,&nbsp;Eleonora De Maio D'Esposito ,&nbsp;Nawale Hajjaji ,&nbsp;Erika Matos ,&nbsp;Lucía González Cortijo ,&nbsp;Giuseppe Fotia ,&nbsp;Ana Fortuna ,&nbsp;Tal Sella ,&nbsp;Helena Gouveia ,&nbsp;Laurent Rosset ,&nbsp;Anastasia Constantinidou ,&nbsp;Eurydice Angeli ,&nbsp;Irfan Cicin ,&nbsp;Vivianne Tjan-Heijnen ,&nbsp;Frederieke van Duijnhoven","doi":"10.1016/j.breast.2025.104669","DOIUrl":"10.1016/j.breast.2025.104669","url":null,"abstract":"<div><h3>Background</h3><div>The benefit of adjuvant ovarian function suppression (OFS) and aromatase inhibitors (AI) in premenopausal patients with hormone receptor positive, HER2 positive (HR+/HER2+) breast cancer (BC) is unclear. We aimed to investigate this question in a retrospective cohort, stratified by timing (adjuvant or neoadjuvant) of chemotherapy and trastuzumab and by response to neoadjuvant therapy.</div></div><div><h3>Methods</h3><div>Patients aged &lt;45Y at diagnosis, with stage I-III HR + HER2+ BC, treated with (neo)adjuvant chemotherapy and trastuzumab ( ± pertuzumab) and endocrine therapy were included. LHRH-agonists and oophorectomy were considered OFS. We compared distant disease-free survival (DDFS) with tamoxifen, OFS + tamoxifen and OFS + AI in three cohorts: neoadjuvant–pathologic complete response (pCR), neoadjuvant-residual disease (RD) and adjuvant. Endocrine therapy (ET) was modeled as a time dependent covariate in cox logistic regression analyses.</div></div><div><h3>Results</h3><div>The study included 1124 patients with median follow-up of 72.6 months (range:0–205 months). DDFS rates at 5 years were 83.9 %, 86.8 % and 92.1 % with tamoxifen, OFS + tamoxifen and OFS + AI respectively in the RD group, 94.3 %, 97.6 % and 96.5 % in the pCR group, and 94.3 %, 93.4 % and 98.6 % in the adjuvant group. OFS + AI was associated with better DDFS compared to tamoxifen in the RD group (n = 366) (multivariable weighted HR 0.28. 95 % CI 0.11-.069, p = 0.006), but associations of ET with DDFS in the pCR (n = 307, p = 0.59) and adjuvant (n = 451, p = 0.18) cohorts were not detected. Stage III was associated with worse DDFS in all groups.</div></div><div><h3>Conclusion</h3><div>OFS + AI were associated with better DDFS in patients with RD after neoadjuvant therapy. Our findings can assist shared decision-making on adjuvant endocrine therapy of these patients.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104669"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740914","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":"Validation of a deep learning-based AI model for breast cancer risk stratification in postmenopausal ER+/HER2-breast cancer patients","authors":"Sandra Sinius Pouplier ,&nbsp;Abhinav Sharma ,&nbsp;Pekka Ruusuvuori ,&nbsp;Johan Hartman ,&nbsp;Maj-Britt Jensen ,&nbsp;Bent Ejlertsen ,&nbsp;Mattias Rantalainen ,&nbsp;Anne-Vibeke Lænkholm","doi":"10.1016/j.breast.2025.104671","DOIUrl":"10.1016/j.breast.2025.104671","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer prognostication is crucial for treatment decisions, and the Nottingham Histologic Grade (NHG) system is widely used. However, NHG suffers from interobserver variability, and its division into three risk groups leaves the intermediate group (comprising ∼50 % of patients) overrepresented, making individualized treatment planning challenging as prognosis within this group differ widely.</div></div><div><h3>Objectives</h3><div>This study aimed to validate the prognostic value of Stratipath's low and high-risk categories and five risk groups and compare NHG performance with the Stratipath deep-learning-based model.</div></div><div><h3>Methods</h3><div>We analyzed clinical data from 2466 postmenopausal, ER+/HER2-breast cancer patients who did not receive chemotherapy according to guidelines at that time. The NHG and Stratipath models were compared using concordance index and hazard ratios (HR) for distant recurrence (DR), with time to any recurrence (TR) and overall survival (OS) as secondary endpoints.</div></div><div><h3>Results</h3><div>The Stratipath five-risk group model showed similar performance to the NHG-system in predicting DR (c-index 0.71 vs. 0.72). HR for DR for Stratipath risk groups 2, 3, 4, and 5 were 1.91 (95 % CI: 1.17–3.13), 2.63 (95 % CI: 1.63–4.24), 3.18 (95 % CI: 2.00–5.07), and 3.25 (95 % CI: 2.00–5.28), respectively (p &lt; 0.0001). In the NHG 2 subgroup, Stratipath Breast retained prognostic value for DR (HR for groups 3–5 vs. group 1: 1.73–1.85; p = 0.05), with a c-index of 0.71.</div></div><div><h3>Conclusions</h3><div>The Stratipath AI model performs similarly to the NHG system. Further prospective validation of the clinical benefits of differentiating Stratipath risk groups 2 and 3 in treatment strategies would be valuable.</div></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"85 ","pages":"Article 104671"},"PeriodicalIF":7.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733462","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}