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(A, B, C) Kaplan-Meier curves for N0, N1, and N2 patients stratified by categorical tumor size, respectively. (C) Demonstrates that among patients with four or more positive nodes, those with T1a tumors experienced significantly lower breast cancer–specific survival (BCSS) relative to patients with T1b tumors. The 8-year BCSS is lower among patients with T1aN2 disease, compared with patients with T1bN2 and T1cN2 disease, respectively.
Source publication
Traditionally, larger tumor size and increasing lymph node (LN) involvement have been considered independent predictors of increased breast cancer-specific mortality (BCSM). We sought to characterize the interaction between tumor size and LN involvement in determination of BCSM. In particular, we evaluated whether very small tumor size may predict...
Context in source publication
Context 1
... addition, earlier year of diagnosis, older age, African American race, higher tumor grade, absence of ER status, absence of PR status, more extensive LN dissection, larger tumor size, and greater LN involve- ment were independently associated with increased BCSM (Table 2). Separate Kaplan-Meier curves for N0, N1, and N2 patients stratified by categorical tumor size are provided in Figure 1. ...
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Breast cancer subtype correlates with response to systemic therapy and overall survival (OS), but its impact on lymphatic spread is incompletely understood. In this study, we used the Surveillance, Epidemiology, and End Results registry to assess whether the subtype can predict the presence of nodal metastasis or advanced nodal stage in breast canc...
Objective
To compare the prognosis of young breast cancer patients with the older ones.
Patients and methods
Utilizing the Surveillance, Epidemiology, and End Results database, we identified 150,588 female breast cancer patients diagnosed during 2003–2014, including 6,668 patients younger than 35 years and 143,920 patients aged between 35 and 60 y...
Background
Although it has been previously reported that radiotherapy (RT) effectively reduced the incidence of local recurrence of ductal carcinoma in situ (DCIS) following breast-conserving surgery (BCS), little is known about the effect of RT on survival of patients with locally excised DCIS.
Patients and methods
Using Surveillance, Epidemiolog...
Citations
... Furthermore, Engstrøm et al. reclassified all cases of breast cancer into six subtypes by gene expression analysis, and found that differences in breast cancer specific survival according to the subtypes occurred almost exclusively amongst patients with Grade2 tumors [7]. Previous studies have shown that histological grade, tumor size, degree of axillary lymph node (LN) involvement, age, hormone receptor status, HER2/neu status and the presence of lymphovascular invasion (LVI) were the prognostic factors for breast cancer [8]. The histological grade that considers both morphology and proliferation has unique prognostic significance compared to other prognostic factors and was widely used in clinical decision-making [4]. ...
Background
The histological grade is an important factor in the prognosis of invasive breast cancer and is vital to accurately identify the histological grade and reclassify of Grade2 status in breast cancer patients.
Methods
In this study, data were collected from 556 invasive breast cancer patients, and then randomly divided into training cohort (n = 335) and validation cohort (n = 221). All patients were divided into actual low risk group (Grade1) and high risk group (Grade2/3) based on traditional histological grade, and tumor-infiltrating lymphocyte score (TILs-score) obtained from multiphoton images, and the TILs assessment method proposed by International Immuno-Oncology Biomarker Working Group (TILs-WG) were also used to differentiate between high risk group and low risk group of histological grade in patients with invasive breast cancer. Furthermore, TILs-score was used to reclassify Grade2 (G2) into G2 /Low risk and G2/High risk. The coefficients for each TILs in the training cohort were retrieved using ridge regression and TILs-score was created based on the coefficients of the three kinds of TILs.
Results
Statistical analysis shows that TILs-score is significantly correlated with histological grade, and is an independent predictor of histological grade (odds ratio [OR], 2.548; 95%CI, 1.648–3.941; P < 0.0001), but TILs-WG is not an independent predictive factor for grade (P > 0.05 in the univariate analysis). Moreover, the risk of G2/High risk group is higher than that of G2/Low risk group, and the survival rate of patients with G2/Low risk is similar to that of Grade1, while the survival rate of patients with G2/High risk is even worse than that of patients with G3.
Conclusion
Our results suggest that TILs-score can be used to predict the histological grade of breast cancer and potentially to guide the therapeutic management of breast cancer patients.
... Therefore, early stage rectal cancer with elevated serum CEA levels may indicate early metastatic potential and poor rectal cancer survival. However, few studies have examined how T stage and serum CEA levels (C0 and C1) affect rectal cancer prognosis [9,10]. This study aimed to explore the role of CEA in predicting both local and distant recurrence in comparison to computed tomography (CT) as the gold standard for rectal cancer. ...
... Despite these improvements, metastasis remains the leading cause of BC-related mortality, affecting more than 20% of patients [2]. Various histopathological characteristics, such as tumour size, lymph node status and tumour grade, are strongly correlated with mortality [3,4]. Lymphovascular invasion (LVI) is considered an early event in the development of tumour metastasis and represents a significant predic-tor of poor outcome [5]. ...
... Approximately 10-15% of breast cancer (BC) patients have evidence of extensive axillary nodal involvement at diagnosis. 1 These patients are usually offered neoadjuvant chemotherapy (NAC) to improve survival, increase local control, and strive for a de-escalation of axillary surgery in case of nodal response after treatment. ...
Background
Systemic inflammatory markers draw great interest as potential blood-based prognostic factors in several oncological settings.
Objectives
The aim of this study is to evaluate whether neutrophil-to-lymphocyte ratio (NLR) and pan-immune-inflammation value (PIV) predict nodal pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in node-positive (cN+) breast cancer (BC) patients.
Design
Clinically, cN+ BC patients undergoing NAC followed by breast and axillary surgery were enrolled in a multicentric study from 11 Breast Units.
Methods
Pretreatment blood counts were collected for the analysis and used to calculate NLR and PIV. Logistic regression analyses were performed to evaluate independent predictors of nodal pCR.
Results
A total of 1274 cN+ BC patients were included. Nodal pCR was achieved in 586 (46%) patients. At multivariate analysis, low NLR [odds ratio (OR) = 0.71; 95% CI, 0.51–0.98; p = 0.04] and low PIV (OR = 0.63; 95% CI, 0.44–0.90; p = 0.01) were independently predictive of increased likelihood of nodal pCR. A sub-analysis on cN1 patients ( n = 1075) confirmed the statistical significance of these variables. PIV was significantly associated with axillary pCR in estrogen receptor (ER)−/human epidermal growth factor receptor 2 (HER2)+ (OR = 0.31; 95% CI, 0.12–0.83; p = 0.02) and ER−/HER2− (OR = 0.41; 95% CI, 0.17–0.97; p = 0.04) BC patients.
Conclusion
This study found that low NLR and PIV levels predict axillary pCR in patients with BC undergoing NAC.
Registration
Eudract number NCT05798806.
... It is generally considered that increasing tumor size correlates with a high risk of lymph node involvement (3). However, some patients with small-sized breast cancer also have lymph node metastasis (LNM), even extensive LNM, when diagnosed (4). In general, patients with 4 or more metastatic lymph nodes (N2-3) are considered to have "extensive LNM" (5). ...
... In general, patients with 4 or more metastatic lymph nodes (N2-3) are considered to have "extensive LNM" (5). It has been reported that approximately 27.8% of T1 breast cancer patients have LNM and approximately 0.7% extensive LNM at the time of diagnosis (4). Several studies have indicated that small tumors might be a surrogate for biologically aggressive disease, especially in extensive node-positive disease (4,5). ...
... It has been reported that approximately 27.8% of T1 breast cancer patients have LNM and approximately 0.7% extensive LNM at the time of diagnosis (4). Several studies have indicated that small tumors might be a surrogate for biologically aggressive disease, especially in extensive node-positive disease (4,5). Therefore, it is of great significance to explore factors associated with LNM, the difference between limited LNM and extensive LNM, and effects on the survival of patients with small tumors. ...
Objectives
To analyze clinicopathological risk factors and regular pattern of regional lymph node metastasis (LNM) in Chinese patients with T1 breast cancer and the effect on overall survival (OS) and disease-free survival (DFS).
Materials and methods
Between 1999 and 2020, breast cancer patients meeting inclusion criteria of unilateral, no distant metastatic site, and T1 invasive ductal carcinoma were reviewed. Clinical pathology characteristics were retrieved from medical records. Survival analysis was performed using Kaplan−Meier methods and an adjusted Cox proportional hazards model.
Results
We enrolled 11,407 eligible patients as a discovery cohort to explore risk factors for LNM and 3484 patients with stage T1N0 as a survival analysis cohort to identify the effect of those risk factors on OS and DFS. Compared with patients with N- status, patients with N+ status had a younger age, larger tumor size, higher Ki67 level, higher grade, higher HR+ and HER2+ percentages, and higher luminal B and HER2-positive subtype percentages. Logistic regression indicated that age was a protective factor and tumor size/higher grade/HR+ and HER2+ risk factors for LNM. Compared with limited LNM (N1) patients, extensive LNM (N2/3) patients had larger tumor sizes, higher Ki67 levels, higher grades, higher HR- and HER2+ percentages, and lower luminal A subtype percentages. Logistic regression indicated that HR+ was a protective factor and tumor size/higher grade/HER2+ risk factors for extensive LNM. Kaplan−Meier analysis indicated that grade was a predictor of both OS and DFS; HR was a predictor of OS but not DFS. Multivariate survival analysis using the Cox regression model demonstrated age and Ki67 level to be predictors of OS and grade and HER2 status of DFS in stage T1N0 patients.
Conclusion
In T1 breast cancer patients, there were several differences between N- and N+ patients, limited LNM and extensive LNM patients. Besides, HR+ plays a dual role in regional LNM. In patients without LNM, age and Ki67 level are predictors of OS, and grade and HER2 are predictors of DFS.
... In cases of broad lymph node involvement, extremely small tumors, according to Wo et al., may represent a more aggressive subtype than larger tumors with equivalent lymph node contribution [30]. Thus, tumor size T1 may correlate to poor clinical outcome or worse prognosis which could explain the lower serum DDX43 protein level. ...
Background
Breast cancer (BC) is the most often diagnosed cancer in women globally. Cancer cells appear to rely heavily on RNA helicases. DDX43 is one of DEAD- box RNA helicase family members. But, the relationship between clinicopathological, prognostic significance in different BC subtypes and DDX43 expression remains unclear. Therefore, the purpose of this study was to assess the clinicopathological significance of DDX43 protein and mRNA expression in different BC subtypes.Materials and methodsA total of 80 females newly diagnosed with BC and 20 control females that were age-matched were recruited for this study. DDX43 protein levels were measured by ELISA technique. We used a real-time polymerase chain reaction quantification (real-time PCR) to measure the levels of DDX43 mRNA expression. Levels of DDX43 protein and mRNA expression within BC patients had been compared to those of control subjects and correlated with clinicopathological data.ResultsThe mean normalized serum levels of DDX43 protein were slightly higher in control than in both benign and malignant groups, but this result was non-significant. The mean normalized level of DDX43 mRNA expression was higher in the control than in both benign and malignant cases, although the results were not statistically significant and marginally significant, respectively. Moreover, the mean normalized level of DDX43 mRNA expression was significantly higher in benign than in malignant cases. In malignant cases, low DDX43 protein expression was linked to higher nuclear grade and invasive duct carcinoma (IDC), whereas high mRNA expression was linked to the aggressive types of breast cancer such as TNBC, higher tumor and nuclear grades.Conclusion
This study explored the potential of using blood DDX43 mRNA expression or protein levels, or both in clinical settings as a marker of disease progression in human breast cancer. DDX43 mRNA expression proposes a less invasive method for discriminating benign from malignant BC.
... Approximately 10-15% of breast cancer (BC) patients have evidence of extensive axillary nodal involvement at diagnosis. 1 These patients are usually offered neoadjuvant chemotherapy (NAC) to improve survival, increase local control, and strive for a de-escalation of axillary surgery in case of nodal response after treatment. ...
... With the wide implementation of breast cancer imaging screening, an increasing number of small-sized breast cancers are being detected (1)(2)(3). Women with small breast cancer generally have favorable long-term outcomes (3)(4)(5). Nevertheless, breast cancer is a heterogeneous disease with complicated pathology and biological behavior, and some women eventually die of breast cancer or have early recurrence despite having a small tumor (6,7). Indeed, tumor size by itself does not tell much about the biological behavior because a specific tumor size can result from an indolent disease that has been growing for some time or from a very aggressive disease that has been developing for a few weeks (5,6,(8)(9)(10). ...
... Nevertheless, breast cancer is a heterogeneous disease with complicated pathology and biological behavior, and some women eventually die of breast cancer or have early recurrence despite having a small tumor (6,7). Indeed, tumor size by itself does not tell much about the biological behavior because a specific tumor size can result from an indolent disease that has been growing for some time or from a very aggressive disease that has been developing for a few weeks (5,6,(8)(9)(10). In addition, even though tumor size is a well-recognized prognostic factor for invasive breast cancer, large ductal carcinoma in situ (DCIS) carries the risk of harboring microinvasive foci that can lead to poor outcomes (11). ...
... The BCSS in the present study was 96.2%, which is consistent with previous studies in similar study populations (3)(4)(5). In the present study, lymph node metastasis was a statistically significant predictor for small cancer. ...
Background
Some women die despite the favorable prognosis of small breast cancers. Breast ultrasound features may reflect pathological and biological characteristics of a breast tumor. This study aimed to explore whether ultrasound features could identify small breast cancers with poor outcomes.
Methods
This retrospective study examined confirmed breast cancers with a size of <20 mm diagnosed in our hospital between 02/2008 and 08/2019. Clinicopathological and ultrasound features were compared between alive and deceased breast cancer patients. Survival was analyzed using the Kaplan-Meier curves. Multivariable Cox proportional hazards models were used to examine the factors associated with breast cancer-specific survival (BCSS) and disease-free survival (DFS).
Results
Among the 790 patients, the median follow-up was 3.5 years. The deceased group showed higher frequencies of spiculated (36.7% vs. 11.2%, P<0.001), anti-parallel orientation (43.3% vs. 15.4%, P<0.001), and spiculated morphology combined with anti-parallel orientation (30.0% vs. 2.4%, P<0.001). Among 27 patients with spiculated morphology and anti-parallel orientation, nine cancer-specific deaths and 11 recurrences occurred, for a 5-year BCSS of 77.8% and DFS of 66.7%, while 21 breast-cancer deaths and 41 recurrences occurred among the remaining patients with higher 5-year BCSS (97.8%, P<0.001) and DFS (95.4%, P<0.001). Spiculated and anti-parallel orientation (HR=7.45, 95%CI: 3.26-17.00; HR=6.42, 95%CI: 3.19-12.93), age ≥55 years (HR=5.94, 95%CI: 2.24-15.72; HR=1.98, 95%CI: 1.11-3.54), and lymph nodes metastasis (HR=3.99, 95%CI: 1.89-8.43; HR=2.99, 95%CI: 1.71-5.23) were independently associated with poor BCSS and DFS.
Conclusions
Spiculated and anti-parallel orientation at ultrasound are associated with poor BCSS and DFS in patients with primary breast cancer <20 mm.
... There is evidence, including from our previous study, that a very small tumor size is indicative of a biologically aggressive disease in patients with extensive LN involvement. 33,34 In contrast, tumors that fail to metastasize to regional LNs, even at a late stage (eg, T3N0 tumors), may reflect a more biologically indolent phenotype. 35 Therefore, tumor size does not directly indicate the degree of tumor malignancy, and the severity of small-sized breast cancer needs to be reconsidered. ...
Introduction
Tripartite motif-containing protein (TRIM) family members play crucial roles in carcinogenesis and chemotherapy resistance. In this study, we aimed to determine whether TRIM58 protein expression is related to patient responses to neoadjuvant therapy (NAT) and their survival outcome.
Methods
Immunohistochemistry was performed on female breast cancer samples from biopsies before NAT in Shenzhen Second People’s Hospital. Univariate and multivariate logistic regression tests were used to analyze the association between TRIM58 protein expression and pathological complete response (pCR). The Cox proportional hazards model was used to calculate the adjusted hazard ratio (HR) with a 95% confidence interval (95% CI). The Kaplan–Meier plotter database was used to analyze the prognostic value of TRIM58.
Results
High TRIM58 expression was associated with small tumor size in all the patients (n = 58). Multivariate analysis suggested that low TRIM58 expression was an independent predictive factor for higher pCR (odds ratio = 0.06, 95% CI 0.005–0.741, P = 0.028). The Kaplan–Meier Plotter dataset suggested that the TRIM58 high-expression group showed a worse 5-year overall survival than the low-expression group (HR = 1.34, 95% CI 1.07–1.67, P = 0.01). Pathway analysis revealed the potential mechanisms of TRIM58 in chemoresistance.
Discussion
Our study suggests that TRIM58 is a promising biomarker for both neoadjuvant chemosensitivity and long-term clinical outcomes in breast cancer. It may also help to identify candidate responders and determine treatment strategies.
... The differences in the mean values may partly be explained by the fact that women aged ≥40-years had slightly larger size primary tumours and a longer duration (months) before presentation (11.5±9.4 vs 10.9±9.2), and this is in line with previous studies. [34][35][36][37] Studies globally, have stressed on the prognostic significance of positive lymph nodes, particularly those with four or more positive nodes, and their association with reduced disease free interval. [38][39][40] Our findings however differ from studies that found young at diagnosis with breast malignancy as a predictor of increased nodal involvement. ...
Objectives: The Clinicopathological features of female breast malignancies (BMs) diagnosed in northern Ghana have not been documented adequately. The objectives of this review were to describe the annual trend, the clinico-pathological features of female BMs in northern Ghana, and offer recommendations.Material and methods: Clinical and biographical data of the patients were correlated with pathological data, such as tumour size, histological subtype, histological grade, TNM stage and the completeness of excision (Tumour margins). The data were analysed using SPSS software version 26.0 (Chicago). Fisher’s exact test was used to compare tumour variables.Results: There were 712 (61.0%) benign and 455 (39.0%) malignant lesions (P<0.0001). There was an annual rise in BMs over the review period. The mean age at diagnosis with invasive BMs was 47.5±15.4 years. Approximately, 35.0% were aged ≤39-years, compared to 65.0% aged ≥40-years (p<0.0001). The commonest clinical presentation in both age groups was a painless palpable lump. Painful swelling (7.9%vs4.6%) and skin involvement (27.2%vs22.5%) were more common in women aged ≤39-years. Increased prevalence of positive tumour margins (P=0.0544), high histological grade (P<0.0001) and TNM stages (P<0.0001) were common in women≤39-years. However, mean nodal involvement by tumour was more common in women’ aged ≥40-years (6.1±4.5 vs 8.4±5).Conclusion: There was a steady annual rise in breast malignancies over the study period. Breast malignancies commonly affect relatively younger women with advanced stages at presentation. There is the need to intensify breast self-examination and early reporting to health facilities for treatment.
