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Zheng HL, Zhang LK, Zheng HH, Lv CB, Xu BB, Lin GT, Chen QY, Lin JX, Zheng CH, Huang CM, Xie JW. Timing of postoperative chemotherapy and prognosis in neoadjuvant-treated gastric cancer patients: a multicenter real-world cohort study. Ann Med 2025; 57:2500690. [PMID: 40329795 PMCID: PMC12064125 DOI: 10.1080/07853890.2025.2500690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 03/27/2025] [Accepted: 04/14/2025] [Indexed: 05/08/2025] Open
Abstract
BACKGROUND The optimal time to chemotherapy (TTC) in locally advanced gastric cancer (LAGC) patients treated with neoadjuvant chemotherapy (NLAGC) remains unclear. METHODS Consecutive 524 patients with NLAGC between Jan. 2010 and Dec. 2022 were identified. Patients were categorized into three groups: TTC < 6w, 6w ≤ TTC ≤ 8w, and TTC > 8w. Survival analysis was conducted using the Cox proportional hazards model to assess the impact of TTC on gastric cancer-specific mortality (GCSM) and all-cause mortality (ACM). Cumulative competing risk curves were employed to evaluate the incidence of competing events. RESULTS Overall, 451 patients were included.Cumulative competing risk curves showed that the 3-year ACM and GCSM were significantly lower in the 6w ≤ TTC ≤ 8w group (ACM: 19.7% vs. 37.2% vs. 39.7%, GCSM: 19.7% vs. 35.2% vs. 38.8%) compared to the TTC < 6w and TTC > 8w groups. Compared to patients with 6w ≤ TTC ≤ 8w, those with TTC < 6w or >8w had an increased risk of GCSM (HR: 2.792 and HR: 2.343, respectively) and ACM (HR: 3.102 and HR: 2.719, respectively) after adjusting for confounders. Furthermore, 6w ≤ TTC ≤ 8w had later peak recurrence compared to TTC < 6w and TTC > 8w (Peak months: 9.7 vs. 4.3 vs. 3.1). CONCLUSION A postoperative chemotherapy timing of 6-8 weeks was associated with better survival and delayed recurrence in NLAGC patients. These findings suggest that the 6-8 week time-window should be a key timeframe for personalized postoperative adjuvant chemotherapy decisions.
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Affiliation(s)
- Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ling-Kang Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Hong-Hong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chen-Bin Lv
- Department of Gastrointestinal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Bin-Bin Xu
- Department of Digestive Endoscopy, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Guang-Tan Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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Jeong SH, Chun SM, Lee H, Kim M, Leigh JH. Impact of diagnosis-to-treatment interval on mortality in patients with early-stage breast cancer: a retrospective nationwide Korean cohort. BMC Womens Health 2025; 25:247. [PMID: 40405168 PMCID: PMC12096538 DOI: 10.1186/s12905-025-03780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/05/2025] [Indexed: 05/24/2025] Open
Abstract
BACKGROUND The diagnosis-to-first-treatment interval (DFTI) is an important prognostic factor and a major concern for patients with breast cancer as well as their clinicians. It may be particularly important for patients with early-stage breast cancer. The aim of this study was to investigate the association between DFTI and risk of mortality in patients with new-onset early-stage breast cancer. METHODS This nationwide, retrospective cohort study utilized data from the Korean National Health Insurance database and the Korea National Cancer Incidence Database (2006-2017). By using 1:5 propensity score matching, 3,625 participants with a DFTI < 60 days and 725 with a DFTI ≥ 60 days were included in the analysis. Cox proportional hazard regression models were used to examine the association between the DFTI and 5-year all-cause mortality risk. RESULTS Compared with patients with breast cancer with a DFTI < 60 days, patients with a DFTI ≥ 60 days had a higher 5-year mortality risk (hazard ratio [95% confidence interval], 2.09 [1.43-3.06]). Similarly, sensitivity analysis with a 45-day threshold revealed higher mortality in patients with a DFTI ≥ 45 days (HR [95% CI], 1.49 [1.14-1.96]) than their counterparts with a DFTI < 45 days. This association was greater for patients with low household income, those who lived in rural areas, and those with a high Charlson comorbidity index. CONCLUSIONS A DFTI ≥ 60 days was associated with mortality risk in patients with early-stage breast cancer. These results emphasize the importance of closely monitoring the waiting times of this patients population and ensuring timely treatment.
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Affiliation(s)
- Sung Hoon Jeong
- Department of Health Policy and Management, Inje University, 50834, Gimhae, Republic of Korea
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, 12564, Yangpyeong, Republic of Korea
| | - Seong Min Chun
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital Seoul, Soonchunhyang University College of Medicine, 04401, Seoul, Republic of Korea
| | - Hyunji Lee
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, 12564, Yangpyeong, Republic of Korea
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, 12564, Yangpyeong, Republic of Korea
| | - Miji Kim
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, 12564, Yangpyeong, Republic of Korea
- Department of Biostatistics and Computing, Graduate School of Yonsei University, 03722, Seoul, Republic of Korea
| | - Ja-Ho Leigh
- National Traffic Injury Rehabilitation Research Institute, National Traffic Injury Rehabilitation Hospital, 12564, Yangpyeong, Republic of Korea.
- Department of Rehabilitation Medicine, Seoul National University Hospital, 03080, Seoul, Republic of Korea.
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, 03080, Seoul, Republic of Korea.
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Kollbeck SLG, Hansen CP, Dencker EE, Krohn PS, Storkholm JH, Burgdorf SK, Millarch AS, Piper TB, Hillingsø JG, Sillesen M. Association of chemotherapy completion rates and overall survival with postoperative complications after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. HPB (Oxford) 2025; 27:222-231. [PMID: 39603870 DOI: 10.1016/j.hpb.2024.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 10/12/2024] [Accepted: 11/04/2024] [Indexed: 11/29/2024]
Abstract
INTRODUCTION Despite the benefits of surgical resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma (PDAC), over 30 % of patients fail to complete adjuvant oncological treatment. Whether postoperative complications affect chemotherapy completion rates and overall survival remains uncertain. We hypothesized that postoperative complications would be associated with chemotherapy delays, omission, and reduced overall survival (OS). METHODS This was a retrospective analysis of patients undergoing pancreaticoduodenectomy for PDAC from 2008 to 2022 to assess whether serious surgical complications, defined as Clavien Dindo Grade 3b or higher, were associated with the omission or delay of adjuvant oncologic treatment as well as OS. RESULTS A total of 920 patients were available for analysis. Pancreatic and bile leakage were associated with risk of chemotherapy omission (OR 1.97 [CI 95 % 1.25-3.12], p = 0.004 and OR 1.96 [CI 95 % 1.04-3.67], p = 0.032, respectively). No delay of adjuvant chemotherapy >90 days nor change in OS was found. CONCLUSION Major surgical complications influence the likelihood of omitting adjuvant chemotherapy but not delaying it > 90 days. Patients with pancreatic or bile leakage were at greater risk of not completing planned chemotherapy but had the same OS.
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Affiliation(s)
- Sophie L G Kollbeck
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark; Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Carsten P Hansen
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Emilie E Dencker
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark; Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Paul S Krohn
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Jan H Storkholm
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark; Department of Surgery, Imperial College NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom
| | - Stefan K Burgdorf
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Andreas S Millarch
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark; Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Thomas B Piper
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Jens G Hillingsø
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Martin Sillesen
- Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark; Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark.
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Cohen D, Verma S, Raman KS, Morton Ninomiya M, Bovill ES, Doherty C, Macadam SA, Van Laeken N, Isaac KV. The Sequence and Reconstructive Modality of Breast Cancer Treatments Affects Wait Times to Adjunctive Therapies in Patients Undergoing Mastectomy with Immediate Breast Reconstruction. Plast Surg (Oakv) 2024:22925503241301723. [PMID: 39703755 PMCID: PMC11653381 DOI: 10.1177/22925503241301723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/06/2024] [Accepted: 10/15/2024] [Indexed: 12/21/2024] Open
Abstract
Introduction: Breast cancer care requires both oncologists and plastic surgeons. Coordinating these specialists and combining extirpative and reconstructive procedures before adjunctive therapies can cause delays in care. For patients with less advanced disease, surgery is performed before adjunctive therapies, requiring early specialist coordination and the possibility of surgical complications. We compare these patients to those with more advanced disease requiring adjunctive therapies before surgery. Methods: A retrospective chart review identified 337 post-mastectomy + immediate breast reconstruction (IBR) patients. Patients were divided into surgery first (SF) and neoadjuvant chemotherapy (NC) first groups with reconstructive subgroups. Wait times between care pathway milestones were compiled and compared to national standards. Results: SF experienced longer wait times from consultation to treatment initiation (47 ± 51.5 vs 22 ± 22, P<.001) and from first to second treatment modality (62 ± 35 vs 39 ± 17, P<.001). Furthermore, only 29% of SF met the standard of receiving treatment within 4 weeks from consultation compared to 63% of NC (P<.001). Within subgroups, SF alloplastic reconstructions had shorter wait times compared to SF autologous reconstructions. For SF, only 31% of alloplastic and 24% of autologous reconstruction initiated treatment within 4 weeks of consultation. Conclusion: In this cohort of Canadian breast cancer patients, those receiving surgery first experienced prolonged wait times to treatment, particularly with autologous reconstruction. Patients should be informed of the potential impact on adjunctive therapies when considering reconstructive modality.
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Affiliation(s)
- Danielle Cohen
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarika Verma
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karanvir S. Raman
- Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Esta S. Bovill
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Doherty
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheina A. Macadam
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Van Laeken
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn V. Isaac
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Raman KS, Ninomiya MM, Bovill ES, Doherty C, Macadam SA, Laeken NV, Isaac KV. Temporal Sequencing of Multimodal Treatment in Immediate Breast Reconstruction and Implications for Wait Times: A Regional Canadian Cross-Sectional Study. Plast Surg (Oakv) 2024; 32:583-592. [PMID: 39430266 PMCID: PMC11489937 DOI: 10.1177/22925503231152261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 10/22/2024] Open
Abstract
Introduction: Treatment of breast cancer requires a multimodal approach with numerous independent specialists. Immediate breast reconstruction (IBR) adds another layer of coordination to comprehensive breast cancer care. To optimize health outcomes for patients seeking IBR, it is essential to efficiently coordinate the temporal sequence of care modalities inclusive of reconstruction. Methods: In this cross-sectional study, patients undergoing IBR following complete or partial mastectomy at one health centre from 2015 to 2021 were included. Patients were categorized into two main groups defined by the first treatment modality received, namely surgery first and Neoadjuvant Chemotherapy. Primary outcome measures were wait times for diagnostic investigations, initiation of treatment, and transitions between therapeutic modalities. Results: Of 195 patients, 158 underwent surgery first, and 37 underwent neoadjuvant chemotherapy. Median wait time from first consultation to first treatment initiated in the neoadjuvant cohort was shorter by 11.5 days as compared to the Surgery First cohort (21.5 +/- 19 vs 33.0 +/- 28 days; P = 0.001). Twenty-three (82%) of the surgery first and 11 (38%) of the neoadjuvant cohort patients waited longer than 8 weeks for initiation of radiotherapy (P = 0.001). Following surgical intervention, the majority of patients failed to meet target benchmarks for transition to chemotherapy (n = 25, 53%) and transition to radiotherapy (n = 26, 93%; P < 0.001). Conclusion: Patients undergoing IBR may incur delays in the setting of upfront surgery and in transitioning to adjuvant therapies. In the setting of breast reconstruction, further efforts are required to achieve target wait-times in multimodal breast cancer care.
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Affiliation(s)
- Karanvir S. Raman
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maya Morton Ninomiya
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esta S. Bovill
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Doherty
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheina A. Macadam
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Van Laeken
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn V. Isaac
- Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Kroenke CH, Kwan ML, Gomez SL, Shim V, Ergas IJ, Roh J, Kushi LH. Social Support and Treatment Delays in Breast Cancer Patients Within an Integrated Health Care System. Psychooncology 2024; 33:e70025. [PMID: 39562781 PMCID: PMC11817851 DOI: 10.1002/pon.70025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 10/08/2024] [Accepted: 11/03/2024] [Indexed: 11/21/2024]
Abstract
OBJECTIVE We evaluated associations between social support and delays to surgery and adjuvant chemotherapy in a cohort of women with breast cancer (BC) from a large integrated healthcare system in Northern California. METHODS This study included 3983 women from the Pathways Study diagnosed from 2005 to 2013 with stages I-IV BC, who had surgery as their first line of treatment and who responded to the Medical Outcomes Study Social Support survey ∼2 months following diagnosis. A second set of analyses included those receiving adjuvant chemotherapy (N = 1761). We used log binomial regression to evaluate associations of social support, and types of support, with relative prevalence of delays from diagnosis to definitive surgery > 30 days, delays to chemotherapy from diagnosis > 90 days, and delays to chemotherapy from definitive surgery > 60 days. We further examined analyses stratified by sociodemographic factors and disease severity. RESULTS Twenty-one percent had surgery delays and 18.3% had chemotherapy delays from diagnosis (24.7% from surgery). Adjusted for covariates, women in the lowest tertile of social support were more likely to have delays to surgery (prevalence ratio (PR) = 1.27, 95% confidence interval (CI):1.08-1.48, p-continuous = 0.01) and chemotherapy (PR = 1.48, 95% CI: 1.08-2.02, p = 0.05) from diagnosis, due to associations of low tangible and emotional support with delays. We noted no effect modification in these analyses. By contrast, low social support was related to chemotherapy delays from diagnosis in women < 54 (PR = 1.96, 95% CI: 1.33-2.88) but not ≥ 54 (PR = 1.09, 95% CI: 0.79-1.49) years of age, p-interaction = 0.05. Other tests of effect modification were nonsignificant. CONCLUSIONS Low social support was associated with delays to BC surgery and chemotherapy.
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Affiliation(s)
- Candyce H Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Kaiser Permanente School of Medicine, Health Systems Sciences, Pasadena, California, USA
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California, Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Veronica Shim
- Department of Surgery, Kaiser Permanente Northern California, Oakland, California, USA
| | - Isaac J Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Janise Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Zhong Q, Liu ZY, Shang-Guan ZX, Li YF, Li Y, Wu J, Huang Q, Li P, Xie JW, Chen QY, Huang CM, Zheng CH. Impact of chemotherapy delay on long-term prognosis of laparoscopic radical surgery for locally advanced gastric cancer: a pooled analysis of four randomized controlled trials. Gastric Cancer 2024; 27:1100-1113. [PMID: 38809487 DOI: 10.1007/s10120-024-01513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Adjuvant chemotherapy following curative surgery for locally advanced gastric cancer (AGC) significantly improves long-term patient prognosis. However, delayed chemotherapy (DC), in which patients are unable to receive timely treatment, is a common phenomenon in clinical practice for various reasons. This study aimed to investigate the impact of DC on the prognosis of patients with stage II-III locally AGC and explore the associated risk factors. METHODS Data from four prospective studies were included in the pooled analysis. The planned chemotherapy (PC) group was defined as the time interval between surgery and the first chemotherapy ≤ 49 d, while the DC group was defined as the time interval between surgery and chemotherapy > 49 d. The prognosis, recurrence, and risk factors were compared, and a nomogram for predicting DC was established. RESULTS In total, 596 patients were included, of whom 531 (89.1%) had PC and 65 (10.9%) had DC. Survival analysis revealed that the 5-year overall survival (OS) and disease-free survival (DFS) were significantly lower in the DC group than those in the PC group (log-rank P < 0.001). Cox univariable and multivariable analyses showed that DC was an independent risk factor for OS and DFS in stage II-III patients (P < 0.05). Based on the significant factors for DC, a prediction model was established that had a good fit, high accuracy (AUC = 0.780), and clinical applicability in both the training and validation sets. CONCLUSION Delayed chemotherapy after gastrectomy is associated with poor long-term prognosis in patients with locally advanced stage II-III GC disease. But standardized, full-cycle adjuvant chemotherapy after surgery may play a remedial role, and can to a certain extent compensate the poor effects caused by delayed chemotherapy.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhi-Xin Shang-Guan
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yi-Fan Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Yi Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Ju Wu
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Qiang Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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D'Alessandro GS, Munhoz AM, Takeuchi FM, Povedano A, Goes JCS. Is Immediate Breast Reconstruction With a Latissimus Dorsi Myocutaneous Flap Safe for Starting Adjuvant Chemotherapy in Patients With Breast Cancer? Clin Breast Cancer 2024; 24:e408-e416. [PMID: 38582616 DOI: 10.1016/j.clbc.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/17/2023] [Accepted: 03/06/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Immediate breast reconstruction following mastectomy reduces perceptions of mutilation and femininity issues in oncological patients, but surgical complications should not delay chemotherapy. This study evaluated postsurgical complications in patients who underwent radical breast surgery followed by immediate reconstruction with latissimus dorsi myocutaneous flaps and silicone implants, along with resulting impacts in delaying chemotherapy. MATERIALS AND METHODS This retrospective study utilized a prospectively maintained database. Clinical, surgical, and oncological data from 196 women were collected according to the operated side. Patients were grouped according to the time elapsed between surgery and the first cycle of adjuvant chemotherapy: ≤ 60 days (group 1), 61 to 90 days (group 2), or > 90 days (group 3). RESULTS A total of 198 immediate reconstructions were performed on 196 patients between August 1, 2010 and March 31, 2020; after surgery, 47.4% had minor complications and 7.1% had major complications. Ninety-six patients (48.5%) received adjuvant chemotherapy. The mean time elapsed between surgery and the first chemotherapy cycle was 65.4 days (median: 59), with 52.7% of the patients assigned to group 1, 37.4% to group 2, and 9.9% to group 3. The occurrence of major postoperative complications significantly affected the start of chemotherapy (64.0 vs. 94.5 days; P = .044). Additionally, patients with 2 or more comorbidities were more likely to experience major complications (OR: 3.35; 95% CI: 1.03-10.95; P = .045) than those with 1 or 0. CONCLUSION Major postoperative complications significantly delayed initiation of adjuvant chemotherapy in oncological patients who underwent radical breast surgery followed by immediate reconstruction with a latissimus dorsi myocutaneous flap and silicone implants.
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Affiliation(s)
- Gabriel Salum D'Alessandro
- Division of Breast and Plastic Surgery, Instituto Brasileiro de Controle do Cancer (IBCC), São Paulo, Brazil.
| | - Alexandre Mendonça Munhoz
- Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, Brazil; Department of Plastic Surgery, Hospital Moriah, São Paulo, Brazil
| | - Fabiana Midori Takeuchi
- Division of Plastic Surgery, Instituto Brasileiro de Controle do Cancer (IBCC), São Paulo, Brazil
| | - Alejandro Povedano
- Division of Plastic Surgery, Instituto Brasileiro de Controle do Cancer (IBCC), São Paulo, Brazil
| | - João Carlos Sampaio Goes
- Division of Breast and Plastic Surgery, Instituto Brasileiro de Controle do Cancer (IBCC), São Paulo, Brazil
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9
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Loibl S, André F, Bachelot T, Barrios CH, Bergh J, Burstein HJ, Cardoso MJ, Carey LA, Dawood S, Del Mastro L, Denkert C, Fallenberg EM, Francis PA, Gamal-Eldin H, Gelmon K, Geyer CE, Gnant M, Guarneri V, Gupta S, Kim SB, Krug D, Martin M, Meattini I, Morrow M, Janni W, Paluch-Shimon S, Partridge A, Poortmans P, Pusztai L, Regan MM, Sparano J, Spanic T, Swain S, Tjulandin S, Toi M, Trapani D, Tutt A, Xu B, Curigliano G, Harbeck N. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35:159-182. [PMID: 38101773 DOI: 10.1016/j.annonc.2023.11.016] [Citation(s) in RCA: 260] [Impact Index Per Article: 260.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
- S Loibl
- GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology, Bethanien, Frankfurt, Germany
| | - F André
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Cancer Campus, Villejuif
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - C H Barrios
- Oncology Department, Latin American Cooperative Oncology Group and Oncoclínicas, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet and Breast Cancer Centre, Karolinska Comprehensive Cancer Centre and University Hospital, Stockholm, Sweden
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Foundation, Champalimaud Cancer Centre, Lisbon; Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - L A Carey
- Division of Medical Oncology, The University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - S Dawood
- Department of Oncology, Mediclinic City Hospital, Dubai, UAE
| | - L Del Mastro
- Medical Oncology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Internal Medicine and Medical Specialities, School of Medicine, University of Genoa, Genoa, Italy
| | - C Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Giessen and Marburg, Marburg
| | - E M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - P A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H Gamal-Eldin
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - K Gelmon
- Department of Medical Oncology, British Columbia Cancer, Vancouver, Canada
| | - C E Geyer
- Department of Internal Medicine, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA
| | - M Gnant
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Oncology 2 Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - S Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S B Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Martin
- Hospital General Universitario Gregorio Maranon, Universidad Complutense, GEICAM, Madrid, Spain
| | - I Meattini
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence; Department of Experimental and Clinical Biomedical Sciences 'M. Serio', University of Florence, Florence, Italy
| | - M Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - W Janni
- Department of Obstetrics and Gynaecology, University of Ulm, Ulm, Germany
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - A Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - L Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven
| | - M M Regan
- Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - J Sparano
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - S Swain
- Medicine Department, Georgetown University Medical Centre and MedStar Health, Washington, USA
| | - S Tjulandin
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - M Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Bunkyo-ku, Japan
| | - D Trapani
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - A Tutt
- Breast Cancer Research Division, The Institute of Cancer Research, London; Comprehensive Cancer Centre, Division of Cancer Studies, Kings College London, London, UK
| | - B Xu
- Department of Medical Oncology, National Cancer Centre/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - N Harbeck
- Breast Centre, Department of Obstetrics & Gynaecology and Comprehensive Cancer Centre Munich, LMU University Hospital, Munich, Germany
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Delenne S, Philip CA, Guimont I, Bienstman J, Mojallal AA, Cortet M. Mastectomies for breast cancer: Comparison between peri-operative morbidity after simple mastectomy or after immediate breast reconstruction in a unicentric serie of 210 patients. J Gynecol Obstet Hum Reprod 2024; 53:102695. [PMID: 37995939 DOI: 10.1016/j.jogoh.2023.102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/07/2023] [Accepted: 11/19/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND In breast cancer surgery, IBR (immediate breast reconstruction) is widely proposed to patients without indications of adjuvant treatments and without risk factors of surgical complications. New INCa's guidelines (2022) allow the expansion of IBR indications. OBJECTIVE A retrospective, unicentric and safety study: post-operative complication rate after IBR in comparison with simple mastectomy (SM, reference treatment). MATERIEL AND METHOD This retrospective study has included all major patients who have received mastectomy for breast cancer between 2016 and 2020 before application of new guidelines, in Hôpital de la Croix-Rousse, Lyon (France). They were distributed in two groups according to their surgery : IBR and SM. Usual risk factors of post-operative complications were collected (tabacco, obesity…). The primary endpoint was the occurrence of an early post-operative complication (within 3 months after surgery). Two secondary analysis focused on the impact of preoperative risk factors on complications, and the proportion of patients eligibled for an IBR among SM based on new INCA's guidelines. RESULTS The study included 185 mastectomies: 153 SM, 32 mastectomies IBR. IBR's patients presented less risk factors, and few indications of adjuvant treatments. The rate of major complications was identical in the two groups (14 % in SM group, 12 % in IBR group), and there were more minor complications in the SM group than in the IBR group (p 0,01). According to our study, the raw proportion of initially possible IBR was 68 % (36 % of breast reconstruction in this study). CONCLUSION This analyse approve IBR in selected patients. In this context, INCa's guidelines (2022) can generalize IBR's proposal to patients. However, the analysis of pre-operative risk factors stay essential in medical care.
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Affiliation(s)
- Sybille Delenne
- Université Claude Bernard Lyon I, faculté de médecine, Lyon, France.
| | | | - Isabelle Guimont
- Service de gynécologie, Hôpital de la Croix-Rousse, Lyon, France
| | - Julie Bienstman
- Service de gynécologie, Hôpital de la Croix-Rousse, Lyon, France
| | - Alain-Ali Mojallal
- Service de chirurgie plastique et reconstructrice, Hôpital de la Croix-Rousse, Lyon, France
| | - Marion Cortet
- Service de gynécologie, Hôpital de la Croix-Rousse, Lyon, France
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Elder E, Fasola C, Clavin N, Hecksher A, Trufan S, Schepel C, Donahue E, Warren Y, White RL, Hadzikadic-Gusic L. Anatomic Location of Tissue Expander Placement Is Not Associated With Delay in Adjuvant Therapy in Women With Breast Cancer. Ann Plast Surg 2023; 91:679-685. [PMID: 37856209 DOI: 10.1097/sap.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Tissue expanders in breast reconstruction are traditionally placed retropectoral. Increasingly, patients are undergoing prepectoral placement. The impact of this placement on the initiation of adjuvant treatment is unknown. METHODS A retrospective review was conducted to identify women diagnosed with breast cancer who underwent mastectomy followed by radiation and/or chemotherapy. Women were divided into 3 groups: prepectoral tissue expander placement, retropectoral tissue expander placement, and no immediate reconstruction. A treatment delay was defined as greater than 8 weeks between tissue expander placement and adjuvant therapy. RESULTS Of 634 women, 205 (32%) underwent tissue expander placement, and 429 (68%) did not have immediate reconstruction. Of those with tissue expanders placed, 84 (41%) had prepectoral placement, and 121 (59%) had retropectoral placement. The median time to adjuvant therapy was 49 days for the entire cohort: no reconstruction, 47 days; prepectoral, 57 days; and retropectoral, 55 days. Treatment delays were observed in 34% of women: no reconstruction, 28%; prepectoral, 51%; and retropectoral, 46% ( P < 0.001). Tissue expander placement was associated with a delay to adjuvant therapy when compared with no reconstruction ( P < 0.001). The location of the tissue expander did not impact the odds of having a delay. On multivariable analysis, having reconstruction, having postoperative infection, not undergoing chemotherapy treatment, and being a current smoker were associated with a delay to adjuvant therapy. A delay to treatment was not associated with worse survival. CONCLUSIONS Placement of a tissue expander delayed adjuvant therapy. The location of tissue expander placement, retropectoral versus prepectoral, did not impact the time to adjuvant treatment.
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Affiliation(s)
- Erin Elder
- From the Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Atrium Health
| | - Carolina Fasola
- Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Nicholas Clavin
- Division of Plastic Surgery, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute
| | | | - Sally Trufan
- Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, NC
| | | | - Erin Donahue
- Department of Cancer Biostatistics, Levine Cancer Institute, Charlotte, NC
| | - Yancey Warren
- From the Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Atrium Health
| | - Richard L White
- From the Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Atrium Health
| | - Lejla Hadzikadic-Gusic
- From the Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Atrium Health
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12
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Morante Z, Ferreyra Y, Pinto JA, Valdivieso N, Castañeda C, Vidaurre T, Valencia G, Rioja P, Fuentes H, Cotrina JM, Neciosup S, Gomez HL. Subpopulation treatment effect pattern plot analysis: a prognostic model for distant recurrence-free survival to estimate delayed adjuvant chemotherapy initiation effect in triple-negative breast cancer. Front Oncol 2023; 13:1193927. [PMID: 38023174 PMCID: PMC10657890 DOI: 10.3389/fonc.2023.1193927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Triple-negative breast cancer (TNBC) is a heterogeneous disease associated with a poor prognosis. Delaying in time to start adjuvant chemotherapy (TTC) has been related to an increased risk of distant recurrence-free survival (DRFS). We aimed to develop a prognostic model to estimate the effects of delayed TTC among TNBC risk subgroups. Materials and methods We analyzed 687 TNBC patients who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). Database was randomly divided to create a discovery set (n=344) and a validation set (n=343). Univariate and multivariate Cox regression models were performed to identify prognostic factors for DRFS. Risk stratification was implemented through two models developed based on proportional hazard ratios from significant clinicopathological characteristics. Subpopulation treatment effect pattern plot (STEPP) analysis was performed to determine the best prognostic cut-off points for stratifying TNBC subgroups according to risk scores and estimate Kaplan-Meier differences in 10-year DRFS comparing TTC (≤30 vs.>30 days). Results In univariate analysis, patients aged ≥70 years (HR=4.65; 95% CI: 2.32-9.34; p=<0.001), those at stages pT3-T4 (HR=3.28; 95% CI: 1.57-6.83; p=0.002), and pN2-N3 (HR=3.00; 95% CI: 1.90-4.76; p=<0.001) were notably associated with higher risk. STEPP analysis defined three risk subgroups for each model. Model N°01 categorized patients into low (score: 0-31), intermediate (score:32-64), and high-risk (score: 65-100) cohorts; meanwhile, Model N°02: low (score: 0-26), intermediate (score: 27-55), and high (score: 56-100). Kaplan-Meier plots showed that in the discovery set, patients with TTC>30 days experienced a 17.5% decrease in 10-year DRFS rate (95%CI=6.7-28.3), and the impact was more remarkable in patients who belong to the high-risk subgroup (53.3% decrease in 10 years-DRFS rate). Similar results were found in the validation set. Conclusions We developed two prognostic models based on age, pT, and pN to select the best one to classify TNBC. For Model N°02, delayed adjuvant chemotherapy conferred a higher risk of relapse in patients ≥70 years and who were characterized by pT3/T4 and pN2/N3. Thus, more efforts should be considered to avoid delayed TTC in TNBC patients, especially those in high-risk subgroups.
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Affiliation(s)
- Zaida Morante
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
- Oncosalud, AUNA, Lima, Peru
| | - Yomali Ferreyra
- Departamento de Bioingeniería, Universidad de Ingeniería y Tecnología, Lima, Peru
| | - Joseph A. Pinto
- Centro de Investigación Básica y traslacional, Auna Ideas, Lima, Peru
| | - Natalia Valdivieso
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Carlos Castañeda
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Tatiana Vidaurre
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Guillermo Valencia
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Patricia Rioja
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Hugo Fuentes
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - José M. Cotrina
- Departamento de Cirugía en Mamas y Tejidos Blandos, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Silvia Neciosup
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Henry L. Gomez
- Oncosalud, AUNA, Lima, Peru
- Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma, Lima, Peru
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Ayala de la Peña F, Antolín Novoa S, Gavilá Gregori J, González Cortijo L, Henao Carrasco F, Martínez Martínez MT, Morales Estévez C, Stradella A, Vidal Losada MJ, Ciruelos E. SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer (2022). Clin Transl Oncol 2023; 25:2647-2664. [PMID: 37326826 PMCID: PMC10425528 DOI: 10.1007/s12094-023-03215-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
Breast cancer is the leading cause of cancer in women in Spain and its annual incidence is rapidly increasing. Thanks to the screening programs in place, nearly 90% of breast cancer cases are detected in early and potentially curable stages, despite the COVID-19 pandemic possibly having impacted these numbers (not yet quantified). In recent years, locoregional and systemic therapies are increasingly being directed by new diagnostic tools that have improved the balance between toxicity and clinical benefit. New therapeutic strategies, such as immunotherapy, targeted drugs, and antibody-drug conjugates have also improved outcomes in some patient subgroups. This clinical practice guideline is based on a systematic review of relevant studies and on the consensus of experts from GEICAM, SOLTI, and SEOM.
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Affiliation(s)
- Francisco Ayala de la Peña
- Department of Medical Oncology, Hospital G. Universitario Morales Meseguer, University of Murcia, Av. Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - Silvia Antolín Novoa
- Department of Medical Oncology, Complexo Hospitalario Universitario, A Coruña (CHUAC), Coruña, Spain
| | | | | | | | - María Teresa Martínez Martínez
- Medical Oncology Department, INCLIVA Biomedical Research Institute, Hospital Clínico of Valencia, University of Valencia, 46010, Valencia, Spain
| | | | - Agostina Stradella
- Medical Oncology Department, Institut Català d'Oncologia. L'Hospitalet,, Barcelona, Spain
| | | | - Eva Ciruelos
- Medical Oncology Department, Breast Cancer Unit, University Hospital 12 de Octubre, Madrid, Spain and HM Hospitales, Madrid, Spain
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14
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Chen KW, Chung KP, Hsu CH. The intention of utilization and experience toward traditional Chinese medicine among breast cancer patients in the early and late stages: a qualitative study. BMC Complement Med Ther 2023; 23:226. [PMID: 37420247 DOI: 10.1186/s12906-023-04054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/24/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND In Taiwan, breast cancer patients usually take conventional medicine and traditional Chinese medicine simultaneously. The utilization of traditional Chinese medicine among breast cancer patients at various stages has not been examined. This study aims to compare the intention of utilization and experience toward traditional Chinese medicine among early- and late-stage breast cancer patients. METHOD This qualitative research collected data from breast cancer patients through focus groups interview by convenience sampling. Conducted in 2 branches of Taipei City Hospital, a public hospital managed by the Taipei City government. Breast cancer patients > 20 years old and had used TCM for breast cancer therapy for at least 3 months were included in the interview. A semi-structured interview guide was adopted in each focus group interview. In the following data analysis, stages I and II were considered early-stage, and stages III and IV were late-stage. For analyzing the data and reporting the results, we used qualitative content analysis as the approach for data analysis, assisted by NVivo 12. Categories and subcategories were identified through content analysis. RESULTS Twelve and seven early- and late-stage breast cancer patients were included in this study, respectively. The side effects were the main intention of utilizing traditional Chinese medicine. Improving side effects and constitution was the main benefit for patients in both stages. Additionally, early-stage breast cancer patients used traditional Chinese medicine to prevent recurrence or metastasis. Late-stage breast cancer patients responded more frequently to the use of traditional Chinese medicine due to the side effects of western medicine. However, some of their symptoms were not fully relieved. CONCLUSIONS Breast cancer staging may influence the intention and utilization of traditional Chinese medicine. Health policymakers should consider the results of this research and the evidence-based illustrations to establish guidelines for integrating traditional Chinese medicine among various stages of breast cancer to improve the outcome and quality of care for cancer patients.
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Affiliation(s)
- Kai-Wei Chen
- Institute of Health Policy and Management, National Taiwan University, 17 Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan
- Linsen, Chinese Medicine and Kunming Branch, Taipei City Hospital, 100 Kunming Street, Wanhua District, Taipei City, 108, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, National Taiwan University, 17 Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan.
| | - Chung-Hua Hsu
- Linsen, Chinese Medicine and Kunming Branch, Taipei City Hospital, 100 Kunming Street, Wanhua District, Taipei City, 108, Taiwan
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15
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Herbert SL, Hirzle P, Bartmann C, Schlaiß T, Kiesel M, Curtaz C, Löb S, Wöckel A, Diessner J. Optimized process quality in certified breast centers through adherence to stringent diagnostic and therapeutic algorithms effects of structural as well as socio-demographic factors on start of therapy. Arch Gynecol Obstet 2023; 307:1097-1104. [PMID: 35927591 PMCID: PMC10023602 DOI: 10.1007/s00404-022-06666-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/08/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE An increasing incidence of breast cancer can be observed worldwide. Since a delay of therapy can have a negative impact on prognosis, timely cancer care is an important quality indicator. By receiving treatment at a certified breast cancer center, the patient has the best chance of treatment in accordance with guidelines and the best prognosis. The identification of risk factors for a delay of therapy is of central importance and should be the basis for a continuous optimization of treatment at breast cancer centers. METHODS This retrospective study included women with breast cancer (primary diagnosis, relapse, or secondary malignancy) at the University Hospital Würzburg in 2019 and 2020. Data were retrieved from patients' records. Correlations and regression analyses were performed to detect potential risk factors for treatment delay. RESULTS Patients who received the histological confirmation of breast cancer at an external institution experienced a later therapy start than those patients who received the histological confirmation at the University Hospital Würzburg itself. (35.7 vs. 32.2 days). The interval between histological confirmation and the first consultation at the University Hospital Würzburg correlated statistically significant with age, distress and distance to the hospital. CONCLUSION Patients with an in-house diagnosis of breast cancer are treated more quickly than those whose diagnosis was confirmed in an external institution. We identified factors such as increased age, greater distance to the hospital as well as increased distress to prolong the time until start of oncological treatment. Intensified patient care should be offered to these subgroups.
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Affiliation(s)
- Saskia-Laureen Herbert
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Universitätsfrauenklinik Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany.
| | - Paula Hirzle
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Universitätsfrauenklinik Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany
| | - Catharina Bartmann
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Universitätsfrauenklinik Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany
| | - Tanja Schlaiß
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Universitätsfrauenklinik Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany
| | - Matthias Kiesel
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Universitätsfrauenklinik Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany
| | - Carolin Curtaz
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Universitätsfrauenklinik Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany
| | - Sanja Löb
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Universitätsfrauenklinik Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany
| | - Achim Wöckel
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Universitätsfrauenklinik Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany
| | - Joachim Diessner
- Department of Obstetrics and Gynaecology, University Medical Centre Würzburg, Universitätsfrauenklinik Würzburg, Josef-Schneider-Straße 4, 97080, Würzburg, Germany
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16
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Thawanyarat K, Johnstone T, Rowley M, Navarro Y, Hinson C, Nazerali RS. Optimizing postoperative outcomes following neoadjuvant chemotherapy and mastectomy with immediate reconstruction: A national analysis. J Surg Oncol 2023; 127:768-775. [PMID: 36602535 DOI: 10.1002/jso.27196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/19/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The optimal timing between last neoadjuvant chemotherapy (NAC) session and mastectomy with immediate reconstruction (MIR) procedures has sparse data to support optimization of postoperative outcomes. Current literature suggests that timing is not a predictor of complications in patients undergoing implant-based reconstruction following NAC and other literature suggests guidelines based on tumor staging. To the best of our knowledge, this is the largest and most recent study characterizing the effect of time between NAC and mastectomy with immediate reconstruction on postoperative complications. METHODS Patients in the Optum Clinformatics Data Mart that underwent all billable forms of breast reconstruction following NAC were identified via CPT and ICD-10 codes. Data concerning these patient's demographics, comorbidities, oncologic treatment, and outcomes were collected by querying relevant reports of CPT, ICD-9, and ICD-10 codes. To meet inclusion criteria, patients needed to have an encounter for antineoplastic chemotherapy within 1 year of their associated reconstruction. Patients with other invasive procedures unrelated to their mastectomy-reconstruction pairing within 90 days of reconstruction were excluded. Outcomes analysis was limited to the 90-day postoperative period. The time between the last recorded chemotherapy encounter and breast reconstruction was computed. A multivariate logistic regression analysis was performed to ascertain the effects of age, race, coexisting conditions, reconstruction type (autologous or implant-based), and time between NAC and reconstruction on the likelihood of any common postoperative complication occurring. Linearity of the continuous variables with respect to the logit of the dependent variable was confirmed. Odds ratios and corresponding 95% confidence intervals were calculated. RESULTS From over 86 million longitudinal patient records, our study population included 139 897 4371 patient records corresponding to 13 399 3759 patients who had NAC and breast reconstruction between January 2003, October 2015, and June 2019. Increased time between last antineoplastic chemotherapy and MIR reconstruction was a statistically significant, independent predictor of decreased complication likelihood. By contrast, autologous reconstruction, hypertension, and type II diabetes mellitus, and African American, White, and Hispanic race (relative to Asian) had statistically significant associations with increased complication likelihood. Waiting an additional day between a patient's most recent chemotherapy session and MIR reconstruction reduces the odds of a complication occurring by 0.25%. This corresponds to reduction in odds of complication occurrence of approximately 7% for each month between neoadjuvant therapy and breast reconstruction. CONCLUSION Increased time between NAC and MIR immediate reconstruction decreases the likelihood of experiencing one or more postoperative complications. Ideal time delay between 4 and 8 weeks has been shown to provide the best benefit for future breast reconstrution outcomes. In consultation with the oncologist, this information can be used to balance postoperative complication risk with increased oncologic risk in delaying mastectomy with immediate reconstruction.
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Affiliation(s)
- Kometh Thawanyarat
- Medical College of Georgia at Augusta University, AU/UGA Medical Partnership, Athens, Georgia, USA
| | - Thomas Johnstone
- Stanford University School of Medicine, Stanford, California, USA
| | - Mallory Rowley
- State University of New York, Upstate Medical University, Syracuse, New York, USA
| | - Yelissa Navarro
- Medical College of Georgia at Augusta University, AU/UGA Medical Partnership, Athens, Georgia, USA
| | - Chandler Hinson
- Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, Alabama, USA
| | - Rahim S Nazerali
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
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17
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Foulon A, Mancaux A, Theret P, Naepels P, Mychaluk J, Merviel P, Abboud P, Fauvet R. Efficacy and aesthetic outcomes for quilting sutures in the prevention of seroma after mastectomy. Sci Rep 2023; 13:1898. [PMID: 36732364 PMCID: PMC9894844 DOI: 10.1038/s41598-023-29154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Worldwide, mastectomy for breast cancer is one of the most frequently performed surgical procedures. As one of the main complications of mastectomy, seroma is associated with pain, infections and a prolonged hospital stay. We performed a prospective multicenter randomized trial to assess the efficacy and esthetic outcomes associated with quilting the skin flap. Eighty-seven patients were included. The proportion of patients with seroma on postoperative day 15 was significantly lower in the quilting group (12 out of 39 (30.8%)) than in a control group with conventional wound closure (21 out of 40 (52.5%); P = 0.05). The mean breast seroma volume was significantly lower in the quilting group (130.2 mL) than in the control group (236.8 mL; P = 0.02). There were no differences in the esthetic outcomes. The pain level on day 1 was similar in the quilting and control groups (mean visual analog scale score: 2.5 vs. 2.1, respectively; P = 0.3). Quilting the skin flap was associated with a lower prevalence of seroma and a lower seroma volume, and did not worsen the esthetic outcomes or pain levels. This technique is technically straightforward and should be offered to all patients scheduled for mastectomy.
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Affiliation(s)
- Arthur Foulon
- Service de Gynécologie Obstétrique, CHU Amiens Picardie, 1 Rond-Point Bd du Pr Christian Cabrol, 80000, Amiens, France.
| | - Albine Mancaux
- Service de Gynécologie Obstétrique, CHU Amiens Picardie, 1 Rond-Point Bd du Pr Christian Cabrol, 80000, Amiens, France
| | - Pierrick Theret
- Service de Gynécologie Obstétrique, CHU Amiens Picardie, 1 Rond-Point Bd du Pr Christian Cabrol, 80000, Amiens, France
| | - Philippe Naepels
- Service de Gynécologie Obstétrique, CHU Amiens Picardie, 1 Rond-Point Bd du Pr Christian Cabrol, 80000, Amiens, France
| | - Johanna Mychaluk
- Service de Gynécologie, CH Compiègne, 8 Avenue Henri Adnot, 60200, Compiègne, France
| | - Philippe Merviel
- Service de Gynécologie, CHU Brest, 2 Avenue Foch, 29200, Brest, France.,Université Occidentale de Bretagne, UFR de Médecine, 3 Rue Des Archives, 29238, Brest, France
| | - Pascal Abboud
- Service de Gynécologie, CH Soissons, 46 aAvenue du Général de Gaulle, 02200, Soissons, France
| | - Raffaele Fauvet
- Service de Gynécologie, CHU Caen Normandie, 1 Bd de La Côte de Nacre, 14000, Caen, France.,Université Caen Normandie, UFR de Médecine, Espl. de La Paix, 14000, Caen, France
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18
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Hamad A, Aquina CT, Ansari A, Salahuddin A, Shen C, Cloyd JM, Pawlik TM, Ejaz A. Impact of delay in adjuvant therapy for gallbladder adenocarcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:212-220. [PMID: 35666061 DOI: 10.1002/jhbp.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Receipt of adjuvant therapy for gallbladder adenocarcinoma (GBAC) is associated with a survival benefit. This study sought to identify whether delays in initiation of adjuvant therapy among patients with resected GBAC impacts long-term survival. METHODS Patients with stage II and III GBAC who underwent a curative-intent resection followed by adjuvant chemotherapy or chemoradiation between 2004 and 2017 were queried from the National Cancer Data Base. Descriptive statistics and multivariate models were constructed to determine the relationship between timely (<12 weeks) and delayed (>12 weeks) adjuvant therapy and overall survival (OS). RESULTS A total of 871 patients with GBAC were identified. The median time to receipt of adjuvant chemotherapy was 67 days and the median time to receipt of adjuvant chemoradiation was 69 days. After controlling for all factors, treatment at an Academic/Research center was the only variable associated with timely receipt of adjuvant therapy. However, after controlling for clinically relevant factors, the timing of adjuvant therapy did not impact OS (delayed: HR 0.93, 95% CI: 0.46-1.85; P = .83). CONCLUSION Current guidelines support the use of adjuvant therapy following resection of GBAC. This national cohort study demonstrates that delays in adjuvant therapy >12 weeks did not impact long-term survival.
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Affiliation(s)
- Ahmad Hamad
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Christopher T Aquina
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Aliya Ansari
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Aneesa Salahuddin
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Chengli Shen
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
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19
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Jeong JH, Jung J, Kim HJ, Lee JW, Ko BS, Son BH, Jung KH, Chung IY. Domestic medical travel from non-Seoul regions to Seoul for initial breast cancer treatment: a nationwide cohort study. Ann Surg Treat Res 2023; 104:71-79. [PMID: 36816739 PMCID: PMC9929435 DOI: 10.4174/astr.2023.104.2.71] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 02/09/2023] Open
Abstract
Purpose This study was conducted to investigate the trend of domestic medical travel from non-Seoul areas to Seoul for initial breast cancer treatment, and identify factors associated with medical travel in breast cancer patients. Methods A nationwide retrospective cohort study was performed using the Health Insurance Review and Assessment data of South Korea. Patients were classified according to the regions in which they underwent breast biopsy (Seoul vs. metropolitan cities vs. other regions). Frequencies of biopsy, diagnosis, treatment, and domestic medical travel were analyzed according to regions, and factors associated with medical travel were investigated. Results A total of 150,709 breast cancer survivors who were diagnosed between January 2010 and December 2017 were included. The total rate of medical travel from non-Seoul regions to Seoul had increased from 14.2% (1,161 of 8,150) in 2010 to 19.8% (2,762 of 13,964) in 2017. Approximately a quarter of patients from other regions traveled to Seoul, and over 40% of patients from Chungbuk, Gyeongbuk, and Jeju regions traveled to Seoul for initial treatment in 2017. The difference in the annual frequencies of upfront surgery between Seoul and non-Seoul regions increased over time. Younger age and regions other than metropolitan cities were significantly related to medical travel. Patients covered by medical aid or past medical histories were significantly less likely to travel to Seoul for initial breast cancer treatment. Conclusion Medical travel to Seoul for upfront breast cancer surgery is increasing. Policies for appropriate healthcare delivery need to be established in the near future.
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Affiliation(s)
- Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom-Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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20
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Yildiz S, Bildik G, Benlioglu C, Turan V, Dilege E, Ozel M, Kim S, Oktem O. Breast cancer treatment and ovarian function. Reprod Biomed Online 2023; 46:313-331. [PMID: 36400663 DOI: 10.1016/j.rbmo.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 02/07/2023]
Abstract
The aim of this study was to provide an update on ovarian function and the mechanisms of gonadal damage after exposure to chemotherapy in breast cancer survivors. The alkylating agents are toxic to both primordial and growing follicles. However, anti-metabolite drugs are more likely to destroy preantral and antral follicles. Younger patients are more likely to have a higher ovarian reserve, and therefore, more likely to retain some residual ovarian function after exposure to gonadotoxic regimens. However, there can be significant variability in ovarian reserve among patients of the same age. Furthermore, patients with critically diminished ovarian reserve may continue to menstruate regularly. Therefore age and menstrual status are not reliable indicators of good ovarian reserve and might give a false sense of security and result in an adverse outcome if the patient is consulted without considering more reliable quantitative markers of ovarian reserve (antral follicle count and anti-Müllerian hormone) and fertility preservation is not pursued. In contrast to well-documented ovarian toxicity of older chemotherapy regimens, data for newer taxane-containing protocols have only accumulated in the last decade and data are still very limited regarding the impact of targeted therapies on ovarian function.
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Affiliation(s)
- Sule Yildiz
- The Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey
| | - Gamze Bildik
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston TX 77054, USA
| | - Can Benlioglu
- Department of Obstetrics and Gynecology, Koç University Hospital, Istanbul, Turkey
| | - Volkan Turan
- Istanbul Tema Hospital, Assisted Reproduction Unit, Istanbul
| | - Ece Dilege
- Department of General Surgery, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey
| | - Melis Ozel
- Department of Gynecology and Obstetrics Klinikum Ingolstadt, Bavaria, Germany
| | - Samuel Kim
- Eden Centers for Advanced Fertility, Fullerton CA 92835, USA
| | - Ozgur Oktem
- The Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Koç University Hospital, Koç University School of Medicine, Istanbul, Turkey.
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21
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Hotton J, Lusque A, Leufflen L, Campone M, Levy C, Honart JF, Mailliez A, Debled M, Gutowski M, Leheurteur M, Goncalves A, Jankowski C, Guillermet S, Bachelot T, Ferrero JM, Eymard JC, Petit T, Pouget N, de La Lande B, Frenel JS, Villacroux O, Simon G, Pons-Tostivint E, Marchai F. Early Locoregional Breast Surgery and Survival in de novo Metastatic Breast Cancer in the Multicenter National ESME Cohort. Ann Surg 2023; 277:e153-e161. [PMID: 33534229 DOI: 10.1097/sla.0000000000004767] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim was to evaluate the impact of local surgery performed during the year after MBC diagnosis on patients' outcomes from a large reallife cohort. SUMMARY BACKGROUND DATA Locoregional treatment for patients with MBC at the time of diagnosis remains debated. METHODS Women with newly diagnosed, de novo stage IV MBC and who started MBC treatment between January 2008 and December 2014 in one of the 18 French Comprehensive Cancer Centers were included (NCT03275311). The impact of local surgery performed during the first year on overall survival (OS) and progression-free survival (PFS) was evaluated by the Cox proportional hazards model in a 12 month-landmark analysis. RESULTS Out of 16,703 patients in the ESME database, 1977 had stage IV MBC at diagnosis, were alive and progression-free at 12 months and eligible for this study. Among them, 530 (26.8%) had received primary breast cancer surgery within 12 months. A greater proportion of patients who received surgery had less than 3 metastatic sites than the no-surgery group (90.8% vs 78.2%, P < 0.0001). Surgery within 12 months was associated with treatment with chemotherapy, HER2-targeted therapy (89.1% vs 69.6%, P < 0.0001) and locoregional radiotherapy (81.7% vs 32.5%, P < 0.0001). Multivariable analyses showed that surgery performed within 12 months was associated with longer OS and PFS (adjusted HR [95%CI] = 0.75 [0.61-0.92] and 0.72 [0.63-0.83], respectively), which were also affected by pattern and number of metastatic sites, histological subtype, and age. CONCLUSIONS In the large ESME cohort, surgery within 1 year after de novo MBC diagnosis was associated with a significantly better OS and PFS.
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Affiliation(s)
- Judicaël Hotton
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
- Department of Surgical Oncology, Institut Godinot, 1 Rue du Général Koenig, 51100 Reims, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irene-Joliot-Curie, 31059 Toulouse, France
| | - Léa Leufflen
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Mario Campone
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Nantes & Angers, 15 rue Andre Boquel, 49055 Angers, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000 Caen, France
| | - Jean-Francois Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Audrey Mailliez
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonie, 229 Cours de l'Argonne, F-33000 Bordeaux, France
| | - Marian Gutowski
- Department of Surgical Oncology, Institut du Cancer de Montpellier, 208 Rue des Apothicaires, 34298 Montpellier, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue d'Amiens, 76000 Rouen, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009 Marseille
| | - Clementine Jankowski
- Department of Surgical Oncology, Centre Georges Francois Leclerc, 1 rue Professeur Marion, 21079 Dijon, France
| | - Sophie Guillermet
- Department of Surgical Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Thomas Bachelot
- Department of Surgical Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacas-sagne, 33 Avenue de Valambrose, 06189 Nice, France
| | - Jean-Christophe Eymard
- Department of Medical Oncology, Institut Godinot, 1 Rue du Général Koenig, 51100 Reims, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de la Porte de l,Hopital, 67000 Strasbourg, France
| | - Nicolas Pouget
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris & Saint-Cloud, France
| | - Brigitte de La Lande
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris & Saint-Cloud, France
| | - Jean-Sébastien Frenel
- Department of Medical Oncology, Institut de Cancerologie de l,Ouest - Rene Gauducheau, Boulevard Professeur Jacques Monod, 44805 Nantes, France
| | - Olivier Villacroux
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France; and
| | - Gaëtane Simon
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France; and
| | - Elvire Pons-Tostivint
- Department of Medical Oncology, Centre Leon Berard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irtine-Joliot-Curie, 31059 Toulouse, France
| | - Frédéric Marchai
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
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22
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Nussbaumer RL, Maggi N, Castrezana L, Zehnpfennig L, Schwab FD, Krol J, Oberhauser I, Weber WP, Kurzeder C, Haug MD, Kappos EA. The impact of neoadjuvant systemic treatment on postoperative complications in breast cancer surgery. Breast Cancer Res Treat 2023; 197:333-341. [PMID: 36403182 PMCID: PMC9823081 DOI: 10.1007/s10549-022-06811-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of the study was to analyze the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment. METHODS This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I-IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021. RESULTS Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5-40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p ≤ 0.001) and chronic pain (42.9% vs. 28.6%, p ≤ 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days). CONCLUSION In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.
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Affiliation(s)
- R. L. Nussbaumer
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - N. Maggi
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - L. Castrezana
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - L. Zehnpfennig
- grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - F. D. Schwab
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - J. Krol
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - I. Oberhauser
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland
| | - W. P. Weber
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - C. Kurzeder
- grid.410567.1Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland ,grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - M. D. Haug
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland ,grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Elisabeth A. Kappos
- grid.410567.1Breast Center, University Hospital of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland ,grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
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23
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Chen X, Song R, Zhang J, Adams SA, Sun L, Lu W. On estimating optimal regime for treatment initiation time based on restricted mean residual lifetime. Biometrics 2022; 78:1377-1389. [PMID: 34263933 DOI: 10.1111/biom.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/13/2021] [Accepted: 07/08/2021] [Indexed: 12/30/2022]
Abstract
When to initiate treatment on patients is an important problem in many medical studies such as AIDS and cancer. In this article, we formulate the treatment initiation time problem for time-to-event data and propose an optimal individualized regime that determines the best treatment initiation time for individual patients based on their characteristics. Different from existing optimal treatment regimes where treatments are undertaken at a pre-specified time, here new challenges arise from the complicated missing mechanisms in treatment initiation time data and the continuous treatment rule in terms of initiation time. To tackle these challenges, we propose to use restricted mean residual lifetime as a value function to evaluate the performance of different treatment initiation regimes, and develop a nonparametric estimator for the value function, which is consistent even when treatment initiation times are not completely observable and their distribution is unknown. We also establish the asymptotic properties of the resulting estimator in the decision rule and its associated value function estimator. In particular, the asymptotic distribution of the estimated value function is nonstandard, which follows a weighted chi-squared distribution. The finite-sample performance of the proposed method is evaluated by simulation studies and is further illustrated with an application to a breast cancer data.
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Affiliation(s)
- Xin Chen
- School of Statistics and Mathematics, Shanghai Lixin University of Accounting and Finance, Shanghai, China.,Interdisciplinary Research Institute of Data Science, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Rui Song
- Department of Statistics, North Carolina State University, Raleigh, North Carolina, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA.,College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Liuquan Sun
- Institute of Applied Mathematics, Chinese Academy of Science, Beijing, China
| | - Wenbin Lu
- Department of Statistics, North Carolina State University, Raleigh, North Carolina, USA
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24
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An D, Choi J, Lee J, Kim JY, Kwon S, Kim J, Lee S, Jeon S, Lee C, Lee S, Woo H. Time to surgery and survival in breast cancer. BMC Surg 2022; 22:388. [PMID: 36369022 PMCID: PMC9652796 DOI: 10.1186/s12893-022-01835-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to investigate the effect of the time from diagnosis to breast cancer surgery on breast cancer patients’ prognosis.
Methods Of the 1900 patients diagnosed with invasive (stage 1–3) breast cancer who underwent surgery in KUH between 2012 and 2019, 279 patients were enrolled in this study. All patients, including those who received neoadjuvant chemotherapy, were classified as Model 1 subjects, and those who received immediate surgical treatment were classified as Model 2 subjects. We conducted a Cox regression analysis to identify prognostic factors of breast cancer associated with the time from diagnosis to surgery. Results The univariate results indicated a sharp drop in both groups’ survival rates when the time to surgery was delayed for more than 8 weeks (Model 1 p = 0.000; Model 2 p = 0.001). In the multivariate analysis, the hazard ratio (HR) of Model 1increased (HR = 6.84, 95% CI 1.06–44.25) in response to a delay in surgery of more than 8 weeks. Smoking and the American Joint Committee on Cancer (AJCC) staging system had a negative effect on breast cancer prognosis, while hormone therapy had a positive effect. Conclusion For all patients, a delay in breast cancer surgery of more than 8 weeks was inversely associated with survival.
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Lyu HG, Raut CP. What enhanced recovery means for patients with cancer undergoing surgery. Cancer 2022; 128:4058-4060. [PMID: 36219468 DOI: 10.1002/cncr.34480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Heather G Lyu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Wu B, Sun C, Sun X, Li X. The effect of chemotherapy on survival in oldest old patients with nonmetastatic triple negative breast cancer: A populationbased observational study. J Clin Pharm Ther 2022; 47:1826-1836. [PMID: 36175133 DOI: 10.1111/jcpt.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Chemotherapy is the primary pharmacotherapy of triple-negative breast cancer (TNBC). But the benefit of adjuvant chemotherapy in the oldest old TNBC patients remains controversial. Hence, we designed this population based observational study in order to assess the survival benefit of adjuvant chemotherapy in oldest old TNBC patients with early-stage disease. METHODS TNBC patients aged 80 years and older that with stage I to III invasive disease were identified in the surveillance, epidemiology, and end results cancer database from 2010 to 2016. RESULTS AND DISCUSSION Of 1611 patients enrolled, 1356 (84.17%) did not receive chemotherapy. Age, race, histology, grade, T stage, N stage, and radiation were found to be strong predictors of chemotherapy recipient by multivariate logistic regression analysis. Chemotherapy significantly prolonged overall survival (OS) (HR, 0.62, 95% CI: 0.49-0.79, p < 0.001), but did not significantly reduce breast cancer specific death (BCSD) (HR, 0.92, 95% CI: 0.63-1.35, p = 0.675). These results were further confirmed by propensity score matching analysis. Chemotherapy was associated with better OS in the subgroup of patients aged 80-84 years old (HR, 0.54, 95% CI: 0.40-0.74, p < 0.001), T2-4 stage disease (HR, 0.58, 95% CI: 0.44-0.76, p < 0.001), or grade 3-4 disease (HR, 0.54, 95% CI: 0.41-0.71, p < 0.001). However, chemotherapy did not reduce the cumulative incidence of BCSD in any subgroup. WHAT IS NEW AND CONCLUSION Chemotherapy should be considered for TNBC patients aged 80-84 years old, T2-4 disease, or grade 3-4 disease.
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Affiliation(s)
- Bing Wu
- Department of Oncology, Weihai Cental Hospital, Weihai, People's Republic of China
| | - Congcong Sun
- Department of Oncology, Weihai Wendeng District People's Hospital, Weihai, People's Republic of China
| | - Xiaoqin Sun
- Department of Oncology, Weihai Wendeng District Zetou Township Health Center, Weihai, People's Republic of China
| | - Xue Li
- Department of Clinical Teaching, Weihai Health School, Weihai, People's Republic of China
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Lanthaler M, Spechtler K, Krapf J, Egle D, Sieb M, Tasch C, Spinelli R, Pierer G, Bauer T. Does the breast reconstruction method have an impact on time delay to adjuvant chemotherapy – A comparison between autologous and expander/implant breast reconstruction. JPRAS Open 2022; 33:131-138. [PMID: 35935516 PMCID: PMC9352396 DOI: 10.1016/j.jpra.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction This study aims to analyze whether autologous breast reconstruction as compared to expander/implant reconstruction has a higher risk of postoperative wound healing problems (WHPs) and thus potentially delays chemotherapy start. Methods Between January 2012 and December 2019, a total of 64 women with NSME/SSME and autologous (Group1, n = 33) or expander/implant reconstruction (Group2, n = 31) and adjuvant chemotherapy were enrolled in this study conducted at Innsbruck Medical University Hospital. Immediate postoperative WHPs in each group were compared, and the time from operation to initiation of chemotherapy was analyzed. If the start of chemotherapy was postponed for more than six weeks postoperatively due to WHP, it was defined as delayed. Statistical analysis was performed with SPSS and Fisher's exact test. Results More postoperative WHP occurred in Group 1 than in Group 2 (51.6% vs. 9.7%, p < 0.001). Due to WHP, chemotherapy start was delayed for more than six weeks postoperatively in 30.3% of Group 1 patients and 3.2% of Group 2 patients. Only small differences in age (Group 1: 47±1 vs. Group 2: 46±2 years) and BMI (Group 1: 24.3 ± 0.6 vs. Group 2: 23.3 ± 0.7 kg/m2) were found. Conclusion Our study shows a far smaller risk for postoperative WHP and delay of chemotherapy start in the expander/implant group in comparison with the autologous group. In some selected patients with high urgency for adjuvant chemotherapy, a bridging operation by means of expander reconstruction prior to chemotherapy could be an oncologically safe pathway.
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Lee YY, Kim SR, Kollara A, Brown T, May T. The impact of interval between primary cytoreductive surgery with bowel resection and initiation of adjuvant chemotherapy on survival of women with advanced ovarian cancer: a multicenter cohort study. J Gynecol Oncol 2022; 33:e76. [PMID: 36047378 PMCID: PMC9634098 DOI: 10.3802/jgo.2022.33.e76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Our aim was to determine if the time interval between bowel resection and initiation of adjuvant chemotherapy impacts survival in advanced ovarian cancers. Methods This was a retrospective cohort study using data from two cancer centers, Princess Margaret Cancer Centre in Toronto, Ontario, Canada and Samsung Comprehensive Cancer Center in Seoul, South Korea. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage III or IV ovarian cancer that underwent large bowel resection during primary cytoreductive surgery (PCS) were included. Results Ninety-one women were eligible of which the majority (90.1%) were diagnosed with high-grade serous cancer. The median interval from PCS to chemotherapy for all patients was 21 days (7–86 days). Patients were stratified into 3 groups: 1) Interval ≤14 days, 32 (35.2%) patients; 2) Interval between 15–28 days, 27 (29.6%) patients; and 3) Interval between 29–90 days, 32 (35.2%) patients. Surgical procedures and postoperative outcomes were similar between groups. Multivariate analysis indicated that PCS to chemotherapy interval of 2–4 weeks, younger age, and completion of 4 or more adjuvant chemotherapy cycles were independent prognostic factors of favorable overall survival. Conclusion Initiation of adjuvant chemotherapy between 2 to 4 weeks after PCS with bowel resection may improve survival outcomes in women with advanced ovarian cancer by maximizing the benefit of PCS plus adjuvant chemotherapy. Optimal waiting time for adjuvant chemotherapy after bowel resection during surgery in advanced ovarian cancer is unclear. Two to 4 weeks after surgery showed best survival outcomes which is similar in colorectal cancer. Stoma formation and intraperitoneal chemotherapy are associated with delayed waiting time.
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Affiliation(s)
- Yoo-Young Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Korea
| | - Soyoun Rachel Kim
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Alexandra Kollara
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Theodore Brown
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Taymaa May
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
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Huttunen T, Leidenius M, Jahkola T, Mattson J, Suominen S, Meretoja T. Delay in the initiation of adjuvant chemotherapy in patients with breast cancer with mastectomy with or without immediate breast reconstruction. BJS Open 2022; 6:zrac096. [PMID: 35950555 PMCID: PMC9366640 DOI: 10.1093/bjsopen/zrac096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/26/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients with breast cancer undergoing mastectomy should be offered the option of immediate breast reconstruction (IBR). The aim of this retrospective study was to assess whether there is a delay in the initiation of adjuvant chemotherapy in patients undergoing mastectomy with or without IBR. METHOD The study included patients aged 70 years or younger with clinically node-negative breast cancer who underwent unilateral mastectomy with IBR (IBR group) or mastectomy alone (no-IBR group) followed by adjuvant chemotherapy at the Helsinki University Hospital between January 2012 to July 2018. RESULTS A total of 645 patients were included; 186 in the IBR group and 459 in the no-IBR group. Sixty-six (35.5 per cent) patients in the IBR group and 102 (22.2 per cent) patients in the no-IBR group received their first chemotherapy cycle later than 6 weeks after surgery (P < 0.001). The respective numbers for later than 8 weeks were 17 (9.1 per cent) and 14 (3.1 per cent) (P = 0.001). Among all 645 patients, postoperative complications were a significant risk factor for a delay in the initiation of chemotherapy. Sixty-seven (39.9 per cent) patients with and 101 (21.2 per cent) patients without complications had a delay in chemotherapy (P < 0.001). The delay in chemotherapy was due to complications in 39 (59.1 per cent) in the IBR group and in 28 (27.5 per cent) in the no-IBR group (P < 0.001). CONCLUSION Patients undergoing mastectomy alone were more likely to receive adjuvant chemotherapy within 6 weeks after surgery compared with the IBR patients. IBR significantly increased the risk of postoperative complications in comparison with mastectomy alone. The complications, in turn, were a significant risk factor for delay in adjuvant chemotherapy.
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Affiliation(s)
- Tuomas Huttunen
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Leidenius
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Jahkola
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Mattson
- Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sinikka Suominen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomo Meretoja
- Department of Breast Surgery, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Gao W, Wang J, Yin S, Geng C, Xu B. An appropriate treatment interval does not affect the prognosis of patients with breast Cancer. HOLISTIC INTEGRATIVE ONCOLOGY 2022; 1:8. [PMID: 37520334 PMCID: PMC9255457 DOI: 10.1007/s44178-022-00010-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/09/2022] [Indexed: 12/24/2022]
Abstract
Purpose Major public health emergencies may lead to delays or alterations in the treatment of patients with breast cancer at each stage of diagnosis and treatment. How much do these delays and treatment changes affect treatment outcomes in patients with breast cancer? Methods This review summarized relevant research in the past three decades and identified the effect of delayed treatment on the prognosis of patients with breast cancer in terms of seeking medical treatment, neoadjuvant treatment, surgery, postoperative chemotherapy, radiotherapy, and targeted therapies. Results Delay in seeking medical help for ≥12 weeks affected the prognosis. Surgical treatment within 4 weeks of diagnosis did not affect patient prognosis. Starting neoadjuvant chemotherapy within 8 weeks after diagnosis, receiving surgical treatment at 8 weeks or less after the completion of neoadjuvant chemotherapy, and receiving radiotherapy 8 weeks after surgery did not affect patient prognosis. Delayed chemotherapy did not increase the risk of relapse in patients with luminal A breast cancer. Every 4 weeks of delay in the start of postoperative chemotherapy in patients with luminal B, triple-negative, or HER2-positive breast cancer treated with trastuzumab will adversely affect the prognosis. Targeted treatment delays in patients with HER2-positive breast cancer should not exceed 60 days after surgery or 4 months after diagnosis. Radiotherapy within 8 weeks after surgery did not increase the risk of recurrence in patients with early breast cancer who were not undergoing adjuvant chemotherapy. Conclusion Different treatments have different time sensitivities, and the careful evaluation and management of these delays will be helpful in minimizing the negative effects on patients.
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Affiliation(s)
- Wei Gao
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Jiaxing Wang
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Sifei Yin
- Department of Chemical and Systems Biology, Stanford University, Stanford, California 94305 USA
| | - Cuizhi Geng
- Department of Breast Cancer, Fourth Hospital of Hebei Medical University, 169 East Tianshan Avenue, Shijiazhuang, 050035 Hebei China
| | - Binghe Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
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Arecco L, Blondeaux E, Bruzzone M, Ceppi M, Latocca MM, Marrocco C, Boutros A, Spagnolo F, Razeti MG, Favero D, Spinaci S, Condorelli M, Massarotti C, Goldrat O, Del Mastro L, Demeestere I, Lambertini M. Safety of fertility preservation techniques before and after anticancer treatments in young women with breast cancer: a systematic review and meta-analysis. Hum Reprod 2022; 37:954-968. [PMID: 35220429 PMCID: PMC9071231 DOI: 10.1093/humrep/deac035] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/19/2022] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION Is it safe to perform controlled ovarian stimulation (COS) for fertility preservation before starting anticancer therapies or ART after treatments in young breast cancer patients? SUMMARY ANSWER Performing COS before, or ART following anticancer treatment in young women with breast cancer does not seem to be associated with detrimental prognostic effect in terms of breast cancer recurrence, mortality or event-free survival (EFS). WHAT IS KNOWN ALREADY COS for oocyte/embryo cryopreservation before starting chemotherapy is standard of care for young women with breast cancer wishing to preserve fertility. However, some oncologists remain concerned on the safety of COS, particularly in patients with hormone-sensitive tumors, even when associated with aromatase inhibitors. Moreover, limited evidence exists on the safety of ART in breast cancer survivors for achieving pregnancy after the completion of anticancer treatments. STUDY DESIGN, SIZE, DURATION The present systematic review and meta-analysis was carried out by three blinded investigators using the keywords 'breast cancer' and 'fertility preservation'; keywords were combined with Boolean operators. Eligible studies were identified by a systematic literature search of Medline, Web of Science, Embase and Cochrane library with no language or date restriction up to 30 June 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS To be included in this meta-analysis, eligible studies had to be case-control or cohort studies comparing survival outcomes of women who underwent COS or ART before or after breast cancer treatments compared to breast cancer patients not exposed to these strategies. Survival outcomes of interest were cancer recurrence rate, relapse rate, overall survival and number of deaths. Adjusted relative risk (RR) and hazard ratio (HR) with 95% CI were extracted. When the number of events for each group were available but the above measures were not reported, HRs were estimated using the Watkins and Bennett method. We excluded case reports or case series with <10 patients and studies without a control group of breast cancer patients who did not pursue COS or ART. Quality of data and risk of bias were assessed using the Newcastle-Ottawa Assessment Scale. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1835 records were retrieved. After excluding ineligible publications, 15 studies were finally included in the present meta-analysis (n = 4643). Among them, 11 reported the outcomes of breast cancer patients who underwent COS for fertility preservation before starting chemotherapy, and 4 the safety of ART following anticancer treatment completion. Compared to women who did not receive fertility preservation at diagnosis (n = 2386), those who underwent COS (n = 1594) had reduced risk of recurrence (RR 0.58, 95% CI 0.46-0.73) and mortality (RR 0.54, 95% CI 0.38-0.76). No detrimental effect of COS on EFS was observed (HR 0.76, 95% CI 0.55-1.06). A similar trend of better outcomes in terms of EFS was observed in women with hormone-receptor-positive disease who underwent COS (HR 0.36, 95% CI 0.20-0.65). A reduced risk of recurrence was also observed in patients undergoing COS before neoadjuvant chemotherapy (RR 0.22, 95% CI 0.06-0.80). Compared to women not exposed to ART following completion of anticancer treatments (n = 540), those exposed to ART (n = 123) showed a tendency for better outcomes in terms of recurrence ratio (RR 0.34, 95% CI 0.17-0.70) and EFS (HR 0.43, 95% CI 0.17-1.11). LIMITATIONS, REASONS FOR CAUTION This meta-analysis is based on abstracted data and most of the studies included are retrospective cohort studies. Not all studies had matching criteria between the study population and the controls, and these criteria often differed between the studies. Moreover, rate of recurrence is reported as a punctual event and it is not possible to establish when recurrences occurred and whether follow-up, which was shorter than 5 years in some of the included studies, is adequate to capture late recurrences. WIDER IMPLICATIONS OF THE FINDINGS Our results demonstrate that performing COS at diagnosis or ART following treatment completion does not seem to be associated with detrimental prognostic effect in young women with breast cancer, including among patients with hormone receptor-positive disease and those receiving neoadjuvant chemotherapy. STUDY FUNDING/COMPETING INTEREST(S) Partially supported by the Associazione Italiana per la Ricerca sul Cancro (AIRC; grant number MFAG 2020 ID 24698) and the Italian Ministry of Health-5 × 1000 funds 2017 (no grant number). M.L. acted as consultant for Roche, Pfizer, Novartis, Lilly, AstraZeneca, MSD, Exact Sciences, Gilead, Seagen and received speaker honoraria from Roche, Pfizer, Novartis, Lilly, Ipsen, Takeda, Libbs, Knight, Sandoz outside the submitted work. F.S. acted as consultant for Novartis, MSD, Sun Pharma, Philogen and Pierre Fabre and received speaker honoraria from Roche, Novartis, BMS, MSD, Merck, Sun Pharma, Sanofi and Pierre Fabre outside the submitted work. I.D. has acted as a consultant for Roche, has received research grants from Roche and Ferring, has received reagents for academic clinical trial from Roche diagnostics, speaker's fees from Novartis, and support for congresses from Theramex and Ferring outside the submitted work. L.D.M. reported honoraria from Roche, Novartis, Eli Lilly, MSD, Pfizer, Ipsen, Novartis and had an advisory role for Roche, Eli Lilly, Novartis, MSD, Genomic Health, Pierre Fabre, Daiichi Sankyo, Seagen, AstraZeneca, Eisai outside the submitted work. The other authors declare no conflict of interest. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript and decision to submit the manuscript for publication. REGISTRATION NUMBER N/A.
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Affiliation(s)
- L Arecco
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - E Blondeaux
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M M Latocca
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - C Marrocco
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Boutros
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - F Spagnolo
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M G Razeti
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - D Favero
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - S Spinaci
- Breast Unit, Ospedale Villa Scassi, Genova, Italy
| | - M Condorelli
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - C Massarotti
- Physiopathology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), School of Medicine, University of Genova, Genova, Italy
| | - O Goldrat
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - L Del Mastro
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
- U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - I Demeestere
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
- Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M Lambertini
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
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Garcia-Nebreda M, Zorrilla-Vaca A, Ripollés-Melchor J, Abad-Motos A, Alvaro Cifuentes E, Abad-Gurumeta A, Mena GE, Grant MC, Paseiro-Crespo G. Early Return to Intended Oncologic Therapy after implementation of an Enhanced Recovery After Surgery pathway for gastric cancer surgery. Langenbecks Arch Surg 2022; 407:2293-2300. [PMID: 35441358 DOI: 10.1007/s00423-022-02515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Time to initiation and completion of adjuvant therapy are critical to improve postoperative oncologic outcomes. This study aims to determine whether an Enhanced Recovery After Surgery (ERAS) pathway for gastric cancer surgery promotes early Return to Intended Oncologic Therapy (RIOT). METHODS This is a before-after intervention study including patients with gastric adenocarcinoma who underwent surgery from January 2016 to January 2021. Two periods were denoted based upon the implementation date of our institutional ERAS pathway (June 2018). Our primary outcome was time to RIOT after surgery. Hodges-Lehmann analysis was used to estimate median differences of non-parametric outcomes. RESULTS Seventy patients with gastric adenocarcinoma were included (35 in pre-ERAS period and 35 in post-ERAS period). Fourteen of the pre-ERAS and twenty-two patients of the post-ERAS period received adjuvant therapy. Time to RIOT was reduced in the post-ERAS period (median 39 days, IQR 31-49) by 12 days (95% CI 3-14 days, p = 0.01) compared to the pre-ERAS period (median 51 days, IQR 42-62). Length of hospital stay (LOS) was lower in the ERAS group (6 days, IQR 5-11 vs 10 days, IQR 8-13, p < 0.01). CONCLUSION Our institutional ERAS pathway for gastric cancer surgery was associated with earlier RIOT and shorter LOS.
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Affiliation(s)
- Maria Garcia-Nebreda
- Department of Surgery, Infanta Leonor University Hospital, Madrid, Spain. .,Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain. .,Universidad Complutense de Madrid, Madrid, Spain.
| | - Andrés Zorrilla-Vaca
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Javier Ripollés-Melchor
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Department of Anesthesiology, Infanta Leonor University Hospital, Madrid, Spain.,Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain
| | - Ane Abad-Motos
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Department of Anesthesiology, Infanta Leonor University Hospital, Madrid, Spain
| | - Edurne Alvaro Cifuentes
- Department of Surgery, Infanta Leonor University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Alfredo Abad-Gurumeta
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Department of Anesthesiology, Infanta Leonor University Hospital, Madrid, Spain.,Spanish Perioperative Audit and Research Network (REDGERM), Zaragoza, Spain
| | - Gabriel E Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gloria Paseiro-Crespo
- Department of Surgery, Infanta Leonor University Hospital, Madrid, Spain.,Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.,Universidad Complutense de Madrid, Madrid, Spain
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Muhammadzai J, Haider K, Moser M, Chalchal H, Shaw J, Gardiner D, Dueck DA, Ahmed O, Brunet B, Iqbal M, Luo Y, Beck G, Zaidi A, Ahmed S. Early discontinuation of adjuvant chemotherapy in patients with early-stage pancreatic cancer correlates with inferior survival: A multicenter population-based cohort study. PLoS One 2022; 17:e0263250. [PMID: 35108323 PMCID: PMC8809602 DOI: 10.1371/journal.pone.0263250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background
The current study aimed to determine the association between timing and completion of adjuvant chemotherapy and outcomes in real-world patients with early-stage pancreatic cancer.
Methods
In this multi-center cohort study patients with early-stage pancreatic cancer who were diagnosed from 2007–2017 and underwent complete resection in the province of Saskatchewan were examined. Cox proportional multivariate analyses were performed for correlation with recurrence and survival.
Results
Of 168 patients, 71 eligible patients with median age of 69 years and M:F of 37:34 were identified. Median time to the start of adjuvant therapy from surgery was 73 days. Of all patients, 49 (69%) patients completed adjuvant chemotherapy and 22 (31%) required early treatment discontinuation. Median recurrence-free survival of patients who completed treatment was 22 months (95%CI:15.8–28.2) vs. 9 months (3.3–14.7) if treatment was discontinued early (P<0.001). Median overall survival of those who completed treatment was 33 (17.5–48.5) vs. 16 months (17.5–48.5) with early treatment discontinuation (P<0.001). In the multivariate analysis, treatment discontinuation was significantly correlated with recurrent disease, hazard ratio (HR), 2.57 (1.41–4.68), P = 0.002 and inferior survival, HR, 2.55 (1.39–4.68), P = 0.003. No correlation between treatment timing and survival was noted.
Conclusions
Early discontinuation but not the timing of adjuvant chemotherapy correlates with inferior outcomes.
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Affiliation(s)
| | - Kamal Haider
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Medical Oncology, Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michael Moser
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Haji Chalchal
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Medical Oncology, Allan Blair Cancer Centre, Regina, SK, Canada
| | - John Shaw
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Donald Gardiner
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Radiation Oncology, Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dorie-Anna Dueck
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Medical Oncology, Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Osama Ahmed
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Medical Oncology, Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bryan Brunet
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Radiation Oncology, Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mussawar Iqbal
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Medical Oncology, Allan Blair Cancer Centre, Regina, SK, Canada
| | - Yigang Luo
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Gavin Beck
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Adnan Zaidi
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Medical Oncology, Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Shahid Ahmed
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Medical Oncology, Saskatoon Cancer Centre, University of Saskatchewan, Saskatoon, SK, Canada
- * E-mail:
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Breast Cancer Management in 2021: A Primer for the OB GYN. Best Pract Res Clin Obstet Gynaecol 2022; 82:30-45. [DOI: 10.1016/j.bpobgyn.2022.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/18/2022]
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Westphal T, Gampenrieder SP, Rinnerthaler G, Balic M, Posch F, Dandachi N, Hauser-Kronberger C, Reitsamer R, Sotlar K, Radl B, Suppan C, Stöger H, Greil R. Transferring MINDACT to Daily Routine: Implementation of the 70-Gene Signature in Luminal Early Breast Cancer - Results from a Prospective Registry of the Austrian Group Medical Tumor Therapy (AGMT). Breast Care (Basel) 2022; 17:1-9. [PMID: 35355702 PMCID: PMC8914232 DOI: 10.1159/000512467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/21/2020] [Indexed: 02/03/2023] Open
Abstract
Background For hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative early breast cancer (EBC), adjuvant chemotherapy (ACT) is recommended in the case of high-risk features only. The MINDACT trial showed that patients with high clinical risk (CR) but low genomic risk (GR) defined by the 70-gene signature (MammaPrint®; 70-GS) did not benefit from ACT. In this registry, we investigated the frequency and feasibility of 70-GS and concurrent 80-gene subtyping (BluePrint®) use in HR-positive, HER2-negative EBC. Furthermore, we recorded the frequency of ACT recommendation and the adherence to it when the "MINDACT strategy" was used. Methods This prospective registry included patients from 2 Austrian cancer centers. Similar to MINDACT, a modified version of Adjuvant!Online was used to determine CR, and 70-GC was used to determine GR in high-CR patients. ACT was recommended to patients with high CR and high GR. Results Of 224 enrolled patients, 76 (33.9%) had high CR and 67 (88.2%) received genomic testing. Of those, 43 (64.2%) were classified as low and 24 (35.8%) as high GR, respectively. All 24 patients with high CR and GR (10.7% of all patients) received the recommendation for ACT, but ACT was started in only 15 patients (62.5%). The median time from surgery to the start of ACT was 45 days (range 32-68), and the median time from test decision to the test result was 15 days (range 9-56). Conclusion We showed that the results of the MINDACT trial are reproducible in an Austrian population. Incorporating 70-GS into the daily clinical routine is feasible and mostly accepted by physicians for the guidance of treatment recommendations.
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Affiliation(s)
- Theresa Westphal
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Simon P. Gampenrieder
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria,Cancer Cluster Salzburg, Salzburg, Austria
| | - Gabriel Rinnerthaler
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria,Cancer Cluster Salzburg, Salzburg, Austria
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nadia Dandachi
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Cornelia Hauser-Kronberger
- Pathologic Institute of the University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Roland Reitsamer
- University Clinic for Special Gynecology of the University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Karl Sotlar
- Pathologic Institute of the University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bianca Radl
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria
| | - Christoph Suppan
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Herbert Stöger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria,Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria,Cancer Cluster Salzburg, Salzburg, Austria,*Richard Greil IIIrd Medical Department Paracelsus Medical University Salzburg Müllner Hauptstrasse 48, AT-5020 Salzburg (Austria)
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Ozcan MCH, Snegovskikh V, Adamson GD. Oocyte and embryo cryopreservation before gonadotoxic treatments: Principles of safe ovarian stimulation, a systematic review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221074886. [PMID: 35130799 PMCID: PMC8829712 DOI: 10.1177/17455065221074886] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/10/2021] [Accepted: 01/04/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Review the safety of fertility preservation through ovarian stimulation with oocyte or embryo cryopreservation, including cycle and medication options. EVIDENCE REVIEW A systematic review of peer-reviewed sources revealed 2 applicable randomized control trials and 60 cohort studies as well as 20 additional expert opinions or reviews. RESULTS The capacity for future family building is important for the majority of reproductive age people, despite life-altering medical or oncologic diagnosis. Modern fertility preservation generates a high rate of oocyte yield while utilizing protocols that can be started at multiple points in the menstrual cycle and suppressing supra-physiologic levels of estrogen. Finally, more than one quarter of fertility preservation patients will return to later utilize fertility services. CONCLUSION For most patients, fertility preservation can safely be pursued and completed within 2 weeks without affecting disease severity or long-term survival.
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Affiliation(s)
- Meghan CH Ozcan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
| | - Victoria Snegovskikh
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI, USA
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Castillo C, Camejo N, Rondan M, Savio F, Herrera G, Krygier G, Delgado L. Survival and Time to Initiation of Adjuvant Chemotherapy Among Breast Cancer Patients in Uruguay. BREAST CANCER (DOVE MEDICAL PRESS) 2021; 13:651-658. [PMID: 34908875 PMCID: PMC8664648 DOI: 10.2147/bctt.s338276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Increases in disease-free survival and overall survival (OS) with the use of adjuvant chemotherapy in early breast cancer (BC) are widely known; however, the optimal time to initiate treatment with adjuvant chemotherapy remains controversial. OBJECTIVE To evaluate the time elapsed between surgery and the initiation of adjuvant chemotherapy and its possible impact on OS in patients diagnosed with BC stages I-III. MATERIALS AND METHODS This retrospective study included 112 patients diagnosed with BC stages I-III who received adjuvant chemotherapy at the Mastology Unit of the Hospital de Clínicas in Uruguay from 2009 to 2019. OS was estimated using the Kaplan-Meier method, and a Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals. RESULTS No statistically significant association was found between the time from surgery to the initiation of chemotherapy and the described variables. OS was worse for patients initiating chemotherapy more than 90 days after breast surgery (n = 19) (HR 7.63; p = 0.004) and between 61 and 90 days after surgery (n = 46) (HR 4.58; p = 0.040) compared to those who started before 30 days (n = 23). Controlling by type of surgery and stage, the prognosis of patients who started chemotherapy between 61 and 90 days after surgery was similar to that of patients who underwent chemotherapy within the first 30 days, controlling for surgery (HR 4.10; p = 0.056) and controlling for stage (HR 3.76; p = 0.075). Prognosis was worse for patients with stage III disease (p = 0.022) who underwent a mastectomy and/or axillary lymph node dissection (p = 0.025). CONCLUSION Patients who started chemotherapy more than 90 days following surgery and those with stage III disease or underwent mastectomy and/or axillary lymph node dissection who initiated it between 61 and 90 days had a worse OS. Multiple factors are involved in the time between surgery and the initiation of chemotherapy, and further studies are needed to evaluate which of these factors influence the delay of chemotherapy in order to design strategies to avoid such delays and their negative impact on survival.
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Affiliation(s)
- Cecilia Castillo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Natalia Camejo
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Monika Rondan
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Florencia Savio
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Guadalupe Herrera
- Department of Quantitative Methods, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Gabriel Krygier
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
| | - Lucia Delgado
- Department of Clinical Oncology, School of Medicine, University of Uruguay, Montevideo, Uruguay
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Impact of neoadjuvant chemotherapy on surgical complications in breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 48:44-52. [PMID: 34548216 DOI: 10.1016/j.ejso.2021.09.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The increased use of neoadjuvant chemotherapy (NACT) facilitates an increase in breast-conserving surgery and immediate breast reconstruction. While NACT is considered to have the same oncological safety as adjuvant chemotherapy, evidence on the impact of NACT on surgical outcomes following breast surgery is unclear and varies across studies. The aim of this systematic review and meta-analysis was to assess the impact of NACT on surgical complications in breast cancer patients undergoing any kind of breast surgery. METHODS Database searches were conducted (March 26, 2021) to identify studies assessing the impact of NACT on postoperative complications. Studies were included if they compared a group of patients treated with NACT to a control group that was not, and if they reported at least one of our defined outcomes. Primary effect measures were odds ratios (ORs) and mean difference with a 95% confidence interval. Study quality was assessed by the Newcastle-Ottawa Scale. RESULTS Twenty-six studies comprising 134,191 patients were included. NACT was not associated with an increased complication rate for overall complications (OR: 1.13, 95% CI: 0.86 to 1.47, p = 0.38), individual postoperative complications, nor surgery duration. There was a non-significant trend towards NACT increasing the risk of seroma, wound complications, skin or nipple necrosis, flap ischemia or loss, and implant loss. A significant difference in blood loss was found, favouring NACT (MD = -75.85, 95% CI: -107.47 to -44.23, p < 0.00001). Heterogeneity was significant between the studies (I2>50%). CONCLUSION Compared to a control group, NACT was not found to affect the surgical complications adversely.
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Tang A, Mittal A, Mooney CM, Khoury AL, Chiang A, Lai N, Knopf KB. Factors delaying chemotherapy in patients with breast cancer at a safety-net hospital. J Natl Med Assoc 2021; 113:706-712. [PMID: 34521514 DOI: 10.1016/j.jnma.2021.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/14/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite advances in healthcare and improved chemotherapy, disparities in breast cancer outcomes continue to persist. Our aim was to evaluate socioeconomic factors that may impact timing of treatment for patients receiving chemotherapy in underserved communities. METHODS A review of patients with breast cancer who received neoadjuvant or adjuvant chemotherapy from 2015-2019 was conducted at a safety-net hospital. The primary outcomes were times from diagnosis to chemotherapy and surgery. Clinicodemographic factors including race, age, clinical stage, primary language, comorbidities, and median income by zip code were collected. Multivariable regression analysis was performed to evaluate for factors associated with the primary outcomes. RESULTS One hundred patients were identified. For the neoadjuvant group, median time from diagnosis to chemotherapy and surgery was 52 ± 34 days and 256 ± 59 days, respectively. For the adjuvant group, median time from diagnosis to surgery and chemotherapy was 24.5 ± 18 days and 94.5 ± 53 days, respectively. Non-English language and older age were associated with increased time to chemotherapy in the adjuvant group (p < 0.05). Language and age were not associated with increased time to surgery in both groups. Race, age, comorbidities, and income were not associated with delay in treatment in either groups. CONCLUSIONS Older age and non-English language were associated with prolonged time from surgery to adjuvant chemotherapy. Targeted interventions directed at patient education and decreasing language barriers especially post-operatively may decrease delays in treatment and subsequently reduce disparities seen in the breast cancer population.
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Affiliation(s)
- Annie Tang
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Ananya Mittal
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Colin M Mooney
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Amal L Khoury
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Anna Chiang
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Nicole Lai
- Department of Surgery, University of California San Francisco, East Bay- Highland Hospital: 1411 E 31(st), QIC: 22134, Oakland CA, 94602 USA.
| | - Kevin B Knopf
- Department of Medicine, Alameda Health System- Highland Hospital: 1411 E 31(st), 2(nd) Floor A2, Oakland CA, 94602 USA.
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Lin H, Chen WH, Wu CH, Ou YC, Chen YJ, Chen YY, Lin YH, Fu HC. Impact of the Time Interval Between Primary Debulking Surgery and Start of Adjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer. Cancer Manag Res 2021; 13:5413-5422. [PMID: 34262349 PMCID: PMC8275047 DOI: 10.2147/cmar.s313013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/20/2021] [Indexed: 01/26/2023] Open
Abstract
Aim To investigate whether the time interval between primary debulking surgery (PDS) and initiating adjuvant chemotherapy affects survival in patients with epithelial ovarian cancer (EOC). Methods We retrospectively reviewed FIGO stage IIB to IV EOC patients who received PDS followed by adjuvant chemotherapy in our hospital between January 2008 and December 2016. The optimal cut-off time interval to chemotherapy related to survival was determined using the Contal and O’Quigley method and Cox hazard models. Cox regression analysis was used to identify the independent effect of time interval on survival. Results A total of 152 patients were identified and divided into three groups based on the time interval between PDS and initiating adjuvant chemotherapy: early (<23 days), intermediate (23–43 days) and late (>43 days). The intermediate group had a significantly better median progression-free survival (PFS, 35.5 months) compared to the early (20 months) and late (22.6 months) groups. After adjustments for confounding factors, time interval was still an independent variable affecting PFS. The intermediate group was associated with a better PFS compared with the early and late groups (hazard ratio 0.27, 95% CI 0.10–0.83, p=0.002). There was no statistical significance in overall survival (OS) in univariate or multivariate analysis, although there was a trend towards better OS in the intermediate group. Conclusion Our results provide evidence that the time interval from PDS to chemotherapy influences PFS in patients with advanced EOC. The optimal time to initiate chemotherapy was between 23 and 43 days, within 3–6 weeks post-operatively. Initiating chemotherapy early (<23 days) did not appear to benefit PFS.
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Affiliation(s)
- Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Hsin Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsuan Wu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Lin-Kou, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Yu-Jen Chen
- Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Ying-Yi Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Han Lin
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hung-Chun Fu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Lin-Kou, Taiwan.,Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan
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Greer AC, Lanes A, Poorvu PD, Kennedy P, Thomas AM, Partridge AH, Ginsburg ES. The impact of fertility preservation on the timing of breast cancer treatment, recurrence, and survival. Cancer 2021; 127:3872-3880. [PMID: 34161610 DOI: 10.1002/cncr.33601] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/10/2021] [Accepted: 03/03/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many young women with breast cancer undergo fertility preservation (FP) before cancer treatment. This study examined the impact of FP on breast cancer outcomes. METHODS The authors performed a retrospective cohort study of 272 women aged 20 to 45 years with newly diagnosed stage 0 to III breast cancer who underwent an FP consultation between 2005 and 2017. Among these women, 123 (45.2%) underwent FP (fertility preservation-positive [FP+]). The remaining 149 women did not undergo FP (fertility preservation-negative [FP-]). RESULTS The characteristics at enrollment were similar with the exception of ethnicity (FP+, 87.8% White; FP-, 67.8% White; P = .002) and BRCA status (FP+, 27.7% BRCA+; FP-, 15.5% BRCA+; P = .021). The median follow-up was approximately 4 years. Women who underwent FP had longer times to first treatment (FP+, 37 days; FP-, 31 days; adjusted hazard ratio [aHR], 0.74; confidence interval [CI], 0.56-0.99) and neoadjuvant chemotherapy (FP+, 36 days; FP-, 26 days; aHR, 0.41; CI, 0.24-0.68) and from surgery to adjuvant chemotherapy (FP+, 41 days; FP-, 33 days; aHR, 0.58; CI, 0.38-0.90). Adjusted 3- and 5-year invasive disease-free survival (IDFS) rates were comparable between the 2 groups (3-year IDFS: FP+, 85.4%; FP-, 79.4%; P = .411; 5-year IDFS: FP+, 73.7%; FP-, 67.1%; P = .288). Similarly, no difference in overall survival (OS) was observed between the 2 groups (3-year OS: FP+, 95.5%; FP-, 93.5%; P = .854; 5-year OS: FP+, 84.2%; FP-, 81.4%; P = .700). CONCLUSIONS FP after a breast cancer diagnosis delays the time to treatment by a small amount, but this delay does not lead to inferior IDFS or OS.
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Affiliation(s)
- Anna C Greer
- Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrea Lanes
- Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Philip D Poorvu
- Harvard Medical School, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Patricia Kennedy
- Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ann M Thomas
- Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ann H Partridge
- Harvard Medical School, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth S Ginsburg
- Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Meyer C, Bailleux C, Chamorey E, Schiappa R, Delpech Y, Dejode M, Fouché Y, Haudebourg J, Barranger E. Factors Involved in Delaying Initiation of Adjuvant Chemotherapy After Breast Cancer Surgery. Clin Breast Cancer 2021; 22:121-126. [PMID: 34154927 DOI: 10.1016/j.clbc.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/15/2021] [Accepted: 05/14/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Delays in initiating adjuvant chemotherapy after breast cancer surgery seems to have an impact on patients' risk of relapse and their survival rate. The aim of this retrospective study was to identify factors delaying initiation of adjuvant chemotherapy after breast surgery. MATERIAL AND METHODS All patients undergoing surgical treatment for mammary cancer between June 2014 and June 2015 and receiving adjuvant chemotherapy were selected retrospectively. RESULTS In multivariate analysis, 3 factors significantly delay initiation of adjuvant chemotherapy: a secondary procedure (odds ratio [OR], 6.67; P = .00012), inclusion in a therapeutic trial (OR, 8.46; P = .0013), and a positive HER2 status (OR, 3.02; P = .063 [statistically significant]). DISCUSSION This study provides a brief overview of the population most likely to experience a delay in the initiation of their adjuvant chemotherapy after cancer surgery. Our findings should assist interventions during initial management.
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Affiliation(s)
- C Meyer
- Pôle de Chirurgie, Institut Universitaire du Sein et de Cancérologie Gynécologique.
| | | | - E Chamorey
- Département d'Epidémiologie, de Biostatistiques et des Données de Santé
| | - R Schiappa
- Département d'Epidémiologie, de Biostatistiques et des Données de Santé
| | - Y Delpech
- Pôle de Chirurgie, Institut Universitaire du Sein et de Cancérologie Gynécologique
| | - M Dejode
- Pôle de Chirurgie, Institut Universitaire du Sein et de Cancérologie Gynécologique
| | - Y Fouché
- Pôle de Chirurgie, Institut Universitaire du Sein et de Cancérologie Gynécologique
| | - J Haudebourg
- Laboratoire d'Anatomopathologie, Centre Antoine Lacassagne, Nice, France
| | - E Barranger
- Pôle de Chirurgie, Institut Universitaire du Sein et de Cancérologie Gynécologique
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Okines AFC, Kipps E, Irfan T, Coakley M, Angelis V, Asare B, Mohammed K, Walsh G, Ring A, Johnston SRD, Parton M, Turner NC, Smith IE. Impact of timing of adjuvant chemothapy for early breast cancer: the Royal Marsden Hospital experience. Br J Cancer 2021; 125:299-304. [PMID: 34017085 DOI: 10.1038/s41416-021-01428-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 03/23/2021] [Accepted: 04/28/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The optimal time to deliver adjuvant chemotherapy has not been defined. METHODS A retrospective study of consecutive patients receiving adjuvant anthracycline and/or taxane 1993-2010. Primary endpoint included 5-year disease-free survival (DFS) in patients commencing chemotherapy <31 versus ≥31 days after surgery. Secondary endpoints included 5-year overall survival (OS) and sub-group analysis by receptor status. RESULTS We identified 2003 eligible patients: 1102 commenced chemotherapy <31 days and 901 ≥31 days after surgery. After a median follow-up of 115 months, there was no difference in 5-year DFS rate with chemotherapy <31 compared to ≥31 days after surgery in the overall population (81 versus 82% hazard ratio (HR) 1.15, 95% confidence interval (95% CI) 0.92-1.43, p = 0.230). The 5-year OS rate was similar in patients who received chemotherapy <31 or ≥31 days after surgery (90 versus 91%, (HR 1.21, 95% CI 0.89-1.64, p = 0.228). For 250 patients with triple-negative breast cancer OS was significantly worse in patients who received chemotherapy ≥31 versus <31 days (HR = 2.18, 95% CI 1.11-4.30, p = 0.02). DISCUSSION Although adjuvant chemotherapy ≥31 days after surgery did not affect DFS or OS in the whole study population, in TN patients, chemotherapy ≥31 days after surgery significantly reduced 5-year OS; therefore, delays beyond 30 days in this sub-group should be avoided.
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Affiliation(s)
| | - Emma Kipps
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Tazia Irfan
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Maria Coakley
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | - Bernice Asare
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Kabir Mohammed
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Geraldine Walsh
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Alistair Ring
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | - Marina Parton
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | - Ian E Smith
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
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Vrdoljak E, Balja MP, Marušić Z, Avirović M, Blažičević V, Tomasović Č, Čerina D, Bajić Ž, Miše BP, Lovasić IB, Flam J, Tomić S. COVID-19 Pandemic Effects on Breast Cancer Diagnosis in Croatia: A Population- and Registry-Based Study. Oncologist 2021; 26:e1156-e1160. [PMID: 33856084 PMCID: PMC8250475 DOI: 10.1002/onco.13791] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/02/2021] [Indexed: 12/31/2022] Open
Abstract
Background Our objective was to assess the effects of COVID‐19 antiepidemic measures and subsequent changes in the function of the health care system on the number of newly diagnosed breast cancers in the Republic of Croatia. Subjects, Materials, and Methods We performed a retrospective, population‐ and registry‐based study during 2020. The comparator was the number of patients newly diagnosed with breast cancer during 2017, 2018, and 2019. The outcome was the change in number of newly diagnosed breast cancer cases. Results The average monthly percent change after the initial lockdown measures were introduced was −11.0% (95% confidence interval − 22.0% to 1.5%), resulting in a 24% reduction of the newly diagnosed breast cancer cases in Croatia during April, May, and June compared with the same period of 2019. However, during 2020, only 1% fewer new cases were detected than in 2019, or 6% fewer than what would be expected based on the linear trend during 2017–2019. Conclusion It seems that national health care system measures for controlling the spread of COVID‐19 had a detrimental effect on the number of newly diagnosed breast cancer cases in Croatia during the first lockdown. As it is not plausible to expect an epidemiological change to occur at the same time, this may result in later diagnosis, later initiation of treatment, and less favorable outcomes in the future. However, the effect weakened after the first lockdown and COVID‐19 control measures were relaxed, and it has not reoccurred during the second COVID‐19 wave. Although the COVID‐19 lockdown affected the number of newly diagnosed breast cancers, the oncology health care system has shown resilience and compensated for these effects by the end of 2020. Implications for Practice It is possible to compensate for the adverse effects of COVID‐19 pandemic control measures on breast cancer diagnosis relatively promptly, and it is of crucial importance to do it as soon as possible. Moreover, as shown by this study's results on the number of newly diagnosed breast cancer cases during the second wave of the pandemic, these adverse effects are preventable to a non‐negligible extent. This article assesses the effects of COVID‐19 on the number of newly diagnosed breast cancer patients in the Republic of Croatia.
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Affiliation(s)
- Eduard Vrdoljak
- Department of Oncology, Clinical Hospital Centre Split, School of Medicine, University of Split, Split, Croatia
| | - Melita Perić Balja
- Department of Pathology, Clinical Hospital Centre Sisters of Mercy, Zagreb, Croatia
| | - Zlatko Marušić
- Department of Pathology, Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Manuela Avirović
- Department of Pathology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | | | - Čedna Tomasović
- Department of Pathology, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Dora Čerina
- Department of Oncology, Clinical Hospital Centre Split, School of Medicine, University of Split, Split, Croatia
| | - Žarko Bajić
- Research unit "Dr. Mirko Grmek," University Psychiatric Hospital "Sveti Ivan," Zagreb, Croatia
| | - Branka Petrić Miše
- Department of Oncology, Clinical Hospital Centre Split, School of Medicine, University of Split, Split, Croatia
| | | | - Josipa Flam
- Department of Oncology, Clinical Hospital Centre Osijek, Osijek, Croatia
| | - Snježana Tomić
- Department of Pathology, University Hospital of Split, Split, Croatia
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Al Sawalhi S, Gysling S, Cai H, Zhao L, Alhadidi H, Al Rimawi D, Vannucci J, Caruana EJ, Gonzalez-Rivas D, Zhao D. Uniportal video-assisted versus open pneumonectomy: a propensity score-matched comparative analysis with short-term outcomes. Gen Thorac Cardiovasc Surg 2021; 69:1291-1302. [PMID: 33895938 DOI: 10.1007/s11748-021-01626-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Uniportal (U-VATS) pneumonectomy in lung cancer patients remains disputed in terms of oncological outcomes, and has not been compared to open approaches previously. We evaluated U-VATS versus open pneumonectomy at a high-volume centre. METHODS Patients undergoing pneumonectomy for lung cancer between 2014 and 2018 were retrospectively reviewed and divided into two groups based on surgical approach. Propensity-score matching was performed (1:1), and intention-to-treat analysis applied. Overall survival, operative time, intraoperative blood loss, hospital-stay and readmission, pain, time to adjuvant therapy, morbidity and mortality were tested. Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc. NC) RESULTS: 341 patients underwent pneumonectomy; 23 patients with small-cell lung cancer were excluded, thus 318 patients were submitted to surgery by either U-VATS (n = 54) or open (n = 264). After matching, 52 patients were selected from each group. Five patients (9.2%) in the uniportal group required conversion. There was no significant difference in intraoperative outcomes, complication rates, readmission rates or mortality. The U-VATS group experienced significantly shorter hospital stay (mean ± SD; 6.7 ± 2.7 vs 9.1 ± 2.3 days, p < 0.001) and reported less pain postoperatively (p < 0.0001). Adjuvant chemotherapy was initiated sooner after U-VATS (38.1 ± 8.4 vs 50.8 ± 11.5 days, p < 0.0001). Overall survival appeared to be superior in U-VATS when pathology stage was aligned (p = 0.001). CONCLUSIONS Uniportal VATS is a safe and effective alternative approach to open surgery for pneumonectomy in lung cancer. Complications and oncologic outcomes were comparatively similar. U-VATS showed lower postoperative pain, shorter hospital stay and superior overall survival. The study is a preliminary analysis.
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Affiliation(s)
- Samer Al Sawalhi
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, Shanghai, 200433, China
| | - Savannah Gysling
- Foundation Programme, University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | - Haomin Cai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, Shanghai, 200433, China
| | - Lantao Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, Shanghai, 200433, China
| | - Hani Alhadidi
- Department of Thoracic Surgery, King Hussein Medical Center, Amman, Jordan
| | - Dalia Al Rimawi
- Department of Biostatistics and Research Unit, King Hussein Cancer Center, Amman, Jordan
| | - Jacopo Vannucci
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, Shanghai, 200433, China
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, Rome, Italy
| | - Edward J Caruana
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, Shanghai, 200433, China
- Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, Shanghai, 200433, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, Shanghai, 200433, China.
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Maxwell C, Alavifard S, Warner E, Barrera M, Brezden-Masley C, Colapinto N, Kassirian S, Madarnas Y, Srikala S, Tozer R, Yu J, Nulman I. Neurocognitive outcomes following fetal exposure to chemotherapy for gestational breast cancer: A Canadian multi-center cohort study. Breast 2021; 58:34-41. [PMID: 33901920 PMCID: PMC8099599 DOI: 10.1016/j.breast.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022] Open
Abstract
Background Limited knowledge exists on outcomes of children exposed prenatally to chemotherapy for breast cancer (BC). The purpose of this study was to compare long-term neurocognitive, behavioral, developmental, growth, and health outcomes of children exposed in-utero to chemotherapy for BC. Methods This is a multi-center matched cross-sectional cohort study involving seven cancer centers across the region of Southern Ontario (Canada), and the Hospital for Sick Children (Toronto, Ontario). Using standardized psychological and behavioral tests, we compared cognitive and behavioral outcomes in children exposed to chemotherapy during pregnancy for BC to age-matched pairs exposed to known non-teratogens. Results We recruited 17 parent-child pairs and their matched controls. There were more preterm deliveries in the chemotherapy-exposed group compared to controls (p < 0.05). Full Scale IQ of children in the chemotherapy group was significantly confounded by maternal IQ and prematurity. Exposed children born at term were not different in cognitive outcomes. Children from both groups were similar in their developmental milestones, pediatric anthropometric measurements and health problems. There were no cases of autoimmune cytopenia. Conclusions This is the first Canadian prospective comparative study designed to assess pediatric cognition following prenatal exposure to chemotherapy for BC. Chemotherapy was not found to be neurotoxic in this cohort and did not affect pediatric health. The decision to plan a preterm birth for initiating or continuing chemotherapy treatment must be taken into consideration in context of pediatric implications. While these results may assist in such decision making, replication with a larger sample is needed for more conclusive findings.
Limited knowledge exists on outcomes of children exposed prenatally to chemotherapy for breast cancer (BC). We compared cognitive and behavioral outcomes in children exposed to chemotherapy during pregnancy for BC to controls. FSIQ of children in the chemotherapy group was significantly confounded by prematurity. Chemotherapy was not found to be neurotoxic and did not affect pediatric health. Pediatric implications of planned preterm birth for further treatment should be considered.
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Affiliation(s)
- Cynthia Maxwell
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada; Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada.
| | - Sepand Alavifard
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Ellen Warner
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
| | - Maru Barrera
- Department of Psychology, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
| | - Christine Brezden-Masley
- Medical Oncology, Mount Sinai Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Shima Kassirian
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Yolanda Madarnas
- Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Sridhar Srikala
- Medical Oncology, Princess Margaret Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Richard Tozer
- Department of Medicine, Juravinski Cancer Centre, Hamilton Health Sciences Centre, Hamilton, ON, Canada.
| | - Joanne Yu
- Medical Oncology, North York General Hospital, Toronto, ON, Canada.
| | - Irena Nulman
- CHES, Research Institute, The Hospital for Sick Children, Toronto, Toronto, ON, Canada.
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Synthetic lethality-mediated precision oncology via the tumor transcriptome. Cell 2021; 184:2487-2502.e13. [PMID: 33857424 DOI: 10.1016/j.cell.2021.03.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/29/2020] [Accepted: 03/12/2021] [Indexed: 01/27/2023]
Abstract
Precision oncology has made significant advances, mainly by targeting actionable mutations in cancer driver genes. Aiming to expand treatment opportunities, recent studies have begun to explore the utility of tumor transcriptome to guide patient treatment. Here, we introduce SELECT (synthetic lethality and rescue-mediated precision oncology via the transcriptome), a precision oncology framework harnessing genetic interactions to predict patient response to cancer therapy from the tumor transcriptome. SELECT is tested on a broad collection of 35 published targeted and immunotherapy clinical trials from 10 different cancer types. It is predictive of patients' response in 80% of these clinical trials and in the recent multi-arm WINTHER trial. The predictive signatures and the code are made publicly available for academic use, laying a basis for future prospective clinical studies.
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Syed A, Kumari G, Kapoor A, Chaitanya S, Sharda P, Chaudhary M, Deori A, Gupta P, Choudhary N, Rao S, Ravi B. Impact of COVID-19 On Breast Cancer Management: A Radiological Prespective from A Tertiary Centre. Eur J Breast Health 2021; 17:180-187. [PMID: 33870119 DOI: 10.4274/ejbh.galenos.2021.6379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/06/2021] [Indexed: 12/23/2022]
Abstract
Objective The coronavirus-2019 (COVID-19) pandemic caused delaying breast cancer management, increasing time interval in chemotherapy cycles and surgery. This has implications on radiological manifestation of cancer. Further, we evaluated changes observed in mammography. Materials and Methods This case control study was conducted from March 25th, 2020 to August 15th, 2020 at the Integrated Breast Care Centre, All India Institute of Medical Science Rishikesh (AIIMS), Rishikesh. Sonomammography was performed on follow-up patients who were on chemotherapy and were scheduled for surgery. Moreover, duration of delay from the last neoadjuvant chemotherapy (NACT) cycle was recorded. Similar data in the pre-COVID-19 period from November 4th, 2019 to March 24th, 2020 was compared with post-COVID-19 data and was analyzed by SPSS Version 23. Results The study included 54 patients who presented between March 25th, 2020 and August 15th, 2020. Furthermore, the delay in NACT cycles has been shown to be associated with disease progression (p = 0.045). Subgroup analysis of treatment duration with various parameters revealed significant correlation between size, appearance of ulceration, and response evaluation (p<0.05). However, no significant association was found between duration of delay and the histological subtype of lesion (p>0.05). A substantial difference was seen in the evaluation of NACT response in pre- and post-COVID-19 time, with partial response (n = 39, 58.24%) seen as the most common response in pre-COVID-19 time and progressive disease (n = 28, 51.9%) as the most common response in post-COVID-19 time (p<0.001). Conclusion The coronavirus pandemic has severe impact on breast cancer management. A delay in NACT causes progression in cancer. This can be seen in ultrasound and mammogram.
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Affiliation(s)
- Anjum Syed
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
| | - Gangotri Kumari
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
| | - Aakriti Kapoor
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
| | - Satish Chaitanya
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
| | - Prateek Sharda
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
| | - Mriganki Chaudhary
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
| | - Ananya Deori
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
| | - Priyanka Gupta
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
| | - Nilotpal Choudhary
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
| | - Shalinee Rao
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
| | - Bina Ravi
- Department of Radiodiagnosis, All India Institute of Medical Science Rishikesh, Rishikesh, India
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Kubo K, Takei H, Hamahata A. Rhomboid Flap Reconstruction after Mastectomy for Locally Advanced Breast Cancer. J NIPPON MED SCH 2021; 88:63-70. [DOI: 10.1272/jnms.jnms.2021_88-204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kazuyuki Kubo
- Division of Breast Surgery, Saitama Cancer Center
- Department of Breast Surgery and Oncology, Nippon Medical School
| | - Hiroyuki Takei
- Department of Breast Surgery and Oncology, Nippon Medical School
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Wang W, Guo B, Cui C, Sun T, Liu S. Management of early-stage breast cancer patients during the coronavirus disease 2019 (COVID-19) pandemic: The experience in China from a surgical standpoint. J Cancer 2021; 12:2190-2198. [PMID: 33758597 PMCID: PMC7974893 DOI: 10.7150/jca.50501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/03/2021] [Indexed: 12/30/2022] Open
Abstract
Breast cancer is the most common malignant tumor in women globally. Currently, due to limited data, there are no international guidelines for addressing the management of a large group of patients during infectious disease pandemics. Coronavirus disease 2019 (COVID-19), declared as a pandemic by the World Health Organization (WHO), has rapidly spread globally. The COVID-19 pandemic changed our daily routines and forced us to rethink the management of breast cancer patients. Clinicians need to take into account multiple factors such as the timing and delivery of cancer care, epidemic prevention and control, and the allocation of medical resources. Determining ways to reasonably adjust the treatment strategy is a real challenge. In this review, we aim to discuss particular challenges associated with managing breast cancer patients during the COVID-19 pandemic, share experience from Chinese oncologists and surgeons and propose some practical approaches to the management of early-stage breast cancer patients from a surgical standpoint.
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Affiliation(s)
- Wan Wang
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Baoliang Guo
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Street, Harbin 150001, China
| | - Chunguo Cui
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Tong Sun
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
| | - Shengnan Liu
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun 130033, China
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