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For residual N1 nodal disease following neoadjuvant chemotherapy (NAC) for patients with breast cancer, the optimal local therapy for axilla is an evolving area. We analyzed the long-term results of these patients according to axillary surgical methods using propensity score matching (PSM) to clarify whether omission of axillary lymph node dissection (ALND) is oncologically safe. This was a single institution retrospective study of patients with ypN1 from Asan Medical Center (AMC). We included 324 patients who had undergone axillary surgery with either sentinel lymph node biopsy (SLNB) only or ALND. The patients received NAC at AMC between 2008 and 2013. General indications for ALND included prominent nodes detected clinically before NAC, evident macrometastasis on multiple nodes during SLNB. Patients who had either micrometastasis or macrometastasis in 1 or 2 node(s) were included. SLNB was performed for patients with good responders to NAC with limited nodal burden. Patients were matched for baseline characteristics. After matching, we included 98 patients in each SLNB only group and ALND group respectively. We compared axillary recurrence-free survival (ARFS), distant metastasis-free survival (DMFS), overall survival (OS), and breast cancer-free survival (BCSS) according to the surgical method. The median follow-up period was 71 months. Univariate and multivariate analyses revealed no statistically significant differences between the two groups for ARFS, DMFS, OS, and BCSS. After the propensity score matching, no significant statistical differences were observed in 5-year ARFS, DMFS, OS, and BCSS between the SLNB only group and ALND group. SLNB might be a possible option for ALND in patients with breast cancer who have limited axillary node metastasis after NAC without compromising survival outcomes.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)-based serum N -glycan analysis has gained acknowledgment for the diagnosis of breast cancer in recent years. In this study, the possibilities of expanding its application for breast cancer management and surveillance were discovered and evaluated. First, a novel MALDI-TOF platform, IDsys RT, was confirmed to be effective for breast cancer analysis, showing a maximum area under the curve of 0.91. Multiple N -glycan markers were identified and validated using this process, and they were found to be applicable for differentiating recurring breast cancer samples from healthy control or ordinary breast cancer samples. Recurrence samples were especially distinct from non-recurrence samples when N -glycan signatures were sampled in multiple time points and monitored via MALDI-TOF, throughout the therapy. These results suggested the feasibility of MALDI-TOF-based N -glycan analysis for tracking the molecular signatures of breast cancer and predicting recurrence.

We used 3D printed-breast surgical guides (3DP-BSG) to designate the original tumor area from the pre-treatment magnetic resonance imaging (MRI) during breast-conserving surgery (BCS) in breast cancer patients who received neoadjuvant systemic therapy (NST). Targeting the original tumor area in such patients using conventional localization techniques is difficult. For precise BCS, a method that marks the tumor area found on MRI directly to the breast is needed. In this prospective study, patients were enrolled for BCS after receiving NST. Partial resection was performed using a prone/supine MRI-based 3DP-BSG. Frozen biopsies were analyzed to confirm clear tumor margins. The tumor characteristics, pathologic results, resection margins, and the distance between the tumor and margin were analyzed. Thirty-nine patients were enrolled with 3DP-BSG for BCS. The median nearest distance between the tumor and the resection margin was 3.9 cm (range 1.2–7.8 cm). Frozen sections showed positive margins in 4/39 (10.3%) patients. Three had invasive cancers, and one had carcinoma in situ; all underwent additional resection. Final pathology revealed clear margins. After 3-year surveillance, 3/39 patients had recurrent breast cancer. With 3DP-BSG for BCS in breast cancer patients receiving NST, the original tumor area can be identified and marked directly on the breast, which is useful for surgery. Trial Registration : Clinical Research Information Service (CRIS) Identifier Number: KCT0002272. First registration number and date: No. 1 (27/04/2016).

We investigated the safety and performance of the Da Vinci SP single-port robot (SP robot) in nipple-sparing mastectomy (NSM) with immediate reconstruction. Medical records of 60 women aged ≥ 19 years who had undergone SP robot-assisted unilateral or bilateral NSM with immediate reconstruction between October 2020 and August 2021 were retrospectively analyzed. Stage I (31, 47.1%) was the most common pathological tumor-node-metastasis stage, followed by stages II (22, 33.3%), 0 (7, 10.6%), and III (4, 6.0%). The median total duration of NSM performed by a breast surgeon and reconstruction performed by a plastic surgeon was 154.0 min (interquartile range [IQR], 130.5–206.0 min) and 133.0 min (IQR, 80.0–255.0 min), respectively. The median length of hospitalization was 5.5 days (IQR, 3.0–9.0 days). Conversion to robotic multiport or open surgery was not required in any case. The median duration to drain removal was 5.0 days (IQR, 4.0–6.0 days). Recurrence of cancer within 6 months was not observed in any patient. SP robot-assisted NSM with immediate reconstruction was performed successfully in all patients without conversion to open surgery or the incidence of significant perioperative complications, indicating its precision and ability to minimize the size of the surgical incision.

This study evaluated the prognostic impact of residual cancer burden (RCB) on breast cancer subtypes following neoadjuvant chemotherapy (NAC). We retrospectively examined 2,416 breast cancer patients treated with NAC and surgery at Asan Medical Center (2015–2020). Baseline characteristics, clinicopathological parameters, recurrence, and survival outcomes were analyzed using Kaplan-Meier and Cox regression methods to assess RCB’s prognostic significance across subtypes. Pathologic complete response (pCR) was achieved in 25.6% (619) of patients. RCB2 was the most common (44.0%, 1,063), followed by RCB3 (19.6%, 474) and RCB1 (10.8%, 260). Among HR-/HER2 + patients, 67% had RCB0/1, while 87% of HR+/HER2- patients had RCB2/3. Higher RCB was significantly associated with worse overall survival (OS) and disease-free survival (DFS) across all subtypes. Subtype-specific analysis revealed that HR-/HER2 + patients with RCB3 and HR-/HER2- patients with RCB2/3 had significantly worse OS and DFS. Multivariate analysis revealed that RCB2/3 (vs. RCB0), total mastectomy (vs. breast-conserving surgery), axillary lymph node dissection (ALND), lymphovascular invasion (LVI), high Ki-67 index (≥ 20), HR negativity, and HER2 negativity were linked to higher risks of recurrence and death ( p  < 0.05). Factors associated with higher RCB included ALND, LVI, higher Ki-67, and HR+/HER2- subtype. RCB classification is a strong prognostic indicator across all subtypes. Patients with RCB2/3 in the HR-/HER2- and RCB3 in the HR-/HER2 + subtypes had particularly poor outcomes, suggesting benefits from additional treatments beyond standard care.

Axillary lymph node dissection (ALND) omission improves quality of life but is only considered under certain conditions. We investigated expanding these conditions in patients receiving neoadjuvant chemotherapy (NAC) for clinical N2–3, pathological N0 breast cancer. We retrospectively reviewed data of 1346 patients with clinical N2–3, M0, who underwent surgical resection (sentinel lymph node biopsy [SLNB] only, or level I–II ALND with/without SLNB) following NAC from January 2008 to December 2021. Univariate and multivariate analyses of overall (OS), disease-free (DFS), regional recurrence-free (RFS), and axillary recurrence-free survival (ARFS) were performed before and after propensity score matching (PSM) to control for confounding factors. Of the total patients, 521 (37.5%) achieved an axillary pathological complete response (ypN0). Of these, 293 (56.2%) underwent SLNB only. The median OS was 52.7 months. After PSM, SLNB-only and ALND groups showed no significant differences in ARFS (long-rank p = 0.765), RFS (long-rank p = 0.764), DFS (long-rank p = 0.186), and OS (long-rank p = 0.760). The 5-year ARFS (97.3 vs. 96.7%) and OS (97.7 vs. 97.3%) of both groups did not differ significantly. ALND omission after NAC in clinical N2-3, pathological N0 patients was not inferior to ALND,. Clinical N2-3 patients achieving ypN0 following NAC may be safely treated with SLNB alone.

This study aimed to investigate the clinical importance and prognostic value of nonmass lesions (NMLs) identified via preoperative magnetic resonance imaging (MRI) in patients with breast cancer, with an emphasis on understanding how these lesions affect treatment decisions and survival outcomes. A retrospective analysis was conducted on 6971 patients diagnosed with breast cancer who underwent surgery at Asan Medical Center, Seoul, between January 2000 and December 2021. Patients were categorized based on the presence or absence of NMLs on preoperative MRI. Various clinicopathological parameters were compared, and survival outcomes, such as overall survival (OS), distant metastasis-free survival (DMFS), regional recurrence-free survival (RFS), and local recurrence-free survival (LFS), were analyzed using Kaplan–Meier and Cox regression methods. Subgroup analyses were performed based on the type of surgery and the administration of neoadjuvant chemotherapy and adjuvant radiation therapy. Of the total cohort, 21.9% ( n  = 1524) had NMLs. The presence of NMLs was associated with a significant improvement in OS ( P  = 0.017) for the entire patient group. Multivariate analysis revealed the presence of NMLs as a favorable prognostic factor (hazard ratio 0.47, 95% confidence intervals 0.25–0.90, P  = 0.022). Subgroup analyses demonstrated significantly improved OS, DMFS, and RFS outcomes for patients with NMLs who underwent mastectomy after neoadjuvant chemotherapy. NMLs on preoperative MRI in patients with breast cancer are associated with improved overall survival (OS) and serve as an independent prognostic factor. However, further research is needed to elucidate the underlying reasons for these outcomes.

The aim of this study was to evaluate the chronological changes over 14 years in the survival of Korean patients with breast cancer. We also sought to investigate the factors that may have influenced the changes in survival rate. We retrospectively analyzed 17,776 breast cancer patients who were treated at Asan Medical Center between January 2000 and December 2013. Patient information was collected from the Asan database, including age at diagnosis, clinical manifestation, pathology report, types of treatment and modality, types of recurrence, and follow-up period. We classified the patients into two cohorts according to the year of their surgery (P1: 2000-2007 and P2: 2008-2013) and compared survival and recurrence between both cohorts. We observed that patients treated more recently had better survival outcomes. The 5-year breast cancer-specific survival increased from 94.0% in P1 to 96.6% in P2 (p<0.001), and the 5-year disease-free survival increased from 87.9% in P1 to 91.2% in P2 (p<0.001). When analyzed by type of recurrence, distant metastasis-free survival increased to a significant degree. In subgroup analysis by the subtypes of breast cancer, the survival rates improved in all of the subtypes except triple negative breast cancer, and the improvement was more prominent in subtypes with overexpressed human epidermal growth factor receptor 2. This study showed improvement in breast cancer survival over the succeeding years, which is consistent with the advancement in systemic therapy.

Progesterone-induced blocking factor 1 (PIBF1) is linked to pregnancy-induced immunity and tumor evasion of maternal immunity. PIBF1 is overexpressed in several cancers, including breast, cervical, and lymphoma. However, limited research is available on the role of PIBF1 in breast cancer and its clinical outcomes. Therefore, we investigated the relationship between PIBF1 expression, prognosis, and its impact on chemotherapy response. Samples from 231 patients with high-risk triple-negative breast cancer (TNBC) who underwent surgery between 2008 and 2013 with lymph node metastasis and underwent taxane-based adjuvant chemotherapy were collected. Additionally, 238 non-TNBC patients matched to TNBC patients were selected. Immunohistochemical detection of the PIBF1 protein in tissues was conducted using a cut-off value of 3 (intensity plus proportion). Kaplan–Meier survival analysis assessed the probability of overall survival (OS). Using the clonogenic unit assay and knockdown methodologies in breast cancer cell lines, we examined the correlation between PIF1 expression and chemosensitivity. In a study of 469 patients with breast cancer, non-TNBC (n = 238) and TNBC (n = 231), those with PIBF1 expression manifested a lower histologic grade ( p  < 0.001), reduced p53 ( p  < 0.001) and decreased Ki-67 ( p  < 0.001) compared with their non-expressing counterparts. A significant difference in OS for patients with PIBF1 was observed, with non-TNBC patients showing superior outcomes. PIBF1 expression showed a relation with a better prognosis, and the statistical significance was borderline (hazard ratio = 0.44, 95% confidence interval = 0.18–1.11, p  = 0.082). A correlation between PIBF1 expression in breast cancer cell lines (BT549, HCC70, BT20, and HS578T) and their sensitivity to paclitaxel was shown in vitro, with certain cell lines showing significant viability reductions and also resisting the treatment after PIBF1 knockdown. We observed a correlation between PIBF1 expression and improved prognosis in breast cancer patients with nodal metastasis undergo taxane-based chemotherapy, particularly in the non-TNBC cohort. We discerned a relationship between PIBF1 and chemosensitivity in our in vitro studies. These findings suggest the potential usefulness of PIBF1 as a predictive marker for guiding therapeutic approaches.