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INTRODUCTION: Triple-negative (TN) breast cancer represents one third of pregnancy-associated breast cancers (PABC). The aims of the current study were to describe oncological and obstetrical outcomes of patients with TN-PABC and to compare their prognosis with TN-non-PABC patients using a propensity score. MATERIALS AND METHODS: Between January 2005 and December 2020, data of patients with histologically proven TN-PABC were collected and compared with data of TN-non-PABC patients under the age of 46 years diagnosed during the same period using a propensity score (PS). RESULTS: After PS matching (tumor size and lymph node involvement),there were 59 patients in each group. The median follow-up was 14 months (IQR 4.8-40.1) for the TN-PABC group and 60 months (IQR 30.7-101.4) for the TN-non-PABC group. Eight recurrences occurred in the TN-PABC group and 10 in the TN-non-PABC group (adjusted OR (AOR) = 0.60 (0.21-1.60), HR (Cox adjusted model- AHR) = 1.25 (0.53-2.94)). Two patients died in the TN-PABC group, and six in the TN-non-PABC group with an AOR = 0.23 (0.03-1.01) and an AHR = 0.58 (0.12-2.69). All the patients diagnosed during the second (n = 17) and third trimesters (n = 28) continued their pregnancies, with a median term at delivery of 38 WG (IQR 36-39). All patients gave birth to healthy newborns. CONCLUSION: Although the TN subtype is associated with poor prognosis in pregnant patients due to advanced stage at diagnosis and high lymph node involvement, our PS-matched case-control study showed that pregnancy per se does not worsen the prognosis in terms of recurrence-free and overall survival.
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Neoplasias de la Mama , Complicaciones Neoplásicas del Embarazo , Neoplasias de la Mama Triple Negativas , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Embarazo , Pronóstico , Puntaje de PropensiónRESUMEN
INTRODUCTION: The prevalence of pregnancy-associated breast cancer is increasing. HER2-positive breast cancers typically have a poor prognosis. The objective of our study was to compare the prognosis of patients with HER2-positive breast cancer diagnosed during pregnancy (HER2-positive BCP) to young women diagnosed with HER2-positive breast cancer outside of pregnancy (HER2 non-BCP). METHODS: Data of patients managed for invasive breast carcinoma between January 2005 and 2020 were retrospectively collected from the database of Tenon University Hospital (Paris, France), part of the "Cancer lié à la Grossesse" network. RESULTS: Fifty-one patients with HER2-positive BCP were matched on age at diagnosis with 51 HER2-positive non-BCP patients. Locally advanced disease with axillary lymph node involvement were frequent. Tumors were frequently aggressive with high grade (p = 0.57) and high Ki67 (p = 0.15). Among the HER2-positive BCP patients, the mean term at diagnosis was 19.3 week of gestation (WG). Eighty-four percent of the patients continued their pregnancy with a mean term at delivery of 34.2WG. Chemotherapy modalities differed between the two groups: neoadjuvant chemotherapy was more frequent in the HER2-positive BCP group (p = 0.03) and adjuvant chemotherapy more frequent in the HER2 non-BCP group (p = 0.009). The recurrence rate was 10% (n = 5) and 18% (n = 9) in the HER2-positive BCP and HER2 non-BCP groups, respectively, p = 0.25. Breast cancer-free survival was poorer in the HER2-positive BCP group with earlier recurrence, p = 0.008. No difference in type of recurrence was found between the groups (p = 0.58). CONCLUSION: This matched case-control study implies that patients with HER2-positive BCP still have a poorer prognosis than non-pregnant HER-positive patients.
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Neoplasias de la Mama/mortalidad , Quimioterapia Adyuvante/mortalidad , Ganglios Linfáticos/patología , Terapia Neoadyuvante/mortalidad , Complicaciones Neoplásicas del Embarazo/mortalidad , Adulto , Axila , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Estudios de Casos y Controles , Femenino , Francia , Edad Gestacional , Humanos , Clasificación del Tumor , Recurrencia Local de Neoplasia/mortalidad , Embarazo , Complicaciones Neoplásicas del Embarazo/tratamiento farmacológico , Complicaciones Neoplásicas del Embarazo/patología , Resultado del Embarazo , Pronóstico , Receptor ErbB-2/metabolismo , Tasa de SupervivenciaRESUMEN
Aim: We conducted a retrospective analysis in 71 Mexican Mestizo patients to evaluate the breast cancer-free survival (BCFS) among the inferred genetic phenotypes (GP) of CYP2D6. Patients & methods:CYP2D6 was genotyped through Taqman-probe analysis; GP were inferred according to international guidelines. The BCFS was estimated through Kaplan-Meier method and analyzed with a log-rank test; hazard ratios were calculated with 95% CI and p < 0.05. Results: The BCFS did not differ among CYP2D6 GP (p = 0.45) and recurrence risk was similar between gNM + gUM and gPM + gIM groups (hazard ratio: 1.54, 95% CI: 0.37-6.38; p = 0.55). Conclusion: The findings do not support any impact of CYP2D6 on BCFS. Evaluation of other genetic/nongenetic biomarkers is needed in Mexican Mestizo patients under tamoxifen treatment.
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Neoplasias de la Mama/genética , Citocromo P-450 CYP2D6/genética , Adulto , Citocromo P-450 CYP2D6/metabolismo , Supervivencia sin Enfermedad , Etnicidad/genética , Femenino , Estudios de Asociación Genética/métodos , Genotipo , Humanos , Estimación de Kaplan-Meier , México/epidemiología , Persona de Mediana Edad , Fenotipo , Polimorfismo Genético/genética , Estudios Retrospectivos , Tamoxifeno/uso terapéuticoRESUMEN
BACKGROUND: Asians are diagnosed with breast cancer at a younger age than Caucasians are. We studied the effect of age on locoregional recurrence and the survival of Asian breast cancer patients treated with breast-conserving therapy. METHODS: Medical records of 2492 patients treated with breast-conserving therapy between 1989 and 2012 were reviewed. The Kaplan-Meier method was used to estimate locoregional recurrence, breast cancer-free survival, and breast cancer-specific survival rates. These rates were then compared using log-rank tests. Outcomes and age were modeled by Cox proportional hazards. Fractional polynomials were then used to test for non-linear relationships between age and outcomes. RESULTS: Patients ≤ 40 years old were more likely to have locoregional recurrence than were older patients (Hazard ratio [HR] = 2.32, P < 0.001). Locoregional recurrence rates decreased year-on-year by 4% for patients with luminal-type breast cancers, compared with 8% for those with triple-negative cancers. Similarly, breast cancer-free survival rates increased year-on-year by 4% versus 8% for luminal-type and triple-negative cancers, respectively. Breast cancer-specific survival rates increased with age by 5% year-on-year. Both breast cancer-free survival and breast cancer-specific survival rates in patients with luminal cancers exhibited a non-linear ("L-shaped") relationship-where decreasing age at presentation was associated with escalating risks of relapse and death. The influence of age on overall survival was confounded by competing non-cancer deaths in older women, resulting in a "U-shaped" relationship. CONCLUSIONS: Young Asian breast cancer patients have a continuous year-on-year increase in rates of disease relapse and cancer deaths compared with older patients with no apparent threshold.
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Neoplasias de la Mama/cirugía , Mastectomía Segmentaria/métodos , Evaluación de Resultado en la Atención de Salud/métodos , Neoplasias de la Mama Triple Negativas/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Pueblo Asiatico/estadística & datos numéricos , Neoplasias de la Mama/etnología , Neoplasias de la Mama/radioterapia , Terapia Combinada , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Singapur , Neoplasias de la Mama Triple Negativas/etnología , Neoplasias de la Mama Triple Negativas/radioterapia , Adulto JovenRESUMEN
PURPOSE: To compare the prognosis of pregnancy associated breast cancer occurring during pregnancy (BCP) to non-pregnancy associated breast cancers (non-BCP) in young women managed at a national expert center. METHODS: Retrospective cohort study of a prospective database using propensity score matching (PSM) analysis with known prognostic factors. RESULTS: We analyzed data of 49 patients with BCP and 104 with non-BCP diagnosed between 2002 and 2017â¯at Tenon University Hospital (Paris, France). The BCP tumors were often locally advanced (lymph node metastases in 59%), of high grade (55%) and highly proliferative (67% with Ki67â¯≥â¯20%). After PSM, breast cancer-free survival (pâ¯=â¯0.45) and breast cancer specific survival (pâ¯=â¯0.81) were similar in the two groups. The recurrence rate was 12% vs 18% (pâ¯=â¯0.45) and the death rate was 6% vs 8% (pâ¯=â¯0.74) for the BCP and non-BCP groups, respectively. No difference in recurrence type was observed between the groups (pâ¯=â¯0.60). CONCLUSIONS: After PSM for known prognostic factors, the prognosis of BCP patients did not differ from that of young patients with non-BCP.
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Neoplasias de la Mama/mortalidad , Complicaciones Neoplásicas del Embarazo/mortalidad , Adulto , Neoplasias de la Mama/patología , Bases de Datos Factuales , Femenino , Francia , Humanos , Metástasis Linfática , Recurrencia Local de Neoplasia/mortalidad , Embarazo , Complicaciones Neoplásicas del Embarazo/patología , Pronóstico , Puntaje de Propensión , Estudios Prospectivos , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Discretization of continuous variables is a common practice in medical research to identify risk patient groups. This work compares the performance of gold-standard categorization procedures (TNM+A protocol) with that of three supervised discretization methods from Machine Learning (CAIM, ChiM and DTree) in the stratification of patients with breast cancer. The performance for the discretization algorithms was evaluated based on the results obtained after applying standard survival analysis procedures such as Kaplan-Meier curves, Cox regression and predictive modelling. The results show that the application of alternative discretization algorithms could lead the clinicians to get valuable information for the diagnosis and outcome of the disease. Patient data were collected from the Medical Oncology Service of the Hospital Clínico Universitario (Málaga, Spain) considering a follow up period from 1982 to 2008.