Multi-gene panel testing has provided new strategies and approaches for adjuvant therapy in early breast cancer. With continuous development and application of genomic technologies， multi-gene panel testing plays an increasingly important role in prognosis evaluation， efficacy prediction， and treatment decisionmaking in early breast cancer. Currently， multi-gene panel testing has shown a significant value in chemotherapy decision-making， extended endocrine therapy， and adjuvant radiotherapy decision-making for hormonal receptor positive and HER-2 negative （HR＋/HER-2-） breast cancer， and potentials in neoadjuvant therapy for triple negative breast cancer. Some explorative studies are conducted in HER-2-positive breast cancer， but its value still needs further confirmation. This article reviewed the application of multi-gene panel testing tools clinically used in individualized adjuvant therapy for early breast cancer， providing a reference for clinical practice.
To explore the optimal treatment strategy for patients diagnosed with fibroepithelial tumor （FT） through core-needle biopsy （CNB）.
Methods
A retrospective analysis was conducted on clinical data of 783 patients diagnosed with FT via CNB in the Department of Breast Surgery，Peking University International Hospital from January 2017 to May 2023. Patients were divided into two groups based on clinical management： the surgery group with 657 patients （83.9%） and the follow-up group with 126 patients （16.1%）. Clinical and ultrasound characteristics were compared between the two groups， and the relationship between postoperative pathology and clinical features in the surgery group， and the natural progression and influencing factors in the follow-up group， were evaluated. Independent sample t-test was used to compare age between groups， and variance analysis was used for multiple group comparisons with LSD-t tests for post-hoc pairwise comparisons. The maximum lesion diameter was compared between two groups using Mann-Whitney U test， between multiple groups using Kruskal-Wallis H test， followed by Dunn-Bonferroni tests for pairwise comparisons. Group comparisons of clinical and ultrasound characteristics were conducted using the chi-square test or Fisher’s exact test， with pairwise comparisons using Bonferroni correction.
Results
There were statistically significant differences in age （t＝7.106，P＜0.001） and family history of breast cancer （χ2 ＝4.581， P＝0.032） between the surgery group and follow-up group. In ultrasound characteristics， significant differences were found in the cases with lesion irregularity （χ2 ＝12.127， P＜0.001） and BI-RADS grade ≥4B（χ2 ＝35.116， P＜0.001） between the two groups. Postoperative pathology in the surgery group revealed 559 cases （85.1%） of fibroadenoma， 84 cases （12.8%） of benign phyllodes tumor （PT）， and 14 cases （2.1%）of non-benign PT. The pathological type of the lesion was associated with palpable masses （χ2 ＝9.252，P＝0.010） and maximum lesion diameter （ultrasound： H ＝9.267， P ＜0.001； pathology： H ＝8.421，P＜0.001）. In the follow-up group， 83 patients （65.9%） had stable lesions， while 43 patients （34.1%）showed an increase in maximum lesion diameter. Older patients （≥40 years） were more likely to have stable lesions （χ2 ＝4.948， P ＝0.026）. All 11 patients who underwent surgery during the follow-up were diagnosed with benign lesions.
Conclusions
Most of the CNB-diagnosed FT patients can avoid unnecessary surgery through outpatient follow-up. Surgery is a reasonable option for patients with lesions which were larger than 3 cm， symptomatic， rapidly growing， or classified as BI-RADS grade ≥4B.
To evaluate the impact of modified radical mastectomy combined with latissimus dorsi muscle repositioning on postoperative drainage， flap perfusion， and tube removal time in breast cancer patients.
Methods
A retrospective analysis was conducted on the clinical data of 375 primary breast cancer patients who underwent modified radical mastectomy in the Fourth Hospital of Hebei Medical University between January 2021 and December 2022. Patients were divided into experimental group （modified radical mastectomy combined with intraoperative latissimus dorsi muscle repositioning） and control group （conventional modified radical mastectomy） based on whether latissimus dorsi muscle repositioning was performed during surgery. The blood flow， color and necrosis of the flap were observed and the postoperative drainage volume was measured daily after surgery. At 6 months after surgery， the patients were surveyed using the Quality of Life Questionnaire-Breast Cancer 23 （QLQ-BR23）. Postoperative drainage volume and QLQ-BR23 scores were continuous variables and expressed as ±s. Between-group comparisons were made using repeated measures ANOVA and t test. Flap perfusion and baseline clinical characteristics were count data expressed as frequency（percentage）， and compared between groups using chi-square test. Age and tube removal time， as nonnormally distributed data， were expressed as M （P25， P75） and compared using the Mann-Whitney U test.
Results
There was a statistically significant difference in postoperative drainage volume between the two groups from day 1 to day 4 （F＝20.510， P＜0.001）. Significant differences were also observed within the same group between different time points （F＝2451.157， P＜0.001）， and there was interaction between the surgical method and time （F＝7.437， P＝0.002）. For the drainage volume on each postoperative day （day 1 to day 4）and total drainage volume， the experimental group had significantly lower values compared with the control group （t＝－7.069， －10.714， －10.162， －4.197， 21.226， all P＜0.001）. The experimental group had 5 cases（2.6%） of flap perfusion complications， compared with 17 cases （9.2%） in the control group， suggesting a significant difference between groups （χ2 ＝7.299， P ＝0.007）. The tube removal time was 6 （6， 7） d after operation in the control group and 4 （4， 5） d in the experimental group， with a statistically significant difference between groups （Z＝-11.229， P＜0.001）. Compared with the control group， the experimental group had significantly higher scores in body image of the QLQ-BR23 functional dimension （t ＝－4.556， P＜0.001）and lower scores in breast symptom of the QLQ-BR23 symptom dimension （t＝2.519，P＝0.012）.
Conclusions
The latissimus dorsi muscle repositioning during modified radical mastectomy can reduce postoperative complications and improve the quality of life in breast cancer patients. This technique is simple， effective， and worthy of clinical promotion.
To investigate the potential of FAM91A1 as an independent prognostic factor in breast cancer and explore the mechanism.
Methods
The expression of FAM91A1 in various breast cancer subtypes were obtained from the “TCGA” module of the UALCAN database， and the expression profiles and clinical data of 1101 breast cancer patients were downloaded from the TCGA database. The patients were divided into low expression group （n＝550） and high expression group （n＝551） according to the median value of FAM91A1 expression （37.653）. Using R 4.4.1 software， survival analysis was conducted to compare the OS between breast cancer patients with high and low FAM91A1 expression， and Cox regression analysis was used to find the influencing factors of OS in breast cancer patients. The correlation between FAM91A1 and immune checkpoints was analyzed， and Spearman method was used to analyze the correlation between FAM91A1 and tumor mutation burden. The STRING website and GEPIA2 database were used to construct FAM91A1-related gene dataset. The GO and KEGG enrichment analysis were used to find the FAM91A1 function and related pathways. FAM91A1-related ceRNA network was constructed using the MiRTarbase database and validated with the StarBase database.
Results
There was a statistically significant difference in FAM91A1 mRNA expression between normal control， luminal， HER-2-positive， and triple negative breast cancer patients in the TCGA database （P ＜0.001）.The results of the survival analysis indicated no significant difference in OS between FAM91A1 high expression group and low expression group （HR ＝1.36，95%CI：0.91-2.05，P ＝0.133）. Cox regression analysis revealed that age （HR ＝1.453，95%CI：1.128-1.875，P ＝0.004）， clinical grade （HR ＝1.773， 95%CI：1.125-2.794， P ＝0.014）， M stage （HR ＝2.155， 95% CI：1.365-3.403， P＜0.001）， and FAM91A1 expression （HR ＝1.297， 95%CI：1.031-1.631， P ＝0.026）were independent factor affecting OS in1101 breast cancer patients. The expression of immune checkpoints （LGLEC15， LAG3， PDCD1， HAVCR2，CD274， PDCD1LG2） was significantly different between FAM91A1 expression group and low expression group（all P ＜0.001）. The expression of FAM91A1 was positively correlated with tumor mutation burden （P ＜0.001）. The Gene Ontology （GO） functional enrichment analysis revealed that gene datasets related to FAM91A1 were predominantly enriched in the following metabolic processes （small molecule and lipid metabolism）， cellular components （external encapsulated structures， cellular unit cell edges） and molecular functions （enzyme activator activity， GTPase activator activity， and metallopeptidase activity）. In the KEGG pathway enrichment analysis， the genes related to FAM91A1 were predominantly enriched in the ABC transporter protein pathway，fatty acid metabolism pathway，etc. By the online database，one miRNA （hsa-mir-15a-5p） and seven lncRNAs （LINC01128， ERI3-IT1， FGD5-AS1， LINC02035， TUG1， XIST， ARMCX5-GPRASP2） were identified within the FAM91A1-associated ceRNA network.
Conclusions
FAM91A1 may serve as an independent prognostic factor in breast cancer， exhibiting a strong correlation with immune infiltration， ABC transporter protein pathway and fatty acid metabolism.
Objective To report a preliminary safety profile of abemaciclib in China.
Methods
Totally 102 patients with non-metastatic hormone receptor-positive/HER-2 negative （HR＋/HER-2-）breast cancer who received treatment regimens containing abemaciclib in the First Affiliated Hospital of Nanjing Medical University from January 2021 to April 2023 were continuously enrolled for a retrospective，uncontrolled， single-center study. The adverse event（AE）-related data were acquired via the follow-up.Categorical variables were expressed as frequency and percentage， and compared between groups using χ2 test or Fisher exact test. Continuous variables were expressed as ±s and compared between groups using Student t test. Univariate and multivariate logistic regression analysis were used to analyze the factors associated with abemaciclib-related AE ≥ grade 2 and the factors associated with dose reduction/treatment suspension/discontinuation.
Results
The overall incidence of AE（≥grade 2） related to abemaciclib was 28.4%（29/102）， including 14.7%（15/102） of hematological toxicity，10.8%（11/102） of diarrhea and 4.9%（5/102） of hepatic function damage. Univariate analysis showed that abemaciclib-related AE（≥grade 2） were not related to age， BMI， T stage， histological type， histological grade and endocrine treatment regimens（all P＜0.050）.Among all cases， 28.4%（29/102） of the patients had to reduce the dose of abemaciclib， 12.7%（13/1 02）had treatment suspension， 12.7%（13/102） had discontinuation， 39.2%（40/102） had drug intervention（such as hepatic function protectors， antidiarrheal drugs）， and 6.9%（7/102） required other symptomatic treatment.Univariate analysis showed that diarrhea（≥grade 2） was a risk factor for dose reduction/treatment suspension/discontinuation（OR＝5.18， 95%CI：1.24-21.60， P ＝0.024）.
Conclusions
Abemaciclib exhibits acceptable safety and tolerability in HR＋/HER-2- breast cancer patients in China. Clinical trials with larger cohorts are warranted for a more reliable conclusion.
