記述言語：英語   掲載種別：研究論文（学術雑誌）  

Eribulin (ERI), clinically utilized for locally advanced or metastatic breast tumors, has shown potential links to the immune system. Notably, the cGAS-STING pathway, a key component of innate immunity, has gained prominence. Yet, limited reports explore ERI's effects on the cGAS-STING pathway. Additionally, the nuclear presence of cGAS remains poorly understood. This study uniquely delves into ERI's impact on both the cytosolic cGAS-STING pathway and nuclear cGAS. ERI enhances nuclear localization of cGAS, resulting in hyper-activation of the cGAS-STING pathway in triple-negative breast cancer cells. Reduction of cGAS heightened both cell proliferation and ERI sensitivity. In clinical data using ERI in a neo-adjuvant setting, patients with low cGAS cases exhibited reduced likelihood of achieving pathological complete response after ERI treatment. These findings illuminate the potential of cGAS and IFNβ as predictive biomarkers for ERI sensitivity, providing valuable insights for personalized breast cancer treatment strategies.

DOI： 10.1038/s41598-024-64651-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Involved surgical margins are risk factors for local recurrence and re-excision is often difficult, particularly in patients with breast cancer undergoing immediate breast reconstruction (IBR). However, the magnitude of the effect of radiation therapy on preventing local recurrence for breast cancers with involved margins has not been sufficiently assessed. MATERIALS AND METHODS: We retrospectively assessed sites of involved surgical margins and local recurrence after mastectomy with IBR in patients with early breast cancer between 2008 and 2016. The effect of postoperative radiation therapy was evaluated in patients with involved margins, adjusted for nuclear grade, lymphatic invasion, surgical procedures, and primary systemic therapy. RESULTS: A total of 274 (5.8 %) out of 4726 patients who underwent mastectomy with IBR had involved surgical margins: 133, 68, 88, and 26 had involvement of the skin, deep margin, lateral margins, and nipple, respectively (including duplicates). Radiation therapy was administered to 54 patients with involved margins. In patients with involved margins, 7-year cumulative incidences of local recurrence were 1.9 % and 12.6 % with and without radiation therapy, respectively (adjusted hazard ratio, 0.17; 95 % CI, 0.04-0.80). Local recurrence occurred in 28 patients, and the sites were skin, subcutaneous tissue, muscle, and nipple-areola complex in 7, 17, 1, and 3 patients, respectively. Among them, 23 (82.1 %) were associated with involved margin sites. CONCLUSIONS: Radiation therapy meaningfully reduced the incidence of local recurrence in patients with breast cancer with margin involvement after mastectomy with IBR. Most local recurrences occurred at involved margin-related sites.

DOI： 10.1016/j.ejso.2024.108360

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In breast cancer patients receiving neoadjuvant chemotherapy (NAC), immediate breast reconstruction (IBR) as a breast cancer treatment option remains controversial. We assessed the impact of NAC on surgical and oncological outcomes of patients undergoing IBR. METHODS: This was a retrospective multicenter study of 4726 breast cancer cases undergoing IBR. The rate of postoperative complications and survival data were compared between IBR patients who received NAC and those who did not receive NAC. Propensity score matching analysis was performed to mitigate selection bias for survival. RESULTS: Of the total 4726 cases, 473 (10.0%) received NAC. Out of the cases with NAC, 96 (20.3%) experienced postoperative complications, while 744 cases (17.5%) without NAC had postoperative complications. NAC did not significant increase the risk of complications after IBR (Odds ratio, 0.96; 95%CI 0.74-1.25). At the median follow-up time of 76.5 months, 36 patients in the NAC group and 147 patients in the control group developed local recurrences. The 5-year local recurrence-free survival rate was 93.1% in the NAC group and 97.1% in the control group. (P < 0.001). After matching, there was no significant difference between the two groups. CONCLUSION: IBR after NAC is a safe procedure with an acceptable postoperative complication profile.

DOI： 10.1007/s12282-024-01570-w

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The Japanese Breast Cancer Society Clinical Practice Guidelines are published as timely guidance on clinical issues in breast cancer treatment in Japan. In the recent edition of these guidelines, we addressed a new clinical question 34 (CQ 34, systemic treatment part) "Is trastuzumab deruxtecan recommended for patients with unresectable or metastatic HER2-low breast cancer?" and a new future research question 7 (FRQ 7, pathological diagnosis part) "How is HER2-low breast cancer diagnosed for the indication of trastuzumab deruxtecan?". These questions address use of trastuzumab deruxtecan in patients with unresectable or metastatic HER2-low breast cancer who have previously received chemotherapy for metastatic disease. The strengths of evidence and recommendation were determined through a quantitative and qualitative systematic review using multiple outcomes, including efficacy and safety. We conclude that trastuzumab deruxtecan is recommended for this patient population (strength of recommendation: 1; strength of evidence: moderate; CQ34) and that HER2-low expression for the indication of trastuzumab deruxtecan should be diagnosed using companion diagnostics based on appropriate criteria (FRQ7).

DOI： 10.1007/s12282-024-01550-0

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記述言語：英語  

Eribulin (ERI), clinically utilized for locally advanced or metastatic breast tumors, has shown potential links to the immune system. Notably, the cGAS-STING pathway, a key component of innate immunity, has gained prominence. Yet, limited reports explore ERI's effects on the cGAS-STING pathway. Additionally, the nuclear presence of cGAS remains poorly understood. This study uniquely delves into ERI's impact on both the cytosolic cGAS-STING pathway and nuclear cGAS. ERI enhances nuclear localization of cGAS, resulting in hyper-activation of the cGAS-STING pathway in triple-negative breast cancer cells. Reduction of cGAS heightened both cell proliferation and ERI sensitivity. In clinical data using ERI in a neo-adjuvant setting, patients with low cGAS cases exhibited reduced likelihood of achieving pathological complete response after ERI treatment. These findings illuminate the potential of cGAS and IFNβ as predictive biomarkers for ERI sensitivity, providing valuable insights for personalized breast cancer treatment strategies.

DOI： 10.21203/rs.3.rs-3672056/v1

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elmer Press, Inc.  

DOI： 10.14740/wjon1694

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elmer Press, Inc.  

DOI： 10.14740/wjon1691

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The Japanese Breast Cancer Society (JBCS) Clinical Practice Guidelines for systemic treatment of breast cancer were updated to the 2022 edition through a process started in 2018. The updated guidelines consist of 12 background questions (BQs), 33 clinical questions (CQs), and 20 future research questions (FRQs). Multiple outcomes including efficacy and safety were selected in each CQ, and then quantitative and qualitative systematic reviews were conducted to determine the strength of evidence and strength of recommendation, which was finally determined through a voting process among designated committee members. Here, we describe eight selected CQs as important updates from the previous guidelines, including novel practice-changing updates, and recommendations based on evidence that has emerged specifically from Japanese clinical trials.

DOI： 10.1007/s12282-023-01505-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1245/s10434-023-14019-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1245/s10434-023-13925-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The number of breast cancer patients in Japan undergoing immediate breast reconstruction (IBR) has increased and the postoperative follow-up period has been extended. This study was conducted to clarify the clinical aspects of, and factors associated with, local recurrence (LR) after IBR. METHODS: This was a multicenter study which included 4153 early breast cancer patients who underwent IBR. Clinicopathological characteristics were examined and factors potentially contributing to LR were analyzed. Risk factors for LR were examined separately for non-invasive and invasive breast cancers. RESULTS: The median follow-up period was 75 months. The 7-year LR rates were 2.1% and 4.3% for non-invasive and invasive cancers, respectively (p < 0.001). The proportions of LR detected by palpation, subjective symptoms, and ultrasonography were 40.0%, 27.3%, and 25.9%, respectively. Overall, 75.7% of LR were solitary, and 92.7% of these cases had no further recurrences during the observational period. Multivariate analysis of LR for invasive cancer showed that skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM), the presence of lymphovascular invasion, cancer at the surgical margin, and not receiving radiation therapy were factors related to LR. The 7-year overall survival rates of the patients with LR and non-LR of invasive cancers were 92.5% and 97.3%, respectively, (p = 0.002). CONCLUSIONS: The rate of LR after IBR was acceptably low and IBR can thus be performed safely for early breast cancer patients. Invasive cancer, SSM/NSM, lymphovascular invasion, and/or cancer at the surgical margin should prompt awareness of the possibility of LR.

DOI： 10.1245/s10434-023-13832-6

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記述言語：日本語   出版者・発行元：(株)篠原出版新社  

近年,乳癌診療の一部として乳房再建術が普及している.乳房再建の実態と周術期治療への影響を検討するため,大規模アンケート調査を行った.429施設より回答が得られ,乳房再建を提供している施設は73%であった.そのうち,自家組織を用いた乳房再建は75%,遊離皮弁を用いた乳房再建は48%の施設で実施されており,それぞれ形成外科医が2名以上,3名以上所属している施設が多かった.乳房再建が周術期治療に及ぼす影響は,化学療法は「変更なし」と回答した施設が94%であったのに対し,放射線療法は15%が「変更する」とし,適応症例や照射範囲を縮小する傾向があった.高度な技術を要する乳房再建術は複数の形成外科医を必要とし,周術期治療の変化が予後に与える影響を評価する必要がある.(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

It is well established that genetic information differs amongst the adolescent and young adult population (AYA) and older patients. Although several studies on genetic information have been conducted, no current prognostic biomarker exists to help differentiate survival outcomes amongst AYA patients. The GALNT family of genes have been associated with several cancer etiologies, such as the Tn antigen and epithelial-mesenchymal transition (EMT); however, the clinical significance of GALNT1 expression in breast cancer (BC) remains unclear. We investigated the clinical relevance of GALNT1 expression in BC using two large independent cohorts. We found that, although triple-negative BC (TNBC) had the highest GALNT1 expression compared to ER-positive/HER2-negative BC, GALNT1 levels in BC were not associated with clinical aggressiveness, including histological grade, AJCC stage and N-category, and patient survival, consistently in both the METABRIC and GSE96058 cohorts. There was also no biological difference between low- and high-GALNT1 expression BC, as analyzed by hallmark gene sets via gene set enrichment analysis (GSEA). Further, no significant difference was found in GALNT1 expression levels among AYAs and older patients. However, high GALNT1 expression was associated with significantly worse survival in AYA patients, in both cohorts. Furthermore, high GALNT1 expression was found to be an independent factor among several clinical features, including subtype, histological grade, AJCC T and N-category, in AYA patients. In both cohorts, BC with high GALNT1 expression demonstrated low levels of CD8+ T-cell infiltration, but not other anti-cancerous or pro-cancerous immune cells. Finally, high levels of GALNT1 BC demonstrated increased EMT, angiogenesis, and protein secretion in the AYA population, but not in older patients. In conclusion, our findings demonstrate that GALNT1 expression was found to be associated with angiogenesis and EMT, and may have potential as prognostic biomarker, specifically in AYA patients.

DOI： 10.3390/cancers15133489

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

KEY CLINICAL MESSAGE: A rare missense mutation was identified as a reversion mutation using cancer genomic profiling and a suspected mechanism underlying resistance to olaparib in breast cancer. ABSTRACT: A 34-year-old woman with breast cancer and BRCA2: p.Gln3047Ter was treated with olaparib. After tumor progression, cancer genomic profiling testing using liquid biopsy revealed BRCA2 p.Gln3047Ter and p.Gln3047Tyr, with 48.9% and 0.37% allele frequency, respectively. These findings shed light on reversion mutation as a mechanism of resistance to olaparib in breast cancer.

DOI： 10.1002/ccr3.7537

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The selection of recipient vessels for free-flap breast reconstruction is important for the success of the surgery and the aesthetics of the breast mound. The thoracodorsal artery and vein (TDA/V) allow reconstruction without noticeable scars from the anterior view, but TDA/V exposure is an invasive and time-consuming process on sentinel node biopsy. This study aimed to determine the effectiveness of the lateral thoracic artery and vein (LTA/V) as recipient vessels by comparing them with the TDA/V. METHODS: This study included 270 flaps that underwent immediate free-flap breast reconstruction after nipple/skin-sparing mastectomy by lateral incision. The patients were categorized into two groups (LTA and TDA) based on the recipient vessel selected. RESULTS: The LTA and TDA groups comprised 78 and 192 flaps, respectively. Among the 131 short and small pedicle flaps, such as gluteal artery perforator flap and profunda artery perforator flap, 65 (50%) used the LTA as the recipient vessel. The external diameters of the LTA/LTV (median, 1.2 mm/1.5 mm) were significantly lower than those of the TDA/TDV (median, 1.65 mm/2.0 mm). The LTV was present in 94%, and the second vein was present in 49% of cases with anastomosis. No significant differences in flap-related complications were observed between the two groups. CONCLUSIONS: The LTA/V can be used as recipient vessels for immediate free-flap reconstruction. Because of their superficial location and small caliber, they are easily accessible and suitable for short and small pedicle flaps. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

DOI： 10.1097/PRS.0000000000010128

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/S0140-6736(23)00285-4.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: One barrier to the widespread use of breast reconstruction (BR) is physicians' perception that BR adversely affects breast cancer prognosis. However, there is limited information regarding physicians' understanding of the impact of BR on patient prognosis and which physicians have misunderstandings about BR. METHODS: We conducted an e-mail survey regarding the impact of BR on the prognosis of patients with breast cancer among members of the Japanese Breast Cancer Society. RESULTS: Of 369 respondents, 99 (27%) said that they believe BR affects patient prognosis. Female respondents and those who treat fewer new breast cancer patients per year were more likely to state that they believe BR affects patient prognosis (P = 0.006 and 0.007). Respondents who believed that BR affects patient prognosis underestimated 5-year overall survival rates in patients who receive BR and subsequently have local or regional recurrence in different sites. CONCLUSION: Our survey demonstrated that a quarter of respondents believe that BR affects patient prognosis and underestimate survival rates in patients who receive BR and have subsequent local or regional recurrence. Because of the lack of evidence regarding the impact of BR on patient prognosis, educating physicians by providing accurate knowledge regarding BR and patient prognosis is highly recommended.

DOI： 10.1007/s12282-022-01421-6

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記述言語：英語  

Granulomatous mastitis (GM) is a rare disease, particularly among men. Herein, we present a case of GM diagnosed in a 63-year-old male patient who showed reduction in the tumor size during 3 months of observation.

DOI： 10.1002/ccr3.7048

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Metabolic reprogramming to sustain immortality is a hallmark of cancer and glycolysis is an important way to attain this. Thus, we investigate the association of glycolysis and associated pathways in the survival of breast cancer. A total of 5,176 breast cancer patients from multiple independent cohorts were analyzed. We determined the glycolytic signaling score by the degree of enrichment by Gene Set Variant Analysis and the median was used to divide each cohort into high vs low score groups. Glycolysis high breast cancer significantly enriched the hallmark cell proliferation-related gene sets (E2F targets, G2M checkpoint, and MYC targets v1 and v2) and was associated with high MKI67 expression. In all cohorts, triple-negative breast cancer (TNBC) was associated with the highest glycolysis score. It was found that in TNBC, glycolysis high breast cancer was associated with worse survival but in ER-positive/HER2-negative breast cancer this was not observed consistently. The glycolysis high TNBC enriched multiple pro-cancerous gene sets and was infiltrated with a low level of B-cells and anti-cancerous immune cells, and significantly associated with a decreased level of cytolytic activity. It was also observed that the glycolysis was higher in the metastatic sites than in the primary breast cancer and the survival was not affected by the metastatic sites. In conclusion, accelerated glycolysis is associated with cancer cell proliferation and worse survival in TNBC.

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記述言語：日本語   出版者・発行元：横浜市立大学医学会  

背景:近年,遺伝性乳がん卵巣がん症候群(HBOC)を含めた各種遺伝学的検査の保険診療が拡充している中で,2020年4月から当院に遺伝子診療科が新設された.これまで各診療科で対応していたBRCA遺伝学的検査に対し,2021年4月から検査前から遺伝カウセリングを行う体制とした.遺伝子診療科開設前後のBRCA遺伝学的検査実施体制についてまとめ,問題点や今後の課題について考察した.対象と方法:2018年8月～2022年2月に当院でBRCA遺伝学的検査実施検討症例について,診療録をもとに後方視的に検討した.結果:BRCA遺伝学的検査実施症例は173例,BRCA変異陽性は18例(10.4%),陰性153例(88.4%),variant of uncertain significance(VUS) 2例(1.2%)であった.遺伝子診療科開設後は全例自施設で検査後カウンセリングが実施できていたが,サーベイランスに結びついている症例は5例,家系員の検査実施は2例のみであった.また多遺伝子パネル検査を推奨する症例25例(80.6%)にも,適切な遺伝カウンセリングが実施できていた.結語:検査前遺伝カウンセリングは重要であるが,HBOCと診断された家系員の検査の受検率の向上や,他の遺伝性腫瘍が疑われる患者への介入,遺伝カウンセリングの継続のタイミングなど,今後も検討が必要である.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01499&link_issn=&doc_id=20230111330001&doc_link_id=https%3A%2F%2Fycu.repo.nii.ac.jp%2Frecords%2F2600&url=https%3A%2F%2Fycu.repo.nii.ac.jp%2Frecords%2F2600&type=%E6%A8%AA%E6%B5%9C%E5%B8%82%E7%AB%8B%E5%A4%A7%E5%AD%A6%EF%BC%9A%E6%A8%AA%E6%B5%9C%E5%B8%82%E7%AB%8B%E5%A4%A7%E5%AD%A6%E5%AD%A6%E8%A1%93%E6%A9%9F%E9%96%A2%E3%83%AA%E3%83%9D%E3%82%B8%E3%83%88%E3%83%AA&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Neoadjuvant chemotherapy (NAC) is essential for surgical downstaging of early-stage breast cancer, but taxane administration is associated with neuropathy. We investigated whether eribulin induces less neuropathy than paclitaxel. METHODS: In this multicentre, randomised study (UMIN000012817), patients diagnosed with invasive breast cancer between December 2013 and April 2016 were randomly assigned to group E (eribulin followed by fluorouracil, epirubicin, and cyclophosphamide; FEC) or group P (paclitaxel followed by FEC). The primary endpoint was incidence of grade 1 or higher peripheral neuropathy according to the Common Terminology Criteria for Adverse Events (CTCAE). Secondary endpoints were pathological complete response (pCR), clinical response, breast-conserving surgery, adverse events, disease-free survival (DFS), and patient neurotoxicity questionnaire (PNQ) analysis. RESULTS: One hundred and eighteen cases were analyzed for safety and 115 were evaluated for efficacy. Peripheral sensory neuropathy was significantly lower in group E after week 6, while peripheral motor neuropathy in group E was significantly lower at weeks 9, 12, and 15. pCR in groups E and P was 20.7% and 29.8% (P = .289), respectively, and clinical response was 55.2% and 77.2% (P = .017), respectively. Three-year DFS was 89.7% in group E and 86.0% in group P (P = .561). Neutropenia was more frequent and more severe in group E. PNQ was evaluated for 4 years, and item 1 (sensory) was consistently lower in group E. CONCLUSION: Neuropathy was significantly less frequent and less severe in patients who received eribulin compared with paclitaxel. Thus, eribulin could be a good alternative to paclitaxel in patients suffering severe neuropathy.

DOI： 10.1016/j.clbc.2022.08.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Little information is available about the clinical and pathologic characteristics of local recurrence (LR) after nipple-sparing mastectomy according to the locations of LR. METHODS: This study classified 99 patients into the following two groups according to the location of LR after nipple-sparing mastectomy: nipple-areolar recurrence (NAR) group and other locations of LR (oLR) group. The study evaluated whether the location of LR was associated with disease-free survival (DFS) after LR resection. RESULTS: For about half of the patients (44.4 %) with NAR, the primary cancer was estrogen receptor (ER)-negative and human epidermal growth factor receptor 2 (HER2)-positive. Conversely, in most of the patients with oLR (79.2 %), the primary cancer was ER-positive and HER2-negative. Among the LR tumors, the frequency of noninvasive carcinoma in the NAR tumors was significantly higher than in the oLR tumors (51.9 % vs 4.2 %, respectively). During a median follow-up period of 46 months, the location of LR was not associated with DFS after LR. In the NAR group, the presence or absence of LR tumor invasiveness was the only factor associated with DFS. In the oLR group, age at primary surgery was the only factor associated with DFS. CONCLUSION: This multi-institutional retrospective study demonstrated that the features of NAR, such as the characteristics of the primary and recurrent tumors and the prognostic factors after LR resection, were quite different from those of oLR.

DOI： 10.1245/s10434-022-12760-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: BRCAness is a characteristic feature of homologous recombination deficiency (HRD) mimicking BRCA gene mutation in breast cancer. We hypothesized that a measure to quantify BRCAness that causes synthetic lethality in BRCA mutated tumors will identify responders to PARP inhibitors. METHODS: A total of 6753 breast cancer patients from 3 large independent cohorts were analyzed. A score was generated by transcriptomic profiling using gene set variation analysis algorithm on 34 BRCA1-mutation related genes selected by high AUC levels in ROC curve between BRCA1 mutation and wildtype breast cancer. RESULTS: The score was significantly associated with BRCA1 mutation, high mutation load and intratumoral heterogeneity as expected, as well as with high HRD, DNA repair and MKi67 expression regardless of BRCA mutations. High BRCAness tumors enriched not only DNA repair, but also all five Hallmark cell proliferation-related gene sets. High BRCAness tumors were significantly associated with higher cytolytic activity and with higher anti-cancerous immune cell infiltration. Not only did the breast cancer cell lines with BRCA-mutation show high score, but even the other cells in human breast cancer tumor microenvironment were contributing to the score. The BRCAness score was the highest in triple-negative breast cancer consistently in all 3 cohorts. BRCAness was associated with response to chemotherapy and correlated strongly with response to PARP inhibitor in both triple-negative and ER-positive/HER2-negative breast cancer. CONCLUSIONS: We established a novel BRCAness score using BRCA-mutation-related gene expressions and found that it associates with DNA repair and predicts response to PARP inhibitors regardless of BRCA mutation.

DOI： 10.1186/s40364-022-00427-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: β-ray strontium-89 (Sr-89) intra-irradiation therapy has been approved and clinically used to reduce bone metastasis pain not alleviated by bone-modifying agents, external radiation, and analgesic agents. We examined the efficacy of zoledronic acid (ZOL) and Sr-89 combination therapy compared with ZOL alone in breast cancer patients with bone metastases. MATERIALS AND METHODS: A randomized controlled trial was conducted on breast cancer patients with bone metastasis to compare the efficacy between ZOL monotherapy and ZOL plus Sr-89 combination therapy. The primary endpoints were changes in urinary NTX levels at 13 weeks and brief pain inventory scores. The secondary endpoints were analgesic drug usages, response rates, changes in bone metabolism markers, quality of life, and adverse event rates. RESULTS: Thirty of the planned 60 cases were randomly assigned to ZOL alone or ZOL + Sr-89. There were no significant differences in the changes in urinary NTX levels between the 2 groups (P = 0.365). There was no consistent difference in the pain score changes between the 2 groups. Sr-89 addition to ZOL slightly reduced the white blood cell and platelet counts. However, all adverse events were Grade 1. Safety and analgesic drug dose reduction were more evident in ZOL + Sr-89. CONCLUSION: This trial showed the lack of benefits from Sr-89 addition to ZOL for breast cancer patients with painful bone metastases. However, safety and analgesic drug dose reduction were more evident in ZOL + Sr-89, indicating its potential for pain control. Sr-89 therapy is safe, thus more effective radiopharmaceuticals are anticipated.

DOI： 10.1007/s00774-022-01366-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Combination therapy with cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors and hormonal therapy as the first-line and second-line treatments has already been shown to be effective in patients with hormone receptor-positive (HR+) human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC) in clinical trials. On the other hand, in clinical practice, CDK4/6 inhibitors are used not only as first-/second-line but also as later-line hormonal therapies, or for patients receiving prior chemotherapy in metastatic setting. However, the efficacy and safety of combination therapy in these patients remain unclear. In this study, we evaluate the clinical efficacy and safety of combination therapy with abemaciclib and hormonal therapy for chemotherapy-treated patients with HR+ HER2- MBC. Methods: This multi-institutional prospective cohort study will involve a total of 300 chemotherapy-treated patients with HR+ HER2- MBC. The primary endpoint is progression-free survival (PFS). Secondary endpoints include overall survival, time to treatment failure, response rate, clinical benefit rate, and adverse events. The preplanned subpopulation analysis is the number of chemotherapy regimens for HR+ HER2- MBC (two or less vs. three or more), prior treatment history with CDK4/6 inhibitors other than abemaciclib (presence vs. absence) and menopausal status (pre vs. post). We also planned to determine PFS of the subpopulation treated with abemaciclib as maintenance therapy after chemotherapy. Discussion: In this multi-institutional prospective cohort study, we evaluate the clinical efficacy and safety of combination therapy with abemaciclib and hormonal therapy for chemotherapy-treated patients with HR+ HER2- MBC. We also evaluate this combination therapy as maintenance therapy in patients who respond to early-line chemotherapy.

DOI： 10.14740/wjon1511

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Combining palbociclib with letrozole or fulvestrant improved progression-free survival in hormone receptor (HR)-positive and human epidermal growth factor receptor-negative metastatic breast cancer. However, combining palbociclib to endocrine treatment increases toxicity and cost compared with the endocrine treatment alone. Moreover, palbociclib treatment may affect the outcome of the subsequent treatment because its benefit in terms of overall survival has not been observed yet. Therefore, it is crucial to examine whether palbociclib can improve clinical outcomes and quality of life (QoL) of patients in the real world. Methods: A prospective observational study with palbociclib is planned in 3 cohorts (A, B, and C) as per the line of endocrine treatment (i.e., first-line, second-line, or third-line or later-line treatment) for postmenopausal metastatic or unresectable breast cancer. The primary endpoint is progression-free survival in each treatment line, the most commonly used endpoint for global phase 3 studies. As per the results of these studies, the planned sample size is 700 cases: cohort A, 340 cases; cohort B, 200 cases; and cohort C, 130 cases. The secondary endpoints are overall survival, clinical benefit rate, time to chemotherapy, adverse events (AEs), patient-reported outcomes (PROs), and health-related QoL (HRQoL). These endpoints are evaluated again during the subsequent treatment. This study will examine whether the efficacy, safety, and QoL effects of palbociclib treatment in daily clinical practice are not inferior compared to those in clinical trials and whether palbociclib treatment affects the efficacy and safety of the subsequent treatment. Moreover, this study would provide information on the most effective time of adding palbociclib to endocrine treatment. Discussion: The reproducibility of randomized clinical trials (RCTs) using real-world data must be confirmed to evaluate whether real-world treatment benefits are similar to those observed in RCTs. Although the efficacy of palbociclib has been confirmed in RCTs, Aes of this drug, including its toxicities and cost, are not comparable to those of mono-hormone therapies. Thus, PROs/HRQoL is an important element of this study because several patients with HR-positive metastatic breast cancer have diseases for which sequential hormone therapy is preferential.

DOI： 10.14740/wjon1507

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: Postmastectomy radiotherapy (PMRT) is the standard treatment for locally advanced breast cancer. However, the effectiveness of PMRT in patients with pT1-2 and N1 tumours remains controversial. Therefore, this study aimed to determine the prognostic impact of PMRT in patients with breast cancer and with pT1-2 and 1-3 lymph node metastases. METHODS: Using data from the Japanese National Clinical Database from 2004 to 2012, we evaluated the association of PMRT with locoregional recurrence (LRR), any recurrence, and mortality. We enrolled patients who had undergone mastectomy and axillary node dissection and were diagnosed with pT1-2 and N1. We compared clinicopathological factors and prognosis between patients who received (PMRT group) and those who did not receive (No-PMRT group) PMRT. RESULTS: Among 8914 patients enrolled, 492 patients belonged to the PMRT group and 8422 to the No-PMRT group. The median observation time was 6.3 years. There was no significant difference in the incidences of LRR (4.0% versus 5.0%, P = 0.61), recurrence (13.8% versus 11.8%, P = 0.23) and breast cancer death (6.0% versus 4.3%, P = 0.08) at 5 years between the groups. Multivariable analysis revealed that LRR was significantly associated with tumour size, number of node metastases and triple-negative subtype but not with PMRT. CONCLUSIONS: The LRR rate in the No-PMRT group was 5.0% at 5 years among patients with T1-2 and N1. PMRT did not significantly influence LRR in patients with T1-2 and N1. However, PMRT administration should be tailored considering the individual risks of tumour size, 3 node metastases and triple-negative subtype.

DOI： 10.1016/j.ejca.2022.05.017

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In some breast cancer patients with a contralateral unaffected hypertrophic and ptotic breast, autologous small-breast reconstruction with contralateral breast reduction is a good option. The current study is aimed to assess the efficacy of the double-pedicle unaffected split-breast (USB) flap harvested from the central half of the unaffected breast for unilateral breast reconstruction with contralateral transverse scar reduction mammoplasty. METHODS: Between February 2003 and May 2020, 14 patients underwent breast reconstruction using the USB flap. The mean patient age was 59.1 (range: 48-76) years, and the mean body mass index was 24.2 (range: 19.5-33.3) kg/m2 . This flap comprised half of the contralateral breast tissues with the 3rd or 4th internal mammary perforator (IMAP) and the lateral thoracic vessel (LTA/V). After USB flap elevation and LTA/V resection, flap perfusion from the IMAP was evaluated on indocyanine green (ICG) angiography. The medial pedicle USB flap was rotated 180° and was transferred to the affected site via the midline. The LTA/V was anastomosed to the recipient vessel to supercharge the distal part of the USB flap, which was then used for breast reconstruction. Then, the remaining contralateral upper and lower breast poles were used for transverse scar reduction mammoplasty. RESULTS: The mean flap size was 13.3 × 26.9 (range: 9.5 × 22 to 16 × 29) cm. All flaps and reduced breasts survived without serious complications such as flap necrosis, although there was one patient with hematoma and one patient with hypertrophic scar. ICG revealed poor perfusion in the distal, lateral part of the flap, ranging from 22.0% to 48.5% of the overall flap area. Final aesthetic evaluation was high, with 11 cases (78.6%) being "good" or "excellent" and 3 cases (21.4%) that were either poor or fair. The mean follow-up period for the patients was 53.8 (range: 15-84) months, with none of the patients presenting second primary breast cancer or recurrence in both breasts. CONCLUSION: USB flap breast reconstruction with contralateral reduction mammoplasty is a valuable option in breast cancer patients with a hypertrophic and ptotic breast.

DOI： 10.1002/micr.30861

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To examine the role of the Modified Glasgow Prognostic Score (mGPS) and Prognostic Nutritional Index (PNI) as prognostic markers for patients with metastatic breast cancer (MBC). PATIENTS AND METHODS: We investigated the associations of clinico-pathological factors with time-to-treatment failure (TTF) and overall survival (OS) in 110 patients with MBC treated with eribulin. RESULTS: C-Reactive protein >1 mg/dl, albumin <3.5 g/dl, mGPS=2, and PNI <40 were significant predictors of shorter TTF in univariate analyses. PNI <40 remained a significant and independent predictor of shorter TTF in multivariate analyses. De novo tumor, visceral metastases, C-reactive protein >1 mg/dl, albumin <3.5 g/dl, mGPS=2, and PNI <40 were significant predictors of poor OS at the univariate level. A PNI <40 was a significant and independent predictor of poor OS in multivariate analyses. CONCLUSION: PNI is a reliable predictor of TTF and OS in patients with MBC treated with eribulin.

DOI： 10.21873/invivo.12903

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIM: There are few models predicting breast cancer prognosis among patients receiving neoadjuvant chemotherapy (NAC) for estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative (luminal) breast cancer. We examined whether biological features (BFs) of residual tumors are prognostic factors following NAC. PATIENTS AND METHODS: We enrolled patients with remnant tumors following NAC for luminal breast cancer and evaluated clinical stage, pathological stage, BFs prior to NAC, and BFs following NAC as prognostic factors. BFs were divided into high and low risk using the previously reported YR-IHC4 model calculated according to ER, progesterone receptor (PgR), HER2, and the proliferation marker Ki-67. RESULTS: A total of 57 patients were enrolled in the current study. We observed a statistically significant difference in relapse-free survival (RFS) between the BF risk categories via YR-IHC4 predictions following NAC (p=0.044). The 5-year RFS rates of the BF low- and high-risk groups following NAC were 84.2% and 52.5%, respectively. CONCLUSION: BFs of residual tumors following NAC may be important prognostic factors in luminal breast cancer.

DOI： 10.21873/invivo.12774

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Sentinel lymph node (SLN) biopsy has been the standard modality for breast cancer patients with clinically node negative disease. In patients who undergo axillary lymph node dissection (ALND) due to SLN metastasis, the harvested nodes (non-SLNs) often contain no metastasis. Here, we evaluated the predictive factors associated with non-SLN metastasis in breast cancer patients. MATERIALS AND METHODS: This was a retrospective study of patients with operable cT1-3, cN0 invasive breast cancer who underwent SLN biopsy followed by ALND due to SLN metastasis. The clinicopathologic factors and predictive factors of non-SLN metastasis were analyzed. The optimal cutoff for the Ki67 index and the number of positive and negative SLNs that were predictive of non-SLN metastasis were evaluated using receiver operating characteristic curves. RESULTS: The median number of SLN and non-SLN was 3 and 11, respectively. Of the 150 patients, 52 (35.0%) had metastases in non-SLNs. The optimal cutoffs for the Ki67 index and the number of positive and negative SLNs were of 12%, 2, and 1, respectively. In the univariate analysis, the Ki67 index and the number of positive SLNs≥2 and negative SLNs≤1 were higher in the non-SLN + group than that in the non-SLN - group. The number of negative SLNs was as a predictive factor for non-SLNs metastasis in the multivariate analysis. CONCLUSIONS: The number of negative SLNs predicts the risk of non-SLN metastasis in breast cancer. When deciding on whether to omit ALND, the number of positive and negative SLNs should be considered.

DOI： 10.1016/j.jss.2021.01.047

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To evaluate the association between bromodomain-containing protein 4 (BRD4) expression and clinicopathological factors and prognosis in human breast cancer specimens. PATIENTS AND METHODS: We used tissue microarrays constructed from samples of patients (n=183) who underwent surgery. We validated the association between BRD4 expression and prognosis in solid tumours, including breast cancer, using The Cancer Genome Atlas (TCGA) database. RESULTS: Immunohistochemical staining showed that BRD4 was widely distributed in breast cancer tissues. BRD4 was strongly expressed in 19.7% of patients but BRD4 staining intensity was not correlated with other clinicopathological factors. Most importantly, patients with a strong BRD4 expression had a significantly longer disease-specific survival than those with a weak BRD4 expression (100.0% vs. 91.3% at 5 years, p=0.027). mRNA expression analysis showed similar results (91.2% vs. 80.2% at 6 years, p=0.047). CONCLUSION: Strong BRD4 expression was associated with a significantly better prognosis in breast cancer tumours.

DOI： 10.21873/anticanres.15148

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：英語  

A malignant tumor in the breast may not be conclusive of breast cancer. It is important to keep the possibility of primary breast lymphoma in rare scenarios. For the diagnosis of primary breast lymphoma, immunohistochemical staining is necessary.

DOI： 10.1002/ccr3.4189

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: As Asians are more vulnerable to febrile neutropenia (FN) than Caucasians, evaluations of FN incidence and risk factors in Asians are important for the appropriate use of primary pegfilgrastim (PEG-G). PATIENTS AND METHODS: Japanese breast cancer patients receiving standard adjuvant chemotherapies were prospectively enrolled in multicenter institutions from August 2015 to July 2017. FN was evaluated from 2 treatment policies: true FN (T-FN): ≥37.5 °C, grade 4 neutropenia, mandatory hospital visit (visiting); surrogate FN (S-FN): ≥37.5 °C, oral antibiotic, no mandatory visit (non-visiting). PEG-G was used at the physicians' discretion. The primary endpoint was FN incidence during all cycles. Multivariate logistic regression analysis was performed to identify T-FN risk factors. RESULTS: Of 1005 enrolled patients, 980 women treated with FEC, E(A)C, and TC were analyzed. The FN incidence proportions in all patients were 22.5%, 27.5%, and 33.9% for FEC, E(A)C, and TC, respectively. Those of T-FN were 27.7%, 22.4%, and 36.6%; those of S-FN were 17.3%, 32.4%, and 31.5% with more frequent primary PEG-G usage. The relative dose intensity (RDI) of the 3 regimens was ≥0.85 in both groups. In the analysis of risk factors, TC (odds ratio = 2.67), age ≥ 65 years (2.24), and pretreatment absolute neutrophil count (ANC)/1000 μl (0.8) remained significant. CONCLUSIONS: FN incidences were above 20% in the 3 regimens, with TC showing the highest. RDI was maintained at a high level in both visiting and non-visiting groups. Patient-related risk factors were age and pretreatment ANC.

DOI： 10.1016/j.breast.2021.01.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: Evaluation of the cosmetic outcome after breast-conserving surgery (BCS) differs depending on the evaluator. We performed a clinical trial to examine the differences between assessments of cosmetic outcomes performed by a surgeon, patients, and a nurse as a third party after BCS; the evaluation was performed two times (at 3 months and 9 months after surgery). Similarly, we identified factors most significantly affecting the overall cosmetic outcomes. METHODS: Sixty-eight patients with primary breast cancer who had undergone BCS between September 2017 and December 2018 were consecutively enrolled in the study. Breast shape, symmetry, hardness, scarring, and overall outcomes were evaluated by a surgeon, patients, and a nurse via a questionnaire. RESULTS: Intraclass correlation coefficients (ICCs) for the 3- to 9-month comparisons of the surgeon, patients, and nurse were 0.73, 0.64, and 0.29, respectively. The ICCs for the surgeon-patient, nurse-patient, and surgeon-nurse comparisons (3 months/9 months) were 0.49/0.44, 0.34/0.10, and 0.41/0.51, respectively. The partial regression coefficient for shape was 0.45 (p = 0.003)/0.61 (p = 0.001), 0.37 (p = 0.005)/0.50 (p < 0.001), and -0.08 (p = 0.48)/0.58 (p < 0.001) for evaluations performed by the surgeon, patients, and nurse, 3 months and 9 months, respectively. CONCLUSION: With reproducibility, only moderate agreement was observed between the surgeon and the patients. Breast shape was identified as the most important factor affecting cosmetic outcomes.

DOI： 10.1016/j.asjsur.2021.03.034

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIM: This study aimed to investigate the efficacy of first-line gemcitabine monotherapy for metastatic breast cancer (MBC) and its effect on health-related quality of life (HRQoL) compared with treatment of physician's choice (TPC). PATIENTS AND METHODS: We enrolled 96 patients into the first-line gemcitabine group (n=47) or other treatment of physician's choice (TPC) group (n=49) from May 2010 to April 2013. HRQoL was evaluated every 4 weeks. RESULTS: There was no significant difference in the median time to treatment failure (5.3 vs. 4.6 months, hazard ratio=0.87, p=0.546) and the incidence rates of grade 3/4 haematological toxicity (10.6% vs. 8.1%, p=0.677) and grade 3/4 non-haematological toxicity (4.2% vs. 8.1%, p=0.429) between the gemcitabine and TPC groups. Changes in HRQoL from baseline to 12 weeks were not significantly different. CONCLUSION: Gemcitabine achieves similar efficacy and HRQoL benefit to other chemotherapy and can be used as first-line treatment for MBC.

DOI： 10.21873/anticanres.14930

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIM: We evaluated the impact of the relative dose intensity (RDI) of neoadjuvant chemotherapy (NAC) on the survival of patients with breast cancer (BC). PATIENTS AND METHODS: This randomized phase II trial included 188 patients with human epidermal growth factor receptor 2 (HER2)-negative BC treated with anthracycline followed by paclitaxel as NAC. We grouped patients using a relative dose intensity (RDI) threshold of 85% and evaluated clinicopathological features and clinical outcomes. RESULTS: The 5-year overall survival rate was 91.2% and 76.3%, when RDI ≥85% and <85%, respectively (p=0.015). Age, tumor, and node status, and the RDI were significantly different on univariate analysis, but not on multivariate analysis. An exploratory subgroup analysis revealed that a low RDI was associated with low overall survival of patients with obesity, T1/2 disease, and lymph node metastases. CONCLUSION: Maintaining the RDI of NAC is crucial for achieving the survival benefit in selected patients with HER2-negative BC.

DOI： 10.21873/anticanres.14863

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose To date, it is not clear which anticancer agent is useful in combination with trastuzumab and pertuzumab As the first and second selective regimens for advanced or metastatic breast cancer (AMBC), this multicenter, open-label, phase II trial (JBCRG-M03: UMIN000012232) presents a prespecified analysis of eribulin in combination with pertuzumab and trastuzumab. Methods We enrolled 50 patients with no or single prior chemotherapy for HER2-positive AMBC during November 2013-April 2016. All patients received adjuvant or first-line chemotherapy with trastuzumab and a taxane. The treatment comprised eribulin on days 1 and 8 of a 21-day cycle and trastuzumabplus pertuzumab once every 3 weeks, all administered intravenously. While the primary endpoint was the progression-free survival (PFS), secondary endpoints were the response rate and safety. Results Of 50 patients, 49 were eligible for safety analysis, and the full analysis set (FAS) included 46 patients. We treated 8 (16%) and 41 (84%) patients in first- and second-line settings, respectively. While 11 patients (23.9%) had advanced disease, 35 (76.1%) had metastatic disease. The median PFS was 9.2 months for all patients [95% confidence interval (CI): 7.0-11.4]. In the FAS, 44 patients had the measurable lesions and the complete response rate (CR) was 17.4%, and partial response rate (PR) was 43.5%. The grade 3/4 adverse events were neutropenia (5 patients, 10.2%), including febrile neutropenia (2 patients, 4.1%), hypertension (3 patients, 6.1%), and other (1 patient). The average of the left ventricular ejection fraction did not decline markedly. No symptomatic left ventricular systolic dysfunction was observed. Conclusions In patients with HER2-positive AMBC, eribulin, pertuzumab, and trastuzumab combination therapy exhibited substantial antitumor activity with an acceptable safety profile. Hence, we have started a randomized phase III study comparing eribulin and a taxane in combination with pertuzumab and trastuzumab for the treatment of HER2-positive AMBC. Trial registration ID: UMIN-CTR: UMIN000012232.

DOI： 10.1007/s10637-020-00991-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Anticancer Research USA Inc.  

BACKGROUND/AIM: Oncotype DX recurrence score (RS) for breast cancer is a useful tool for determining chemotherapy indication but it is expensive and time-consuming. We determined whether four immuno-histochemical markers, namely human epidermal growth factor 2 (HER2), estrogen receptor (ER), progesterone receptor (PgR), and Ki-67, are predictive of an RS ≥26 in Japanese patients. PATIENTS AND METHODS: The study included 95 Japanese patients evaluated for RS. A predictive model was created using logistic regression analysis. RESULTS: The discriminant function was calculated as follows: p=1/{1+exp [-(4.611+1.2342×HER2-0.0813×ER- 0.0489 ×PgR+0.0857×Ki67)]}. Using a probability of 0.5 as the cutoff, the accuracy, sensitivity, specificity, positive predictive and negative predictive values were 90.5%, 72.2%, 94.8%, 76.4% and 93.5%, respectively. CONCLUSION: The model had a high negative predictive value in predicting RS ≥26 in Japanese patients, indicating that Oncotype DX testing may be omitted in patients with a negative result according to the predictive model.

DOI： 10.21873/invivo.12522

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media Deutschland GmbH  

Background: Internal mammary vessels are often used as recipient vessels during free flap breast reconstruction, especially in delayed reconstruction. Vessel dissection occasionally results in incidental identification of internal mammary lymph nodes (IMLNs). Some studies have reported the positivity of these nodes but few studies have focused on delayed reconstruction and no other study examined the difference between patients with and without artificial materials. Methods: This is a retrospective review of patients undergoing delayed free flap breast reconstruction using internal mammary vessels. If IMLNs were accidentally identified during preparation of recipient vessels, the authors sent it for pathological review. Patient characteristics, tumor staging, IMLN positivity, treatment alteration after operation, and outcome were studied. Results: Overall, 174 patients underwent delayed free flap breast reconstruction
internal mammary vessels were exposed in 167 patients. Of these, 68 IMLNs (65 patients, 38.9%) were identified and sampled. IMLNs were identified in 40 patients (43.0%) in patients with artificial materials such as tissue expander, silicone implant, and injected foreign material for breast augmentation, while in 25 patients (33.8%) without them. Three patients (4.6%) were tumor positive. One patient was found to have multiple metastasis and two of three patients had an increase in cancer stage after reconstruction. Two patients had changes in cancer treatment after reconstruction. All patients with positive IMLNs were alive at the last follow-up. Conclusions: During delayed free flap breast reconstruction, IMLNs are identified more frequently in patients with artificial materials than patients without them. Its positivity is rare, but it might affect breast cancer reevaluation and treatment after reconstruction. Level of evidence: Level IV, diagnostic study.

DOI： 10.1007/s00238-021-01879-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIM: Aldehyde dehydrogenase 1 (ALDH1) is known as a breast cancer stem cell (CSC) marker. This study aimed to identify genes associated with ALDH1. MATERIALS AND METHODS: ALDH1-positive and -negative breast cancer cells were isolated using laser capture microdissection from five tissue samples of ALDH1-positive breast cancer patients. Messenger RNA expression levels were compared between ALDH1-positive and -negative cells. RESULTS: We found 104 differentially expressed genes between ALDH1-positive and -negative cells. Gene ontology and pathway analysis revealed that these genes were correlated with CSC functions and pathways. Network analyses identified 10 genes that were closely associated with ALDH1. We validated these 10 genes utilizing The Cancer Genome Atlas and the Molecular Taxonomy of Breast Cancer International Consortium cohort, and found that they were associated with ALDH1 expression and correlated with Wnt pathway signaling. CONCLUSION: The 10 genes we identified could be potential targets for CSC therapy of breast cancer.

DOI： 10.21873/anticanres.14696

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pathological complete response (pCR) is often achieved by neoadjuvant chemotherapy (NAC), particularly in hormone receptor-negative breast cancer. Contrast-enhanced magnetic resonance imaging (cMRI) is the most reliable imaging modality to evaluate the pathological effect of NAC. Ultrasonography is indispensable to collect representative specimens from the target lesion by core needle biopsy (CNB). This study aimed to evaluate the accuracy of predicting pCR by adding CNB after NAC, in cases with complete clinical response (cCR) diagnosed by cMRI. METHODS: In this prospective multicentre study, we evaluated patients diagnosed with cCR by cMRI after NAC. Ultrasound-guided CNB (uCNB) using a 14G needle was performed without clip markers under general anaesthesia as planned surgery. Specimens collected by uCNB were compared to those resected surgically and were categorized as (i) no carcinoma (ypT0), (ii) no invasive carcinoma and only residual carcinoma in situ (ypTis) and (iii) residual invasive carcinoma. The concordance of pathological results between the uCNB and surgical specimens was evaluated. RESULTS: Of the 83 patients evaluated, 41 (49.4%) and 17 (20.5%) of them had ypT0 and ypTis, respectively. The false negative rates (FNR), sensitivity and specificity for predicting ypT0 by uCNB were 50.0%, 50.0%, 100%, respectively, and those for predicting ypT0+ypTis were 28.0%, 72.0% and 98.3%, respectively. The concordance rates were 74.7% (62/83) for ypT0 and 90.4% (75/83) for ypT0+ypTis. CONCLUSION: In cCR cases diagnosed by cMRI, uCNB was not accurate enough to predict pCR. Additional modalities like clip placements and/or thicker core needles may be required for better prediction.

DOI： 10.1016/j.suronc.2020.10.002

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Nipple-areola complex (NAC) reconstruction is a technique used in breast reconstructive surgery, which is performed during the final stage of breast reconstruction after total mastectomy of primary breast cancer. Composite nipple grafts utilizing the contralateral NAC are common; however, to our knowledge, there are no reports of new primary invasive ductal carcinoma development within the graft. Here, we describe one such case for the first time. CASE PRESENTATION: A 54-year-old woman was referred to us by the Department of Plastic and Reconstructive Surgery in our medical center for further evaluation of right nipple erosion. She had undergone total mastectomy of the right breast following a breast cancer diagnosis 15 years ago, at which time tumor biological profiling revealed the following: estrogen receptor (ER), positive; progesterone receptor (PgR), negative; and human epidermal growth factor receptor 2 (HER2), undetermined. She received adjuvant chemotherapy and endocrine therapy. She defaulted endocrine therapy for a few years, and 7 years after surgery, she underwent autologous breast reconstruction with a deep inferior epigastric perforator (DIEP) flap. In the following year, NAC reconstruction was performed using a composite graft technique. Seven years after the NAC reconstruction, erosion appeared on the nipple grafted from its contralateral counterpart; scrape cytology revealed malignancy. The skin on the right side of her chest around the NAC and subcutaneous fat tissue consisted of transferred tissue from the abdomen, as the DIEP flap and grafted nipple were located on the graft skin. The right nipple carcinoma arose from the tissue taken from the left nipple. Magnetic resonance imaging (MRI) or computed tomography showed no malignant findings in the left breast. As the malignant lesion seemed limited to the area around the grafted right nipple on MRI, surgical resection with sufficient lateral and deep margins was performed around the right nipple. Pathological findings revealed invasive ductal carcinoma with comedo ductal components infiltrating the graft skin and underlying adipose tissue. Immunohistochemistry revealed positive for ER, PgR, and HER2. CONCLUSIONS: To our knowledge, this is the first case involving the development of invasive ductal carcinoma in a nipple graft constructed on the skin of a DIEP flap, with the origin from the contralateral breast's nipple.

DOI： 10.1186/s40792-020-00962-2

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There is limited information on the oncological outcomes of immediate autologous breast reconstruction in the Asian population. This study aimed to evaluate the oncological outcomes of immediate one-stage autologous breast reconstruction using a free perforator flap for breast cancer patients at a single institution in Japan. METHODS: We retrospectively reviewed 239 patients who underwent immediate one-stage autologous breast reconstruction using a free perforator flap after skin- or nipple-sparing mastectomy. The whole breast was pathologically analyzed in 5-mm sections. Clinical and pathological data were collected from medical records. RESULTS: For tumor stage among the 239 patients, 101 (42.3%) had stage 0, 127 (53.1%) had stage I and II, and 11 (4.6%) had stage III. Twenty-three patients (9.6%) had margin involvement in the surgical specimen. Adjuvant chemotherapy was performed in 75 patients (30%), and endocrine therapy was administered in 153 patients (64%). Radiation therapy was performed in 15 patients (6.3%) because of multiple lymph node metastases or margin involvement. With a median follow-up time of 73 mo, local recurrence was found in 3.3%, distant metastases in 2.5%, and contralateral breast cancer in 3.7%. All patients with local recurrence did not receive radiation therapy as adjuvant treatment. CONCLUSIONS: Among the patients who underwent immediate one-stage autologous reconstruction after breast surgery, 3.3% had local recurrence. For patients with margin involvement, radiation therapy is a promising option.

DOI： 10.1016/j.jss.2020.01.010

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A subgroup of triple-negative breast cancer (TNBC) shows impaired BRCA1 function owing to causes other than mutation, which is called "BRCAness." DNA-damaging agents are known to have more efficacy in BRCA1-mutant tumors than mitotic poisons. We conducted a prospective single-arm clinical trial of neoadjuvant chemotherapy (NAC) using an anthracycline-based regimen without taxanes for BRCAness TNBCs. MATERIALS AND METHODS: BRCAness was examined using the multiplex ligation-dependent probe amplification (MLPA) method in TNBC cases. For BRCAness cases, NAC was performed with anthracycline-based regimens without additional taxanes. RESULTS: A total of 30 patients with TNBC were enrolled. MLPA was successfully performed in 25 patients. Eighteen patients (72%) showed BRCAness. Twenty-three patients received NAC as per the protocol. On analysis, the clinical response rate (complete response plus partial response) was 76.4%, and the pathological complete response rate was 35.3%. CONCLUSIONS: The interim analysis revealed that the pathological complete response rate was lower than estimated. Therefore, BRCAness by MLPA was not sufficient to predict the therapeutic response to anthracycline-based regimens in TNBC.

DOI： 10.1016/j.jss.2019.12.047

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Despite the excellent prognosis associated with pathological complete response (pCR) to neoadjuvant chemotherapy (NAC), some patients still develop recurrence. Here, we investigated the outcomes of breast cancer patients with pCR, as well as the clinical and pathological predictors of cancer recurrence in these patients. MATERIALS AND METHODS: Of the 1599 breast cancer patients treated with NAC, we evaluated 394 patients who achieved pCR between January 2007 and December 2016. pCR was defined as no evidence of invasive cancer in breast. Residual in situ ductal and axillary lymph node diseases were not considered. We analyzed the outcomes using the Kaplan-Meier method. We assessed the association of clinical and pathological predictors with cancer recurrence using the cox proportional hazards regression model. RESULTS: The median follow-up time was 63 months. The 5-year disease-free survival rate was 92.3%. Cancer recurrence was observed in 28 patients (7.1%): local recurrence 8 patients (2.0%), visceral metastasis 10 patients (2.5%), and brain metastasis 10 patients (2.5%). Brain metastases were found in patients with HER2 type breast cancer. The significant predictors of cancer recurrence were HER2 positivity (p = 0.04), clinical tumor size (p < 0.01), and lymph node metastasis (p < 0.01) before NAC on univariate analysis and only lymph node metastasis on multivariate analysis. CONCLUSION: Patients achieving pCR to NAC showed excellent outcomes. Advanced clinical stage, large tumor size, presence of lymph node metastasis, and HER2 positivity before NAC were identified as significant predictors of cancer recurrence. Residual in situ ductal and lymph node diseases after NAC were not significant predictors.

DOI： 10.1016/j.ejso.2019.08.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Mastectomy and flap harvesting can be accomplished simultaneously in immediate deep inferior epigastric perforator (DIEP) flap breast reconstruction. However, this is not always possible, particularly in a teaching institution, where supervisors, trainees, and assistants must participate in the surgery, because there is not enough working space for breast and plastic: surgeons to perform surgery together. We attempted to overcome this problem by placing the patient in the lithotomy position and have reported the outcomes. We evaluated patients who underwent unilateral immediate DIEP flap breast reconstruction in the supine or lithotomy position between October 2014 and July 2016. The surgeries were performed by the same inexperienced plastic surgeon our hospital. In the lithotomy position, 1 plastic surgeon stands between the patient's legs and 1 stands beside the abdomen, and they perform DIEP flap harvesting simultaneously with mastectomy performed by 3 breast surgeons. After mastectomy, breast reconstruction is performed by 4 plastic surgeons. The supine position was used in the first 8 patients, and the lithotomy position was used in the following 8 patients. The mean operative time was 11 hours 21 minutes in the supine group and 8 hours 52 minutes in the lithotomy group, with a significant difference (P = 0.027). Breast reconstruction with a DIEP flap in the lithotomy position is useful for teaching institutions because it provides sufficient working space and allows simultaneous procedures without prolonging operative time. However, issues such as pressure sores, nerve palsy and difficulty in patient placement still exist.

DOI： 10.1097/GOX.0000000000002552

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.breast.2019.06.003

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記述言語：日本語   出版者・発行元：(一社)日本骨粗鬆症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.21873/anticanres.13596

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Osteoporosis is a major side effect of aromatase inhibitors (AIs), which are greatly effective in the treatment of breast cancer. However, there are no satisfactory measures against osteoporosis. In this multicenter, randomized, comparative study, we evaluate the efficacy of denosumab for preventing loss of bone mineral density (BMD) induced by adjuvant therapy with AI s in breast cancer patients with normal BMD. PATIENTS AND METHODS: The bone loss-suppressing effect of denosumab will be comparatively evaluated in postmenopausal patients scheduled to receive letrozole or anastrozole as a postoperative endocrine therapy for stage I-IIIA hormone-sensitive breast cancer and a control group. Patients will be administered letrozole 2.5 mg or anastrozole 1 mg once a day, and the treatment will be continued for 5 years unless recurrence, secondary cancer, or unacceptable toxicity develops. Patients in the denosumab group will receive a subcutaneous injection of 60 mg of denosumab every 6 months. The primary endpoint is the rate of change in the lumbar spine (L1-L4) BMD, as determined by dual-energy X-ray absorptiometry (DXA), 12 months after the start of the injection. The secondary endpoints were ETHICS AND DISSEMINATION:: The protocol was approved by the institutional review boards of Kyoto Prefectural University of Medicine and all the participating faculties. Written informed consent was obtained from all patients before registration, in accordance with the Declaration of Helsinki. Results of the study will be disseminated via publications in peer-reviewed journals. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT03324932, Japan Registry of Clinical Trial (jRCT): CRB5180001.

DOI： 10.1097/MD.0000000000016770

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.21873/anticanres.13536

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10549-019-05276-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Aromatase inhibitors (AI) have been established as the gold-standard therapy for postmenopausal patients. Worldwide, adjuvant denosumab at a dose of 60 mg twice per year reduces the risk of clinical fractures in postmenopausal patients with breast cancer who received AI. However, the efficacy of denosumab in the treatment of AI-associated bone loss had not been prospectively evaluated in Japan. Previously, we reported the 12-month effect of denosumab in Japanese patients for the first time; the primary endpoint was the change in the percentage of bone mineral density (BMD) of the lumbar spine from baseline to 12 months. METHODS: This secondary follow-up study prospectively evaluated the change in the percentage of BMD of the lumbar spine from baseline to 24 months. Postmenopausal women with early-stage, histologically confirmed, hormone receptor-positive, invasive breast cancer who were receiving or scheduled to receive AI were included. Denosumab was administered subcutaneously on day 1 of the study and then 6, 12, 18, and 24 months. The lumbar spine and bilateral femoral neck BMD was measured at baseline and 6, 12, 18, and 24 months. RESULTS: At 18 and 24 months, the lumbar spine BMD increased by 5.9 and 7.0%, respectively. The femoral neck BMD also increased. Grade ≥ 2 hypocalcemia, osteonecrosis of the jaw, and atypical femoral fractures did not occur. CONCLUSIONS: Our prospective study showed that semiannual treatment with denosumab was associated with continuously increased BMD in Japanese women receiving adjuvant AI therapy for up to 24 months, regardless of prior AI treatment.

DOI： 10.1007/s12282-018-0896-y

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記述言語：日本語   出版者・発行元：(一社)日本骨粗鬆症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Aldehyde dehydrogenase1 (ALDH1) is widely accepted as a stem cell marker for normal breast as well as in breast cancer. Although the clinical impact of ALDH1 was observed in our previous study, we do not know how ALDH1 affects stem cell features resulting in worsening of prognosis in breast cancer. The purpose of this study is to explore ALDH1-related gene and its function on cancer stem cell (CSC). METHODS: In five cases of ALDH1-positive triple-negative breast cancer, mRNA expression profile was compared between ALDH1-positive and ALDH1-negative cells by Affymetrix microarray analysis after microdissection. Among the genes modulated in ALDH1-positive cells, we focused on H19, which encodes a long non-coding RNA, in this study. An in-vitro study was conducted with H19 siRNA in HCC1934 and iCSCL10A cell lines. The association of H19 with prognosis was examined in 180 breast cancer cases. RESULTS: Network analysis revealed the existence of five genes related with H19, including miR-103, miR-107, let-7, miR-29b-1, and Trx. In-vitro analysis showed that suppression of H19 using siRNA reduces sphere formation capacity in both HCC1934 and iCSCL10A cell lines. In clinical studies, H19 expression was associated with hormone negativity, tumor size, and nodal status. Patients with H19 expression had significantly poor disease-free survival (DFS) (26.3 vs. 64.8% at 5 years, p = 0.001) and overall survival (OS) (28.9 vs. 68.3% at 5 years, p = 0.004). The effect of H19 expression on prognosis was the most significant in triple-negative breast cancer compared to that in other subtypes (20.0 vs. 65.4% at 5 years DFS, p = 0.012, 20.0 vs. 69.2% at 5 years OS, p = 0.016). CONCLUSION: This study indicated that H19 was associated with stem cell phenotype in ALDH1-positive breast cancer. H19 regulates CSC and is associated with poor prognosis in breast cancer patients, particularly in triple-negative subtype.

DOI： 10.1007/s10549-018-4793-z

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出版者・発行元：Springer Nature America, Inc  

DOI： 10.1007/s00238-018-1449-5

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記述言語：英語  

DOI： 10.1097/PRS.0000000000004908

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Impact Journals LLC  

We previously reported the establishment of several types of long-term estrogendepleted- resistant (EDR) cell lines from MCF-7 breast cancer cells. Type 1 EDR cells exhibited the best-studied mechanism of aromatase inhibitor (AI) resistance, in which estrogen receptor (ER) expression remained positive and PI3K signaling was upregulated. Type 2 EDR cells showed reduced ER activity and upregulated JNK-related signaling. The mTOR inhibitor everolimus reduced growth in cells similar to Type 1 EDR cells. The present study generated everolimus-resistant (EvR) cells from Types 1 and 2 EDR cells following long-term exposure to everolimus in vitro. These EvR cells modeled resistance to AI and everolimus combination therapies following first-line AI treatment failure. In Type 1 EvR cells, everolimus resistance was dependent on MAPK signaling
single agents were not effective, but hormonal therapy combined with a kinase inhibitor effectively reduced cell growth. In Type 2 EvR cells, ER expression remained negative and a JNK inhibitor was ineffective, but a Src inhibitor reduced cell growth. The mechanism of acquired everolimus resistance appears to vary depending on the mechanism of AI resistance. Strategies targeting resistant tumors should be tailored based on the resistance mechanisms, as these mechanisms impact therapeutic efficacy.

DOI： 10.18632/oncotarget.25133

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose We evaluated the noninferiority of dexamethasone (DEX) on day 1, with sparing on days 2 and 3, combined with neurokinin-1 receptor antagonist (NK1-RA) and palonosetron (Palo) compared with the 3-day use of DEX in highly-emetogenic chemotherapy (HEC). Patients and Methods Patients who were scheduled to receive HEC (cisplatin ≥ 50 mg/m2 or anthracycline plus cyclophosphamide) were randomly assigned to receive either DEX on days 1 to 3 (Arm D3) or DEX on day 1 and placebo on days 2 and 3 (Arm D1) combined with NK1-RA and Palo. The primary end point was complete response (CR), defined as no emesis and no rescue medications during the overall (0 to 120 h) phase. The noninferiority margin was set at -15.0% (Arm D1 - Arm D3). Results A total of 396 patients-196 and 200 patients in Arms D3 and D1, respectively-were evaluated. CR rates during the overall period were 46.9% for Arm D3 and 44.0% for Arm D1 (95% CI, -12.6% to 6.8%; P = .007). CR rates during the acute (0 to 24 h) phase were 63.3% and 64.5% for Arms D3 and D1, respectively (95% CI, -8.1% to 10.6%; P < .001), and they were 56.6% and 51.5%, respectively, during the delayed (24 to 120 h) phase (95% CI, -14.8% to 4.6%; P = .023). Hot flushes and tremors were observed more frequently as DEX-related adverse events on days 4 and 5 in Arm D3, whereas anorexia, depression, and fatigue were observed more frequently on days 2 and 3 in Arm D1. As an indication of quality of life, global health status was similar in both arms. Conclusion Antiemetic DEX administration on days 2 and 3 can be spared when combined with NK1-RA and Palo in HEC.

DOI： 10.1200/JCO.2017.74.4375

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記述言語：英語  

DOI： 10.1080/23320885.2018.1515020

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

DOI： 10.1007/s12282-017-0792-x

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記述言語：日本語   出版者・発行元：(一社)日本核医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

My arguments regarding postmastectomy radiotherapy (PMRT) for this case are based on the following 4 reasons: (1) high rate of local recurrence in the no PMRT group in the Early Breast Cancer Trialists' Collaborative Group meta-analysis on which the present guideline is based, (2) stage migration by sentinel node biopsy, (3) possible adverse events of radiotherapy, and (4) problems on extrapolation of data from western countries.

DOI： 10.1007/s12282-016-0749-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

DOI： 10.1007/s12282-016-0745-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

Background A free fascioadipocutaneous flap obtained from the medial thigh is suitable for breast reconstruction in Asian women with a small-to-moderate breast size. In this region, both a medial circumflex femoral artery perforator flap (MCFAp flap) and a posterior medial thigh perforator flap (PMTp flap) are options, based on perforators from the deep femoral vessels. Here, we evaluated the anatomic basis of the medial circumflex femoral artery (MCFA) perforators from the medial circumflex femoral vessels.
Methods Between July 2010 and June 2014, 53 patients (55 flaps) underwent breast reconstruction using a fascioadipocutaneous flap from the medial thigh. MCFA perforators larger than or equal to 0.5 mm in this region were investigated. The following parameters were recorded intraoperatively: number of perforators, perforator locations, distance of the perforating point from the proximal thigh crease and anterior border of the gracilis muscle.
Results The total number of perforators was 131, with a mean of 2.4. The number of perforators coursing through the gracilis muscle (gracilis perforators) was the largest, followed by septocutaneous perforator coursing between the adductor longus and gracilis muscle. The average perforating point was located 6.5 cm below the proximal thigh crease and 2.2 cm from the anterior border of the gracilis muscle. Of the 102 procedures performed since 2006, 15 flaps were elevated as MCFAp flaps and there was no major complication.
Conclusions In some cases, MCFA perforators are dominant in this region compared to PMT perforators. A perforator map can be helpful for identifying adequate MCFA perforators intraoperatively.

DOI： 10.1007/s12282-016-0728-x

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記述言語：英語   出版者・発行元：AMER SOC CLINICAL ONCOLOGY  

DOI： 10.1200/JCO.2017.35.15_suppl.e13092

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The aim of this study was to assess therapeutic response to breast cancer neoadjuvant chemotherapy (NAC) by F-FDG positron emission mammography (PEM) compared with that to whole-body F-FDG PET (WBPET). METHODS: Twenty patients underwent WBPET and PEM 3 times: the first time was before NAC, the second time was after 2 courses of NAC, and the third time was after all courses of NAC. A pathological complete response (pCR) was defined as no evidence of residual invasive cancer with or without ductal carcinoma in situ. The relationships between each modality's SUVmax and pathological response were evaluated. RESULTS: Nine patients achieved a pCR, whereas the other 11 patients had a non-pCR. The SUVmax of WBPET after 2 courses of NAC was significantly lower in the pCR group than in the non-pCR group (1.4 ± 0.4 vs 2.7 ± 2.1, P = 0.0334). There were no significant differences in the SUVmax of PEM (ie, PEM uptake value [PUV]) between the groups. The SUVmax of WBPET (area under the ROC curve [AUC] = 0.761) was superior to the PUVmax (AUC, 0.648) for predicting non-pCR at the interim time point. After all courses of chemotherapy, there were no significant differences between the groups in the SUVmax of WBPET; however, PUVmax was significantly lower in the pCR group than in the non-pCR group (1.0 ± 0.2 vs 2.5 ± 2.7, P = 0.0351). After NAC, the PUVmax (AUC, 0.796) was superior to the SUVmax of WBPET (AUC, 0.671). CONCLUSIONS: There proved to be no apparent superiority of PEM in predicting pCR at the interim time point. Positron emission mammography had greater diagnostic capability for detecting residual cancer after all courses of NAC.

DOI： 10.1097/RLU.0000000000001497

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ACADEMIC PRESS INC ELSEVIER SCIENCE  

Background: The standard of care for elderly women with breast cancer remains controversial. The aim of this study was to clarify the management of elderly breast cancer patients who undergo surgery.
Materials and methods: This retrospective single-center cohort study included 2276 breast cancer patients who underwent surgery between 1993 and 2014. The patients were divided into three groups according to age: &lt;= 64 y (young), 65-74 y (older), and &gt;= 75 y (elderly).
Results: The elderly had more advanced stage disease at diagnosis (stage III and IV, 16.2%, 17.5%, and 22.1% for the young, older, and elderly groups, respectively). The elderly were more likely to undergo mastectomy (43.3%, 41.4%, and 50.7%, respectively), omit axillary operation (0.6%, 1.1%, and 9.3%, respectively), and skip radiotherapy after breast-conserving surgery (93.1%, 86.8%, and 29.1%, respectively). Endocrine therapy was widely used in all the groups (94.4%, 93.8%, and 90.1%, respectively), but frequency of chemotherapy was lower in the elderly regardless of hormone receptor (HR) status (40.8%, 25.5%, and 9.3% in HR(+), 87.2%, 75.3%, and 39.5% in HR(-), respectively). Although the locoregional recurrence rate was higher in the elderly (4.2%, 3.4%, and 7.0% at 5 y, respectively; P = 0.028), there were no differences among groups in distant metastasis-free survival or breast cancerespecific survival.
Conclusions: Although elderly patients had more advanced stages of cancer and received less treatment, there were no differences in survival. Omission of axillary dissection, radiation, and chemotherapy after operation may be an option for breast cancer patients aged &gt;= 75 y. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jss.2016.05.031

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記述言語：英語  

With the increasing use of adjuvant chemotherapy for treating early breast cancer, febrile neutropenia management has become crucial. Guidelines for febrile neutropenia management are mostly based on a Caucasian population survey although ethnic differences are reported in terms of adverse events. We survey the current status of febrile neutropenia and risk factors in Japanese female breast cancer patients receiving neoadjuvant and adjuvant chemotherapy regimens potential for febrile neutropenia. Subsequently, we plan to conduct a multicenter prospective cohort study involving 1000 patients with operable breast cancer. With the current state of oral antibiotics being routinely prescribed without hematology tests, we survey febrile neutropenia based on two different definitions, namely, true febrile neutropenia: ≥37.5°C and Grade 4 neutropenia, and surrogate febrile neutropenia: ≥37.5°C and oral antibiotic and antipyretic intake. The comparison of true febrile neutropenia and surrogate febrile neutropenia incidences is anticipated to provide information on the safety and feasibility of chemotherapy management without performing blood tests.

DOI： 10.1093/jjco/hyw045

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

Aim: Triple negative breast cancer (TNBC) is a heterogeneous disease and is associated with the cancer stem cell (CSC), basal-like, and BRCA1 function deficient (BRCAness) subtypes. We examined these 3 subtypes in TNBC and compared their chemosensitivity against anthracycline or taxane with a special attention to BRCAness.
Methods: Sixty-six TNBC cases were obtained from a randomized phase II trial comparing TCx6 (TC6) with PEC-Docetaxel (FEC-D) as neoadjuvant chemotherapy. The core needle specimens before chemotherapy were used for subtyping. The basal-like and CSC subtypes were identified by immunohistochemistry; CK5/6 and EGFR staining for the basal-like subtype and ALDH1 staining for the CSC subtype. The BRCAness subtype was examined by Multiplex Ligation-dependent Probe Amplification (MLPA). Correlations between subgroups and pCR rates according to each regimen and subtype were examined.
Results: The basal-like and BRCAness subtypes were significantly associated (p = 0.010) with the other subtypes, but not the CSC subtype. The pCR rates were higher with 1-EC-D than with TC6 in the basal-like (54.5% vs 14.3%, p = 0.081) and BRCAness (56.2% vs 16.7%, p = 0.030) subtypes. Both were not effective in the CSC subtype (18.2% vs 11.8%, p = 1.00).
Conclusion: BRCAness identified by MLPA was practically useful for treatment selection for avoiding taxane. ALDH1 may be considered as a marker for the CSC subtype requiring novel agents. (C) 2016 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ejso.2016.02.246

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記述言語：英語   出版者・発行元：AMER SOC CLINICAL ONCOLOGY  

DOI： 10.1200/JCO.2016.34.15_suppl.10019

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Aldehyde dehydrogenase 1 (ALDH1) has been identified as a breast cancer stem cell marker, but its value as a predictor of prognosis and chemoresistance is controversial. This study investigated the effect of ALDH1 on prognosis and chemoresponse by breast cancer subtype. We immunohistochemically analyzed 653 invasive breast cancer specimens and evaluated correlations among clinicopathological factors, survival status, response to neoadjuvant chemotherapy, and ALDH1 expression. Of 653 specimens, 139 (21.3 %) expressed ALDH1 in tumor cells. ALDH1 expression was correlated significantly with larger tumor size, node metastasis, higher nuclear grade, and with HER2(+) and progesterone/estrogen receptor (HR)(-) subtypes. ALDH1 expression was significantly observed in HER2 type and triple-negative breast cancer (TNBC). Patients with ALDH1(+) cancers had significantly shorter disease-free survival (P &lt; 0001) and overall survival (P = 0.044). ALDH1 expression significantly affected prognosis of luminal types, but not TNBC and HER2-enriched types. For the 234 patients treated with neoadjuvant chemotherapy, pathological complete response (pCR) rate was significantly lower in ALDH1(+) cases (13.5 vs. 30.3 %, P = 0.003). pCR and ALDH1 expression were significantly correlated in TNBC patients (P = 0.003). ALDH1(+) breast cancers tended to be aggressive, with poor prognoses. Although ALDH1(+) TNBC showed higher chemoresistance, ALDH1 had significant impact on prognosis in the luminal type but not in TNBC.

DOI： 10.1007/s10549-016-3738-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

Background: The objective of this study was to examine the clinical outcomes of immediate breast reconstruction using perforator flaps from different donor sites, and to characterize the trends among these flaps.
Methods: We retrospectively reviewed 136 consecutive patients who underwent immediate breast reconstruction using free flaps after skin sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM). The whole breast was pathologically analyzed in 5-mm sections. Breast reconstruction was performed using the deep inferior epigastric perforator (DIEP) flap, gluteal artery perforator (GAP) flap, and posterior medial thigh perforator (PMTP) flap. Patient characteristics were compared among donor sites.
Results: NSM was converted to SSM because of intraoperative subareolar tumor positivity in 7 of 107 patients. Eleven patients had positive margins in permanent sections. All but one patient had a positive horizontal margin in the peripheral direction. The 5-year recurrence-free survival rate was 91.9%. The locoregional recurrence rate was 5.1% with a mean follow-up observation period of 75 months. DRIP, GAP, and PMTP flaps were used in 64 (47.1%), 38 (27.9%), and 34 (25.0%) patients, retrospectively. DIEP flaps were used in older patients and those with a higher body mass index. GAP flaps were used in younger patients. DIEP and GAP flaps were used for larger breasts, and PMTP flaps for smaller breasts.
Conclusion: NSM or SSM with immediate perforator flap breast reconstruction is an oncologically acceptable surgical option. We believe that age, desire to have children, body mass index, and excised breast volume are valuable factors for selecting the optimal donor site. (C) 2015 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ejso.2015.12.002

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DOI： 10.1158/1538-7445.AM2015-4247

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DOI： 10.1158/1538-7445.SABCS14-P2-06-16

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PubMed

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DOI： 10.1158/1538-7445.AM2014-1899

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：英語   出版者・発行元：AMER SOC CLINICAL ONCOLOGY  

DOI： 10.1200/jco.2014.32.15_suppl.e12013

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(株)篠原出版新社  

53歳女性、主訴は左乳房腫瘤。USで左ED領域に7.2cmの低エコー腫瘤を認め、マンモグラフィでは同部にカテゴリー4の腫瘤を認めた。Core needle biopsyで組織型はMPC、ER(-)、PgR(-)、HER2(-)、NG=3、Ki67=69%、AE1/AE3(+)、vimentin(+)、T3N1M0 cStage IIIAの診断で術前化学療法(FEC100×4-DOC75×2)施行しcPR。Bt+Ax(I+II)施行、組織学的治療効果はGrade 2a、pN0(0/14)であった。MPCのほとんどはTriple negative乳癌だが術前化学療法施行症例の報告は少ない。文献的考察を加え報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本乳癌検診学会  

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記述言語：日本語   出版者・発行元：(NPO)日本乳癌検診学会  

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記述言語：日本語   出版者・発行元：(NPO)日本乳癌検診学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：Study Group of Microwave Surgery  

<b>Background/Purpose:</b> The purpose of this study was to evaluate the efficacy of laparoscopy-assisted liver surgery, to introduce laparoscopic surgery for hepatectomy.<br><b>Operative procedure:</b> After the mobilization of the liver under the laparoscope, hepatectomy was performed through the small skin incision as the same procedure as the conventional hepatectomy without the laparoscope.<br><b>Method:</b> Between 2009 and Jun. 2011, 31 patients underwent laparoscopy-assisted hepatectomy (Laparoscopic group). Twenty-seven patients who underwent conventional hepatectomy under wide incision without laparoscope were control as a matched group (Open group). Operation time, operative blood loss, total amount of transfusion and the short term outcome were compared.<br><b>Result:</b> Operating time in the laparoscopy group was significantly longer than that of the open group. There were no significant differences in other operating factor and postoperative complications. Short term outcomes was not significantly different because of the same clinical pathways in both groups.<br><b>Conclusion:</b> Laparoscopy-assisted hepatectomy is feasible and well tolerated. It seemed to be minimal invasive and useful as the early stage of the introduction of laparoscopic surgery for hepatectomy.

DOI： 10.3380/jmicrowavesurg.30.191

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その他リンク： http://search.jamas.or.jp/link/ui/2013011597

記述言語：日本語   出版者・発行元：The Japan Society of Coloproctology  

症例は72歳の男性で，2009年6月，突然右下腹部痛が出現し，近医を受診した．右下腹部に腫瘤を触知し，腹部超音波検査でtarget signを認め，腸重積の診断で緊急入院となった．腸重積は自然に解除されたが，大腸内視鏡検査で盲腸に4cm大の腫瘤を認めた．粘膜下腫瘍が疑われたが，悪性を否定できず，手術を施行した．盲腸に4cm大の弾性硬の壁外性腫瘤を認め，回盲部切除術を施行した．病理組織検査で紡錘形細胞の増生と炎症細胞の浸潤が見られ，炎症性偽腫瘍（inflammatory pseudotumor；以下，IPT）と診断した．大腸原発IPTは稀であり，今回われわれは腸重積を契機に発見された盲腸IPTの1例を経験したので報告する.<br>

DOI： 10.3862/jcoloproctology.64.249

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その他リンク： http://search.jamas.or.jp/link/ui/2011187335

記述言語：日本語   出版者・発行元：The Japan Society of Coloproctology  

症例は53歳，男性．直腸癌の診断で当科に紹介され受診した．局所進行直腸癌（RS～Ra，長径7.5cm，SI（骨盤壁），N2，H0，P0，M0，Stage IIIb）と診断し，横行結腸双孔式人工肛門造設術を行い，化学療法（mFOLFOX6，7サイクル）を施行した．画像診断で直腸腫瘍の縮小とリンパ節腫大の消退を認め，化学療法の効果はPR（部分奏功）であった．化学療法終了後17日目に直腸低位前方切除術（D3）を行い，合併症なく退院した．病理組織学的検査ではpSS，pN0，根治度A，化学療法の効果判定はGrade1bであった．<br> 局所進行直腸癌に対して欧米では放射線化学療法が標準治療とされるが，本邦では手術単独治療が多く行われている．放射線照射は様々な合併症や晩期障害を惹起する一方で，前治療なしに充分な切除断端を保持して切除するのは困難な症例がある．本症例では術前化学療法（FOLFOX）により腫瘍縮小を図り，安全に根治手術を施行し得たので報告する．<br>

DOI： 10.3862/jcoloproctology.63.295

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その他リンク： http://search.jamas.or.jp/link/ui/2010194203

記述言語：日本語   出版者・発行元：Japanese College of Surgeons  

下血を繰り返し手術に至った，NSAIDsが誘因と考えられる多発小腸潰瘍の１例を経験したので報告する．症例は59歳，男性．C型慢性肝炎によるHCCに対して肝動脈塞栓術を施行した．術後の発熱に対し非ステロイド系消炎鎮痛剤（NSAIDs）を投与した．第10病日に下血し緊急下部消化管内視鏡検査を施行したところ，回腸末端に浅い多発潰瘍を認めた．第16病日，再度下血し出血性ショックに陥ったので緊急開腹術を施行した．回腸末端の潰瘍からの出血と判断し回盲部切除術を施行した．UＬ-IからIVの潰瘍が多発し，種々の程度の線維化，出血，血管増生を伴っていたがNSAIDsによる潰瘍として診断された．

DOI： 10.4030/jjcs.34.1057

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その他リンク： http://search.jamas.or.jp/link/ui/2010209623

記述言語：日本語   出版者・発行元：Japanese College of Surgeons  

症例は63歳の男性で，下痢を主訴に近医を受診した際に血液生化学検査で肝機能障害を指摘され，精査目的に当院を紹介された．腹部CTおよびMRCPでは左葉を中心とする肝内胆管と総胆管の拡張が認められたが，肝内および胆道系に腫瘍および結石は認められなかった．ERCPでは下部胆管の壁不整と狭窄が認められ，その中枢の総胆管は拡張していた．下部胆管癌を疑って膵頭十二指腸切除術を行った．切除標本では下部胆管に1.3×1.0cmの全周性の隆起性病変が認められた．病理組織学的検査では異型性のない腺管構造と平滑筋線維の増生が認められ，総胆管腺筋腫と診断された．術後経過は良好で，第33病日に退院し，現在まで術後３年６カ月間再発は認められていない．稀な総胆管腺筋腫の１例を経験したので，文献的考察を加えて報告する．

DOI： 10.4030/jjcs.34.621

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その他リンク： http://search.jamas.or.jp/link/ui/2010043636

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT INST ANTICANCER RESEARCH  

The feasibility and efficacy of adriamycin or epirubicin in combination with cyclophosphamide followed by weekly paclitaxel (AC/EC-weekly PAC) as adjuvant chemotherapy for breast cancer was investigated. Patients and Methods: Node-positive breast cancer was treated with AC/EC-weekly PAC, namely AC at 60/600 mg/m(2) or EC at 90/600 mg/m(2) x 4 at three-week intervals, followed by weekly PAC (80 mg/m(2)) x 12, namely four cycles of single weekly administration for three weeks followed by a one-week rest (3x4 PAC) or single weekly administration for 12 consecutive weeks (12 PAC). Results: One hundred and three of 109 consecutive patients enrolled were analyzed, of whom 96 (93.2%) completed the regimen. Grade 314 neutropenia occurred in 52.4% receiving AC/EC, and 10.9% of 55 receiving 12 PAC but only 2.1% of 48 receiving 3x4 PAC. Neuropathy disorders occurred in more than half receiving PAC, which did not improve after one-week rest in 3x4 PAC. Conclusion: AC/EC-weekly PAC is feasible and without serious complications.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society of Gastroenterological Surgery  

We report a case of true enterolithiasis caused by radiation enteritis. A 69-year-old woman undergoing radical hysterectomy and radiotherapy for uterine cervix cancer 28 years earlier and suffering lower abdominal pain in January 2006 was found in contrast-enhanced computed tomography (CT) to have ileal stenosis and calculus in the dilated ileum oral to the stenosis underwent resection of the stenotic and dilated ileum. Pathological study of resected specimens showed radiation-induced fibrous change. Stenosis was thought to be due to an ulcer scar due to radiation enteritis. Bile acid was a component of calculus. Radiation enteritis should be considered as a differential diagnosis, despite the long decades since radiotherapy. Radiation enteritis presents various conditions and enterolithiasis may be one complication. © 2009 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.42.1728

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 52-year-old woman visited our hospital with epigastralgia. Detailed examination revealed a duodenal cancer of the ascending limbs. Since she refused the resection, the administration of S-1 alone was commenced. After one course of this treatment, oral intake became impossible. Duodenography and endoscopy showed duodenal obstruction, and she underwent surgery. The tumor proved to be unresectable due to direct invasion of the inferior vena cava. Duodenojejunostomy was performed. After surgery, she was treated by S-1 and survived 2 years and 11 months, which resulted in 3 years and 2 months' long survival from her first visit. The intervals of the intake and home stay, after the operation, were 2 years and 8 months and 2 years and 5 months, respectively. The combination of S-1 administration and bypass operation provides a useful alternative for the treatment of unresectable duodenal cancer with stenosis.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本外科感染症学会  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2008050695

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We report a case of radiation-induced rectal cancer, which is thought to originate from dysplasia due to radiation colitis. The patient is a 73 year-old woman, who underwent radical hysterectomy and radiotherapy for uterine cervical cancer 31 years ago. She visited to our hospital complaining of hematochezia. Colonoscopy in January 2004 disclosed redness of the rectal mucosa accompanied with contact bleeding and pathological study of the biopsy specimen revealed severe dysplasia. However, colonoscopy showed an ulcerative lesion of the rectum in December 2004, and pathological findings of the biopsy specimen disclosed moderately differentiated adenocarcinoma. She underwent a rectal resection in January 2005. Pathological study of resected specimen revealed fibrous change induced by radiation. Predominant histological type of the tumor was moderately differentiated carcinoma followed by well differentiated type. However, multiple dysplasias were found around the main tumor or in the mucosa which was treated with radiotherapy.

Scopus

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：The Japan Society of Coloproctology  

症例は59歳,女性.2002年10月腹部膨満感のため近医を受診した.12月当院に紹介受診し,横行結腸癌の診断で手術予定とされていた.入院待機中の2003年2月に腹痛,腹部膨満感を主訴に来院し,大腸癌イレウスの診断で緊急手術を施行した.術中所見で横行結腸癌を先進部とする腸重積症を認め,重積を解除しないまま重積領域を含めた結腸右半切除術(D3)を施行した.<BR>成人の大腸重積症の原因としては癌腫によるものが多く,部位別では回盲部,S状結腸が多く横行結腸例は少ない.大腸癌症例が大腸イレウスを発症した場合,癌腫による狭窄だけでなく腸重積も念頭に置いた診断が必要であり,その鑑別にはCT,超音波検査が有用である.<BR>腸重積をきたした横行結腸癌の1例を,文献的考察を加えて報告した.

DOI： 10.3862/jcoloproctology.58.397

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その他リンク： http://search.jamas.or.jp/link/ui/2005291257

記述言語：日本語   出版者・発行元：Japan Surgical Association  

症例は66歳,女性. 1977年7月に特発性血小板減少性紫斑病 (ITP) と診断され脾臓摘出術を施行するも軽快せず,プレドニゾロン内服を継続していた. 2004年3月下血精査の大腸内視鏡検査で多発大腸ポリープと診断.免疫グロブリン大量投与,ステロイド大量投与で血小板数上昇せず,免疫グロブリン大量先行投与と濃厚血小板輸血後にポリペクトミーを予定した.しかし上行結腸とS状結腸の計3個のポリープは内視鏡的切除は不可能と判断し,さらに免疫グロブリン投与後濃厚血小板輸血を行い,開腹術を施行した. S状結腸ポリープは術後病理診断で深達度smの高分化腺癌と診断した.術後第1, 2病日に免疫グロブリン大量投与と濃厚血小板輸血を行い,血小板数は最高11.9万/μlまで上昇し,術後の経過は良好で第12病日に軽快退院した.免疫グロブリン大量投与とステロイド大量投与が無効であったITP合併S状結腸癌症例に対して,免疫グロブリン大量先行投与と濃厚血小板輸血を行い,安全に手術を施行しえた1例を経験したので報告する.

DOI： 10.3919/jjsa.66.2772

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記述言語：日本語   出版者・発行元：Japan Surgical Association  

症例は67歳,男性. 1996年2月S状結腸癌に対してS状結腸切除術を施行した後, 1997年2月肝S₆ (2.5cm)とS₄ (1.0cm)に再発を認めた.同年3月より5-FUによる肝動注療法を施行したところ9月の腹部CTで肝転移巣は消失しCRとなった.肝動注療法は, 1998年3月まで施行し, 5-FUの総投与量は43.75gであった. 2001年1月肝S₈に再々発を認め, 3月27日肝S₈部分切除術を施行した.腫瘍は長径4cmで横隔膜への直接浸潤を認め一部合併切除した.患者は2002年1月現在,無再発生存中である.<br> 本症例では,肝動注療法に奏効した転移巣と奏効しなかった転移巣が存在し,再々発に対しては肝切除術を施行することで長期生存期間がえられている.<br> 大腸癌肝転移の治療戦略として肝動注後の肝切除は有効であると思われた.

DOI： 10.3919/jjsa.63.1962

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：日本語   出版者・発行元：克誠堂出版  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：日本臨床検査医学会  

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記述言語：日本語   出版者・発行元：(一社)日本核医学会  

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記述言語：日本語   出版者・発行元：(NPO)日本乳癌検診学会  

ステレオガイド下吸引式乳房組織生検は侵襲的な検査であり、検査時間の短縮に努める必要がある。検査技術の習得のためには穿刺ファントムを用いた穿刺実習が有用と考えるが、市販の穿刺ファントムは高価で頻回の購入は困難である。そこでわれわれは、実習用の穿刺ファントムの自作を検討した。穿刺ファントムの素材には、作成する観点および実用性の観点から、軽量粘土およびウレタン樹脂が選択された。さらに使用感について検討し、ウレタン樹脂を採用した。ウレタン樹脂の主剤(主成分ポリエーテルポリオール)と硬化剤(主成分ジイソシアネート)の配合割合についても検討を行った。模擬石灰化の深さは、中央部、表層部、深部の3段階に意図的に配置することが可能であった。柔らかい乳房を想定した配合割合で、3層の模擬石灰化を含むウレタン樹脂のファントム(直径7cm、高さ5cm円柱型)を作成したところ、作成日数30日、作成費用約2,000円であった。安価かつ容易に教育用穿刺ファントムを自作することが可能であったので報告する。(著者抄録)

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その他リンク： http://search.jamas.or.jp/link/ui/2017406625

記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：日本語   出版者・発行元：聖マリアンナ医科大学医学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER SOC CLINICAL ONCOLOGY  

DOI： 10.1200/JCO.2017.35.15_suppl.1025

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.SABCS16-P5-16-04

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記述言語：日本語   出版者・発行元：神奈川県医師会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2017391926

記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   出版者・発行元：(一社)日本核医学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：OXFORD UNIV PRESS  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER SOC CLINICAL ONCOLOGY  

DOI： 10.1200/JCO.2016.34.15_suppl.2527

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記述言語：日本語   出版者・発行元：(一社)日本病理学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER SCI LTD  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は64歳,女性.右乳癌T2N0M0(ER陽性,PgR境界域,HER2未検)に対して右乳房切除とセンチネルリンパ節生検を施行した.術後3年で傍胸骨リンパ節再発を認め,切除した.免疫染色ではER陽性,PgR陰性,HER2陽性(3+)であった.術後5年で胸骨転移を認め,ゾレドロン酸の投与を開始した.以降,左腋窩リンパ節再発と胸骨転移に対して,ホルモン療法,化学療法および抗HER2療法を続行し,ゾレドロン酸も継続投与した.投与開始から8年経過時に,右大腿の動揺を自覚し転倒した.右大腿骨骨幹部非定型骨折(atypical femoral fracture:AFF)の診断で入院,患側の骨折治療と,対側の骨折予防のために,両側大腿骨の髄内釘固定を行った.BP製剤によるAFF発症は極めて稀であるが,骨転移治療においてBP製剤を長期に用いる際は,AFF発症の可能性を念頭に置くべきと考えられた.(著者抄録)

DOI： 10.3919/jjsa.76.2930

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その他リンク： http://search.jamas.or.jp/link/ui/2016108263

記述言語：日本語   出版者・発行元：(NPO)日本乳癌検診学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：横浜市立大学医学会  

医療者ががん患者に死の話題を詳細に告げることは困難を伴うとされ、根治不能ながん患者の最期の場面で蘇生処置をするべきか否かについての確認は、患者本人からではなく、患者の家族との話し合いの中で決定されていることが多い。今回我々は横浜市立大学附属病院の医療スタッフに対して根治不能ながん患者に対するDNR確認の要否に関するアンケート調査を施行した。その結果を報告する。横浜市立大学附属病院でがん診療に関わる医師、看護師、薬剤師521人を対象とし、回収率は92.1%であった。内訳は医師171人、看護師285人、薬剤師24人であった。根治不能ながん患者本人からDNRの確認が必要であるかという質問には、医師、看護師の98%が必要と回答し、不要の解答は1%に過ぎなかった。医療者の70%以上がDNRを「患者自身が医療者に向けた命令」であると捉えており、患者自身からのDNR確認の実現に向けて医療者自身の努力がなされなければならない。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：英語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本病理学会  

J-GLOBAL

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記述言語：英語  

© 2015, International Institute of Anticancer Research. All rights reserved. Aim: We aimed to clarify which breast cancer subtypes respond best to docetaxel/cyclophosphamide chemotherapy (TC) as neoadjuvant chemotherapy (NAC). Patients and Methods: We analyzed pathological responses, clinicopathological characteristics and biological markers (estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), Ki-67, p53, topoisomerase IIα, class III β tubulin, cytokeratin 5/6, epidermal growth factor receptor (EGFR)) in specimens from 79 patients who received NAC-TC. Results: Out of 79 patients, 33 (41.8%) achieved quasipathological complete responses (QpCR). Univariate analysis associated negative ER (p&lt;0.001), negative PR (p=0.007), triple-negative subtype (TNBC; p=0.001), high Ki-67 (p=0.022) and low class III β tubulin (p=0.032) with QpCR. Multivariate analyses associated only negative ER (p=0.050) and low class III β tubulin (p=0.028) and only non-basal subtype in TNBC with QpCR. Conclusion: NAC-TC may be especially effective in ER-breast cancer with low class III β tubulin or non-basal TNBC.

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記述言語：英語   出版者・発行元：WILEY-BLACKWELL  

AimThe indications for intersphincteric (ISR) anterior resection are not clearly defined. The aim of this study was to evaluate vertical extension of T2 or T3 low rectal cancer treated by rectal amputation to optimize patient selection for ISR.
MethodThe abdominoperineal excision specimens of T2 or T3 low rectal cancer from 53 patients treated between 1992 and 2004 were retrospectively reviewed. Vertical invasion was quantified by measuring the shortest distance between the tumour and the striated muscle (T-SM), assuming that this represented the surgical margin that would have be achieved had an ISR been performed.
ResultsInvolvement of the dentate line (DL) and intramural distal spread were independent risk factors for T-SM 2mm. The T-SM was less when the inferior border of the tumour was on the distal side of the DL (r=0.572, P&lt;0.001). The probability of involvement of the DL, intramural distal spread or either one of these being associated with T-SM2mm was 43, 46 and 43%, respectively. All patients without both intramural distal spread and involvement of the DL had T-SM&gt;2.
ConclusionWe recommend that ISR should only be performed for patients with T2 or T3 low rectal cancer in whom the lowest edge of the tumour is above the DL and there is no intramural distal spread. Such patients are relatively unlikely to have a T-SM 2mm.

DOI： 10.1111/codi.12769

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記述言語：英語   出版者・発行元：ELSEVIER SCI LTD  

Background: The impact of neoadjuvant chemotherapy (NACT) on immediate free flap breast reconstruction remains controversial. Furthermore, the oncological outcomes of immediate free flap breast reconstruction after skin-sparing mastectomy (SSM) following NACT remain unclear. This study aimed to investigate the surgical complications and oncological outcomes of immediate perforator flap reconstruction after SSM following NACT.
Methods: A total of 201 consecutive patients with indications for immediate perforator flap reconstruction after SSM were included between 2004 and 2012. Surgical and oncological outcomes were compared between patients with and without NACT.
Results: There were 38 patients in the NACT group and 163 in the non-NACT control group. The median age of the NACT group was 39.5 years, which was significantly younger than the control group (43.0 years; P &lt; 0.05). Patients in the NACT group also had more advanced and aggressive disease (P &lt; 0.05). There was no significant difference in the frequency of surgical complications between the groups, no difference in the type of complications, and no significant difference in the frequencies of major and minor complications. No patients in the NACT group had delayed adjuvant therapy. Eight patients (4%) developed recurrences, with a median follow-up time of 3.0 years. Local recurrences occurred in three control patients but no patients in the NACT group.
Conclusion: NACT does not affect short-term or interim outcomes after immediate perforator flap reconstruction and may thus represent a safe and practical treatment option for the multidisciplinary treatment of breast cancer. (C) 2014 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ejso.2014.09.001

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記述言語：英語   出版者・発行元：ELSEVIER SCI LTD  

Background: The impact of neoadjuvant chemotherapy (NACT) on immediate free flap breast reconstruction remains controversial. Furthermore, the oncological outcomes of immediate free flap breast reconstruction after skin-sparing mastectomy (SSM) following NACT remain unclear. This study aimed to investigate the surgical complications and oncological outcomes of immediate perforator flap reconstruction after SSM following NACT.
Methods: A total of 201 consecutive patients with indications for immediate perforator flap reconstruction after SSM were included between 2004 and 2012. Surgical and oncological outcomes were compared between patients with and without NACT.
Results: There were 38 patients in the NACT group and 163 in the non-NACT control group. The median age of the NACT group was 39.5 years, which was significantly younger than the control group (43.0 years; P &lt; 0.05). Patients in the NACT group also had more advanced and aggressive disease (P &lt; 0.05). There was no significant difference in the frequency of surgical complications between the groups, no difference in the type of complications, and no significant difference in the frequencies of major and minor complications. No patients in the NACT group had delayed adjuvant therapy. Eight patients (4%) developed recurrences, with a median follow-up time of 3.0 years. Local recurrences occurred in three control patients but no patients in the NACT group.
Conclusion: NACT does not affect short-term or interim outcomes after immediate perforator flap reconstruction and may thus represent a safe and practical treatment option for the multidisciplinary treatment of breast cancer. (C) 2014 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ejso.2014.09.001

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

J-GLOBAL

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記述言語：日本語   掲載種別：書評論文，書評，文献紹介等   出版者・発行元：Medical Association of Yokohama City University  

In Japan, it has been considered difficult for medical staff to talk with advanced cancer patients in detail about the patient's death, and decision-making regarding "do not resuscitate" (DNR) or cardiopulmonary resuscitation (CPR) at the time of cardiopulmonary arrest. Therefore, whether to perform CPR is decided by the patient's family without consideration of the patient's wishes. This report provides results from a questionnaire completed by medical staff at Yokohama City University Hospital regarding whether decision making for DNR was confirmed by cancer patients themselves. Survey slips were sent to 521 medical staff involved in the treatment of cancer patients at Yokohama City University Hospital, and the response rate was 92.1%. Ninety-eight percent of medical doctors and nurses replied that DNR should be confirmed by the individual patient. Over 70% of medical staff recognized DNR as an order from patients to medical staff, and that medical staff have to make efforts to talk with patients themselves about DNR decisions.

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER SCI LTD  

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記述言語：英語  

Breast cancer patients who achieve a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) usually have a favourable prognosis. We report on a patient with early metastases to the brain after achieving pCR. The primary tumour was 7.0 cm in diameter with axillary lymph node metastases, hormone receptor-negative, human epidermal growth factor receptor-2-positive (3+), and histological grade 2 with 60% of cells positive for Ki-67. The patient underwent NAC followed by surgery, and achieved pCR. Five months after surgery, during adjuvant treatment with trastuzumab, she developed headache and dizziness. Brain imaging revealed multiple metastatic brain tumours. She received whole-brain radiotherapy followed by lapatinib and capecitabine therapy. At 7 months after surgery, she remains alive with a persistent mild headache. Physicians should be aware of the possibility of early brain metastases, and consider new treatment strategies to prevent brain metastases in high-risk patients who achieve pCR.

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記述言語：英語   出版者・発行元：日本癌学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER SCI LTD  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(NPO)日本緩和医療学会  

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語  

CiNii Books

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記述言語：英語   出版者・発行元：ELSEVIER SCI LTD  

Background: The use of radioisotopes (RIs) is regulated and not all institutions have nuclear medicine facilities for sentinel node biopsy (SNB). We previously reported blue dye-assisted four-node axillary sampling (4NAS/dye) to be a suitable method for detecting sentinel nodes (SNs) without RIs. Here, we present an interim report on an observational study of this technique.
Methods: From May 2003 to June 2008, 234 early breast cancer patients underwent SNB with 4NAS/dye. Lymphatic mapping was performed by injection of patent blue, and axillary sampling was performed until 4 SNs were detected. Patients with metastatic SNs underwent axillary lymph node dissection (ALND) at levels 1 and 11, while SN-negative patients did not undergo further axillary procedures.
Results: The SN identification rate was 99%. In total, 44 patients were diagnosed with metastatic disease by using the 4NAS/dye technique and underwent ALND; the remaining 189 patients did not undergo ALND (the SNB group). After a median follow-up period of 54 months, only 1 patient (0.5%) in the SNB group developed axillary recurrence. For the 4NAS/dye procedure, blue SNs were harvested in 220 patients (94%) and only unstained SNs were harvested in 13 patients (6%). Among the 44 patients with SN metastases, foci were found in blue SNs in 37 patients (84%), while they were found in only unstained SNs in 7 patients (16%).
Conclusions: SNB with 4NAS/dye is a safe and reliable technique for treatment of early breast cancer patients. This technique may be particularly useful for surgeons who do not have access to radioisotope facilities. (C) 2010 Published by Elsevier Ltd.

DOI： 10.1016/j.ejso.2010.06.011

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語  

CiNii Books

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

52歳、女性。心窩部痛を主訴に来院。精査にて十二指腸第4部の進行癌と診断。切除の同意が得られずS-1(4週間内服、2週間休薬)を開始したが、1コース終了後に十二指腸狭窄により経口摂取困難となり手術を施行した。開腹すると腫瘍は下大静脈に浸潤していたため、十二指腸空腸吻合術を行った。術後にS-1を再開し、術後2年11ヵ月、初診からは3年2ヵ月という長期生存を得た。術後在宅通院期間は2年5ヵ月、経口摂取期間は2年8ヵ月であった。根治切除不能で狭窄を呈する十二指腸癌に対し、バイパス手術とS-1投与を行うことは経口摂取期間や在宅通院期間、生存期間の延長に寄与する可能性があると考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：神奈川県医師会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本外科感染症学会  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2009199933

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：BLACKWELL PUBLISHING  

Web of Science

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記述言語：日本語   出版者・発行元：日本外科感染症学会  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2007104058

記述言語：日本語   出版者・発行元：日本臨床外科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Books

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