The receptor activator of NF-B (RANK) pathway is involved in bone health as well as breast cancer (BC) pathogenesis and progression. Whereas the therapeutic implication of this pathway is established for the treatment of osteoporosis and bone metastases, the application in adjuvant BC is currently investigated. As genetic variants in this pathway have been described to influence bone health, aim of this study was the prognostic relevance of genetic variants in RANK and RANKL. Single nucleotide polymorphisms in RANK(L) (rs1054016/rs1805034/rs35211496) were genotyped and analyzed with regard to bone metastasis-free survival (BMFS), disease-free survival, and overall survival for a retrospective cohort of 1251 patients. Cox proportional hazard models were built to examine the prognostic influence in addition to commonly established prognostic factors. The SNP rs1054016 seems to influence BMFS. Patients with two minor alleles had a more favorable prognosis than patients with at least one common allele (HR 0.37 (95% CI: 0.17, 0.84)), whereas other outcome parameters remained unaffected. rs1805034 and rs35211496 had no prognostic relevance. The effect of rs1054016(RANKL) adds to the evidence that the RANK pathway plays a role in BC pathogenesis and progression with respect to BMFS, emphasizing the connection between BC and bone health.
Introduction The placement of intramammary marker clips has proven to be helpful for tumor localization in patients undergoing neoadjuvant chemotherapy and breast-conserving surgery. The purpose of our study was to investigate the feasibility of using a clip marker system for breast cancer localization and its influence on the imaging assessment of treatment responses after neoadjuvant chemotherapy.
Patients and Methods Between March and June 2015, a total of 25 patients (n = 25), with a suspicion of invasive breast cancer with diameters of at least 2 cm (cT2), underwent preoperative sonographically guided core needle biopsy using a single-use breast biopsy system (HistoCore™) and intramammary clip marking using a directly adapted clip system based on the established O-Twist Marker™, before their scheduled preoperative neoadjuvant chemotherapy. Localization of the intramammary marker clip was controlled by sonography and digital breast tomosynthesis.
Results Sonography detected no dislocation of intrammammary marker clips in 20 of 25 patients (80 %), while digital breast tomosynthesis showed accurate placement without dislocation in 24 patients (96 %) (p < 0.05). There was no evidence of significant clip migration during preoperative follow-up imaging after neoadjuvant chemotherapy. No complication related to the clip marking was noted and there was no difficulty in evaluating the treatment response to neoadjuvant chemotherapy. Among the breast-conserving surgeries performed, no cases were identified in which intraoperative loss of the marker clip had occurred.
Conclusion Our study underscores the importance of intramammary marking clip systems before neoadjuvant chemotherapy. Placement of marker clips is advised to facilitate accurate tumor bed localization. With regard to digital breast tomosynthesis, its development continues to improve the quality of diagnostics and the therapy of breast cancer particularly for small breast cancer tumors or in neoadjuvant chemotherapy setting.
Background: No screening programs are available for ovarian or endometrial cancer. One reason for this is the low incidence of the conditions, resulting in low positive predictive values for tests, which are not very specific. One way of addressing this problem might be to use risk factors to define subpopulations with a higher incidence. The aim of this study was to investigate the extent to which a medical history of endometriosis can serve as a risk factor for ovarian or endometrial cancer. Methods: In a hospital-based case-control analysis, the cases represented patients with endometrial or ovarian cancer who were participating in studies aimed at assessing the risk for these diseases. The controls were women between the age of 40 and 85 who were invited to take part via a newspaper advertisement. A total of 289 cases and 1016 controls were included. Using logistic regression models, it was tested whether self-reported endometriosis is a predictor of case-control status in addition to age, body mass index (BMI), number of pregnancies and previous oral contraceptive (OC) use. Results: Endometriosis was reported in 2.1 % of the controls (n = 21) and 4.8 % of the cases (n = 14). Endometriosis was a relevant predictor for case-control status in addition to other predictive factors (OR 2.63; 95 % CI, 1.28 to 5.41). Conclusion: This case-control study found that self-reported endometriosis may be a risk factor for endometrial or ovarian cancer in women between 40 and 85 years. There have been very few studies addressing this issue, and incorporating it into a clinical prediction model would require a more precise characterization of the risk factor of endometriosis.
Zielsetzung: Zentrumsbildung mit Zertifizierung hat einen qualitätsoptimierenden Effekt, fordert jedoch zusätzliche Ressourcen, insbesondere für die Dokumentation. Da bisher keine publizierten Daten zum tatsächlichen Dokumentationsaufwand vorliegen, wurde dieser im vorliegenden Projekt für Patientinnen mit einem primären Mammakarzinom ermittelt, um eine Datenlage für zukünftige strategische Entscheidungen zu etablieren. Material und Methoden: Im Rahmen des unizentrischen Projekts wurden sämtliche Dokumentationszeitpunkte der gesamten Versorgungskette erfasst. Folgend wurden die Dokumentationszeiten einer repräsentativen Anzahl von Patientinnen ermittelt und der Personalaufwand mit berufsgruppenspezifischen Kosten hinterlegt, um die finanziellen Dokumentationsressourcen darzustellen. Ergebnisse: Insgesamt wurden 494 Dokumentationszeitpunkte sowie 21 an der Dokumentation beteiligte Fachbereiche und 20 Berufsgruppen ermittelt. Mit 54 % entfällt der größte Dokumentationsanteil auf die ärztliche Berufsgruppe. 62 % aller Dokumentationszeitpunkte betreffen den ambulanten Sektor. In Fallbeispielen einer Mammakarzinompatientin mit Diagnose, Therapie und Nachsorge im zertifizierten Brustzentrum zeigte sich ein Dokumentationsaufwand von bis zu 105 Stunden mit entsprechenden Personalkosten von bis zu 4135 €. Zusammenfassung: Die vorliegende Analyse verdeutlicht den erheblichen personellen und finanziellen Aufwand für die Dokumentation in zertifizierten Strukturen. Dies wird folgend in einer multizentrischen Erhebung validiert.
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