Single‐atom nanozymes have revolutionized catalytic tumor therapy by maximizing atomic efficiency and enabling enzyme‐mimetic reactive oxygen species (ROS) generation. Yet, their single active‐site architecture imposes fundamental limitations on catalytic selectivity and intermediate adsorption–desorption kinetics. Here, a manganese/ruthenium dual‐metal single‐atom nanozyme (Mn/Ru BMSA) is reported that overcomes these constraints through synergistic metal interactions, exhibiting unprecedented multienzyme activities, including catalase, peroxidase, and superoxide dismutase. By leveraging tumor‐overexpressed hydrogen peroxide, Mn/Ru BMSA simultaneously alleviates hypoxia and produces cytotoxic hydroxyl radicals, creating a self‐sustaining catalytic cycle that amplifies ROS for radiotherapy synergy. Density functional theory calculations reveal that Mn coordination modulates the d‐band center of Ru, optimizing electronic structure to enhance substrate activation. In radioresistant breast cancer models, Mn/Ru BMSA exhibits a synergistic triple‐modal antitumor action: 1) sustained oxygen generation alleviates tumor hypoxia, 2) X‐ray‐enhanced ROS production amplifies oxidative stress, and 3) hypoxia‐inducible factor 1α pathway inhibition suppresses cancer stem cell (CSC) stemness (as validated by transcriptomics). Patient‐derived organoid assays demonstrated complete radioresistance reversal while maintaining exceptional biosafety. This work establishes Mn/Ru BMSA as a potential radiosensitizer that overcomes the limitations of conventional high‐Z materials by targeting the hypoxia‐CSC axis, providing a strategy for developing multi‐functional nanozymes against treatment‐resistant cancers.

BACKGROUND:Breast cancer-related lymphedema (BCRL) remains a common and morbid complication after axillary lymph node dissection, particularly in patients receiving regional nodal irradiation. Although microsurgical preventive strategies such as the lymphatic microsurgical preventive healing approach are effective, their widespread adoption is limited by technical complexity and resource requirements. This study evaluated the feasibility, safety, and preliminary outcomes of a standardized nonmicrosurgical lymph-interpositional technique using a pedicled lateral thoracic lymph-adipofascial flap (LT-LAF). METHODS:This retrospective, hypothesis-generating study included 55 consecutive breast cancer patients at high risk for BCRL who underwent axillary lymph node dissection with immediate axillary reconstruction using a pedicled LT-LAF between October 2020 and January 2024. Lymphedema was defined by patient-reported symptoms and a relative volume change ≥ 10% and classified according to International Society of Lymphology criteria. RESULTS:After a median follow-up of 24 months, 6 patients (10.9%) developed mild lymphedema (ISL stage I). No moderate or severe lymphedema and no axillary nodal recurrences were observed during follow-up. All flaps survived completely, with no major flap-related or donor-site complications. The LT-LAF harvest and inset added a mean operative time of 35 ± 6.4 minutes. CONCLUSIONS:Immediate axillary reconstruction using a pedicled LT-LAF is a safe, simple, and reproducible nonmicrosurgical technique with a favorable preliminary signal for mitigating BCRL risk in high-risk patients. These findings support further prospective and comparative studies to define its role within contemporary lymphedema prevention strategies.

Background:Breast phyllodes tumors (PTs) tend to grow rapidly and often present as large tumors. Consequently, conventional surgery (CS) typically leaves large and conspicuous scars on the breast. In contrast, endoscopic-assisted surgery (EAS) via the axillary approach offers smaller, more concealed incisions, leaving the breast surface unscarred. However, whether this technique can enhance aesthetic outcomes without increasing the risk of PTs recurrence remains unclear. The study aimed to compare the oncologic safety and cosmetic outcomes of EAS versus CS in patients with PTs. Methods:Patients with newly diagnosed PTs who received surgical treatment were included, and they were stratified into two groups: EAS group and CS group. Propensity score matching (PSM) was used to balance the baseline differences between two groups. Oncologic safety, cosmetic satisfaction, intraoperative indicators, and postoperative complications were compared between patients underwent EAS and CS. Results:After 3:1 PSM, 200 patients were included in the final analysis (147 CS and 53 EAS). The median follow-up was 23.77 months. EAS was associated with a significantly longer operative time (83.77±26.81 vs. 73.44±34.66 min, P=0.01) but yielded superior cosmetic outcomes, as evidenced by higher BREAST-Q scores for breast satisfaction (76.81±9.15 vs. 69.21±9.64, P<0.001) and psychological well-being (91.16±6.69 vs. 85.17±11.71, P<0.001). Postoperative complications and intraoperative blood loss did not differ significantly. Oncologic outcomes were comparable between the groups, with similar 3-year local recurrence-free survival (LRFS; 97.0% EAS vs. 93.4% CS), distant metastasis-free survival (DMFS; 100% EAS vs. 97.5% CS), and overall survival (OS; 100% EAS vs. 98.3% CS). Conclusions:In this matched cohort study, EAS approved to be a safe and feasible substitute to CS for PTs, offering equivalent oncologic outcomes while significantly improving cosmetic satisfaction and psychological well-being.

Immunotherapy has emerged as a promising treatment option for triple-negative breast cancer (TNBC); however, the pronounced heterogeneity of the tumor immune microenvironment significantly hinders the prediction of therapeutic efficacy, with effective biomarkers also remaining limited. This study utilizes single-cell RNA sequencing (scRNA-seq) and transcriptome analysis to dissect the immune landscapes of TNBC, emphasizing CD8 effector T cells (CD8Teff) as potential predictors of immune checkpoint inhibitors (ICIs) treatment response. Immune profiling revealed that CD8Teff cells were predominantly enriched in "hot" tumors strongly correlating with improved progression-free and overall survival. Notably, the cytokine C-X-C Motif Chemokine Ligand 13 (CXCL13) emerged as a key regulator, with its high expression marking an immune-active tumor microenvironment favorable to ICI efficacy. Comprehensive analysis uncovered critical interactions between CD8Teff cells and other immune and stromal components, supporting the formation of an immunologically active tumor microenvironment (TME) conducive to tumor control. Additionally, metabolic reprogramming of CD8Teff cells in responsive tumors highlighted pathways that may influence ICIs efficacy. CD8Teff cells significantly influence the TME and predict ICI success in TNBC, with CXCL13 as a pivotal modulator. A pathology-based artificial intelligence model for CD8Teff recognition was developed, achieving an area under the curve (AUC) of 0.823 in the training cohort and 0.805 in the validation cohort. This study provides an in-depth characterization of the TNBC immune microenvironment, identifying CD8Teff functionality, CXCL13 signaling, and immune-metabolic pathways as critical determinants of immunotherapy success. These findings support the development of personalized treatment strategies based on immune profiling to enhance therapeutic efficacy in TNBC.

Background:Postoperative chest wall seroma is a common complication following modified radical mastectomy. When persistent, it can lead to the formation of a dense fibrous capsule (pseudobursa), resulting in a refractory seroma that is unresponsive to conventional treatments and may delay essential adjuvant therapies. Surgical excision of the capsule carries significant risks. This study introduces a less invasive surgical technique to manage this challenging condition. Methods:From 2018 to 2021, 20 patients with refractory seroma after modified radical mastectomy were included in this retrospective study. Inclusion required seroma persistence for over one month despite repeated aspirations, with the presence of a fibrous capsule confirmed by ultrasonography. A minimally traumatic, four-step technique was employed under local anesthesia, involving capsule scraping, "cross-hatch" scoring, and flap fixation. A drainage tube was inserted post-procedure. Color Doppler ultrasound was used for pre- and post-procedural assessment. Results:The study included 20 female patients with a median age of 57.5 years. All patients had node-positive breast cancer. The "cross-hatch" capsular scoring technique was successfully performed in all cases. The median postoperative drainage time was 7 days (range 6-12 days). During a median follow-up of 3 months, no seroma recurrence was observed. The procedure was well-tolerated with minimal pain, and no significant complications such as hematoma or infection occurred. Conclusion:The "cross-hatch" capsular scoring technique is a safe, effective, and less invasive method for managing refractory post-mastectomy seroma. This approach minimizes patient trauma, reduces recovery time, and helps maintain the continuity of adjuvant therapies, thereby offering a valuable alternative to more aggressive surgical interventions.

Objective:Despite cardiotoxicity overlap, the trastuzumab/pertuzumab and anthracycline combination remains crucial due to significant benefits. Pegylated liposomal doxorubicin (PLD), a less cardiotoxic anthracycline, was evaluated for efficacy and cardiac safety when combined with cyclophosphamide and followed by taxanes with trastuzumab/pertuzumab in human epidermal growth factor receptor-2 (HER2)-positive early breast cancer (BC). Methods:In this multicenter, phase II study, patients with confirmed HER2-positive early BC received four cycles of PLD (30-35 mg/m2) and cyclophosphamide (600 mg/m2), followed by four cycles of taxanes (docetaxel, 90-100 mg/m2 or nab-paclitaxel, 260 mg/m2), concomitant with eight cycles of trastuzumab (8 mg/kg loading dose, then 6 mg/kg) and pertuzumab (840 mg loading dose, then 420 mg) every 3 weeks. The primary endpoint was total pathological complete response (tpCR, ypT0/is ypN0). Secondary endpoints included breast pCR (bpCR), objective response rate (ORR), disease control rate, rate of breast-conserving surgery (BCS), and safety (with a focus on cardiotoxicity). Results:Between May 27, 2020 and May 11, 2022, 78 patients were treated with surgery, 42 (53.8%) of whom had BCS. After neoadjuvant therapy, 47 [60.3%, 95% confidence interval (95% CI), 48.5%-71.2%] patients achieved tpCR, and 49 (62.8%) achieved bpCR. ORRs were 76.9% (95% CI, 66.0%-85.7%) and 93.6% (95% CI, 85.7%-97.9%) after 4-cycle and 8-cycle neoadjuvant therapy, respectively. Nine (11.5%) patients experienced asymptomatic left ventricular ejection fraction (LVEF) reductions of ≥10% from baseline, all with a minimum value of >55%. No treatment-related abnormal cardiac function changes were observed in mean N-terminal pro-BNP (NT-proBNP), troponin I, or high-sensitivity troponin. Conclusions:This dual HER2-blockade with sequential polychemotherapy showed promising activity with rapid tumor regression in HER2-positive BC. Importantly, this regimen showed an acceptable safety profile, especially a low risk of cardiac events, suggesting it as an attractive treatment approach with a favorable risk-benefit balance.

The ATR-Chk1 pathway is essential in cellular responses to DNA damage and replication stress, whereas the role of long noncoding RNAs (lncRNAs) in regulating this pathway remains largely unknown. In this study, we identify an ATR and Chk1 interacting lncRNA (ACIL, also known as LRRC75A-AS1 or SNHG29), which promotes the phosphorylation of Chk1 by ATR upon DNA damages. High ACIL levels are associated with chemoresistance to DNA damaging agents and poor outcome of breast cancer patients. ACIL knockdown sensitizes breast cancer cells to DNA damaging drugs in vitro and in vivo. ACIL protects cancer cells against DNA damages by inducing cell cycle arrest, stabilizing replication forks and inhibiting unscheduled origin firing, thereby guarding against replication catastrophe and contributing to DNA damage repair. These findings demonstrate a lncRNA-dependent mechanism of activating the ATR-Chk1 pathway and highlight the potential of utilizing ACIL as a predictive biomarker for chemotherapy sensitivity, as well as targeting ACIL to reverse chemoresistance in breast cancer.

Background: In breast cancer oncogenesis, the precise role of cell apoptosis holds untapped potential for prognostic and therapeutic insights. Thus, it is important to develop a model predicated for breast cancer patients’ prognosis and immunotherapy response based on apoptosis-related signature.Methods: Our approach involved leveraging a training dataset from The Cancer Genome Atlas (TCGA) to construct an apoptosis-related gene prognostic model. The model’s validity was then tested across several cohorts, including METABRIC, Sun Yat-sen Memorial Hospital Sun Yat-sen University (SYSMH), and IMvigor210, to ensure its applicability and robustness across different patient demographics and treatment scenarios. Furthermore, we utilized Quantitative Polymerase Chain Reaction (qPCR) analysis to explore the expression patterns of these model genes in breast cancer cell lines compared to immortalized mammary epithelial cell lines, aiming to confirm their differential expression and underline their significance in the context of breast cancer.Results: Through the development and validation of our prognostic model based on seven apoptosis-related genes, we have demonstrated its substantial predictive power for the survival outcomes of breast cancer patients. The model effectively stratified patients into high and low-risk categories, with high-risk patients showing significantly poorer overall survival in the training cohort and across all validation cohorts. Importantly, qPCR analysis confirmed that the genes constituting our model indeed exhibit differential expression in breast cancer cell lines when contrasted with immortalized mammary epithelial cell lines.Conclusion: Our study establishes a groundbreaking prognostic model using apoptosis-related genes to enhance the precision of breast cancer prognosis and treatment, particularly in predicting immunotherapy response.

Supplementary methods, tables and figures

BackgroundWomen with atypical hyperplasia (AH) is associated with a higher risk of future breast cancer. However, whether AH found at margins in patients with breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NAC) needs re-excision is not well-defined. The aim of the present study was to evaluate the impact of AH at the surgical margins on the local recurrence and survival outcomes in breast cancer patients treated with NAC and BCS.MethodsA retrospective analysis comparing patients who treated with NAC and BCS with AH at the margins to those without AH was performed.Results598 patients were included in this study. The 5-year rates of ipsilateral breast tumor recurrence (IBTR) were 4.6% and 6.2% in patients with and without AH, respectively. No significant differences were observed among the two groups in terms of IBTR, DMFS, or OS. HER2 overexpressing breast cancer patients with severe AH at margins have a significantly higher risk of IBTR compared to those without severe AH.ConclusionOur study suggests that the presence of AH at the surgical margins of BCS in patients who received NAC does not appear to increase the risk of ipsilateral breast cancer. Therefore, there is no need for surgeons to routinely perform additional re-excision of AH found at the margins of BCS in these patients. However, selective re-excision should be considered in certain cases, particularly in patients with HER2 overexpression.

Background: Internal jugular vein (IJV) and axillary vein/subclavian vein (AxV/SCV) are commonly used for implantable venous access port (IVAP) implantation in breast cancer (BC) patients with chemotherapy. Previous studies focused on complications between these different approaches and ignored patient comfort. In this study, we aim to compare patient comfort between IJV and AxV/SCV approaches, as well as surgery duration and complications. Methods: This is a single-center prospective randomized controlled clinical trial. A total of 200 patients diagnosed with invasive BC will be enrolled in this study. After signing written informed consent, patients schedule to undergo IVAP implantation will be randomized at a 1:1 ratio to receive central venous catheters (CVC) with either IJV or AxV/SCV approaches. Baseline as well as demographic data and procedure time of port implantation will be recorded. All patients will receive assessment of comfort with a comfort scale table at days 1, 2 and 7 after implantation surgery. Patients will be followed up and complications will be recorded until devices are removed at the end of the treatment period, or in case of complications. Patient comfort, procedure time of implantation and complications will be compared and analyzed between these two arms. Discussion: To the best of our knowledge, this is the first study to compare patient comfort as primary outcome measure between IJV and AxV/SCV puncture. This study will further confirm the benefits of ultrasound guidance and may provide a better choice of IVAP implantation for BC patients. Trial registration: This study has been registered at Chinese Clinical Trial Registry (ChiCTR, www.chictr.org.cn) and Chinese Ethics Committee of Registering Clinical Trials (No. ChiCTR2000034986).

Abstract Purpose: The limited efficacy of chimeric antigen receptor (CAR) T-cell therapies with solid malignancies prompted us to test whether epigenetic therapy could enhance the antitumor activity of B7-H3.CAR T cells with several solid cancer types. Experimental Design: We evaluated B7-H3 expression in many human solid cancer and normal tissue samples. The efficacy of the combinatorial therapy with B7-H3.CAR T cells and the deacetylase inhibitor SAHA with several solid cancer types and the potential underlying mechanisms were characterized with in vitro and ex vivo experiments. Results: B7-H3 is expressed in most of the human solid tumor samples tested, but exhibits a restricted expression in normal tissues. B7-H3.CAR T cells selectively killed B7-H3 expressing human cancer cell lines in vitro. A low dose of SAHA upregulated B7-H3 expression in several types of solid cancer cells at the transcriptional level and B7-H3.CAR expression on human transgenic T-cell membrane. In contrast, the expression of immunosuppressive molecules, such as CTLA-4 and TET2, by T cells was downregulated upon SAHA treatment. A low dose of SAHA significantly enhanced the antitumor activity of B7-H3.CAR T cells with solid cancers in vitro and ex vivo, including orthotopic patient-derived xenograft and metastatic models treated with autologous CAR T-cell infusions. Conclusions: Our results show that our novel strategy which combines SAHA and B7-H3.CAR T cells enhances their therapeutic efficacy with solid cancers and justify its translation to a clinical setting.

Breast cancer is rare in men and there is no report of male breast cancer (MBC) with ureteral metastasis. In this study, we report the first case of MBC with ureteral metastasis. A 60-year-old man was diagnosed with triple negative breast cancer (TNBC) with local lymph nodes metastasis (TNM stage: T4N3M0). After surgery, chemotherapy and radiotherapy he was diagnosed with ureter metastasis because of hematuria. This patient took a Precitype gene test (immune index and PAM50) after several lines of treatment and the result indicated that this was a Luminal A subtype case as well as HER-2 mRNA positive, which was quite different from his immunohistochemical staining. Because of his poor condition and he could not tolerate chemotherapy, we adjusted his therapeutic regimen with endocrine therapy and anti-HER-2 therapy according to the gene expression analysis with the informed consent of the patient and his families. However, it seemed that there was no obvious efficacy and he passed away five months later. In our opinion, MBC patients with urinary symptoms should be considered for the possibility of metastasis although urinary metastasis in breast cancer is rare. We still need more research about gene expression analysis and more evidence of treatment recommendations for MBC.

e12528 Background: We previously reported a Chinese version of 21-genes Recurrence Score (RS) provides reduction chemotherapy prescription in patients with ER-Positive/HER2-Negative node negative breast cancer, while Oncotype Dx was hardly to be reached. However, the impact on clinical outcome was not mentioned. Herein, we explored whether this 21-genes recurrence score (RS) impacted on prognosis in patients with this molecular subtype of breast cancer. Methods: From Jan 2013 to Aug 2018, 378 patients with ER-Positive/HER2-Negative early stage breast cancer were enrolled. All patients received a Chinese version of 21-genes RS test, which is a new method using RNA extracted from formalin-fixed paraffin-embedded tissue performed by SurExam Campany, Guangzhou, China. . The RS score for each patient was calculated based on expression level of 21-genes used in a prosperctively defined algorithm and calculate a recurrence score range from 0 to 100 and divided three risk groups according to TAILORs study.Distant metastases-free survival (DMFS) were correlated with the 21-genes RS by Kaplan-Meier (log-rank method), and Cox regression. Multivariable logistic regression was performed to determine factors correlated with RS testing and receipt of a high-risk RS. Results: Median patient age was 46 years (18 to 77 years). The Chinese version of 21-gene RS was generated for 378 patients: 61 (16.1%) low risk ( < 11), 241 (63.8%) intermediate risk (11 to 25), and 76 (20.1%) high risk (≥ 26). At a median follow-up of 40 months, the 4-year-rate of estimated DMFS was 100%, 98.7% and 92.9% in low risk, intermediate risk and high risk groups. Meanwhile, there was no difference in RFS among three risk groups. For all patients, 21-gene RS was associated with DMFS ( P = .021). In multivariable Cox regression models, 21-gene RS was independently prognostic factor of DMFS (hazard ratio, 5.375; 95% CI, 1.00 to 28.84; P = .05). Tumor size (>2cm vs ≤2cm, OR = 2.31, P = .005), high grade ( OR = 2.15, P = .013), ki67 index ( > 14% vs ≤14%, OR = 4.24, P = .002), progesterone receptor expression ( < 20% vs ≥20%, OR = 5.07, P < .001) were predictor of high risk of RS. Conclusions: The Chinese version of 21-genes RS is independently prognostic factor for DMFS patients with ER–positive/HER2-negative node negative breast cancer. Future study was needed to explore the impact of 21 gene RS on long-term prognosis.

BACKGROUND Internal jugular vein (IJV) and axillary vein/subclavian vein (AxV/SCV) are commonly used for implantable venous access port (IVAP) implantation in breast cancer (BC) patients with chemotherapy. Previous studies focused on complications between these different approaches and ignored patient comfort. In this study, we aim to compare patient comfort between IJV and AxV/SCV approaches, as well as surgery duration and complications. METHODS This is a single-center prospective randomized controlled clinical trial. A total of 200 patients diagnosed with invasive BC will be enrolled in this study. After signing written informed consent, patients schedule to undergo IVAP implantation will be randomized at a 1:1 ratio to receive central venous catheters (CVC) with either IJV or AxV/SCV approaches. Baseline as well as demographic data and procedure time of port implantation will be recorded. All patients will receive assessment of comfort with a comfort scale table at days 1, 2 and 7 after implantation surgery. Patients will be followed up and complications will be recorded until devices are removed at the end of the treatment period, or in case of complications. Patient comfort, procedure time of implantation and complications will be compared and analyzed between these two arms. DISCUSSION To the best of our knowledge, this is the first study to compare patient comfort as primary outcome measure between IJV and AxV/SCV puncture. This study will further confirm the benefits of ultrasound guidance and may provide a better choice of IVAP implantation for BC patients. TRIAL REGISTRATION This study has been registered at Chinese Clinical Trial Registry (ChiCTR, www. chictr.org.cn) and Chinese Ethics Committee of Registering Clinical Trials (No. ChiCTR2000034986).

Abstract Background: Breast cancer is rare in men and there is no report of male breast cancer (MBC) with ureteral metastasis. In this study, we report a special case of MBC with ureteral metastasis. Case presentation: A 60-year-old man was diagnosed with breast cancer and lymph nodes metastasis. After surgery, chemotherapy and radiotherapy he was diagnosed with left arm metastasis. Then he received mass dissection and chemotherapy again. He was diagnosed with ureter metastasis because of hematuria. This patient took a Precitype gene test (immune index and PAM50) after several lines of treatment and the result indicated that this was a Luminal A subtype case, which was quite different from his immunohistochemical subtype. We adjusted his therapeutic regimen according to the genetic test but there was no obvious efficacy and he passed away five months later. Conclusions: MBC patients with urinary symptoms should be considered for the possibility of metastasis although urinary metastasis in breast cancer is rare. We still need more research and evidence of treatment recommendations for MBC.

INTRODUCTION:The ideal treatment for idiopathic granulomatous mastitis (IGM) remains unclear. In a prospective, single-centre, pilot study, we reported that ductal lavage treatment for non-lactational mastitis patients had a 1-year clinical complete response (cCR) rate of >90%, without any significant adverse events. Thus, in this multicentre, randomised, open-label, non-inferiority trial, we will aim to compare the effectiveness and safety of ductal lavage vs oral corticosteroids as the first-line treatment for patients with IGM. METHODS AND ANALYSIS:The trial will be conducted at the Breast Tumor Center of Sun Yat-sen Memorial Hospital in China and at least at one participating regional centre. We plan to recruit 140 eligible IGM patients who will be randomised into the ductal lavage group or oral corticosteroid group with a 1:1 ratio. The patients in the oral corticosteroid group will receive meprednisone or prednisone for 6 months. The patients in the ductal lavage group will receive ductal lavage and breast massage, as previously reported. All the participants will be followed up at the clinic for 1 year post randomisation. The primary endpoint of this trial will be the 1-year cCR rate, and the secondary endpoints will include the time to cCR, treatment failure rate, relapse rate and protocol compliance rate. The trial was designed to determine whether ductal lavage is non-inferior to oral corticosteroids (1-year cCR rate assumed to be 90%), with a non-inferiority margin of 15%. ETHICS AND DISSEMINATION:The ethics committee of Sun Yat-sen Memorial Hospital at Sun Yat-sen University approved the study (2018-Lun-Shen-Yan-No. 30). The results of the trial will be communicated to the participating primary care practices, published in international journals and presented at international clinical and scientific conferences. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov Registry (NCT03724903); Pre-results.

To assess the prognostic risk factors and establish prognostic nomograms based on lymph node ratio (LNR) to predict the survival of young patients with breast cancer (BC). Patients aged < 40 years and diagnosed with BC between 2010 and 2016 from the Surveillance, Epidemiology and End Results database were assessed. Nomograms incorporating LNR were constructed to predict overall survival (OS) and breast cancer-specific survival (BCSS) based on Cox proportional hazards model. The performance of the nomograms was assessed by C-index, calibration curves, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and risk group stratification and compared with the TNM staging system. Based on the univariate and multivariate Cox regression analysis, significant prognostic factors were identified and integrated to create the nomograms for OS and BCSS. The calibration curves indicated optimal agreement between model predictions and actual observations. The nomograms showed favorable sensitivity with a C-index of 0.8351 (95% CI 0.8234–0.8469) for OS and 0.8474 (95% CI 0.8355–0.8594) for BCSS. The ROC curves of the nomograms showed better predictive ability than those of the TNM staging system for OS (AUC: 0.8503 vs. 0.7819) and BSCC (AUC: 0.8607 vs. 0.8081). Significant differences in Kaplan–Meier curves were observed in patients stratified into different risk groups (p < 0.001). These nomograms provided more accurate individualized risk prediction of OS and BCSS and may assist clinicians in making decisions for young patients with BC.

Breast cancer is the most commonly diagnosed malignancy in women worldwide [1, 2] and in the twentieth century, mastectomy was the primary surgical treatment for breast cancer patients. Advances in breast-conserving surgery (BCS) propelled a change in treatment rational from “maximum tolerable” to “minimum effective” therapy. Oncoplastic breast surgery aims to restore the shape of the breast and has been widely adopted since the past decade. Although the cosmetic outcome has been significantly improved, the scar remaining on the surgeried breast skin is still a major pitfall that urges urgent consideration. In this editorial, we review a series of techniques that can be incorporated in oncoplastic breast surgery to minimize scarring, signifying the beginning of an era for scarless oncoplastic surgery.

BACKGROUND:Distant metastasis (DM) from breast cancer has a poor prognosis. Our objective was to develop and validate a nomogram to predict individual distant metastasis-free survival (DMFS) and risk stratification in non-metastatic breast cancer patients.METHODS:A nomogram was based on an analysis of 1,201 breast cancer patients treated at Sun Yat-sen Memorial Hospital from 2001 to 2014. Using univariate and multivariate analyses to identify the predictors, this model was externally validated in an independent cohort of 538 patients from the Guangdong General Hospital between 2004 and 2012. The predictive discrimination and calibration ability of this nomogram were assessed using concordance index (C-index), risk group stratification, and calibration curve.RESULTS:The 5-year DMFS in the training and validation cohorts were 95.74% and 91.02%, respectively. On multivariable analysis of training cohort, the prognostic factors in the nomogram comprised age, tumor size, lymph node status, molecular subtype, and lymphovascular invasion (LVI). The C-index of our model was 0.75 [95% confidence interval (CI): 0.67-0.83] for the training cohort and 0.71 (95% CI: 0.64-0.78) for the validation cohort. The calibration curves for 5-year DMFS showed good agreement between the model prediction and actual observation. Based on the risk stratification, Kaplan-Meier curves indicated that the low-risk group had significantly better prognosis than the high-risk group (P<0.001).CONCLUSIONS:Our nomogram can provide an individual prediction of 5-year DMFS in non-metastatic breast cancer patients. This prognostic tool may help clinicians to make appropriate treatment regimens and optimal surveillance plans.