Purpose Atypical hyperplasia (AH) management remains controversial due to variable malignant disease progression rates. While Western studies report 10% to 25% upgrade rates, data from Asian populations, particularly from referral academic centers, are limited. We aimed to identify predictive factors for malignant upgrade in Korean women with AH at academic hospitals. Methods This retrospective multi-institutional study analyzed 340 patients diagnosed with AH on initial biopsy who underwent subsequent excision at five Korean academic hospitals from 2000 to 2022. Malignant upgrade was defined as ductal carcinoma in situ or invasive cancer on the final pathology. Multivariate logistic regression was used to identify independent predictors of upgrades. Results Among 340 patients (319 atypical ductal hyperplasia, 20 atypical lobular hyperplasia, and 1 mixed), 128 (37.6%) experienced a malignant upgrade, 98 (76.6%) to ductal carcinoma in situ, and 30 (23.4%) to invasive cancer. In multivariate analysis, multifocal atypia (odds ratio [OR], 25.61; 95% confidence interval [CI], 11.20–58.55; P<0.001) and Breast Imaging-Reporting and Data System 4c-5 lesions (OR, 11.02; 95% CI, 1.43–84.86; P=0.021) were significant predictors. Multifocal atypia showed an 84.4% upgrade rate. Core needle biopsy had higher upgrade rates than vacuum-assisted biopsy (45.2% vs. 20.0%; P<0.001). The upgrade rates decreased from 50% to 25% over the study period (P<0.05). Conclusion The 37.6% upgrade rate in this tertiary referral cohort exceeded that in Western reports, with multifocal atypia emerging as the strongest predictor. These findings support immediate excision for multifocal atypia while allowing individualized management for unifocal lesions with favorable imaging in Korean tertiary care settings.

BACKGROUND:This study evaluated the prevalence of various mental disorders and their influence on mortality outcomes in individuals with cancer. METHODS:The authors' institutional database included patients with cancer diagnosed between 2011 and 2015 who had mental disorders and death information up to 2021. Mental disorders included nonaffective psychotic disorders, affective psychotic disorders, anxiety-related and stress-related disorders, alcohol or drug misuse, and mood disorders without psychotic symptoms. The causes of death were classified as all-cause, cancer-related, or suicide. Individual matching was performed to randomly match cancer survivors with and without mental disorders according to age at cancer diagnosis, year of cancer diagnosis, sex, and cancer site. The association between mental disorders and mortality risk was assessed using a Cox proportional hazards model and competing-risk analyses. RESULTS:Among 637,491 cancer survivors (mean age, 58.9 years), there were 238,654 deaths from any cause and 2255 deaths from suicide. Incidence rates varied across disorders, with the highest rates observed for anxiety-related and stress-related disorders and mood disorders without psychotic symptoms. Mental disorders were associated with an increased risk of all-cause and cancer-related mortality. Adjusted hazard ratios (HRs) for nonaffective psychotic disorders, affective psychotic disorders, anxiety-related and stress-related disorders, alcohol and drug misuse, and mood disorders without psychotic symptoms were as follows: HR, 2.49 (95% confidence interval [CI], 2.22-2.80); HR, 2.38 (95% CI, 2.21-2.57); HR, 1.02 (95% CI, 1.01-1.04); HR, 2.13 (95% CI, 1.87-2.43); and HR, 1.27 (95% CI, 1.24-1.30), respectively, for all-cause mortality. Suicide risk was higher in patients who had mental disorders, especially within the first 6 months after diagnosis. CONCLUSIONS:The current findings underscore the impact of mental illness on mortality among cancer survivors in Korea, specifically highlighting the elevated rates of anxiety, stress, and mood disorders.

Background: Digital high-resolution H&E images provide valuable insights into tumor heterogeneity within the tumor microenvironment (TME). However, the ability to perform detailed cell typing solely based on H&E images remains limited. Recent advances in high-resolution spatial transcriptomics (ST) enable precise characterization of cell types and their spatial relationships within the TME, addressing challenges in understanding tumor heterogeneity. In this study, we developed AI models to predict cell types in breast cancer—including subtypes of lymphocytes that are challenging to differentiate visually—using large-scale image-based ST data aligned with H&E images. Methods: We established a breast cancer image-based ST database comprising 190 samples from 113 breast cancer patients, obtained from surgically resected primary tumors. Image-based ST data were generated using the Xenium platform with a 500-gene panel and matched with high-resolution H&E images. Cell type maps were constructed using reference single-cell RNA-seq data and transferred to ST data. The ST data were spatially registered to the corresponding H&E images, and cell type masks were generated at matching resolutions. AI models were trained to segment cell type masks, including epithelial cells, cancer cells, myeloid cells, fibroblasts, endothelial cells, T cells, and B cells. Additionally, refined cell type predictions were performed for dendritic cells, NK cells, CD4+ T cells, and CD8+ T cells. Model performance was validated using external whole-slide image datasets containing ST data from four independent cohorts. Results: Model performance was assessed using the area under the receiver operating characteristic (AUROC) curve for each cell type mask. Internal validation on four samples yielded AUROC values ranging from 0.90 to 0.95. External validation across independent whole-slide datasets demonstrated AUROC values between 0.88 and 0.97 for all cell type masks. The AI model successfully mapped TME cell types with high resolution, using only H&E images. Conclusion: By employing a self-supervised approach that integrates high-resolution H&E images with image-based ST data, we developed AI-driven tools for TME analysis. These models enable accurate identification of detailed cell types and their spatial relationships within the TME. This approach facilitates large-scale analysis of breast cancer TME and holds potential for advancing our understanding of tumor biology and therapeutic strategies. Citation Format: Haenara Shin, Dongjoo Lee, Yooeun Kim, Daeseung Lee, Kwon Joong Na, Chihwan David Cha, Hosub Park, Hongyoon Choi. A self-supervised AI model leveraging spatial omics for analyzing tumor microenvironment heterogeneity in breast cancer only with H&E [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Functional and Genomic Precision Medicine in Cancer: Different Perspectives, Common Goals; 2025 Mar 11-13; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2025;85(5 Suppl):Abstract nr B038.

Background Since the approval of the trastuzumab deruxtecan for human epidermal growth factor receptor 2 (HER2)-low breast cancer, evidence suggests that low-HER2 expression may affect prognosis; however, it remains unclear how HER2-low subtype affects outcomes. Thus, this study aimed to investigate the differences in prognosis between patients with HER2-low and HER2-zero status. Methods This retrospective cohort study conducted at multi-institution included 1,627 patients diagnosed with HER2-low or HER2-zero breast cancer (stages I–III). For comparing outcomes between two groups, the survival analysis after propensity score matching was used. Survival outcomes including distant recurrence-free survival, and overall survival were evaluated using the Kaplan–Meier analyses. Results After propensity score matching, 445 patients with HER2-low and 707 patients with HER2-zero status were included. Among them, 914 (79.3%) and 238 (20.7%) patients had hormone receptor-positive and -negative disease. Median follow-up was 92.7 months. Locoregional recurrence-free survival and distant recurrence-free survival were comparable between patients with HER2-low and HER2-zero status (p = 0.872, p = 0.746, respectively). HER2-low status did not affect overall survival. However, in a subgroup with lymph node metastases, patients with HER2-low status showed better recurrence-free survival compared with that of patients with HER2-zero status (p = 0.033). Conclusions In this study, survival outcomes were comparable between patients with HER2-low and HER2-zero breast cancer. Additionally, patients with HER2-low status showed better survival outcomes compared with those with HER2-zero in the subgroup with lymph node metastasis. Further studies are needed to examine the biological mechanism underlying these prognostic differences.

552 Background: Among patients with sporadic breast cancer, it is well known that prognoses are similar following breast-conserving surgery (BCS) versus mastectomy. However, previous data assessing oncologic outcomes between BCS and mastectomy in patients with BRCA mutation are limited and inconsistent. Thus, this study aims to compare the oncologic outcomes including locoregional recurrence (LRR), distant recurrence (DR), and overall survival (OS) among this population. Methods: Patients with BRCA mutation and index breast cancer who underwent BCS or mastectomy between January 2008 and December 2015 were retrospectively screened from 13 institutions. We included patients aged from 20-80 with invasive breast cancer (pT1-3 N0-3). Patients with de novo metastasis were excluded. To minimize selection bias from retrospective nature, the propensity score matching (PSM) with Greedy nearest neighbor method was performed for covariates including age, molecular subtype, and tumor stage. Results: A total of 553 patients with BRCA mutation were identified. Among them, 367 (66.2%) patients received BCS and 186 (33.8%) were treated with mastectomy. After 1:1 PSM, there was no significant differences in age, molecular subtype, tumor size, nodal status, and histologic tumor grade between patients undergoing BCS versus mastectomy. At 8.3 years of median follow up, LRR, DR, and OS rates did not differ between groups (all p > 0.05). On multivariate analysis, type of breast surgery (BCS vs. mastectomy) was not significantly associated with the oncologic outcomes after adjusting covariates including age, molecular subtype, tumor stage, and histologic grade (all p > 0.05). Additionally, we performed subgroup analysis in matched patients based on tumor size, LN metastasis, HG, and subtype. In all subgroup, the type of breast surgery was not a significant risk factor influencing disease recurrence. Conclusions: Our findings suggest that there was no difference in oncologic outcomes among BRCA mutation carriers who underwent BCS or mastectomy. Breast conservation with close surveillance is a reasonable treatment option for BRCA mutation carriers. Further studies combined with prospectively collected data are warranted to validate our findings.

ImportanceWhile nipple-sparing mastectomy (NSM) for breast cancer was only performed using the open method in the past, its frequency using endoscopic and robotic surgical instruments has been increasing rapidly. However, there are limited studies regarding postoperative complications and the benefits and drawbacks of minimal access NSM (M-NSM) compared with conventional NSM (C-NSM).ObjectiveTo examine the differences in postoperative complications between C-NSM and M-NSM.Design, Setting, ParticipantsThis was a retrospective multicenter cohort study enrolling 1583 female patients aged 19 years and older with breast cancer who underwent NSM at 21 university hospitals in Korea between January 2018 and December 2020. Those with mastectomy without preserving the nipple-areolar complex (NAC), clinical or pathological malignancy in the NAC, inflammatory breast cancer, breast cancer infiltrating the chest wall or skin, metastatic breast cancer, or insufficient medical records were excluded. Data were analyzed from November 2021 to March 2024.ExposuresM-NSM or C-NSM.Main Outcomes and MeasuresClinicopathological factors and postoperative complications within 3 months of surgery were assessed. Statistical analyses, including logistic regression, were used to identify the factors associated with complications.ResultsThere were 1356 individuals (mean [SD] age, 45.47 [8.56] years) undergoing C-NSM and 227 (mean [SD] age, 45.41 [7.99] years) undergoing M-NSM (35 endoscopy assisted and 192 robot assisted). There was no significant difference between the 2 groups regarding short- and long-term postoperative complications (<30 days: C-NSM, 465 of 1356 [34.29%] vs M-NSM, 73 of 227 [32.16%]; P = .53; <90 days: C-NSM, 525 of 1356 [38.72%] vs M-NSM, 73 of 227 [32.16%]; P = .06). Nipple-areolar complex necrosis was more common in the long term after C-NSM than M-NSM (C-NSM, 91 of 1356 [6.71%] vs M-NSM, 5 of 227 [2.20%]; P = .04). Wound infection occurred more frequently after M-NSM (C-NSM, 58 of 1356 [4.28%] vs M-NSM, 18 of 227 [7.93%]; P = .03). Postoperative seroma occurred more frequently after C-NSM (C-NSM, 193 of 1356 [14.23%] vs M-NSM, 21 of 227 [9.25%]; P = .04). Mild or severe breast ptosis was a significant risk factor for nipple or areolar necrosis (odds ratio [OR], 4.75; 95% CI, 1.66-13.60; P = .004 and OR, 8.78; 95% CI, 1.88-41.02; P = .006, respectively). Conversely, use of a midaxillary, anterior axillary, or axillary incision was associated with a lower risk of necrosis (OR for other incisions, 32.72; 95% CI, 2.11-508.36; P = .01). Necrosis occurred significantly less often in direct-to-implant breast reconstruction compared to other breast reconstructions (OR, 2.85; 95% CI, 1.11-7.34; P = .03).Conclusions and RelevanceThe similar complication rates between C-NSM and M-NSM demonstrates that both methods were equally safe, allowing the choice to be guided by patient preferences and specific needs.

Abstract Purpose: Nipple-sparing mastectomy (NSM) is known for its excellent cosmetic results and acceptable oncologic safety. However, evidence supporting NSM in breast cancer (BC) patients carrying pathogenic variant (PV) or likely pathogenic variant (LPV) in BRCA1/2 genes is still limited. This study aims to evaluate the oncologic safety of NSM in BC patients and examine its preventive effect in unaffected individuals with BRCA1/2 PV/LPV. Methods: In this multicenter, retrospective study was conducted by the Korea Robot-Endoscopic minimal access Breast Surgery study Group (KoREa-BSG). We evaluated data from women who underwent NSM and BRCA1/2 genetic testing across 19 South Korean institutions. This study included BC patients aged between 20 and 80 years who had NSM and BRCA1/2 genetic testing between January 2008 and December 2018. Patients with distant metastasis at the initial diagnosis were excluded. Results: A total of 786 women, encompassing 906 NSM cases, were included. This population comprised 120 patients who underwent bilateral NSM, 666 with unilateral NSM for unilateral BC. Among them, 214 who received neoadjuvant chemotherapy. The median follow-up period was 62 months, with an age range of 26-74 years (median 44). Sentinel lymph node biopsy was carried out in 74.7% of cases. In the bilateral NSM cohort (n=120), 36 were bilateral BC patients, 41 were unaffected carriers of BRCA1/2 PV/LPV who underwent bilateral risk-reducing NSM (RRNSM), and 33 presented with unilateral BC with BRCA1/2 PV/LPV. In the subset of 33 patients who underwent contralateral RRNSM for unilateral BC, incidental ductal carcinoma in situ (DCIS) was discovered in two cases. In comparing NSM outcomes according to BRCA status, we found no significant difference in local recurrence (LR) between BC patients with BRCA1/2 PV/LPV (n=172) and those without BRCA1/2 PV/LPV (n=592) (LR rates: 11 in BRCA1/2 PV/LPV vs. 45 in non-carriers; p = 0.7965). Of the 172 BRCA1/2 PV/LPV carriers who did not undergo RRNSM, contralateral BC occurred in 11 patients (6.4%), while no recurrence was recorded in the RRNSM group. Conclusions: NSM appears to be a feasible option in BC patients with BRCA1/2 PV/LPV. While the long-term impact of NSM on breast cancer prevention in BRCA1/2 PV/LPV carriers requires further investigation, current evidence suggests that NSM could serve as an effective risk-reducing strategy. Citation Format: Hong-Kyu Kim, Sung Yoon Jang, Soong June Bae, Eun Young Kim, Chihwan Cha, Hyung Seok Park, Jeeyeon Lee, Jun-Hee Lee, Eun-Shin Lee, Jung Eun Choi, Soo Youn Bae, Hee-Chul Shin, Dongwon Kim, Moo Hyun Lee, Yong-Yeup Kim, Sang-Ah Han, Janghee Lee, Youngwoo Chang, Junwon Min, Sanghwa Kim, Hee Jun Choi, Young-Joon Kang, Sae Byul Lee, Jai Min Ryu. Oncologic Safety and Preventive Impact of Nipple-Sparing Mastectomy in BRCA1/2 Mutation Carriers: A Multicenter Retrospective Study of the Korea Robot-Endoscopy Minimal Access Breast Surgery Study Group (KoREa-BSG) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-08-12.

Background: Light-emitting diode (LED) light sources have become an increasingly popular choice for the treatment and rejuvenation of various dermatological conditions. Aims: This study aimed to evaluate the effects of neck rejuvenation, patient satisfaction, and the safety of LED application to the neck in an Asian population. Methods: This was a multicenter, randomized, double-blind, sham device study. Seventy participants were enrolled in the study. The participants wore the home-use LED neck device for 9 min a day, 5 times a week, for a total of 60 sessions. The Lemperle Wrinkle Scale (LWS) and Global Aesthetic Improvement Scale (GAIS) were used to evaluate the results of both investigators and participants. The thyroid gland was examined using ultrasonography to evaluate the safety of the investigational device. Results: The percentage of participants with improved LWS at Week 12 was significantly higher in the study group. Additionally, the percentage of participants with improved LWS was significantly higher in the study group at Weeks 8, 12, and 16. The LWS at Week 12 corrected with baseline values was found to be significantly different between the two groups. GAIS showed significant differences at 8, 12, and 16 weeks in the investigators' evaluation but not in the participants' evaluation. Repeated-measures analysis of variance at Weeks 4, 8, 12, and 16 also confirmed a significant difference between the two groups only in investigator assessment. No significant thyroid-related complications were observed. Conclusion: LED application to the neck may be considered a satisfactory and safe procedure for neck rejuvenation.

e12500 Background: It is well known that adjuvant tamoxifen treatment for breast cancer in postmenopausal women decreases bone loss. However, the adverse effect of adjuvant tamoxifen therapy for bone mineral density (BMD) in premenopausal breast cancer patients remains uncertain. This meta-analysis aimed to assess the effects of adjuvant tamoxifen therapy on BMD changes in premenopausal women with primary breast cancer. Methods: Through April 2020, studies reporting BMD changes of lumbar spine or hip in premenopausal women with primary breast cancer treated with adjuvant tamoxifen were collected from EMBASE and PubMed. The pooled analysis was performed using random effects model of the standardized mean difference (SMD) of BMD in patients. Results: A total of 1,432 premenopausal patients from eight studies were included in the pooled analysis. After 3 years of median follow up, adjuvant tamoxifen therapy decreased BMD by as much as SMD of -0.79 [95% confidence interval (CI); -1.25 to -0.33, P < 0.01] at lumbar spines and -0.38 at hip (95%CI; -0.88 to 0.12, P > 0.05). Compared with patients received tamoxifen alone, patients who received combination therapy with chemotherapy or ovarian function suppression (OFS) showed decreased bone loss at lumbar spine (SMD -1.17 with 95%CI -1.59 to -0.75, -0.43 with 95%CI -2.26 to 1.40, and -0.75 with 95%CI -1.38 to -0.13, respectively). Conclusions: Our meta-analysis revealed that premenopausal women who received adjuvant tamoxifen treatment showed significant bone loss over a period of time, especially at lumbar spine. However, tamoxifen attenuated bone loss in those who received tamoxifen after chemotherapy or along with OFS.[Table: see text]

The Korean Breast Cancer Society (KBCS) has collected nationwide registry data on clinicopathologic characteristics and treatment since 1996. This study aimed to analyze the clinical characteristics of breast cancer in Korea and assess changes in breast cancer statistics for 2021 using data from the KBCS registry and the Korean Central Cancer Registry. In 2021, 34,628 women were newly diagnosed with breast cancer. The median age of women diagnosed with breast cancer was 53.4 years, with the highest incidence occurring in the 40-49 age group. The most common molecular subtype was hormone receptor-positive and human epidermal growth factor receptor 2 (HER2)-negative, accounting for 69.1% of cases, while HER2-positive subtypes comprised 19.3%. During the coronavirus disease 2019 pandemic, the national breast cancer screening rate declined. However, the incidence of early-stage breast cancer (stages 0 and I) continued to increase, accounting for 65.6% of newly diagnosed cases in 2021. Our results showed that the overall survival rate for patients with breast cancer has improved, primarily due to a rise in early-stage diagnoses and advancements in treatment.

The purpose of this review is to summarize the recent technical advancements in RNSM, describe the ongoing teaching programs, and discuss the ongoing controversies. Robot-assisted nipple sparing mastectomy (RNSM) is the newest addition to the armamentarium of surgical techniques for patients who require a mastectomy. The potential benefits of using the da Vinci® Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA) are the small 3D camera and lighting offering superior visualization, the Endowrist robotic instruments offering greater range of motion, and surgeon being at a seated position at the console rendering a more ergonomic operating position. RNSM can potentially help overcome the technical difficulties of performing a conventional NSM. Further studies are needed to elucidate the oncologic safety and cost-effectiveness of RNSM.

Purpose This study assessed the temporal trends of uptake of national general health and cancer screening among women with breast cancer in Korea between 2009 and 2016.Materials and Methods We retrospectively analyzed the claims data from the Korean National Health Insurance Service database. Participants included 101,403 breast cancer patients diagnosed between 2009 and 2016. Information on participation in national screening programs, including breast cancer screening, general health, and gastric, colorectal, and cervical cancers, up to 2020 was collected. Screening participation rates within the first 2 and 5 years postdiagnosis were calculated by diagnosis year and fitted with joinpoint regression models to assess temporal trends.Results Overall, the participation rate in breast cancer screening within 2 years postdiagnosis increased from 10.9% to 14.0% from 2009-2016, with an annual percentage change (APC) of 3.7% (p < 0.05). The participation rate in breast cancer screening was lower than that in general health checkup and screening for other cancers within 2 and 5 years postdiagnosis. A steady increase in screening trends was also observed for general health, gastric, colorectal, and cervical cancers, with APC of 5.3%, 5.7%, 6.9%, and 7.6% in the 2-year postdiagnosis rate, and APC of 3.6%, 3.7%, 3.7%, and 4.4% in 5-year postdiagnosis rate, respectively. The screening rate was highest among age groups 50-59 and 60-69 in 2009 and significant upward trends were observed in all age groups for general health checkup and gastric, colorectal, and cervical cancer screening.Conclusion Among female breast cancer survivors in Korea, the uptake rate of screenings for general health and various cancers, including breast, gastric, colorectal, and cervical cancers, has shown a gradual increase in recent years.

Breast cancer is a major global health burden with high morbidity and mortality rates. Previous studies have reported that increased expression of ASAP1 is associated with poor prognosis in various types of cancer. This study was conducted on 452 breast cancer patients who underwent surgery at Hanyang University Hospital, Seoul, South Korea. Data on clinicopathological characteristics including molecular pathologic markers were collected. Immunohistochemical staining of ASAP1 expression level were used to classify patients into high and low groups. In total, 452 cases low ASAP1 expression group was associated with significantly worse recurrence-free survival (p = 0.029). In ER-positive cases (n = 280), the low ASAP1 expression group was associated with significantly worse overall survival (p = 0.039) and recurrence-free survival (p = 0.029). In multivariate cox analysis, low ASAP1 expression was an independent significant predictor of poor recurrence-free survival in the overall patient group (hazard ratio = 2.566, p = 0.002) and ER-positive cases (hazard ratio = 4.046, p = 0.002). In the analysis of the TCGA dataset, the low-expression group of ASAP1 protein demonstrated a significantly poorer progression-free survival (p = 0.005). This study reports that low ASAP1 expression was associated with worse recurrence-free survival in invasive breast cancer.

Yin Yang 1 (YY1) is a transcription factor that regulates epigenetic pathways and protein modifications. CP2c is a transcription factor that functions as an oncogene to regulate cell proliferation. YY1 is known to interact with CP2c to suppress CP2c’s transcriptional activity. This study aimed to investigate YY1 and CP2c expression in breast cancer and prognostic implications. In this study, YY1 and CP2c expression was evaluated using immunohistochemical staining, Western blot and RT-PCR assays. Of 491 patients with primary breast cancer, 138 patients showed YY1 overexpression. Luminal subtype and early stage were associated with overexpression (p < 0.001). After a median follow-up of 68 months, YY1 overexpression was found to be associated with a better prognosis (disease-free survival rates of 92.0% vs. 79.2%, p = 0.014). In Cox proportional hazards model, YY1 overexpression functioned as an independent prognostic factor after adjustment of hormone receptor/HER2 status and tumor size (hazard ratio of 0.50, 95% CI 0.26–0.98, p = 0.042). Quantitative analysis of YY1 and CP2c protein expression in tumors revealed a negative correlation between them. In conclusion, YY1 overexpression is a favorable prognostic biomarker in patients with breast cancer, and it has a negative correlation with CP2c at the protein level.

Background: Single-stranded DNA binding protein 2 (SSBP2) is involved in the DNA damage response and the maintenance of genome stability. Previous studies have suggested that SSBP2 has a tumor suppressor function or oncogenic function. Loss of SSBP2 expression has been reported in various tumors. However, the role of SSBP2 expression in invasive breast carcinoma has not been reported. Methods: Immunohistochemical staining for SSBP2 was performed on tissue microarrays consisting of 491 invasive breast carcinoma cases. The result of nuclear SSBP2 staining was stratified as either negative or positive. Then, we investigated the correlations between SSBP2 expression and various clinicopathological parameters and patient outcomes. Results: Loss of nuclear SSBP2 expression was observed in 61 cases (12.4%) of 491 invasive breast carcinomas. Loss of nuclear SSBP2 expression was significantly correlated with larger tumor size (p < 0.001, chi-squared test), higher histological grade (p = 0.016, Cochran–Armitage trend test), higher pathological T stage (p < 0.001, Cochran–Armitage trend test), estrogen receptor status (p < 0.001, chi-squared test), and molecular subtype (p < 0.001, chi-squared test). Kaplan–Meier survival analysis revealed that patients with loss of nuclear SSBP2 expression had worse overall survival (p = 0.013, log-rank test). However, loss of nuclear SSBP2 expression was not correlated with recurrence-free survival (p = 0.175, log-rank test). Conclusions: Loss of nuclear SSBP2 expression was associated with adverse clinicopathological characteristics and poor patient outcomes. SSBP2 acts as a tumor suppressor in invasive breast carcinoma and may be used as a prognostic biomarker.

Background: Older patients with breast cancer have good prognosis and most die from diseases other than breast cancer. Previous studies suggested that the surgical extent in older patients could be reduced. We aimed to compare survival outcomes in patients aged >= 70 years with clinically node-negative breast cancer, based on whether axillary surgery was performed.Methods: A total of 2,995 patients with breast cancer aged >= 70 years who underwent breast surgery were included in the Korean Breast Cancer Registry. Patients were classified into two groups according to the performance of axillary surgery. We used propensity score matching for demographic and treatment factors to minimize selection bias. We compared the 5-year overall survival (OS) and breast cancer-specific survival (BCSS).Results: Among 708 patients after 3:1 propensity score matching, 531 underwent breast surgery with axillary surgery and 177 underwent breast surgery alone. Of all patients, 51.7% had T1 stage, and 73.2% underwent mastectomy. Approximately 31.2% of patients received chemotherapy. Among patients who did not undergo axillary surgery, the 5-year OS and BCSS rates were 85.2% and 96.7%, respectively. The hazard ratio of axillary surgery for OS was 0.943 (95% confidence interval 0.652-1.365, p = 0.757), indicating no significant difference between two groups.Conclusions: Our study demonstrates that axillary surgery in a matched cohort of older patients with breast cancer and clinically negative nodes does not provide a survival benefit compared to patients undergoing breast surgery alone. These findings suggest that axillary surgery may be safely omitted in a select group of patients aged >= 70 years with clinically node-negative cancer. Further studies are needed to identify potential candidates for omitting axillary surgery.(c) 2022 Published by Elsevier Ltd.