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      Clinicopathological characteristics, diagnosis, and prognosis of pregnancy‐associated breast cancer

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          Abstract

          Background

          The aim of this study was to evaluate the characteristics, diagnosis, prognosis, and effective treatment modalities of pregnancy‐associated breast cancer (PABC).

          Methods

          From 1 January 2005 to 31 December 2015, 142 patients with PABC were identified in the Cancer Institute and Hospital of Tianjin Medical University database. The clinicopathological features, treatment methods, and outcomes were retrospectively evaluated.

          Results

          The median age at diagnosis was 30 years. All patients presented with a palpable mass in the breast. The sensitivity of ultrasound and mammography in PABC diagnosis was 86% and 83.3%, respectively, which increased to 91.3% when a combination of mammography and ultrasound was used. The median tumor size was 5.5 cm, and 63.1% of patients had associated axillary lymph node metastases. The proportions of ER negative, PR negative and HER2 positive were 45.7%, 45.7% and 30%, respectively. The five‐year overall survival (OS) and disease‐free survival (DFS) rates were 76.8% and 63.5%, respectively. According to univariate analysis, T stage, N stage, and HER2 status were significant prognostic factors for OS and DFS. The time interval between the onset of the first symptom and the first meeting with a health professional was also significant for OS. Multivariate analysis showed that T stage and HER2 status were independent prognostic risk factors for OS and DFS.

          Conclusion

          PABC is an aggressive form of breast cancer associated with advanced stage at diagnosis. Despite the existing difficulties in diagnosis, imaging examinations are indispensable. Early diagnosis and multidisciplinary therapy, including anti‐HER2 targeted therapy, may be important to improve prognosis.

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          Most cited references28

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          Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

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            Breast cancer in pregnancy.

            Breast cancer staging and treatment are possible during pregnancy, and should be defined in a multidisciplinary setting. Tumour biology, tumour stage, and gestational stage at diagnosis determine the appropriate approach. Surgery for breast cancer is possible during all trimesters of pregnancy. Radiotherapy is possible during pregnancy but, dependent on the fetal dose received, can result in poor fetal outcomes. The decision to give radiotherapy should be made on an individual basis. Evidence increasingly supports administration of chemotherapy from 14 weeks' gestation onwards. New breast cancer treatments might be applicable to pregnant patients, but tamoxifen and trastuzumab are contraindicated during pregnancy. Cancer treatment during pregnancy will decrease the need for early delivery and thus prematurity, which is a major concern in management of breast cancer in pregnancy. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Prognosis of pregnancy-associated breast cancer: a meta-analysis of 30 studies.

              Pregnancy-associated breast cancer (PABC) is relatively rare with considerable controversy regarding its prognosis. Two of the authors independently performed a literature search with no date or language restrictions. Eligible studies were control-matched, population-based and hospital-based studies that addressed the outcome of patients diagnosed during pregnancy or 1-year afterwards. The primary and secondary end-points were overall and disease-free survival respectively. Pooling of data was done using the random effect model. 30 studies were included in this meta-analysis (3,628 cases and 37,100 controls). PABC patients had a significantly higher risk of death compared to those with non-pregnancy-related breast cancer (pooled hazard ratio (pHR): 1.44; 95% CI [1.27-1.63]). The same results were encountered on restricting the analysis to HRs of multivariate analyses (pHR: 1.40 [1.17-1.67]). A clearer trend of poorer outcome was seen in those diagnosed postpartum (pHR: 1.84; 95% CI [1.28-2.65]) than those diagnosed during pregnancy (pHR: 1.29; 95% CI [0.74-2.24]). DFS analysis showed a significantly higher risk of relapse associated with PABC as well (pHR: 1.60 [1.19-2.16]). Our results show that PABC is independently associated with poor survival particularly those diagnosed shortly post-partum. This underscores a possible impact of the pregnant breast microenvironment on the biology and consequently the prognosis of these tumors. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                tjyangyf@126.com
                zhangjin@tjmuch.com
                Journal
                Thorac Cancer
                Thorac Cancer
                10.1111/(ISSN)1759-7714
                TCA
                Thoracic Cancer
                John Wiley & Sons Australia, Ltd (Melbourne )
                1759-7706
                1759-7714
                28 March 2019
                May 2019
                : 10
                : 5 ( doiID: 10.1111/tca.2019.10.issue-5 )
                : 1060-1068
                Affiliations
                [ 1 ] Key Laboratory of Cancer, Prevention and Therapy National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital Tianjin China
                [ 2 ] Key Laboratory of Breast Cancer Prevention and Therapy Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education Tianjin China
                [ 3 ] Second Department of Breast Cancer
                [ 4 ] Department of Integrative Oncology
                [ 5 ] Department of Ultrasound Diagnosis & Treatment
                [ 6 ] Third Department of Breast Cancer
                Author notes
                [*] [* ] Correspondence

                Jin Zhang, Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Hexi District, Tianjin, China.

                Tel: +86 22 2334 0123

                Fax: +86 22 2334 0123

                Email: zhangjin@ 123456tjmuch.com

                [†]

                These authors contributed equally to this work.

                Author information
                https://orcid.org/0000-0002-5707-5148
                Article
                TCA13045
                10.1111/1759-7714.13045
                6500985
                30920126
                66af1a6d-be6f-41d9-aa5e-450a0b33ade1
                © 2019 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 January 2019
                : 24 February 2019
                : 24 February 2019
                Page count
                Figures: 4, Tables: 3, Pages: 9, Words: 5252
                Funding
                Funded by: National Natural Science Foundation of China
                Award ID: 81803004
                Funded by: Seed Start‐up Fund, Cancer Hospital of Tianjin Medical University
                Award ID: 20160602
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                tca13045
                May 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:06.05.2019

                clinical characteristic,pregnancy‐associated breast cancer,prognosis,therapeutic strategy

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