Personalized treatment for cancer patients is a hot topic of debate, particularly the decision to initiate chemotherapy in patients with Estrogen receptor (ER)-positive, HER2-negative tumors in the early stages of breast cancer (BC). Owing to significant advancements in information technology (IT) and genomics, clinicians are increasingly attaining therapeutic goals rapidly and safely by effectively differentiating patient subsets that require chemotherapy. IBM Watson for Oncology (WFO) is a cognitive computing system employed by clinicians to provide evidence-based treatment options for cancer. WFO aids in clinical diagnosis, with claims that it may be superior in performance to human clinicians. The current study was based on the hypothesis that WFO alone cannot effectively determine whether or not chemotherapy is essential for the subset of ER-positive, HER2-negative BC patients. From December 2015 to July 2017, 95 patients with ER-positive, HER2- negative BC subjected to treatment were retrospectively examined using WFO, and outputs compared to real clinical practice. Treatment options were suggested by WFO, and WFO recommendations calculated both with and without data from the gene expression assay (GEA). WFO without GEA was unable to determine the groups of patients that did not require chemotherapy. Concordant therapeutic recommendations between real clinical practice and WFO without GEA were obtained for 23.2% of the patient group. On the other hand, the results of WFO with GEA showed good clinical applicability. Sensitivity, specificity, positive predictive and negative predictive values of WFO with GEA were 100%, 80%, 61% and 100%, respectively. Our collective findings indicate that WFO without the gene expression assay has limited clinical utility.

Kim YY, et al. J Breast Cancer. 2016 Jun;19(2):163-168. http://dx.doi.org/10.4048/jbc.2016.19.2.163

Kang M, et al. Ann Surg Treat Res. 2022 Feb;102(2):73-82. https://doi.org/10.4174/astr.2022.102.2.73

Background: Seromas frequently develop in patients who undergo total mastectomy with node surgery. We aimed to prospectively explore whether use of oxidized regenerated cellulose (ORC, SurgiGuard^®) affects seroma formation after total mastectomy with node surgery (sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND)). Materials and methods: Ninety four breast cancer patients were enrolled in the study who underwent total mastectomy with ALND or SLNB. The patients were randomized into two groups, one treated with ORC plus closed suction drainage and the other with closed suction drainage alone. Results: Mean drainage volume was slightly lower in the ORC group on postoperative day 1 (123 ± 54 vs 143 ± 104 ml), but was slightly higher at all other time points; however, these differences were not significant. Mean total drainage volume in patients treated with ORC plus drainage did not differ from that of patients treated with drainage alone (1134 ± 507 ml vs 1033 ± 643 ml, P = 0.486). Conclusions: Use of ORC (SurgiGuard^®) did not significantly alter the risk of seroma formation.

Purpose: In-vivo proton magnetic resonance spectroscopy (MRS) is a non-invasive method of analyzing choline metabolism that has been used to predict breast cancer prognosis. A strong choline peak may be a surrogate for aggressive tumor biology but its clinical relevance is unclear. The present study assessed whether total choline (tCho), as measured by proton MRS, can predict late recurrence in patients with hormone receptor (HR)-positive, HER2-negative early breast cancer. Methods: The study cohort included 261 HR+/HER2- breast cancer patients who underwent diagnostic single-voxel proton MRS (3.0T scanner) prior to first-line surgery from March 2011 to July 2014. The relationships between tCho compound peak integral (tChoi) values and others prognostic factor were analyzed, as were the effects of tChoi on 10-year disease-free survival (DFS) and overall survival (OS). The clinical significance of tChoi was also analyzed using Harrell’s C-index. Results: Mean tChoi in HR+/HER2- study group was 15.47 and we set the cut-off for tChoi at 15 for survival analysis. 10-year DFS differed significantly between tChoi <15 and ≥15 (p = 0.017), with differences differing significantly for late (5–10 years; p = 0.02) but not early (0–5 years; p = 0.323) recurrence. Cox regression analysis showed that tChoi was significantly predictive of 10-year DFS (p = 0.046, OR 2.69) and tended to be predictive of late recurrence (HR 4.36, p = 0.066). Harrell’s C-index showed that the Ki-67 index (AUC = 0.597) and lymphovascular invasion (AUC = 0.545) were also predictive of survival, with the addition of normalized tChoi improving the AUC to 0.622 (p = 0.014), indicating better predictive power. Conclusion: tChoi determined by in vivo MRS was predictive of prognosis in patients with HR+/HER2- early breast cancer. This parameter may serve as a valuable, non-invasive tool to predict prognosis when combined with other known prognostic factors.