United Christian Hospital

Abstract Background: Metaplastic breast cancer (MpBC) is a rare and aggressive subtype of breast cancer with limited guidance on an optimal management approach in existing clinical guidelines. We evaluated long-term outcomes and treatment efficacy in early MpBC patients across major cancer centers in Hong Kong. Methods: Women with non-metastatic MpBC diagnosed from January 2001 to December 2023 at four Hong Kong hospitals were identified via Hong Kong Cancer Registry. Clinical data, treatment response, recurrence, and survival were analyzed by histological and molecular subtype according to current standards, based on review of original pathology reports. Survival analyses were conducted using the Kaplan-Meier method and compared using log-rank test. Factors associated with survival were evaluated by univariate and multivariate Cox regression. Results: In total, 145 consecutive patients with non-metastatic MpBC were included. The median age at diagnosis was 57 years (IQR 51-68 years), with 64.8% being postmenopausal. Most patients presented with a solitary tumor (94.5%), commonly in upper outer quadrant (58.6%). Squamous cell carcinoma (20.7%) and spindle cell carcinoma (13.1%) were the most common histological subtypes. Most cases were stage II (55.2%), with a median tumor size of 3.5 cm (IQR 2.4-6.0 cm), node-negative at diagnosis (66.2%), and grade 3 tumors (66.9%). Molecular subtyping showed that 49.7% of tumors were triple-negative, 45.5% were hormone receptor-positive only (≥1% ER and/or PR-positive tumor cells), 2.8% were HER2-positive only, and 2.1% were both ER/PR-positive and HER2-positive. 4.1% of tumors were ER low, and 37.9% HER2 low. Most patients underwent mastectomy (77.2%) with axillary dissection (58.6%), and 93.8% achieved clear margins. Neoadjuvant chemotherapy was given to 13.8% of patients, with a pathological complete response (pCR) in 5.0% and a partial response in 50.0%. Adjuvant chemotherapy and radiotherapy were given to 57.2% and 60.7% of patients, respectively. At a median follow-up of 112 months (IQR 28-165), the 5-year overall survival was 67%. Five-year locoregional and distant relapse-free survival rates were 90.4% and 72.1%, respectively. Locoregional recurrence occurred in 11%, and distant metastases in 27.6% of patients, mainly involving visceral sites (90%). Upon univariate analysis followed by multivariate analysis adjusted for grade, T stage, and molecular subtype, adjuvant chemotherapy was significantly associated with improved overall survival (HR 0.42, 95% CI 0.22-0.82, p=0.01), while adjuvant radiotherapy was not (HR 0.69, 95% CI 0.38-1.24, p=0.21). In T3/4 or node-positive subgroup, adjuvant chemotherapy remained significantly associated with improved overall survival (HR 0.32, 95% CI 0.12-0.83, p=0.02), whereas adjuvant radiotherapy did not show significance for overall survival (HR 0.65, 95% CI 0.29-1.45, p=0.29) or for locoregional relapse-free survival (HR 0.98, 95% CI 0.40-2.40, p=0.96). No significant differences in pCR rates following neoadjuvant chemotherapy were observed across molecular subtypes (p=0.67). Adjuvant endocrine therapy was not associated with overall survival in hormone receptor-positive cases (p=0.88), nor was targeted therapy in HER2-positive cases (p=0.47). Conclusion: This study showed that MpBC is a distinct subtype of breast cancer, characterized by unique clinicopathological characteristics and responsiveness to treatments. Adjuvant chemotherapy was associated with improved overall survival in non-metastatic MpBC, while adjuvant radiotherapy did not demonstrate a significant benefit. The low response rate to neoadjuvant chemotherapy highlights the urgent need to develop novel therapeutic strategies to enhance outcomes for this challenging patient population. Citation Format: S. S. Tse, K. Bao, K. Cheung, J. Chow, I. Wong, C. Wong, O. Mang, H. Yiu, C. Kwan. Long-term outcomes and prognostic factors in metaplastic breast cancer treated with curative intent: a 22-year multicenter retrospective cohort study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-08-09.

<h3>Background</h3> Current guidelines for hepatocellular carcinoma (HCC) screening in patients with chronic liver disease (CLD) recommend ultrasound and/or α-fetoprotein (AFP) testing every 6 months. However, both methods exhibit low sensitivity for early-stage HCC. Building on our previous study that identified a novel blood test signature for HCC, this study aims to develop a routine blood-based artificial intelligence (AI) model for HCC detection. <h3>Patients and methods</h3> Records from 2000 to 2018 were retrieved from Hospital Authority Data Collaboration Laboratory, a territory-wide database. CLD (hepatitis/cirrhosis) patients with and without HCC were identified with International Classification of Diseases codes, anti-viral drug history, virology test, and radiology reports. Decompensated cases were excluded. Blood records within 1 month before the diagnosis of HCC and CLD patients were retrieved. Data from 2000 to 2015 were split into training and testing cohorts in an 80 : 20 ratio, while data from 2016 to 2018 were used as the validation set. Machine learning models were applied and their performances were compared with AFP. <h3>Results</h3> The cohort yielded >75 000 patients including 19 670 patients with HCC. Results from the test set demonstrated promising capabilities in excluding CLD patients, achieving a sensitivity of 80% and a specificity of 81% (area under the receiver operating characteristic curve=0.894) at a cut-off value of 0.43. The AI model outperformed AFP in early-stage detection, maintaining higher sensitivity across all Barcelona Clinic Liver Cancer stages. <h3>Conclusions</h3> This novel AI model, which uses only standard blood test results, shows strong potential for improving the detection of HCC, significantly outperforming the traditional alpha-fetoprotein (AFP) test. Its straightforward design offers a practical and widely accessible screening option that could be integrated into existing healthcare pathways to aid earlier diagnosis.

Objective: Eosinophilic granulomatosis with polyangiitis (EGPA) is a form of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Data among Chinese patients is sparse. This multicenter retrospective study aims to assess the presentation, treatment strategies, and outcomes of EGPA in Hong Kong. Methods: Patients with newly diagnosed EGPA who presented to eight participating hospitals in Hong Kong between January 1, 2013 and December 31, 2023 were identified. Clinical history and laboratory parameters were collected and analyzed. Outcomes, including mortality, relapse, and complications from disease and treatment, were assessed. Results: Seventy-six patients were identified. The annual incidence of EGPA was estimated at 1.9 per million population. Regarding the presentation, neurological symptoms (71.1%) were most frequently observed, followed by cutaneous (54%) and pulmonary symptoms (52.6%). The presence of anti-myeloperoxidase antibody (anti-MPO) correlated with a higher Birmingham Vasculitis Activity Score (BVAS) on presentation, more renal involvement, and absence of asthma. While anti-PR3 was associated with cardiovascular manifestations. Treatment mainly involved corticosteroids and cyclophosphamide as induction and azathioprine as maintenance. Biologics were used for induction in 18.4% of cases and for maintenance in 7.9%. Infective complications occurred in 29% of patients; a starting prednisolone dose [Formula: see text] 40 mg daily and a history of diabetes mellitus were identified as risk factors. Relapses occurred in 26.3% of subjects; the mean time to relapse was 39.5 months. Multivariate survival analysis revealed that a history of smoking [Formula: see text] 1 year (HR 20.63, 95% CI 2.76–154.37, [Formula: see text] = 0.03), absence of asthma (HR 0.13, 95% CI 0.02–0.96, [Formula: see text] = 0.045), and absence of neurological involvement on presentation (HR 0.06, 95% CI 0.01–0.45, [Formula: see text] = 0.006) were associated with mortality. Conclusion: This study underscored the heterogeneity of EGPA in the Chinese population and supports categorization based on anti-MPO status. Smoking history and absence of asthma or neurological symptoms were associated with mortality. The findings aim to inform clinical practice and direct future research efforts in managing this complex disease.

BackgroundEmergency department (ED) visits present opportunities to promote smoking cessation, as patients seeking urgent care may be more receptive to adopting healthier behaviors. This study evaluated the efficacy of brief cessation advice plus active referral to smoking cessation services among smokers attending EDs.MethodsA single-arm, real-world, multicenter clinical trial was conducted in the EDs of four public hospitals in Hong Kong from August 2019 to November 2021. Current smokers aged ≥ 18 years, triaged as semi- or non-urgent, were enrolled. Participants received the AWARD (Ask, Warn, Advise, Refer, and Do-it-again) model-based brief counseling and were offered active referral by trained healthcare professionals (HCPs) to local cessation services. Booster calls at 1 week and 1 month reinforced referrals for those who accepted. All participants were followed up at 6 and 12 months. The primary outcome was biochemically validated 7-day point prevalence abstinence (PPA) at 6 months; secondary outcomes included validated PPA at 12 months, self-reported PPA, and cigarette reduction rates. Implementation outcomes were evaluated using the RE-AIM framework. Propensity score matching (PSM) and multivariable logistic regression were applied to compare referred and unreferred groups.ResultsAmong the 1601 enrolled smokers, most were male (1443, 90%), with a mean age of 48 years; 77.6% and 72.1% completed 6-month and 12-month follow-ups, respectively. Following the brief advice intervention at baseline, 455 (28.4%) participants opted to receive a referral to smoking cessation services. Their overall biochemically validated 7-day PPA was 4.4% and 5.1% at 6 and 12 months, respectively. After PSM, the active referral group had significantly higher biochemically validated 7-day PPA at 6 months (6.1% vs. 3.2%; adjusted OR 2.35, p = .009) and 12-month follow-up (9.3% vs. 3.0%; adjusted OR 3.54, p < .001), higher self-reported 7-day PPA, and significant reduction rates at 6 and 12 months compared with the unreferred group. Implementation outcomes revealed strong institutional adoption, with 93 trained HCPs and a high reach among eligible smokers. This trial was limited by a non-randomized design.ConclusionsBrief cessation advice combined with active referral is feasible in ED settings and may yield clinically meaningful improvements in smoking abstinence.Trial registrationClinicalTrials.gov: NCT03818360, 25 January 2019.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04534-9.

IntroductionNeutropenic fever (NF) has a crude mortality rate of 3–18%. International guidelines recommend that all patients with NF receive ultrabroad-spectrum antibiotics (UBSAs) within 1 hour of emergency department (ED) registration. However, over 70% patients presenting to hospital with suspected NF (sNF) cannot access absolute neutrophil count (ANC) result within 1 hour, do not have NF and do not require UBSAs. In ED and hospitalised patients with sNF, we hypothesise that the ASTERIC protocol effectively and safely reduces the use of UBSAs compared with standard care alone.Methods and analysisThis pragmatic, parallel, multicentre, type 1, hybrid effectiveness-implementation, stepped-wedge, before-and-after, cluster randomised controlled trial aims to evaluate whether antibiotic prescribing can be safely reduced through implementing a multifaceted antibiotic stewardship intervention (ASTERIC) in adult patients with sNF presenting to EDs. The sNF was defined as a fever with a single oral temperature of ≥38.3°C (101°F) within 24 hours before ED registration or a temperature of ≥38.0°C (100.4°F) sustained over a 1-hour period, following last chemotherapy or targeted therapy within 6 weeks for any solid tumour, or in any period following therapies against leucaemia, lymphoma, myelodysplastic syndrome, aplastic anaemia, multiple myeloma or recipient of HSCT. The study will involve eight hospitals in Hong Kong with variable baseline practice. We will include 704 adult patients (352 patients in pre-implementation and post-implementation periods, respectively) with sNF (tympanic temperature ≥38.3°C) and 48 staff participants (6 staff participants in each hospital). Healthcare professionals will receive a multifaceted stewardship intervention consisting of risk assessment tools, fast-track ANCs, a decision tool for patient management and antibiotic use, supported by an educational package and staff interaction programmes (ASTERIC protocol). Patients’ blood ANC, and cancer therapy and chronic illness therapy scores will be measured. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and Proctor conceptual frameworks will be followed for evaluation of implementation. The main outcome measures are the mean total dose of UBSAs prescribed in 7 days and serious adverse events at 30 days. Data analysis will incorporate intention-to-treat, per-protocol and as-treated analyses for service outcomes (effectiveness, safety, quality of life assessments and cost-effectiveness) and mixed methods for implementation outcomes, informed by the Theoretical Domains Framework. We expect that the study results will inform health policy with improvement in hospital services in treating stable sNF, evidenced by improved safe antibiotic stewardship, early antibiotic de-escalation and reduced costs and length of stay.Ethics and disseminationThe institutional review boards of all study sites approved this study. This study will establish the ASTERIC protocol safely improves antibiotic stewardship and clinical management in adult patients with sNF. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities. All patients with sNF will be influenced by the new protocol which is agreed at hospital level. Randomisation is at hospital level, not patient level. Patient consent is sought for follow-up and data access, not for treatment. Staff consent is sought for interviewing.Trial registration numberNCT06794320.

A 78-year-old man was evaluated for a non-sustained ventricular tachycardia episode detected in a dual-chamber pacemaker (Boston Scientific Essentio MRI EL L131) implanted for sick sinus syndrome. Blanking of a premature ventricular beat caused delivery of ventricular pacing in the vulnerable period triggering non-sustained ventricular tachycardia. Review of literature found more than half of reported cases involved Boston devices. The commonalities of such phenomenon are summarized and reprogramming strategies presented.