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Freeman JQ, Shubeck SP, Chen N, Yarlagadda SR, Nanda R, Huo D, Howard FM. Quantitative Biomarkers, Genomic Assays, and Demographics Associated with Breast-Conserving Surgery Following Neoadjuvant Therapy in Early-Stage, Hormone Receptor-Positive, HER-Negative Breast Cancer. Ann Surg Oncol 2024:10.1245/s10434-024-16160-5. [PMID: 39251516 DOI: 10.1245/s10434-024-16160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/24/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Given increased neoadjuvant therapy use in early-stage, hormone receptor (HR)-positive/HER2-negative breast cancer, we sought to quantify likelihood of breast-conserving surgery (BCS) after neoadjuvant chemotherapy (NACT) or endocrine therapy (NET) as a function of ER%/PR%/Ki-67%, 21-gene recurrence scores (RS), or 70-gene risk groups. METHODS We analyzed the 2010-2020 National Cancer Database. Surgery was categorized as "mastectomy/BCS." Logistic regression was performed. Adjusted odds ratios (AOR) were per 10-unit increase in ER%/PR%/Ki-67%. RESULTS Overall, 42.3% underwent BCS after NACT, whereas 64.0% did after NET. Increasing ER% (AOR = 0.96, 95% confidence interval [CI] 0.94-0.97) or PR% (AOR=0.98, 95% CI 0.96-0.99) was associated with lower odds of BCS after NACT. Increasing Ki-67% was associated with greater odds of BCS (AOR = 1.07, 95% CI 1.04-1.10). Breast-conserving surgery rates increased by ~20 percentage points, with Ki-67% ≥15 or RS >20. Patients with a low (43.0%, AOR = 0.50, 95% CI 0.29-0.88) or intermediate (46.4%, AOR = 0.58, 95% CI 0.41-0.81) RS were less likely than patients with a high RS (65.0%) to undergo BCS after NACT. Increasing ER% was associated with higher odds of BCS after NET (AOR = 1.09, 95% CI 1.01-1.17). Breast-conserving surgery rates increased by ~20 percentage points between ER <50% and >80%. In both cohorts, the odds of BCS were similar between 70-gene low-risk and high-risk groups. Asian or uninsured patients had lower odds of BCS. CONCLUSIONS Neoadjuvant chemotherapy is unlikely to downstage tumors with a low-intermediate RS, higher ER%/PR%, or lower Ki-67%. Breast-conserving surgery after NET was most dependent on ER%. Findings could facilitate treatment decision-making based on tumor biology and racial/socioeconomic disparities and improve patient counseling on the likelihood of successful BCS.
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Affiliation(s)
- Jincong Q Freeman
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Cancer Prevention and Control Program, UChicago Medicine Comprehensive Cancer Center, Chicago, IL, USA
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA
| | - Sarah P Shubeck
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Nan Chen
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Sudha R Yarlagadda
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Rita Nanda
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Center for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, IL, USA
| | - Frederick M Howard
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA.
- Center for Clinical Cancer Genetics and Global Health, University of Chicago, Chicago, IL, USA.
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2
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Rewcastle E, Skaland I, Gudlaugsson E, Fykse SK, Baak JPA, Janssen EAM. The Ki67 dilemma: investigating prognostic cut-offs and reproducibility for automated Ki67 scoring in breast cancer. Breast Cancer Res Treat 2024; 207:1-12. [PMID: 38797793 PMCID: PMC11231004 DOI: 10.1007/s10549-024-07352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Quantification of Ki67 in breast cancer is a well-established prognostic and predictive marker, but inter-laboratory variability has hampered its clinical usefulness. This study compares the prognostic value and reproducibility of Ki67 scoring using four automated, digital image analysis (DIA) methods and two manual methods. METHODS The study cohort consisted of 367 patients diagnosed between 1990 and 2004, with hormone receptor positive, HER2 negative, lymph node negative breast cancer. Manual scoring of Ki67 was performed using predefined criteria. DIA Ki67 scoring was performed using QuPath and Visiopharm® platforms. Reproducibility was assessed by the intraclass correlation coefficient (ICC). ROC curve survival analysis identified optimal cutoff values in addition to recommendations by the International Ki67 Working Group and Norwegian Guidelines. Kaplan-Meier curves, log-rank test and Cox regression analysis assessed the association between Ki67 scoring and distant metastasis (DM) free survival. RESULTS The manual hotspot and global scoring methods showed good agreement when compared to their counterpart DIA methods (ICC > 0.780), and good to excellent agreement between different DIA hotspot scoring platforms (ICC 0.781-0.906). Different Ki67 cutoffs demonstrate significant DM-free survival (p < 0.05). DIA scoring had greater prognostic value for DM-free survival using a 14% cutoff (HR 3.054-4.077) than manual scoring (HR 2.012-2.056). The use of a single cutoff for all scoring methods affected the distribution of prediction outcomes (e.g. false positives and negatives). CONCLUSION This study demonstrates that DIA scoring of Ki67 is superior to manual methods, but further study is required to standardize automated, DIA scoring and definition of a clinical cut-off.
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Affiliation(s)
- Emma Rewcastle
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway.
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway.
| | - Ivar Skaland
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Einar Gudlaugsson
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Silja Kavlie Fykse
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Jan P A Baak
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Emiel A M Janssen
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
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3
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Fonseca VC, Sidiropoulou Z. Geriatric Breast Cancer: Staging, Molecular Surrogates, and Treatment. A Review & Meta-analysis. Aging Dis 2024; 15:1602-1618. [PMID: 37962462 PMCID: PMC11272193 DOI: 10.14336/ad.2023.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023] Open
Abstract
Breast cancer (BC) is one of the most frequent cancers in females across the globe. Treatment recommendations for BC patients are primarily driven by patient age, staging and tumor molecular subtype. Thus, we updated the general overview of BC staging, molecular surrogates, and treatment choices for women >70 years based on a systematic study encompassing the years 2013-2023. A PRISMA guidelines and PICO framework were followed, and relevant research articles were searched using different data bases (Web of Sciences, PubMed, MEDLINE, and Scopus). Mixed Methods Appraisal Tool was used for studies quality assessment. The research articles that made it into the systematic review were compiled using qualitative criteria. In the meanwhile, heterogeneity was determined using meta-analysis with RevMan 5.4. We applied a random effects model with a 0.05 significance level. Overall, there were 4151 research articles, after screening only 17 articles with 39,906 patients were included. Conclusion: Elderly patients with breast cancer should be treated differently in an adapted way. The treatment should not be the same worldwide due to different health systems. Molecular surrogates are different in geriatric patients. Surgery is the best option for treatment in this subset of patients. We need to have therapeutic decision appointments for elderly patients with breast cancer. The guidelines and medical authority should be used in the best decision.
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Affiliation(s)
- Vasco C Fonseca
- Department of Oncology, Hospital Centre of West Lisbon, Portugal.
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4
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Golijanin D, Radovanović Z, Radovanović D, Đermanović A, Starčević S, Đermanović M. Molecular subtype and risk of local recurrence after nipple‑sparing mastectomy for breast cancer. Oncol Lett 2024; 28:389. [PMID: 38966584 PMCID: PMC11223028 DOI: 10.3892/ol.2024.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
The present study aimed to investigate whether local recurrence (LR) after nipple-sparing mastectomy (NSM) and reconstruction was associated with i) Ki67 values and molecular subtypes of the initial lesions, and ii) the size of the initial tumor and the size of the implant. A total of 156 patients with breast cancer with a mean age of 51.58 years (age range, 26-75 years) who underwent NSM with primary implant breast reconstruction were analyzed. After surgery, the mean follow-up time was 59.26 months (range, 17-85 months). Molecular subtypes, Ki67 values, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status were recorded for each patient. Additionally, information regarding the size of the implant and the initial tumor size were collected. The information was used to assess LR. For univariate analyses of risk factors, χ2 test, Fisher's exact test, Mann-Whitney U test and Student's t-test for independent samples were used. For multivariate analyses, a Cox proportional-hazards model was used. NSM was the primary treatment for breast cancer in 34/156 patients (21.8%), while 122/156 (78.2%) of patients received neoadjuvant chemotherapy followed by surgery. Luminal B was the most frequent molecular subtype, detected in 82/156 patients (52.6%), whereas the luminal A subtype was detected in 37 patients (23.7%) and the HER2-enriched subtype was detected in 17/156 patients (10.9%). Ki67 expression was low in 13/156 patients (8.3%), while medium expression was detected in 78/156 patients (50.0%) and high expression was present in 58/156 patients (37.2%). LR was noted in 17/156 patients (10.9%). As determined by univariate analysis, lower ER (P=0.010) and PR (P=0.008) expression were indicated to be significant risk factors for LR. In conclusion, in the present patient cohort, low ER and PR expression were risk factors for LR of breast cancer, whereas Ki67 status and molecular subtype were not statistically significant risk factors for LR. Additionally, the size of the initial tumor and the size of the implant were not risk factors for LR. These findings are consistent with the current literature, and should be utilized when discussing treatment options and potential clinical outcomes with patients prior to surgical management.
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Affiliation(s)
- Danica Golijanin
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Republic of Serbia
- Clinic for Surgical Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Republic of Serbia
| | - Zoran Radovanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Republic of Serbia
- Clinic for Surgical Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Republic of Serbia
| | - Dragana Radovanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Republic of Serbia
- Department for Anesthesiology with Reanimatology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Republic of Serbia
| | - Aleksandar Đermanović
- Clinic for Surgical Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Republic of Serbia
| | - Sanja Starčević
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Republic of Serbia
- Department for Anesthesiology with Reanimatology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Republic of Serbia
| | - Marija Đermanović
- Department for Neonatology, Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Republic of Serbia
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5
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Gao L, Medford A, Spring L, Bar Y, Hu B, Jimenez R, Isakoff SJ, Bardia A, Peppercorn J. Searching for the "Holy Grail" of breast cancer recurrence risk: a narrative review of the hunt for a better biomarker and the promise of circulating tumor DNA (ctDNA). Breast Cancer Res Treat 2024; 205:211-226. [PMID: 38355821 DOI: 10.1007/s10549-024-07253-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND This paper is a narrative review of a major clinical challenge at the heart of breast cancer care: determining which patients are at risk of recurrence, which require systemic therapy, and which remain at risk in the survivorship phase of care despite initial therapy. METHODS We review the literature on prognostic and predictive biomarkers in breast cancer with a focus on detection of minimal residual disease. RESULTS While we have many tools to estimate and refine risk that are used to individualize local and systemic therapy, we know that we continue to over treat many patients and undertreat others. Many patients also experience what is, at least in hindsight, needless fear of recurrence. In this review, we frame this dilemma for the practicing breast oncologist and discuss the search for what we term the "holy grail" of breast cancer evaluation: the ideal biomarker of residual distant disease. We review the history of attempts to address this problem and the up-to-date science on biomarkers, circulating tumor cells and circulating tumor DNA (ctDNA). CONCLUSION This review suggests that the emerging promise of ctDNA may help resolve a crticical dilemma at the heart of breast cancer care, and improve prognostication, treatment selection, and outcomes for patients with breast cancer.
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Affiliation(s)
- Lucy Gao
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Arielle Medford
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura Spring
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yael Bar
- Massachusetts General Hospital, Boston, MA, USA
| | - Bonnie Hu
- Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Jimenez
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Steven J Isakoff
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aditya Bardia
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey Peppercorn
- Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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6
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Yıldırım H, Turan G, Turan M. Expression of CD44, PCNA and E-cadherin in pterygium tissues. Indian J Ophthalmol 2024; 72:S501-S504. [PMID: 38648458 PMCID: PMC467005 DOI: 10.4103/ijo.ijo_2579_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/18/2024] [Accepted: 02/07/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Pterygium is a common ocular surface disease defined by fibrovascular conjunctival growth extending onto the cornea. However, its pathogenesis remains unclear. This study aimed to determine the role of CD44, proliferating cell nuclear antigen (PCNA), and E-cadherin in pterygium formation and recurrence. METHODS Sixty patients with pterygium participated in the study, and we collected conjunctival samples from 30 patients to form a control group. CD44, PCNA, and E-cadherin expressions in surgically excised pterygium were compared with tissue samples from the control group. RESULTS We observed that the percentages of CD44 and PCNA were statistically higher in the primary pterygium group and recurrent pterygium group than in the control group (P < 0.001 and P < 0.001, respectively). Conversely, E-cadherin values were statistically higher in the control group than in the primary and recurrent pterygium groups (P = 0.013 and P < 0.001, respectively). CONCLUSION Cell proliferation and cell adhesion factors may play important roles in the pathogenesis of pterygium.
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Affiliation(s)
- Humeyra Yıldırım
- Department of Ophthalmology, Balıkesir University, Faculty of Medicine, Balıkesir, Türkiye
| | - Gulay Turan
- Department of Pathology, Balıkesir University, Faculty of Medicine, Balıkesir, Türkiye
| | - Meydan Turan
- Balikesir Ataturk Cıty Hospital, Ophthalmology, Balikesir, Türkiye
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7
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Dawe M, Shi W, Liu TY, Lajkosz K, Shibahara Y, Gopal NEK, Geread R, Mirjahanmardi S, Wei CX, Butt S, Abdalla M, Manolescu S, Liang SB, Chadwick D, Roehrl MHA, McKee TD, Adeoye A, McCready D, Khademi A, Liu FF, Fyles A, Done SJ. Reliability and Variability of Ki-67 Digital Image Analysis Methods for Clinical Diagnostics in Breast Cancer. J Transl Med 2024; 104:100341. [PMID: 38280634 DOI: 10.1016/j.labinv.2024.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/20/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024] Open
Abstract
Ki-67 is a nuclear protein associated with proliferation, and a strong potential biomarker in breast cancer, but is not routinely measured in current clinical management owing to a lack of standardization. Digital image analysis (DIA) is a promising technology that could allow high-throughput analysis and standardization. There is a dearth of data on the clinical reliability as well as intra- and interalgorithmic variability of different DIA methods. In this study, we scored and compared a set of breast cancer cases in which manually counted Ki-67 has already been demonstrated to have prognostic value (n = 278) to 5 DIA methods, namely Aperio ePathology (Lieca Biosystems), Definiens Tissue Studio (Definiens AG), Qupath, an unsupervised immunohistochemical color histogram algorithm, and a deep-learning pipeline piNET. The piNET system achieved high agreement (interclass correlation coefficient: 0.850) and correlation (R = 0.85) with the reference score. The Qupath algorithm exhibited a high degree of reproducibility among all rater instances (interclass correlation coefficient: 0.889). Although piNET performed well against absolute manual counts, none of the tested DIA methods classified common Ki-67 cutoffs with high agreement or reached the clinically relevant Cohen's κ of at least 0.8. The highest agreement achieved was a Cohen's κ statistic of 0.73 for cutoffs 20% and 25% by the piNET system. The main contributors to interalgorithmic variation and poor cutoff characterization included heterogeneous tumor biology, varying algorithm implementation, and setting assignments. It appears that image segmentation is the primary explanation for semiautomated intra-algorithmic variation, which involves significant manual intervention to correct. Automated pipelines, such as piNET, may be crucial in developing robust and reproducible unbiased DIA approaches to accurately quantify Ki-67 for clinical diagnosis in the future.
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Affiliation(s)
- Melanie Dawe
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Wei Shi
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tian Y Liu
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Lajkosz
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Yukiko Shibahara
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Nakita E K Gopal
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Rokshana Geread
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Seyed Mirjahanmardi
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, Ontario, Canada; Division of Medical Physics, Department of Radiation Oncology, Stanford University, Stanford, California
| | - Carrie X Wei
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sehrish Butt
- STTARR Innovation Centre, University Health Network, Toronto, Ontario, Canada
| | - Moustafa Abdalla
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sabrina Manolescu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sheng-Ben Liang
- Princess Margaret Cancer Biobank, University Health Network, Toronto, Ontario, Canada
| | - Dianne Chadwick
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Biobank, University Health Network, Toronto, Ontario, Canada; Ontario Tumour Bank, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Michael H A Roehrl
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Biobank, University Health Network, Toronto, Ontario, Canada; Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Trevor D McKee
- STTARR Innovation Centre, University Health Network, Toronto, Ontario, Canada
| | - Adewunmi Adeoye
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David McCready
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - April Khademi
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, Ontario, Canada; St. Michael's Hospital, Unity Health Network, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Anthony Fyles
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Susan J Done
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
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Đokić S, Gazić B, Grčar Kuzmanov B, Blazina J, Miceska S, Čugura T, Grašič Kuhar C, Jeruc J. Clinical and Analytical Validation of Two Methods for Ki-67 Scoring in Formalin Fixed and Paraffin Embedded Tissue Sections of Early Breast Cancer. Cancers (Basel) 2024; 16:1405. [PMID: 38611083 PMCID: PMC11011015 DOI: 10.3390/cancers16071405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/29/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
Proliferation determined by Ki-67 immunohistochemistry has been proposed as a useful prognostic and predictive marker in breast cancer. However, the clinical validity of Ki-67 is questionable. In this study, Ki-67 was retrospectively evaluated by three pathologists using two methods: a visual assessment of the entire slide and a quantitative assessment of the tumour margin in 411 early-stage breast cancer patients with a median follow-up of 26.8 years. We found excellent agreement between the three pathologists for both methods. The risk of recurrence for Ki-67 was time-dependent, as the high proliferation group (Ki-67 ≥ 30%) had a higher risk of recurrence initially, but after 4.5 years the risk was higher in the low proliferation group. In estrogen receptor (ER)-positive patients, the intermediate Ki-67 group initially followed the high Ki-67 group, but eventually followed the low Ki-67 group. ER-positive pN0-1 patients with intermediate Ki-67 treated with endocrine therapy alone had a similar outcome to patients treated with chemotherapy. A cut-off value of 20% appeared to be most appropriate for distinguishing between the high and low Ki-67 groups. To summarize, a simple visual whole slide Ki-67 assessment turned out to be a reliable method for clinical decision-making in early breast cancer patients. We confirmed Ki-67 as an important prognostic and predictive biomarker.
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Affiliation(s)
- Snežana Đokić
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Barbara Gazić
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
| | - Biljana Grčar Kuzmanov
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
| | - Jerca Blazina
- Department of Pathology, Institute of Oncology, 1000 Ljubljana, Slovenia; (S.Đ.); (B.G.)
| | - Simona Miceska
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Cytopathology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Tanja Čugura
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Cvetka Grašič Kuhar
- Faculty of Medicine Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Jera Jeruc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Wrzeszcz K, Kwiatkowska K, Rhone P, Formanowicz D, Kruszewski S, Ruszkowska-Ciastek B. Traditional Clinicopathological Biomarkers Still Determine Disease-Free and Overall Survival in Invasive Breast Cancer Patients: A Pilot Study. J Clin Med 2024; 13:2021. [PMID: 38610786 PMCID: PMC11012512 DOI: 10.3390/jcm13072021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Molecular classification, tumor diameter, Ki67 expression, and brachytherapy administration still act as the most potent potential predictors of breast cancer recurrence and overall survival. Methods: Over the period of 23 months, we included in the study 92 invasive breast cancer (IBrC) patients initially diagnosed at the Clinical Ward of Breast Cancer and Reconstructive Surgery, Oncology Center in Bydgoszcz, Poland. The probability of disease-free survival (DFS) and overall survival (OS) in relation to potential prognostic factors for the patients were determined using a Kaplan-Meier analysis, and univariate and multivariate Cox regression analyses evaluated the predictive factors of IBrC patients. The investigation of the potential prognostic model's accuracy was analyzed using the ROC curve. Results: Patients with tumor size < 2 cm, Ki67 expression < 20%, luminal-A molecular subtype, and extra-dose brachytherapy boost administration displayed the most favorable prognosis according to breast cancer disease-free survival and overall survival. The estimated 5 year probability of DFS and OS rates in women with tumor diameter < 2 cm were 89% and 90%, respectively. In tumor diameter > 2 cm, the estimated 5 year probability of DFS was 73% and OS was 76%. Interestingly, the tumor diameter of 1.6 cm with a specificity of 60.5% and a sensitivity of 75% occurred as the best threshold point to differentiate patients with cancer recurrence from those without cancer progression. Conclusions: Our study provides essential information on the clinicopathological profile and future outcomes of early stage IBrC patients. Furthermore, the tumor diameter cut-off value of 1.6 cm discriminating between disease recurrence and those without disease progression patients represents an innovative direction for further research.
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Affiliation(s)
- Katarzyna Wrzeszcz
- Department of Pathophysiology, Faculty of Pharmacy, Nicolaus Copernicus University, Collegium Medicum, 85-094 Bydgoszcz, Poland;
| | - Katarzyna Kwiatkowska
- Department of Pathophysiology, Faculty of Pharmacy, Nicolaus Copernicus University, Collegium Medicum, 85-094 Bydgoszcz, Poland;
| | - Piotr Rhone
- Clinical Ward of Breast Cancer and Reconstructive Surgery, Oncology Centre Prof. F. Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland;
| | - Dorota Formanowicz
- Poznan University of Medical Sciences, Department of Medical Chemistry and Laboratory Medicine, 60-806 Poznan, Poland;
| | - Stefan Kruszewski
- Biophysics Department, Collegium Medicum of Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland;
| | - Barbara Ruszkowska-Ciastek
- Department of Pathophysiology, Faculty of Pharmacy, Nicolaus Copernicus University, Collegium Medicum, 85-094 Bydgoszcz, Poland;
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10
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Watanabe F, Sato S, Hirose T, Endo M, Endo A, Ito H, Ohba K, Mori T, Takahashi K. NRIP1 regulates cell proliferation in lung adenocarcinoma cells. J Biochem 2024; 175:323-333. [PMID: 38102728 DOI: 10.1093/jb/mvad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
Nuclear receptor interacting protein 1 (NRIP1) is a transcription cofactor that regulates the activity of nuclear receptors and transcription factors. Functional expression of NRIP1 has been identified in multiple cancers. However, the expression and function of NRIP1 in lung adenocarcinoma have remained unclear. Thus, we aimed to clarify the NRIP1 expression and its functions in lung adenocarcinoma cells. NRIP1 and Ki-67 were immunostained in the tissue microarray section consisting of 64 lung adenocarcinoma cases, and the association of NRIP1 immunoreactivity with clinical phenotypes was examined. Survival analysis was performed in lung adenocarcinoma data from The Cancer Genome Atlas (TCGA). Human A549 lung adenocarcinoma cell line with an NRIP1-silencing technique was used in vitro study. Forty-three of 64 cases were immunostained with NRIP1. Ki-67-positive cases were more frequent in NRIP1-positive cases as opposed to NRIP1-negative cases. Higher NRIP1 mRNA expression was associated with poor prognosis in the TCGA lung adenocarcinoma data. NRIP1 was mainly located in the nucleus of A549 cells. NRIP1 silencing significantly reduced the number of living cells, suppressed cell proliferation, and induced apoptosis. These results suggest that NRIP1 participates in the progression and development of lung adenocarcinoma. Targeting NRIP1 may be a possible therapeutic strategy against lung adenocarcinoma.
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Affiliation(s)
- Fumihiko Watanabe
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo, Aoba, 980-8575 Sendai, Japan
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, 1, Hikarigaoka, Fukushima, 960-1295 Fukushima, Japan
| | - Shigemitsu Sato
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo, Aoba, 980-8575 Sendai, Japan
- Division of Integrative Renal Replacement Therapy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1, Fukumuro, Miyagino, 983-8536 Sendai, Japan
| | - Takuo Hirose
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo, Aoba, 980-8575 Sendai, Japan
- Division of Integrative Renal Replacement Therapy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1, Fukumuro, Miyagino, 983-8536 Sendai, Japan
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1, Fukumuro, Miyagino, 983-8536 Sendai, Japan
| | - Moe Endo
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo, Aoba, 980-8575 Sendai, Japan
| | - Akari Endo
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo, Aoba, 980-8575 Sendai, Japan
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1, Fukumuro, Miyagino, 983-8536 Sendai, Japan
| | - Hiroki Ito
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo, Aoba, 980-8575 Sendai, Japan
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1, Fukumuro, Miyagino, 983-8536 Sendai, Japan
| | - Koji Ohba
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo, Aoba, 980-8575 Sendai, Japan
| | - Takefumi Mori
- Division of Integrative Renal Replacement Therapy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1, Fukumuro, Miyagino, 983-8536 Sendai, Japan
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1, Fukumuro, Miyagino, 983-8536 Sendai, Japan
| | - Kazuhiro Takahashi
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo, Aoba, 980-8575 Sendai, Japan
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11
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Li H, Liu R, Long C, Teng Y, Liu Y. A novel machine learning prediction model for metastasis in breast cancer. Cancer Rep (Hoboken) 2024; 7:e2006. [PMID: 38425238 PMCID: PMC10905156 DOI: 10.1002/cnr2.2006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Breast cancer (BC) metastasis is the common cause of high mortality. Conventional prognostic criteria cannot accurately predict the BC metastasis risk. The machine learning technologies can overcome the disadvantage of conventional models. AIM We developed a model to predict BC metastasis using the random survival forest (RSF) method. METHODS Based on demographic data and routine clinical data, we used RSF-recursive feature elimination to identify the predictive variables and developed a model to predict metastasis using RSF method. The area under the receiver operating characteristic curve (AUROC) and Kaplan-Meier survival (KM) analyses were plotted to validate the predictive effect when C-index was plotted to assess the discrimination and Brier scores was plotted to assess the calibration of the predictive model. RESULTS We developed a metastasis prediction model comprising three variables (pathological stage, aspartate aminotransferase, and neutrophil count) selected by RSF-recursive feature elimination. The model was reliable and stable when assessed by the AUROC (0.932 in training set and 0.905 in validation set) and KM survival analyses (p < .0001). The C-indexes (0.959) and Brier score (0.097) also validated the good predictive ability of this model. CONCLUSIONS This model relies on routine data and examination indicators in real-time clinical practice and exhibits an accurate prediction performance without increasing the cost for patients. Using this model, clinicians can facilitate risk communication and provide precise and efficient individualized therapy to patients with breast cancer.
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Affiliation(s)
- Huan Li
- Department of Thyroid and Breast SurgeryThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Ren‐Bin Liu
- Department of Thyroid and Breast SurgeryThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Chen‐meng Long
- Department of Breast SurgeryLiuzhou Women and Children's Medical CenterLiuzhouChina
| | - Yuan Teng
- Department of Breast SurgeryGuangzhou Women and Children's Medical CenterGuangzhouChina
| | - Yu Liu
- Department of Thyroid and Breast SurgeryThird Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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12
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Chidananda Murthy G. Ki-67 Index and Its Correlation with Clinical and Pathological Variables in Breast Cancer. Indian J Surg Oncol 2023; 14:943-948. [PMID: 38187860 PMCID: PMC10766571 DOI: 10.1007/s13193-023-01833-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 10/03/2023] [Indexed: 01/09/2024] Open
Abstract
The role of the Ki-67 index as a prognostic marker in breast cancer is controversial. This study was undertaken to assess the association of Ki-67 index with other clinicopathological factors in breast cancer. The prospectively conducted study included 127 female patients with clinical tumor stage 1-3 and nodal stage 0 or 1 treated between March 2015 and March 2017. Ki-67 index was correlated with age, tumor size, lymph node status, histological grade, ER, PR, HER2, and molecular subtypes using Chi-square or Fisher's exact test. Mean age of the patients was 53.28 years (range, 25-86 years). Mean Ki-67 index was 33.59 (range, 2.5-95). Ki-67 index showed a positive correlation with pathological stage (p=0.025), grade (p=0.0001), and molecular subtype (p=0.0001) of the tumor. It was inversely associated with ER (p=0.0001) and PR status (p=0.0001). Its association with pathological nodal status (p=0.06) and size (p=0.08) of the tumor was not statistically significant. There was no correlation with age (p=0.892) and HER2 status (p=0.287). Association of the Ki-67 index with common prognostic factors such as grade, stage, ER, PR, and molecular subtype suggests its role as a prognostic factor in breast cancer.
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Affiliation(s)
- Giridhar Chidananda Murthy
- Department of Surgical Oncology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Nallurahalli, Whitefield, Bangalore, 560066 India
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13
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Meneveau MO, Crawford MP, Turkheimer LM, Millard TA, Atkins KA, Showalter SL. The POWER-PAK Score Characterizes Tumor Response to 3 Months of Preoperative Endocrine Therapy. Ann Surg Oncol 2023; 30:6034-6040. [PMID: 37454014 PMCID: PMC10766409 DOI: 10.1245/s10434-023-13892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The Pre-Operative Window of Endocrine Therapy to Inform Radiation Therapy Decisions (POWER, NCT04272801) trial aims to determine whether 3 months of preoperative endocrine therapy (pre-ET) informs adjuvant radiation therapy decisions among older women with early stage, ER-positive breast cancer. We propose the POWER Pathologic Assessment and Ki-67 (POWER-PAK) scoring system to characterize the histologic effects of pre-ET. METHODS Histologic evaluation was performed on core biopsy and lumpectomy specimens from 37 POWER trial participants who completed pre-ET and surgery. The POWER-PAK score consists of tumor regression, decrease in Ki-67 expression, and ER expression, each ranging from 0 to 2. Scores were aggregated to create the POWER-PAK score with a range from 0 to 6. Participants with no residual tumor were labelled 6-NRT. RESULTS ER expression did not decrease after pre-ET. Ki-67 decreased from 13% in biopsy specimens to 5% in the lumpectomy specimens (p < 0.001). Cellularity decreased from 40% to 23% (p < 0.001). There was heterogeneity of POWER-PAK scores ranging from 2 to 6-NRT: score of 2, n = 2 (5.4%); 4, n = 8 (21.6%); 5, n = 4 (10.8%); 6, n = 16 (43.2%); and 6-NRT, n = 7 (18.9%). Participants with a score ≥ 5 were more likely to have smaller tumors after pre-ET compared with those with a score < 5 (p = 0.04). CONCLUSIONS The tumor responses following treatment with pre-ET are heterogenous. We propose that the POWER-PAK scoring system can be used to quantify response to pre-ET. Future studies will explore the use of POWER-PAK to support informed decision-making for adjuvant therapy options for older women with early stage breast cancer.
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Affiliation(s)
- Max O Meneveau
- Department of Surgery, Division of Breast and Melanoma Surgery, University of Virginia, Charlottesville, VA, USA
| | - Michael P Crawford
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Lena M Turkheimer
- Department of Surgery, Division of Breast and Melanoma Surgery, University of Virginia, Charlottesville, VA, USA
| | - Trish A Millard
- Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, USA
| | - Kristen A Atkins
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Shayna L Showalter
- Department of Surgery, Division of Breast and Melanoma Surgery, University of Virginia, Charlottesville, VA, USA.
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14
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Althobaiti F, Sahyon HA, Shanab MMAH, Aldhahrani A, Helal MA, Khireldin A, Shoair AGF, Almalki ASA, Fathy AM. A comparative study of novel ruthenium(III) and iron(III) complexes containing uracil; docking and biological studies. J Inorg Biochem 2023; 247:112308. [PMID: 37441923 DOI: 10.1016/j.jinorgbio.2023.112308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
Structural and biological studies were conducted on the novel complexes [Fe(U)2(H2O)2]Cl3 (FeU) and [Ru(U)2(H2O)2]Cl3 (RuU) (U = 5,6-Diamino-1,3-dimethylpyrimidine-2,4(1H,3H)-dione) to develop an anticancer drug candidate. The two complexes have been synthesized and characterized. Based on our findings, these complexes have octahedral geometry. The DNA-binding study proved that both complexes coordinated with CT-DNA. The docking study confirmed the potency of both complexes in downregulating the topoisomerase I protein through their high binding affinity. Biological studies have established that both complexes can act as potent anticancer agents against three cancer cell lines. RuU or FeU complexes induce apoptosis in breast cancer cells by increasing caspase9 protein and inhibiting proliferating cell nuclear antigen (PCNA) activity. In addition, both complexes down-regulate topoisomerase I expression in breast cancer cells. Therefore, the RuU and FeU complexes' anticancer activities were mediated via both apoptosis induction and topoisomerase I down-regulation. In conclusion, both complexes have dual anticancer activity pathways that may be responsible for the selective cytotoxicity of the complexes. This makes them more suitable for the development of novel cancer treatment strategies.
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Affiliation(s)
- Fayez Althobaiti
- Department of Biotechnology, College of Science, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Heba A Sahyon
- Chemistry Department, Faculty of Science, Kafrelsheikh University, 33516 Kafrelsheikh, Egypt.
| | - Mai M A H Shanab
- Department of Chemistry, College of Sciences and Humanities Studies (Girls section), Hawtat Bani Tamim 11149, Prince Sattam Bin Abdulaziz University, P.O. Box:13, Saudi Arabia.
| | - Adil Aldhahrani
- Clinical Laboratory Science Department, Turabah University College, Taif University, Taif 21995, Saudi Arabia.
| | - Marihan A Helal
- Chemistry Department, Faculty of Science, Damietta University, Damietta, Egypt
| | - Awad Khireldin
- Air transport management, Singapore Institute of Technology (SIT), Singapore.
| | - Abdel Ghany F Shoair
- Department of Science and Technology, University College-Ranyah, postcode 21975, Taif University, Saudi Arabia; High Altitude Research Center, Taif University, 21944, Saudi Arabia.
| | | | - Ahmed M Fathy
- Chemistry Department, Faculty of Science, Zagazig University, Zagazig, Egypt
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15
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Probert J, Dodwell D, Broggio J, Charman J, Dowsett M, Kerr A, McGale P, Taylor C, Darby SC, Mannu GS. Ki67 and breast cancer mortality in women with invasive breast cancer. JNCI Cancer Spectr 2023; 7:pkad054. [PMID: 37567612 PMCID: PMC10500622 DOI: 10.1093/jncics/pkad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The percentage of cells staining positive for Ki67 is sometimes used for decision-making in patients with early invasive breast cancer (IBC). However, there is uncertainty regarding the most appropriate Ki67 cut points and the influence of interlaboratory measurement variability. We examined the relationship between breast cancer mortality and Ki67 both before and after accounting for interlaboratory variability and 8 patient and tumor characteristics. METHODS A multicenter cohort study of women with early IBC diagnosed during 2009-2016 in more than 20 NHS hospitals in England and followed until December 31, 2020. RESULTS Ki67 was strongly prognostic of breast cancer mortality in 8212 women with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative early IBC (Ptrend < .001). This relationship remained strong after adjustment for patient and tumor characteristics (Ptrend < .001). Standardization for interlaboratory variability did little to alter these results. For women with Ki67 scores of 0%-5%, 6%-10%, 11%-19%, and 20%-29% the corresponding 8-year adjusted cumulative breast cancer mortality risks were 3.3% (95% confidence interval [CI] = 2.8% to 4.0%), 3.7% (95% CI = 3.0% to 4.4%), 3.4% (95% CI = 2.8% to 4.1%), and 3.4% (95% CI = 2.8% to 4.1%), whereas for women with Ki67 scores of 30%-39% and 40%-100%, these risks were higher, at 5.1% (95% CI = 4.3% to 6.2%) and 7.7% (95% CI = 6.6% to 9.1) (Ptrend < .001). Similar results were obtained when the adjusted analysis was repeated with omission of pathological information about tumor size and nodal involvement, which would not be available preoperatively for patients being considered for neoadjuvant therapy. CONCLUSION Our findings confirm the prognostic value of Ki67 scores of 30% or more in women with ER-positive, HER2-negative early IBC, irrespective of interlaboratory variability. These results also suggest that Ki67 may be useful to aid decision-making in the neoadjuvant setting.
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Affiliation(s)
- Jake Probert
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John Broggio
- The National Disease Registration Service, NHS England, Leeds, UK
| | - Jackie Charman
- The National Disease Registration Service, NHS England, Leeds, UK
| | | | - Amanda Kerr
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul McGale
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Carolyn Taylor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah C Darby
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gurdeep S Mannu
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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16
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Wang M, Wang Y, Xie F, Ren H, Chen J, Wang Z. Efficacy of post‑mastectomy radiotherapy in patients with T1‑2N1 breast cancer aged ≤35 years or with a positive HER‑2 status. Mol Clin Oncol 2023; 19:58. [PMID: 37359715 PMCID: PMC10288432 DOI: 10.3892/mco.2023.2654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Post-mastectomy radiotherapy (PMRT) is highly recommended for patients with breast cancer with one to three positive nodes; however, there remains some controversy regarding its use. The present retrospective study aimed to explore which patients may be able to avoid PMRT and its associated side effects. A total of 728 patients with T1-2N1 breast cancer who were treated with or without PMRT were included in the present study. The results suggested that PMRT significantly decreased the locoregional recurrence rate (LRR) [hazard ratio (HR)=5.602, 95% confidence interval (CI)=3.139-9.998, P<0.01; 3-year LRR: 4 vs. 17%] and improved overall survival (OS) (HR=0.651, 95% CI=0.437-0.971, P=0.03; 3-year OS: 91 vs. 87%) for patients with T1-2N1 breast cancer. By contrast, PMRT had no significant effect on the distant metastasis (DM) rate (HR=0.691, 95% CI=0.468-1.019, P=0.06; 3-year DM: 10 vs. 15%). Further stratified analysis revealed that PMRT did not reduce the LRR and DM, or improve OS in patients aged ≤35 years or in those with a positive human epidermal growth factor receptor-2 (HER-2) status. The analysis of 438 patients treated with PMRT revealed that patients aged ≤35 years or those with a positive HER-2 status were more likely to experience local recurrence even following PMRT. Thus, the benefits of using PMRT in patients with T1-2N1 breast cancer who are aged ≤35 years or in those with a positive HER-2 status need to be carefully considered. Further studies are required to confirm whether this patient group may be exempted from PMRT.
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Affiliation(s)
- Mincong Wang
- Department of Radiotherapy, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Yali Wang
- Department of Radiotherapy, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Fei Xie
- Department of Neurosurgery, Xi'an Central Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710003, P.R. China
| | - Hongtao Ren
- Department of Radiotherapy, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Jing Chen
- Department of Radiotherapy, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Zhongwei Wang
- Department of Radiotherapy, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
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17
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Targeting KK-LC-1 inhibits malignant biological behaviors of triple-negative breast cancer. J Transl Med 2023; 21:184. [PMID: 36895039 PMCID: PMC9996895 DOI: 10.1186/s12967-023-04030-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Cancer/testis antigens (CTAs) participate in the regulation of malignant biological behaviors in breast cancer. However, the function and mechanism of KK-LC-1, a member of the CTA family, in breast cancer are still unclear. METHODS Bioinformatic tools, immunohistochemistry, and western blotting were utilized to detect the expression of KK-LC-1 in breast cancer and to explore the prognostic effect of KK-LC-1 expression in breast cancer patients. Cell function assays, animal assays, and next-generation sequencing were utilized to explore the function and mechanism of KK-LC-1 in the malignant biological behaviors of triple-negative breast cancer. Small molecular compounds targeting KK-LC-1 were also screened and drug susceptibility testing was performed. RESULTS KK-LC-1 was significantly highly expressed in triple-negative breast cancer tissues than in normal breast tissues. KK-LC-1 high expression was related to poor survival outcomes in patients with breast cancer. In vitro studies suggested that KK-LC-1 silencing can inhibit triple-negative breast cancer cell proliferation, invasion, migration, and scratch healing ability, increase cell apoptosis ratio, and arrest the cell cycle in the G0-G1 phase. In vivo studies have suggested that KK-LC-1 silencing decreases tumor weight and volume in nude mice. Results showed that KK-CL-1 can regulate the malignant biological behaviors of triple-negative breast cancer via the MAL2/MUC1-C/PI3K/AKT/mTOR pathway. The small-molecule compound Z839878730 had excellent KK-LC-1 targeting ability and cancer cell killing ability. The EC50 value was 9.7 μM for MDA-MB-231 cells and 13.67 µM for MDA-MB-468 cells. Besides, Z839878730 has little tumor-killing effect on human normal mammary epithelial cells MCF10A and can inhibit the malignant biological behaviors of triple-negative breast cancer cells by MAL2/MUC1-C/PI3K/AKT/mTOR pathway. CONCLUSIONS Our findings suggest that KK-LC-1 may serve as a novel therapeutic target for triple-negative breast cancer. Z839878730, which targets KK-LC-1, presents a new path for breast cancer clinical treatment.
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18
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O'Shaughnessy J, Gradishar W, O'Regan R, Gadi V. Risk of Recurrence in Patients with HER2+ Early-Stage Breast Cancer: Literature Analysis of Patient and Disease Characteristics. Clin Breast Cancer 2023; 23:350-362. [PMID: 37149421 DOI: 10.1016/j.clbc.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/10/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
Human epidermal growth factor receptor 2 (HER2) overexpression occurs in 15% to 20% of patients with early-stage breast cancers (EBCs). Without HER2-targeted therapy, 30% to 50% of patients relapse within 10 years, many developing incurable metastatic disease. This literature review was designed to identify and validate patient- and disease-related factors associated with recurrence in patients with HER2+ EBC. Peer-reviewed primary research articles and congress abstracts were identified by searching MEDLINE. Articles published in English from 2019 to 2022 were included to identify contemporary treatment options. Results were analyzed for the relationship between risk factors and surrogates of HER2+ EBC recurrence to determine how identified risk factors affected HER2+ EBC recurrence. Sixty-one articles and 65 abstracts that assessed age at diagnosis, body mass index (BMI), tumor size at diagnosis, hormone receptor (HR) status, pathologic complete response (pCR) status, and biomarkers were analyzed. We confirmed the results of previously published reviews reporting residual cancer burden >0, non-pCR, and fewer tumor-infiltrating lymphocytes (TILs) as risk factors of recurrence. HR status remained an important risk factor for recurrence, with HER2+/HR+ disease more likely to recur. Two or more positive lymph nodes, higher BMI, larger primary tumor size, and low Ki67 were more commonly associated with HER2+ EBC recurrence. The identification of patient and disease factors frequently associated with HER2+ EBC recurrence in the literature provides insight into potential recurrence risk factors. Further investigation into the risk factors identified in this review could lead to improved treatments for patients at high risk for HER2+ EBC recurrence.
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Affiliation(s)
- Joyce O'Shaughnessy
- Baylor University Medical Center, Dallas, TX; Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, TX.
| | | | - Ruth O'Regan
- Department of Medicine, University of Rochester, Rochester, NY
| | - Vijayakrishna Gadi
- Department of Medicine, University of Illinois Chicago, Chicago, IL; Translational Oncology Program, University of Illinois Cancer Center, Chicago, IL
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19
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Lashen AG, Toss MS, Ghannam SF, Makhlouf S, Green A, Mongan NP, Rakha E. Expression, assessment and significance of Ki67 expression in breast cancer: an update. J Clin Pathol 2023; 76:357-364. [PMID: 36813558 DOI: 10.1136/jcp-2022-208731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
Ki67 expression is one of the most important and cost-effective surrogate markers to assess for tumour cell proliferation in breast cancer (BC). The Ki67 labelling index has prognostic and predictive value in patients with early-stage BC, particularly in the hormone receptor-positive, HER2 (human epidermal growth factor receptor 2)-negative (luminal) tumours. However, many challenges exist in using Ki67 in routine clinical practice and it is still not universally used in the clinical setting. Addressing these challenges can potentially improve the clinical utility of Ki67 in BC. In this article, we review the function, immunohistochemical (IHC) expression, methods for scoring and interpretation of results as well as address several challenges of Ki67 assessment in BC. The prodigious attention associated with use of Ki67 IHC as a prognostic marker in BC resulted in high expectation and overestimation of its performance. However, the realisation of some pitfalls and disadvantages, which are expected with any similar markers, resulted in an increasing criticism of its clinical use. It is time to consider a pragmatic approach and weigh the benefits against the weaknesses and identify factors to achieve the best clinical utility. Here we highlight the strengths of its performance and provide some insights to overcome the existing challenges.
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Affiliation(s)
- Ayat Gamal Lashen
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Michael S Toss
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of pathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suzan Fathy Ghannam
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Histology, Suez Canal University, Ismailia, Egypt
| | - Shorouk Makhlouf
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Andrew Green
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
| | - Nigel P Mongan
- School of Veterinary Medicine and Sciences, University of Nottingham, Nottingham, UK.,Department of Pharmacology, Weill Cornell Medicine, New York, New York, USA
| | - Emad Rakha
- Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK .,Department of Pathology, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt.,Pathology Department, Hamad Medical Corporation, Doha, Qatar
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20
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Tong Y, Dai J, Huang J, Fei X, Shen K, Liu Q, Chen X. Ki67 increase after core needle biopsy associated with worse disease outcome in HER2-negative breast cancer patients. Sci Rep 2023; 13:2489. [PMID: 36781892 PMCID: PMC9925825 DOI: 10.1038/s41598-022-25206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/28/2022] [Indexed: 02/15/2023] Open
Abstract
Ki67 would change after core needle biopsy (CNB) in invasive breast cancer. However, whether Ki67 alteration (ΔKi67) influences disease outcomes remains unclear. Here we aim to evaluate the prognostic value of ΔKi67. Patients with paired CNB and open excision biopsy (OEB) samples between January 2009 and June 2016 were retrospectively analyzed. ΔKi67 was calculated as the absolute difference between Ki67 level in CNB and OEB samples, and the median value of 5% was adopted to category patients into high- and low ΔKi67 groups. Disease-free survival (DFS) and overall survival (OS) were compared between different ΔKi67 groups. Overall, 2173 invasive breast cancer patients were included. Median Ki67 was higher in OEB than CNB samples: 25.00% versus 20.00% (P < 0.001). Axillary nodal status, STI, histological grading, and molecular subtype were independently associated with ΔKi67 (P < 0.05). In the whole population, patients with low ΔKi67 showed superior 5-year DFS (89.6% vs 87.0%, P = 0.026), but similar OS (95.8% vs 94.3%, P = 0.118) compared to those with high ΔKi67. HER2 status at surgery was the only significant factor interacting with ΔKi67 on both DFS (P = 0.026) and OS (P = 0.007). For patients with HER2-negative disease, high ΔKi67 was associated with worse 5-year DFS (87.2% vs 91.2%, P = 0.004) as well as impaired 5-year OS (93.9% vs 96.8%, P = 0.010). ΔKi67 had no significant impact on survival of HER2-positive patients. Ki67 increase after CNB was significantly associated with worse disease outcomes in HER2-negative, but not in HER2-positive patients, which warrants further study.
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Affiliation(s)
- Yiwei Tong
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jiangfeng Dai
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Jiahui Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Qingmeng Liu
- Department of Pathology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China.
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
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21
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Zhu Y, Dou Y, Qin L, Wang H, Wen Z. Prediction of Ki-67 of Invasive Ductal Breast Cancer Based on Ultrasound Radiomics Nomogram. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:649-664. [PMID: 35851691 DOI: 10.1002/jum.16061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The objective of this research was to develop and validate an ultrasound-based radiomics nomogram for the pre-operative assessment of Ki-67 in breast cancer (BC). MATERIALS AND METHODS From December 2016 to December 2018, 515 patients with invasive ductal breast cancer who received two-dimensional (2D) ultrasound and Ki-67 examination were studied and analyzed retrospectively. The dataset was distributed at random into a training cohort (n = 360) and a test cohort (n = 155) in the ratio of 7:3. Each tumor region of interest was defined based on 2D ultrasound images and radiomics features were extracted. ANOVA, maximum correlation minimum redundancy (mRMR) algorithm, and minimum absolute shrinkage and selection operator (LASSO) were performed to pick features, and independent clinical predictors were integrated with radscore to construct the nomogram for predicting Ki-67 index by univariate and multivariate logistic regression analysis. The performance and utility of the models were evaluated by plotting receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves. RESULTS In the testing cohort, the area under the receiver characteristic curve (AUC) of the nomogram was 0.770 (95% confidence interval, 0.690-0.860). In both cohorts, the nomogram outperformed both the clinical model and the radiomics model (P < .05 according to the DeLong test). The analysis of DCA proved that the model has clinical utility. CONCLUSIONS The nomogram based on 2D ultrasound images offered an approach for predicting Ki-67 in BC.
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Affiliation(s)
- Yunpei Zhu
- Ultrasound Department, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Yanping Dou
- Ultrasound Department, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Ling Qin
- Ultrasound Department, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Hui Wang
- Ultrasound Department, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Zhihong Wen
- Radiology Department, Dalian Fifth People's Hospital, Dalian City, Liaoning Province, China
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22
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Finkelman BS, Zhang H, Hicks DG, Turner BM. The Evolution of Ki-67 and Breast Carcinoma: Past Observations, Present Directions, and Future Considerations. Cancers (Basel) 2023; 15:808. [PMID: 36765765 PMCID: PMC9913317 DOI: 10.3390/cancers15030808] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
The 1983 discovery of a mouse monoclonal antibody-the Ki-67 antibody-that recognized a nuclear antigen present only in proliferating cells represented a seminal discovery for the pathologic assessment of cellular proliferation in breast cancer and other solid tumors. Cellular proliferation is a central determinant of prognosis and response to cytotoxic chemotherapy in patients with breast cancer, and since the discovery of the Ki-67 antibody, Ki-67 has evolved as an important biomarker with both prognostic and predictive potential in breast cancer. Although there is universal recognition among the international guideline recommendations of the value of Ki-67 in breast cancer, recommendations for the actual use of Ki-67 assays in the prognostic and predictive evaluation of breast cancer remain mixed, primarily due to the lack of assay standardization and inconsistent inter-observer and inter-laboratory reproducibility. The treatment of high-risk ER-positive/human epidermal growth factor receptor-2 (HER2) negative breast cancer with the recently FDA-approved drug abemaciclib relies on a quantitative assessment of Ki-67 expression in the treatment decision algorithm. This further reinforces the urgent need for standardization of Ki-67 antibody selection and staining interpretation, which will hopefully lead to multidisciplinary consensus on the use of Ki-67 as a prognostic and predictive marker in breast cancer. The goals of this review are to highlight the historical evolution of Ki-67 in breast cancer, summarize the present literature on Ki-67 in breast cancer, and discuss the evolving literature on the use of Ki-67 as a companion diagnostic biomarker in breast cancer, with consideration for the necessary changes required across pathology practices to help increase the reliability and widespread adoption of Ki-67 as a prognostic and predictive marker for breast cancer in clinical practice.
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Affiliation(s)
| | | | | | - Bradley M. Turner
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14620, USA
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23
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Intratumoral heterogeneity affects tumor regression and Ki67 proliferation index in perioperatively treated gastric carcinoma. Br J Cancer 2023; 128:375-386. [PMID: 36347963 PMCID: PMC9902476 DOI: 10.1038/s41416-022-02047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Intratumoral heterogeneity (ITH) is a major problem in gastric cancer (GC). We tested Ki67 and tumor regression for ITH after neoadjuvant/perioperative chemotherapy. METHODS 429 paraffin blocks were obtained from 106 neoadjuvantly/perioperatively treated GCs (one to five blocks per case). Serial sections were stained with Masson's trichrome, antibodies directed against cytokeratin and Ki67, and finally digitalized. Tumor regression and three different Ki67 proliferation indices (PI), i.e., maximum PI (KiH), minimum PI (KiL), and the difference between KiH/KiL (KiD) were obtained per block. Statistics were performed in a block-wise (all blocks irrespective of their case-origin) and case-wise manner. RESULTS Ki67 and tumor regression showed extensive ITH in our series (maximum ITH within a case: 31% to 85% for KiH; 4.5% to 95.6% for tumor regression). In addition, Ki67 was significantly associated with tumor regression (p < 0.001). Responders (<10% residual tumor, p = 0.016) exhibited prolonged survival. However, there was no significant survival benefit after cut-off values were increased ≥20% residual tumor mass. Ki67 remained without prognostic value. CONCLUSIONS Digital image analysis in tumor regression evaluation might help overcome inter- and intraobserver variability and validate classification systems. Ki67 may serve as a sensitivity predictor for chemotherapy and an indicator of ITH.
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24
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Linguanti F, Abenavoli EM, Briganti V, Danti G, Lavacchi D, Matteini M, Vaggelli L, Novelli L, Grosso AM, Mungai F, Mini E, Antonuzzo L, Miele V, Sciagrà R, Berti V. Added prognostic value of molecular imaging parameters over proliferation index in typical lung carcinoid: an [18F]FDG PET/CT and SSTR imaging study. Ann Nucl Med 2023; 37:1-9. [PMID: 36309948 PMCID: PMC9813078 DOI: 10.1007/s12149-022-01797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/10/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study was performed to evaluate the prognostic meaning of volumetric and semi-quantitative parameters measured using [18F]FDG PET/CT and somatostatin receptor (SSTR) imaging in patients with typical lung carcinoid (TC), and their relationship with proliferative index (Ki67). METHODS We retrospectively reviewed 67 patients (38-94 years old, mean: 69.7) with diagnosis of TC who underwent [18F]FDG PET/CT and/or SSTR scintigraphy/SPECT with [111In]DTPA-Octreotide plus contrast-enhanced CT (CECT) at staging evaluation. All patients had Ki67 measured and a follow-up (FU) of at least 1 year. SSTR density (SSTRd) was calculated as the percentage difference of tumor/non-tumor ratio at 4 and 24 h post-injection. At PET/CT, metabolic activity was measured using SUVmax and SUVratio; volumetric parameters included MTV and TLG of the primary tumor, measured using the threshold SUV41%. ROC analysis, discriminant analysis and Kaplan-Meier curves (KM) were performed. RESULTS 11 patients died during FU. Disease stage (localized versus advanced), SUVratio, SUVmax, Ki67, MTV and TLG were significantly higher in non-survivors than in survivors. ROC curves resulted statistically significant for Ki67, SUVratio, SUVmax, MTV and TLG. On multivariate analysis, stage of disease and TLG were significant independent predictors of overall survival (OS). In KM curves, the combination of disease stage and TLG identified four groups with significantly different outcomes (p < 0.005). Metabolic activity (SUVmax and SUVratio) was confirmed as significant independent prognostic factor for OS also in patients with advanced disease, with the best AUC using SUVmax. In patients with advanced and localized disease, SSTRd proved to be the best imaging prognostic factor for progression and for disease-free survival (DFS), respectively. In localized disease, SSTRd 31.5% identified two subgroups of patients with significant different DFS distribution and in advanced disease, a high cutoff value (58.5%) was a significant predictor of adverse prognosis. CONCLUSION Volumetric and semi-quantitative parameters measured using [18F]FDG PET/CT and SSTR imaging combined with Ki67 may provide a reference for prognosis evaluation of patients with TC, to better stratify risk groups with the goal of developing individualized therapeutic strategies.
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Affiliation(s)
- Flavia Linguanti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ``Mario Serio’’, University of Florence, 50134 Florence, Italy
| | - Elisabetta M. Abenavoli
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ``Mario Serio’’, University of Florence, 50134 Florence, Italy
| | - Vittorio Briganti
- Nuclear Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Ginevra Danti
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Daniele Lavacchi
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Maria Matteini
- Nuclear Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Luca Vaggelli
- Nuclear Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Luca Novelli
- Department of Pathology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Anna M. Grosso
- Unit of Pneumology and Thoracic-Pulmonary Physiopathology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Francesco Mungai
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Enrico Mini
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
| | - Lorenzo Antonuzzo
- Medical Oncology Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy ,Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ``Mario Serio’’, University of Florence, 50134 Florence, Italy
| | - Valentina Berti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ``Mario Serio’’, University of Florence, 50134 Florence, Italy
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Klæstad E, Opdahl S, Raj SX, Bofin AM, Valla M. Long term trends of breast cancer incidence according to proliferation status. BMC Cancer 2022; 22:1340. [PMID: 36544164 PMCID: PMC9773605 DOI: 10.1186/s12885-022-10438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Long-term breast cancer incidence trends according to proliferation status are poorly described. We studied time-trends in breast cancer incidence, using mitotic count and Ki-67 as markers of proliferation. METHODS Among 83,298 Norwegian women followed for breast cancer occurrence 1961-2012, 2995 incident breast cancers were diagnosed. Ki-67 was assessed using immunohistochemistry on tissue microarrays and mitoses were counted on whole sections. We compared incidence rates according to proliferation status among women born 1886-1928 and 1929-1977, estimating age-specific incidence rate ratios. We performed multiple imputations to account for unknown proliferation status. Mean values of Ki-67 and mitotic counts were calculated, according to age and birth year. We performed separate incidence analyses for HER2+ and triple negative breast cancers. RESULTS Among women aged 40-69 years, incidence rates of tumours with low-proliferative activity were higher among those born in 1929 or later, compared to before 1929, according to Ki-67 and mitotic count. Incidence rates of tumours with high-proliferative activity were also higher in women born in 1929 or later compared to before 1929 according to Ki-67, but not according to mitotic count. Mean values of Ki-67 and mitotic count varied according to age and birth year. In subtype-specific analyses we found an increase of high-proliferative HER2+ tumours according to Ki-67 in women born in 1929 or later, compared to before 1929. CONCLUSIONS There has been a temporal increase in both low- and high-proliferative breast cancers.
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Affiliation(s)
- Elise Klæstad
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Signe Opdahl
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sunil Xavier Raj
- grid.52522.320000 0004 0627 3560Cancer Clinic, St. Olav’s Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Anna Mary Bofin
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit Valla
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Pathology, St. Olav’s Hospital, Trondheim University Hospital, 7006 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Clinic of Laboratory Medicine, St. Olav’s Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
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Wu J, Fang Q, Yao J, Ge L, Hu L, Wang Z, Jin G. Integration of ultrasound radiomics features and clinical factors: A nomogram model for identifying the Ki-67 status in patients with breast carcinoma. Front Oncol 2022; 12:979358. [PMID: 36276108 PMCID: PMC9581085 DOI: 10.3389/fonc.2022.979358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of this study was to develop and validate an ultrasound-based radiomics nomogram model by integrating the clinical risk factors and radiomics score (Rad-Score) to predict the Ki-67 status in patients with breast carcinoma. Methods Ultrasound images of 284 patients (196 high Ki-67 expression and 88 low Ki-67 expression) were retrospectively analyzed, of which 198 patients belonged to the training set and 86 patients to the test set. The region of interest of tumor was delineated, and the radiomics features were extracted. Radiomics features underwent dimensionality reduction analysis by using the independent sample t test and least absolute shrinkage and selection operator (LASSO) algorithm. The support vector machine (SVM), logistic regression (LR), decision tree (DT), random forest (RF), naive Bayes (NB) and XGBoost (XGB) machine learning classifiers were trained to establish prediction model based on the selected features. The classifier with the highest AUC value was selected to convert the output of the results into the Rad-Score and was regarded as Rad-Score model. In addition, the logistic regression method was used to integrate Rad-Score and clinical risk factors to generate the nomogram model. The leave group out cross-validation (LGOCV) method was performed 200 times to verify the reliability and stability of the nomogram model. Results Six classifier models were established based on the 15 non-zero coefficient features. Among them, the LR classifier achieved the best performance in the test set, with the area under the receiver operating characteristic curve (AUC) value of 0.786, and was obtained as the Rad-Score model, while the XGB performed the worst (AUC, 0.615). In multivariate analysis, independent risk factor for high Ki-67 status was age (odds ratio [OR] = 0.97, p = 0.04). The nomogram model based on the age and Rad-Score had a slightly higher AUC than that of Rad-Score model (AUC, 0.808 vs. 0.798) in the test set, but no statistical difference (p = 0.144, DeLong test). The LGOCV yielded a median AUC of 0.793 in the test set. Conclusions This study proposed a convenient, clinically useful ultrasound radiomics nomogram model that can be used for the preoperative individualized prediction of the Ki-67 status in patients with BC.
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Affiliation(s)
- Jiangfeng Wu
- Department of Ultrasound, Dongyang People’s Hospital, Dongyang, China
- *Correspondence: Guilong Jin, ; Zhengping Wang, ; Liyan Hu, ; Lifang Ge,
| | - Qingqing Fang
- Department of Ultrasound, Tianxiang East Hospital, Yiwu, China
| | - Jincao Yao
- Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou, China
| | - Lifang Ge
- Department of Ultrasound, Dongyang People’s Hospital, Dongyang, China
- *Correspondence: Guilong Jin, ; Zhengping Wang, ; Liyan Hu, ; Lifang Ge,
| | - Liyan Hu
- Department of Ultrasound, Dongyang People’s Hospital, Dongyang, China
- *Correspondence: Guilong Jin, ; Zhengping Wang, ; Liyan Hu, ; Lifang Ge,
| | - Zhengping Wang
- Department of Ultrasound, Dongyang People’s Hospital, Dongyang, China
- *Correspondence: Guilong Jin, ; Zhengping Wang, ; Liyan Hu, ; Lifang Ge,
| | - Guilong Jin
- Department of Ultrasound, Dongyang People’s Hospital, Dongyang, China
- *Correspondence: Guilong Jin, ; Zhengping Wang, ; Liyan Hu, ; Lifang Ge,
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Patel R, Hovstadius M, Kier MW, Moshier EL, Zimmerman BS, Cascetta K, Jaffer S, Sparano JA, Tiersten A. Correlation of the Ki67 Working Group prognostic risk categories with the Oncotype DX Recurrence Score in early breast cancer. Cancer 2022; 128:3602-3609. [PMID: 35947048 PMCID: PMC9529824 DOI: 10.1002/cncr.34426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The relationship between Ki67 assessed by immunohistochemistry (IHC) and the Oncotype DX Recurrence Score (RS) is unclear. The objective of this study was to determine the correlation between the 21-gene RS and IHC-measured Ki67 with the prognostic classification groups recommended by the International Ki67 Working Group (IKWG). METHODS The authors performed a retrospective chart review of women who had hormone receptor (HR)-positive, human epidermal growth factor receptor 2-negative early breast cancer with zero to three positive lymph nodes and both Ki67 and the 21-gene RS performed at their institution from 2013 to 2021. Patients were categorized into low (≤5%), intermediate (6%-29%), and high Ki67 groups (≥30%) according to IKWG recommendations. Overall agreement and risk-stratified agreement between Ki67 and RS were assessed with the proportion of agreement and the κ statistic. RESULTS The study included 525 patients with HR-positive breast cancer. Among the 49% of patients with intermediate Ki67 values of 6%-29%, the distribution of low (0-10), intermediate (11-25), and high RS (26-100) was 19%, 66%, and 15%, respectively. There was slight agreement (κ = 0.01-0.20) between Ki67 and RS (κ = 0.027) in the overall population, although this was not significant (p = .1985). There was fair agreement (κ = 0.21-0.40) between high Ki67 and RS values (κ = 0.280; p < .0001). A higher progesterone receptor percentage was associated with lower RS values (p > .0001) but not lower Ki67 values. A positive nodal status and a larger tumor size were associated with higher Ki67 values (p = .0059 and p < .0001) but not with RS. CONCLUSIONS In this group of patients selected to have a 21-gene RS, there was no significant correlation between Ki67 and RS in the overall population, and there was fair agreement between high Ki67 and high RS values. LAY SUMMARY In patients with early-stage, hormone receptor-positive breast cancer, decisions on adjuvant chemotherapy are based on certain biological features of the cancer and genomic assays such as the Oncotype DX Recurrence Score (RS). The goal of this study was to determine the correlation between Ki67, a marker of proliferation, and the Oncotype DX RS, a 21-gene assay demonstrated to be predictive of an adjuvant chemotherapy benefit in patients with early-stage breast cancer. In 525 patients, the authors did not find a significant correlation between Ki67 and RS.
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Affiliation(s)
- Rima Patel
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, United States
| | - Malin Hovstadius
- Frank H. Netter School of Medicine at Quinnipiac University, Hamden, Connecticut, United States
| | - Melanie W. Kier
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, United States
| | - Erin L. Moshier
- Division of Biostatistics, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - Krystal Cascetta
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, United States
| | - Shabnam Jaffer
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Joseph A. Sparano
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, United States
| | - Amy Tiersten
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, New York, United States
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Kaszak I, Witkowska-Piłaszewicz O, Domrazek K, Jurka P. The Novel Diagnostic Techniques and Biomarkers of Canine Mammary Tumors. Vet Sci 2022; 9:526. [PMID: 36288138 PMCID: PMC9610006 DOI: 10.3390/vetsci9100526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 07/25/2023] Open
Abstract
Canine mammary tumors (CMTs) are considered a serious clinical problem in older bitches. Due to the high malignancy rate and poor prognosis, an early diagnosis is essential. This article is a summary of novel diagnostic techniques as well as the main biomarkers of CMTs. So far, CMTs are detected only when changes in mammary glands are clinically visible and surgical removal of the mass is the only recommended treatment. Proper diagnostics of CMT is especially important as they represent a very diverse group of tumors and therefore different treatment approaches may be required. Recently, new diagnostic options appeared, like a new cytological grading system of CMTs or B-mode ultrasound, the Doppler technique, contrast-enhanced ultrasound, and real-time elastography, which may be useful in pre-surgical evaluation. However, in order to detect malignancies before macroscopic changes are visible, evaluation of serum and tissue biomarkers should be considered. Among them, we distinguish markers of the cell cycle, proliferation, apoptosis, metastatic potential and prognosis, hormone receptors, inflammatory and more recent: metabolomic, gene expression, miRNA, and transcriptome sequencing markers. The use of a couple of the above-mentioned markers together seems to be the most useful for the early diagnosis of neoplastic diseases as well as to evaluate response to treatment, presence of tumor progression, or further prognosis. Molecular aspects of tumors seem to be crucial for proper understanding of tumorigenesis and the application of individual treatment options.
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Affiliation(s)
- Ilona Kaszak
- Laboratory of Small Animal Reproduction, Department of Small Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Olga Witkowska-Piłaszewicz
- Department of Pathology and Veterinary Diagnostics, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Kinga Domrazek
- Laboratory of Small Animal Reproduction, Department of Small Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Piotr Jurka
- Laboratory of Small Animal Reproduction, Department of Small Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
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Wang YY, Hung AC, Wu YC, Lo S, Chen HD, Chen YK, Hsieh YC, Hu SCS, Hou MF, Yuan SSF. ADSCs stimulated by resistin promote breast cancer cell malignancy via CXCL5 in a breast cancer coculture model. Sci Rep 2022; 12:15437. [PMID: 36104403 PMCID: PMC9475041 DOI: 10.1038/s41598-022-19290-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
The tumor microenvironment represents one of the main obstacles in breast cancer treatment owing to the presence of heterogeneous stromal cells, such as adipose-derived stem cells (ADSCs), that may interact with breast cancer cells and promote cancer development. Resistin is an adipocytokine associated with adverse breast cancer progression; however, its underlying mechanisms in the context of the breast tumor microenvironment remain largely unidentified. Here, we utilized a transwell co-culture model containing patient-derived ADSCs and breast cancer cell lines to investigate their potential interaction, and observed that breast cancer cells co-cultured with resistin-treated ADSCs (R-ADSCs) showed enhanced cancer cell growth and metastatic ability. Screening by proteome arrays revealed that C-X-C motif chemokine ligand 5 (CXCL5) was released in the conditioned medium of the co-culture system, and phosphorylated ERK was increased in breast cancer cells after co-culture with R-ADSCs. Breast cancer cells treated with the recombinant proteins of CXCL5 showed similarly enhanced cell migration and invasion ability as occurred in the co-culture model, whereas application of neutralizing antibodies against CXCL5 reversed these phenomena. The orthotopic xenograft in mice by breast cancer cells after co-culture with R-ADSCs had a larger tumor growth and more CXCL5 expression than control. In addition, clinical analysis revealed a positive correlation between the expression of resistin and CXCL5 in both tumor tissues and serum specimens of breast cancer patients. The current study suggests that resistin-stimulated ADSCs may interact with breast cancer cells in the tumor microenvironment via CXCL5 secretion, leading to breast cancer cell malignancy.
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Affiliation(s)
- Yen-Yun Wang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Amos C Hung
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chia Wu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Steven Lo
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Huan-Da Chen
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yuk-Kwan Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Oral Pathology and Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Oral and Maxillofacial Imaging Center, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Ching Hsieh
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Feng Hou
- Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shyng-Shiou F Yuan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
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Gao H, Zhou H, Gao Y, He L, Li W, Xu M, Feng H, Feng X, Qiu C. Establishment of a new cell line of canine inflammatory mammary cancer: IMC-118. Vet Comp Oncol 2022; 20:679-687. [PMID: 35429113 DOI: 10.1111/vco.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
Canine inflammatory mammary cancer (IMC) has long been regarded as an attractive animal model for research into human inflammatory breast cancer (IBC), Although some canine mammary tumour cell lines corresponding to human mammary cancer cell lines have been established, there is still a need to supplement the canine mammary tumour cell bank. The goal of this study was to create a new type of IMC cell line. The primary tumour, IMC-118, was identified as IMC by pathology examination. Immunohistochemistry analysis revealed negative immunoreactivity to oestrogen receptor (ER), but positive immunoreactivity to progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2). Immunofluorescence (IF) analysis revealed that the IMC-118 cell line from this primary tumour was negative for ER but positive for PR and HER-2, and was also positive for epithelial and mesenchymal cell markers. This cell line was cultured stably for more than 50 passages and grew well after cryopreservation. In vivo, tumour masses and metastases in the lungs were discovered after inoculating the IMC-118 cells into the nude mice model. As a result, a novel canine IMC cell line, IMC-118, was effectively established, and could be employed as a promising model for immunotherapy and epithelial-mesenchymal transition mechanism of IMC research in both dogs and humans.
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Affiliation(s)
- Hongbo Gao
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Han Zhou
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Yiming Gao
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Lixin He
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Wenxuan Li
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Meixia Xu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Huili Feng
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Xiujuan Feng
- Nanjing Police Dog Research Institute of the Ministry of the Public Security, Nanjing, China
| | - Changwei Qiu
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
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Integrative, In Silico and Comparative Analysis of Breast Cancer Secretome Highlights Invasive-Ductal-Carcinoma-Grade Progression Biomarkers. Cancers (Basel) 2022; 14:cancers14163854. [PMID: 36010848 PMCID: PMC9406168 DOI: 10.3390/cancers14163854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Globally, BC is the most frequently diagnosed cancer in women. The aim of this study was to identify novel secreted biomarkers that may indicate progression to high-grade BC malignancies and therefore predict metastatic potential. A total of 33 studies of breast cancer and 78 of other malignancies were screened via a systematic review for eligibility, yielding 26 datasets, 8 breast cancer secretome datasets, and 18 of other cancers that were included in the comparative secretome analysis. Sequential bioinformatic analysis using online resources enabled the identification of enriched GO_terms, overlapping clusters, and pathway reconstruction. This study identified putative predictors of IDC grade progression and their association with breast cancer patient mortality outcomes, namely, HSPG2, ACTG1, and LAMA5 as biomarkers of in silico pathway prediction, offering a putative approach by which the abovementioned proteins may mediate their effects, enabling disease progression. This study also identified ITGB1, FBN1, and THBS1 as putative pan-cancer detection biomarkers. The present study highlights novel, putative secretome biomarkers that may provide insight into the tumor biology and could inform clinical decision making in the context of IDC management in a non-invasive manner.
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32
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Negative Impact of Vitamin D Deficiency at Diagnosis on Breast Cancer Survival: A Prospective Cohort Study. Breast J 2022. [DOI: 10.1155/2022/4625233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. We prospectively evaluated the association between vitamin D concentration at diagnosis and overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) in postmenopausal women treated for breast cancer. Methods. This study included 192 patients newly diagnosed with invasive breast cancer, aged ≥45 years, and serum 25-hydroxy vitamin D (25 (OH)D) concentration assessment at diagnosis. Patients were classified into groups according to 25 (OH)D concentrations: sufficient (≥30 ng/mL), insufficient (between 20 and 29 ng/mL), and deficient (<20 ng/mL). The primary outcome was OS, and the secondary outcomes were DFS and CSS. The Kaplan–Meier curve and Cox regression model were used to assess the association between 25 (OH)D concentrations and survival rates. Differences in survival were evaluated by hazard ratios (HRs). Results. The mean age was 61.3 ± 9.6 years, 25 (OH)D concentration was 26.9 ± 7.5 ng/mL (range 12.0–59.2 ng/mL), and the follow-up period was between 54 and 78 months. Sufficient 25 (OH)D was detected in 33.9% of patients, insufficient in 47.9%, and deficient in 18.2%. A total of 51 patients (26.6%) died during the study period, with a mean OS time of 54.4 ± 20.2 months (range 9–78 months). Patients with 25 (OH)D deficiency and insufficiency at diagnosis had a significantly lower OS, DFS, and CSS compared with patients with sufficient values (
). After adjustment for clinical and tumoral prognostic factors, patients with 25 (OH)D concentrations considered deficient at diagnosis had a significantly higher risk of global death (HR, 4.65; 95% CI, 1.65–13.12), higher risk of disease recurrence (HR, 6.87; 95% CI, 2.35–21.18), and higher risk of death from the disease (HR, 5.91; 95% CI, 1.98–17.60) than the group with sufficient 25(OH)D concentrations. Conclusion. In postmenopausal women treated for breast cancer, vitamin D deficiency and insufficiency at diagnosis were independently associated with lower OS, DFS, and CSS compared with patients with sufficient 25(OH)D concentrations.
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Iraqi M, Edri A, Greenshpan Y, Goldstein O, Ofir N, Bolel P, Abu Ahmad M, Zektser M, Campbell KS, Rouvio O, Gazit R, Porgador A. Blocking the PCNA/NKp44 Checkpoint to Stimulate NK Cell Responses to Multiple Myeloma. Int J Mol Sci 2022; 23:4717. [PMID: 35563109 PMCID: PMC9105815 DOI: 10.3390/ijms23094717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
Abstract
Multiple Myeloma (MM) is a devastating malignancy that evades immune destruction using multiple mechanisms. The NKp44 receptor interacts with PCNA (Proliferating Cell Nuclear Antigen) and may inhibit NK cells' functions. Here we studied in vitro the expression and function of PCNA on MM cells. First, we show that PCNA is present on the cell membrane of five out of six MM cell lines, using novel anti-PCNA mAb developed to recognize membrane-associated PCNA. Next, we stained primary bone marrow (BM) mononuclear cells from MM patients and showed significant staining of membrane-associated PCNA in the fraction of CD38+CD138+ BM cells that contain the MM cells. Importantly, blocking of the membrane PCNA on MM cells enhanced the activity of NK cells, including IFN-γ-secretion and degranulation. Our results highlight the possible blocking of the NKp44-PCNA immune checkpoint by the mAb 14-25-9 antibody to enhance NK cell responses against MM, providing a novel treatment option.
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Affiliation(s)
- Muhammed Iraqi
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel; (M.I.); (A.E.); (Y.G.); (O.G.); (N.O.); (P.B.); (M.A.A.); (R.G.)
| | - Avishay Edri
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel; (M.I.); (A.E.); (Y.G.); (O.G.); (N.O.); (P.B.); (M.A.A.); (R.G.)
| | - Yariv Greenshpan
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel; (M.I.); (A.E.); (Y.G.); (O.G.); (N.O.); (P.B.); (M.A.A.); (R.G.)
| | - Oron Goldstein
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel; (M.I.); (A.E.); (Y.G.); (O.G.); (N.O.); (P.B.); (M.A.A.); (R.G.)
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Noa Ofir
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel; (M.I.); (A.E.); (Y.G.); (O.G.); (N.O.); (P.B.); (M.A.A.); (R.G.)
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Priyanka Bolel
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel; (M.I.); (A.E.); (Y.G.); (O.G.); (N.O.); (P.B.); (M.A.A.); (R.G.)
| | - Muhammad Abu Ahmad
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel; (M.I.); (A.E.); (Y.G.); (O.G.); (N.O.); (P.B.); (M.A.A.); (R.G.)
| | - Miri Zektser
- Internal Medicine A and Multiple Myeloma Clinic, Soroka Medical Center, Beer Sheva 8489501, Israel; (M.Z.); (O.R.)
| | - Kerry S. Campbell
- Blood Cell Development and Host Defense Program, Research Institute at Fox Chase Cancer Center, Philadelphia, PA 19111, USA;
| | - Ory Rouvio
- Internal Medicine A and Multiple Myeloma Clinic, Soroka Medical Center, Beer Sheva 8489501, Israel; (M.Z.); (O.R.)
| | - Roi Gazit
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel; (M.I.); (A.E.); (Y.G.); (O.G.); (N.O.); (P.B.); (M.A.A.); (R.G.)
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Angel Porgador
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel; (M.I.); (A.E.); (Y.G.); (O.G.); (N.O.); (P.B.); (M.A.A.); (R.G.)
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Faculty of Health Science, National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
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Mestrum SGC, Vanblarcum RBY, Drent RJM, Boonen BT, van Hemert WLW, Ramaekers FCS, Hopman AHN, Leers MPG. Proliferative and anti‐apoptotic fractions in maturing hematopoietic cell lineages and their role in homeostasis of normal bone marrow. Cytometry A 2022; 101:552-563. [PMID: 35429122 PMCID: PMC9540078 DOI: 10.1002/cyto.a.24558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/04/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022]
Abstract
Recent developments in clinical flow cytometry allow the simultaneous assessment of proliferative and anti‐apoptotic activity in the different hematopoietic cell lineages and during their maturation process. This can further advance the flow cytometric diagnosis of myeloid malignancies. In this study we established indicative reference values for the Ki‐67 proliferation index and Bcl‐2 anti‐apoptotic index in blast cells, as well as maturing erythroid, myeloid, and monocytic cells from normal bone marrow (BM). Furthermore, the cell fractions co‐expressing both proliferation and anti‐apoptotic markers were quantified. Fifty BM aspirates from femoral heads of patients undergoing hip replacement were included in this study. Ten‐color/twelve‐parameter flow cytometry in combination with a software‐based maturation tool was used for immunophenotypic analysis of Ki‐67 and Bcl‐2 positive fractions during the erythro‐, myelo‐, and monopoiesis. Indicative reference values for the Ki‐67 and Bcl‐2 positive fractions were established for different relevant hematopoietic cell populations in healthy BM. Ki‐67 and Bcl‐2 were equally expressed in the total CD34 positive blast cell compartment and 30% of Ki‐67 positive blast cells also showed Bcl‐2 positivity. The Ki‐67 and Bcl‐2 positive fractions were highest in the more immature erythroid, myeloid and monocytic cells. Both fractions then gradually declined during the subsequent maturation phases of these cell lineages. We present a novel application of an earlier developed assay that allows the simultaneous determination of the Ki‐67 proliferative and Bcl‐2 anti‐apoptotic indices in maturing hematopoietic cell populations of the BM. Their differential expression levels during the maturation process were in accordance with the demand and lifespan of these cell populations. The indicative reference values established in this study can act as a baseline for further cell biological and biomedical studies involving hematological malignancies.
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Affiliation(s)
- Stefan G. C. Mestrum
- Department of Molecular Cell Biology, GROW‐School for Oncology and Developmental Biology Maastricht University Medical Center Maastricht The Netherlands
- Department of Clinical Chemistry & Hematology Zuyderland Medical Center Sittard‐Geleen The Netherlands
| | - Roanalis B. Y. Vanblarcum
- Department of Clinical Chemistry & Hematology Zuyderland Medical Center Sittard‐Geleen The Netherlands
| | - Roosmarie J. M. Drent
- Department of Clinical Chemistry & Hematology Zuyderland Medical Center Sittard‐Geleen The Netherlands
| | - Bert T. Boonen
- Department of Orthopedic Surgery Zuyderland Medical Center Heerlen The Netherlands
| | | | - Frans C. S. Ramaekers
- Department of Molecular Cell Biology, GROW‐School for Oncology and Developmental Biology Maastricht University Medical Center Maastricht The Netherlands
- Nordic‐MUbio, Susteren The Netherlands
| | - Anton H. N. Hopman
- Department of Molecular Cell Biology, GROW‐School for Oncology and Developmental Biology Maastricht University Medical Center Maastricht The Netherlands
| | - Math P. G. Leers
- Department of Clinical Chemistry & Hematology Zuyderland Medical Center Sittard‐Geleen The Netherlands
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Garutti M, Griguolo G, Botticelli A, Buzzatti G, De Angelis C, Gerratana L, Molinelli C, Adamo V, Bianchini G, Biganzoli L, Curigliano G, De Laurentiis M, Fabi A, Frassoldati A, Gennari A, Marchiò C, Perrone F, Viale G, Zamagni C, Zambelli A, Del Mastro L, De Placido S, Guarneri V, Marchetti P, Puglisi F. Definition of High-Risk Early Hormone-Positive HER2−Negative Breast Cancer: A Consensus Review. Cancers (Basel) 2022; 14:cancers14081898. [PMID: 35454806 PMCID: PMC9029479 DOI: 10.3390/cancers14081898] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is one of the major causes of cancer-related morbidity and mortality in women worldwide. During the past three decades, several improvements in the adjuvant treatment of hormone receptor-positive/HER2−negative breast cancer have been achieved with the introduction of optimized adjuvant chemotherapy and endocrine treatment. However, estimating the risk of relapse of breast cancer on an individual basis is still challenging. The IRIDE (hIGh Risk DEfinition in breast cancer) working group was established with the aim of reviewing evidence from the literature to synthesize the current relevant features that predict hormone-positive/HER2−negative early breast cancer relapse. A panel of experts in breast cancer was involved in identifying clinical, pathological, morphological, and genetic factors. A RAND consensus method was used to define the relevance of each risk factor. Among the 21 features included, 12 were considered relevant risk factors for relapse. For each of these, we provided a consensus statement and relevant comments on the supporting scientific evidence. This work may guide clinicians in the practical management of hormone-positive/HER2−negative early breast cancers.
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Affiliation(s)
- Mattia Garutti
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy; (L.G.); (F.P.)
- Correspondence: ; Tel.: +39-04-3465-9092
| | - Gaia Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy; (G.G.); (V.G.)
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, 35100 Padova, Italy
| | - Andrea Botticelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy;
| | - Giulia Buzzatti
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, 16100 Genova, Italy; (G.B.); (C.M.); (L.D.M.)
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80100 Naples, Italy; (C.D.A.); (S.D.P.)
| | - Lorenzo Gerratana
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy; (L.G.); (F.P.)
| | - Chiara Molinelli
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, 16100 Genova, Italy; (G.B.); (C.M.); (L.D.M.)
| | - Vincenzo Adamo
- Department of Human Pathology, Papardo Hospital, University of Messina, 89121 Messina, Italy;
| | - Giampaolo Bianchini
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
- School of Medicine and Surgery, Università Vita-Salute San Raffaele, 20020 Milan, Italy
| | - Laura Biganzoli
- Ospedale Santo Stefano, Prato Sandro Pitigliani Medical Oncology Division, Hospital of Prato, 59100 Prato, Italy;
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, 20100 Milan, Italy;
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Michelino De Laurentiis
- Department of Breast and Thoracic Oncology, IRCCS INT Fondazione G. Pascale, 80144 Napoli, Italy;
| | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Department of Woman and Child Health and Public Health, IRCCS, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy;
| | - Antonio Frassoldati
- Department of Traslational Medicine and for Romagna, Clinical Oncology, S Anna University Hospital, Università degli Studi di Ferrara, 44121 Ferrara, Italy;
| | - Alessandra Gennari
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy;
- Azienda Ospedaliero-Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Caterina Marchiò
- Candiolo Cancer Institute, FPO IRCCS, 10060 Candiolo, Italy;
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Francesco Perrone
- Clinical Trials Unit, Istituto Nazionale Tumori di Napoli, IRCCS Fondazione Pascale, 80144 Naples, Italy;
| | - Giuseppe Viale
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
- Department of Pathology, European Institute of Oncology IRCCS, 20122 Milan, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Universitaria di Bologna, 40100 Bologna, Italy;
| | - Alberto Zambelli
- Breast Cancer Section Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, 20089 Milan, Italy;
| | - Lucia Del Mastro
- Department of Medical Oncology, IRCCS Ospedale Policlinico San Martino, 16100 Genova, Italy; (G.B.); (C.M.); (L.D.M.)
- Dipartimento di Medicina Interna e Specialità Mediche, University of Genova, 16159 Genova, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80100 Naples, Italy; (C.D.A.); (S.D.P.)
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35100 Padova, Italy; (G.G.); (V.G.)
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, 35100 Padova, Italy
| | - Paolo Marchetti
- IRCCS Istituto Dermopatico dell’Immacolata (IDI-IRCCS), 00167 Rome, Italy;
| | - Fabio Puglisi
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy; (L.G.); (F.P.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
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Musat OR, Stefan-van Staden RI. Stochastic Sensors for the Enantioselective Determination of Serine in Blood for the Early Diagnosis of Breast Cancer. ANAL LETT 2022. [DOI: 10.1080/00032719.2022.2047999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Oana-Raluca Musat
- Faculty of Applied Chemistry and Material Science, Politehnica University of Bucharest, Bucharest, Romania
| | - Raluca-Ioana Stefan-van Staden
- Faculty of Applied Chemistry and Material Science, Politehnica University of Bucharest, Bucharest, Romania
- Laboratory of Electrochemistry and PATLAB, Bucharest, Romania
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Low correlation between Ki67 assessed by qRT-PCR in Oncotype Dx score and Ki67 assessed by Immunohistochemistry. Sci Rep 2022; 12:3617. [PMID: 35256657 PMCID: PMC8901910 DOI: 10.1038/s41598-022-07593-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/16/2022] [Indexed: 12/16/2022] Open
Abstract
Breast cancers expressing high levels of Ki67 are associated with poor outcomes. Oncotype DX test was designed for ER+/HER2- early-stage breast cancers to help adjuvant chemotherapy decision by providing a Recurrent Score (RS). RS measures the expression of 21 specific genes from tumor tissue, including Ki67. The primary aim of this study was to assess the agreement between Ki67RNA obtained with Oncotype DX RS and Ki67IHC. Other objectives were to analyze the association between the event free survival (EFS) and the expression level of Ki67RNA; and association between RS and Ki67RNA. Herein, we report a low agreement of 0.288 by Pearson correlation coefficient test between Ki67IHC and Ki67RNA in a cohort of 98 patients with early ER+/HER2- breast cancers. Moreover, Ki67RNAhigh tumors were significantly associated with the occurrence of events (p = 0.03). On the other hand, we did not find any association between Ki67IHC and EFS (p = 0.26). We observed a low agreement between expression level of Ki67RNA and Ki67 protein labelling by IHC. Unlike Ki67IHC and independently of the RS, Ki67RNA could have a prognostic value. It would be interesting to better assess the prognosis and predictive value of Ki67RNA measured by qRT-PCR. The Ki67RNA in medical routine could be a good support in countries where Oncotype DX is not accessible.
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Li H, Liu RB, Long CM, Teng Y, Cheng L, Liu Y. Development and Validation of a New Multiparametric Random Survival Forest Predictive Model for Breast Cancer Recurrence with a Potential Benefit to Individual Outcomes. Cancer Manag Res 2022; 14:909-923. [PMID: 35256862 PMCID: PMC8898179 DOI: 10.2147/cmar.s346871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Breast cancer (BC) is a multi-factorial disease. Its individual prognosis varies; thus, individualized patient profiling is instrumental to improving BC management and individual outcomes. An economical, multiparametric, and practical model to predict BC recurrence is needed. Patients and Methods We retrospectively investigated the clinical data of BC patients treated at the Third Affiliated Hospital of Sun Yat-sen University and Liuzhou Women and Children’s Medical Center from January 2013 to December 2020. Random forest-recursive feature elimination (run by R caret package) was used to determine the best variable set, and the random survival forest method was used to develop a predictive model for BC recurrence. Results The training and validations sets included 623 and 151 patients, respectively. We selected 14 variables, the pathological (TNM) stage, gamma-glutamyl transpeptidase, total cholesterol, Ki-67, lymphocyte count, low-density lipoprotein, age, apolipoprotein B, high-density lipoprotein, globulin, neutrophil count to lymphocyte count ratio, alanine aminotransferase, triglyceride, and albumin to globulin ratio, using random survival forest (RSF)-recursive feature elimination. We developed a recurrence prediction model using RSF. Using area under the receiver operating characteristic curve and Kaplan–Meier survival analyses, the model performance was determined to be accurate. C-indexes were 0.997 and 0.936 for the training and validation sets, respectively. Conclusion The model could accurately predict BC recurrence. It aids clinicians in identifying high-risk patients and making treatment decisions for Breast cancer patients in China. This new multiparametric RSF model is instrumental for breast cancer recurrence prediction and potentially improves individual outcomes.
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Affiliation(s)
- Huan Li
- Department of Thyroid and Breast Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Ren-Bin Liu
- Department of Thyroid and Breast Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Chen-Meng Long
- Department of Breast Surgery, Liuzhou Women and Children’s Medical Center, Liuzhou, Guangxi, People’s Republic Of China
| | - Yuan Teng
- Department of Breast Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, People’s Republic of China
| | - Lin Cheng
- Department of Thyroid and Breast Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Yu Liu
- Department of Thyroid and Breast Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Yu Liu, Tel +8613560170809, Fax +86 20 85252154, Email
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Feng S, Yin J. Radiomics of dynamic contrast-enhanced magnetic resonance imaging parametric maps and apparent diffusion coefficient maps to predict Ki-67 status in breast cancer. Front Oncol 2022; 12:847880. [PMID: 36895526 PMCID: PMC9989944 DOI: 10.3389/fonc.2022.847880] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose This study was aimed at evaluating whether a radiomics model based on the entire tumor region from breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parametric maps and apparent diffusion coefficient (ADC) maps could indicate the Ki-67 status of patients with breast cancer. Materials and methods This retrospective study enrolled 205 women with breast cancer who underwent clinicopathological examination. Among them, 93 (45%) had a low Ki-67 amplification index (Ki-67 positivity< 14%), and 112 (55%) had a high Ki-67 amplification index (Ki-67 positivity ≥ 14%). Radiomics features were extracted from three DCE-MRI parametric maps and ADC maps calculated from two different b values of diffusion-weighted imaging sequences. The patients were randomly divided into a training set (70% of patients) and a validation set (30% of patients). After feature selection, we trained six support vector machine classifiers by combining different parameter maps and used 10-fold cross-validation to predict the expression level of Ki-67. The performance of six classifiers was evaluated with receiver operating characteristic (ROC) analysis, sensitivity, and specificity in both cohorts. Results Among the six classifiers constructed, a radiomics feature set combining three DCE-MRI parametric maps and ADC maps yielded an area under the ROC curve (AUC) of 0.839 (95% confidence interval [CI], 0.768-0.895) within the training set and 0.795 (95% CI, 0.674-0.887) within the independent validation set. Additionally, the AUC value, compared with that for a single parameter map, was moderately increased by combining features from the three parametric maps. Conclusions Radiomics features derived from the DCE-MRI parametric maps and ADC maps have the potential to serve as imaging biomarkers to determine Ki-67 status in patients with breast cancer.
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Affiliation(s)
- Shuqian Feng
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.,School of Intelligent Medicine, China Medical University, Shenyang, Liaoning, China
| | - Jiandong Yin
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Gnanamuttupulle M, Henke O, Ntundu SH, Serventi F, Mwakipunda LE, Amsi P, Mremi A, Chilonga K, Msuya D, Chugulu SG. Clinicopathological characteristics of breast cancer patients from Northern Tanzania: common aspects of late stage presentation and triple negative breast cancer. Ecancermedicalscience 2021; 15:1282. [PMID: 34824605 PMCID: PMC8580599 DOI: 10.3332/ecancer.2021.1282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 01/22/2023] Open
Abstract
Purpose Breast cancer (BC) is the second most common cancer among Tanzanian women. Oestrogen (ER), progesterone and human epidermal growth factor receptor 2 play major roles in prognosis and treatment but data for Tanzania are sparse. This study aimed to determine these patterns and histological types, tumour grading and staging of BC patients in northern Tanzania for a better understanding of BC in the Sub-Saharan African (SSA) setting. Methods A cross-sectional study recorded newly diagnosed BC cases at Kilimanjaro Christian Medical Centre between October 2018 and March 2019. Receptor status, histological types and grade, clinical stage and socio-demographic were recorded and descriptive and bivariate analyses performed. Results 116 patients were enrolled. Median age was 53 years, 71.6% were ≥45 years. The commonest molecular subtype was triple negative breast cancer (TNBC) (n = 33; 28.4%). One hundred and two (87.9%) patients had invasive ductal carcinoma (IDC), poorly differentiated tumours (60; 51.7%) and clinical stage III disease (62; 53.0%). ER negative tumours were associated with poorly differentiated histological grade (relative risk (RR): 1.34 (0.87–2.07)), tumour size > 5 cm (RR: 1.67 (0.33–8.35)) and IDC (RR: 3.35 (0.56–20.23)). Clinical stages III & IV (odds ratio (OR): 1.64 (0.63–4.24)) were associated with hormone receptor (HR) negative tumours and metastasis (OR: 1.60 (0.68–3.74)) with TNBC. 18% of the patients reported about first-degree relatives with BC. Conclusions Most patients presented in advanced stages and TNBC in their menopause. HR negative tumours were associated with poor histological differentiation and IDC. The high percentage of positive family history of BC and the differences in receptor patterns compared to other parts of the world should urge further genetic research on BC in SSA.
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Affiliation(s)
- Marianne Gnanamuttupulle
- Department of General Surgery, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
| | - Oliver Henke
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Shilanaiman Hilary Ntundu
- Department of General Surgery, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
| | - Furaha Serventi
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Leila E Mwakipunda
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Patrick Amsi
- Department of Pathology, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Kondo Chilonga
- Department of General Surgery, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
| | - Samuel G Chugulu
- Department of General Surgery, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
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Karakolevska-Ilova M, Zdravkovska M, Jasar D, Petrushevska G, Simeonovska-Joveva E. Can Estrogen Receptor, Progesterone Receptor, and Proliferative Index be Considered as Isolated Prognostic Factors of Overall Survival in Early luminal Breast Cancer? Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: There are a number of proven molecular and pathological markers important for the prognosis for OS of early luminal type breast cancer, but there are still some deficiencies mainly due to the non-linear relationship between the markers and the outcome of the disease.
METHODS AND PATIENTS: In this retro-prospective study, clinical and pathological data were provided from 336 patients with breast cancer who underwent breast surgery and treatment between January 2010 and December 2013, and followed until December 2018. The aim of the study was an evaluation of ER, PR, and Ki-67 as independent prognostic factors for OS of early luminal breast cancer.
RESULTS: Early luminal breast cancers were not predictive of ER expression status (p = 0.699, p = 0.356), whereas only early Luminal B was predictive for PR expression (>10%: 72.2%). Ki-67 in most of the cases of early Luminal B was with expression of >14–20% (p = 0.056). Patients with ER of 1–10% survived over 80 months (p = 0.0020) in early Luminal A, but ER expression status did not show prognostic significance for OS of early Luminal B (p = 0.775). PR status did not show prognostic significance for OS in early luminal types (p = 0.257, p = 0.622). ER >1%/PR >1% was protective in early Luminal B (p = 0.00043), but not in early Luminal A.
CONCLUSION: Our results suggest ER, but not PR as independent prognostic factor for OS but only of early Luminal A. We did not prove Ki-67 as independent prognostic factor for OS of highly proliferative early breast cancer.
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de Gregorio A, Friedl TWP, Hering E, Widschwendter P, de Gregorio N, Bekes I, Janni W, Dayan D, Huober JB. Ki67 as Proliferative Marker in Patients with Early Breast Cancer and Its Association with Clinicopathological Factors. Oncology 2021; 99:780-789. [PMID: 34535596 DOI: 10.1159/000517490] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ki67 as a proliferative marker has prognostic and therapeutic relevance in early breast cancer (EBC). However, standard cutoffs for distinguishing low and high Ki67 do not exist. MATERIAL AND METHODS Data from all patients treated at the University Hospital Ulm for EBC between January 2013 and December 2015 with documented results for internal Ki67 assessment of the primary (n = 917) tumor were retrospectively analyzed evaluating the associations between Ki67 and other clinicopathological factors. RESULTS 595 (64.9%) patients had a Ki67 <20% and 322 (35.1%) a Ki67 ≥20%. The median Ki67 was 10% (range 1-90%). Median Ki67 values according to the hormone receptor (HR)/ human epidermal growth factor receptor 2 (HER2) subtypes were 10% for HR-positive/HER2 negative (HR+/HER2-) disease (n = 717), 20% for HR+/HER2+ (n = 76), 30% for HR-/HER2+ (n = 45), and 60% for HR-/HER2- (n = 75). 75.2% or 89.3% of all patients with HER2-positive or triple-negative disease had a Ki67 ≥20%, respectively. Using a multivariable logistic regression with Ki67 (<20% vs. ≥20%) as binary dependent variable, younger age, positive nodal status, higher grading, histological nonspecific type carcinoma, negative HR status, and positive HER2 status were shown to be significantly associated with a higher proliferative index (Ki67 ≥20%). CONCLUSION This analysis described Ki67 in different subtypes in EBC and its association with clinicopathological factors. According to more aggressive tumor biology, the respective subgroups also showed higher median Ki67 levels. However, definition of low and high proliferation index itself is difficult. It is essential to interpret Ki67 indices carefully with regard to the own institutional values and other clinicopathological factors.
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Affiliation(s)
- Amelie de Gregorio
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | | | | | - Peter Widschwendter
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany.,Department of Gynecology and Obstetrics, Landeskrankenhaus Hall, Hall in Tirol, Austria
| | | | - Inga Bekes
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany.,Breast Cancer Center St. Gallen, St. Gallen, Switzerland
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Davut Dayan
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Jens Bodo Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany.,Breast Cancer Center St. Gallen, St. Gallen, Switzerland
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A new tool for technical standardization of the Ki67 immunohistochemical assay. Mod Pathol 2021; 34:1261-1270. [PMID: 33536573 PMCID: PMC8222064 DOI: 10.1038/s41379-021-00745-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/20/2022]
Abstract
Ki67, a nuclear proliferation-related protein, is heavily used in anatomic pathology but has not become a companion diagnostic or a standard-of-care biomarker due to analytic variability in both assay protocols and interpretation. The International Ki67 Working Group in breast cancer has published and has ongoing efforts in the standardization of the interpretation of Ki67, but they have not yet assessed technical issues of assay production representing multiple sources of variation, including antibody clones, antibody formats, staining platforms, and operators. The goal of this work is to address these issues with a new standardization tool. We have developed a cell line microarray system in which mixes of human Karpas 299 or Jurkat cells (Ki67+) with Sf9 (Spodoptera frugiperda) (Ki67-) cells are present in incremental standardized ratios. To validate the tool, six different antibodies, including both ready-to-use and concentrate formats from six vendors, were used to measure Ki67 proliferation indices using IHC protocols for manual (bench-top) and automated platforms. The assays were performed by three different laboratories at Yale and analyzed using two image analysis software packages, including QuPath and Visiopharm. Results showed statistically significant differences in Ki67 reactivity between each antibody clone. However, subsets of Ki67 assays using three clones performed in three different labs show no significant differences. This work shows the need for analytic standardization of the Ki67 assay and provides a new tool to do so. We show here how a cell line standardization system can be used to normalize the staining variability in proliferation indices between different antibody clones in a triple negative breast cancer cohort. We believe that this cell line standardization array has the potential to improve reproducibility among Ki67 assays and laboratories, which is critical for establishing Ki67 as a standard-of-care assay.
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Elsayed AM, Sherif NM, Hassan NS, Althobaiti F, Hanafy NAN, Sahyon HA. Novel quercetin encapsulated chitosan functionalized copper oxide nanoparticles as anti-breast cancer agent via regulating p53 in rat model. Int J Biol Macromol 2021; 185:134-152. [PMID: 34147524 DOI: 10.1016/j.ijbiomac.2021.06.085] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/01/2021] [Accepted: 06/12/2021] [Indexed: 01/18/2023]
Abstract
This study was designed to present a new quercetin encapsulated chitosan functionalized copper oxide nanoparticle (CuO-ChNPs-Q) and assessed its anti-breast cancer activity both in vitro and in vivo. The CuO-ChNPs-Q may act as anti-proliferating agent against DMBA-induced mammary carcinoma in female rats. The CuONPs was functionalized with chitosan then quercetin was conjugated with them producing CuO-ChNPs-Q, then characterized. The in vitro anti-proliferating activity of the CuO-ChNPs-Q was evaluated against three human cell line. Then, the anti-breast cancer effect of the CuO-ChNPs-Q was assessed against DMBA-induction compared to both CuONPs and Q in female rat model. The in vitro results proved the potent anticancer activity of the CuO-ChNPs-Q compared to CuONPs and quercetin. The in vivo data showed significant reduction in breast tumors of DMBA-induced rats treated with CuO-ChNPs-Q compared to CuONPs and Q. The CuO-ChNPs-Q treatment had induced apoptosis via increased p53 gene, arrested the cell-cycle, and increased both cytochrome c and caspase-3 levels leading to mammary carcinoma cell death. Also, the CuO-ChNPs-Q treatment had suppressed the PCNA gene which decreased the proliferation of the mammary carcinoma cells. In conclusion, the CuO-ChNPs-Q might be a promising chemotherapeutic agent for treatment of breast cancer with a minimal toxicity on vital organs.
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Affiliation(s)
- Awny M Elsayed
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Naglaa M Sherif
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Nahla S Hassan
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Fayez Althobaiti
- Department of Biotechnology, Collage of Science, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Nemany A N Hanafy
- Nanomedicine group, Institute of Nanoscience and Nanotechnology, Kafrelsheikh University, 33516 Kafrelsheikh, Egypt.
| | - Heba A Sahyon
- Chemistry Department, Faculty of Science, Kafrelsheikh University, Kafrelsheikh 33516, Egypt.
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Dar H, Johansson A, Nordenskjöld A, Iftimi A, Yau C, Perez-Tenorio G, Benz C, Nordenskjöld B, Stål O, Esserman LJ, Fornander T, Lindström LS. Assessment of 25-Year Survival of Women With Estrogen Receptor-Positive/ERBB2-Negative Breast Cancer Treated With and Without Tamoxifen Therapy: A Secondary Analysis of Data From the Stockholm Tamoxifen Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2114904. [PMID: 34190995 PMCID: PMC8246315 DOI: 10.1001/jamanetworkopen.2021.14904] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE Clinically used breast cancer markers, such as tumor size, tumor grade, progesterone receptor (PR) status, and Ki-67 status, are known to be associated with short-term survival, but the association of these markers with long-term (25-year) survival is unclear. OBJECTIVE To assess the association of clinically used breast cancer markers with long-term survival and treatment benefit among postmenopausal women with lymph node-negative, estrogen receptor [ER]-positive and ERBB2-negative breast cancer who received tamoxifen therapy. DESIGN, SETTING, AND PARTICIPANTS This study was a secondary analysis of data from a subset of 565 women with ER-positive/ERBB2-negative breast cancer who participated in the Stockholm tamoxifen (STO-3) randomized clinical trial. The STO-3 clinical trial was conducted from 1976 to 1990 and comprised 1780 postmenopausal women with lymph node-negative breast cancer who were randomized to receive adjuvant tamoxifen therapy or no endocrine therapy. Complete 25-year follow-up data through December 31, 2016, were obtained from Swedish national registers. Immunohistochemical markers were reannotated in 2014. Data were analyzed from April to December 2020. INTERVENTIONS Patients in the original STO-3 clinical trial were randomized to receive 2 years of tamoxifen therapy vs no endocrine therapy. In 1983, patients who received tamoxifen therapy without cancer recurrence during the 2-year treatment and who consented to continued participation in the STO-3 study were further randomized to receive 3 additional years of tamoxifen therapy or no endocrine therapy. MAIN OUTCOMES AND MEASURES Distant recurrence-free interval (DRFI) by clinically used breast cancer markers was assessed using Kaplan-Meier and multivariable Cox proportional hazards analyses adjusted for age, period of primary diagnosis, tumor size (T1a and T1b [T1a/b], T1c, and T2), tumor grade (1-3), PR status (positive vs negative), Ki-67 status (low vs medium to high), and STO-3 clinical trial arm (tamoxifen treatment vs no adjuvant treatment). A recursive partitioning analysis was performed to evaluate which markers were able to best estimate long-term DRFI. RESULTS The study population comprised 565 postmenopausal women (mean [SD] age, 62.0 [5.3] years) with lymph node-negative, ER-positive/ERBB2-negative breast cancer. A statistically significant difference in long-term DRFI was observed by tumor size (88% for T1a/b vs 76% for T1c vs 63% for T2 tumors; log-rank P < .001) and tumor grade (81% for grade 1 vs 77% for grade 2 vs 65% for grade 3 tumors; log-rank P = .02) but not by PR status or Ki-67 status. Patients with smaller tumors (hazard ratio [HR], 0.31 [95% CI, 0.17-0.55] for T1a/b tumors and 0.58 [95% CI, 0.38-0.88] for T1c tumors) and grade 1 tumors (HR, 0.48; 95% CI, 0.24-0.95) experienced a significant reduction in the long-term risk of distant recurrence compared with patients with larger (T2) tumors and grade 3 tumors, respectively. A significant tamoxifen treatment benefit was observed among patients with larger tumors (HR, 0.53 [95% CI, 0.32-0.89] for T1c tumors and 0.34 [95% CI, 0.16-0.73] for T2 tumors), lower tumor grades (HR, 0.24 [95% CI, 0.07-0.82] for grade 1 tumors and 0.50 [95% CI, 0.31-0.80] for grade 2 tumors), and PR-positive status (HR, 0.38; 95% CI, 0.24-0.62). The recursive partitioning analysis revealed that tumor size was the most important characteristic associated with long-term survival, followed by clinical trial arm among patients with larger tumors. CONCLUSIONS AND RELEVANCE This secondary analysis of data from the STO-3 clinical trial indicated that, among the selected subgroup of patients, tumor size followed by tumor grade were the markers most significantly associated with long-term survival. Furthermore, a significant long-term tamoxifen treatment benefit was observed among patients with larger tumors, lower tumor grades, and PR-positive tumors.
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Affiliation(s)
- Huma Dar
- Department of Oncology and Pathology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Annelie Johansson
- Department of Oncology and Pathology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Anna Nordenskjöld
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Medicine, Southern Älvsborg Hospital, Borås, Sweden
| | - Adina Iftimi
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Christina Yau
- Department of Surgery, University of California, San Francisco, San Francisco
| | - Gizeh Perez-Tenorio
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Oncology, Linköping University, Linköping, Sweden
| | - Christopher Benz
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Bo Nordenskjöld
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Oncology, Linköping University, Linköping, Sweden
| | - Olle Stål
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Oncology, Linköping University, Linköping, Sweden
| | - Laura J. Esserman
- Department of Surgery, University of California, San Francisco, San Francisco
| | - Tommy Fornander
- Department of Oncology and Pathology, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Linda S. Lindström
- Department of Oncology and Pathology, Karolinska Institutet and University Hospital, Stockholm, Sweden
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Polley MYC, Dignam JJ. Statistical Considerations in the Evaluation of Continuous Biomarkers. J Nucl Med 2021; 62:605-611. [PMID: 33579807 DOI: 10.2967/jnumed.120.251520] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/19/2021] [Indexed: 01/02/2023] Open
Abstract
Discovery of biomarkers has been steadily increasing over the past decade. Although a plethora of biomarkers has been reported in the biomedical literature, few have been sufficiently validated for broader clinical applications. One particular challenge that may have hindered the adoption of biomarkers into practice is the lack of reproducible biomarker cut points. In this article, we attempt to identify some common statistical issues related to biomarker cut point identification and provide guidance on proper evaluation, interpretation, and validation of such cut points. First, we illustrate how discretization of a continuous biomarker using sample percentiles results in significant information loss and should be avoided. Second, we review the popular "minimal-P-value" approach for cut point identification and show that this method results in highly unstable P values and unduly increases the chance of significant findings when the biomarker is not associated with outcome. Third, we critically review a common analysis strategy by which the selected biomarker cut point is used to categorize patients into different risk categories and then the difference in survival curves among these risk groups in the same dataset is claimed as the evidence supporting the biomarker's prognostic strength. We show that this method yields an exaggerated P value and overestimates the prognostic impact of the biomarker. We illustrate that the degree of the optimistic bias increases with the number of variables being considered in a risk model. Finally, we discuss methods to appropriately ascertain the additional prognostic contribution of the new biomarker in disease settings where standard prognostic factors already exist. Throughout the article, we use real examples in oncology to highlight relevant methodologic issues, and when appropriate, we use simulations to illustrate more abstract statistical concepts.
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Affiliation(s)
- Mei-Yin C Polley
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, and NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - James J Dignam
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, and NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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Li C, Song L, Yin J. Intratumoral and Peritumoral Radiomics Based on Functional Parametric Maps from Breast DCE-MRI for Prediction of HER-2 and Ki-67 Status. J Magn Reson Imaging 2021; 54:703-714. [PMID: 33955619 DOI: 10.1002/jmri.27651] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Radiomics has been applied to breast magnetic resonance imaging (MRI) for gene status prediction. However, the features of peritumoral regions were not thoroughly investigated. PURPOSE To evaluate the use of intratumoral and peritumoral regions from functional parametric maps based on breast dynamic contrast-enhanced MRI (DCE-MRI) for prediction of HER-2 and Ki-67 status. STUDY TYPE Retrospective. POPULATION A total of 351 female patients (average age, 51 years) with pathologically confirmed breast cancer were assigned to the training (n = 243) and validation (n = 108) cohorts. FIELD STRENGTH/SEQUENCE 3.0T, T1 gradient echo. ASSESSMENT Radiomic features were extracted from intratumoral and peritumoral regions on six functional parametric maps calculated using time-intensity curves of DCE-MRI. The intraclass correlation coefficients (ICCs) were used to determine the reproducibility of feature extraction. Based on the intratumoral, peritumoral, and combined intra- and peritumoral regions, three radiomics signatures (RSs) were built using the least absolute shrinkage and selection operator (LASSO) logistic regression model, respectively. STATISTICAL TESTS Wilcoxon rank-sum test, minimum redundancy maximum relevance, LASSO, receiver operating characteristic curve (ROC) analysis, and DeLong test. RESULTS The intratumoral and peritumoral RSs for prediction of HER-2 and Ki-67 status achieved areas under the ROC (AUCs) of 0.683 (95% confidence interval [CI], 0.574-0.793) and 0.690 (95% CI, 0.577-0.804), and 0.714 (95% CI, 0.616-0.812) and 0.692 (95% CI, 0.590-0.794) in the validation cohort, respectively. The combined RSs yielded AUCs of 0.713 (95% CI, 0.604-0.823) and 0.749 (95% CI, 0.656-0.841), respectively. There were no significant differences in prediction performance among intratumoral, peritumoral, and combined RSs. Most (69.7%) of the features had good agreement (ICCs >0.8). DATA CONCLUSION Radiomic features of intratumoral and peritumoral regions on functional parametric maps based on breast DCE-MRI had the potential to identify HER-2 and Ki-67 status. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 2.
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Affiliation(s)
- Chunli Li
- Department of Biomedical Engineering, School of Fundamental Sciences, China Medical University, Shenyang, China.,Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lirong Song
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiandong Yin
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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Ko SM, Lee J, Bae SJ, Baik SJ, Ji J, Kim D, Ahn SG, Jeong J. Body mass index and absolute lymphocyte count predict disease-free survival in Korean breast cancer patients. Br J Cancer 2021; 125:119-125. [PMID: 33875823 PMCID: PMC8257741 DOI: 10.1038/s41416-021-01391-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/16/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022] Open
Abstract
Background Our study evaluated the association between body mass index (BMI) and absolute lymphocyte count (ALC) in breast cancer patients and healthy females. Additionally, we determined the prognostic value of these factors in breast cancer. Methods We retrospectively identified 1225 primary invasive breast cancer patients and 35,991 healthy females. Factors including BMI and complete blood count associated with disease-free survival (DFS) were assessed using a multi-variable Cox proportional hazard model. Results BMI and ALC were positively correlated in breast cancer patients and healthy females (both P < 0.001). In multi-variable analysis, overweight or obese participants had worse DFS (hazards ratio [HR], 1.98; 95% confidence interval [CI], 1.34–2.92; P = 0.001) than underweight or normal-weight individuals, but patients with high ALC had better DFS than those with low ALC (HR, 0.43; 95% CI, 0.29–0.65; P < 0.001). After risk stratification according to BMI/ALC, high-risk patients with high BMI/low ALC had worse DFS than others (HR, 2.48; 95% CI, 1.70–3.62; P < 0.001). Conclusions BMI and ALC were positive correlated, but their effect on breast cancer prognosis was opposite. Patients with high BMI/low ALC had worse DFS than others. Underlying mechanisms for effect of BMI/ALC on breast cancer prognosis should be studied in the future.
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Affiliation(s)
- Sung Min Ko
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Janghee Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Surgery, Sacred Heart Hospital, Hallym University, Dongtan, Republic of Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jung Baik
- Healthcare Research Team, Health Promotion Center, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Junghwan Ji
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dooreh Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Acs B, Fredriksson I, Rönnlund C, Hagerling C, Ehinger A, Kovács A, Røge R, Bergh J, Hartman J. Variability in Breast Cancer Biomarker Assessment and the Effect on Oncological Treatment Decisions: A Nationwide 5-Year Population-Based Study. Cancers (Basel) 2021; 13:1166. [PMID: 33803148 PMCID: PMC7963154 DOI: 10.3390/cancers13051166] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 02/08/2023] Open
Abstract
We compared estrogen receptor (ER), progesterone receptor (PR), human epidermal growth-factor receptor 2 (HER2), Ki67, and grade scores among the pathology departments in Sweden. We investigated how ER and HER2 positivity rates affect the distribution of endocrine and HER2-targeted treatments among oncology departments. All breast cancer patients diagnosed between 2013 and 2018 in Sweden were identified in the National Quality Register for Breast Cancer. Cases with data on ER, PR, HER2, Ki67, grade, and treatment were selected (43,261 cases from 29 departments following the guidelines for biomarker testing). The ER positivity rates ranged from 84.2% to 97.6% with 6/29 labs out of the overall confidence intervals (CIs), while PR rates varied between 64.8% and 86.6% with 7/29 labs out of the CIs. HER2 positivity rates ranged from 9.4% to 16.3%, with 3/29 labs out of the overall CIs. Median Ki67 varied between 15% and 30%, where 19/29 labs showed significant intra-laboratory variability. The proportion of grade-II cases varied between 42.9% and 57.1%, and 13/29 labs were outside of the CI. Adjusting for patient characteristics, the proportion of endocrine and anti-HER2 treatments followed the rate of ER and HER2 positivity, illustrating the clinical effect of inter- and intra-laboratory variability. There was limited variability among departments in ER, PR, and HER2 testing. However, even a few outlier pathology labs affected endocrine and HER2-targeted treatment rates in a clinically relevant proportion, suggesting the need for improvement. High variability was found in grading and Ki67 assessment, illustrating the need for the adoption of new technologies in practice.
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Affiliation(s)
- Balazs Acs
- Department of Oncology and Pathology, Karolinska Institutet, 17176 Stockholm, Sweden; (B.A.); (C.R.); (J.B.)
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, 11883 Stockholm, Sweden
| | - Irma Fredriksson
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, 17176 Stockholm, Sweden;
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Caroline Rönnlund
- Department of Oncology and Pathology, Karolinska Institutet, 17176 Stockholm, Sweden; (B.A.); (C.R.); (J.B.)
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, 11883 Stockholm, Sweden
| | - Catharina Hagerling
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, 22185 Lund, Sweden; (C.H.); (A.E.)
| | - Anna Ehinger
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, 22185 Lund, Sweden; (C.H.); (A.E.)
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, 22184 Lund, Sweden
| | - Anikó Kovács
- Department of Clinical Pathology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden;
| | - Rasmus Røge
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- NordiQC, Institute of Pathology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institutet, 17176 Stockholm, Sweden; (B.A.); (C.R.); (J.B.)
- Breast Center, Cancer Theme, Karolinska University Hospital and Karolinska Comprehensive Cancer Center, Gävlegatan 55, 17164 Solna, Sweden
| | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institutet, 17176 Stockholm, Sweden; (B.A.); (C.R.); (J.B.)
- Department of Clinical Pathology and Cytology, Karolinska University Laboratory, 11883 Stockholm, Sweden
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Almatroodi SA, Alsahli MA, Almatroudi A, Verma AK, Aloliqi A, Allemailem KS, Khan AA, Rahmani AH. Potential Therapeutic Targets of Quercetin, a Plant Flavonol, and Its Role in the Therapy of Various Types of Cancer through the Modulation of Various Cell Signaling Pathways. Molecules 2021; 26:molecules26051315. [PMID: 33804548 PMCID: PMC7957552 DOI: 10.3390/molecules26051315] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 02/07/2023] Open
Abstract
Polyphenolic flavonoids are considered natural, non-toxic chemopreventers, which are most commonly derived from plants, fruits, and vegetables. Most of these polyphenolics exhibit remarkable antioxidant, anti-inflammatory, and anticancer properties. Quercetin (Qu) is a chief representative of these polyphenolic compounds, which exhibits excellent antioxidant and anticancer potential, and has attracted the attention of researchers working in the area of cancer biology. Qu can regulate numerous tumor-related activities, such as oxidative stress, angiogenesis, cell cycle, tumor necrosis factor, proliferation, apoptosis, and metastasis. The anticancer properties of Qu mainly occur through the modulation of vascular endothelial growth factor (VEGF), apoptosis, phosphatidyl inositol-3-kinase (P13K)/Akt (proteinase-kinase B)/mTOR (mammalian target of rapamycin), MAPK (mitogen activated protein kinase)/ERK1/2 (extracellular signal-regulated kinase 1/2), and Wnt/β-catenin signaling pathways. The anticancer potential of Qu is documented in numerous in vivo and in vitro studies, involving several animal models and cell lines. Remarkably, this phytochemical possesses toxic activities against cancerous cells only, with limited toxic effects on normal cells. In this review, we present extensive research investigations aimed to discuss the therapeutic potential of Qu in the management of different types of cancers. The anticancer potential of Qu is specifically discussed by focusing its ability to target specific molecular signaling, such as p53, epidermal growth factor receptor (EGFR), VEGF, signal transducer and activator of transcription (STAT), PI3K/Akt, and nuclear factor kappa B (NF-κB) pathways. The anticancer potential of Qu has gained remarkable interest, but the exact mechanism of its action remains unclear. However, this natural compound has great pharmacological potential; it is now believed to be a complementary—or alternative—medicine for the prevention and treatment of different cancers.
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Affiliation(s)
- Saleh A. Almatroodi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51542, Saudi Arabia; (S.A.A.); (M.A.A.); (A.A.); (K.S.A.)
| | - Mohammed A. Alsahli
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51542, Saudi Arabia; (S.A.A.); (M.A.A.); (A.A.); (K.S.A.)
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51542, Saudi Arabia; (S.A.A.); (M.A.A.); (A.A.); (K.S.A.)
| | - Amit Kumar Verma
- Department of Biotechnology, Jamia Millia Islamia, New Delhi 51542, India;
| | - Abdulaziz Aloliqi
- Department of Medical Biotechnology, College of Applied Medical Sciences, Qassim University, Buraydah 51542, Saudi Arabia;
| | - Khaled S. Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51542, Saudi Arabia; (S.A.A.); (M.A.A.); (A.A.); (K.S.A.)
| | - Amjad Ali Khan
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, Buraydah 51542, Saudi Arabia;
| | - Arshad Husain Rahmani
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah 51542, Saudi Arabia; (S.A.A.); (M.A.A.); (A.A.); (K.S.A.)
- Correspondence:
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