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Xu K, Hua M, Mai T, Ren X, Fang X, Wang C, Ge M, Qian H, Xu M, Zhang R. A Multiparametric MRI-based Radiomics Model for Stratifying Postoperative Recurrence in Luminal B Breast Cancer. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:1475-1487. [PMID: 38424277 PMCID: PMC11300413 DOI: 10.1007/s10278-023-00923-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 03/02/2024]
Abstract
This study aims to develop an MRI-based radiomics model to assess the likelihood of recurrence in luminal B breast cancer. The study analyzed medical images and clinical data from 244 patients with luminal B breast cancer. Of 244 patients, 35 had experienced recurrence and 209 had not. The patients were randomly divided into the training set (51.5 ± 12.5 years old; n = 171) and the test set (51.7 ± 11.3 years old; n = 73) in a ratio of 7:3. The study employed univariate and multivariate Cox regression along with the least absolute shrinkage and selection operator (LASSO) regression methods to select radiomics features and calculate a risk score. A combined model was constructed by integrating the risk score with the clinical and pathological characteristics. The study identified two radiomics features (GLSZM and GLRLM) from DCE-MRI that were used to calculate a risk score. The AUCs were 0.860 and 0.868 in the training set and 0.816 and 0.714 in the testing set for 3- and 5-year recurrence risk, respectively. The combined model incorporating the risk score, pN, and endocrine therapy showed improved predictive power, with AUCs of 0.857 and 0.912 in the training set and 0.943 and 0.945 in the testing set for 3- and 5-year recurrence risk, respectively. The calibration curve of the combined model showed good consistency between predicted and measured values. Our study developed an MRI-based radiomics model that integrates clinical and radiomics features to assess the likelihood of recurrence in luminal B breast cancer. The model shows promise for improving clinical risk stratification and treatment decision-making.
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Affiliation(s)
- Kepei Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Hospital of Traditional Chinese Medicine), Zhejiang Province, Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, China
| | - Meiqi Hua
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Hospital of Traditional Chinese Medicine), Zhejiang Province, Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, China
| | - Ting Mai
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Hospital of Traditional Chinese Medicine), Zhejiang Province, Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, China
| | - Xiaojing Ren
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Hospital of Traditional Chinese Medicine), Zhejiang Province, Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, China
| | - Xiaozheng Fang
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Hospital of Traditional Chinese Medicine), Zhejiang Province, Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, China
| | - Chunjie Wang
- Department of Radiology, Hangzhou First People's Hospital, Zhejiang Province, Hangzhou, China
| | - Min Ge
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Hospital of Traditional Chinese Medicine), Zhejiang Province, Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, China
| | - Hua Qian
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Hospital of Traditional Chinese Medicine), Zhejiang Province, Hangzhou, China
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, China
| | - Maosheng Xu
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Hospital of Traditional Chinese Medicine), Zhejiang Province, Hangzhou, China.
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, China.
| | - Ruixin Zhang
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Hospital of Traditional Chinese Medicine), Zhejiang Province, Hangzhou, China.
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, China.
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Liu W, Wang D, Liu L, Zhou Z. Assessing the Influence of B-US, CDFI, SE, and Patient Age on Predicting Molecular Subtypes in Breast Lesions Using Deep Learning Algorithms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1375-1388. [PMID: 38581195 DOI: 10.1002/jum.16460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES Our study aims to investigate the impact of B-mode ultrasound (B-US) imaging, color Doppler flow imaging (CDFI), strain elastography (SE), and patient age on the prediction of molecular subtypes in breast lesions. METHODS Totally 2272 multimodal ultrasound imaging was collected from 198 patients. The ResNet-18 network was employed to predict four molecular subtypes from B-US imaging, CDFI, and SE of patients with different ages. All the images were split into training and testing datasets by the ratio of 80%:20%. The predictive performance on testing dataset was evaluated through 5 metrics including mean accuracy, precision, recall, F1-scores, and confusion matrix. RESULTS Based on B-US imaging, the test mean accuracy is 74.50%, the precision is 74.84%, the recall is 72.48%, and the F1-scores is 0.73. By combining B-US imaging with CDFI, the results were increased to 85.41%, 85.03%, 85.05%, and 0.84, respectively. With the integration of B-US imaging and SE, the results were changed to 75.64%, 74.69%, 73.86%, and 0.74, respectively. Using images from patients under 40 years old, the results were 90.48%, 90.88%, 88.47%, and 0.89. When images from patients who are above 40 years old, they were changed to 81.96%, 83.12%, 80.5%, and 0.81, respectively. CONCLUSION Multimodal ultrasound imaging can be used to accurately predict the molecular subtypes of breast lesions. In addition to B-US imaging, CDFI rather than SE contribute further to improve predictive performance. The predictive performance is notably better for patients under 40 years old compared with those who are 40 years old and above.
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Affiliation(s)
- Weiyong Liu
- Department of Ultrasound, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dongyue Wang
- School of Management, Hefei University of Technology, Hefei, China
- Key Laboratory of Process Optimization and Intelligent Decision-Making, Ministry of Education, Hefei, China
- Ministry of Education Engineering Research Center for Intelligent Decision-Making & Information System Technologies, Hefei, China
| | - Le Liu
- Department of Ultrasound, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Zhiguo Zhou
- Reliable Intelligence and Medical Innovation Laboratory (RIMI Lab), Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
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Chen L, Chen Q, Zhu M. A retrospective analysis of clinicopathological characteristics and risk factors for recurrence in young patients with breast cancer. Gland Surg 2024; 13:1281-1290. [PMID: 39175705 PMCID: PMC11336790 DOI: 10.21037/gs-24-193] [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: 05/25/2024] [Accepted: 07/05/2024] [Indexed: 08/24/2024]
Abstract
Background Younger and older patients with breast cancer often present with different clinicopathological characteristics and exhibit different risk factors for recurrence. This study sought to evaluate the biological characteristics and identify the recurrence risk factors in patients with operable breast cancer who were ≤40 years of age. Methods This retrospective study investigated the biological characteristics and clinical outcomes of young patients (aged ≤40 years) with operable breast cancer who had been admitted to the Second Affiliated Hospital of Soochow University for treatment from January 2015 to December 2019. Clinicopathological and follow-up data were collected and statistically analyzed using IBM SPSS 27.0 software. The disease-free survival (DFS) rates were evaluated, and regression analyses were conducted to identify risk factors associated with adverse outcomes. Results A total of 154 young patients (aged ≤40 years) with operable breast cancer were included in this study, of whom 68 (44.2%) were aged ≤35 years. In terms of breast cancer subtypes, there were 19 (12.3%) patients with luminal A-like disease, 74 (48.1%) patients with luminal B-like disease, 17 (11.0%) patients with human epidermal growth factor receptor 2 (HER2)-positive (non-luminal) disease, and 44 (28.6%) patients with triple-negative breast cancer (TNBC). The 5-year DFS rate of all the patients was 88%; among those with TNBC, the rate was slightly lower at 76%. According to the results of the log-rank test, tumor (T) stage, node (N) status (N0 or N+), the biological subtype, and the Ki-67 index (with a 14% cut-off value between high and low expression levels) were risk factors for recurrence. The Cox regression analysis showed that the biological subtype was the only risk factor for recurrence. The multiple linear regression analysis demonstrated that the pathological type, tumor grade, estrogen receptor (ER) labeling intensity, and progesterone receptor (PR) expression level significantly affected the level of Ki-67 expression. Conclusions This retrospective study showed that biological subtype was the most important risk factor for recurrence in operable breast cancer patients ≤40 years. The Ki-67 index is influenced by the pathological type, primary tumor grade, ER labeling intensity, and PR expression level. Fourteen percent is recommended as the cut-off value for the high and low expression of Ki-67 in clinical practice.
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Affiliation(s)
- Lei Chen
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiang Chen
- General Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Mingao Zhu
- Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, China
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Marazzi F, Masiello V, Orlandi A, Moschella F, Chiesa S, Di Leone A, Garufi G, Mazzarella C, Sanchez AM, Casa C, Bucaro A, De Lauretis F, Borghesan N, Tagliaferri L, Franceschini G, Bria E, Masetti R, Fabi A, Aristei C, Tortora G, Valentini V, Gambacorta MA. Outcomes of Radiotherapy in Oligoprogressive Breast Cancer. J Pers Med 2024; 14:805. [PMID: 39201997 PMCID: PMC11355129 DOI: 10.3390/jpm14080805] [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: 06/26/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Radiotherapy (RT) shows potential for improving local control in cases of oligoprogressive metastatic breast cancer (mBC). This retrospective analysis aims to evaluate the advantages of RT in such a clinical scenario. METHODS We conducted a retrospective analysis including patients with mBC who received radiation therapy (RT) for up to three sites of oligoprogression while continuing systemic therapy. The study took place between January 2014 and December 2021. Our endpoints were progression-free survival after radiotherapy (PFS-AR), the rate of discontinuation of systemic therapy (RDT) at three months post-RT, and overall survival (OS). We used Cox regression analysis to perform multivariate analysis for PFS-AR. RESULTS Fifty-nine patients met the inclusion criteria. The PFS-AR was 13 months (95% CI 8.5-18.8 months). At three months, the RDT was 3% (two patients). A significant difference in median PFS-AR was observed between patients in the first + second-line group and those in the subsequent line group (p = 0.03). In the multivariate analysis conducted for PFS-AR, the biologically effective dose (BED) with α/β = 4 > 100 Gy emerged as the sole significant variable (p = 0.0017). The median overall survival (OS) was 24.4 months (95% CI 17-24.4 months). CONCLUSIONS This study is the first report on the outcomes of radiotherapy in a cohort of over 50 patients with oligoprogressive metastatic breast cancer (mBC). Our findings emphasize the significant relationship between PFS-AR, the number of ongoing lines of systemic therapy, and the BED of radiotherapy.
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Affiliation(s)
- Fabio Marazzi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, 00168 Rome, Italy; (F.M.); (V.M.); (S.C.); (C.M.); (C.C.); (L.T.); (V.V.); (M.A.G.)
| | - Valeria Masiello
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, 00168 Rome, Italy; (F.M.); (V.M.); (S.C.); (C.M.); (C.C.); (L.T.); (V.V.); (M.A.G.)
| | - Armando Orlandi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Rome, Italy; (A.O.); (G.G.); (E.B.); (G.T.)
| | - Francesca Moschella
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, 00168 Rome, Italy; (F.M.); (A.D.L.); (A.B.); (F.D.L.); (N.B.); (G.F.); (R.M.)
| | - Silvia Chiesa
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, 00168 Rome, Italy; (F.M.); (V.M.); (S.C.); (C.M.); (C.C.); (L.T.); (V.V.); (M.A.G.)
| | - Alba Di Leone
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, 00168 Rome, Italy; (F.M.); (A.D.L.); (A.B.); (F.D.L.); (N.B.); (G.F.); (R.M.)
| | - Giovanna Garufi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Rome, Italy; (A.O.); (G.G.); (E.B.); (G.T.)
| | - Ciro Mazzarella
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, 00168 Rome, Italy; (F.M.); (V.M.); (S.C.); (C.M.); (C.C.); (L.T.); (V.V.); (M.A.G.)
| | - Alejandro M. Sanchez
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, 00168 Rome, Italy; (F.M.); (A.D.L.); (A.B.); (F.D.L.); (N.B.); (G.F.); (R.M.)
| | - Calogero Casa
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, 00168 Rome, Italy; (F.M.); (V.M.); (S.C.); (C.M.); (C.C.); (L.T.); (V.V.); (M.A.G.)
| | - Angela Bucaro
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, 00168 Rome, Italy; (F.M.); (A.D.L.); (A.B.); (F.D.L.); (N.B.); (G.F.); (R.M.)
| | - Flavia De Lauretis
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, 00168 Rome, Italy; (F.M.); (A.D.L.); (A.B.); (F.D.L.); (N.B.); (G.F.); (R.M.)
| | - Niccolo Borghesan
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, 00168 Rome, Italy; (F.M.); (A.D.L.); (A.B.); (F.D.L.); (N.B.); (G.F.); (R.M.)
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, 00168 Rome, Italy; (F.M.); (V.M.); (S.C.); (C.M.); (C.C.); (L.T.); (V.V.); (M.A.G.)
| | - Gianluca Franceschini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, 00168 Rome, Italy; (F.M.); (A.D.L.); (A.B.); (F.D.L.); (N.B.); (G.F.); (R.M.)
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Emilio Bria
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Rome, Italy; (A.O.); (G.G.); (E.B.); (G.T.)
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Riccardo Masetti
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, 00168 Rome, Italy; (F.M.); (A.D.L.); (A.B.); (F.D.L.); (N.B.); (G.F.); (R.M.)
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandra Fabi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOSD di Medicina Personalizzata in Senologia, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Direzione Scientifica, 00168 Rome, Italy;
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, 06156 Perugia, Italy;
| | - Giampaolo Tortora
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Oncologia Medica, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Rome, Italy; (A.O.); (G.G.); (E.B.); (G.T.)
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, 00168 Rome, Italy; (F.M.); (V.M.); (S.C.); (C.M.); (C.C.); (L.T.); (V.V.); (M.A.G.)
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria A. Gambacorta
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, 00168 Rome, Italy; (F.M.); (V.M.); (S.C.); (C.M.); (C.C.); (L.T.); (V.V.); (M.A.G.)
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Vanni G, Materazzo M, Paduano F, Pellicciaro M, Di Mauro G, Toscano E, Tacconi F, Longo B, Cervelli V, Berretta M, Buonomo OC. New Insight for Axillary De-Escalation in Breast Cancer Surgery: "SoFT Study" Retrospective Analysis. Curr Oncol 2024; 31:4141-4157. [PMID: 39195292 DOI: 10.3390/curroncol31080309] [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: 06/21/2024] [Revised: 07/20/2024] [Accepted: 07/21/2024] [Indexed: 08/29/2024] Open
Abstract
Background: The SOUND study demonstrated that an axillary de-escalation may be sufficient in locoregional and distant disease control in selected early breast cancer (EBC) patients. To establish any preoperative variables that may drive sentinel lymph node biopsy (SLNB) omission, a study named sentinel omission risk factor (SOFT) 1.23 was planned. Methods: A single-center retrospective study from a prospectively maintained database was designed, aiming at underlying preoperative prognostic factors involved in sentinel lymph node (SLN) metastasis (lymph node involvement (LN+) vs. negative lymph node (LN-) group). Secondary outcomes included surgical room occupancy analysis for SLNB in patients fulfilling the SOUND study inclusion criteria. The institutional ethical committee Area Territoriale Lazio 2 approved the study (n° 122/23). Results: Between 1 January 2022 and 30 June 2023, 160 patients were included in the study and 26 (%) were included in the LN+ group. Multifocality, higher cT stage, and larger tumor diameter were reported in the LN+ group (p = 0.020, p = 0.014, and 0.016, respectively). Tumor biology, including estrogen and progesterone receptors, and molecular subtypes showed association with the LN+ group (p < 0.001; p = 0.001; and p = 0.001, respectively). A total of 117 (73.6%) patients were eligible for the SOUND study and the potential operating room time saved was 2696.81 min. Conclusions: De-escalating strategies may rationalize healthcare activities. Multifactorial risk stratification may further refine the selection of patients who could benefit from SLNB omission.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of Surgical Science, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Floriana Paduano
- Breast Unit, Department of Surgical Science, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of Surgical Science, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Giordana Di Mauro
- Department of Human Pathology "G. Barresi", University of Messina, 98125 Messina, Italy
| | - Enrica Toscano
- Department of Human Pathology "G. Barresi", University of Messina, 98125 Messina, Italy
| | - Federico Tacconi
- Department of Surgical Sciences, Unit of Thoracic Surgery, Tor Vergata University, 00133 Rome, Italy
| | - Benedetto Longo
- Breast Unit, Department of Surgical Science, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Valerio Cervelli
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Massimiliano Berretta
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
- General Surgery Program, Department of Health Science, UNIBAS, University of Basilicata, Via dell'Ateneo Lucano, 10, 85100 Potenza, Italy
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Shibata A, Tamura N, Kinowaki K, Nishikawa A, Tanaka K, Kobayashi Y, Ogura T, Tanabe Y, Kawabata H. Development of a nomogram to predict recurrence scores obtained using Oncotype DX in Japanese patients with breast cancer. Breast Cancer 2024:10.1007/s12282-024-01616-z. [PMID: 39020239 DOI: 10.1007/s12282-024-01616-z] [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: 04/21/2024] [Accepted: 07/07/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Chemotherapy is crucial for hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer, and its survival benefits may outweigh adverse events. Oncotype DX (ODX) assesses this balance; however, it is expensive. Using nomograms to identify cases requiring ODX may be economically beneficial. We aimed to identify clinicopathological variables that correlated with the recurrence score (RS) and develop a nomogram that predicted the RS. METHODS We included 457 patients with estrogen receptor-positive, HER2-negative breast cancer with metastases in fewer than four axillary lymph nodes who underwent surgery and ODX at our hospital between 2007 and 2023. We developed nomograms and internally validated them in 310 patients who underwent surgery between 2007 and 2021 and validated the model's performance in 147 patients who underwent surgery between 2022 and 2023. RESULTS Logistic regression analysis revealed that progesterone receptor (PgR) level, histological grade (HG), and Ki67 index independently predicted the RS. A nomogram was developed using these variables to predict the RS (area under the curve [AUC], 0.870; 95% confidence interval [CI], 0.82-0.92). The nomogram was applied to the model validation group (AUC, 0.877; 95% CI, 0.80-0.95). When the sensitivity of the nomogram was 90%, the model was able to identify 52.3% low-RS and 41.2% high-RS cases not requiring ODX. CONCLUSIONS This was the first nomogram model developed based on data from a cohort of Japanese women. It may help determine the indications for ODX and the use of nomogram to identify cases requiring ODX may be economically beneficial.
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Affiliation(s)
- Akio Shibata
- Department of Breast and Endocrine Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan.
| | - Nobuko Tamura
- Department of Breast and Endocrine Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | | | - Aya Nishikawa
- Department of Breast and Endocrine Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Kiyo Tanaka
- Department of Breast and Endocrine Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Yoko Kobayashi
- Department of Breast and Endocrine Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Takuya Ogura
- Department of Breast and Endocrine Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
| | - Yuko Tanabe
- Department of Clinical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Hidetaka Kawabata
- Department of Breast and Endocrine Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato City, Tokyo, 105-8470, Japan
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Rejmer C, Dihge L, Bendahl PO, Förnvik D, Dustler M, Rydén L. Preoperative prediction of nodal status using clinical data and artificial intelligence derived mammogram features enabling abstention of sentinel lymph node biopsy in breast cancer. Front Oncol 2024; 14:1394448. [PMID: 39050572 PMCID: PMC11266164 DOI: 10.3389/fonc.2024.1394448] [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: 03/01/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Patients with clinically node-negative breast cancer have a negative sentinel lymph node status (pN0) in approximately 75% of cases and the necessity of routine surgical nodal staging by sentinel lymph node biopsy (SLNB) has been questioned. Previous prediction models for pN0 have included postoperative variables, thus defeating their purpose to spare patients non-beneficial axillary surgery. We aimed to develop a preoperative prediction model for pN0 and to evaluate the contribution of mammographic breast density and mammogram features derived by artificial intelligence for de-escalation of SLNB. Materials and methods This retrospective cohort study included 755 women with primary breast cancer. Mammograms were analyzed by commercially available artificial intelligence and automated systems. The additional predictive value of features was evaluated using logistic regression models including preoperative clinical variables and radiological tumor size. The final model was internally validated using bootstrap and externally validated in a separate cohort. A nomogram for prediction of pN0 was developed. The correlation between pathological tumor size and the preoperative radiological tumor size was calculated. Results Radiological tumor size was the strongest predictor of pN0 and included in a preoperative prediction model displaying an area under the curve of 0.68 (95% confidence interval: 0.63-0.72) in internal validation and 0.64 (95% confidence interval: 0.59-0.69) in external validation. Although the addition of mammographic features did not improve discrimination, the prediction model provided a 21% SLNB reduction rate when a false negative rate of 10% was accepted, reflecting the accepted false negative rate of SLNB. Conclusion This study shows that the preoperatively available radiological tumor size might replace pathological tumor size as a key predictor in a preoperative prediction model for pN0. While the overall performance was not improved by mammographic features, one in five patients could be omitted from axillary surgery by applying the preoperative prediction model for nodal status. The nomogram visualizing the model could support preoperative patient-centered decision-making on the management of the axilla.
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Affiliation(s)
- Cornelia Rejmer
- Department of Clinical Sciences, Division of Surgery, Lund University, Lund, Sweden
| | - Looket Dihge
- Department of Clinical Sciences, Division of Surgery, Lund University, Lund, Sweden
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Pär-Ola Bendahl
- Department of Clinical Sciences, Division of Oncology, Lund University, Lund, Sweden
| | - Daniel Förnvik
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Hematology, Oncology and Radiations Physics, Skåne University Hospital, Lund, Sweden
| | - Magnus Dustler
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden
- Diagnostic Radiology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lisa Rydén
- Department of Clinical Sciences, Division of Surgery, Lund University, Lund, Sweden
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Scardina L, Carnassale B, Di Leone A, Sanchez AM, Biondi E, Moschella F, D'Archi S, Franco A, De Lauretis F, Di Guglielmo E, Petrazzuolo E, Magno S, Masetti R, Franceschini G. Young Women with Early-Stage Breast Cancer Treated with Upfront Surgery: Overview of Oncological Outcomes. J Clin Med 2024; 13:3966. [PMID: 38999531 PMCID: PMC11242681 DOI: 10.3390/jcm13133966] [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: 06/04/2024] [Revised: 06/21/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Breast cancer in young women aged < 40 years is rare and often aggressive with less favorable survival rates. The lack of systematic screening, later stage at diagnosis, and a more aggressive disease biology may all contribute to their poor prognosis. Data on the best management remain conflicting, especially those regarding surgical management, either breast-conserving or mastectomy. To our knowledge, there are limited studies surrounding the treatment of young women with early breast cancer, and this analysis evaluated the oncological outcomes for those patients who underwent surgery upfront. Methods: We conducted a retrospective study including 130 young women with early breast cancer from a total of 373 consecutive patients treated with upfront surgery between January 2016 and December 2021 at our institution. Local recurrence-free survival (LR-FS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were evaluated. Results: The median follow-up was 61.1 months (range, 25-95). A total of 92 (70.8%) patients underwent breast-conserving surgery, while 38 (29.2%) patients underwent conservative mastectomy with immediate implant breast reconstruction. In total, 8 of 130 patients (6.2%) developed a local recurrence in the treated breast, an7 (5.4%) patients presented distant metastasis. Overall, two (1.6%) patients died due to breast cancer recurrence. Conclusions: The results of our study interestingly support breast-conserving surgery in young patients with early-stage breast cancer. While appropriate breast-conserving surgery can achieve favorable oncological outcomes and can always be considered a valid alternative to conservative mastectomy in upfront surgery, a younger age at diagnosis should never be used alone to choose the type of surgery.
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Affiliation(s)
- Lorenzo Scardina
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Beatrice Carnassale
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alba Di Leone
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alejandro Martin Sanchez
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Ersilia Biondi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Moschella
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Sabatino D'Archi
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Franco
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Flavia De Lauretis
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Di Guglielmo
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Eleonora Petrazzuolo
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Magno
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Masetti
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gianluca Franceschini
- Breast Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Tang ELS, Sim EJ, Ang WW, Su J, Chen JJC, Chan MYP, Choo BA, Tan EY. Post-Operative Radiation in Early Breast Cancer with N1 Disease: 10-Year Follow-Up. Diseases 2024; 12:145. [PMID: 39057116 PMCID: PMC11276503 DOI: 10.3390/diseases12070145] [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: 04/28/2024] [Revised: 06/16/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
Post-operative radiotherapy for post-menopausal women with early breast cancer and N1 disease is controversial. Although locoregional control is improved, overall survival (OS) benefit is unclear. The clinical benefit of post-operative irradiation in this group of patients over 10 years was reviewed. We aimed to evaluate the OS, disease-free survival (DFS), and factors affecting OS and DFS. A retrospective review of 191 post-menopausal women with early breast cancer and N1 disease from 2004 to 2011 was performed. Demographics, post-operative histology, adjuvant treatment, OS, and DFS were evaluated. Post-operative radiation was given to 95 of 191 women (49.7%). Younger age at diagnosis (p < 0.001), a greater number of involved nodes (p = 0.004), lymphovascular invasion (LVI), and a higher tumor grade (p = 0.001) were more likely in women who received post-operative radiation. Nodal radiation did not improve 10-year DFS (p = 0.084) or OS (p = 0.203). Post-operative nodal radiation was associated with significant improvement in 10-year OS in women who received only hormonal therapy (p = 0.047) and no other systemic therapy. Women with unfavorable risk factors were more likely to receive post-operative radiation, likely due to a perceived higher risk of recurrence. Nodal radiation did not significantly improve 10-year DFS or OS in early breast cancer patients with N1 disease, and the benefit was not clearly demonstrated. However, in those who were on hormonal therapy, radiotherapy was beneficial in improving overall survival.
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Affiliation(s)
- Ee Ling Serene Tang
- Department of Surgery, Woodlands Health, Singapore 737628, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore (E.Y.T.)
| | - E-Jan Sim
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore (E.Y.T.)
| | - Wei-Wen Ang
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore (E.Y.T.)
| | - Jun Su
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore (E.Y.T.)
| | - Juliana Jia Chuan Chen
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore (E.Y.T.)
| | - Mun Yew Patrick Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore (E.Y.T.)
| | - Bok Ai Choo
- Department of Radiation Oncology, Icon Cancer Centre, Singapore 574623, Singapore
| | - Ern Yu Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore (E.Y.T.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), 61 Biopolis Street, Singapore 138673, Singapore
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60
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Falahi F, Akbari-Birgani S, Mortazavi Y, Johari B. Caspase-9 suppresses metastatic behavior of MDA-MB-231 cells in an adaptive organoid model. Sci Rep 2024; 14:15116. [PMID: 38956424 PMCID: PMC11219723 DOI: 10.1038/s41598-024-65711-z] [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: 03/18/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
Caspase-9, a cysteine-aspartate protease traditionally associated with intrinsic apoptosis, has recently emerged as having non-apoptotic roles, including influencing cell migration-an aspect that has received limited attention in existing studies. In our investigation, we aimed to explore the impact of caspase-9 on the migration and invasion behaviors of MDA-MB-231, a triple-negative breast cancer (TNBC) cell line known for its metastatic properties. We established a stable cell line expressing an inducible caspase-9 (iC9) in MDA-MB-231 and assessed their metastatic behavior using both monolayer and the 3D organotypic model in co-culture with human Foreskin fibroblasts (HFF). Our findings revealed that caspase-9 had an inhibitory effect on migration and invasion in both models. In monolayer culture, caspase-9 effectively suppressed the migration and invasion of MDA-MB-231 cells, comparable to the anti-metastatic agent panitumumab (Pan). Notably, the combination of caspase-9 and Pan exhibited a significant additional effect in reducing metastatic behavior. Interestingly, caspase-9 demonstrated superior efficacy compared to Pan in the organotypic model. Molecular analysis showed down regulation of epithelial-mesenchymal transition and migratory markers, in caspase-9 activated cells. Additionally, flow cytometry analysis indicated a cell cycle arrest. Moreover, pre-treatment with activated caspase-9 sensitized cells to the chemotherapy of doxorubicin, thereby enhancing its effectiveness. In conclusion, the anti-metastatic potential of caspase-9 presents avenues for the development of novel therapeutic approaches for TNBC/metastatic breast cancer. Although more studies need to figure out the exact involving mechanisms behind this behavior.
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Affiliation(s)
- Farzaneh Falahi
- Department of Medical Biotechnology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
- Department of Biological Sciences, Institute for Advanced Studies in Basic Sciences (IASBS), Zanjan, 45137-66731, Iran
| | - Shiva Akbari-Birgani
- Department of Biological Sciences, Institute for Advanced Studies in Basic Sciences (IASBS), Zanjan, 45137-66731, Iran.
- Research Center for Basic Sciences and Modern Technologies (RBST), Institute for Advanced Studies in Basic Sciences (IASBS), Zanjan, 45137-66731, Iran.
| | - Yousef Mortazavi
- Department of Medical Biotechnology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
- Cancer Gene Therapy Research Center, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Behrooz Johari
- Department of Medical Biotechnology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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61
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Bennani-Baiti BI, Weber M, Bernathova M, Clauser P, Kapetas P, Pinker K, Woitek R, Helbich T, Baltzer PTA. Pilot study: A simple CAD-based tool to detect breast cancer on MRI of the breast. Magn Reson Imaging 2024; 110:1-6. [PMID: 38479541 DOI: 10.1016/j.mri.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/06/2024] [Accepted: 03/10/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE This pilot-study aims to assess, whether quantitatively assessed enhancing breast tissue as a percentage of the entire breast volume can serve as an indicator of breast cancer at breast MRI and whether the contrast-agent employed affects diagnostic efficacy. MATERIALS This retrospective IRB-approved study, included 39 consecutive patients, that underwent two subsequent breast MRI exams for suspicious findings at conventional imaging with 0.1 mmol/kg gadobenic and gadoteric acid. Two independent readers, blinded to the histopathological outcome, assessed unenhanced and early post-contrast images using computer-assisted software (Brevis, Siemens Healthcare). Diagnostic performance was statistically determined for percentage of ipsilateral voxel volume enhancement and for percentage of contralateral enhancing voxel volume subtracted from ipsilateral enhancing voxel volume after crosstabulation with the dichotomized histological outcome (benign/malignant). RESULTS Ipsilateral enhancing voxel volume versus histopathological outcome resulted in an AUC of 0.707 and 0.687 for gadobenic acid, reader 1 and 2, respectively and in an AUC of 0.778 and 0.773 for gadoteric acid, reader 1 and 2, respectively. Accounting for background parenchymal enhancement by subtracting contralateral enhancing volume from ipsilateral enhancing voxel volume versus histolopathological outcome resulted in an AUC of 0.793 and 0.843 for gadobenic acid, reader 1 and 2, respectively and in an AUC of 0.692 and 0.662 for gadoteric acid, reader 1 and 2, respectively. Pairwise testing yielded no statistically significant difference both between readers and between contrast agents employed (p > 0.05). CONCLUSION Our proposed CAD algorithm, which quantitatively assesses enhancing breast tissue as a percentage of the entire breast volume, allows indicating the presence of breast cancer.
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Affiliation(s)
- Barbara I Bennani-Baiti
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems 3500, Austria; Department of Radiology, University Hospital Krems, Mitterweg 10, Krems 3500, Austria; Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria.
| | - Michael Weber
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems 3500, Austria
| | - Maria Bernathova
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems 3500, Austria
| | - Paola Clauser
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems 3500, Austria
| | - Panagiotis Kapetas
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems 3500, Austria; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Katja Pinker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ramona Woitek
- Medical Image Analysis and AI (MIAAI), Danube Private University, Krems 3500, Austria
| | - Thomas Helbich
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems 3500, Austria
| | - Pascal T A Baltzer
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems 3500, Austria
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Dai Y, Ji Z, Liang H, Jiang M, Wang L, Bao X, Liu J, Liu M, Yang C. CD44v5 domain regulates crosstalk between TNBC cells and tumor-associated macrophages by enhancing the IL-4R/STAT3 axis. Cancer Sci 2024; 115:2235-2253. [PMID: 38700108 PMCID: PMC11247601 DOI: 10.1111/cas.16200] [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: 01/24/2024] [Revised: 04/06/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
Triple-negative breast cancer (TNBC) has greater infiltration of M2-like macrophages (TAMs), which enhances cancer cell invasion and leads to a poor prognosis. TNBC progression is mediated by both tumor cells and the tumor microenvironment (TME). Here we elucidate the mechanism of the interaction between TNBC cells and TAMs. In this study, we confirmed that CD44v5 is highly expressed in TNBC, which drives TNBC cell metastasis and promotes TAM polarization by co-localizing with IL4Rα and inhibiting its internalization and degradation, thereby promoting activation of the STAT3/IL6 signaling axis. At the same time, TAMs also facilitate TNBC cell metastasis by secreting IL-4, IL-6, and other cytokines, in which the IL-4/IL-4R/STAT3/IL-6 signaling axis plays the same role for TNBC cells responding to TAMs. Moreover, we found that the above progress could be suppressed when the CD44v5 domain was blocked. We demonstrated that the CD44v5/IL-4R/STAT3/IL-6 signaling pathway plays a key role in TNBC cell metastasis, and in TNBC cells inducing TAM polarization and responding to TAMs, promoting metastasis. Collectively, we suggest that the CD44v5 domain may be a promising target for regulating the TME of TNBC as well as treating TNBC.
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Affiliation(s)
- Yanhua Dai
- Department of Clinical LaboratoryThe 4th Hospital of Harbin Medical UniversityHarbinChina
| | - Zhongjian Ji
- Department of Clinical LaboratoryThe 4th Hospital of Harbin Medical UniversityHarbinChina
| | - Hongyan Liang
- Department of Clinical LaboratoryThe 4th Hospital of Harbin Medical UniversityHarbinChina
| | - Meng Jiang
- Faculty of ComputingHarbin Institute of TechnologyHarbinChina
| | - Lan Wang
- Department of Clinical LaboratoryThe 4th Hospital of Harbin Medical UniversityHarbinChina
| | - Xinyi Bao
- Department of Clinical LaboratoryThe 4th Hospital of Harbin Medical UniversityHarbinChina
| | - Jiaren Liu
- Department of Clinical LaboratoryThe 4th Hospital of Harbin Medical UniversityHarbinChina
| | - Ming Liu
- Department of General SurgeryThe 4th Hospital of Harbin Medical UniversityHarbinChina
| | - Chun Yang
- Department of Clinical LaboratoryThe 4th Hospital of Harbin Medical UniversityHarbinChina
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Na S, Kim M, Park Y, Kwon HJ, Shin HC, Kim EK, Jang M, Kim SM, Park SY. Concordance of HER2 status between core needle biopsy and surgical resection specimens of breast cancer: an analysis focusing on the HER2-low status. Breast Cancer 2024; 31:705-716. [PMID: 38643429 PMCID: PMC11194196 DOI: 10.1007/s12282-024-01585-3] [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: 12/21/2023] [Accepted: 04/07/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Human epidermal growth factor receptor 2 (HER2)-low status has recently gained attention because of the potential therapeutic benefits of antibody-drug conjugates (ADCs) in breast cancer patients. We aimed to investigate the concordance of HER2 status between core needle biopsy (CNB) and subsequent surgical resection specimens focusing on the HER2-low status. METHODS This retrospective study was conducted in 1,387 patients with invasive breast cancer whose HER2 status was evaluated in both CNB and surgical resection specimens. The discordance rates between CNB and surgical resection specimens and the clinicopathological features associated with HER2 status discordance were analyzed. RESULTS The overall concordance rates of HER2 status between CNB and surgical resection specimens were 99.0% (κ = 0.925) for two-group classification (negative vs. positive) and 78.5% (κ = 0.587) for three-group classification (zero vs. low vs. positive). The largest discordance occurred in CNB-HER2-zero cases with 42.8% of them reclassified as HER2-low in surgical resection. HER2 discordance was associated with lower histologic grade, tumor multiplicity, and luminal A subtype. In multivariate analysis, tumor multiplicity and estrogen receptor (ER) positivity were independent predictive factors for HER2-zero to low conversion. CONCLUSIONS Incorporation of HER2-low category in HER2 status interpretation reduces the concordance rate between CNB and surgical resection specimens. Tumor multiplicity and ER positivity are predictive factors for conversion from HER2-zero to HER2-low status. Therefore, HER2 status should be re-evaluated in resection specimens when considering ADCs in tumors exhibiting multiplicity and ER positivity.
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Affiliation(s)
- Sei Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Milim Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Yujun Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Hyun Jung Kwon
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Hee-Chul Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Mijung Jang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - Sun Mi Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea.
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Fernandez-Gonzalez S, Falo C, Pla MJ, Campos M, Ortega-Exposito C, Ortega R, Vicente M, Petit A, Bosch-Schips J, Bajen MT, Reyes G, Martínez E, González-Viguera J, Peñafiel J, Stradella A, Pernas S, Ponce J, Garcia-Tejedor A. Sentinel lymph node biopsy before and after neoadjuvant chemotherapy in cN0 breast cancer patients: impact on axillary morbidity and survival-a propensity score cohort study. Breast Cancer Res Treat 2024; 206:131-141. [PMID: 38635082 PMCID: PMC11182812 DOI: 10.1007/s10549-024-07274-1] [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: 11/26/2023] [Accepted: 01/30/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE In patients with clinically lymph node-negative (cN0) breast cancer, performing sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) has been preferentially embraced in comparison to before NACT. However, survival outcomes associated with both strategies remain understudied. We aimed to compare the axillary lymphadenectomy (ALND) rate, disease-free survival (DFS), and overall survival (OS), between two strategies. METHODS We included 310 patients in a retrospective observational study. SNLB was performed before NACT from December 2006 to April 2014 (107 cases) and after NACT from May 2014 to May 2020 (203 patients). An inverse probability of treatment weighting (IPTW) method was applied to homogenize both groups. Hazard ratios (HR) and odd ratios (OR) are reported with 95% confidence intervals (95%CI). RESULTS The lymphadenectomy rate was 29.9% before NACT and 7.4% after NACT (p < 0.001), with an OR of 5.35 95%CI (2.7-10.4); p = .002. After 4 years of follow-up, SLNB after NACT was associated with lower risk for DFS, HR 0.42 95%CI (0.17-1.06); p = 0.066 and better OS, HR 0.21 CI 95% (0.07-0.67); p = 0.009 than SLNB before NACT. After multivariate analysis, independent adverse prognostic factors for OS included SLNB before NACT, HR 3.095 95%CI (2.323-4.123), clinical nonresponse to NACT, HR 1.702 95% CI (1.012-2.861), and small tumors (cT1) with high proliferation index, HR 1.889 95% (1.195-2.985). CONCLUSION Performing SLNB before NACT results in more ALND and has no benefit for patient survival. These findings support discontinuing the practice of SLNB before NACT in patients with cN0 breast cancer.
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Affiliation(s)
- Sergi Fernandez-Gonzalez
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain.
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Feixa Llarga, s/n, 08907, l'Hospitalet de Llobregat, Spain.
| | - Catalina Falo
- Department of Medical Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncologia, Idibell, Barcelona, Spain
| | - Maria J Pla
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain
| | - Miriam Campos
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain
| | - Carlos Ortega-Exposito
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain
| | - Raul Ortega
- Department of Radiology, Multidisciplinary, Breast Cancer Unit. Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Maria Vicente
- Department of Radiology, Multidisciplinary, Breast Cancer Unit. Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Ana Petit
- Department of Pathology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Jan Bosch-Schips
- Department of Pathology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Maria Teresa Bajen
- Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Gabriel Reyes
- Department of Nuclear Medicine, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, Barcelona, Spain
| | - Evelyn Martínez
- Department of Radiation Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncologia, Barcelona, Spain
| | - Javier González-Viguera
- Department of Radiation Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncologia, Barcelona, Spain
| | - Judith Peñafiel
- Biostatistics Unit, Institut d'Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Spain
| | - Agostina Stradella
- Department of Medical Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncologia, Idibell, Barcelona, Spain
| | - Sonia Pernas
- Department of Medical Oncology, Multidisciplinary Breast Cancer Unit, Institut Català d'Oncologia, Idibell, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain
| | - Amparo Garcia-Tejedor
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Idibell, c/ Feixa Llarga s/n. Hospitalet de Llobregat, CP: 08907, Barcelona, Spain
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Støer NC, Vangen S, Singh D, Fortner RT, Hofvind S, Ursin G, Botteri E. Menopausal hormone therapy and breast cancer risk: a population-based cohort study of 1.3 million women in Norway. Br J Cancer 2024; 131:126-137. [PMID: 38740969 PMCID: PMC11231299 DOI: 10.1038/s41416-024-02590-1] [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: 09/11/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND It is important to monitor the association between menopausal hormone therapy (HT) use and breast cancer (BC) risk with contemporary estimates, and specifically focus on HT types and new drugs. METHODS We estimated hazard ratios (HR) of BC risk according to HT type, administration route and individual drugs, overall and stratified by body mass index (BMI), molecular subtype and detection mode, with non-HT use as reference. RESULTS We included 1,275,783 women, 45+ years, followed from 2004, for a median of 12.7 years. Oral oestrogen combined with daily progestin was associated with the highest risk of BC (HR 2.42, 95% confidence interval (CI) 2.31-2.54), with drug-specific HRs ranging from Cliovelle®: 1.63 (95% CI 1.35-1.96) to Kliogest®: 2.67 (2.37-3.00). Vaginal oestradiol was not associated with BC risk. HT use was more strongly associated with luminal A cancer (HR 1.97, 95% CI 1.86-2.09) than other molecular subtypes, and more strongly with interval (HR 2.00, 95% CI: 1.83-2.30) than screen-detected (HR 1.33, 95% CI 1.26-1.41) BC in women 50-71 years. HRs for HT use decreased with increasing BMI. CONCLUSIONS The use of oral and transdermal HT was associated with an increased risk of BC. The associations varied according to HT type, individual drugs, molecular subtype, detection mode and BMI.
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Affiliation(s)
- Nathalie C Støer
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway.
- Norwegian Research Centre for Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.
| | - Siri Vangen
- Norwegian Research Centre for Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Deependra Singh
- Norwegian Research Centre for Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Renée T Fortner
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Edoardo Botteri
- Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
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Cheng BWT, Ko TY, Lai YTA. Radiologic-Pathologic Correlation: Is There an Association Between Contrast-Enhanced Mammography Imaging Features and Molecular Subtypes of Breast Cancer? Cureus 2024; 16:e64791. [PMID: 39156463 PMCID: PMC11329886 DOI: 10.7759/cureus.64791] [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] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVE This study aims to assess the correlation between imaging features of contrast-enhanced mammography (CEM) and molecular subtypes of breast cancer. METHODS This is a retrospective single-institution study of patients who underwent CEM from December 2019 to August 2023. Each patient had at least one histologically proven invasive breast cancer with a core biopsy performed. Patients with a history of breast cancer treatment and lesions not entirely included in the CEM images were excluded. The images were interpreted using the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) lexicon for CEM, published in 2022. Different imaging features, including the presence of calcifications, architectural distortion, non-mass enhancement, mass morphology, internal enhancement pattern, the extent of enhancement, and lesion conspicuity, were analyzed. The molecular subtypes were studied as dichotomous variables, including luminal A, luminal B, HER2, and basal-like. The association between the imaging features and molecular subtypes was analyzed with a Fisher's exact test. Statistical significance was assumed when the p-value was <0.05. RESULTS A total of 31 patients with 36 malignant lesions were included in this study. Sixteen lesions (44.4%) were luminal A, four lesions (11.1%) were luminal B, 10 lesions (27.8%) were HER2, and six (16.7%) were basal-like subtypes. The presence of calcifications was associated with the HER2 subtype (p=0.024). Rim-enhancement on recombined images was associated with a basal-like subtype (p=0.001). Heterogeneous enhancement on recombined images was associated with non-basal-like breast cancer (p=0.027). No statistically significant correlation was found between other analyzed CEM imaging features and molecular subtypes. CONCLUSION CEM imaging features, including the presence of calcifications and certain internal enhancement patterns, were correlated with distinguishing breast cancer molecular subtypes and thus may further expand the role of CEM.
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Affiliation(s)
| | - Tsz Yan Ko
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, HKG
| | - Yee Tak Alta Lai
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, HKG
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Jögi A, Johnson K, Wittgren S, Sundgren V, Tomic H, Olinder J, Åkesson A, Andersson I, Zackrisson S, Bakic PR. Assessing Digital Breast Tomosynthesis Impact on Early Cancer Detection: Insights from Consecutive Screening. Radiology 2024; 312:e233417. [PMID: 39078298 DOI: 10.1148/radiol.233417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Background Analysis of how digital breast tomosynthesis (DBT) screening affects consecutive screening performance is important to estimate its future value in screening. Purpose To evaluate whether DBT contributes to early detection of breast cancer by assessing cancer detection rates (CDRs), including the fraction of invasive cancers and cancer subtypes in consecutive routine digital mammography (DM). Materials and Methods The paired prospective Malmö Breast Tomosynthesis Screening Trial (MBTST) was performed between January 2010 and February 2015. Participating women underwent one-view DBT and two-view DM at one screening occasion. In this secondary analysis, women were followed up through their first (DM1) and second (DM2) consecutive two-view DM screening rounds after MBTST participation. Cancer diagnoses were identified by referencing records. A logistic regression model, adjusted for age, was used to calculate the odds of luminal A-like cancers with use of the MBTST as reference. Results There were 14 848 final participants in the MBTST (median age, 57 years [IQR, 49-65 years]). Of those, 12 876 women were screened in DM1 (median age, 58 years [IQR, 50-66 years]) and 10 883 were screened in DM2 (median age, 59 years [IQR, 51-67 years]). Compared with CDRs in the trial of 6.5 of 1000 women (95% CI: 5.2, 7.9) for DM and 8.7 of 1000 women (95% CI: 7.3, 10.3) for DBT, the CDR was lower in DM1 (4.6 of 1000 women [95% CI: 3.6, 5.9]) and DM2 (5.3 of 1000 women [95% CI: 4.1, 6.9]). The proportion of invasive cancers was 84.9% (118 of 139 cancers) in the MBTST; the corresponding numbers were 66% (39 of 59 cancers) for DM1 and 83% (50 of 60 cancers) for DM2. The odds of luminal A-like cancers were lower in DM1 at 0.28 (95% CI: 0.12, 0.66 [P = .004]) but not in DM2 at 0.80 (95% CI: 0.40, 1.58 [P = .52]) versus screening in the MBTST. Conclusion CDR and the fraction of invasive cancers were lower in DM1 and then increased in DM2 following the MBTST, indicating earlier cancer detection mainly due to increased detection of luminal A-like cancers in DBT screening. Clinical trials registration no. NCT01091545 © RSNA, 2024 See also the editorial by Hooley and Philpotts in this issue.
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Affiliation(s)
- Annika Jögi
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Kristin Johnson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Sofia Wittgren
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Victor Sundgren
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Hanna Tomic
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Jakob Olinder
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Anna Åkesson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Ingvar Andersson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Sophia Zackrisson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Predrag R Bakic
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
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Li JL, McClellan JC, Zhang H, Gao G, Huo D. Multi-tissue transcriptome-wide association studies identified 235 genes for intrinsic subtypes of breast cancer. J Natl Cancer Inst 2024; 116:1105-1115. [PMID: 38400758 PMCID: PMC11223833 DOI: 10.1093/jnci/djae041] [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: 09/22/2023] [Revised: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Although genome-wide association studies (GWAS) of breast cancer (BC) identified common variants which differ between intrinsic subtypes, genes through which these variants act to impact BC risk have not been fully established. Transcriptome-wide association studies (TWAS) have identified genes associated with overall BC risk, but subtype-specific differences are largely unknown. METHODS We performed two multi-tissue TWAS for each BC intrinsic subtype, including an expression-based approach that collated TWAS signals from expression quantitative trait loci (eQTLs) across multiple tissues and a novel splicing-based approach that collated signals from splicing QTLs (sQTLs) across intron clusters and subsequently across tissues. We used summary statistics for five intrinsic subtypes including Luminal A-like, Luminal B-like, Luminal B/HER2-negative-like, HER2-enriched-like, and triple-negative BC, generated from 106 278 BC cases and 91 477 controls in the Breast Cancer Association Consortium. RESULTS Overall, we identified 235 genes in 88 loci that were associated with at least one of the five intrinsic subtypes. Most genes were subtype-specific, and many have not been reported in previous TWAS. We discovered common variants that modulate expression of CHEK2 confer increased risk to Luminal A-like BC, in contrast to the viewpoint that CHEK2 primarily harbors rare, penetrant mutations. Additionally, our splicing-based TWAS provided population-level support for MDM4 splice variants that increased the risk of triple-negative BC. CONCLUSION Our comprehensive, multi-tissue TWAS corroborated previous GWAS loci for overall BC risk and intrinsic subtypes, while underscoring how common variation that impacts expression and splicing of genes in multiple tissue types can be used to further elucidate the etiology of BC.
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Affiliation(s)
- James L Li
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Julian C McClellan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Haoyu Zhang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Guimin Gao
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, IL, USA
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Mrabti H, Sauvaget C, Bendahhou K, Selmouni F, Muwonge R, Lucas E, Chami Y, Bennani M, Errihani H, Benider A, Bekkali R, Basu P. Breast cancer treatment and its impact on survival in Morocco: a study over a decade. BMC Cancer 2024; 24:786. [PMID: 38956536 PMCID: PMC11218305 DOI: 10.1186/s12885-024-12570-6] [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: 01/19/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND In Morocco, much progress has been made in breast cancer treatment. However, there is limited information on survival outcomes of breast cancer patients according to their therapeutic management. METHODS A pattern-of-care study was conducted in Morocco's two main oncology centres: Rabat and Casablanca and has shown that major progress has been made in the quality of care with survival rates comparable to those in developed countries. The present study focuses on the different therapeutic strategies used in breast cancer and their impact on prognosis. Patients were classified into two categories: those considered as appropriately managed and those who were not. RESULTS A total of 1901 women with stage I to III breast cancer were included in this study, the majority (53%) were adequately managed and had better disease-free survival (DFS) rates than those who were not: DFS at 3 years (88% versus 62%) and at 5 years (80% versus 50%). Potential significant determinants of better management were: treatment in Rabat's oncology centre, treatment between 2008 and 2012, being aged younger than 60 years, and early TN stage. CONCLUSION This study demonstrated the value of proper integrated and coordinated management in a comprehensive cancer centre, to improve breast cancer survival.
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Affiliation(s)
- Hind Mrabti
- Institut National d'oncologie, CHU-Rabat, Rabat, Morocco
| | - Catherine Sauvaget
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.
| | - Karima Bendahhou
- Cancer Registry of the Grand Casablanca Region, Casablanca, Morocco
| | - Farida Selmouni
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Richard Muwonge
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Eric Lucas
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Youssef Chami
- Lalla Salma Foundation - Prevention and Treatment of Cancers, Rabat, Morocco
| | - Maria Bennani
- Lalla Salma Foundation - Prevention and Treatment of Cancers, Rabat, Morocco
| | | | - Abdellatif Benider
- Centre Mohammed VI Pour Le Traitement Des Cancers, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
| | - Rachid Bekkali
- Lalla Salma Foundation - Prevention and Treatment of Cancers, Rabat, Morocco
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
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Falo C, Azcarate J, Fernandez-Gonzalez S, Perez X, Petit A, Perez H, Vethencourt A, Vazquez S, Laplana M, Ales M, Stradella A, Fullana B, Pla MJ, Gumà A, Ortega R, Varela M, Pérez D, Ponton JL, Cobo S, Benitez A, Campos M, Fernández A, Villanueva R, Obadia V, Recalde S, Soler-Monsó T, Lopez-Ojeda A, Martinez E, Ponce J, Pernas S, Gil-Gil M, Garcia-Tejedor A. Breast Cancer Patient's Outcomes after Neoadjuvant Chemotherapy and Surgery at 5 and 10 Years for Stage II-III Disease. Cancers (Basel) 2024; 16:2421. [PMID: 39001483 PMCID: PMC11240707 DOI: 10.3390/cancers16132421] [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: 06/11/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction: Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response. Material and Methods: A retrospective single-institution cohort of 482 stage II and III breast cancer patients treated with neoadjuvant chemotherapy based on anthracycline and taxans, plus antiHEr2 in Her2-positive cases, was studied. Survival was calculated at 5 and 10 years. Kaplan-Meier curves with a log-rank test were calculated for differences according to age, BRCA status, menopausal status, TNM, pathological and molecular surrogate subtype, 20% TIL cut-off, surgical procedure, response to chemotherapy and the presence of vascular invasion. Results: The pCR rate was 25.3% and was greater in HER2 (51.3%) and TNBC (31.7%) and in BRCA carriers (41.9%). The factors independently related to patient survival were pathology and molecular surrogate subtype, type of surgery, response to NACT and vascular invasion. BRCA status was a protective prognostic factor without reaching statistical significance, with an HR 0.5 (95%CI 0.1-1.4). Mastectomy presented a double risk of distant recurrence compared to breast-conservative surgery (BCS), supporting BCS as a safe option after NACT. After a mean follow-up of 126 (SD 43) months, luminal tumors presented a substantial difference in survival rates calculated at 5 or 10 years (81.2% compared to 74.7%), whereas that for TNBC was 75.3 and 73.5, respectively. The greatest difference was seen according to the response in patients with pCR, who exhibited a 10 years DDFS of 95.5% vs. 72.4% for those patients without pCR, p < 0001. This difference was especially meaningful in TNBC: the 10 years DDFS according to an RCB of 0 to 3 was 100%, 80.6%, 69% and 49.2%, respectively, p < 0001. Patients with a particularly poor prognosis were those with lobular carcinomas, with a 10 years DDFS of 42.9% vs. 79.7% for ductal carcinomas, p = 0.001, and patients with vascular invasion at the surgical specimen, with a 10 years DDFS of 59.2% vs. 83.6% for those patients without vascular invasion, p < 0.001. Remarkably, BRCA carriers presented a longer survival, with an estimated 10 years DDFS of 89.6% vs. 77.2% for non-carriers, p = 0.054. Conclusions: Long-term outcomes after neoadjuvant chemotherapy can help patients and clinicians make well-informed decisions.
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Affiliation(s)
- Catalina Falo
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Juan Azcarate
- Multidisciplinary Breast Cancer Unit, Department of Pathology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (J.A.); (T.S.-M.)
| | - Sergi Fernandez-Gonzalez
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Gynecology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain;
| | - Xavier Perez
- Information and Data Analysis Department, Institut Català d’Oncologia, Bellvitge Research Institute, 08908 Barcelona, Spain; (X.P.); (J.L.P.)
| | - Ana Petit
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Pathology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (J.A.); (T.S.-M.)
| | - Héctor Perez
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Radiotherapy, Institut Català d’Oncologia, 08908 Barcelona, Spain
| | - Andrea Vethencourt
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Silvia Vazquez
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Maria Laplana
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Radiotherapy, Institut Català d’Oncologia, 08908 Barcelona, Spain
| | - Miriam Ales
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
| | - Agostina Stradella
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Bartomeu Fullana
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Maria J. Pla
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Pathology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (J.A.); (T.S.-M.)
| | - Anna Gumà
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Radiology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain
| | - Raul Ortega
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Radiology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain
| | - Mar Varela
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Pathology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (J.A.); (T.S.-M.)
| | - Diana Pérez
- Multidisciplinary Breast Cancer Unit, Department of Reparative Surgery, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (D.P.); (A.L.-O.)
| | - Jose Luis Ponton
- Information and Data Analysis Department, Institut Català d’Oncologia, Bellvitge Research Institute, 08908 Barcelona, Spain; (X.P.); (J.L.P.)
| | - Sara Cobo
- Multidisciplinary Breast Cancer Unit, Department of Pharmacy, Hospital Universitari Bellvitge, 08907 Barcelona, Spain;
| | - Ana Benitez
- Multidisciplinary Breast Cancer Unit, Department of Nuclear Medicine, Hospital Universitari Bellvitge, 08907 Barcelona, Spain;
| | - Miriam Campos
- Multidisciplinary Breast Cancer Unit, Department of Gynecology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain;
| | - Adela Fernández
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Rafael Villanueva
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Veronica Obadia
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Sabela Recalde
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Teresa Soler-Monsó
- Multidisciplinary Breast Cancer Unit, Department of Pathology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (J.A.); (T.S.-M.)
| | - Ana Lopez-Ojeda
- Multidisciplinary Breast Cancer Unit, Department of Reparative Surgery, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (D.P.); (A.L.-O.)
| | - Evelyn Martinez
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Radiotherapy, Institut Català d’Oncologia, 08908 Barcelona, Spain
| | - Jordi Ponce
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Gynecology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain;
| | - Sonia Pernas
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Miguel Gil-Gil
- Multidisciplinary Breast Cancer Unit, Department of Medical Oncology, Institut Català d’Oncologia, 08908 Barcelona, Spain; (A.V.); (S.V.); (A.S.); (B.F.); (A.F.); (R.V.); (V.O.); (S.R.); (S.P.); (M.G.-G.)
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
| | - Amparo Garcia-Tejedor
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), 08908 Barcelona, Spain; (S.F.-G.); (A.P.); (H.P.); (M.L.); (M.J.P.); (A.G.); (R.O.); (M.V.); (E.M.); (J.P.); (A.G.-T.)
- Multidisciplinary Breast Cancer Unit, Department of Pathology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (J.A.); (T.S.-M.)
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Schandiz H, Farkas L, Park D, Liu Y, Andersen SN, Geisler J, Sauer T. Low progesterone receptor levels in high-grade DCIS correlate with HER2 upregulation and the presence of invasive components. Front Oncol 2024; 14:1347166. [PMID: 39011488 PMCID: PMC11247389 DOI: 10.3389/fonc.2024.1347166] [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: 11/30/2023] [Accepted: 06/04/2024] [Indexed: 07/17/2024] Open
Abstract
Objective In this study, we investigated pivotal molecular markers in human high-grade breast ductal carcinoma in situ (DCIS). Expression status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth receptor 2 (HER2) was measured among various subtypes (Luminal (Lum) A, LumB HER2-, LumB HER2+, HER2-enriched and triple-negative). Methods In total, 357 DCIS cases were classified into respective subtypes, according to the 2013 St. Gallen guidelines. Each subtype was categorized into three subcategories: "Pure" (those without an invasive component), "W/invasive" (those with an invasive component), and "All" (the entire group of the given subtype). ER and PR expression were registered as intervals. Equivocal HER2 immunohistochemistry (IHC) cases (2+) were further investigated using dual-color in situ hybridization. Results The majority of patients (71%) were over the age of 50. We discovered no significant differences in the proportion of age between the "Pure" and "W/invasive" groups. There was no significant difference in ER/PR expression between "Pure" luminal subtypes of DCIS and "W/invasive" cases. We compared the HER2 IHC scores of "0", "1+", and "2+" among LumA and LumB HER2 subtypes and identified no statistically significant differences between "Pure" and "W/invasive" (p = 0.603). ER and PR expression ≥ 50% cutoff value was present in > 90% of all LumA cases. The incidences of cases with ER expression at cutoff values of < 10% and ≥ 50% in LumA were significantly different compared to other luminal subtypes (p < 0.0001). The proportion of cases with PR expression < 20% showed significant differences in the various luminal subtypes. In luminal B subtypes, low PR expression (< 20%) was significantly associated with both strong HER2 expression (3+) and the presence of an invasive component (p = 0.0001 and p = 0.0365, respectively). Conclusions ER and PR expression at ≥ 50% cutoff values were found in more than 90% of LumA cases. Samples with ER < 10% and ≥ 50% in LumA were significantly different compared to other luminal subtypes (p < 0.0001). Low PR expression in high-grade DCIS was strongly associated with HER2 overexpression (3+) and an invasive component (p = 0.0001 and p = 0.0365, respectively).
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Affiliation(s)
- Hossein Schandiz
- Department of Oncology, Akershus University Hospital (AHUS), Lorenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lorant Farkas
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Daehoon Park
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Yan Liu
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Molecular Biology (EpiGen), Akershus University Hospital (AHUS), Lorenskog, Norway
| | - Solveig N Andersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jürgen Geisler
- Department of Oncology, Akershus University Hospital (AHUS), Lorenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torill Sauer
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Nicotra R, Lutz C, Messal HA, Jonkers J. Rat Models of Hormone Receptor-Positive Breast Cancer. J Mammary Gland Biol Neoplasia 2024; 29:12. [PMID: 38913216 PMCID: PMC11196369 DOI: 10.1007/s10911-024-09566-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/07/2024] [Indexed: 06/25/2024] Open
Abstract
Hormone receptor-positive (HR+) breast cancer (BC) is the most common type of breast cancer among women worldwide, accounting for 70-80% of all invasive cases. Patients with HR+ BC are commonly treated with endocrine therapy, but intrinsic or acquired resistance is a frequent problem, making HR+ BC a focal point of intense research. Despite this, the malignancy still lacks adequate in vitro and in vivo models for the study of its initiation and progression as well as response and resistance to endocrine therapy. No mouse models that fully mimic the human disease are available, however rat mammary tumor models pose a promising alternative to overcome this limitation. Compared to mice, rats are more similar to humans in terms of mammary gland architecture, ductal origin of neoplastic lesions and hormone dependency status. Moreover, rats can develop spontaneous or induced mammary tumors that resemble human HR+ BC. To date, six different types of rat models of HR+ BC have been established. These include the spontaneous, carcinogen-induced, transplantation, hormone-induced, radiation-induced and genetically engineered rat mammary tumor models. Each model has distinct advantages, disadvantages and utility for studying HR+ BC. This review provides a comprehensive overview of all published models to date.
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Affiliation(s)
- Raquel Nicotra
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Oncode Institute, Amsterdam, Netherlands
| | - Catrin Lutz
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
- Oncode Institute, Amsterdam, Netherlands.
| | - Hendrik A Messal
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
- Oncode Institute, Amsterdam, Netherlands.
| | - Jos Jonkers
- Division of Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
- Oncode Institute, Amsterdam, Netherlands.
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73
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Mota AM, Mendes J, Matela N. Breast Cancer Molecular Subtype Prediction: A Mammography-Based AI Approach. Biomedicines 2024; 12:1371. [PMID: 38927578 PMCID: PMC11201998 DOI: 10.3390/biomedicines12061371] [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: 06/05/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Breast cancer remains a leading cause of mortality among women, with molecular subtypes significantly influencing prognosis and treatment strategies. Currently, identifying the molecular subtype of cancer requires a biopsy-a specialized, expensive, and time-consuming procedure, often yielding to results that must be supported with additional biopsies due to technique errors or tumor heterogeneity. This study introduces a novel approach for predicting breast cancer molecular subtypes using mammography images and advanced artificial intelligence (AI) methodologies. Using the OPTIMAM imaging database, 1397 images from 660 patients were selected. The pretrained deep learning model ResNet-101 was employed to classify tumors into five subtypes: Luminal A, Luminal B1, Luminal B2, HER2, and Triple Negative. Various classification strategies were studied: binary classifications (one vs. all others, specific combinations) and multi-class classification (evaluating all subtypes simultaneously). To address imbalanced data, strategies like oversampling, undersampling, and data augmentation were explored. Performance was evaluated using accuracy and area under the receiver operating characteristic curve (AUC). Binary classification results showed a maximum average accuracy and AUC of 79.02% and 64.69%, respectively, while multi-class classification achieved an average AUC of 60.62% with oversampling and data augmentation. The most notable binary classification was HER2 vs. non-HER2, with an accuracy of 89.79% and an AUC of 73.31%. Binary classification for specific combinations of subtypes revealed an accuracy of 76.42% for HER2 vs. Luminal A and an AUC of 73.04% for HER2 vs. Luminal B1. These findings highlight the potential of mammography-based AI for non-invasive breast cancer subtype prediction, offering a promising alternative to biopsies and paving the way for personalized treatment plans.
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Affiliation(s)
- Ana M. Mota
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisbon, Portugal; (J.M.); (N.M.)
| | - João Mendes
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisbon, Portugal; (J.M.); (N.M.)
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisbon, Portugal
| | - Nuno Matela
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisbon, Portugal; (J.M.); (N.M.)
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Chen X, Sun H, Yang C, Wang W, Lyu W, Zou K, Zhang F, Dai Z, He X, Dong H. Bioinformatic analysis and experimental validation of six cuproptosis-associated genes as a prognostic signature of breast cancer. PeerJ 2024; 12:e17419. [PMID: 38912044 PMCID: PMC11192027 DOI: 10.7717/peerj.17419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/28/2024] [Indexed: 06/25/2024] Open
Abstract
Background Breast carcinoma (BRCA) is a life-threatening malignancy in women and shows a poor prognosis. Cuproptosis is a novel mode of cell death but its relationship with BRCA is unclear. This study attempted to develop a cuproptosis-relevant prognostic gene signature for BRCA. Methods Cuproptosis-relevant subtypes of BRCA were obtained by consensus clustering. Differential expression analysis was implemented using the 'limma' package. Univariate Cox and multivariate Cox analyses were performed to determine a cuproptosis-relevant prognostic gene signature. The signature was constructed and validated in distinct datasets. Gene set variation analysis (GSVA) and gene set enrichment analysis (GSEA) were also conducted using the prognostic signature to uncover the underlying molecular mechanisms. ESTIMATE and CIBERSORT algorithms were applied to probe the linkage between the gene signature and tumor microenvironment (TME). Immunotherapy responsiveness was assessed using the Tumor Immune Dysfunction and Exclusion (TIDE) web tool. Real-time quantitative PCR (RT-qPCR) was performed to detect the expressions of cuproptosis-relevant prognostic genes in breast cancer cell lines. Results Thirty-eight cuproptosis-associated differentially expressed genes (DEGs) in BRCA were mined by consensus clustering and differential expression analysis. Based on univariate Cox and multivariate Cox analyses, six cuproptosis-relevant prognostic genes, namely SAA1, KRT17, VAV3, IGHG1, TFF1, and CLEC3A, were mined to establish a corresponding signature. The signature was validated using external validation sets. GSVA and GSEA showed that multiple cell cycle-linked and immune-related pathways along with biological processes were associated with the signature. The results ESTIMATE and CIBERSORT analyses revealed significantly different TMEs between the two Cusig score subgroups. Finally, RT-qPCR analysis of cell lines further confirmed the expressional trends of SAA1, KRT17, IGHG1, and CLEC3A. Conclusion Taken together, we constructed a signature for projecting the overall survival of BRCA patients and our findings authenticated the cuproptosis-relevant prognostic genes, which are expected to provide a basis for developing prognostic molecular biomarkers and an in-depth understanding of the relationship between cuproptosis and BRCA.
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Affiliation(s)
- Xiang Chen
- Department of Hainan General Hospital, Hainan Medical College, Haikou City, Hainan Province, China
| | - Hening Sun
- Department of Hainan General Hospital, Hainan Medical College, Haikou City, Hainan Province, China
| | - Changcheng Yang
- Department of The First Affiliated Hospital, Hainan Medical College, Haikou City, Hainan Province, China
| | - Wei Wang
- Department of Hainan General Hospital, Hainan Medical College, Haikou City, Hainan Province, China
| | - Wenzhi Lyu
- Department of Hainan General Hospital, Hainan Medical College, Haikou City, Hainan Province, China
| | - Kejian Zou
- Department of Hainan General Hospital, Hainan Medical College, Haikou City, Hainan Province, China
| | - Fan Zhang
- Department of Hainan General Hospital, Hainan Medical College, Haikou City, Hainan Province, China
| | - Zhijun Dai
- Department of The First Affiliated Hospital, Zhejiang University, Hangzhou City, Zhejiang Province, China
| | - Xionghui He
- Department of Hainan General Hospital, Hainan Medical College, Haikou City, Hainan Province, China
| | - Huaying Dong
- Department of Hainan General Hospital, Hainan Medical College, Haikou City, Hainan Province, China
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Lenárt M, Bober P, Marcin M, Tkáčiková S, Kacírová M, Alexovič M, Tóth D, Madárová N, Radoňak J, Urdzík P, Fedačko J, Sabo J. Peripheral Blood CD8 + T-Lymphocyte Immune Response in Benign and Subpopulations of Breast Cancer Patients. Int J Mol Sci 2024; 25:6423. [PMID: 38928129 PMCID: PMC11204132 DOI: 10.3390/ijms25126423] [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: 04/10/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Peripheral blood CD8+ T lymphocytes play a crucial role in cell-mediated immunity and tumor-related immune responses in breast cancer. In this study, label-free quantification analysis and gene set enrichment analysis (GSEA) of CD8+ T lymphocytes in the peripheral blood of benign patients and patients with different breast cancer (BC) subtypes, i.e., luminal A, luminal B, and triple-negative breast cancer (TNBC), were performed using nano-UHPLC and Orbitrap mass spectrometry. Differential protein expression in CD8+ T lymphocytes revealed significant downregulation (log2 FC ≥ 0.38 or ≤-0.38, adj. p < 0.05), particularly in proteins involved in cytotoxicity, cytolysis, and proteolysis, such as granzymes (GZMs) and perforin 1 (PRF1). This downregulation was observed in the benign group (GZMH, GZMM, and PRF1) and luminal B (GZMA, GZMH) subtypes, whereas granzyme K (GZMK) was upregulated in TNBC in comparison to healthy controls. The RNA degradation pathway was significantly downregulated (p < 0.05, normalized enrichment score (NES) from -1.47 to -1.80) across all BC subtypes, suggesting a potential mechanism for regulating gene expression during T cell activation. Also, the Sm-like proteins (LSM2, LSM3, and LSM5) were significantly downregulated in the RNA degradation pathway. Proteomic analysis of CD8+ T lymphocytes in peripheral blood across different breast cancer subtypes provides a comprehensive view of the molecular mechanisms of the systemic immune response that can significantly contribute to advancements in the diagnosis, treatment, and prognosis of this disease.
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Affiliation(s)
- Marek Lenárt
- 1st Department of Surgery, Faculty of Medicine, University of Pavol Jozef Šafárik and UNLP in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (M.L.); (N.M.); (J.R.)
| | - Peter Bober
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of Pavol Jozef Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (M.M.); (S.T.); (M.A.)
| | - Miroslav Marcin
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of Pavol Jozef Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (M.M.); (S.T.); (M.A.)
| | - Soňa Tkáčiková
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of Pavol Jozef Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (M.M.); (S.T.); (M.A.)
| | - Mária Kacírová
- Center of Clinical and Preclinical Research MEDIPARK, Faculty of Medicine, University of Pavol Jozef Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (M.K.); (J.F.)
| | - Michal Alexovič
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of Pavol Jozef Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (M.M.); (S.T.); (M.A.)
| | - Dávid Tóth
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Pavol Jozef Šafárik and UNLP in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (D.T.); (P.U.)
| | - Natália Madárová
- 1st Department of Surgery, Faculty of Medicine, University of Pavol Jozef Šafárik and UNLP in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (M.L.); (N.M.); (J.R.)
| | - Jozef Radoňak
- 1st Department of Surgery, Faculty of Medicine, University of Pavol Jozef Šafárik and UNLP in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (M.L.); (N.M.); (J.R.)
| | - Peter Urdzík
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Pavol Jozef Šafárik and UNLP in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (D.T.); (P.U.)
| | - Ján Fedačko
- Center of Clinical and Preclinical Research MEDIPARK, Faculty of Medicine, University of Pavol Jozef Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (M.K.); (J.F.)
| | - Ján Sabo
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of Pavol Jozef Šafárik in Košice, Trieda SNP 1, 04011 Košice, Slovakia; (M.M.); (S.T.); (M.A.)
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Xie T, Gong J, Zhao Q, Wu C, Wu S, Peng W, Gu Y. Development and validation of peritumoral vascular and intratumoral radiomics to predict pathologic complete responses to neoadjuvant chemotherapy in patients with triple-negative breast cancer. BMC Med Imaging 2024; 24:136. [PMID: 38844842 PMCID: PMC11155097 DOI: 10.1186/s12880-024-01311-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND To develop and validate a peritumoral vascular and intratumoral radiomics model to improve pretreatment predictions for pathologic complete responses (pCRs) to neoadjuvant chemoradiotherapy (NAC) in patients with triple-negative breast cancer (TNBC). METHODS A total of 282 TNBC patients (93 in the primary cohort, 113 in the validation cohort, and 76 in The Cancer Imaging Archive [TCIA] cohort) were retrospectively included. The peritumoral vasculature on the maximum intensity projection (MIP) from pretreatment DCE-MRI was segmented by a Hessian matrix-based filter and then edited by a radiologist. Radiomics features were extracted from the tumor and peritumoral vasculature of the MIP images. The LASSO method was used for feature selection, and the k-nearest neighbor (k-NN) classifier was trained and validated to build a predictive model. The diagnostic performance was assessed using the ROC analysis. RESULTS One hundred of the 282 patient (35.5%) with TNBC achieved pCRs after NAC. In predicting pCRs, the combined peritumoral vascular and intratumoral model (fusion model) yields a maximum AUC of 0.82 (95% confidence interval [CI]: 0.75, 0.88) in the primary cohort, a maximum AUC of 0.67 (95% CI: 0.57, 0.76) in the internal validation cohort, and a maximum AUC of 0.65 (95% CI: 0.52, 0.78) in TCIA cohort. The fusion model showed improved performance over the intratumoral model and the peritumoral vascular model, but not significantly (p > 0.05). CONCLUSION This study suggested that combined peritumoral vascular and intratumoral radiomics model could provide a non-invasive tool to enable prediction of pCR in TNBC patients treated with NAC.
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Affiliation(s)
- Tianwen Xie
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Gong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiufeng Zhao
- Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chengyue Wu
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, USA
| | - Siyu Wu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Bielcikova Z, Holanek M, Selingerova I, Sorejs O, Kolarova I, Soumarova R, Proks J, Reifova L, Cmejlova V, Linkova L, Zabojnikova M, Chodacka M, Janovska L, Lisnerova L, Kasparova K, Pohankova D, Petruzelka L. Treatment and Prognosis of Male Breast Cancer: A Multicentric, Retrospective Study Over 11 Years in the Czech Republic. Oncologist 2024; 29:e750-e762. [PMID: 38431780 PMCID: PMC11144991 DOI: 10.1093/oncolo/oyae031] [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: 08/21/2023] [Accepted: 12/22/2023] [Indexed: 03/05/2024] Open
Abstract
PURPOSE Male breast cancer (MBC) is a rare, but increasingly common disease, and lacks prospective studies. Collaborative efforts are needed to understand and address MBC, including its prognosis, in different countries. METHODS We retrospectively reviewed the clinical, histopathological, and molecular-genetic characteristics, treatments, and survival outcomes of MBC diagnosed between 2007 and 2017 in the Czech Republic. Prognostic factors of overall survival (OS), recurrence-free interval (RFi), and breast cancer-specific mortality (BCSM) were analyzed and indirectly compared to international data. RESULTS We analyzed 256 patients with MBC (median age 66 years), including 12% with de novo metastatic (M1). Of 201 non-metastatic (M0) patients, 6% were <40 years old, 29% had stage I, 55% were cN0, and 54% underwent genetic testing. Overall, 97% of tumors had estrogen receptor expression ≥10%, 61% had high Ki67 index, 40% were high-grade (G3), and 68% were luminal B-like (HER2-negative). Systemic therapies included endocrine therapy (90%) and chemotherapy (53%). Few (5%) patients discontinued adjuvant endocrine therapy for reasons other than disease relapse or death. Patients treated with aromatase inhibitors alone had significantly shorter RFi (P < .001). OS, RFi, and BCSM were associated with disease stage, T stage, N stage, progesterone receptor expression, grade, and Ki67 index. Median OS reached 122 and 42 months in M0 and de novo M1 patients, respectively. CONCLUSION Due to the rarity of MBC, this study highlights important findings from real clinical practice. Although the number of patients with MBC with unfavorable features was higher in this Czech dataset than in international studies, the prognosis remains consistent with real-world evidence.
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Affiliation(s)
- Zuzana Bielcikova
- Department of Oncology, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
| | - Milos Holanek
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Iveta Selingerova
- Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Department of Mathematics and Statistics, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Ondrej Sorejs
- Department of Oncology and Radiotherapeutics, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Iveta Kolarova
- Department of Oncology and Radiotherapy, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
- Faculty of Health Studies, Pardubice University, Pardubice, Czech Republic
| | - Renata Soumarova
- Department of Radiotherapy and Oncology, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Proks
- Clinic of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Lucie Reifova
- Institute of Radiation Oncology, Faculty Hospital Bulovka, Prague, Czech Republic
| | - Vlastimila Cmejlova
- Department of Oncology, Second Medical Faculty, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Lenka Linkova
- Comprehensive Oncology Center, The Liberec Regional Hospital, Liberec, Czech Republic
| | | | - Martina Chodacka
- Department of Oncology, Hospital of Chomutov, Chomutov, Czech Republic
| | - Lucie Janovska
- Department of Oncology, First Faculty of Medicine of Charles University, General University Hospital in Prague and Military University Hospital Prague, Prague, Czech Republic
| | - Lenka Lisnerova
- Department of Clinical Oncology, Na Homolce Hospital, Prague, Czech Republic
| | | | - Denisa Pohankova
- Department of Oncology and Radiotherapy, Faculty of Medicine in Hradec Kralove and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Lubos Petruzelka
- Department of Oncology, First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic
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Das C, Bhattacharya A, Adhikari S, Mondal A, Mondal P, Adhikary S, Roy S, Ramos K, Yadav KK, Tainer JA, Pandita TK. A prismatic view of the epigenetic-metabolic regulatory axis in breast cancer therapy resistance. Oncogene 2024; 43:1727-1741. [PMID: 38719949 PMCID: PMC11161412 DOI: 10.1038/s41388-024-03054-9] [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: 12/15/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 06/09/2024]
Abstract
Epigenetic regulation established during development to maintain patterns of transcriptional expression and silencing for metabolism and other fundamental cell processes can be reprogrammed in cancer, providing a molecular mechanism for persistent alterations in phenotype. Metabolic deregulation and reprogramming are thus an emerging hallmark of cancer with opportunities for molecular classification as a critical preliminary step for precision therapeutic intervention. Yet, acquisition of therapy resistance against most conventional treatment regimens coupled with tumor relapse, continue to pose unsolved problems for precision healthcare, as exemplified in breast cancer where existing data informs both cancer genotype and phenotype. Furthermore, epigenetic reprograming of the metabolic milieu of cancer cells is among the most crucial determinants of therapeutic resistance and cancer relapse. Importantly, subtype-specific epigenetic-metabolic interplay profoundly affects malignant transformation, resistance to chemotherapy, and response to targeted therapies. In this review, we therefore prismatically dissect interconnected epigenetic and metabolic regulatory pathways and then integrate them into an observable cancer metabolism-therapy-resistance axis that may inform clinical intervention. Optimally coupling genome-wide analysis with an understanding of metabolic elements, epigenetic reprogramming, and their integration by metabolic profiling may decode missing molecular mechanisms at the level of individual tumors. The proposed approach of linking metabolic biochemistry back to genotype, epigenetics, and phenotype for specific tumors and their microenvironment may thus enable successful mechanistic targeting of epigenetic modifiers and oncometabolites despite tumor metabolic heterogeneity.
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Affiliation(s)
- Chandrima Das
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, 700064, India.
- Homi Bhabha National Institute, Mumbai, 400094, India.
| | - Apoorva Bhattacharya
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, 700064, India
| | - Swagata Adhikari
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, 700064, India
- Homi Bhabha National Institute, Mumbai, 400094, India
| | - Atanu Mondal
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, 700064, India
- Homi Bhabha National Institute, Mumbai, 400094, India
| | - Payel Mondal
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, 700064, India
- Homi Bhabha National Institute, Mumbai, 400094, India
| | - Santanu Adhikary
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, 700064, India
- Structural Biology and Bioinformatics Division, Council of Scientific and Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, 700032, India
| | - Siddhartha Roy
- Structural Biology and Bioinformatics Division, Council of Scientific and Industrial Research (CSIR)-Indian Institute of Chemical Biology, Kolkata, 700032, India
| | - Kenneth Ramos
- Center for Genomics and Precision Medicine, Texas A&M University, School of Medicine, Houston, TX, 77030, USA
| | - Kamlesh K Yadav
- Center for Genomics and Precision Medicine, Texas A&M University, School of Medicine, Houston, TX, 77030, USA
- School of Engineering Medicine, Texas A&M University, School of Medicine, Houston, TX, 77030, USA
| | - John A Tainer
- The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Tej K Pandita
- Center for Genomics and Precision Medicine, Texas A&M University, School of Medicine, Houston, TX, 77030, USA.
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Thy JE, Larsen M, Vigeland E, Koch H, Hovda T, Hofvind S. Early performance measures following regular versus irregular screening attendance in the population-based screening program for breast cancer in Norway. J Med Screen 2024; 31:107-114. [PMID: 37691575 DOI: 10.1177/09691413231199583] [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] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Irregular attendance in breast cancer screening has been associated with higher breast cancer mortality compared to regular attendance. Early performance measures of a screening program following regular versus irregular screening attendance have been less studied. We aimed to investigate early performance measures following regular versus irregular screening attendance. METHODS We used information from 3,302,396 screening examinations from the Cancer Registry of Norway. Examinations were classified as regular or irregular. Regular was defined as an examination 2 years ± 6 months after the prior examination, and irregular examination >2 years and 6 months after prior examination. Performance measures included recall, biopsy, screen-detected and interval cancer, positive predictive values, and histopathological tumor characteristics. RESULTS Recall rate was 2.4% (72,429/3,070,068) for regular and 3.5% (8217/232,328) for irregular examinations. The biopsy rate was 1.0% (29,197/3,070,068) for regular and 1.7% (3825/232,328) for irregular examinations, while the rate of screen-detected cancers 0.51% (15,664/3,070,068) versus 0.86% (2003/232,328), respectively. The adjusted odds ratio was 1.53 (95% CI: 1.49-1.56) for recall, 1.73 (95% CI: 1.68-1.80) for biopsy, and 1.68 (95% CI: 1.60-1.76) for screen-detected cancer after irregular examinations compared to regular examinations. The proportion of lymph node-positive tumors was 20.1% (2553/12,719) for regular and 25.6% (426/1662) for irregular examinations. CONCLUSION Irregular attendance was linked to higher rates of recall, needle biopsies, and cancer detection. Cancers detected after irregular examinations had less favorable histopathological tumor characteristics compared to cancers detected after regular examinations. Women should be encouraged to attend screening when invited to avoid delays in diagnosis.
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Affiliation(s)
- Jonas E Thy
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Marthe Larsen
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Einar Vigeland
- Department of Radiology, Vestfold Hospital, Tønsberg, Norway
| | - Henrik Koch
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Tone Hovda
- Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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80
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Ohnstad HO, Blix ES, Akslen LA, Gilje B, Raj SX, Skjerven H, Borgen E, Janssen EAM, Mortensen E, Brekke MB, Falk RS, Schlichting E, Boge B, Songe-Møller S, Olsson P, Heie A, Mannsåker B, Vestlid MA, Kursetgjerde T, Gravdehaug B, Suhrke P, Sanchez E, Bublevic J, Røe OD, Geitvik GA, Halset EH, Rypdal MC, Langerød A, Lømo J, Garred Ø, Porojnicu A, Engebraaten O, Geisler J, Lyngra M, Hansen MH, Søiland H, Nakken T, Asphaug L, Kristensen V, Sørlie T, Nygård JF, Kiserud CE, Reinertsen KV, Russnes HG, Naume B. Impact of Prosigna test on adjuvant treatment decision in lymph node-negative early breast cancer-a prospective national multicentre study (EMIT-1). ESMO Open 2024; 9:103475. [PMID: 38838499 PMCID: PMC11190479 DOI: 10.1016/j.esmoop.2024.103475] [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: 01/18/2024] [Revised: 04/15/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND EMIT-1 is a national, observational, single-arm trial designed to assess the value of the Prosigna, Prediction Analysis of Microarray using the 50 gene classifier (PAM50)/Risk of Recurrence (ROR), test as a routine diagnostic tool, examining its impact on adjuvant treatment decisions, clinical outcomes, side-effects and cost-effectiveness. Here we present the impact on treatment decisions. PATIENTS AND METHODS Patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative pT1-pT2 lymph node-negative early breast cancer (EBC) were included. The Prosigna test and standard histopathology assessments were carried out. Clinicians' treatment decisions were recorded before (pre-Prosigna) and after (post-Prosigna) the Prosigna test results were disclosed. RESULTS Of 2217 patients included, 2178 had conclusive Prosigna results. The pre-Prosigna treatment decisions were: no systemic treatment (NT) in 27% of patients, endocrine treatment alone (ET) in 38% and chemotherapy (CT) followed by ET (CT + ET) in 35%. Post-Prosigna treatment decisions were 25% NT, 51% ET and 24% CT + ET, respectively. Adjuvant treatment changed in 28% of patients, including 21% change in CT use. Among patients assigned to CT + ET pre-Prosigna, 45% were de-escalated to ET post-Prosigna. Of patients assigned to ET, 12% were escalated to CT + ET and 8% were de-escalated to NT; of those assigned to NT, 18% were escalated to ET/CT + ET. CT was more frequently recommended for patients aged ≤50 years. In the subgroup with pT1c-pT2 G2 and intermediate Ki67 (0.5-1.5× local laboratory median Ki67 score), the pre-Prosigna CT treatment decision varied widely across hospitals (3%-51%). Post-Prosigna, the variability of CT use was markedly reduced (8%-24%). The correlation between Ki67 and ROR score within this subgroup was poor (r = 0.25-0.39). The median ROR score increased by increasing histological grade, but the ROR score ranges were wide (for G1 0-79, G2 0-90, G3 16-94). CONCLUSION The Prosigna test result changed adjuvant treatment decisions in all EBC clinical risk groups, markedly decreased the CT use for patients categorized as higher clinical risk pre-Prosigna and reduced treatment decision discrepancies between hospitals.
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Affiliation(s)
- H O Ohnstad
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo
| | - E S Blix
- Department of Oncology, University of North Norway, Tromsø; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø
| | - L A Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen; Department of Pathology Haukeland University Hospital, Bergen
| | - B Gilje
- Department of Haematology and Oncology, Stavanger University Hospital, Stavanger
| | - S X Raj
- Department of Oncology, St Olavs Hospital, Trondheim
| | - H Skjerven
- Department of Breast Surgery, Vestre Viken Hospital Trust, Drammen
| | - E Borgen
- Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo
| | - E A M Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger; Department of Chemistry, Bioscience and Environmental Engineering, Stavanger University, Stavanger, Norway; Menzies Health Institute Queensland and Griffith University, Southport, Australia
| | - E Mortensen
- Department of Pathology, University of North Norway, Tromsø
| | - M B Brekke
- Department of Pathology, St Olavs Hospital, Trondheim
| | - R S Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo
| | - E Schlichting
- Department of Oncology, Breast and Endocrine Surgery Unit, Division of Cancer Medicine, Oslo University Hospital, Oslo
| | - B Boge
- Department of Oncology, Hospital of Southern Norway, Kristiansand
| | | | - P Olsson
- Department of Breast Surgery, Innlandet Hospital Trust, Hamar
| | - A Heie
- Department of Breast Surgery, Haukeland University Hospital, Bergen
| | - B Mannsåker
- Department of Oncology, Nordland Hospital, Bodø
| | - M A Vestlid
- Department of Breast Surgery, Telemark Hospital Trust, Skien
| | - T Kursetgjerde
- Department of Oncology, Møre og Romsdal Hospital Trust, Ålesund
| | - B Gravdehaug
- Department of Breast Surgery, Akershus University Hospital, Lørenskog
| | - P Suhrke
- Department of Pathology, Vestfold Hospital Trust, Tønsberg
| | - E Sanchez
- Department of Oncology, Haugesund Hospital, Haugesund
| | - J Bublevic
- Department of Oncology, Førde Central Hospital, Førde
| | - O D Røe
- Department of Oncology, Levanger Hospital, Levanger
| | - G A Geitvik
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo
| | - E H Halset
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo
| | - M C Rypdal
- Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo
| | - A Langerød
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo
| | - J Lømo
- Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo
| | - Ø Garred
- Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo
| | - A Porojnicu
- Department of Oncology, Vestre Viken Hospital Trust, Drammen
| | - O Engebraaten
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo; Institute of Clinical Medicine, University of Oslo, Oslo
| | - J Geisler
- Institute of Clinical Medicine, University of Oslo, Oslo; Department of Oncology, Akershus University Hospital, Lørenskog
| | - M Lyngra
- Department of Pathology, Akershus University Hospital, Lørenskog
| | - M H Hansen
- Department of Breast Surgery, University of North Norway, Tromsø
| | - H Søiland
- Department of Research, Stavanger University Hospital, Stavanger; Department of Clinical Science, University of Bergen, Bergen
| | - T Nakken
- User representative, Oslo University Hospital, Oslo
| | - L Asphaug
- Clinical Trials Unit, Oslo University Hospital, Oslo; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo
| | - V Kristensen
- Institute of Clinical Medicine, University of Oslo, Oslo
| | - T Sørlie
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo; Institute of Clinical Medicine, University of Oslo, Oslo
| | | | - C E Kiserud
- National Advisory Unit for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - K V Reinertsen
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo; National Advisory Unit for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - H G Russnes
- Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Oslo; Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo; Institute of Clinical Medicine, University of Oslo, Oslo
| | - B Naume
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo; Institute of Clinical Medicine, University of Oslo, Oslo.
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Aragón-Sánchez S, Sánchez-Bayona R, López-Marín L, Ciruelos-Gil E, Parrilla-Rubio L, Zaragoza-Ballester P, Galindo-Izquierdo A, García-Chapinal B, Álvaro-Valiente L, Oliver-Pérez MR. De-escalating axillary management after neoadjuvant chemotherapy in breast cancer: The ratio of positive sentinel lymph nodes matters. Surg Oncol 2024; 54:102062. [PMID: 38531288 DOI: 10.1016/j.suronc.2024.102062] [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: 09/17/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND De-escalation of axillary surgery in breast cancer (BC) patients diminishes sequelae without compromising cancer outcomes. Surgical management of the axilla is challenging after neoadjuvant treatment. We aimed to identify the factors associated with residual axillary disease amenable to lymphadenectomy in patients with positive sentinel lymph node biopsy (SLNB). METHODS We conducted a retrospective observational study in Hospital 12 de Octubre (Spain). We included BC patients with positive SLNB who underwent axillary dissection after neoadjuvant chemotherapy. Univariate and multivariate logistic regression models were performed to identify independent predictors of residual axillary disease. We estimated the ratio of positive nodes in SLNB and assessed the diagnostic validity of this ratio in relation to residual axillary disease. RESULTS We included 103 patients in the study. Residual axillary disease was identified in 54 patients (52.4%). Clinically node positive status at diagnosis (OR = 18.3, 95%CI: 4.0-83.6) and a ratio of positive nodes in SLNB ≥0.5 (OR = 6.5, 95%CI 41.7-23.7) were associated with residual axillary disease. The sensitivity and negative predictive value of a ratio of positive nodes in SLNB ≥0.5 were 87% (95%CI 75.1%-94.6%) and 75% (95%CI 55.1%-89.3%), respectively. CONCLUSIONS In our study, for patients with positive SLNB after neoadjuvant chemotherapy, stage N+ at diagnosis and a ratio of positive nodes in SLNB ≥0.5 were independent risk factors of positive residual axillary disease. This ratio is a feasible measure with a good diagnostic validity for residual axillary disease and could be used as a guiding factor in the surgical management of these patients.
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Affiliation(s)
- S Aragón-Sánchez
- Department of Obstetrics and Gynaecology. University Hospital 12 de Octubre. Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12]. Universidad Complutense de Madrid, Madrid, Spain
| | - R Sánchez-Bayona
- Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12]. Universidad Complutense de Madrid, Madrid, Spain; Department of Medical Oncology. University Hospital 12 de Octubre. Madrid, Spain.
| | - L López-Marín
- Department of Obstetrics and Gynaecology. University Hospital 12 de Octubre. Madrid, Spain
| | - E Ciruelos-Gil
- Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12]. Universidad Complutense de Madrid, Madrid, Spain; Department of Medical Oncology. University Hospital 12 de Octubre. Madrid, Spain
| | - L Parrilla-Rubio
- Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12]. Universidad Complutense de Madrid, Madrid, Spain; Department of Pathology. University Hospital 12 de Octubre. Madrid, Spain
| | | | - A Galindo-Izquierdo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital 12 de Octubre, Complutense University, Madrid, Spain; Research Institute Hospital 12 de Octubre (imas12), Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS network), RD21/0012/0024, Madrid, Spain
| | - B García-Chapinal
- Department of Obstetrics and Gynaecology. University Hospital 12 de Octubre. Madrid, Spain
| | - L Álvaro-Valiente
- Department of Obstetrics and Gynaecology. University Hospital 12 de Octubre. Madrid, Spain
| | - M R Oliver-Pérez
- Department of Obstetrics and Gynaecology. University Hospital 12 de Octubre. Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre [imas12]. Universidad Complutense de Madrid, Madrid, Spain
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Liu D, Chang L, Zhao X, Dai L, Cui H, Liu P, Zhai Z, Wu H, Ma X, Kang H. Effect of T Stages on the Choice of Axillary Evaluation Modality in Breast Cancer Patients With 1-2 Sentinel Lymph Node Metastases. Clin Breast Cancer 2024; 24:e232-e243.e1. [PMID: 38368246 DOI: 10.1016/j.clbc.2024.01.012] [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: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The survival benefit of axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB) combined with radiation, and ALND combined with radiation remains unclear in breast cancer (BC) patients with 1-2 metastatic sentinel lymph nodes (SLNs). This study aims to rigorously evaluate the prognostic impact of these axillary evaluation modalities on BC patients with varying T-stages and to construct a survival prediction nomogram. METHODS Following screening for inclusion and exclusion criteria, data pertaining to BC patients were extracted from the SEER database. Overall survival (OS) and breast cancer-specific survival (BCSS) were assessed using Kaplan-Meier curves and Cox proportional hazards model among patients with different stages who underwent various axillary evaluation modalities. A nomogram was constructed to predict the probability of OS and BCSS. RESULTS A total of 20,283 patients were included, comprising 9626 who underwent breast-conserving surgery (BCS) and 10,657 who underwent mastectomy. In the T4 stage stratified analysis, both BCS and mastectomy groups exhibited superior OS and BCSS with ALND compared to SLNB combined with radiation. Further, ALND combined with radiation improved OS. However, for T1-3 stages, patients treated with ALND experienced similar or worse survival compared to those treated with SLNB combined with radiation. The calibration curve and C-index (0.746-0.794) of the nomogram demonstrated the efficacy of the survival prediction model. CONCLUSION In T1-3 BC patients with 1-2 metastatic SLNs, SLNB combined with radiation is a safe alternative to ALND. Conversely, for T4 patients, ALND combined with radiation may offer a preferable choice.
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Affiliation(s)
- Dandan Liu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Lidan Chang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Xuyan Zhao
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Luyao Dai
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Hanxiao Cui
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Peinan Liu
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Zhen Zhai
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China
| | - Hao Wu
- Department of Biophysics, School of Basic Medical Sciences, Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University Health Science Center, No.76 Western Yanta Road, Xi'an, Shaanxi, 710061, China.
| | - Xiaobin Ma
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China.
| | - Huafeng Kang
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, Shaanxi, 710004, China.
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Finsterbusch K, van Diest PJ, Focke CM. Intertumoral heterogeneity of bifocal breast cancer: a morphological and molecular study. Breast Cancer Res Treat 2024; 205:413-421. [PMID: 38453779 DOI: 10.1007/s10549-024-07281-2] [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: 12/18/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To analyze concordance rates between individual foci of bifocal BC for histological grade, type and intrinsic subtype based on immunohistochemical (IHC) and mRNA-testing using MammaTyper. METHODS We evaluated histological grade and type as well as intrinsic subtype based on IHC status for estrogen and progesterone receptors, HER2 and the mitotic activity index in 158 individual foci of 79 bifocal BC. A subgroup of 31 cases additionally underwent mRNA-based subtyping using the MammaTyper (MT) test. We calculated concordance rates between individual foci, as well as Cohen's Kappa (K). RESULTS For 79 bifocal BC, concordance rates between individual foci for grade, histological type, and IHC-based subtype were 69.6% (K=0.53), 92.4% (K=0.81), and 74.7% (K=0.62), respectively. In the MT subgroup of 31 bifocal BC, concordance rates between individual foci for grade, histological type, IHC-based and mRNA-based intrinsic subtype were 87.1% (K=0.78), 90.3% (K=0.73), 87.1% (K=0.82), and 87.1% (K=0.7), respectively. Overall concordance between IHC- and mRNA-based subtype in the MT subgroup was 79% (K=0.7). In 6/79 cases (7.6%), testing of the smaller focus added clinically relevant information either on IHC- or mRNA-level: four cases showed high hormonal receptor expression while the expression in the larger focus was negative or low, warranting additional endocrine treatment; two cases presented with higher proliferative activity in the smaller focus, warranting additional chemotherapy. CONCLUSION In bifocal BC, intertumoral heterogeneity on the morphological, immunohistochemical and molecular level is common, with discordant intrinsic subtype in up to 25% between individual foci, with about 8% clinically relevant discordances.
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Affiliation(s)
- Kai Finsterbusch
- Department of Surgical Pathology, Dietrich Bonhoeffer Klinikum, Allendestrasse 30, 17033, Neubrandenburg, Germany
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Cornelia M Focke
- Department of Surgical Pathology, Dietrich Bonhoeffer Klinikum, Allendestrasse 30, 17033, Neubrandenburg, Germany.
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Depretto C, D'Ascoli E, Della Pepa G, Irmici G, De Berardinis C, Ballerini D, Bonanomi A, Ancona E, Ferranti C, Scaperrotta GP. Assessing the malignancy of suspicious breast microcalcifications: the role of contrast enhanced mammography. LA RADIOLOGIA MEDICA 2024; 129:855-863. [PMID: 38607514 DOI: 10.1007/s11547-024-01813-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To assess the role of contrast-enhanced mammography (CEM) in predicting the malignancy of breast calcifications. MATERIAL AND METHODS We retrospectively evaluated patients with suspicious calcifications (BIRADS 4) who underwent CEM and stereotactic vacuum-assisted biopsy (VAB) at our institution. We assessed the sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of CEM in predicting malignancy of microcalcifications with a 95% confidence interval; we performed an overall analysis and a subgroup analysis stratified into group A-low risk (BIRADS 4a) and group B-medium/high risk (BIRADS 4b-4c). We then evaluated the correlation between enhancement and tumour proliferation index (Ki-67) for all malignant lesions. RESULTS Data from 182 patients with 184 lesions were collected. Overall the SE of CEM in predicting the malignancy of microcalcifications was 0.70, SP was 0.85, the PPV was 0.82, the NPV was 0.76 and AUC was 0.78. SE in group A was 0.89, SP was 0.89, PPV was 0.57, NPV was 0.98 and AUC was 0.75. SE in group B was 0.68, SP was 0.80, PPV was 0.87, NPV was 0.57 and AUC was 0.75. Among malignant microcalcifications that showed enhancement (N = 52), 61.5% had Ki-67 ≥ 20% and 38.5% had low Ki-67 values. Among the lesions that did not show enhancement (N = 22), 90.9% had Ki-67 < 20% and 9.1% showed high Ki-67 values 20%. CONCLUSIONS The absence of enhancement can be used as an indicative parameter for the absence of disease in cases of low-suspicious microcalcifications, but not in intermediate-high suspicious ones for which biopsy remains mandatory and can be used to distinguish indolent lesions from more aggressive neoplasms, with consequent reduction of overdiagnosis and overtreatment.
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Affiliation(s)
- Catherine Depretto
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Elisa D'Ascoli
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy.
| | - Gianmarco Della Pepa
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Giovanni Irmici
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Claudia De Berardinis
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Daniela Ballerini
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Alice Bonanomi
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Eleonora Ancona
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - Claudio Ferranti
- Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Via Giacomo Venezian 1, 20133, Milan, Italy
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Svanøe AA, Humlevik ROC, Knutsvik G, Sæle AKM, Askeland C, Ingebriktsen LM, Hugaas U, Kvamme AB, Tegnander AF, Krüger K, Davidsen B, Hoivik EA, Aas T, Stefansson IM, Akslen LA, Wik E. Age-related phenotypes in breast cancer: A population-based study. Int J Cancer 2024; 154:2014-2024. [PMID: 38319154 DOI: 10.1002/ijc.34863] [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: 05/25/2023] [Revised: 12/21/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
Breast cancer in young (<40 years) is associated with a higher frequency of aggressive tumor types and poor prognosis. It remains unclear if there is an underlying age-related biology that contributes to the unfavorable outcome. We aim to investigate the relationship between age and breast cancer biology, with emphasis on proliferation. Clinico-pathologic information, immunohistochemical markers and follow-up data were obtained for all patients aged <50 (Bergen cohort-1; n = 355, not part of a breast screening program) and compared to previously obtained information on patients aged 50 to 69 years (Bergen cohort-2; n = 540), who participated in the Norwegian Breast Cancer Screening Program. Young breast cancer patients presented more aggressive tumor features such as hormone receptor negativity, HER2 positivity, lymph-node metastasis, the HER2-enriched and triple-negative subtypes and shorter survival. Age <40 was significantly associated with higher proliferation (by Ki67). Ki67 showed weaker prognostic value in young patients. We point to aggressive phenotypes and increased tumor cell proliferation in breast cancer of the young. Hence, tumors of young breast cancer patients may present unique biological features, also when accounting for screen/interval differences, that may open for new clinical opportunities, stratifying treatment by age.
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Affiliation(s)
- Amalie A Svanøe
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rasmus O C Humlevik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Gøril Knutsvik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Anna K M Sæle
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Cecilie Askeland
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Lise M Ingebriktsen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ulrikke Hugaas
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Amalie B Kvamme
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Amalie F Tegnander
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kristi Krüger
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Erling A Hoivik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Turid Aas
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ingunn M Stefansson
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Lars A Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth Wik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
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Gao XL, Pan T, Duan WB, Zhu WB, Liu LK, Liu YL, Yue LL. Systematic proteomics analysis revealed different expression of laminin interaction proteins in breast cancer: lower in luminal subtype and higher in claudin-low subtype. Transl Cancer Res 2024; 13:2108-2121. [PMID: 38881926 PMCID: PMC11170511 DOI: 10.21037/tcr-23-2214] [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: 12/03/2023] [Accepted: 04/17/2024] [Indexed: 06/18/2024]
Abstract
Background Breast cancer is a major public health concern. Proteomics enables identification of proteins with aberrant properties. Here, we identified proteins with abnormal expression levels in breast cancer tissues and systematically analyzed and validated the data to locate potential diagnostic and therapeutic targets. Methods Protein expression level in breast cancer tissues and para-carcinoma tissues were detected by Isobaric Tags for Relative and Absolute Quantification (iTRAQ) technology and further screened through Gene Expression Profiling Interactive Analysis (GEPIA) database. Cellular components, protein domain and Reactome pathway analysis were performed to screen functional targets. Abnormal expression levels of functional targets were validated by Oncomine database, quantitative real time polymerase chain reaction (qRT-PCR) and proteomics detection. Protein correlation analysis was performed to explain the abnormal expression levels of potential targets in breast cancer. Results Overall, 207 and 207 proteins were up- and down-regulated, respectively, in breast cancer tissues, and approximately 50% were also detected in the GEPIA database. The overlapping proteins were mainly extracellular proteins containing epidermal growth factor-like domain in leukocyte adhesion molecule (EGF-Lam) domain and enriched in laminin interaction pathway. Moreover, the downregulated laminin interaction proteins could be functional targets, which were also validated through Oncomine-Richardson and Oncomine-Curtis database. However, the lower expression level of laminin interaction proteins only fit for luminal breast cancer cells with no or low metastasis ability because the proteins achieved higher expression level in more invasive claudin-low breast cancer cells. In addition, when compared with corresponding in situ carcinoma tissues, above-mentioned proteins also showed higher expression levels in invasive carcinoma tissues. Finally, we have revealed the negative correlation between the laminin interaction proteins and the claudins. Conclusions The laminin interaction protein, especially for laminins with β1 and γ1 subunits and their integrin receptors with α1 and α6 subunits, showed lower expression levels in luminal breast cancer with no or lower metastatic ability, but showed higher expression levels in claudin-low breast cancer with higher metastatic ability; and their higher expression could be related to the low claudin expression.
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Affiliation(s)
- Xiu-Li Gao
- Research Institute of Medicine and Pharmacy, Qiqihar Medical University, Qiqihar, China
| | - Ting Pan
- Department of Medical Technology, Qiqihar Medical University, Qiqihar, China
| | - Wen-Bo Duan
- Department of Medical Technology, Qiqihar Medical University, Qiqihar, China
| | - Wen-Bin Zhu
- Research Institute of Medicine and Pharmacy, Qiqihar Medical University, Qiqihar, China
| | - Li-Kun Liu
- Research Institute of Medicine and Pharmacy, Qiqihar Medical University, Qiqihar, China
| | - Yun-Long Liu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Qiqihar Medical University, Qiqihar, China
| | - Li-Ling Yue
- Research Institute of Medicine and Pharmacy, Qiqihar Medical University, Qiqihar, China
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Liu D, Chang L, Hao Q, Ren X, Liu P, Liu X, Wei Y, Wang M, Wu H, Kang H, Lin S. Is neoadjuvant chemotherapy necessary for T2N0-1M0 hormone receptor-positive/HER2-negative breast cancer patients undergoing breast-conserving surgery? J Cancer Res Clin Oncol 2024; 150:285. [PMID: 38814494 PMCID: PMC11139699 DOI: 10.1007/s00432-024-05810-6] [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: 05/09/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION For HR-positive/HER2-negative patients who can undergo breast-conserving surgery (BCS) but have a tumor size of 2-5 cm or 1-3 lymph node metastases, neoadjuvant chemotherapy (NAC) is still controversial. METHODS Patients with T2N0-1M0 HR-positive/HER2-negative BC who underwent BCS between 2010 and 2017 were selected from the SEER database. Propensity score matching (PSM) was used to minimize the influence of confounding factors. The overall survival (OS) and breast cancer-specific survival (BCSS) of patients were estimated by Kaplan‒Meier curves and Cox proportional hazard models. Independent prognostic factors were included to construct a nomogram prediction model. RESULTS A total of 6475 BC patients were enrolled, of whom 553 received NAC and 5922 received adjuvant chemotherapy (AC). In the T2N0-1M0 population and T2N1M0 subgroup, AC patients before PSM had better OS and BCSS than NAC patients. After PSM, there was no significant difference in OS or BCSS between the two groups. However, in the T2N0M0 subgroup, there was no difference in survival between the AC and NAC groups before and after PSM. Stratified analysis revealed that for complete response (CR) patients, survival was roughly equivalent between the NAC and AC groups. However, the survival of no response (NR) and partial response (PR) patients was significantly worse than that of AC patients. Cox analysis revealed that radiotherapy after BCS was an independent protective factor for OS. NAC is an independent risk factor for NR and PR patients. The nomogram has good prediction efficiency. CONCLUSION NAC before BCS is not necessary for T2N0-1M0 HR-positive/HER2-negative BC patients.
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Affiliation(s)
- Dandan Liu
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Lidan Chang
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Qian Hao
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xueting Ren
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Peinan Liu
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xingyu Liu
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yumeng Wei
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Meng Wang
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hao Wu
- School of Basic Medical Sciences, Xi'an Key Laboratory of Immune Related Diseases, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Huafeng Kang
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Shuai Lin
- The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Alwahsh M, Hamadneh Y, Marchan R, Dahabiyeh LA, Alhusban AA, Hasan A, Alrawabdeh J, Hergenröder R, Hamadneh L. Glutathione and Xanthine Metabolic Changes in Tamoxifen Resistant Breast Cancer Cell Lines are Mediated by Down-Regulation of GSS and XDH and Correlated to Poor Prognosis. J Cancer 2024; 15:4047-4058. [PMID: 38947399 PMCID: PMC11212086 DOI: 10.7150/jca.96659] [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: 03/26/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024] Open
Abstract
Background: Tamoxifen is commonly used in the treatment of hormonal-positive breast cancer. However, 30%-40% of tumors treated with tamoxifen develop resistance; therefore, an important step to overcome this resistance is to understand the underlying molecular and metabolic mechanisms. In the present work, we used metabolic profiling to determine potential biomarkers of tamoxifen resistance, and gene expression levels of enzymes important to these metabolites and then correlated the expression to the survival of patients receiving tamoxifen. Methods: Tamoxifen-resistant cell lines previously developed and characterized in our laboratory were metabolically profiled with nuclear magnetic resonance spectroscopy (NMR) using cryogenic probe, and the findings were correlated with the expression of genes that encode the key enzymes of the significant metabolites. Moreover, the effect of significantly altered genes on the overall survival of patients was assessed using the Kaplan-Meier plotter web tool. Results: We observed a significant increase in the levels of glutamine, taurine, glutathione, and xanthine, and a significant decrease in the branched-chain amino acids, valine, and isoleucine, as well as glutamate and cysteine in the tamoxifen-resistant cells compared to tamoxifen sensitive cells. Moreover, xanthine dehydrogenase and glutathione synthase gene expression were downregulated, whereas glucose-6-phosphate dehydrogenase was upregulated compared to control. Additionally, increased expression of xanthine dehydrogenase was associated with a better outcome for breast cancer patients. Conclusion: Overall, this study sheds light on metabolic pathways that are dysregulated in tamoxifen-resistant cell lines and the potential role of each of these pathways in the development of resistance.
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Affiliation(s)
- Mohammad Alwahsh
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman-17138, Jordan
| | - Yazan Hamadneh
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Rosemarie Marchan
- Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany
| | - Lina A. Dahabiyeh
- Department of Pharmaceutical Sciences, School of Pharmacy, The University of Jordan, 11942 Amman, Jordan
| | - Ala A Alhusban
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman-17138, Jordan
| | - Aya Hasan
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman-17138, Jordan
| | | | - Roland Hergenröder
- Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., 44139 Dortmund, Germany
| | - Lama Hamadneh
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, 19117, Al-Salt, Jordan
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Zhao S, Wang Y, Zhou A, Liu X, Zhang Y, Zhang J. Neoadjuvant chemotherapy efficacy and prognosis in HER2-low and HER2-zero breast cancer patients by HR status: a retrospective study in China. PeerJ 2024; 12:e17492. [PMID: 38827304 PMCID: PMC11143972 DOI: 10.7717/peerj.17492] [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: 02/28/2024] [Accepted: 05/09/2024] [Indexed: 06/04/2024] Open
Abstract
Background The promising efficacy of novel anti-HER2 antibody-drug conjugates (ADC) in HER2-low breast cancer has made HER2-low a research hotspot. However, controversy remains regarding the neoadjuvant chemotherapy (NAC) efficacy, prognosis, and the relationship with hormone receptor (HR) status of HER2-low. Methods A retrospective analysis was conducted on 975 patients with HER2-negative breast cancer undergoing NAC at Tianjin Medical University Cancer Institute and Hospital, evaluating pathological complete response (pCR) rate and prognosis between HER2-low and HER2-zero in the overall cohort and subgroups. Results Overall, 579 (59.4%) and 396 (40.6%) patients were HER2-low and HER2-zero disease, respectively. Compared with HER2-zero, the HER2-low cohort consists of more postmenopausal patients, with lower histological grade and higher HR positivity. In the HR-positive subgroup, HER2-low cases remain to exhibit lower histological grade, while in the HR-negative subgroup, they show higher grade. The HER2-low group had lower pCR rates than the HER2-zero group (16.4% vs. 24.0%). In the HR-positive subgroup, HER2-low consistently showed lower pCR rate (8.1% vs. 15.5%), and served as an independent suppressive factor for the pCR rate. However, no significant difference was observed in the pCR rates between HER2-low and HER2-zero in the HR-negative breast cancer. In the entire cohort and in stratified subgroups based on HR and pCR statuses, no difference in disease-free survival were observed between HER2-low and HER2-zero. Conclusions In the Chinese population, HER2-low breast cancer exhibits distinct characteristics and efficacy of NAC in different HR subgroups. Its reduced pCR rate in HR-positive subgroup is particularly important for clinical decisions. However, HER2-low is not a reliable factor for assessing long-term survival outcomes.
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Affiliation(s)
- Shaorong Zhao
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yuyun Wang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Angxiao Zhou
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xu Liu
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yi Zhang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jin Zhang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
- Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Wang X, Wang X, Cai L, Zhang C, Li Y. Clinical characteristics and prognostic analysis of metachronous bilateral breast carcinoma: a retrospective study based on propensity score matching. Clin Transl Oncol 2024:10.1007/s12094-024-03528-y. [PMID: 38801511 DOI: 10.1007/s12094-024-03528-y] [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: 03/20/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND To investigate clinical characteristics, treatment, outcomes, and prognostic risk factors of metachronous bilateral breast carcinoma (MBBC) and provide a theoretical basis for clinical management of MBBC. METHODS This was a retrospective study. From January 1, 2010 to March 31, 2022, a total of 23,010 patients with breast cancer underwent surgical treatment at the Breast Center of the Fourth Hospital of Hebei Medical University, including 386 patients with MBBC. Propensity score matching (PSM) was performed on MBBC patients and unilateral breast cancer (UBC) patients in a 1:1 ratio, and 210 UBC patients and 210 MBBC patients were finally matched. Clinical medical records of all patients were collected, including age of onset, family history of breast cancer, tumor size, lymph node status, TNM stage, mode of surgery, menstruation, pathological type, immunohistochemical (IHC) typing, treatment, disease-free survival (DFS), and overall survival (OS). RESULTS The result showed that age of onset of the second primary cancer (SPC) was significantly older than that of the first primary cancer (FPC) (P = 0.024). Baseline data from MPPC patients showed that the tumor size of FPC was significantly larger than that of SPC (P = 0.043), and the proportion of PR ( +) in FPC is significantly higher than that in SPC (P = 0.045). Among MBBC patients with FPC for estrogen receptor (ER) or progesterone receptor (PR) ( +) and Her-2 (-), clinical characteristics and treatment results showed that the proportion of PR ( +) in the drug-resistant group was significantly lower than that in the non-drug-resistant group. The 2-year OS rate of SPC in the drug-resistant group was significantly shorter than those of the non-drug-resistant group (78.9% vs 100%, P < 0.05). The result of PSM-based comparison between MBBC patients and UBC patients showed significantly lower proportion of MBBC patients with SPC received chemotherapy compared to UBC patients (P = 0.026), and there was no significant difference in OS and DFS between SPC course of MBBC patients and UBC patients (P > 0.05). The univariate analysis showed that high TNM stage was a risk factor for death and disease progression in MBBC patients, with the risk of death in stage III MBBC patients being about 5 times higher than that in stage I MBBC patients (HR = 4.97, 95%CI = 1.42-17.31, P = 0.012), and the risk of disease recurrence being about 3.5 times higher than that in stage I MBBC patients (HR = 3.55, 95%CI = 1.07-11.81, P = 0.039). CONCLUSION In summary, this study presented clinical characteristics, treatment options, and outcomes of MBBC patients and patients with MBBC who were resistant to endocrine therapy have a worse SPC survival prognosis. The course of SPC in MBBC patients was similar to that of UBC in terms of prognosis and survival, which suggested that SPC can be treated according to UBC treatment regimen. High TNM stage was a prognostic risk factor for SPC patients.
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Affiliation(s)
- Xinle Wang
- Breast Disease Diagnosis and Treatment Center, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Avenue, ShijiazhuangShijiazhuang, 050011, Hebei, China
| | - Xinrui Wang
- Breast Disease Diagnosis and Treatment Center, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Avenue, ShijiazhuangShijiazhuang, 050011, Hebei, China
| | - Lijing Cai
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Cong Zhang
- Scientific Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuntao Li
- Breast Disease Diagnosis and Treatment Center, The Fourth Hospital of Hebei Medical University, No. 169 Tianshan Avenue, ShijiazhuangShijiazhuang, 050011, Hebei, China.
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91
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Li F, Zhou X, Hu W, Du Y, Sun J, Wang Y. Prognostic predictive value of Ki-67 in stage I-II triple-negative breast cancer. Future Sci OA 2024; 10:FSO936. [PMID: 38827797 PMCID: PMC11140645 DOI: 10.2144/fsoa-2023-0129] [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: 06/20/2023] [Accepted: 11/06/2023] [Indexed: 06/05/2024] Open
Abstract
Aim: Our research aimed to determine an optimal cutoff value and investigate the prognostic predictive function of Ki-67. Materials & methods: We retrospectively enrolled 1146 patients diagnosed with stage I-II triple-negative breast cancer. Disease-free and overall survival were analyzed using the Kaplan-Meier method and the Cox regression model. Results: We classified Ki-67 >45% as the high group (n = 716). A Ki-67 level of >45% was associated with poorer disease-free survival (p = 0.039) and overall survival (p = 0.029). Lymph node stage, neoadjuvant chemotherapy, and radiotherapy were independent predictive variables of prognosis. Conclusion: Triple-negative breast cancer may be further subcategorized according to the Ki-67 level. Neoadjuvant chemotherapy and postoperative radiotherapy can improve the prognosis of early triple-negative breast cancer.
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Affiliation(s)
- Fengyan Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, PR China
| | - Xinhui Zhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, PR China
| | - Wendie Hu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, PR China
| | - Yujie Du
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, PR China
| | - Jiayuan Sun
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, PR China
| | - Yaxue Wang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, PR China
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Cicciarelli F, Guiducci E, Galati F, Moffa G, Ricci P, Pediconi F, Rizzo V. Digital Mammography (DM) vs. Dynamic Contrast Enhancement-Magnetic Resonance Imaging (DCE-MRI) in Microcalcifications Assessment: A Radiological-Pathological Comparison. Diagnostics (Basel) 2024; 14:1063. [PMID: 38893590 PMCID: PMC11172046 DOI: 10.3390/diagnostics14111063] [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: 03/30/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
The aim of this study was to compare the characteristics of breast microcalcification on digital mammography (DM) with the histological and molecular subtypes of breast cancer and to identify the predictive value of DM and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing microcalcifications for radiologic-pathologic correlation. We relied on our prospectively maintained database of suspicious microcalcifications on DM, from which data were retrospectively collected between January 2020 and April 2023. We enrolled 158 patients, all of whom were subjected to biopsy. Additionally, 63 patients underwent breast DCE-MRI. Microcalcifications with a linear branched morphology were correlated with malignancies (p < 0.001), among which an association was highlighted between triple negatives (TNs) and segmental distribution (p < 0.001). Amorphous calcifications were correlated with atypical ductal hyperplasia (ADH) (p = 0.013), coarse heterogeneous (p < 0.001), and fine-pleomorphic (p = 0.008) with atypical lobular hyperplasia (ALH) and fine pleomorphic (p = 0.009) with flat epithelial atypia (FEA). Regarding DCE-MRI, no statistical significance was observed between non-mass lesions and ductal carcinoma in situ (DCIS). Concerning mass lesions, three were identified as DCIS and five as invasive ductal carcinoma (IDC). In conclusion, microcalcifications assessed in DM exhibit promising predictive characteristics concerning breast lesion subtypes, leading to a reduction in diagnostic times and further examination costs, thereby enhancing the clinical management of patients.
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Affiliation(s)
- Federica Cicciarelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
| | - Elisa Guiducci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
| | - Francesca Galati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
| | - Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
| | - Paolo Ricci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
- Unit of Emergency Radiology, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
| | - Veronica Rizzo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.C.); (F.G.); (G.M.); (P.R.); (F.P.); (V.R.)
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Hua C, Wenwen C, Huijuan R, Ting P, Jin Z. The value of the malignant subregion-based texture analysis in predicting the Ki-67 status in breast cancer. Front Oncol 2024; 14:1359925. [PMID: 38835373 PMCID: PMC11148296 DOI: 10.3389/fonc.2024.1359925] [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: 12/22/2023] [Accepted: 05/02/2024] [Indexed: 06/06/2024] Open
Abstract
Objective To evaluate the value of the malignant subregion-based texture analysis in predicting Ki-67 status in breast cancer. Materials and methods The dynamic contrast-enhanced magnetic resonance imaging data of 119 histopathologically confirmed breast cancer patients (81 patients with high Ki-67 expression status) from January 2018 to February 2023 in our hospital were retrospectively collected. According to the enhancement curve of each voxel within the tumor, three subregions were divided: washout subregion, plateau subregion, and persistent subregion. The washout subregion and the plateau subregion were merged as the malignant subregion. The texture features of the malignant subregion were extracted using Pyradiomics software for texture analysis. The differences in texture features were compared between the low and high Ki-67 expression cohorts and then the receiver operating characteristic (ROC) curve analysis to evaluate the predictive performance of texture features on Ki-67 expression. Finally, a support vector machine (SVM) classifier was constructed based on differential features to predict the expression level of Ki-67, the performance of the classifier was evaluated using ROC analysis and confirmed using 10-fold cross-validation. Results Through comparative analysis, 51 features exhibited significant differences between the low and high Ki-67 expression cohorts. Following feature reduction, 5 features were selected to build the SVM classifier, which achieved an area under the ROC curve (AUC) of 0.77 (0.68-0.87) for predicting the Ki-67 expression status. The accuracy, sensitivity, and specificity were 0.76, 0.80, and 0.68, respectively. The average AUC from the 10-fold cross-validation was 0.72 ± 0.14. Conclusion The texture features of the malignant subregion in breast cancer were potential biomarkers for predicting Ki-67 expression level in breast cancer, which might be used to precisely diagnose and guide the treatment of breast cancer.
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Affiliation(s)
- Chao Hua
- Department of Radiology, Changzhou Cancer Hospital, Changzhou, China
| | - Chen Wenwen
- Department of Radiology, Changzhou Cancer Hospital, Changzhou, China
| | - Rui Huijuan
- Department of Radiology, Changzhou Cancer Hospital, Changzhou, China
| | - Pan Ting
- Department of Radiology, Changzhou Cancer Hospital, Changzhou, China
| | - Zhang Jin
- Department of Radiology, Changzhou Cancer Hospital, Changzhou, China
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Mooghal M, Khan MAA, Samar MR, Shaikh H, Valimohammad AT, Idrees R, Abdul Rashid Y, Sattar AK. Association Between Ki-67 Proliferative Index and Oncotype-Dx Recurrence Score in Hormone Receptor-Positive, HER2-Negative Early Breast Cancers. A Systematic Review of the Literature. Breast Cancer (Auckl) 2024; 18:11782234241255211. [PMID: 38779417 PMCID: PMC11110513 DOI: 10.1177/11782234241255211] [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: 01/15/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Background Oncotype-Dx (ODx) is a 21-gene assay used as a prognostic and predictive tool for hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative, node-negative, or 1 to 3 lymph node-positive early breast cancers (EBCs). The cost of the test, which is not available in low-middle income countries (LMICs), is not within the means of most individuals. The Ki-67 index is a marker of tumor proliferation that is cost-effective and easily performed and has been substituted in many cases to obtain prognostic information. Objective We aimed to identify the correlation between the ODx recurrence score (RS) and the Ki-67 index in HR-positive EBCs and to determine whether Ki-67, like the ODx, can help facilitate clinical decision-making. Design Systematic review correlating Ki-67 index and ODx in HR-positive and HER2-negative EBCs as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources and methods We searched different databases between January 2010 and May 2023 and included retrospective/prospective cohorts, clinical trials, case-control, and cross-sectional studies involving HR-positive and HER2-negative EBCs correlating the Ki-67 index and ODx RS categories. Results Of the 18 studies included, 16 indicated a positive or weakly positive correlation between ODx and the Ki-67 index. The combined P value of the included studies is <0.05 (P = .000), which shows a statistical significance between the 2. Our review also discusses the potential of machine learning and artificial intelligence (AI) in Ki-67 assessment, offering a cost-effective and reproducible alternative. Conclusion Even although there are limitations, studies indicate a favorable association between ODx and the Ki-67 index in specific situations. This implies that Ki-67 can offer important predictive details, especially regarding the likelihood of relapse in HR-positive EBC. This is particularly significant in LMICs where financial constraints often hinder the availability of costly diagnostic tests.
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Affiliation(s)
- Mehwish Mooghal
- Section of Breast Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | | | - Mirza Rameez Samar
- Section of Medical Oncology, Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Hafsa Shaikh
- Section of Breast Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Azmina Tajdin Valimohammad
- Section of Medical Oncology, Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Romana Idrees
- Department of Pathology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Yasmin Abdul Rashid
- Section of Medical Oncology, Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Abida K Sattar
- Section of Breast Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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Boutrus RR, Abdelazim YA, Mohammed T, Bayomy M, Ibraheem MH, Hussein A, Sebaie ME. The impact of loco-regional treatment modality on the outcomes in breast cancer patients younger than forty years of age. BMC Cancer 2024; 24:599. [PMID: 38760780 PMCID: PMC11100067 DOI: 10.1186/s12885-024-12325-3] [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: 08/24/2023] [Accepted: 04/30/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE To determine the impact of the loco-regional treatment modality, on the loco-regional recurrence (LRR) rates and overall survival (OS) in breast cancer patients younger than 40 years. METHODS Data of 623 breast cancer patients younger than 40 years of age were retrospectively reviewed. Patients were stratified according to the locoregional treatment approach into three groups: the mastectomy group (M), the mastectomy followed by radiation therapy group (MRX) and the breast conservative therapy group (BCT). RESULTS Median follow-up was 72 months (range, 6-180). Two hundred and nine patients were treated with BCT, 86 with MRM and 328 with MRX. The 10-year rate LRR rates according to treatment modality were: 13.4% for BCT, 15.1% for MRM and 8.5% for MRX (p 0.106). On univariate analysis, T stage (p 0.009), AJCC stage (p 0.047) and Her 2 status (p 0.001) were associated with LRR. Ten-year overall survival (OS) was 72.7% (78.5% in the BCT group, 69.8% in the MRM group and 69.8% in the MRX group, p 0.072). On Univariate analysis, age < 35 (p 0.032), grade III (p 0.001), N3 stage (p 0.001), AJCC stage III (p 0.005), ER negative status (0.04), Her 2-status positive (0.006) and lack of chemotherapy administration (p 0.02) were all predictors of increased mortality. CONCLUSION For patients younger than 40 years of age, similar LRR and overall survival outcomes were achieved using BCT, M or MRX. Young age at diagnosis should not be used alone in recommending one loco-regional treatment approach over the others.
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Affiliation(s)
- Rimoun R Boutrus
- Radiation Oncology Department, National Cancer Institute, Cairo University, 1 Kasr El Aini Street, Fom El Khalig, Cairo, 11796, Egypt
| | - Yasser A Abdelazim
- Radiation Oncology Department, National Cancer Institute, Cairo University, 1 Kasr El Aini Street, Fom El Khalig, Cairo, 11796, Egypt.
| | - Toka Mohammed
- Radiation Oncology Department, National Cancer Institute, Cairo University, 1 Kasr El Aini Street, Fom El Khalig, Cairo, 11796, Egypt
| | - Mohammed Bayomy
- Department of Clinical Oncology, Zagazig University, Zagazig, Egypt
| | - Maher H Ibraheem
- Surgical Oncology Department, Breast Division, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Alaadin Hussein
- Surgical Oncology Department, Breast Division, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Medhat El Sebaie
- Radiation Oncology Department, National Cancer Institute, Cairo University, 1 Kasr El Aini Street, Fom El Khalig, Cairo, 11796, Egypt
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96
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Muradás TC, Freitas RDS, Gonçalves JIB, Xavier FAC, Marinowic DR. Potential antitumor effects of short-chain fatty acids in breast cancer models. Am J Cancer Res 2024; 14:1999-2019. [PMID: 38859825 PMCID: PMC11162650 DOI: 10.62347/etuq6763] [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: 10/30/2023] [Accepted: 03/13/2024] [Indexed: 06/12/2024] Open
Abstract
The effects of short-chain fatty acids (SCFAs) have been explored against cancer due to the crosstalk between gut microbiota alterations and the immune system as a crucial role in cancer development. We evaluated the SCFAs effects in both in vitro and in vivo breast cancer models. In vitro, the SCFAs displayed contrasting effects on viability index, according to the evaluation of breast cancer cells with different phenotypes, human MCF-7, SK-BR-3, MDA-MD-231, or the mouse 4T1 lineage. Acetate displayed minimal effects at concentrations up to 100 mM. Alternatively, propionate increases or reduces cell viability depending on the concentration. Butyrate and valerate showed consistent time- and concentration-dependent effects on the viability of human or mouse breast cancer cells. The selective FFA2 4-CMTB or FFA3 AR420626 receptor agonists failed to overtake the SCFA actions, except by modest inhibitory effects on MDA-MB-231 and 4T1 cell viability. The FFA2 CATPB or FFA3 and β-hydroxybutyrate receptor antagonists lacked significant activity on human cell lines, although CATPB reduced 4T1 cell viability. Butyrate significantly affected cell morphology, clonogenicity, and migration, according to the evaluation of MDA-MB-231 and 4T1 cells. A preliminary examination of in vivo oral effects of butyrate, propionate, or valerate, dosed in prophylactic or therapeutic regimens, on several parameters evaluated in an orthotopic breast cancer model showed a reduction of lung metastasis in post-tumor induction butyrate-treated mice. Overall, the present results indicate that in vitro effects of SCFAs did not rely on FFA2 or FFA3 receptor activation, and they were not mirrored in vivo, at least at the tested conditions. Overall, the present results indicate potential in vitro inhibitory effects of SCFAs in breast cancer, independent of FFA2 or FFA3 receptor activation, and, in the metastatic breast cancer model, the butyrate-dosed therapeutic regimen reduced the number of lung metastases.
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Affiliation(s)
- Thaís C Muradás
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do SulPorto Alegre, RS, Brazil
| | - Raquel DS Freitas
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do SulPorto Alegre, RS, Brazil
| | - João IB Gonçalves
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do SulPorto Alegre, RS, Brazil
- Brain Institute of Rio Grande do SulPorto Alegre, RS, Brazil
| | - Fernando AC Xavier
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do SulPorto Alegre, RS, Brazil
- Brain Institute of Rio Grande do SulPorto Alegre, RS, Brazil
| | - Daniel R Marinowic
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do SulPorto Alegre, RS, Brazil
- Brain Institute of Rio Grande do SulPorto Alegre, RS, Brazil
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Raj-Kumar PK, Lin X, Liu T, Sturtz LA, Gritsenko MA, Petyuk VA, Sagendorf TJ, Deyarmin B, Liu J, Praveen-Kumar A, Wang G, McDermott JE, Shukla AK, Moore RJ, Monroe ME, Webb-Robertson BJM, Hooke JA, Fantacone-Campbell L, Mostoller B, Kvecher L, Kane J, Melley J, Somiari S, Soon-Shiong P, Smith RD, Mural RJ, Rodland KD, Shriver CD, Kovatich AJ, Hu H. Proteogenomic characterization of difficult-to-treat breast cancer with tumor cells enriched through laser microdissection. Breast Cancer Res 2024; 26:76. [PMID: 38745208 PMCID: PMC11094977 DOI: 10.1186/s13058-024-01835-4] [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: 01/12/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Breast cancer (BC) is the most commonly diagnosed cancer and the leading cause of cancer death among women globally. Despite advances, there is considerable variation in clinical outcomes for patients with non-luminal A tumors, classified as difficult-to-treat breast cancers (DTBC). This study aims to delineate the proteogenomic landscape of DTBC tumors compared to luminal A (LumA) tumors. METHODS We retrospectively collected a total of 117 untreated primary breast tumor specimens, focusing on DTBC subtypes. Breast tumors were processed by laser microdissection (LMD) to enrich tumor cells. DNA, RNA, and protein were simultaneously extracted from each tumor preparation, followed by whole genome sequencing, paired-end RNA sequencing, global proteomics and phosphoproteomics. Differential feature analysis, pathway analysis and survival analysis were performed to better understand DTBC and investigate biomarkers. RESULTS We observed distinct variations in gene mutations, structural variations, and chromosomal alterations between DTBC and LumA breast tumors. DTBC tumors predominantly had more mutations in TP53, PLXNB3, Zinc finger genes, and fewer mutations in SDC2, CDH1, PIK3CA, SVIL, and PTEN. Notably, Cytoband 1q21, which contains numerous cell proliferation-related genes, was significantly amplified in the DTBC tumors. LMD successfully minimized stromal components and increased RNA-protein concordance, as evidenced by stromal score comparisons and proteomic analysis. Distinct DTBC and LumA-enriched clusters were observed by proteomic and phosphoproteomic clustering analysis, some with survival differences. Phosphoproteomics identified two distinct phosphoproteomic profiles for high relapse-risk and low relapse-risk basal-like tumors, involving several genes known to be associated with breast cancer oncogenesis and progression, including KIAA1522, DCK, FOXO3, MYO9B, ARID1A, EPRS, ZC3HAV1, and RBM14. Lastly, an integrated pathway analysis of multi-omics data highlighted a robust enrichment of proliferation pathways in DTBC tumors. CONCLUSIONS This study provides an integrated proteogenomic characterization of DTBC vs LumA with tumor cells enriched through laser microdissection. We identified many common features of DTBC tumors and the phosphopeptides that could serve as potential biomarkers for high/low relapse-risk basal-like BC and possibly guide treatment selections.
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Affiliation(s)
- Praveen-Kumar Raj-Kumar
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Xiaoying Lin
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tao Liu
- Pacific Northwest National Laboratory, Richland, WA, USA
| | - Lori A Sturtz
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | | | | | - Brenda Deyarmin
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
| | - Jianfang Liu
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
| | | | - Guisong Wang
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | | | - Anil K Shukla
- Pacific Northwest National Laboratory, Richland, WA, USA
| | - Ronald J Moore
- Pacific Northwest National Laboratory, Richland, WA, USA
| | | | | | - Jeffrey A Hooke
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Leigh Fantacone-Campbell
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Brad Mostoller
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
| | - Leonid Kvecher
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jennifer Kane
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
| | - Jennifer Melley
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
| | - Stella Somiari
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
| | | | | | - Richard J Mural
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA
| | | | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Albert J Kovatich
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Hai Hu
- Chan Soon-Shiong Institute of Molecular Medicine at Windber, Windber, PA, USA.
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Peng L, Ma M, Zhao D, Zhao J, Sun Q, Mao F. Comparison of clinical characteristics and outcomes in primary neuroendocrine breast carcinoma versus invasive ductal carcinoma. Front Oncol 2024; 14:1291034. [PMID: 38800403 PMCID: PMC11116559 DOI: 10.3389/fonc.2024.1291034] [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: 09/08/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background Neuroendocrine breast carcinoma (NECB) is a rare, special histologic type of breast cancer. There are some small sample studies on the clinical outcomes of NECB patients, which are worthy of further discussion. Methods We conducted a retrospective case-control study of clinical characteristics and outcomes among patients with primary NECB versus invasive carcinoma of no special type (NST) between November 2004 and November 2017 in the Peking Union Medical College Hospital, Beijing. NST patients were strictly matched 1:4 during the same period based on the TNM stage. Statistical comparisons were performed to determine the differences in survival between NST and NECB patients and to identify clinical factors that correlate with prognosis. Results A total of 121 participants affected by primary NECB were included in our analysis from November 2004 to November 2017. Elderly persons (>60 years of age) were more likely to have primary NECB than young persons (p=0.001). In addition, primary NECB patients had significantly higher odds of having tumors 2-5 cm (36.5%) and >5 cm (6.1%) in size than NST patients. Despite a significant difference in tumor size, the proportion of patients with lymph node metastases showed no difference between the two groups (p=0.021). In addition, the rate of patients with ER-negative tumors in the NECB group (4.2%) was significantly lower than that in the primary NST group (29.8%). Significant differences were noted in the PR-negative (13.3% versus 36.6%, P<0.001) and HER2-negative (90.5% versus 76.4%, P=0.001) expression statuses among these patients. Of 121 primary NECB patients, 11 (9.1%) experienced relapses during the follow-up period. We found that tumor size was an independent risk factor for relapse. For hormone receptors on tumor cells, ER-positive breast cancer patients had significantly lower odds of relapse than receptor-negative patients. Conclusions Our data demonstrate no significant difference in mortality and relapse between the primary NECB and NST groups. The tumor size in the primary NECB group was significantly larger than that in the NST group. In addition, the absence of ER independently increased the relapse rate for breast carcinoma patients.
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Affiliation(s)
- Li Peng
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Mingwei Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dachun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jialin Zhao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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99
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Püsküllüoğlu M, Grela-Wojewoda A, Ambicka A, Pacholczak-Madej R, Pietruszka A, Mucha-Małecka A, Rudzińska A, Ziobro M, Ryś J, Mituś JW. Non-metastatic primary neuroendocrine neoplasms of the breast: a reference cancer center's experience of a heterogenous entity. Front Endocrinol (Lausanne) 2024; 15:1217495. [PMID: 38800480 PMCID: PMC11116701 DOI: 10.3389/fendo.2024.1217495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
Background Primary neuroendocrine neoplasms of the breast (Br-NENs) are rare. The classification has been updated in recent years making interpretation of the data published challenging. It is unclear whether neuroendocrine differentiation is associated with poorer prognosis and what treatment approaches should be applied. Methods The database for breast cancer patients treated between 2009 and 2022 at the Maria Sklodowska-Curie National Research Institute of Oncology Branch Krakow was explored to search for Br-NENs. Patients' medical and pathological data were collected and analyzed. Results We included 22 females with Br-NEN without metastases at the time of diagnosis. The median age was 64 years (range: 28-88), Of the cases, 18 were hormone receptor positive, all were HER-2 negative, the median Ki67 was 27% (10-100%). The median tumor size at the time of diagnosis was 29.5mm (7-75mm), 9 patients were N-positive. DCIS was present in 5 cases. Only one case was negative for chromogranin and synaptophysin staining, but data were missing for 4 cases. Nine patients received adjuvant chemotherapy, mainly based on anthracyclines and taxanes, while 16 received adjuvant hormonal therapy and 15 received postoperative radiotherapy. Radical surgery was performed in all patients, but two underwent suboptimal tumorectomy. One patient had local recurrence, three experienced metastatic disease, all involving the lungs, but these patients are still alive. The median follow-up was 96 months (8-153). Two patients died, with a follow up time of no recurrence >4 years. Our results were compared to twelve case series collecting clinical data on Br-NENs, with median patient number of 10.5 (range: 3-142). Conclusion Br-NENs represent a heterogenous group of diseases, lacking data from prospective studies or clinical trials. There are no established treatment standards tailored for Br-NENs. Our patients' cohort exhibited a favorable prognosis, potentially attributed to lower tumor stage and Ki67 index compared to other reported case series. We suggest that radical surgery and postoperative radiotherapy be administered akin to standard treatment for breast cancer of no special type. ESMO also advocates for this approach in systemic treatment, although we recommend considering platinum-based chemotherapy for patients with poorly differentiated Br-NENs exhibiting high Ki67.
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Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Aleksandra Ambicka
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Renata Pacholczak-Madej
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Agnieszka Pietruszka
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków Branch, Kraków, Poland
| | - Agnieszka Rudzińska
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Marek Ziobro
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Janusz Ryś
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Jerzy W. Mituś
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Department of Surgical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Kraków, Poland
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100
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Maimaitiaili A, Li Y, Chai N, Liu Z, Ling R, Zhao Y, Yang H, Liu Y, Liu K, Zhang J, Mao D, Yu Z, Liu Y, Fu P, Wang J, Jiang H, Zhao Z, Tian X, Cao Z, Wu K, Song A, Jin F, Wu P, He J, Fan Z, Zhang H. A nomogram for predicting pathologic node negativity after neoadjuvant chemotherapy in breast cancer patients: a nationwide, multicenter retrospective cohort study (CSBrS-012). Front Oncol 2024; 14:1326385. [PMID: 38800388 PMCID: PMC11116706 DOI: 10.3389/fonc.2024.1326385] [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: 12/26/2023] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose This study aimed to investigate the factors associated with pathologic node-negativity (ypN0) in patients who received neoadjuvant chemotherapy (NAC) to develop and validate an accurate prediction nomogram. Methods The CSBrS-012 study (2010-2020) included female patients with primary breast cancer treated with NAC followed by breast and axillary surgery in 20 hospitals across China. In the present study, 7,711 eligible patients were included, comprising 6,428 patients in the primary cohort from 15 hospitals and 1,283 patients in the external validation cohort from five hospitals. The hospitals were randomly assigned. The primary cohort was randomized at a 3:1 ratio and divided into a training set and an internal validation set. Univariate and multivariate logistic regression analyses were performed on the training set, after which a nomogram was constructed and validated both internally and externally. Results In total, 3,560 patients (46.2%) achieved ypN0, and 1,558 patients (20.3%) achieved pathologic complete response in the breast (bpCR). A nomogram was constructed based on the clinical nodal stage before NAC (cN), ER, PR, HER2, Ki67, NAC treatment cycle, and bpCR, which were independently associated with ypN0. The area under the receiver operating characteristic curve (AUC) for the training set was 0.80. The internal and external validation demonstrated good discrimination, with AUCs of 0.79 and 0.76, respectively. Conclusion We present a real-world study based on nationwide large-sample data that can be used to effectively screen for ypN0 to provide better advice for the management of residual axillary disease in breast cancer patients undergoing NAC.
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Affiliation(s)
- Amina Maimaitiaili
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yijun Li
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Na Chai
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhenzhen Liu
- Department of Breast Disease, Henan Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Yi Zhao
- Surgical Oncology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongjian Yang
- Department of Breast Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Yunjiang Liu
- Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ke Liu
- Fourth Department of Breast Surgery, Jilin Cancer Hospital, Changchun, China
| | - Jianguo Zhang
- Department of Breast Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dahua Mao
- Department of Breast Surgery, Affiliated Wudang Hospital of Guizhou Medical University, Guiyang, China
| | - Zhigang Yu
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yinhua Liu
- Breast Disease Center, Peking University First Hospital, Beijing, China
| | - Peifen Fu
- Department of Breast Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiandong Wang
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongchuan Jiang
- Department of Breast Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zuowei Zhao
- Department of Breast Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xingsong Tian
- Department of Breast and Thyroid Surgery , Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Zhongwei Cao
- Department of Thyroid, Breast, Hernia Surgery, The Inner Mongolia Autonomous Region People’s Hospital, Hohhot, China
| | - Kejin Wu
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ailin Song
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Feng Jin
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Puzhao Wu
- Department of Vascular Surgery/Interventional Medicine, Xiang yang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jianjun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhimin Fan
- Department of Breast Surgery, The First Hospital of Jilin University, Changchun, China
| | - Huimin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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