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Mahmoud MA, Ouf TIA, Kamal TH, El Aziz HTA. Predictive value of biological markers in loco-regional recurrence of breast cancer after mastectomy and radiotherapy. THE EGYPTIAN JOURNAL OF SURGERY 2023; 42:439-443. [DOI: 10.4103/ejs.ejs_82_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Objective
To assess the prognostic usefulness of the human epidermal growth factor receptor-2 (Her 2), the progestin receptor (PR), and the oestrogen receptor (ER) in locoregional recurrence following mastectomy radiotherapy in Egyptian breast cancer patients.
Patients and methods
This retrospective analysis comprised 432 female patients who had received radiation and had a mastectomy and immunohistochemistry reports. The Ethics Committee’s clearance was required before this study could be carried out at the Ain-Shams University hospitals.
Results
A total of 24 individuals developed LRR after a median follow-up period of 68.9 months. Although lymph nodes with more than three exhibited a statistically significant risk for LLR, tumour grade and pT were not significant risk factors. LRR risk rose for those who were HER2-positive and those with TNBC, but Luminal B had a non-significantly greater risk than Luminal A.
Conclusion
For breast cancer patients receiving PMRT, the biological subtype based on the categorization standard from the St. Gallen International Breast Cancer Conference (2013) Expert Panel acts as an accurate prognostic predictor. In HER2-positive and hormonal receptor-positive individuals, trastuzumab treatment significantly reduced the risk of LRR.
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Fendereski A, Hajizadeh E, Haghighat S, Rasekhi A. Long-term outcomes of non-metastatic breast cancer patients by molecular subtypes. BMC Womens Health 2022; 22:268. [PMID: 35787692 PMCID: PMC9254545 DOI: 10.1186/s12905-022-01846-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/23/2022] [Indexed: 11/11/2022] Open
Abstract
Background Today, with the progress of medical sciences, increasing the cure probability and survival time is an important goal of cancer treatment. This study compared long-term disease-free survival (DFS) of non-metastatic breast cancer patients based on different molecular subtypes. Methods This retrospective cohort study consisted of 1287 patients diagnosed with breast cancer and treated at Motamed Cancer Institute from 2000 to 2016 and followed up until 2018. Kaplan–Meier curve was fitted to data based on molecular subtypes. Then the semi-parametric mixture cure model was applied to determine the survival and cure probability of molecular subtypes by adjusting clinical and demographic factors. Results Among 1287 breast cancer patients, 200 (15.5%) cases died. The mean age of patients was 47.00 ± 10.72 years. Women with the HR+/HER2-subtype had the best 5-year survival rate (84.2%), whereas other subtypes had a lower rate as follows: HR+/HER2+ (77.3%), triple-negative (76.5%), and HR−/HER2+ (62.3%). Kaplan–Meier curve calculated a cure rate of about 60% and patients who survived more than 150 months were intuitively considered cured. After adjustment for clinical and demographic variables, the cure probability of HR−/Her2+ patients was substantially lower than HR+/HER2– patients (OR = 0.22), though there were no significant variations in short-term DFS based on molecular subtypes (HR = 0.91). Conclusions Our results confirm that the most prevalent breast cancer was HR+/HER2− tumor type which had the best prognosis. It is also concluded that HR−/HER2+ patients had the worst outcomes, with the highest rates of recurrence and metastasis and the lowest overall and disease-free survival rates.
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Affiliation(s)
- Afsaneh Fendereski
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ebrahim Hajizadeh
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran.
| | - Aliakbar Rasekhi
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Christensen NJ, Demharter S, Machado M, Pedersen L, Salvatore M, Stentoft-Hansen V, Iglesias MT. Identifying interactions in omics data for clinical biomarker discovery using symbolic regression. Bioinformatics 2022; 38:3749-3758. [PMID: 35731214 PMCID: PMC9344843 DOI: 10.1093/bioinformatics/btac405] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/22/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Motivation The identification of predictive biomarker signatures from omics and multi-omics data for clinical applications is an active area of research. Recent developments in assay technologies and machine learning (ML) methods have led to significant improvements in predictive performance. However, most high-performing ML methods suffer from complex architectures and lack interpretability. Results We present the application of a novel symbolic-regression-based algorithm, the QLattice, on a selection of clinical omics datasets. This approach generates parsimonious high-performing models that can both predict disease outcomes and reveal putative disease mechanisms, demonstrating the importance of selecting maximally relevant and minimally redundant features in omics-based machine-learning applications. The simplicity and high-predictive power of these biomarker signatures make them attractive tools for high-stakes applications in areas such as primary care, clinical decision-making and patient stratification. Availability and implementation The QLattice is available as part of a python package (feyn), which is available at the Python Package Index (https://pypi.org/project/feyn/) and can be installed via pip. The documentation provides guides, tutorials and the API reference (https://docs.abzu.ai/). All code and data used to generate the models and plots discussed in this work can be found in https://github.com/abzu-ai/QLattice-clinical-omics. Supplementary information Supplementary material is available at Bioinformatics online.
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Affiliation(s)
- Niels Johan Christensen
- Department of Chemistry, University of Copenhagen, Thorvaldsensvej 40, 1871, Denmark.,Abzu ApS, Orient Plads, Copenhagen, 2150, Denmark
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Ragusi MAA, van der Velden BHM, van Maaren MC, van der Wall E, van Gils CH, Pijnappel RM, Gilhuijs KGA, Elias SG. Population-based estimates of overtreatment with adjuvant systemic therapy in early breast cancer patients with data from the Netherlands and the USA. Breast Cancer Res Treat 2022; 193:161-173. [PMID: 35239071 PMCID: PMC8993748 DOI: 10.1007/s10549-022-06550-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/20/2022] [Indexed: 12/18/2022]
Abstract
Purpose Although adjuvant systemic therapy (AST) helps increase breast cancer-specific survival (BCSS), there is a growing concern for overtreatment. By estimating the expected BCSS of AST using PREDICT, this study aims to quantify the number of patients treated with AST without benefit to provide estimates of overtreatment. Methods Data of all non-metastatic unilateral breast cancer patients diagnosed in 2015 were retrieved from cancer registries from The Netherlands and the USA. The PREDICT tool was used to estimate AST survival benefit. Overtreatment was defined as the proportion of patients that would have survived regardless of or died despite AST within 10 years. Three scenarios were evaluated: actual treatment, and recommendations by the Dutch or USA guidelines. Results 59.5% of Dutch patients were treated with AST. 6.4% (interquartile interval [IQI] = 2.5, 8.2%) was expected to survive at least 10 years due to AST, leaving 93.6% (IQI = 91.8, 97.5%) without AST benefit (overtreatment). The lowest expected amount of overtreatment was in the targeted and chemotherapy subgroup, with 86.5% (IQI = 83.4, 89.6%) overtreatment, and highest in the only endocrine treatment subgroup, with 96.7% (IQI = 96.0, 98.1%) overtreatment. Similar results were obtained using data from the USA, and guideline recommendations. Conclusion Based on PREDICT, AST prevents 10-year breast cancer death in 6.4% of the patients treated with AST. Consequently, AST yields no survival benefit to many treated patients. Especially improved personalization of endocrine therapy is relevant, as this therapy is widely used and is associated with the highest amount of overtreatment. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06550-2.
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Affiliation(s)
- M. A. A. Ragusi
- Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - B. H. M. van der Velden
- Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - M. C. van Maaren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Hallenweg 5, 7522 NH Enschede, The Netherlands
| | - E. van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - C. H. van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - R. M. Pijnappel
- Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - K. G. A. Gilhuijs
- Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - S. G. Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
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Huang PH, Kim KH, Schermer M. Ethical Issues of Digital Twins for Personalized Health Care Service: Preliminary Mapping Study. J Med Internet Res 2022; 24:e33081. [PMID: 35099399 PMCID: PMC8844982 DOI: 10.2196/33081] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/27/2021] [Accepted: 11/16/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The concept of digital twins has great potential for transforming the existing health care system by making it more personalized. As a convergence of health care, artificial intelligence, and information and communication technologies, personalized health care services that are developed under the concept of digital twins raise a myriad of ethical issues. Although some of the ethical issues are known to researchers working on digital health and personalized medicine, currently, there is no comprehensive review that maps the major ethical risks of digital twins for personalized health care services. OBJECTIVE This study aims to fill the research gap by identifying the major ethical risks of digital twins for personalized health care services. We first propose a working definition for digital twins for personalized health care services to facilitate future discussions on the ethical issues related to these emerging digital health services. We then develop a process-oriented ethical map to identify the major ethical risks in each of the different data processing phases. METHODS We resorted to the literature on eHealth, personalized medicine, precision medicine, and information engineering to identify potential issues and developed a process-oriented ethical map to structure the inquiry in a more systematic way. The ethical map allows us to see how each of the major ethical concerns emerges during the process of transforming raw data into valuable information. Developers of a digital twin for personalized health care service may use this map to identify ethical risks during the development stage in a more systematic way and can proactively address them. RESULTS This paper provides a working definition of digital twins for personalized health care services by identifying 3 features that distinguish the new application from other eHealth services. On the basis of the working definition, this paper further layouts 10 major operational problems and the corresponding ethical risks. CONCLUSIONS It is challenging to address all the major ethical risks that a digital twin for a personalized health care service might encounter proactively without a conceptual map at hand. The process-oriented ethical map we propose here can assist the developers of digital twins for personalized health care services in analyzing ethical risks in a more systematic manner.
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Affiliation(s)
- Pei-Hua Huang
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ki-Hun Kim
- Department of Industrial Engineering, Pusan National University, Busan, Republic of Korea
| | - Maartje Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
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6
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Lizarraga IM, Schroeder MC, Jatoi I, Sugg SL, Trentham-Dietz A, Hoeth L, Chrischilles EA. Surgical Decision-Making Surrounding Contralateral Prophylactic Mastectomy: Comparison of Treatment Goals, Preferences, and Psychosocial Outcomes from a Multicenter Survey of Breast Cancer Patients. Ann Surg Oncol 2021; 28:8752-8765. [PMID: 34251554 DOI: 10.1245/s10434-021-10426-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 06/23/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Differences in patient characteristics and decision-making preferences have been described between those who elect breast-conserving surgery (BCS), unilateral mastectomy (UM), or contralateral prophylactic mastectomy (CPM) for breast cancer. However, it is not known whether preferred and actual decision-making roles differ across these surgery types, or whether surgery choice reflects a woman's goals or achieves desired outcomes. METHODS Women diagnosed with stage 0-III unilateral breast cancer across eight large medical centers responded to a mailed questionnaire regarding treatment decision-making goals, roles, and outcomes. These data were linked to electronic medical records. Differences were assessed using descriptive analyses and logistic regression. RESULTS There were 750 study participants: 60.1% BCS, 17.9% UM, and 22.0% CPM. On multivariate analysis, reducing worry about recurrence was a more important goal for surgery in the CPM group than the others. Although women's preferred role in the treatment decision did not differ by surgery, the CPM group was more likely to report taking a more-active-than-preferred role than the BCS group. On multivariate analysis that included receipt of additional surgery, posttreatment worry about both ipsilateral and contralateral recurrence was higher in the BCS group than the CPM group (both p < 0.001). The UM group was more worried than the CPM group about contralateral recurrence only (p < 0.001). CONCLUSIONS Women with CPM were more likely to report being able to reduce worry about recurrence as a very important goal for surgery. They were also the least worried about ipsilateral breast recurrence and contralateral breast cancer almost two years postdiagnosis.
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Affiliation(s)
- Ingrid M Lizarraga
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Mary C Schroeder
- Division of Health Services Research, College of Pharmacy, University of Iowa, Iowa City, IA, USA.
| | - Ismail Jatoi
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sonia L Sugg
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Amy Trentham-Dietz
- Carbone Cancer Center and Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Machine-Learning Provides Patient-Specific Prediction of Metastatic Risk Based on Innovative, Mechanobiology Assay. Ann Biomed Eng 2021; 49:1774-1783. [PMID: 33483841 DOI: 10.1007/s10439-020-02720-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/30/2020] [Indexed: 12/13/2022]
Abstract
Cancer mortality is mostly related to metastasis. Metastasis is currently prognosed via histopathology, disease-statistics, or genetics; those are potentially inaccurate, not rapidly available and require known markers. We had developed a rapid (~ 2 h) mechanobiology-based approach to provide early prognosis of the clinical likelihood for metastasis. Specifically, invasive cell-subsets seeded on impenetrable, physiological-stiffness polyacrylamide gels forcefully indent the gels, while non-invasive/benign cells do not. The number of indenting cells and their attained depths, the mechanical invasiveness, accurately define the metastatic risk of tumors and cell-lines. Utilizing our experimental database, we compare the capacity of several machine learning models to predict the metastatic risk. Models underwent supervised training on individual experiments using classification from literature and commercial-sources for established cell-lines and clinical histopathology reports for tumor samples. We evaluated 2-class models, separating invasive/non-invasive (e.g. benign) samples, and obtained sensitivity and specificity of 0.92 and 1, respectively; this surpasses other works. We also introduce a novel approach, using 5-class models (i.e. normal, benign, cancer-metastatic-non/low/high) that provided average sensitivity and specificity of 0.69 and 0.91. Combining our rapid, mechanical invasiveness assay with machine learning classification can provide accurate and early prognosis of metastatic risk, to support choice of treatments and disease management.
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Zaguirre K, Kai M, Kubo M, Yamada M, Kurata K, Kawaji H, Kaneshiro K, Harada Y, Hayashi S, Shimazaki A, Morisaki T, Mori H, Oda Y, Chen S, Moriyama T, Shimizu S, Nakamura M. Validity of the prognostication tool PREDICT version 2.2 in Japanese breast cancer patients. Cancer Med 2021; 10:1605-1613. [PMID: 33452761 PMCID: PMC7940221 DOI: 10.1002/cam4.3713] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/08/2020] [Accepted: 12/22/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction PREDICT is a prognostication tool that calculates the potential benefit of various postsurgical treatments on the overall survival (OS) of patients with nonmetastatic invasive breast cancer. Once patient, tumor, and treatment details have been entered, the tool will show the estimated 5‐, 10‐, and 15‐year OS outcomes, both with and without adjuvant therapies. This study aimed to conduct an external validation of the prognostication tool PREDICT version 2.2 by evaluating its predictive accuracy of the 5‐ and 10‐year OS outcomes among female patients with nonmetastatic invasive breast cancer in Japan. Methods All female patients diagnosed from 2001 to 2013 with unilateral, nonmetastatic, invasive breast cancer and had undergone surgical treatment at Kyushu University Hospital, Fukuoka, Japan, were selected. Observed and predicted 5‐ and 10‐year OS rates were analyzed for the validation population and the subgroups. Calibration and discriminatory accuracy were assessed using Chi‐squared goodness‐of‐fit test and area under the receiver operating characteristic curve (AUC). Results A total of 636 eligible cases were selected from 1, 213 records. Predicted and observed OS differed by 0.9% (p = 0.322) for 5‐year OS, and 2.4% (p = 0.086) for 10‐year OS. Discriminatory accuracy results for 5‐year (AUC = 0.707) and 10‐year (AUC = 0.707) OS were fairly well. Conclusion PREDICT tool accurately estimated the 5‐ and 10‐year OS in the overall Japanese study population. However, caution should be used for interpretation of the 5‐year OS outcomes in patients that are ≥65 years old, and also for the 10‐year OS outcomes in patients that are ≥65 years old, those with histologic grade 3 and Luminal A tumors, and in those considering ETx or no systemic treatment.
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Affiliation(s)
- Karen Zaguirre
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Institute of Surgery, St. Luke's Medical Center, Quezon City, Philippines
| | - Masaya Kai
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makoto Kubo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mai Yamada
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kanako Kurata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hitomi Kawaji
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhisa Kaneshiro
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yurina Harada
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Saori Hayashi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Shimazaki
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takafumi Morisaki
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hitomi Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sanmei Chen
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taiki Moriyama
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,International Medical Department, Kyushu University Hospital, Fukuoka, Japan
| | - Shuji Shimizu
- International Medical Department, Kyushu University Hospital, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Hagerling C, Owyong M, Sitarama V, Wang CY, Lin C, van den Bijgaart RJE, Koopman CD, Brenot A, Nanjaraj A, Wärnberg F, Jirström K, Klein OD, Werb Z, Plaks V. LGR5 in breast cancer and ductal carcinoma in situ: a diagnostic and prognostic biomarker and a therapeutic target. BMC Cancer 2020; 20:542. [PMID: 32522170 PMCID: PMC7285764 DOI: 10.1186/s12885-020-06986-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Novel biomarkers are required to discern between breast tumors that should be targeted for treatment from those that would never become clinically apparent and/or life threatening for patients. Moreover, therapeutics that specifically target breast cancer (BC) cells with tumor-initiating capacity to prevent recurrence are an unmet need. We investigated the clinical importance of LGR5 in BC and ductal carcinoma in situ (DCIS) to explore LGR5 as a biomarker and a therapeutic target. METHODS We stained BC (n = 401) and DCIS (n = 119) tissue microarrays with an antibody against LGR5. We examined an LGR5 knockdown ER- cell line that was orthotopically transplanted and used for in vitro colony assays. We also determined the tumor-initiating role of Lgr5 in lineage-tracing experiments. Lastly, we transplanted ER- patient-derived xenografts into mice that were subsequently treated with a LGR5 antibody drug conjugate (anti-LGR5-ADC). RESULTS LGR5 expression correlated with small tumor size, lower grade, lymph node negativity, and ER-positivity. ER+ patients with LGR5high tumors rarely had recurrence, while high-grade ER- patients with LGR5high expression recurred and died due to BC more often. Intriguingly, all the DCIS patients who later died of BC had LGR5-positive tumors. Colony assays and xenograft experiments substantiated a role for LGR5 in ER- tumor initiation and subsequent growth, which was further validated by lineage-tracing experiments in ER- /triple-negative BC mouse models. Importantly, by utilizing LGR5high patient-derived xenografts, we showed that anti-LGR5-ADC should be considered as a therapeutic for high-grade ER- BC. CONCLUSION LGR5 has distinct roles in ER- vs. ER+ BC with potential clinical applicability as a biomarker to identify patients in need of therapy and could serve as a therapeutic target for high-grade ER- BC.
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Affiliation(s)
- Catharina Hagerling
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA. .,Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, SE-221 85, Lund, Sweden. .,Present Address: Department of Laboratory Medicine, Division of Clinical Genetics, Lund University, SE-221 85, Lund, Sweden.
| | - Mark Owyong
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA
| | - Vaishnavi Sitarama
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA
| | - Chih-Yang Wang
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA.,Department of Biochemistry and Molecular Biology, Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Charlene Lin
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA
| | - Renske J E van den Bijgaart
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA.,Present Address: Radiotherapy and Oncoimmunology Laboratory, Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 32, 6525 GA, Nijmegen, Netherlands
| | - Charlotte D Koopman
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA.,Present Address: Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Yalelaan 50, 3584CM, Utrecht, Netherlands.,Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), University Medical Centre Utrecht, 3584CT, Utrecht, Netherlands
| | - Audrey Brenot
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA.,Present Address: ICCE Institute, School of Medicine, Department of Medicine, Washington University, St Louis, MO, 63110, USA
| | - Ankitha Nanjaraj
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA
| | - Fredrik Wärnberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, S413 45, Gothenburg, Sweden
| | - Karin Jirström
- Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, SE-221 85, Lund, Sweden
| | - Ophir D Klein
- Department of Orofacial Sciences, University of California, 513 Parnassus Avenue, San Francisco, CA, 94143-0452, USA.,Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Zena Werb
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA
| | - Vicki Plaks
- Department of Anatomy and the Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, 94143-0452, USA. .,Department of Orofacial Sciences, University of California, 513 Parnassus Avenue, San Francisco, CA, 94143-0452, USA.
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10
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Validation of an Automated Quantitative Digital Pathology Approach for Scoring TMEM, a Prognostic Biomarker for Metastasis. Cancers (Basel) 2020; 12:cancers12040846. [PMID: 32244564 PMCID: PMC7226227 DOI: 10.3390/cancers12040846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 11/25/2022] Open
Abstract
Metastasis causes ~90% of breast cancer mortality. However, standard prognostic tests based mostly on proliferation genes do not measure metastatic potential. Tumor MicroEnvironment of Metastasis (TMEM), an immunohistochemical biomarker for doorways on blood vessels that support tumor cell dissemination is prognostic for metastatic outcome in breast cancer patients. Studies quantifying TMEM doorways have involved manual scoring by pathologists utilizing static digital microscopy: a labor-intensive process unsuitable for use in clinical practice. We report here a validation study evaluating a new quantitative digital pathology (QDP) tool (TMEM-DP) for identification and quantification of TMEM doorways that closely mimics pathologists’ workflow and reduces pathologists’ variability to levels suitable for use in a clinical setting. Blinded to outcome, QDP was applied to a nested case-control study consisting of 259 matched case-control pairs. Sixty subjects of these were manually scored by five pathologists, digitally recorded using whole slide imaging (WSI), and then used for algorithm development and optimization. Validation was performed on the remainder of the cohort. TMEM-DP shows excellent reproducibility and concordance and reduces pathologist time from ~60 min to ~5 min per case. Concordance between manual scoring and TMEM-DP was found to be >0.79. These results show that TMEM-DP is capable of accurately identifying and scoring TMEM doorways (also known as MetaSite score) equivalent to pathologists.
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11
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Wang J, Luo J, Jin K, Wang X, Yang Z, Ma J, Mei X, Wang X, Zhou Z, Yu X, Chen X, Guo X. Biological subtype predicts locoregional recurrence after postmastectomy radiotherapy in Chinese breast cancer patients. Cancer Med 2020; 9:2427-2434. [PMID: 32048817 PMCID: PMC7131860 DOI: 10.1002/cam4.2904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/24/2019] [Accepted: 01/22/2020] [Indexed: 12/20/2022] Open
Abstract
Aim To investigate the impact of biological subtypes in locoregional recurrence in Chinese breast cancer patients receiving postmastectomy radiotherapy (PMRT). Methods and Materials About 583 patients who received postmastectomy radiation between 2010 and 2012 were retrospectively analyzed. According to immunohistochemical staining profile, patients were classified into: Luminal A‐like, Luminal B‐like, HER2‐positive, and triple‐negative breast cancer (TNBC). Local and regional recurrence (LRR) cumulative incidences were calculated by competing risks methodology and the power of prognostic factors was examined by Gray's test and the test of Fine and Gray. Results The median follow‐up was 70.9 months. About 34 LRR events occurred. For Luminal A, Luminal B, HER2‐positive, and TNBC patients, the 5‐year LRR cumulative incidence rates were 1.57%, 4.09%, 10.74%, and 10.28%. Compared with Luminal A, HER2‐positive subtype and TNBC had a significant increased risk of LRR (HR was 5.034 and 5.188, respectively). In univariate analysis, predictive factors for higher LRR were HER2‐positive subtype (HR = 4.43, P < .05), TNBC (HR = 4.70, P < .05), and pN3 (HR = 5.83, P < .05). In the multivariate model, HER2‐positive subtype (HR = 5.034, P < .05), TNBC (HR = 5.188, P < .05), and pN3 (HR = 9.607, P < .01) were independent predictors of LRR. LRR without trastuzumab was similar to that of TNBC (without vs TNBC, 17.88% vs 10.28%, P > .05) in HER2‐positive subtype patients, while LRR with trastuzumab was approximate to Luminal A (with vs Luminal A, P > .05). Additionally, endocrine therapy also significantly reduced LRR incidence in the luminal subtype cohort (without vs with therapy, 6.25% vs 2.89%, HR = 0.365, P < .1). Conclusions Biological subtype was a prognostic factor of LRR in the PMRT setting among Chinese breast cancer patients.
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Affiliation(s)
- Jiangfeng Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jurui Luo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kairui Jin
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xuanyi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhaozhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinli Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Mei
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaofang Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhirui Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xingxing Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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12
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Özmen V, Çakar B, Gökmen E, Özdoğan M, Güler N, Uras C, Ok E, Demircan O, Işıkdoğan A, Saip P. Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study. Eur J Breast Health 2019; 15:183-190. [PMID: 31312795 DOI: 10.5152/ejbh.2019.4761] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/22/2019] [Indexed: 11/22/2022]
Abstract
Objective Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective. Materials and Methods A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57% had low recurrence score (RS), 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33%. Results The cost of adjuvant chemotherapy in public hospitals was estimated at $3.649, and Oncotype Dx test was $5.141. Based on the cost-effectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be $7207.9 per QALY gained and $5720.6 per LY gained versus current clinical practice. Conclusion As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey.
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Affiliation(s)
- Vahit Özmen
- Department of General Surgery, İstanbul University School of Medicine, İstanbul, Turkey
| | - Burcu Çakar
- Division of Medical Oncology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Erhan Gökmen
- Division of Medical Oncology, Department of Internal Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Özdoğan
- Division of Medical Oncology, Memorial Hopital, Antalya, Turkey
| | - Nilufer Güler
- Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Cihan Uras
- Department of General Surgery, Acıbadem University, İstanbul, Turkey
| | - Engin Ok
- Department of General Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Orhan Demircan
- Department of General Surgery, Acıbadem University, İstanbul, Turkey
| | - Abdurrahman Işıkdoğan
- Division of Medical Oncology, Department of Internal Medicine, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Pınar Saip
- Division of Medical Oncology, Department of Internal Medicine, İstanbul University School of Medicine, İstanbul, Turkey
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13
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Social Network, Surgeon, and Media Influence on the Decision to Undergo Contralateral Prophylactic Mastectomy. Am J Clin Oncol 2019; 41:519-525. [PMID: 27465657 PMCID: PMC5976223 DOI: 10.1097/coc.0000000000000321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The rate of contralateral prophylactic mastectomy (CPM) has risen sharply in the past decade. The current study was designed to examine social network, surgeon, and media influence on patients' CPM decision-making, examining not only who influenced the decision, and to what extent, but also the type of influence exerted. METHODS Patients (N=113) who underwent CPM at 4 Indiana University-affiliated hospitals between 2008 and 2012 completed structured telephone interviews in 2013. Questions addressed the involvement and influence of the social network (family, friends, and nonsurgeon health professionals), surgeon, and media on the CPM decision. RESULTS Spouses, children, family, friends, and health professionals were reported as exerting a meaningful degree of influence on patients' decisions, largely in ways that were positive or neutral toward CPM. Most surgeons were regarded as providing options rather than encouraging or discouraging CPM. Media influence was present, but limited. CONCLUSIONS Patients who choose CPM do so with influence and support from members of their social networks. Reversing the increasing choice of CPM will require educating these influential others, which can be accomplished by encouraging patients to include them in clinical consultations, and by providing patients with educational materials that can be shared with their social networks. Surgeons need to be perceived as having an opinion, specifically that CPM should be reserved for those patients for whom it is medically indicated.
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14
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Imaging Biomarkers as Predictors for Breast Cancer Death. JOURNAL OF ONCOLOGY 2019; 2019:2087983. [PMID: 31093281 PMCID: PMC6481030 DOI: 10.1155/2019/2087983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/03/2019] [Accepted: 02/16/2019] [Indexed: 01/17/2023]
Abstract
Background To differentiate the risk of breast cancer death in a longitudinal cohort using imaging biomarkers of tumor extent and biology, specifically, the mammographic appearance, basal phenotype, histologic tumor distribution, and conventional tumor attributes. Methods Using a prospective cohort study design, 498 invasive breast cancer patients diagnosed between 1996 and 1998 were used as the test cohort to assess the independent effects of the imaging biomarkers and other predictors on the risk of breast cancer death. External validation was performed with a cohort of 848 patients diagnosed between 2006 and 2010. Results Mammographic tumor appearance was an independent predictor of risk of breast cancer death (P=0.0003) when conventional tumor attributes and treatment modalities were controlled. The casting type calcifications and architectural distortion were associated with 3.13-fold and 3.19-fold risks of breast cancer death, respectively. The basal phenotype independently conferred a 2.68-fold risk compared with nonbasal phenotype. The observed deaths did not differ significantly from expected deaths in the validation cohort. The application of imaging biomarkers together with other predictors classified twelve categories of risk for breast cancer death. Conclusion Combining imaging biomarkers such as the mammographic appearance of the tumor with the histopathologic distribution and basal phenotype, accurately predicted long-term risk of breast cancer death. The information may be relevant for determining the need for molecular testing, planning treatment, and determining the most appropriate clinical surveillance schedule for breast cancer patients.
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15
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Kaiser K, Cameron KA, Beaumont J, Garcia SF, Lacson L, Moran M, Karavites L, Rodgers C, Kulkarni S, Hansen NM, Khan SA. What does risk of future cancer mean to breast cancer patients? Breast Cancer Res Treat 2019; 175:579-584. [PMID: 30840165 DOI: 10.1007/s10549-019-05182-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Newly diagnosed breast cancer patients greatly overestimate their risk of developing contralateral breast cancer (CBC). Better understanding of patient conceptions of risk would facilitate doctor-patient communication and surgical decision making. In this mixed methods study, we prospectively examined breast cancer patients' perceived risk of future cancer and the reported factors that drove their risk perceptions. METHODS Women age 21-60 diagnosed with breast cancer without a BRCA mutation or known distant metastases completed a study interview between surgical consult and surgical treatment. Participants completed a 12-item Perceived Risk Questionnaire, which assessed 10-year and lifetime risks of ipsilateral local recurrence, CBC, and distant recurrence. Patients provided qualitative explanations for their answers. RESULTS Sixty-three patients completed study interviews (mean age 50.3). Participants were primarily White (85.7%) and 90.5% had attended college. Patients estimated their 10-year risk of CBC as 22.0%, nearly 4 times the established 10-year risk. Women attributed their risk perceptions to "gut feelings" about future cancer, even when women knew those feelings contradicted medically established risk. Perceptions of risk also reflected beliefs that cancer is random and that risk for local recurrence, CBC, and distant recurrence are the same. CONCLUSIONS Our findings point to the need for novel ways of presenting factual information regarding both risk of recurrence and of new primary cancers, as well as the necessity of acknowledging cognitive and affective processes many patients use when conceptualizing risk. By differentiating women's intuitive feelings about risk from their knowledge of medically estimated risk, doctors can enhance informed decision making.
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Affiliation(s)
- Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, 60611, Chicago, IL, USA.
| | - Kenzie A Cameron
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, 60611, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, 60611, Chicago, IL, USA
| | - Leilani Lacson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 2700, 60611, Chicago, IL, USA
| | | | | | - Chiara Rodgers
- American Association of Hip and Knee Surgeons, Chicago, IL, USA
| | - Swati Kulkarni
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nora M Hansen
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Seema A Khan
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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16
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Pollom EL, Qian Y, Chin AL, Dirbas FM, Asch SM, Kurian AW, Horst KC, Tsai CJ. Rising rates of bilateral mastectomy with reconstruction following neoadjuvant chemotherapy. Int J Cancer 2018; 143:3262-3272. [PMID: 29992582 PMCID: PMC6263854 DOI: 10.1002/ijc.31747] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 01/04/2023]
Abstract
Neoadjuvant chemotherapy (NAC) is used to allow more limited breast surgery without compromising local control. We sought to evaluate nationwide surgical trends in patients with operable breast cancer treated with NAC and factors associated with surgical type. We used the National Cancer Database to identify 235,339 women with unilateral T1-3 N0-3 M0 breast cancer diagnosed between 2010 and 2014 and treated with surgery and chemotherapy. Of these, 59,568 patients (25.3%) were treated with NAC. Rates of pathological complete response (pCR) to NAC increased from 33.3% at the start of the study period in 2010 to 46.3% at the end of the period in 2014 (p = 0.02). Rates of breast-conserving surgery (BSC) changed little, from 37.0 to 40.8% (p = 0.22). Although rates of unilateral mastectomy decreased from 43.3 to 34.7% (p = 0.02) and rates of bilateral mastectomy without immediate reconstruction remained similar (11.7-11.5%; p = 0.82), rates of bilateral mastectomy with immediate reconstruction rose from 8.0 to 13.1% (p = 0.02). Patients who were younger, with private/managed care insurance, and diagnosed in more recent years were more likely to achieve pCR; however, these same characteristics were associated with receipt of bilateral mastectomy (vs. BCS). In addition, non-Hispanic white ethnic and higher area education attainment were both associated with bilateral mastectomy. These findings did not differ by age or molecular subtype. Further study of nonclinical factors that influence selection of more extensive surgery despite excellent response to NAC is warranted.
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Affiliation(s)
- Erqi L Pollom
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Yushen Qian
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Alexander L Chin
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | | | - Steven M Asch
- Division of Primary Care and Population Health, Stanford University, Stanford, CA
| | - Allison W Kurian
- Department of Medicine (Oncology) and Health Research and Policy, Stanford University, Stanford, CA
| | - Kathleen C Horst
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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17
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Rodriguez-Velazquez A, Velez R, Lafontaine JC, Colon-Echevarria CB, Lamboy-Caraballo RD, Ramirez I, Mendoza A, Casbas-Hernandez P, Armaiz-Pena GN. Prevalence of breast and ovarian cancer subtypes in Hispanic populations from Puerto Rico. BMC Cancer 2018; 18:1177. [PMID: 30482165 PMCID: PMC6260719 DOI: 10.1186/s12885-018-5077-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 11/12/2018] [Indexed: 12/28/2022] Open
Abstract
Background Previous epidemiological studies aimed at describing characteristics of breast (BC) and ovarian cancer (OC) patients tend to examine Hispanic populations using a mix of individuals that come from ethnically different Hispanic backgrounds. Since most USA cancer statistics do not include cancer data from Puerto Rico (PR), there is a lack of historical and descriptive data analysis for Hispanic women in the island that suffer from these diseases. Therefore, the aim of our study is to provide a comprehensive clinicopathological characterization of BC and OC cases in PR. Methods Our study consisted of a longitudinal retrospective review of archived pathology reports at Southern Pathology Services (SPS), which mostly serves southwestern PR, from years 2000–2015. After filtering SPS records with pre-established criteria, tumor samples from 3451 BC and 170 OC cases were used for descriptive statistics and analysis using R program. Results In our cohort, the mean age of diagnosis for BC was 60.5 years and 60.3 years for OC. Available data for subtype characterization from BC cases, exhibited an expected subtype distribution that remained stable over time (Luminal A = 68.8%, Luminal B = 9.7%, HER-2 = 6.1% and Triple negative = 15.4%). Additionally, tumor grades distribution varied within different BC subtypes in which the majority of Luminal A tumors were G2 and most Triple negative tumors were G3. For OC cases, available subtype and tumor grade information identified serous histology in 64.71% of all cases and G3 as being the most prevalent tumor grade. Pathology reports revealed that 39.42% of all OC cases were described as late stage, while 50.5% as early stage (by pathological staging). Conclusion Our data suggests that OC and BC subtypes distribution in Hispanic populations from PR are in-line with national averages. In a significant number of BC cases, subtype could not be determined due to study limitations, health insurance coverage, or other reasons described here and may constitute a health disparity. Altogether, and despite these gaps, this study represents one of the most complete reviews of BC and OC in PR and provides an opportunity to further study this population separate from other US Hispanic populations. Electronic supplementary material The online version of this article (10.1186/s12885-018-5077-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariel Rodriguez-Velazquez
- Department of Basic Sciences, Division of Biochemistry, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Rosa Velez
- Southern Pathology Services Inc, Ponce, PR, USA
| | - Jean Carlo Lafontaine
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Claudia B Colon-Echevarria
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Rocio D Lamboy-Caraballo
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Ingrid Ramirez
- Department of Obstetrics and Gynecology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Adalberto Mendoza
- Southern Pathology Services Inc, Ponce, PR, USA.,Department of Pathology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA
| | - Patricia Casbas-Hernandez
- Department of Basic Sciences, Division of Biochemistry, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA.,Division of Cancer Biology, Ponce Research Institute, Ponce, PR, USA
| | - Guillermo N Armaiz-Pena
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, PR, USA. .,Division of Cancer Biology, Ponce Research Institute, Ponce, PR, USA.
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18
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Correlation of 18F-FDG PET/CT with pathological features and survival in primary breast cancer. Nucl Med Commun 2018; 38:694-700. [PMID: 28557954 DOI: 10.1097/mnm.0000000000000694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to determine the correlation between the primary tumor (PT) maximum standardized uptake value (SUVmax) and breast cancer prognostic factors, overall survival, and relapse-free survival on the basis of histopathological and molecular characteristics. PATIENTS AND METHODS In this retrospective study, 436 female patients with breast cancer were evaluated following a pretreatment F-FDG PET/CT scan. The PT SUVmax and histopathological/molecular characteristics were determined from primary tumor tissues and analyzed using the Mann-Whitney U and Kruskal-Wallis tests. RESULTS The median SUVmax of 436 PT was 10.1 (1.7-72). The PT SUVmax values were higher in ER- versus ER+ (P=0.001), PR- versus PR+ (P=0.001), Her2+ versus Her2- (P=0.01), Ki-67% of at least 20 versus Ki-67% of less than 20 (P<0.001), histological grade 3 versus grade 1-2 (P<0.001), nuclear pleomorphism score 3 versus score 1-2 (P<0.001), and mitotic score 3 versus score 1-2 patients (P<0.001). The lowest SUVmax levels were observed in the LumA group and the highest SUVmax levels were observed in the Her2 group (P<0.001). LumA patients with PR values greater than 20% had lower PT SUVmax values than the patients with PR values of 20% or less (P=0.023). The PT SUVmax was higher in patients with recurrence (P=0.03) and died related to disease (P<0.001) independent of time. CONCLUSION The PT SUVmax showed a significant correlation with most of the prognostic factors and histopathological subtypes as a noninvasive tool. It is also usable in the prediction of tumor-related deaths or relapse independent of time. Our results could guide future studies to provide new histopathologic subtype definitions on the basis of new PR criteria.
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19
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How Well Informed Do Patients Feel about Their Breast Cancer Surgery Options? Findings from a Nationwide Survey of Women after Lumpectomy and/or Mastectomy. J Am Coll Surg 2017; 226:134-146.e3. [PMID: 29246706 DOI: 10.1016/j.jamcollsurg.2017.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/05/2017] [Accepted: 10/18/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Women diagnosed with breast cancer often describe the process of treatment decision making as bewildering and worrisome. Patients who do not feel completely informed about their surgical options might make choices that are suboptimal or regretted later. The Institute of Medicine has called for more research on why breast cancer patients are inadequately informed about treatment options. The aims of the study were to explore how women become informed about their breast cancer surgery treatment options and to identify improvement opportunities. STUDY DESIGN A nationwide internet survey was conducted among women who reported being surgically treated by lumpectomy only (n = 215), mastectomy only (n = 140), or by both procedures (n = 132) for breast cancer. To improve generalizability, Census-based enrollment quotas were applied for geographic region, health insurance, and income. RESULTS Only 47% (95% CI 41% to 54%) of lumpectomy-only patients, 67% (95% CI 59% to 75%) of mastectomy-only patients, and 28% (95% CI 21% to 35%) of patients having both procedures said they felt "completely informed" about treatment options before their operations. "Making a quick decision" was more important than "thoroughly researching all options" for 35% of lumpectomy-only patients, 31% of mastectomy-only patients, and 22% of patients having both procedures. Nearly all women used some other source of information to research treatment options. Lumpectomy-only and mastectomy-only patients who relied on their surgeon's recommendation without additional research were significantly less likely to report feeling "completely informed" (odds ratio 0.6; 95% CI 0.4 to 0.9; p < 0.02). CONCLUSIONS Many women who had surgery for breast cancer did not feel completely informed about their surgical options. This appears to be due, in part, to a false sense of urgency and perhaps insufficient or misdirected information gathering by patients. The responsibility for fully informing patients about their treatment options must be better fulfilled by surgeons.
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20
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Blok EJ, Bastiaannet E, van den Hout WB, Liefers GJ, Smit VTHBM, Kroep JR, van de Velde CJH. Systematic review of the clinical and economic value of gene expression profiles for invasive early breast cancer available in Europe. Cancer Treat Rev 2017; 62:74-90. [PMID: 29175678 DOI: 10.1016/j.ctrv.2017.10.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/29/2017] [Indexed: 01/12/2023]
Abstract
Gene expression profiles with prognostic capacities have shown good performance in multiple clinical trials. However, with multiple assays available and numerous types of validation studies performed, the added value for daily clinical practice is still unclear. In Europe, the MammaPrint, OncotypeDX, PAM50/Prosigna and Endopredict assays are commercially available. In this systematic review, we aim to assess these assays on four important criteria: Assay development and methodology, clinical validation, clinical utility and economic value. We performed a literature search covering PubMed, Embase, Web of Science and Cochrane, for studies related to one or more of the four selected assays. We identified 147 papers for inclusion in this review. MammaPrint and OncotypeDX both have evidence available, including level IA clinical trial results for both assays. Both assays provide prognostic information. Predictive value has only been shown for OncotypeDX. In the clinical utility studies, a higher reduction in chemotherapy was achieved by OncotypeDX, although the number of available studies differ considerably between tests. On average, economic evaluations estimate that genomic testing results in a moderate increase in total costs, but that these costs are acceptable in relation to the expected improved patient outcome. PAM50/prosigna and EndoPredict showed comparable prognostic capacities, but with less economical and clinical utility studies. Furthermore, for these assays no level IA trial data are available yet. In summary, all assays have shown excellent prognostic capacities. The differences in the quantity and quality of evidence are discussed. Future studies shall focus on the selection of appropriate subgroups for testing and long-term outcome of validation trials, in order to determine the place of these assays in daily clinical practice.
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Affiliation(s)
- E J Blok
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - W B van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - G J Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - V T H B M Smit
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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21
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van Maaren MC, van Steenbeek CD, Pharoah PDP, Witteveen A, Sonke GS, Strobbe LJA, Poortmans PMP, Siesling S. Validation of the online prediction tool PREDICT v. 2.0 in the Dutch breast cancer population. Eur J Cancer 2017; 86:364-372. [PMID: 29100191 DOI: 10.1016/j.ejca.2017.09.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND PREDICT version 2.0 is increasingly used to estimate prognosis in breast cancer. This study aimed to validate this tool in specific prognostic subgroups in the Netherlands. METHODS All operated women with non-metastatic primary invasive breast cancer, diagnosed in 2005, were selected from the nationwide Netherlands Cancer Registry (NCR). Predicted and observed 5- and 10-year overall survival (OS) were compared for the overall cohort, separated by oestrogen receptor (ER) status, and predefined subgroups. A >5% difference was considered as clinically relevant. Discriminatory accuracy and goodness-of-fit were determined using the area under the receiver operating characteristic curve (AUC) and the Chi-squared-test. RESULTS We included 8834 patients. Discriminatory accuracy for 5-year OS was good (AUC 0.80). For ER-positive and ER-negative patients, AUCs were 0.79 and 0.75, respectively. Predicted 5-year OS differed from observed by -1.4% in the entire cohort, -0.7% in ER-positive and -4.9% in ER-negative patients. Five-year OS was accurately predicted in all subgroups. Discriminatory accuracy for 10-year OS was good (AUC 0.78). For ER-positive and ER-negative patients AUCs were 0.78 and 0.76, respectively. Predicted 10-year OS differed from observed by -1.0% in the entire cohort, -0.1% in ER-positive and -5.3 in ER-negative patients. Ten-year OS was overestimated (6.3%) in patients ≥75 years and underestimated (-13.%) in T3 tumours and patients treated with both endocrine therapy and chemotherapy (-6.6%). CONCLUSIONS PREDICT predicts OS reliably in most Dutch breast cancer patients, although results for both 5-year and 10-year OS should be interpreted carefully in ER-negative patients. Furthermore, 10-year OS should be interpreted cautiously in patients ≥75 years, T3 tumours and in patients considering endocrine therapy and chemotherapy.
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Affiliation(s)
- M C van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - C D van Steenbeek
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - P D P Pharoah
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - A Witteveen
- Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - G S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - P M P Poortmans
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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22
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Morrow M, Abrahamse P, Hofer TP, Ward KC, Hamilton AS, Kurian AW, Katz SJ, Jagsi R. Trends in Reoperation After Initial Lumpectomy for Breast Cancer: Addressing Overtreatment in Surgical Management. JAMA Oncol 2017; 3:1352-1357. [PMID: 28586788 DOI: 10.1001/jamaoncol.2017.0774] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance Surgery after initial lumpectomy to obtain more widely clear margins is common and may lead to mastectomy. Objective To describe surgeons' approach to surgical margins for invasive breast cancer, and changes in postlumpectomy surgery rates, and final surgical treatment following a 2014 consensus statement endorsing a margin of "no ink on tumor." Design, Setting, and Participants This was a population-based cohort survey study of 7303 eligible women ages 20 to 79 years with stage I and II breast cancer diagnosed in 2013 to 2015 and identified from the Georgia and Los Angeles County, California, Surveillance, Epidemiology, and End Results registries. A total of 5080 (70%) returned a survey. Those with bilateral disease, missing stage or treatment data, and with ductal carcinoma in situ were excluded, leaving 3729 patients in the analytic sample; 98% of these identified their attending surgeon. Between April 2015 and May 2016, 488 surgeons were surveyed regarding lumpectomy margins; 342 (70%) responded completely. Pathology reports of all patients having a second surgery and a 30% sample of those with 1 surgery were reviewed. Time trends were analyzed with multinomial regression models. Main Outcomes and Measures Rates of final surgical procedure (lumpectomy, unilateral mastectomy, bilateral mastectomy) and rates of additional surgery after initial lumpectomy over time, and surgeon attitudes toward an adequate lumpectomy margin. Results The 67% rate of initial lumpectomy in the 3729 patient analytic sample was unchanged during the study. The rate of final lumpectomy increased by 13% from 2013 to 2015, accompanied by a decrease in unilateral and bilateral mastectomy (P = .002). Surgery after initial lumpectomy declined by 16% (P < .001). Pathology review documented no significant association between date of treatment and positive margins. Of 342 responding surgeons, 69% endorsed a margin of no ink on tumor to avoid reexcision in estrogen receptor-positive progesterone receptor-positive cancer and 63% for estrogen receptor-negative progesterone- receptor-negative cancer. Surgeons treating more than 50 breast cancers annually were significantly more likely to report this margin as adequate (85%; n = 105) compared with those treating 20 cases or fewer (55%; n = 131) (P < .001). Conclusions and Relevance Additional surgery after initial lumpectomy decreased markedly from 2013 to 2015 concomitant with dissemination of clinical guidelines endorsing a minimal negative margin. These findings suggest that surgeon-led initiatives to address potential overtreatment can reduce the burden of surgical management in patients with cancer.
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Affiliation(s)
- Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Abrahamse
- School of Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Timothy P Hofer
- School of Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor.,Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Service Center of Innovation, Ann Arbor, Michigan
| | - Kevin C Ward
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Ann S Hamilton
- Keck School of Medicine, Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Allison W Kurian
- Departments of Medicine and Health Research and Policy, Stanford University, Stanford, California
| | - Steven J Katz
- School of Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor.,School of Public Health, Department of Health Management and Policy, University of Michigan, Ann Arbor
| | - Reshma Jagsi
- School of Medicine, Department of Radiation Oncology, University of Michigan, Ann Arbor
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23
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Cheng SHC, Huang TT, Cheng YH, Tan TBK, Horng CF, Wang YA, Brian NS, Shih LS, Yu BL. Validation of the 18-gene classifier as a prognostic biomarker of distant metastasis in breast cancer. PLoS One 2017; 12:e0184372. [PMID: 28886126 PMCID: PMC5590926 DOI: 10.1371/journal.pone.0184372] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/22/2017] [Indexed: 12/14/2022] Open
Abstract
We validated an 18-gene classifier (GC) initially developed to predict local/regional recurrence after mastectomy in estimating distant metastasis risk. The 18-gene scoring algorithm defines scores as: <21, low risk; ≥21, high risk. Six hundred eighty-three patients with primary operable breast cancer and fresh frozen tumor tissues available were included. The primary outcome was the 5-year probability of freedom from distant metastasis (DMFP). Two external datasets were used to test the predictive accuracy of 18-GC. The 5-year rates of DMFP for patients classified as low-risk (n = 146, 21.7%) and high-risk (n = 537, 78.6%) were 96.2% (95% CI, 91.1%-98.8%) and 80.9% (74.6%-81.9%), respectively (median follow-up interval, 71.8 months). The 5-year rates of DMFP of the low-risk group in stage I (n = 62, 35.6%), stage II (n = 66, 20.1%), and stage III (n = 18, 10.3%) were 100%, 94.2% (78.5%-98.5%), and 90.9% (50.8%-98.7%), respectively. Multivariate analysis revealed that 18-GC is an independent prognostic factor of distant metastasis (adjusted hazard ratio, 5.1; 95% CI, 1.8-14.1; p = 0.0017) for scores of ≥21. External validation showed that the 5-year rate of DMFP in the low- and high-risk patients was 94.1% (82.9%-100%) and 80.3% (70.7%-89.9%, p = 0.06) in a Singapore dataset, and 89.5% (81.9%-94.1%) and 73.6% (67.2%-79.0%, p = 0.0039) in the GEO-GSE20685 dataset, respectively. In conclusion, 18-GC is a viable prognostic biomarker for breast cancer to estimate distant metastasis risk.
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Affiliation(s)
- Skye Hung-Chun Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
- Department of Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Tzu-Ting Huang
- Department of Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Yu-Hao Cheng
- Resident, Department of Medicine, Cathy General Hospital, Taipei, Taiwan
| | - Tee Benita Kiat Tan
- National Cancer Center, Singapore (NCCS), Singapore, Singapore
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - Chen-Fang Horng
- Department of Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Yong Alison Wang
- Department of Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nicholas Shannon Brian
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - Li-Sun Shih
- Department of Laboratory and Pathology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Ben-Long Yu
- Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
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24
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O’Brien M, Dhesy-Thind S, Charles C, Hammond Mobilio M, Leighl N, Grunfeld E. Uptake of a 21-gene expression assay in breast cancer practice: views of academic and community-based oncologists. Curr Oncol 2017; 24:e138-e145. [PMID: 28490937 PMCID: PMC5407877 DOI: 10.3747/co.24.3395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Advances in personalized medicine have produced novel tests and treatment options for women with breast cancer. Relatively little is known about the process by which such tests are adopted into oncology practice. The objectives of the present study were to understand the experiences of medical oncologists with multigene expression profile (gep) tests, including their adoption into practice in early-stage breast cancer, and the perceptions of the oncologists about the influence of test results on treatment decision-making. METHODS We conducted a qualitative descriptive study involving interviews with medical oncologists from academic and community cancer centres or hospitals in 8 communities in Ontario. A 21-gene breast cancer assay was used as the example of gep testing. Qualitative analytic techniques were used to identify the main themes. RESULTS Of 28 oncologists who were approached, 21 (75%) participated in the study [median age: 43 years; 12 women (57%)]. Awareness and knowledge of gep testing were derived from several sources: international scientific meetings, participation in clinical studies, discussions with respected colleagues, and manufacturer-sponsored meetings. Oncologists observed that incorporating gep testing into their clinical practice resulted in several changes, including longer consultation times, second visits, and taking steps to minimize treatment delays. Oncologists expressed divergent opinions about the strength of evidence and added value of gep testing in guiding treatment decisions. CONCLUSIONS Incorporation of gep testing into clinical practice in early-stage breast cancer required oncologists to make changes to their usual routines. The opinions of oncologists about the quality of evidence underpinning the test affected how much weight they gave to test results in treatment decision-making.
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Affiliation(s)
- M.A. O’Brien
- Department of Family and Community Medicine, University of Toronto, Toronto
| | | | - C. Charles
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton
| | | | - N.B. Leighl
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto; and
| | - E. Grunfeld
- Department of Family and Community Medicine, University of Toronto, Toronto
- Ontario Institute for Cancer Research, Toronto, ON
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25
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Arora NK, Hesse BW, Clauser SB. Walking in the shoes of patients, not just in their genes: a patient-centered approach to genomic medicine. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:239-45. [PMID: 25300612 DOI: 10.1007/s40271-014-0089-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Genomic technologies are increasing the precision with which clinicians can assess an individual patient's risk for developing diseases and identify which patients are likely to benefit from specific treatments. Also advocating for a shift away from a one-size-fits-all approach is the growing emphasis on "patient-centered" care. Using examples from breast cancer, we make a case for why, in order to optimize patient health outcomes, genomic medicine will need to be practiced within a patient-centered framework. We present a six-function conceptual framework for patient-centered care and discuss findings from a national survey evaluating the patient-centeredness of care delivered in the USA.
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Affiliation(s)
- Neeraj K Arora
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, 9609 Medical Center Drive, 3E514, MSC 9762, Bethesda, MD, 20892-9762, USA,
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26
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Raziee H, Berlin A. Gaps between Evidence and Practice in Postoperative Radiotherapy for Prostate Cancer: Focus on Toxicities and the Effects on Health-Related Quality of Life. Front Oncol 2016; 6:70. [PMID: 27047800 PMCID: PMC4805642 DOI: 10.3389/fonc.2016.00070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/10/2016] [Indexed: 12/24/2022] Open
Abstract
Adjuvant radiotherapy (ART) after prostatectomy for patients with high-risk features [extracapsular extension (ECE), seminal vesicle invasion (SVI), and positive margin] has been shown to be associated with improved biochemical disease-free survival in three large randomized trials and with improved overall survival in one. Similarly, salvage radiotherapy (SRT) can effectively achieve biochemical control in a significant proportion of patients with a rising PSA after surgery. Nonetheless, both approaches of postoperative RT remain highly underutilized. This might be partly due to concerns with overtreatment inherent to adjuvant approaches, and/or hesitance about causing radiation toxicities and their subsequent effects on the patient's quality of life. Herein, we review the literature lending evidence to these arguments. We show recent series of ART/SRT and their low rates of acute and long-term toxicities, translating only in transient decline in quality-of-life (QoL) outcomes. We conclude that concerns with side effects should not preclude the recommendation of an effective and curative-intent therapy for men with prostate cancer initially treated with radical surgery.
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Affiliation(s)
- Hamid Raziee
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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27
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Angelos P, Bedrosian I, Euhus DM, Herrmann VM, Katz SJ, Pusic A. Contralateral Prophylactic Mastectomy: Challenging Considerations for the Surgeon. Ann Surg Oncol 2015; 22:3208-12. [PMID: 26259752 DOI: 10.1245/s10434-015-4758-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Indexed: 01/02/2023]
Abstract
The use of both bilateral prophylactic mastectomy and contralateral prophylactic mastectomy (CPM) has increased significantly during the last decade. Various risk models have been developed to identify patients at increased risk for breast cancer. The indications for bilateral prophylactic mastectomy for patients without a diagnosis of breast cancer include high risk from mutation in BRCA or other breast cancer predisposition gene, very strong family history with no identifiable mutation, and high risk based on breast histology. Additionally, the use of CPM has more than doubled in the last decade, and this increase is noted among all stages of breast cancer, even in patients with ductal carcinoma in situ (stage 0). The risk of contralateral breast cancer often is overestimated by both patients and physicians. Nevertheless, specific risk factors are associated with an increased risk of contralateral breast cancer, including BRCA or other genetic mutation, young age at diagnosis, lobular histology, family history, and prior chest wall irradiation. Although CPM reduces the incidence of contralateral breast cancer, the effect on disease-free survival and, more importantly, overall survival is questionable and underscored by the fact that the reason most patients choose CPM is to achieve "peace of mind." Newer and effective reconstructive options have made the procedure more attractive. This panel addresses the indications and rationale for bilateral prophylactic mastectomy and CPM, the decision-making process by patients, and ethical considerations. Changes in the physician-patient relationship during the past few decades have altered the approach, and ethical considerations are paramount in addressing these issues.
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Affiliation(s)
- Peter Angelos
- McLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
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28
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Feig SA. Overdiagnosis of breast cancer at screening is clinically insignificant. Acad Radiol 2015; 22:961-6. [PMID: 25797300 DOI: 10.1016/j.acra.2015.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 01/12/2015] [Accepted: 01/22/2015] [Indexed: 11/30/2022]
Abstract
Long-term follow-up of randomized trials provide the most accurate estimates of overdiagnosis. Estimates from follow-up of service screening studies are almost as accurate if there is sufficient adjustment for lead time and risk status. When properly analyzed data from both of these types of trials indicate that the rate of overdiagnosis at screening mammography is clinically negligible: 0-5%. Population trend studies are a potentially highly inaccurate means to estimate overdiagnosis. Most cases of DCIS detected at screening are medium and high grade with substantial potential to become an invasive disease. To avoid overtreatment, clinicians need to tailor their treatment of DCIS to the histologic and molecular characteristics of each case.
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Affiliation(s)
- Stephen A Feig
- Department of Radiological Sciences, University of California Irvine Medical Center, 101 City Drive South, Orange CA 92869-3298.
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29
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Katz SJ, Belkora J, Elwyn G. Shared decision making for treatment of cancer: challenges and opportunities. J Oncol Pract 2015; 10:206-8. [PMID: 24839284 DOI: 10.1200/jop.2014.001434] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Treatment recommendations are based on complicated clinical information that is revealed variably over time after initial diagnosis. Integrating this information into a treatment plan is challenging, as different specialists direct the various treatments.
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Affiliation(s)
- Steven J Katz
- University of Michigan Institute for Health Policy Studies, Ann Arbor, MI; University of California, San Francisco, San Francisco, CA; The Dartmouth Center for Health Care Delivery Science; and The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Jeffrey Belkora
- University of Michigan Institute for Health Policy Studies, Ann Arbor, MI; University of California, San Francisco, San Francisco, CA; The Dartmouth Center for Health Care Delivery Science; and The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Glyn Elwyn
- University of Michigan Institute for Health Policy Studies, Ann Arbor, MI; University of California, San Francisco, San Francisco, CA; The Dartmouth Center for Health Care Delivery Science; and The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
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30
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Martinez KA, Kurian AW, Hawley ST, Jagsi R. How can we best respect patient autonomy in breast cancer treatment decisions? BREAST CANCER MANAGEMENT 2015; 4:53-64. [PMID: 25733982 PMCID: PMC4342843 DOI: 10.2217/bmt.14.47] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Helping patients to maximize their autonomy in breast cancer decision-making is an important aspect of patient-centered care. Shared decision-making is a strategy that aims to maximize patient autonomy by integrating the values and preferences of the patient with the biomedical expertise of the physician. Application of this approach in breast cancer decision-making has not been uniform across cancer-specific interventions (e.g., surgery, chemotherapy), and in some circumstances may present challenges to evidence-based care delivery. Increasingly precise estimates of individual patients' risk of recurrence and commensurate predicted benefit from certain therapies hold significant promise in helping patients exercise autonomous decision-making for their breast cancer care, yet will also likely complicate decision-making for certain subgroups of patients.
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Affiliation(s)
- Kathryn A Martinez
- VA Center for Clinical Management Research, 2800 Plymouth Road, Building 16, 3rd Floor, Ann Arbor, MI 48105, USA
| | - Allison W Kurian
- Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305, USA
| | - Sarah T Hawley
- VA Center for Clinical Management Research, 2800 Plymouth Road, Building 16, 3rd Floor, Ann Arbor, MI 48105, USA
- Division of General Medicine, University of Michigan, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor MI, 48105, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
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31
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Martinez KA, Li Y, Resnicow K, Graff JJ, Hamilton AS, Hawley ST. Decision Regret following Treatment for Localized Breast Cancer: Is Regret Stable Over Time? Med Decis Making 2014; 35:446-57. [PMID: 25532824 DOI: 10.1177/0272989x14564432] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/21/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND While studies suggest most women have little regret regarding their breast cancer treatment decisions immediately following treatment, no studies to date have evaluated how regret may change over time. OBJECTIVE To measure the stability of posttreatment decision regret over time among women with breast cancer. METHODS Women diagnosed with breast cancer between August 2005 and May 2007 reported to the Detroit, Michigan, or Los Angeles County Surveillance, Epidemiology, and End Results (SEER) registry and completed surveys at 9 months following diagnosis (time 1) and again approximately 4 years later (time 2). A decision regret scale consisting of 5 items was summed to create 2 decision regret scores at both time 1 and time 2 (range, 0-20). Multivariable linear regression was used to examine change in regret from 9 months to 4 years. Independent variables included surgery type, receipt of reconstruction, and recurrence status at follow-up. The model controlled for demographic and clinical factors. RESULTS The analytic sample included 1536 women. Mean regret in the overall sample was 4.9 at time 1 and 5.4 at time 2 (P < 0.001). In the multivariable linear model, we found no difference in change in decision regret over time by surgery type. Reporting a new diagnosis of breast cancer at time 2 was associated with a 2.6-point increase in regret over time compared with women without an additional diagnosis (P = 0.003). Receipt of reconstruction was not associated with change in decision regret over time. CONCLUSIONS Decision regret following treatment was low and relatively stable over time for most women. Those facing an additional diagnosis of breast cancer following treatment may be at risk for elevated regret-related distress.
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Affiliation(s)
- Kathryn A Martinez
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (KAM, STH)
| | - Yun Li
- University of Michigan School of Public Health, Department of Biostatistics, Ann Arbor, Michigan (YL)
| | - Ken Resnicow
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, Michigan (KR)
| | - John J Graff
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey (JJG)
| | - Ann S Hamilton
- Keck School of Medicine, University of Southern California, Los Angeles, California (ASH)
| | - Sarah T Hawley
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (KAM, STH),University of Michigan, Division of General Medicine, Ann Arbor, Michigan (STH)
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32
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Danzig MR, McKiernan JM. Overtreatment of men with early-stage prostate cancer and limited life expectancy. Cancer 2014; 120:3592-4. [PMID: 25042257 DOI: 10.1002/cncr.28927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/30/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew R Danzig
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
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