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Molière S, Lodi M, Leblanc S, Gressel A, Mathelin C, Alpy F, Chenard MP, Tomasetto C. MMP-11 expression in early luminal breast cancer: associations with clinical, MRI, pathological characteristics, and disease-free survival. BMC Cancer 2024; 24:295. [PMID: 38438841 PMCID: PMC10913243 DOI: 10.1186/s12885-024-11998-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/13/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Early hormone-positive breast cancers typically have favorable outcomes, yet long-term surveillance is crucial due to the risk of late recurrences. While many studies associate MMP-11 expression with poor prognosis in breast cancer, few focus on early-stage cases. This study explores MMP-11 as an early prognostic marker in hormone-positive breast cancers. METHODS In this retrospective study, 228 women with early hormone-positive invasive ductal carcinoma, treated surgically between 2011 and 2016, were included. MMP-11 expression was measured by immunohistochemistry, and its association with clinical and MRI data was analyzed. RESULTS Among the patients (aged 31-89, median 60, with average tumor size of 15.7 mm), MMP-11 staining was observed in half of the cases. This positivity correlated with higher uPA levels and tumor grade but not with nodal status or size. Furthermore, MMP-11 positivity showed specific associations with MRI features. Over a follow-up period of 6.5 years, only 12 oncological events occurred. Disease-free survival was linked to Ki67 and MMP-11. CONCLUSION MMP-11, primarily present in tumor-surrounding stromal cells, correlates with tumor grade and uPA levels. MMP-11 immunohistochemical score demonstrates a suggestive trend in association with disease-free survival, independent of Ki67 and other traditional prognostic factors. This highlights the potential of MMP-11 as a valuable marker in managing early hormone-positive breast cancer.
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Affiliation(s)
- Sébastien Molière
- Institute of Genetics and Molecular and Cellular Biology, Illkirch, France.
- Centre National de la Recherche Scientifique, UMR 7104, Illkirch, France.
- Institut National de la Santé et de la Recherche Médicale, U1258, Illkirch, France.
- University of Strasbourg, Illkirch, France.
- Department of Radiology, Strasbourg University Hospital, Hôpital de Hautepierre, Strasbourg, France.
- Breast and Thyroid Imaging Unit, ICANS, Strasbourg, France.
| | - Massimo Lodi
- Institute of Genetics and Molecular and Cellular Biology, Illkirch, France
- Centre National de la Recherche Scientifique, UMR 7104, Illkirch, France
- Institut National de la Santé et de la Recherche Médicale, U1258, Illkirch, France
| | | | - Anne Gressel
- Department of Pathology, Strasbourg University Hospital, Hôpital de Hautepierre, Avenue Molière, Strasbourg, France
| | - Carole Mathelin
- University of Strasbourg, Illkirch, France
- Department of Senology, ICANS, Strasbourg, France
- Department of Gynecology and Obstetrics, Strasbourg University Hospital, Hôpital de Hautepierre, Avenue Molière, Strasbourg, France
| | - Fabien Alpy
- Institute of Genetics and Molecular and Cellular Biology, Illkirch, France
- Centre National de la Recherche Scientifique, UMR 7104, Illkirch, France
- Institut National de la Santé et de la Recherche Médicale, U1258, Illkirch, France
- University of Strasbourg, Illkirch, France
| | - Marie-Pierre Chenard
- University of Strasbourg, Illkirch, France
- Department of Pathology, Strasbourg University Hospital, Hôpital de Hautepierre, Avenue Molière, Strasbourg, France
| | - Catherine Tomasetto
- Institute of Genetics and Molecular and Cellular Biology, Illkirch, France
- Centre National de la Recherche Scientifique, UMR 7104, Illkirch, France
- Institut National de la Santé et de la Recherche Médicale, U1258, Illkirch, France
- University of Strasbourg, Illkirch, France
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2
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Dogan I, Aydin E, Khanmammadov N, Paksoy N, Ferhatoğlu F, Ak N, Emiroglu S, Ibis K, Onder S, Tukenmez M, Cabioglu N, Kucucuk S, Muslumanoğlu M, Ozmen V, Saip P, Igci A, Aydiner A. Long-term outcomes and predictors of recurrence in node-negative early stage breast cancer patients. J Cancer Res Clin Oncol 2023; 149:14833-14841. [PMID: 37594533 DOI: 10.1007/s00432-023-05276-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND We evaluated the outcomes, and risk factors for recurrence in patients with early stage node-negative breast cancer in this study. METHOD Retrospective data analysis was done on patient treatment records from 1988 to 2018. The patient's demographic, clinical, pathological, and therapeutic characteristics were noted. To evaluate survival analysis and predictors of recurrence, we employed Kaplan-Meier analysis with the log-rank test. RESULTS A total of 357 patients in all were enrolled in the research. At the time of diagnosis, the median age was 50 (with a range of 18-81). A total of 85.5% of patients had undergone a lumpectomy, while 14.5% had a mastectomy. 78.7% of patients had sentinel lymph node biopsy, and 21.3% had axillary lymph node dissection. In addition, the patients received adjuvant radiotherapy (88.7%), adjuvant endocrine therapy (82.1%), and adjuvant chemotherapy (48.5%). Recurrence of the tumor occurred in 31 (8.7%) patients (local recurrence 45.2% and metastatic disease 54.8%). Ten- and twenty-year recurrence-free survival rates were 92% and 77%. 19 (5.3%) patients had also developed contralateral breast cancer. Ten-year survival rates were 91.6%, and 20-year survival rates were 76.6%, respectively. Aged over 65 years (p = 0.004), necrosis (p = 0.002), mitosis (p = 0.003), and nuclear pleomorphism (p = 0.049) were found as statistically significant factors for recurrence in univariate analysis. In the ROC analysis, the largest size of the tumor (over 1.45 cm, p = 0.07) remained outside the statistical significance limit in terms of recurrence. CONCLUSIONS Thirty-year outcomes in individuals with early stage, node-negative breast cancer were shown in this study. We found that the recurrence ratios between 10 and 20 years were more frequent than the first 10 years during the follow-up. Despite the small number of patients who experienced a recurrence, we demonstrated that, in univariate analysis, being older than 65 and having some pathological characteristics (nuclear pleomorphism, mitosis, and necrosis) were statistically significant factors for disease recurrence.
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Affiliation(s)
- Izzet Dogan
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey.
| | - Esra Aydin
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Nijat Khanmammadov
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Nail Paksoy
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Ferhat Ferhatoğlu
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Naziye Ak
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Selman Emiroglu
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Kamuran Ibis
- Istanbul University Institute of Oncology, Radiation Oncology, Istanbul, Turkey
| | - Semen Onder
- Department of Pathology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Tukenmez
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Neslihan Cabioglu
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Seden Kucucuk
- Istanbul University Institute of Oncology, Radiation Oncology, Istanbul, Turkey
| | - Mahmut Muslumanoğlu
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Vahit Ozmen
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Pinar Saip
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
| | - Abdullah Igci
- Department of Surgery, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Adnan Aydiner
- Department of Medical Oncology, Istanbul University Institute of Oncology, Medical Oncology, Çapa, Fatih, 34093, Istanbul, Turkey
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3
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Wu C, Huang O, Wu J, Shen K, Chen X, Zhu S. Tumor size is associated with adjuvant chemotherapy benefit in T1N0M0 triple-negative breast cancer: a multicenter and propensity score matched analysis. Gland Surg 2023; 12:1375-1386. [PMID: 38021197 PMCID: PMC10660177 DOI: 10.21037/gs-23-189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/17/2023] [Indexed: 12/01/2023]
Abstract
Background Triple-negative breast cancer (TNBC) is characterized by aggressive phonotypes and relatively poor outcomes. There are controversies on the effect of adjuvant chemotherapy in small (T1N0M0) TNBCs, especially among T1a-b patients. This study evaluated the survival benefit of adjuvant chemotherapy and influential factors in T1N0M0 TNBC patients. Methods All T1N0M0 TNBC patients were identified from the Shanghai Jiao Tong University Breast Cancer Database (SJTU-BCDB) between January 2009 and December 2021. Propensity score matched (PSM) was applied to create a matched cohort. We used Kaplan-Meier analysis and Cox regression models to evaluate the associations of adjuvant chemotherapy with breast cancer-free interval (BCFI) and overall survival (OS). Stratified analysis according to different influential factors was also performed. Results In total, 1,113 T1N0M0 TNBC patients (297 T1a, T1b and 816 T1c) were enrolled, including 928 patients with adjuvant chemotherapy and 185 patients without adjuvant chemotherapy. After matching 441 patients by using PSM analysis, 294 patients with chemotherapy and 147 patients without chemotherapy were identified. Patients with or without chemotherapy had similar BCFI (P=0.241) and OS (P=0.509). However, regarding patients with different tumor sizes, adjuvant chemotherapy could significantly improve BCFI in T1c patients (5-year BCFI: 92.1% vs. 79.5%, P=0.035) but not in T1a-b patients (5-year BCFI: 93.6% vs. 94.6%, P=0.546). No significant difference in OS was observed among patients with different tumor sizes. Subgroup analysis found that only tumor size was significantly associated with adjuvant chemotherapy benefit in terms of BCFI (Pinteraction=0.021) and OS (Pinteraction=0.040). Conclusions The survival benefit of adjuvant chemotherapy was significantly associated with tumor size in T1N0M0 TNBC. Benefit of adjuvant chemotherapy was found in T1c, but not in T1a-b patients. Our findings do not support the routine use of chemotherapy in patients with T1a-bN0 TNBC.
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Affiliation(s)
- Chenghui Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ou Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siji Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Schreier S, Budchart P, Borwornpinyo S, Arpornwirat W, Lertsithichai P, Chirappapha P, Triampo W. New inflammatory indicators for cell-based liquid biopsy: association of the circulating CD44+/CD24− non-hematopoietic rare cell phenotype with breast cancer residual disease. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04330-5. [PMID: 36100762 PMCID: PMC9470072 DOI: 10.1007/s00432-022-04330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
Background Breast cancer residual disease assessment in early-stage patients has been challenging and lacks routine identification of adjuvant therapy benefit and objective measure of therapy success. Liquid biopsy assays targeting tumor-derived entities are investigated for minimal residual disease detection, yet perform low in clinical sensitivity. We propose the detection of CD44−related systemic inflammation for the assessment of residual cancer. Methods Circulating CD44+/CD45− rare cells from healthy, noncancer- and cancer-afflicted donors were enriched by CD45 depletion and analyzed by immuno-fluorescence microscopy. CD44+ rare cell subtyping was based on cytological feature analysis and referred to as morphological index. AUC analysis was employed for identification of the most cancer-specific CD44+ subtype. Results The EpCam−/CD44+/CD24−/CD71−/CD45−/DNA+ phenotype alludes to a distinct cell type and was found frequently at concentrations below 5 cells per 5 mL in healthy donors. Marker elevation by at least 5 × on average was observed in all afflicted cohorts. The positive predicted value for the prediction of malignancy-associated systemic inflammation of a CD44+ rare cell subtype with a higher morphological index was 87%. An outlook for the frequency of sustained inflammation in residual cancer may be given to measure 78%. Conclusion The CD44+ rare cell and subtype denotes improvement in detection of residual cancer disease and may provide an objective and alternative measure of disease burden in early-stage breast cancer.
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Affiliation(s)
- Stefan Schreier
- School of Bioinnovation and Bio-Based Product Intelligence, Faculty of Science, Mahidol University, Rama VI Rd, Bangkok, 10400, Thailand.
- Thailand Center of Excellence in Physics, Ministry of Higher Education, Science, Research and Innovation, 328 Si Ayutthaya Road, Bangkok, 10400, Thailand.
- Premise Biosystems Co. Ltd, Bangkok, 10540, Thailand.
| | | | - Suparerk Borwornpinyo
- Premise Biosystems Co. Ltd, Bangkok, 10540, Thailand
- Excellent Center for Drug Discovery, Faculty of Science, Mahidol University, Rama VI Rd, Bangkok, 10400, Thailand
| | - Wichit Arpornwirat
- Department of Oncology, Bangkok Hospital, 2 Soi Soonvijai 7, New Petchburi Rd, Huaykwang, Bangkok, 10310, Thailand
| | - Panuwat Lertsithichai
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Prakasit Chirappapha
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Wannapong Triampo
- Thailand Center of Excellence in Physics, Ministry of Higher Education, Science, Research and Innovation, 328 Si Ayutthaya Road, Bangkok, 10400, Thailand
- Department of Physics, Faculty of Science, Mahidol University, Bangkok, 10400, Thailand
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5
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Zhong W, Yi J, Wu H, Zou X, Feng J, Huang X, Li S, Wang X. Androgen receptor expression and its prognostic value in T1N0 luminal/HER2- breast cancer. Future Oncol 2022; 18:1745-1756. [PMID: 35227076 DOI: 10.2217/fon-2021-1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: The authors aimed to evaluate the prognostic and predictive value of androgen receptor (AR) expression in patients with luminal/human EGFR2 negative (HER2-) T1N0 breast cancer. Methods: The cohort in this retrospective study comprised 471 patients with luminal/HER2- T1N0 breast cancer who had undergone surgery between 2013 and 2017 in the authors' center. Results: Androgen receptor (AR)+ tumors were associated with favorable characteristics. AR+ patients had better 5-year recurrence-free survival rates and the risk of recurrence was greater for AR- than for AR+ patients. AR- status predicted the failure of adjuvant endocrine therapy with aromatase inhibitors and of adjuvant chemotherapy with docetaxel plus cyclophosphamide. Conclusion: AR+ expression is significantly related to a better prognosis. AR expression may be an additional biomarker for both endocrine and chemotherapy responsiveness.
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Affiliation(s)
- Wenjing Zhong
- Department of Breast Surgery, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Jiarong Yi
- Department of Breast Surgery, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Haoming Wu
- Department of Breast Surgery, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Xuxiazi Zou
- Department of Breast Surgery, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Jikun Feng
- Department of Breast Surgery, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Xinjian Huang
- Department of Breast Surgery, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Siqi Li
- Department of Breast Surgery, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Xi Wang
- Department of Breast Surgery, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-Sen University, Guangzhou, 510060, China
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Karakolevska-Ilova M, Zdravkovska M, Jasar D, Petrushevska G, Simeonovska-Joveva E. Can Estrogen Receptor, Progesterone Receptor, and Proliferative Index be Considered as Isolated Prognostic Factors of Overall Survival in Early luminal Breast Cancer? Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: There are a number of proven molecular and pathological markers important for the prognosis for OS of early luminal type breast cancer, but there are still some deficiencies mainly due to the non-linear relationship between the markers and the outcome of the disease.
METHODS AND PATIENTS: In this retro-prospective study, clinical and pathological data were provided from 336 patients with breast cancer who underwent breast surgery and treatment between January 2010 and December 2013, and followed until December 2018. The aim of the study was an evaluation of ER, PR, and Ki-67 as independent prognostic factors for OS of early luminal breast cancer.
RESULTS: Early luminal breast cancers were not predictive of ER expression status (p = 0.699, p = 0.356), whereas only early Luminal B was predictive for PR expression (>10%: 72.2%). Ki-67 in most of the cases of early Luminal B was with expression of >14–20% (p = 0.056). Patients with ER of 1–10% survived over 80 months (p = 0.0020) in early Luminal A, but ER expression status did not show prognostic significance for OS of early Luminal B (p = 0.775). PR status did not show prognostic significance for OS in early luminal types (p = 0.257, p = 0.622). ER >1%/PR >1% was protective in early Luminal B (p = 0.00043), but not in early Luminal A.
CONCLUSION: Our results suggest ER, but not PR as independent prognostic factor for OS but only of early Luminal A. We did not prove Ki-67 as independent prognostic factor for OS of highly proliferative early breast cancer.
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Schaduangrat N, Malik AA, Nantasenamat C. ERpred: a web server for the prediction of subtype-specific estrogen receptor antagonists. PeerJ 2021; 9:e11716. [PMID: 34285834 PMCID: PMC8274494 DOI: 10.7717/peerj.11716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/11/2021] [Indexed: 11/22/2022] Open
Abstract
Estrogen receptors alpha and beta (ERα and ERβ) are responsible for breast cancer metastasis through their involvement of clinical outcomes. Estradiol and hormone replacement therapy targets both ERs, but this often leads to an increased risk of breast and endometrial cancers as well as thromboembolism. A major challenge is posed for the development of compounds possessing ER subtype specificity. Herein, we present a large-scale classification structure-activity relationship (CSAR) study of inhibitors from the ChEMBL database which consisted of an initial set of 11,618 compounds for ERα and 7,810 compounds for ERβ. The IC50 was selected as the bioactivity unit for further investigation and after the data curation process, this led to a final data set of 1,593 and 1,281 compounds for ERα and ERβ, respectively. We employed the random forest (RF) algorithm for model building and of the 12 fingerprint types, models built using the PubChem fingerprint was the most robust (Ac of 94.65% and 92.25% and Matthews correlation coefficient (MCC) of 89% and 76% for ERα and ERβ, respectively) and therefore selected for feature interpretation. Results indicated the importance of features pertaining to aromatic rings, nitrogen-containing functional groups and aliphatic hydrocarbons. Finally, the model was deployed as the publicly available web server called ERpred at http://codes.bio/erpred where users can submit SMILES notation as the input query for prediction of the bioactivity against ERα and ERβ.
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Affiliation(s)
- Nalini Schaduangrat
- Center of Data Mining and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Aijaz Ahmad Malik
- Center of Data Mining and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Chanin Nantasenamat
- Center of Data Mining and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
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Völkel V, Hueting TA, Draeger T, van Maaren MC, de Munck L, Strobbe LJA, Sonke GS, Schmidt MK, van Hezewijk M, Groothuis-Oudshoorn CGM, Siesling S. Improved risk estimation of locoregional recurrence, secondary contralateral tumors and distant metastases in early breast cancer: the INFLUENCE 2.0 model. Breast Cancer Res Treat 2021; 189:817-826. [PMID: 34338943 PMCID: PMC8505302 DOI: 10.1007/s10549-021-06335-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To extend the functionality of the existing INFLUENCE nomogram for locoregional recurrence (LRR) of breast cancer toward the prediction of secondary primary tumors (SP) and distant metastases (DM) using updated follow-up data and the best suitable statistical approaches. METHODS Data on women diagnosed with non-metastatic invasive breast cancer were derived from the Netherlands Cancer Registry (n = 13,494). To provide flexible time-dependent individual risk predictions for LRR, SP, and DM, three statistical approaches were assessed; a Cox proportional hazard approach (COX), a parametric spline approach (PAR), and a random survival forest (RSF). These approaches were evaluated on their discrimination using the Area Under the Curve (AUC) statistic and on calibration using the Integrated Calibration Index (ICI). To correct for optimism, the performance measures were assessed by drawing 200 bootstrap samples. RESULTS Age, tumor grade, pT, pN, multifocality, type of surgery, hormonal receptor status, HER2-status, and adjuvant therapy were included as predictors. While all three approaches showed adequate calibration, the RSF approach offers the best optimism-corrected 5-year AUC for LRR (0.75, 95%CI: 0.74-0.76) and SP (0.67, 95%CI: 0.65-0.68). For the prediction of DM, all three approaches showed equivalent discrimination (5-year AUC: 0.77-0.78), while COX seems to have an advantage concerning calibration (ICI < 0.01). Finally, an online calculator of INFLUENCE 2.0 was created. CONCLUSIONS INFLUENCE 2.0 is a flexible model to predict time-dependent individual risks of LRR, SP and DM at a 5-year scale; it can support clinical decision-making regarding personalized follow-up strategies for curatively treated non-metastatic breast cancer patients.
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Affiliation(s)
- Vinzenz Völkel
- Tumor Center Regensburg/University of Regensburg, Institute for Quality Control and Health Services Research, Regensburg, Germany
| | - Tom A Hueting
- Evidencio, medical Decision Support, Haaksbergen, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, POBox 217, Enschede, 7500 AE, The Netherlands
| | - Teresa Draeger
- Tumor Center Regensburg/University of Regensburg, Institute for Quality Control and Health Services Research, Regensburg, Germany
| | - Marissa C van Maaren
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, POBox 217, Enschede, 7500 AE, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), POBox 19079, Utrecht, 3501 DB, The Netherlands
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), POBox 19079, Utrecht, 3501 DB, The Netherlands
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - Catharina G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, POBox 217, Enschede, 7500 AE, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, POBox 217, Enschede, 7500 AE, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), POBox 19079, Utrecht, 3501 DB, The Netherlands.
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Bacinschi XE, Zgura A, Safta I, Anghel R. Biomolecular Factors Represented by Bcl-2, p53, and Tumor-Infiltrating Lymphocytes Predict Response for Adjuvant Anthracycline Chemotherapy in Patients with Early Triple-Negative Breast Cancer. Cancer Manag Res 2020; 12:11965-11971. [PMID: 33244272 PMCID: PMC7685384 DOI: 10.2147/cmar.s274104] [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: 07/30/2020] [Accepted: 11/01/2020] [Indexed: 12/21/2022] Open
Abstract
Treatment of triple-negative breast cancer is challenging. Standard adjuvant tretment is considered to be the cobination of anthracycline and taxanes although the role of anthracyclines administered preoperatively remains controversial. Actually, some studies recommended taxane-only regimens. We reviewed literatures to examine whether tissue biomarkers available in an ordinary laboratory setting (eg, haematoxylin and eosin and immunohistochemistry) may predict response to adjuvant anthracyclines in patients with triple-negative breast cancer. Our review showed that Bcl-2, p53, and tumor-infiltrating lymphocytes (TILs) expression may become independent predictors for triple-negative breast cancer. This finding was based on data from retrospective studies, and, thus, randomized controlled study is needed to confirm the present results.
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Affiliation(s)
- Xenia Elena Bacinschi
- Department of Oncology-Radiotherapy, Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Anca Zgura
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Inga Safta
- Department of Medical Oncology, Antoine Lacassagne Cancer Center, Nice, France
| | - Rodica Anghel
- Department of Oncology-Radiotherapy, Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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Witteveen A, de Munck L, Groothuis‐Oudshoorn CG, Sonke GS, Poortmans PM, Boersma LJ, Smidt ML, Vliegen IM, IJzerman MJ, Siesling S. Evaluating the Age-Based Recommendations for Long-Term Follow-Up in Breast Cancer. Oncologist 2020; 25:e1330-e1338. [PMID: 32510767 PMCID: PMC7485372 DOI: 10.1634/theoncologist.2019-0973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND After 5 years of annual follow-up following breast cancer, Dutch guidelines are age based: annual follow-up for women <60 years, 60-75 years biennial, and none for >75 years. We determined how the risk of recurrence corresponds to these consensus-based recommendations and to the risk of primary breast cancer in the general screening population. SUBJECTS, MATERIALS, AND METHODS Women with early-stage breast cancer in 2003/2005 were selected from the Netherlands Cancer Registry (n = 18,568). Cumulative incidence functions were estimated for follow-up years 5-10 for locoregional recurrences (LRRs) and second primary tumors (SPs). Risks were compared with the screening population without history of breast cancer. Alternative cutoffs for age were determined by log-rank tests. RESULTS The cumulative risk for LRR/SP was lower in women <60 years (5.9%, 95% confidence interval [CI] 5.3-6.6) who are under annual follow-up than for women 60-75 (6.3%, 95% CI 5.6-7.1) receiving biennial visits. All risks were higher than the 5-year risk of a primary tumor in the screening population (ranging from 1.4% to 1.9%). Age cutoffs <50, 50-69, and > 69 revealed better risk differentiation and would provide more risk-based schedules. Still, other factors, including systemic treatments, had an even greater impact on recurrence risks. CONCLUSION The current consensus-based recommendations use suboptimal age cutoffs. The proposed alternative cutoffs will lead to a more balanced risk-based follow-up and thereby more efficient allocation of resources. However, more factors should be taken into account for truly individualizing follow-up based on risk for recurrence. IMPLICATIONS FOR PRACTICE The current age-based recommendations for breast cancer follow-up after 5 years are suboptimal and do not reflect the actual risk of recurrent disease. This results in situations in which women with higher risks actually receive less follow-up than those with a lower risk of recurrence. Alternative cutoffs could be a start toward risk-based follow-up and thereby more efficient allocation of resources. However, age, or any single risk factor, is not able to capture the risk differences and therefore is not sufficient for determining follow-up. More risk factors should be taken into account for truly individualizing follow-up based on the risk for recurrence.
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Affiliation(s)
- Annemieke Witteveen
- Department of Biomedical Signals and Systems / Personalized eHealth Technology, University of TwenteEnschedeThe Netherlands
| | - Linda de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | | | - Gabe S. Sonke
- Department of Medical Oncology, Netherlands Cancer Institute (NKI)AmsterdamThe Netherlands
| | - Philip M. Poortmans
- Iridium KankernetwerkWilrijk‐AntwerpBelgium
- University of Antwerp, Faculty of Medicine and Health SciencesWilrijk‐AntwerpBelgium
| | - Liesbeth J. Boersma
- Department of Radiation Oncology, Maastricht University Medical Center (Maastro)MaastrichtThe Netherlands
- GROW‐School for Oncology and Developmental Biology, Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Marjolein L. Smidt
- GROW‐School for Oncology and Developmental Biology, Maastricht University Medical CentreMaastrichtThe Netherlands
- Department of Surgery, Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Ingrid M.H. Vliegen
- Department of Industrial Engineering and Innovation Sciences, Technical University EindhovenEindhovenThe Netherlands
| | - Maarten J. IJzerman
- Department of Health Technology and Services Research, Technical Medical Centre, University of TwenteEnschedeThe Netherlands
- University of Melbourne, Centre for Cancer Research and Centre for Health PolicyParkvilleMelbourneAustralia
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of TwenteEnschedeThe Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
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11
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Zhong W, Yang Y, Zhang A, Lin W, Liang G, Ling Y, Zhong J, Yong J, Liu Z, Tian Z, Lin Q, Luo Q, Li Y, Gong C. Prognostic and predictive value of the combination of TOP2A and HER2 in node-negative tumors 2 cm or smaller (T1N0) breast cancer. Breast Cancer 2020; 27:1147-1157. [PMID: 32780321 DOI: 10.1007/s12282-020-01142-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND We aim to evaluate the prognostic and predictive value of TOP2A and HER2 expression in T1N0 breast cancer patients. METHODS 299 cases with T1N0 breast cancer were obtained from the Oncomine database (Cohort 1) and 963 of T1N0 breast cancer patients from Sun Yat-sen Memorial Hospital (Cohort 2) were retrospectively enrolled. Kaplan-Meier product was applied to estimate survival curve. Cox proportional hazard models was used to identify prognostic factors. We used PSM (propensity score matching) to balance clinicopathologic characteristics among four groups of different HER2/TOP2A status. Survival between groups and chemotherapy regimens were analyzed, before and after PSM. RESULTS In Cohort 1, we found that the group with HER2+ and higher expression of TOP2A mRNA was associated with poor breast cancer-specific survival (BCSS) compared to the group of HER2- with lower expression of TOP2A mRNA. In Cohort 2, HER2+ patients with higher TOP2A protein expression had greater risk of recurrence and distant recurrence compared to HER2- patients with lower expression of TOP2A protein. Among the patients who developed both HER2+ and higher expression of TOP2A protein and received chemotherapy, patients who received an anthracycline-based regimen had a significantly better recurrence-free survival (RFS) than those with a non-anthracycline-based regime. CONCLUSION Patients with both HER2+ and high expression level of TOP2A protein predicts poor prognosis in T1N0 breast cancer patients. Patients with double positive for TOP2A protein and HER2 may benefit from anthracycline-based regimens.
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Affiliation(s)
- Wenjing Zhong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Ailing Zhang
- Department of Breast Surgery, Dongguan City People's Hospital, Dongguan, People's Republic of China
| | - Wanyi Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Gehao Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Yun Ling
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Jiajie Zhong
- Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Juanjuan Yong
- Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zihao Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Zhenluan Tian
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Qun Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Qing Luo
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Yangyang Li
- Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Chang Gong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China. .,Department of Breast Surgery, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China.
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12
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The prognostic and predictive potential of Ki-67 in triple-negative breast cancer. Sci Rep 2020; 10:225. [PMID: 31937819 PMCID: PMC6959292 DOI: 10.1038/s41598-019-57094-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/20/2019] [Indexed: 01/02/2023] Open
Abstract
As a cell proliferation biomarker, Ki-67 is principally used in ER+/HER2− breast cancer. However, the importance and the best cutoff point of Ki-67 in triple-negative breast cancer (TNBC) remains unclear and was evaluated in this study.A total of 1800 patients with early invasive TNBC between 2011 and 2016 at Fudan University Shanghai Cancer Center were consecutively recruited for this study. The optimal cutoff for Ki-67 was assessed by Cutoff Finder. Propensity score matching (PSM, ratio = 1:2) was performed to match the Ki-67low group with the Ki-67high group. Overall survival (OS) and disease-free survival (DFS) were compared between the two groups using the Kaplan-Meier method and Cox regression model. The most relevant cutoff value for Ki-67 for prognosis was 30% (p = 0.008). At the cutoff point of 30%, worse DFS and OS were observed in the Ki-67high group. In multivariate analyses, N-stage (p < 0.001), T-stage (p = 0.038), and Ki-67 at the 30% threshold (p = 0.020) were independently linked to OS. In subgroup analysis, Ki-67 cutoff at 30% had prognostic and predictive potential for DFS with either tumor size ≤2 cm (p = 0.008) or lymph node-negative (N−) (p = 0.038) and especially with T1N0M0 (stage I) TNBCs. For 945 N− TNBC patients, adjuvant chemotherapy (CT) was associated with better OS in the Ki-67high group (p = 0.017) than in the Ki-67low group (p = 0.875). For stage I/Ki-67low patients, adjuvant CT did not affect DFS (p = 0.248). Thus, Ki-67 cutoff at 30% had early independent prognostic and predictive potential for OS and DFS in TNBCs, and Ki-67 > 30% was significantly associated with worse prognosis, especially for stage I patients. For stage I/Ki-67low TNBC patients, the advantage of CT is unclear, providing the basis for future de-escalation therapy.
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13
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Predicting the risk of locoregional recurrence after early breast cancer: an external validation of the Dutch INFLUENCE-nomogram with clinical cancer registry data from Germany. J Cancer Res Clin Oncol 2019; 145:1823-1833. [PMID: 30927074 PMCID: PMC6571079 DOI: 10.1007/s00432-019-02904-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/22/2019] [Indexed: 12/13/2022]
Abstract
Purpose Follow-up after breast cancer treatment aims for an early detection of locoregional breast cancer recurrences (LRR) to improve the patients’ outcome. By estimating individual’s 5-year recurrence-risks, the Dutch INFLUENCE-nomogram can assist health professionals and patients in developing personalized risk-based follow-up pathways. The objective of this study is to validate the prediction tool on non-Dutch patients. Material and methods Data for this external validation derive from a large clinical cancer registry in southern Germany, covering a population of 1.1 million. Patients with curative resection of early-stage breast cancer, diagnosed between 2000 and 2012, were included in the analysis (n = 6520). For each of them, an individual LRR-risk was estimated by the INFLUENCE-nomogram. Its predictive ability was tested by comparing estimated and observed LRR-probabilities using the Hosmer–Lemeshow goodness-of-fit test and C-statistics. Results In the German validation-cohort, 2.8% of the patients developed an LRR within 5 years after primary surgery (n = 184). While the INFLUENCE-nomogram generally underestimates the actual LRR-risk of the German patients (p < 0.001), its discriminative ability is comparable to the one observed in the original Dutch modeling-cohort (C-statistic German validation-cohort: 0.73, CI 0.69–0.77 vs. C-statistic Dutch modeling-cohort: 0.71, CI 0.69–0.73). Similar results were obtained in most of the subgroup analyses stratified by age, type of surgery and intrinsic biological subtypes. Conclusion The outcomes of this external validation underline the generalizability of the INFLUENCE-nomogram beyond the Dutch population. The model performance could be enhanced in future by incorporating additional risk factors for LRR.
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14
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Zhong W, Tan L, Jiang WG, Chen K, You N, Sanders AJ, Liang G, Liu Z, Ling Y, Gong C. Effect of younger age on survival outcomes in T1N0M0 breast cancer: A propensity score matching analysis. J Surg Oncol 2019; 119:1039-1046. [PMID: 30892719 DOI: 10.1002/jso.25457] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE We evaluated the effect of younger age on recurrence risk in Chinese women diagnosed with T1N0M0 breast cancer (BC), using propensity score matching (PSM) analysis. METHODS We included 365 women who were diagnosed with T1N0M0 BC between 2003 and 2016, and who received surgery at our center. They were classified as younger (≤40 years) and older (>40 years). We used PSM to balance clinicopathologic characteristics between the two age groups. Survival was analyzed by the Kaplan-Meier method, before and after PSM. RESULTS Over a median follow-up period of 79 months, 54 patients developed recurrences. Before PSM, younger patients had worse recurrence-free survival (RFS) than older patients. Significantly worse RFS was seen in younger patients with HER2+ BC compared with their older counterparts. Younger patients had higher rates of locoregional recurrence rather than metastasis, especially in the first 5 years after diagnosis. After PSM, the two age groups still significantly differed in 5-year RFS. CONCLUSION Among PSM pairs with T1N0M0 BC, with equal baselines and treatment conditions, we found that patients who presented at younger ages had worse outcomes, independently of other pathological features. Younger patients with BC may require more individualized therapy to improve their prognosis.
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Affiliation(s)
- Wenjing Zhong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Luyuan Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wen G Jiang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Cardiff China Medical Research Collaborative, Cardiff University School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Na You
- Department of Statistical Science, School of Mathematics and Computational Science & Southern China Research Center of Statistical Science, Sun Yat-sen University, Guangzhou, China
| | - Andrew J Sanders
- Cardiff China Medical Research Collaborative, Cardiff University School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Gehao Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zihao Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yun Ling
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chang Gong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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15
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Zarella MD, Heintzelman RC, Popnikolov NK, Garcia FU. BCL-2 expression aids in the immunohistochemical prediction of the Oncotype DX breast cancer recurrence score. BMC Clin Pathol 2018; 18:14. [PMID: 30574014 PMCID: PMC6299556 DOI: 10.1186/s12907-018-0082-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 11/29/2018] [Indexed: 01/08/2023] Open
Abstract
Background The development of molecular techniques to estimate the risk of breast cancer recurrence has been a significant addition to the suite of tools available to pathologists and breast oncologists. It has previously been shown that immunohistochemistry can provide a surrogate measure of tumor recurrence risk, effectively providing a less expensive and more rapid estimate of risk without the need for send-out. However, concordance between gene expression-based and immunohistochemistry-based approaches has been modest, making it difficult to determine when one approach can serve as an adequate substitute for the other. We investigated whether immunohistochemistry-based methods can be augmented to provide a useful therapeutic indicator of risk. Methods We studied whether the Oncotype DX breast cancer recurrence score can be predicted from routinely acquired immunohistochemistry of breast tumor histology. We examined the effects of two modifications to conventional scoring measures based on ER, PR, Ki-67, and Her2 expression. First, we tested a mathematical transformation that produces a more diagnostic-relevant representation of the staining attributes of these markers. Second, we considered the expression of BCL-2, a complex involved in regulating apoptosis, as an additional prognostic marker. Results We found that the mathematical transformation improved concordance rates over the conventional scoring model. By establishing a measure of prediction certainty, we discovered that the difference in concordance between methods was even greater among the most certain cases in the sample, demonstrating the utility of an accompanying measure of prediction certainty. Including BCL-2 expression in the scoring model increased the number of breast cancer cases in the cohort that were considered high certainty, effectively expanding the applicability of this technique to a greater proportion of patients. Conclusions Our results demonstrate an improvement in concordance between immunohistochemistry-based and gene expression-based methods to predict breast cancer recurrence risk following two simple modifications to the conventional scoring model.
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Affiliation(s)
- Mark D Zarella
- 1Department of Pathology & Laboratory Medicine, Drexel University, 245 N 15th St, Philadelphia, PA 19102 USA
| | - Rebecca C Heintzelman
- 2Cancer Treatment Centers of America, Eastern Regional Medical Center, Department of Pathology & Laboratory Medicine, 1331 E. Wyoming Ave, Philadelphia, PA 19124 USA
| | - Nikolay K Popnikolov
- 1Department of Pathology & Laboratory Medicine, Drexel University, 245 N 15th St, Philadelphia, PA 19102 USA
| | - Fernando U Garcia
- 2Cancer Treatment Centers of America, Eastern Regional Medical Center, Department of Pathology & Laboratory Medicine, 1331 E. Wyoming Ave, Philadelphia, PA 19124 USA
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16
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Chen Y, Zhang Y, Yang W, Li X, Zhu L, Chen K, Chen X. Accuracy of a nomogram to predict the survival benefit of surgical axillary staging in T1 breast cancer patients. Medicine (Baltimore) 2018; 97:e11273. [PMID: 29953003 PMCID: PMC6039583 DOI: 10.1097/md.0000000000011273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
T1 breast cancer patients have favorable clinical outcomes, so that whether axillary stating (AS) surgery can be omitted in these patients is still unclear. This retrospective cohort study developed a nomogram to predict the cancer-specific survival (CSS) of T1 breast cancer patients with and without AS and estimate the survival benefit of AS in these patients.We used surveillance, epidemiology, and end results (SEER) database to identify 232,195 breast cancer patients with T1 tumors diagnosed between 1990 and 2008. In the training cohort, we used the Kaplan-Meier method and the competing risk analysis, with non-CSS as the competing risk, to screen for prognostic factors for CSS. A nomogram to predict the CSS, with receiving AS or not as one of the predictors, was developed and externally validated, using the C-index and calibration plots. The survival benefit of AS can be estimated by the difference of 2 predicted CSS, when the patient was considered as having and not having AS.With a median follow-up of 109 months, the CSS of the study population were 96.3%, 92.3%, and 88.5% at 5, 10, and 15 years, respectively. Significant predictors for CSS identified in the training cohort were used to develop a nomogram, which was validated internally [C-index = 0.707, 95% confidence interval (95% CI) 0.702-0.712] and externally (C-index = 0.704, 95% CI 0.698-0.710). The nomogram was well calibrated. With this nomogram, AS was predicted to have less than 2% benefit of 5-, 10-, and 15-year CSS in 60.6% (140,599/232,195), 15.5% (36,074/232,195), and 8.6% (20,043/232,195) of the entire study population, respectively.The new nomogram can accurately predict the CSS of T1 breast cancer patients, and also be able to estimate the survival benefit of AS in these patients. Prospective studies are needed to confirm our findings.
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Affiliation(s)
- Yuxia Chen
- Galactphore Department, Maoming People's Hospital, Maoming
| | - Yuanqi Zhang
- Department of Breast Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang
| | - Weixiong Yang
- Galactphore Department, Maoming People's Hospital, Maoming
| | - Xiaoping Li
- General Surgery Department, Jiangmen Central Hospital, Jiangmen
| | - Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiang Chen
- General Surgery Department, Baoshan Traditional Chinese Medicine-Integrated Hospital of Shanghai, Shanghai
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17
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Musolino A, Falcini F, Sikokis A, Boggiani D, Rimanti A, Pellegrino B, Silini EM, Campanini N, Barbieri E, Zamagni C, Degli Esposti R, Cortesi L, Bisagni G, Cavanna L, Frassoldati A, Sgargi P, Michiara M. Prognostic impact of interval breast cancer detection in women with pT1a N0M0 breast cancer with HER2-positive status: Results from a multicentre population-based cancer registry study. Eur J Cancer 2017; 88:10-20. [PMID: 29175735 DOI: 10.1016/j.ejca.2017.10.024] [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] [Received: 07/29/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although human epidermal growth factor receptor 2 (HER2) overexpression is associated with poor prognosis, patients (pts) with pT1a N0M0 breast cancers (BCs) have an excellent outcome across all subtypes. Interval cancers (ICs) have poorer survival than screen-detected (SD) tumours, and an association has been reported between ICs and HER2 overexpression. We aimed to determine, in a general population of pT1a N0M0 BCs with known screening status, whether HER2-positive ICs have a poorer outcome than HER2-positive SD cancers. METHODS We evaluated all incident pT1a N0M0 BCs (n = 874) collected in the Emilia-Romagna region (Italy) from 2003 to 2009 and diagnosed in women aged 50-69. Pts unexposed to screening, with unknown HER2 status and/or treated with adjuvant trastuzumab were excluded from analysis. RESULTS Sixty-one percent of the BCs were SD, whereas 19% were ICs. BCs with high histologic grade, hormone receptor-negative or HER2-positive status (odds ratio=1.7; 95% confidence interval [CI]: 1.1-2.7) were more likely ICs. Median follow-up was 115 months. The 10-year invasive disease-free survival (iDFS) for HER2-positive ICs was lower than that for HER2-positive SD cancers: 75.0% (95% CI: 55.5%-94.5%) versus 93.8% (95% CI: 86.5%-100%). An interaction between ICs and HER2-positive status was found for poorer iDFS after adjusting for prognostic variables (HR = 5.3; 95% CI: 1.6-16.7). CONCLUSIONS IC detection may identify pts with HER2-positive pT1a N0M0 tumours in whom the rate of recurrence justifies consideration for conventional, anti-HER2, adjuvant treatment.
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Affiliation(s)
- A Musolino
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy.
| | - F Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Forlì, Italy; Azienda USL Della Romagna, Forlì, Italy
| | - A Sikokis
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - D Boggiani
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - A Rimanti
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - B Pellegrino
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - E M Silini
- Section of Anatomy and Pathology, University Hospital of Parma, Italy
| | - N Campanini
- Section of Anatomy and Pathology, University Hospital of Parma, Italy
| | - E Barbieri
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Zamagni
- SSD Oncologia Medica Addarii, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Degli Esposti
- Medical Oncology Unit, Azienda USL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - L Cortesi
- Department of Oncology, Hematology and Respiratory Diseases, University Hospital of Modena, Italy
| | - G Bisagni
- Department of Oncology and Advanced Technologies, Oncology Unit, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - L Cavanna
- Department of Oncology-Hematology, G. da Saliceto Hospital, Piacenza, Italy
| | - A Frassoldati
- Division of Medical Oncology, University Hospital of Ferrara, Italy
| | - P Sgargi
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
| | - M Michiara
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, Italy
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De Angelis C, Di Maio M, Crispo A, Giuliano M, Schettini F, Bonotto M, Gerratana L, Iacono D, Cinausero M, Riccardi F, Ciancia G, De Laurentiis M, Puglisi F, De Placido S, Arpino G. Luminal-like HER2-negative stage IA breast cancer: a multicenter retrospective study on long-term outcome with propensity score analysis. Oncotarget 2017; 8:112816-112824. [PMID: 29348868 PMCID: PMC5762553 DOI: 10.18632/oncotarget.22643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/28/2017] [Indexed: 11/25/2022] Open
Abstract
The benefit of adding chemotherapy (CT) to adjuvant hormone therapy (HT) in stage IA luminal-like HER2-negative breast cancer (BC) is unclear. We retrospectively evaluated predictive factors and clinical outcome of 1,222 patients from 4 oncologic centers. Three hundred and eighty patients received CT and HT (CT-cohort) and 842 received HT alone (HT-cohort). Disease-free survival (DFS) and overall survival (OS) were evaluated with univariate and multivariate analyses. We also applied the propensity score methodology. Compared with the HT-cohort, patients in the CT-cohort were more likely to be younger, have larger tumors of a higher histological grade that were Ki67-positive, and lower estrogen and progesterone receptor expression. At univariate analysis, a higher histological grade and Ki67 were significantly associated to a lower DFS. At multivariable analysis, only histological grade was predictive of DFS. The CT-cohort had a worse outcome than the HT-cohort in terms of DFS and OS, but differences disappeared when matched according to propensity score. In summary, patients with stage IA luminal-like BC had an excellent prognosis, however relapse and mortality were higher in the CT-cohort than in the HT-cohort. Longer use of adjuvant HT or other therapeutic strategies may be needed to improve outcome.
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Affiliation(s)
- Carmine De Angelis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Massimo Di Maio
- Oncology Department, University of Turin, 10043 Orbassano, Italy
| | - Anna Crispo
- Epidemiology Department, 'Fondazione G. Pascale' Istituto Nazionale Tumori, 80131 Naples, Italy
| | - Mario Giuliano
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas 77030, USA.,Clinical Medicine and Surgery Department, University of Naples Federico II, 80131 Naples, Italy
| | - Francesco Schettini
- Clinical Medicine and Surgery Department, University of Naples Federico II, 80131 Naples, Italy
| | - Marta Bonotto
- Department of Medical and Biological Sciences, University of Udine, 33100 Udine, Italy
| | - Lorenzo Gerratana
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Donatella Iacono
- Department of Medical and Biological Sciences, University of Udine, 33100 Udine, Italy
| | - Marika Cinausero
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Ferdinando Riccardi
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale A. Cardarelli, 80131 Naples, Italy
| | - Giuseppe Ciancia
- Advanced Biomedical Sciences Department, University of Naples Federico II, 80131 Naples, Italy
| | | | - Fabio Puglisi
- Department of Medicine (DAME), University of Udine, 33100 Udine, Italy.,Department of Clinical Oncology, CRO Aviano National Cancer Institute, 33081 Aviano, Italy
| | - Sabino De Placido
- Clinical Medicine and Surgery Department, University of Naples Federico II, 80131 Naples, Italy
| | - Grazia Arpino
- Clinical Medicine and Surgery Department, University of Naples Federico II, 80131 Naples, Italy
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Tumor thickness and histological features as predictors of invasive foci within preoperatively diagnosed ductal carcinoma in situ. Hum Pathol 2017; 64:145-155. [PMID: 28434924 DOI: 10.1016/j.humpath.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 11/23/2022]
Abstract
Small invasion into ductal carcinoma in situ (DCIS) can easily be overlooked in resected breast specimens. To disclose useful markers predictive of invasive foci within preoperatively diagnosed DCIS lesions, a retrospective histopathological comparison was made between postoperatively diagnosed invasive ductal carcinoma with a predominant intraductal component (IDCPIC) (n=43) and pure DCIS (n=82). Through a multivariate logistic regression analysis model, 5 variables (DCIS grade, "tumor thickness," extent of retraction cleft, presence of lymph node metastasis, and HER2 score) were found to be significantly associated with the presence of invasive foci within DCIS; with a cutoff point of 0.315, sensitivity, specificity, positive predictive value, and negative predictive value were 0.93, 0.77, 0.68, and 0.95, respectively. No statistically significant difference was observed in recurrence-free survival between IDCPIC and pure DCIS, whereas the IDCPIC curve showed a slightly earlier decline than the DCIS one. In general, preoperative detection of lymph node metastasis in DCIS patients is elusive because of the extremely tiny metastatic size in most cases; thus, a 4-variable model, without lymph node metastasis, would be the actual working model. Furthermore, tumor "thickness" was found to be the most significant parameter predictive of invasive foci within DCIS. Although IDCPIC and pure DCIS showed similar recurrence-free survival curves, prediction of invasive foci within DCIS necessitates postoperative pathological analysis of surgically resected lesions.
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20
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Rahman NA, Yazan LS, Wibowo A, Ahmat N, Foo JB, Tor YS, Yeap SK, Razali ZA, Ong YS, Fakurazi S. Induction of apoptosis and G2/M arrest by ampelopsin E from Dryobalanops towards triple negative breast cancer cells, MDA-MB-231. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:354. [PMID: 27609190 PMCID: PMC5017001 DOI: 10.1186/s12906-016-1328-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 08/26/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several compounds isolated from Dryobalanops have been reported to exhibit cytotoxic effects to several cancer cell lines. This study investigated the cytotoxic effects, cell cycle arrest and mode of cell death in ampelopsin E-treated triple negative cells, MDA-MB-231. METHODS Cytotoxicity of ampelopsin E, ampelopsin F, flexuosol A, laevifonol, Malaysianol A, Malaysianol D and nepalensinol E isolated from Dryobalanops towards human colon cancer HT-29, breast cancer MDA-MB-231 and MCF-7, alveolar carcinoma HeLa and mouse embryonic fibroblast NIH/3 T3 cells were determined by MTT assay. The cells were treated with the compounds (0.94-30 μM) for 72 h. The mode of cell death was evaluated by using an inverted light microscope and annexin V/PI analysis. Cell cycle analysis was performed by using a flow cytometer. RESULTS Data showed that ampelopsin E was most cytotoxic toward MDA-MB-231 with the IC50 (50 % inhibition of cell viability compared to control) of 14.5 ± 0.71 μM at 72 h. Cell shrinkage, membrane blebbing and formation apoptotic bodies characteristic of apoptosis were observed following treatment with ampelopsin E. The annexin V/PI flow cytometric analysis further confirmed that ampelopsin E induced apoptosis in MDA-MB-231 cells. Cell cycle analysis revealed that ampelopsin E induced G2/M phase cell cycle arrest in the cells. CONCLUSION Ampelopsin E induced apoptosis and cell cycle arrest in MDA-MB-231 cells. Therefore, ampelopsin E has the potential to be developed into an anticancer agent for treatment of triple negative breast cancer.
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Prognostic risk factors for treatment decision in pT1a,b N0M0 HER2-positive breast cancers. Cancer Treat Rev 2016; 43:1-7. [DOI: 10.1016/j.ctrv.2015.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 12/26/2022]
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Colonna SV, Higgins AK, Alvarez J, Saville BR, Lawrence J, Abramson VG. Analysis of Risk of Recurrence by Subtype in ≤ 1-cm Breast Tumors. Clin Breast Cancer 2015; 16:223-31. [PMID: 26683741 DOI: 10.1016/j.clbc.2015.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 09/24/2015] [Accepted: 10/28/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer with higher recurrence rates than other breast cancer subtypes. Increasing numbers of women are being diagnosed with early-stage breast cancer because of improvements in screening mammography. TNBC is known to be highly sensitive to chemotherapy; however, the benefit of adjuvant chemotherapy among women with ≤ 1-cm, lymph node-negative TNBC is unknown. MATERIALS AND METHODS We evaluated the recurrence rates and recurrence-free survival of 437 women diagnosed with stage T1a-T1bN0 breast cancer from 1997 to 2009 at 2 institutions, with a median follow-up time of 6.2 years. Furthermore, we examined the treatment regimens of these women and evaluated the association of adjuvant chemotherapy with recurrence-free survival. RESULTS Chemotherapy was administered more often to younger women and to women with high-grade, human epidermal growth factor receptor 2-positive or TNBC. Recurrence-free survival did not differ significantly between TNBC and estrogen receptor-positive breast cancer (hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.10-1.04; P = .058). After appropriate adjustments, no significant differences were detected in recurrence-free survival between the women who had received chemotherapy and those who had not among the women with TNBC (P = .132) or within any of the breast cancer subtypes (HR, 0.6; 95% CI, 0.2-1.9; P = .392). CONCLUSION Prospective trials of this subcentimeter node-negative breast cancer population are warranted to guide adjuvant chemotherapy decisions.
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Affiliation(s)
- Sarah V Colonna
- Huntsman Cancer Institute, Salt Lake City, UT; George E. Whalen Veterans Affairs Hospital, Salt Lake City, UT; Vanderbilt-Ingram Cancer Center, Nashville, TN.
| | | | - Joann Alvarez
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Benjamin R Saville
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Julia Lawrence
- Wake Forest Comprehensive Cancer Center, Winston-Salem, NC
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Petrelli F, Viale G, Cabiddu M, Barni S. Prognostic value of different cut-off levels of Ki-67 in breast cancer: a systematic review and meta-analysis of 64,196 patients. Breast Cancer Res Treat 2015; 153:477-91. [PMID: 26341751 DOI: 10.1007/s10549-015-3559-0] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/28/2015] [Indexed: 12/15/2022]
Abstract
A proliferative marker, expressed as the percentage of cells in a cell cycle, has been developed and used as a discriminant of more aggressive malignant phenotypes in early breast cancer (BC). The marker is usually expressed by the immunohistochemical staining of the cell cycle antigen Ki-67. It has not, however, yet been definitely evaluated, due to methodological concerns, which specific Ki-67 cut-off provide the strongest prognostic information in resected BC. We conducted a meta-analysis to explore the prognostic value of different cut-off levels of Ki-67 in terms of overall survival (OS) and disease-free survival (DFS) in early BC. The databases of PubMed, the ISI Web of Science, EMBASE, SCOPUS, the Cochrane Central Register of Controlled Trials, and CINHAL were used to identify the relevant literature. Data from studies reporting a hazard ratio (HR) and a 95 % confidence interval (CI) calculated as a multivariate analysis were pooled in a meta-analysis, with metaregression used to test for trends in predefined subgroups. All the statistical tests were 2-sided. Forty-one studies encompassing 64,196 BC patients were included in the analysis. Overall, n = 25 studies were available for the OS analysis. The pooled HR for high versus low Ki-67 was 1.57 (95 % CI 1.33-1.87, P < 0.00001). Twenty-nine studies were available for the DFS analysis. The pooled HR for high versus low Ki-67 was 1.50 (95 % CI 1.34-1.69, P < 0.00001). When a cut-off of Ki-67 staining ≥ 25 % was used, the pooled HR for OS was 2.05 (95 % CI 1.66-2.53, P < 0.00001), which was significantly different to studies where the cut-offs chosen were <25 %. In ER+ tumors, the HR for high versus low Ki-67 was similar and significant (HR = 1.51, 95 % CI 1.25-1.81, P < 0.0001). We conclude that Ki-67 has an independent prognostic value in terms of OS in BC patients. The Ki-67 threshold with the greatest prognostic significance is as yet unknown, but a cut-off >25 % is associated with a greater risk of death compared with lower expression rates.
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Affiliation(s)
- Fausto Petrelli
- Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
| | - G Viale
- Pathology Department, European Institute of Oncology, Milan, Italy
| | - M Cabiddu
- Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - S Barni
- Oncology Department, Medical Oncology Unit, Azienda Ospedaliera Treviglio, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
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Witteveen A, Vliegen IMH, Sonke GS, Klaase JM, IJzerman MJ, Siesling S. Personalisation of breast cancer follow-up: a time-dependent prognostic nomogram for the estimation of annual risk of locoregional recurrence in early breast cancer patients. Breast Cancer Res Treat 2015; 152:627-36. [PMID: 26162567 PMCID: PMC4519578 DOI: 10.1007/s10549-015-3490-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/29/2015] [Indexed: 12/27/2022]
Abstract
The objective of this study was to develop and validate a time-dependent logistic regression model for prediction of locoregional recurrence (LRR) of breast cancer and a web-based nomogram for clinical decision support. Women first diagnosed with early breast cancer between 2003 and 2006 in all Dutch hospitals were selected from the Netherlands Cancer Registry (n = 37,230). In the first 5 years following primary breast cancer treatment, 950 (2.6 %) patients developed a LRR as first event. Risk factors were determined using logistic regression and the risks were calculated per year, conditional on not being diagnosed with recurrence in the previous year. Discrimination and calibration were assessed. Bootstrapping was used for internal validation. Data on primary tumours diagnosed between 2007 and 2008 in 43 Dutch hospitals were used for external validation of the performance of the nomogram (n = 12,308). The final model included the variables grade, size, multifocality, and nodal involvement of the primary tumour, and whether patients were treated with radio-, chemo- or hormone therapy. The index cohort showed an area under the ROC curve of 0.84, 0.77, 0.70, 0.73 and 0.62, respectively, per subsequent year after primary treatment. Model predictions were well calibrated. Estimates in the validation cohort did not differ significantly from the index cohort. The results were incorporated in a web-based nomogram (http://www.utwente.nl/mira/influence). This validated nomogram can be used as an instrument to identify patients with a low or high risk of LRR who might benefit from a less or more intensive follow-up after breast cancer and to aid clinical decision making for personalised follow-up.
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Affiliation(s)
- Annemieke Witteveen
- Department of Health Technology and Services Research (HTSR), MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands,
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Zhou X, Zhu HQ, Lu J. Regulation of gene expression in HBV- and HCV-related hepatocellular carcinoma: integrated GWRS and GWGS analyses. Int J Clin Exp Med 2014; 7:4038-4050. [PMID: 25550913 PMCID: PMC4276171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To explore the molecular mechanism of hepatitis B virus-related and hepatitis C virus-related hepatocellular carcinoma, samples from hepatitis B virus and hepatitis C virus infected patients and the normal were compared, respectively. METHODS In both experiments, genes with high value were selected based on a genome-wide relative significance and genome-wide global significance model. Co-expression network of the selected genes was constructed, and transcription factors in the network were identified. Molecular complex detection algorithm was used to obtain sub-networks. RESULTS Based on the new model, the top 300 genes were selected. Co-expression network was constructed and transcription factors were identified. We obtained two common genes FCN2 and CXCL14, and two common transcription factors RFX5 and EZH2. In hepatitis B virus experiment, cluster 1 and 3 had the higher value. In cluster 1, ten of the 17 genes and one transcription factor were all reported associated with hepatocellular carcinoma. In cluster 3, transcription factor ESR1 was reported related with hepatocellular carcinoma. In hepatitis C virus experiment, the value of cluster 3 and 4 was higher. In cluster 3, nine genes were reported to play a key role in hepatocellular carcinoma. In cluster 4, there were 5 genes in the 34 genes. To compare the relevance of a node in holding together communicating nodes, centralities based analysis was performed and we obtained some genes with high stress value. CONCLUSION The analysis above helped us to understand the pathogenesis of hepatitis B virus and hepatitis C virus associated hepatocellular carcinoma.
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Affiliation(s)
- Xu Zhou
- Department of General Surgery, Provincial Hospital Affiliated to Shandong University Ji'nan 250014, China
| | - Hua-Qiang Zhu
- Department of General Surgery, Provincial Hospital Affiliated to Shandong University Ji'nan 250014, China
| | - Jun Lu
- Department of General Surgery, Provincial Hospital Affiliated to Shandong University Ji'nan 250014, China
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Endocrine sensitivity is decisive for patient outcome in small node-negative breast cancers (BC) (pT1a,b) - results from the Munich Cancer Registry. Breast 2014; 24:24-31. [PMID: 25543874 DOI: 10.1016/j.breast.2014.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/25/2014] [Accepted: 10/24/2014] [Indexed: 11/23/2022] Open
Abstract
PURPOSE In clinical routine, adjuvant systemic therapy in small node-negative (N0) BC is controversial, in particular in HER2-positive disease. We aimed to evaluate outcome of consecutive patients with small N0 BC in a population-based cancer registry and thus consequently substantiate indications for chemotherapy in those patient subgroups at increased relapse risk or poor survival. METHODS From 2002 to 2009 (median follow-up 6 years), 9707 primary breast cancer patients with N0 tumors <2 cm (pTis, pT1N0M0) were reported to the Munich Cancer Registry. Patients with pTis tumors (n = 1870) served as internal comparator. Time to progression, observed (OS) and relative survival rates (Kaplan-Meier estimates) are presented. Cox regression analysis was used to assess the influence of tumor size, age, HR-, and HER2-status. RESULTS 10-year-OS for pTis was 94.0%. In HR-positive tumors it was 91.9% in pT1a, 90.6% in pT1b, and 86.8% in pT1c. In HR-negative tumors, rates were 91.7%, 86.8%, and 86.8%, respectively. In HER2-positive tumors it was 81.2%, 88.1%, and 86.7%, in HER2-negative 93.1%, 90.6%, and 86.0%, respectively. In the multivariate model, age, tumor size, and HR-status showed a significant impact on OS (HRneg. vs. HRpos.: hazard ratio 1.50 (95% CI; 1.12-1.99), while HER2-status was not an independent prognostic factor. CONCLUSION Prognosis of N0 tumors <1 cm is excellent, especially if they are HR-positive, even in HER2-positive cases. Weighing potential benefits vs. side-effects, there seems to be no need for chemotherapy in tumors <0.5 cm. In pT1b chemotherapy may be considered, if tumors are triple negative or HER2-positive and HR-negative. In pT1c guideline-based adjuvant therapy using all therapeutic options seems to be warranted.
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Outcomes of HER2-positive early breast cancer patients in the pre-trastuzumab and trastuzumab eras: a real-world multicenter observational analysis. The RETROHER study. Breast Cancer Res Treat 2014; 147:599-607. [PMID: 25234842 PMCID: PMC4174332 DOI: 10.1007/s10549-014-3133-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/09/2014] [Indexed: 01/03/2023]
Abstract
Addition of trastuzumab to adjuvant chemotherapy has dramatically reduced the risk of recurrence and has become the standard of care for human epidermal growth factor receptor 2 (HER2)-positive early breast cancer patients. Since most data on trastuzumab benefits come from clinical trials, conducted in selected patient populations, we performed a retrospective analysis of HER2-positive early breast cancer patients treated in the "pre-trastuzumab" and "trastuzumab" eras, with the aim to determine patients' outcomes in real-world practice. 925 consecutive HER2-positive breast cancer patients treated with adjuvant chemotherapy in ten Italian oncologic centers were identified. Patients who had received adjuvant chemotherapy alone (cohort A, 352 patients), and patients who had received adjuvant chemotherapy followed or combined with trastuzumab (cohort B, 573 patients) were analyzed. Relapse rate at 3 years, relapse-free survival, and overall survival were significantly more unfavorable in the cohort A than in the cohort B (p < 0.0001). In multivariate analysis, factors related to relapse were younger age, advanced stage at diagnosis, absence of hormonal and of trastuzumab therapy. The benefit derived from the addition of trastuzumab was independent of nodal status and hormonal receptors expression. A subgroup analysis including 163 "triple positive" tumors with high levels of estrogen and progesterone receptor (TP50) suggested that addition of trastuzumab to adjuvant chemotherapy and hormonal therapy did not translate into better outcomes. In our analysis, trastuzumab benefit was confirmed in all but a small subset of TP50 tumors subgroups. In this subset further investigations are needed.
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Schroeder MC, Lynch CF, Abu-Hejleh T, Chrischilles EA, Thomas A. Chemotherapy use and surgical treatment by receptor subtype in node-negative T1a and T1b female breast cancers, Iowa SEER Registry, 2010 to 2012. Clin Breast Cancer 2014; 15:e27-34. [PMID: 25245424 DOI: 10.1016/j.clbc.2014.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/16/2014] [Accepted: 07/29/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with small node-negative breast tumors who are younger or who have human epidermal growth factor receptor 2-positive (HER2(+)) or triple-negative breast cancer (TNBC) subtypes are at increased risk of recurrence. Concurrently, systemic treatment recommendations have evolved. Less is known about how frequently cytotoxic chemotherapy is given to these patients. Mastectomy rates have also increased. This study reports the recent incidence of T1a,bN0M0 breast cancer and the characteristics associated with chemotherapy delivery and the surgery selected. PATIENTS AND METHODS This retrospective cohort is composed of invasive female breast cancers diagnosed with American Joint Committee on Cancer (AJCC) stage T1a,bN0M0 during 2010 to 2012 from the Iowa Surveillance, Epidemiology, and End Results (SEER) Cancer Registry. Chemotherapy use and surgery were identified by the registry. Univariate and multivariate analyses were performed to determine patient differences across subtype and factors associated with treatment. RESULTS The study included 1687 patients. This represented 27.6% of all AJCC stages I(a-c) to III breast cancer in 2010 to 2012, up from 18% in 1990 (P < .0001). Of 1456 patients with known subtype, 8.8% and 6.4% had HER2(+) and TNBC disease, respectively. Chemotherapy was given to 7.5% of women with T1aN0M0 and 12.7% of T1bN0M0 tumors. The likelihood of systemic treatment was associated with breast cancer subtype, tumor differentiation, and age in a multivariate model. The mastectomy rate was 31.8%. CONCLUSION Small node-negative breast cancers continue to grow significantly as a percentage of invasive breast cancer diagnoses. In 2010 to 2012 in Iowa, systemic chemotherapy correlated with risk factors associated with recurrence: age, subtype, and tumor differentiation. Relatively high rates of mastectomy were seen.
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Affiliation(s)
- Mary C Schroeder
- Department of Pharmacy Practice and Science, College of Pharmacy, Iowa City, IA
| | - Charles F Lynch
- Department of Epidemiology, College of Public Health, Iowa City, IA
| | - Taher Abu-Hejleh
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, Iowa City, IA
| | | | - Alexandra Thomas
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, Iowa City, IA.
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Oven Ustaalioglu BB, Bilici A, Yilmaz BE, Aliustaoglu M, Seker M, Vardar F, Gumus M. Important Factors Affecting Adjuvant Treatment Decision in Stage IA Breast Cancer Patients in Turkey. ACTA ACUST UNITED AC 2014; 9:123-7. [PMID: 24944556 DOI: 10.1159/000360929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In Turkey, the gene expression profile test is not standard, so adjuvant treatment is planned according to clinicopathological factors. Therefore, we retrospectively analyzed important parameters that affect the decision on adjuvant chemotherapy, and also factors related to survival in stage IA breast cancer patients in Turkey. METHODS We retrospectively evaluated 347 stage IA patients. The relationship between the clinicopathological parameters and adjuvant chemotherapy was analyzed. RESULTS The median age and follow-up time were 52 years (range: 25-86) and 22.6 months (range: 1-113), respectively. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 87.9% and 98.7%, respectively, but the median DFS was not reached. Age, estrogen receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, and the presence of triple-negative breast tumor (TNBC) were related to DFS, and lymphovascular invasion (LVI), perineural invasion (PNI), HER2 status, the presence of TNBC, and recurrence were related to OS (p > 0.05). Furthermore, age, menopausal status, multicentricity, grade, tumor size, necrosis, ER, the presence of TNBC, and HER2 were found to be related to adjuvant therapy decision (p > 0.05). All these parameters, in addition to LVI and PNI, were independent factors for chemotherapy by logistic regression analysis. CONCLUSIONS In decisions about adjuvant therapy in stage IA breast cancer patients, clinicopathological factors should be kept in mind.
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Affiliation(s)
- Bala B Oven Ustaalioglu
- Department of Medical Oncology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Bilici
- Department of Medical Oncology, Medipol University, Istanbul, Turkey
| | - Burçak E Yilmaz
- Department of Medical Oncology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Aliustaoglu
- Department of Medical Oncology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Mesut Seker
- Department of Medical Oncology, Kartal Education and Research Hospital, Istanbul, Turkey
| | - Fugen Vardar
- Department of Pathology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Mahmut Gumus
- Department of Medical Oncology, Kartal Education and Research Hospital, Istanbul, Turkey
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Natoli C, Brocco D, Sperduti I, Nuzzo A, Tinari N, De Tursi M, Grassadonia A, Mazzilli L, Iacobelli S, Gamucci T, Vici P. Breast cancer "tailored follow-up" in Italian oncology units: a web-based survey. PLoS One 2014; 9:e94063. [PMID: 24714591 PMCID: PMC3979748 DOI: 10.1371/journal.pone.0094063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/10/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose Breast cancer follow-up procedures after primary treatment are still a controversial issue. Aim of this study was to investigate, through a web-based survey, surveillance methodologies selected by Italian oncologists in everyday clinical practice. Methods Referents of Italian medical oncology units were invited to participate to the study via e-mail through the SurveyMonkey website. Participants were asked how, in their institution, exams of disease staging and follow-up are planned in asymptomatic women and if surveillance continues beyond the 5th year. Results Between February and May 2013, 125 out of 233 (53.6%) invited referents of Italian medical oncology units agreed to participate in the survey. Ninety-seven (77.6%) referents state that modalities of breast cancer follow-up are planned according to the risk of disease progression at diagnosis and only 12 (9.6%) oncology units apply the minimal follow-up procedures according to international guidelines. Minimal follow-up is never applied in high risk asymptomatic women. Ninety-eight (78.4%) oncology units continue follow-up in all patients beyond 5 years. Conclusions Our survey shows that 90.4% of participating Italian oncology units declare they do not apply the minimal breast cancer follow-up procedures after primary treatment in asymptomatic women, as suggested by national and international guidelines. Interestingly, about 80.0% of interviewed referents performs the so called “tailored follow-up”, high intensity for high risk, low intensity for low risk patients. There is an urgent need of randomized clinical trials able to determine the effectiveness of risk-based follow-up modalities, their ideal frequency and persistence in time.
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Affiliation(s)
- Clara Natoli
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
- * E-mail:
| | - Davide Brocco
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Isabella Sperduti
- Unit of Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Nuzzo
- Oncology Department, “Floraspe Renzetti” Hospital, Lanciano, Italy
| | - Nicola Tinari
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Michele De Tursi
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Antonino Grassadonia
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Lorenzo Mazzilli
- Clinical Governance Unit, “SS. Annunziata” Hospital, Chieti, Italy
| | - Stefano Iacobelli
- Department of Experimental and Clinical Sciences, University “G. d'Annunzio”, Chieti, Italy
| | - Teresa Gamucci
- Department of Oncology, “S.S. Trinita′” Hospital, Sora, Italy
| | - Patrizia Vici
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
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Gorshein E, Klein P, Boolbol SK, Shao T. Clinical significance of HER2-positive and triple-negative status in small (≤ 1 cm) node-negative breast cancer. Clin Breast Cancer 2014; 14:309-14. [PMID: 24703318 DOI: 10.1016/j.clbc.2014.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data regarding the clinical significance of HER2(+) and TN status in patients with small node-negative tumors are limited and conflicting. It remains unclear who, among those with small lesions, might benefit from more aggressive adjuvant therapy. PATIENTS AND METHODS We identified all node-negative breast cancer patients with tumor size ≤ 1 cm diagnosed between January 1, 1995 and December 31, 2008 using our institutional breast service database. Patients were classified according to their receptor status into 3 groups: (1) hormone receptor (HR)-positive (estrogen receptor [ER]- or progesterone receptor [PR]-positive, HER2(-)); (2) HER2(+) (immunohistochemistry 3(+) or fluorescence in situ hybridization amplification ≥ 2); and (3) TN (ER(-), PR(-), and HER2(-)). RFS was calculated using Kaplan-Meier methods. RESULTS Among 656 patients with tumors ≤ 1 cm, 494 (75%) of the patients were HR(+), 107 (16%) were HER2(+), and 55 (9%) were TN. Median age was 59 years (range, 27-92 years). Median follow-up was 3.5 years. The 5-year RFS rates were 98.2%, 97.1%, and 83.5% in patients with HR(+), HER2(+), and TN tumors, respectively (P < .001). In multivariate analysis, TN status was associated with worse RFS (hazard ratio, 6.70; 95% confidence interval [CI], 3.02-14.86), and HER2(+) was not (hazard ratio, 1.64; 95% CI, 0.73-3.69). CONCLUSION TN, but not HER2(+) status, was associated with worse RFS in patients with T1abN0 tumors, and adjuvant chemotherapy might be considered in patients with TN breast cancer.
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Affiliation(s)
- Elan Gorshein
- Beth Israel Medical Center, Mount Sinai Health System, New York, NY
| | - Paula Klein
- Beth Israel Medical Center, Mount Sinai Health System, New York, NY
| | - Susan K Boolbol
- Beth Israel Medical Center, Mount Sinai Health System, New York, NY
| | - Theresa Shao
- Beth Israel Medical Center, Mount Sinai Health System, New York, NY.
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Heger Z, Rodrigo MAM, Krizkova S, Zitka O, Beklova M, Kizek R, Adam V. Identification of estrogen receptor proteins in breast cancer cells using matrix-assisted laser desorption/ionization time of flight mass spectrometry (Review). Oncol Lett 2014; 7:1341-1344. [PMID: 24765135 PMCID: PMC3997732 DOI: 10.3892/ol.2014.1912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 12/06/2013] [Indexed: 01/03/2023] Open
Abstract
Estrogen receptors [ERs (subtypes α and β)], classified as a nuclear receptor super family, are intracellular proteins with an important biological role as the transcription factors for estrogen target genes. For ER-induced transcription, an interaction must exist between ligand and coregulators. Coregulators may stimulate (coactivators) or inhibit (corepressors) transcription, following binding with a specific region of the gene, called the estrogen response element. Misbalanced activity of coregulators or higher ligand concentrations may cause increased cell proliferation, resulting in specific types of cancer. These are exhibited as overexpression of ER proteins. Breast cancer currently ranks first in the incidence and second in the mortality of cancer in females worldwide. In addition, 70% of breast tumors are ERα positive and the importance of these proteins for diagnostic use is indisputable. Early diagnosis of the tumor and its classification has a large influence on the selection of appropriate therapy, as ER-positive tumors demonstrate a positive response to hormonal therapy. Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI TOF MS) has been hypothesized to have great potential, as it offers reliable, robust and efficient analysis methods for biomarker monitoring and identification. The present review discusses ER protein analysis by MALDI TOF MS, including the crucial step of protein separation.
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Affiliation(s)
- Zbynek Heger
- Department of Veterinary Ecology and Environmental Protection, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Brno CZ-612 42, Czech Republic ; Department of Chemistry and Biochemistry, Faculty of Agronomy, Mendel University in Brno, Brno CZ-613 00, Czech Republic
| | - Miguel Angel Merlos Rodrigo
- Department of Veterinary Ecology and Environmental Protection, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Brno CZ-612 42, Czech Republic
| | - Sona Krizkova
- Department of Chemistry and Biochemistry, Faculty of Agronomy, Mendel University in Brno, Brno CZ-613 00, Czech Republic ; Central European Institute of Technology, Brno University of Technology, Brno CZ-616 00, Czech Republic
| | - Ondrej Zitka
- Department of Veterinary Ecology and Environmental Protection, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, Brno CZ-612 42, Czech Republic ; Department of Chemistry and Biochemistry, Faculty of Agronomy, Mendel University in Brno, Brno CZ-613 00, Czech Republic ; Central European Institute of Technology, Brno University of Technology, Brno CZ-616 00, Czech Republic
| | - Miroslava Beklova
- Department of Chemistry and Biochemistry, Faculty of Agronomy, Mendel University in Brno, Brno CZ-613 00, Czech Republic
| | - Rene Kizek
- Department of Chemistry and Biochemistry, Faculty of Agronomy, Mendel University in Brno, Brno CZ-613 00, Czech Republic ; Central European Institute of Technology, Brno University of Technology, Brno CZ-616 00, Czech Republic
| | - Vojtech Adam
- Department of Chemistry and Biochemistry, Faculty of Agronomy, Mendel University in Brno, Brno CZ-613 00, Czech Republic ; Central European Institute of Technology, Brno University of Technology, Brno CZ-616 00, Czech Republic
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Steward L, Conant L, Gao F, Margenthaler JA. Predictive factors and patterns of recurrence in patients with triple negative breast cancer. Ann Surg Oncol 2014; 21:2165-71. [PMID: 24558065 DOI: 10.1245/s10434-014-3546-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND We investigated the outcomes of patients with triple negative breast cancer ([TNBC] = estrogen receptor negative, progesterone receptor negative, and HER2 nonamplified). METHODS We identified 414 patients with stage I-III TNBC treated between 1999 and 2008. Data included patient/tumor characteristics, surgical, systemic, and radiation treatment received, and breast cancer-specific survival. Data were compared using Chi square, Fisher exact test, and logistic regression. A p value <.05 was considered significant. RESULTS The cohort included 414 patients (mean age 53.8 ± 12.5 years) with a mean follow-up of 68.2 ± 36.4 months. Of 414 patients, 304 (73.4 %) had no evidence of recurrence, while 110 (26.6 %) had recurrent disease, including 19 (17.3 %) with isolated locoregional recurrence, 70 (63.6 %) with isolated distant recurrence, and 21 (19.1 %) with both. Of 91 patients with distant recurrences, lung was most common (n = 38), followed by brain (n = 32), bone (n = 31), and liver (n = 29). Factors significantly associated with recurrence included increasing tumor size, positive nodal status, increasing stage, and type of chemotherapy (adjuvant vs neoadjuvant). After controlling for all potential confounders in multivariate stepwise regression, these same factors were also found to be independent predictors of recurrence. In the survival analysis, these same factors, in addition to receipt of radiation were found to be predictive of survival. CONCLUSIONS Approximately 25 % of patients with TNBC experienced a locoregional and/or distant recurrence, resulting in greater than 75 % breast cancer-specific mortality for those who experienced a distant recurrence. The lack of targeted therapy for this aggressive breast cancer subtype likely contributed to this finding.
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Affiliation(s)
- Lauren Steward
- Department of Surgery, Washington University School of Medicine, St. Louis, MI, USA
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Lin PH, Yeh MH, Liu LC, Chen CJ, Tsui YC, Su CH, Wang HC, Liang JA, Chang HW, Wu HS, Yeh SP, Li LY, Chiu CF. Clinical and pathologic risk factors of tumor recurrence in patients with node-negative early breast cancer after mastectomy. J Surg Oncol 2013; 108:352-7. [PMID: 23996583 DOI: 10.1002/jso.23403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/16/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with node-negative breast cancer (NNBC) usually have a good prognosis, but tumor recurrence still compromises survival. In this study, we sought to identify clinical and pathologic factors that predict recurrence. METHODS A total of 716 patients who were proved with pT1-2N0M0 breast cancer between 2005 and 2009 were enrolled in this study. RESULTS Forty-seven of the 716 patients developed tumor recurrence during the 47.0 months of median follow-up. The significant risk factors of recurrence were lymphovascular invasion (LVI) (hazard ratio [HR] = 4.60, 95% CI. 2.32-9.10) and Nottingham grade 3 (HR = 4.99, 95% CI. 1.06-23.48); adjuvant radiotherapy (HR = 0.35, 95% CI. 0.14-0.92) prevented tumor recurrence. Furthermore, we investigate the therapeutic impact of adjuvant chemotherapy and radiotherapy on patients with LVI and Nottingham grade 3. The adverse effect of LVI and grade 3 can be abrogated by adjuvant radiotherapy in recurrence-free survival (RFS) (LVI((+)) radiotherapy((+)) , no recurrence; grade 3((+)) radiotherapy((+)) , HR = 0.82, 95% CI. 0.18-3.70). However, adjuvant chemotherapy did not. CONCLUSIONS LVI and Nottingham grade 3 were the independent risk factors predicting tumor recurrence for patients with NNBC. Adjuvant radiotherapy might be considered in NNBC patients with these unfavorable factors to improve the RFS.
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Affiliation(s)
- Po-Han Lin
- Graduate Institute of Clinical Medicine Science, China Medical University, Taichung, Taiwan; Department of Medical Genetics, China Medical University Hospital, Taichung, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
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