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Circulating HDL and Non-HDL Associated Apolipoproteins and Breast Cancer Severity. J Clin Med 2022; 11:jcm11051345. [PMID: 35268435 PMCID: PMC8911350 DOI: 10.3390/jcm11051345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/13/2022] [Accepted: 02/26/2022] [Indexed: 02/04/2023] Open
Abstract
Plasma lipids are carried within lipoproteins with various apolipoprotein content. This study evaluates the interest of measuring the apolipoproteins of circulating lipoproteins in breast cancer. Patients with early-stage breast cancer (n = 140) were included. Tumors differed by the expression of estrogen and progesterone receptor (HR- and HR+ for negative and positive expression) and the proliferation marker Ki-67 (≤20% or ≥30%). Apolipoprotein concentrations were determined in plasma, HDL and non-HDL fractions, and results are given in mg/dL, median (25th-75th). Patients did not differ in their plasma and lipoprotein lipid concentrations. HDL apoC-I and non-HDL apoC-II were reduced (1.34 (1.02-1.80) vs. 1.61 (1.32-2.04), p = 0.04; 0.31 (0.18-0.65) vs. 0.63 (0.39-1.02), p = 0.01; respectively), in RH-/high Ki-67 patients in comparison to RH-/low Ki-67 patients, while plasma apoD and HDL apoD were higher (3.24 (2.99-4.16) vs. 3.07 (2.39-3.51), p = 0.04; 2.74 (2.36-3.35) vs. 2.45 (2.01-2.99), p = 0.04; respectively). When RH+/high Ki-67 patients were compared with RH+/low Ki-67 patients, HDL apoC-I and HDL apoC-III were higher (1.56 (1.20-1.95) vs. 1.35 (1.10-1.62), p = 0.02; 2.80 (2.42-3.64) vs. 2.38 (1.69-2.96), p = 0.02; respectively). The distribution of exchangeable apolipoproteins, such as apoC-I, apoC-II, apoC-III, apoD, between lipoproteins is linked to the severity of breast cancer.
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Chantada-Vázquez MDP, Conde-Amboage M, Graña-López L, Vázquez-Estévez S, Bravo SB, Núñez C. Circulating Proteins Associated with Response and Resistance to Neoadjuvant Chemotherapy in HER2-Positive Breast Cancer. Cancers (Basel) 2022; 14:cancers14041087. [PMID: 35205837 PMCID: PMC8870308 DOI: 10.3390/cancers14041087] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 12/13/2022] Open
Abstract
Simple Summary The goal of this study was to find circulating proteins that can be easily sampled and incorporated into a clinical setting to improve predictive treatment response in HER2-positive breast cancer patients receiving neoadjuvant chemotherapy. We looked for potential biomarkers in serum, which we identified using two proteomics techniques: qualitative LC-MS/MS and a quantitative assay that assessed protein expression between responders and non-responders HER2-positive breast cancer patients to neoadjuvant chemotherapy. Abstract Despite the increasing use of neoadjuvant chemotherapy (NAC) in HER2-positive breast cancer (BC) patients, the clinical problem of predicting individual treatment response remains unanswered. Furthermore, the use of ineffective chemotherapeutic regimens should be avoided. Serum biomarker levels are being studied more and more for their ability to predict therapy response and aid in the development of personalized treatment regimens. This study aims to identify effective protein networks and biomarkers to predict response to NAC in HER2-positive BC patients through an exhaustive large-scale LC-MS/MS-based qualitative and quantitative proteomic profiling of serum samples from responders and non-responders. Serum samples from HER2-positive BC patients were collected before NAC and were processed by three methods (with and without nanoparticles). The qualitative analysis revealed differences in the proteomic profiles between responders and non-responders, mainly in proteins implicated in the complement and coagulation cascades and apolipoproteins. Qualitative analysis confirmed that three proteins (AFM, SERPINA1, APOD) were correlated with NAC resistance. In this study, we show that serum biomarker profiles can predict treatment response and outcome in the neoadjuvant setting. If these findings are further developed, they will be of significant clinical utility in the design of treatment regimens for individual BC patients.
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Affiliation(s)
- María del Pilar Chantada-Vázquez
- Research Unit, Lucus Augusti University Hospital (HULA), Servizo Galego de Saúde (SERGAS), 27002 Lugo, Spain;
- Proteomic Unit, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela (CHUS), 15706 Santiago de Compostela, Spain
| | - Mercedes Conde-Amboage
- Models of Optimization Decision, Statistics and Applications Research Group (MODESTYA), Department of Statistics, Mathematical Analysis and Optimization, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain;
- CITMAga, 15782 Santiago de Compostela, Spain
| | - Lucía Graña-López
- Breast Pathology Group, Lucus Augusti University Hospital (HULA)-IDIS, Servizo Galego de Saúde (SERGAS), 27002 Lugo, Spain;
- Radiology Department, Lucus Augusti University Hospital (HULA), Servizo Galego de Saúde (SERGAS), 27002 Lugo, Spain
| | - Sergio Vázquez-Estévez
- Oncology Division, Lucus Augusti University Hospital (HULA), Servizo Galego de Saúde (SERGAS), 27002 Lugo, Spain;
| | - Susana B. Bravo
- Proteomic Unit, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela (CHUS), 15706 Santiago de Compostela, Spain
- Correspondence: (S.B.B.); (C.N.)
| | - Cristina Núñez
- Research Unit, Lucus Augusti University Hospital (HULA), Servizo Galego de Saúde (SERGAS), 27002 Lugo, Spain;
- Correspondence: (S.B.B.); (C.N.)
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Sanchez D, Ganfornina MD. The Lipocalin Apolipoprotein D Functional Portrait: A Systematic Review. Front Physiol 2021; 12:738991. [PMID: 34690812 PMCID: PMC8530192 DOI: 10.3389/fphys.2021.738991] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022] Open
Abstract
Apolipoprotein D is a chordate gene early originated in the Lipocalin protein family. Among other features, regulation of its expression in a wide variety of disease conditions in humans, as apparently unrelated as neurodegeneration or breast cancer, have called for attention on this gene. Also, its presence in different tissues, from blood to brain, and different subcellular locations, from HDL lipoparticles to the interior of lysosomes or the surface of extracellular vesicles, poses an interesting challenge in deciphering its physiological function: Is ApoD a moonlighting protein, serving different roles in different cellular compartments, tissues, or organisms? Or does it have a unique biochemical mechanism of action that accounts for such apparently diverse roles in different physiological situations? To answer these questions, we have performed a systematic review of all primary publications where ApoD properties have been investigated in chordates. We conclude that ApoD ligand binding in the Lipocalin pocket, combined with an antioxidant activity performed at the rim of the pocket are properties sufficient to explain ApoD association with different lipid-based structures, where its physiological function is better described as lipid-management than by long-range lipid-transport. Controlling the redox state of these lipid structures in particular subcellular locations or extracellular structures, ApoD is able to modulate an enormous array of apparently diverse processes in the organism, both in health and disease. The new picture emerging from these data should help to put the physiological role of ApoD in new contexts and to inspire well-focused future research.
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Affiliation(s)
- Diego Sanchez
- Instituto de Biologia y Genetica Molecular, Unidad de Excelencia, Universidad de Valladolid-Consejo Superior de Investigaciones Cientificas, Valladolid, Spain
| | - Maria D Ganfornina
- Instituto de Biologia y Genetica Molecular, Unidad de Excelencia, Universidad de Valladolid-Consejo Superior de Investigaciones Cientificas, Valladolid, Spain
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Radmilović Varga L, Dedić Plavetić N, Podolski P, Mijatović D, Kulić A, Vrbanec D. PROGNOSTIC VALUE OF TOPOISOMERASE 2-ALPHA AND B-MYB IN EARLY BREAST CANCER TREATED WITH ADJUVANT CHEMOTHERAPY. Acta Clin Croat 2021; 60:16-24. [PMID: 34588717 PMCID: PMC8305358 DOI: 10.20471/acc.2021.60.01.03] [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: 03/27/2020] [Accepted: 02/12/2021] [Indexed: 11/24/2022] Open
Abstract
Breast cancer is the most common malignancy in females. Despite its well-established prognostic factors, our prognostic ability at an individual patient level remains limited. In this study, the immunohistochemical expression of B-Myb and DNA topoisomerase 2-alpha (Topo2a) was analyzed in primary tumors to identify patients with a higher risk of disease recurrence after adjuvant chemotherapy for early invasive breast cancer. We analyzed a cohort of 215 early invasive breast cancer patients having undergone surgery from 2002 to 2003 at the Zagreb University Hospital Centre, including 153 patients treated with adjuvant chemotherapy. All of them were followed-up prospectively for at least ten years according to routine institutional practice. Statistically significant correlations were found between B-Myb and Topo2a expression levels and particular well-established prognostic factors. B-Myb expression was lower in estrogen receptor (ER)-positive tumors (p=0.0773), whereas larger tumors and those with positive lymphovascular invasion displayed a statistically significantly higher B-Myb expression (p=0.0409 and p=0.0196). Higher tumor grade indicated higher Topo2a values (p=0.0102 and p=0.0069). The subgroup with the expression of both proteins above the median value had an almost statistically significantly (p=0.0613) inferior prognosis compared to the rest of the cohort. Study results showed the B-Myb and Topo2a expression to have a prognostic value in breast cancer patients after adjuvant chemotherapy, which should be additionally explored in future studies in a larger patient cohort.
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Affiliation(s)
| | - Natalija Dedić Plavetić
- 1Department of Pulmonology, Varaždin General Hospital, Klenovnik, Croatia; 2Department of Oncology, Division of Medical Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Pathophysiology, Zagreb University Hospital Centre, Zagreb, Croatia; 6Juraj Dobrila University of Pula, Pula, Croatia
| | - Paula Podolski
- 1Department of Pulmonology, Varaždin General Hospital, Klenovnik, Croatia; 2Department of Oncology, Division of Medical Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Pathophysiology, Zagreb University Hospital Centre, Zagreb, Croatia; 6Juraj Dobrila University of Pula, Pula, Croatia
| | - Davor Mijatović
- 1Department of Pulmonology, Varaždin General Hospital, Klenovnik, Croatia; 2Department of Oncology, Division of Medical Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Pathophysiology, Zagreb University Hospital Centre, Zagreb, Croatia; 6Juraj Dobrila University of Pula, Pula, Croatia
| | - Ana Kulić
- 1Department of Pulmonology, Varaždin General Hospital, Klenovnik, Croatia; 2Department of Oncology, Division of Medical Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Pathophysiology, Zagreb University Hospital Centre, Zagreb, Croatia; 6Juraj Dobrila University of Pula, Pula, Croatia
| | - Damir Vrbanec
- 1Department of Pulmonology, Varaždin General Hospital, Klenovnik, Croatia; 2Department of Oncology, Division of Medical Oncology, Zagreb University Hospital Centre, Zagreb, Croatia; 3School of Medicine, University of Zagreb, Zagreb, Croatia; 4Department of Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 5Department of Pathophysiology, Zagreb University Hospital Centre, Zagreb, Croatia; 6Juraj Dobrila University of Pula, Pula, Croatia
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Qiao J, Li J, Wang L, Guo X, Bian X, Lu Z. Predictive risk factors for sentinel lymph node metastasis using preoperative contrast-enhanced ultrasound in early-stage breast cancer patients. Gland Surg 2021; 10:761-769. [PMID: 33708558 DOI: 10.21037/gs-20-867] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in clinically node-negative (cN0) breast cancer patients. The positive rate of SLNs in cN0 stage patients ranges from 20.5% to 25.5%, so identifying appropriate candidates for SLNB is quite challenging. The aims of this study were to assess whether contrast-enhanced ultrasound (CEUS) could be utilized to noninvasively predict SLN metastasis, and to explore the predictive value of the involved factors. Methods Between May 2016 and May 2018, 217 consenting breast cancer patients undergoing SLNB were enrolled. Before the surgery, CEUS was utilized to identify the SLNs, and predict whether metastasis had occurred according to their enhancement pattern. Blue dye was also used to identify the SLNs during SLNB. The rates of identification and accuracy of both methods were recorded. The predictive outcomes of SLNs identified by CEUS were recorded and compared with the pathological diagnosis. Results Of the 217 cases, SLNs in 212 cases were successfully identified, comprising 208 cases identified by CEUS and 206 cases by blue dye, with no significant difference between the two methods (P=0.6470). A total of 78 cases were predicted SLN-positive preoperatively by CEUS, comprising 61 cases of SLN metastasis confirmed by pathology and 17 cases of no SLN metastasis, and 130 cases were predicted SLN-negative by CEUS, comprising 6 cases of SLN metastasis and 124 cases of no SLN metastasis. The sensitivity of CEUS preoperative prediction was 91.0%, the specificity was 87.9%, the positive and negative predictive values were 78.2% and 95.4%, respectively, and the accuracy was 88.9%. The maximum diameter size of positive SLNs predicted by CEUS was greater than that of negative SLNs (mean value 1.67±0.06 vs. 1.40±0.05 cm, P=0.0007). Similarly, the primary tumor size predicted SLN-positive by CEUS was greater than that in patients with negative SLNs (mean value 2.64±0.12 vs. 1.79±0.09 cm, P<0.0001). Conclusions CEUS accurately identified SLNs and can be used to noninvasively predict SLN metastasis in early-stage breast cancer patients. However, the primary tumor size and the SLN size should not be overlooked by clinicians when judging the status of SLNs. This novel method may be a recommended strategy for identifying appropriate SLNB candidates.
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Affiliation(s)
- Jianghua Qiao
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Juntao Li
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Lina Wang
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Xiaoxia Guo
- Department of Ultrasound, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Xiaolin Bian
- Department of Ultrasound, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
| | - Zhenduo Lu
- Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China
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Loco-regional recurrence after skin and nipple-sparing mastectomy and immediate breast reconstruction using free flap autologous tissue in a single institution. J Plast Reconstr Aesthet Surg 2020; 74:1770-1778. [PMID: 33436340 DOI: 10.1016/j.bjps.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Immediate autologous tissue breast reconstruction after skin- and nipple-sparing mastectomy, is becoming increasingly popular, while the benefits are evident, the concern is in leaving breast tissue under the skin envelope, which could potentially lead to a higher chance of recurrence. We aim to determine the incidence and study the management of loco-regional recurrence (LR) of breast cancer following immediate autologous free flap reconstruction (AFFR) from a 10-year database at a single tertiary breast unit. METHODS This is a retrospective analysis of a prospectively maintained database of consecutive patients who underwent AFFR between July 2008 and December 2018. All patients undergoing delayed reconstruction and risk-reducing surgery were excluded, leaving a total of 216 patients. Statistical analysis was performed to determine significance in the prediction of LR. Management and outcome of the LR was also studied. RESULTS LR was found in 7/216 cases (3.25%). The median age at surgery for patients with LR, was 45 (range 31-54). Median time to recurrence was 54 months (7-79 months). Three patients presented with self-detected lesions. In all, 6/7 patients were ER/PR positive, 2/7 were HER2 + at recurrence, and 1/7 was triple negative. All patients underwent surgical excision for the LR followed by radiotherapy, either chemotherapy (n-5) and/or hormone therapy (n-2). No patients have developed further LR. Because of low numbers of recurrences, no statistical significance was observed for factors causing recurrence. CONCLUSION The low LR we report demonstrates that immediate AFFR is oncologically safe. Timely recognition through post-reconstruction patient education and appropriate management results in good outcomes.
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Kim BH, Shin KH, Chie EK, Kim JH, Kim K, Hwang KT, Kim J, Choi IS, Park JH, Kim S. Identifying Long-Term Survival Candidates among Patients with Isolated Locoregionally Recurrent Breast Cancer: Implications of the Use of Systemic Chemotherapy. J Breast Cancer 2020; 23:279-290. [PMID: 32595990 PMCID: PMC7311366 DOI: 10.4048/jbc.2020.23.e31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose We aimed to investigate the clinicopathologic factors associated with distant metastasis (DM) and post-recurrence overall survival (OS) after salvage treatments for isolated locoregional recurrence (ILRR) of breast cancer and identify long-term surviving patients for providing a more personalized therapy. Methods We analyzed 125 patients who underwent salvage local treatments for ILRR after initial curative breast surgery. Results Fifty-two (41.6%) patients experienced secondary recurrence or disease progression, of which 20 (38.5%) experienced a secondary locoregional recurrence and 40 (76.9%) experienced DM as the first site of failure. In multivariate analysis of distant metastasis free survival (DMFS) and post-recurrence OS, the initial pN2-3 stage, a disease-free interval of < 36 months, and non-curative resection for recurrent disease were independently poor prognosticators. The score for patients stratified according to the number of risk factors increased from 0 to 3; the corresponding 5-year DMFS rates were 91.4%, 53.0%, 35.9%, and 0% and the 5-year OS rates were 97.3%, 70.4%, 32.7%, and 25.0%, respectively (p < 0.001). Systemic chemotherapy reduced DM in patients with a score of 2-3, but it did not in those with a score of 0-1. Conclusion Our collective stratification can help with prognosis prediction for ILRR of breast cancer. Depending on the DM risk of patients, the potential combination of systemic therapy should be discussed further.
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Affiliation(s)
- Byoung Hyuck Kim
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ki-Tae Hwang
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jongjin Kim
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - In Sil Choi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jin Hyun Park
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Suzy Kim
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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The estrogen receptor coactivator AIB1 is a new putative prognostic biomarker in ER-positive/HER2-negative invasive lobular carcinoma of the breast. Breast Cancer Res Treat 2019; 175:305-316. [PMID: 30796653 PMCID: PMC6533234 DOI: 10.1007/s10549-019-05138-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/18/2019] [Indexed: 12/20/2022]
Abstract
Purpose According to the 2017 St Gallen surrogate definitions of the intrinsic subtypes, Ki67, progesterone receptor (PR) and Nottingham histological grade (NHG) are used for prognostic classification of estrogen receptor (ER) positive/HER2-negative breast cancer into luminal A- or luminal B-like. The aim of the present study was to investigate if additional biomarkers, related to endocrine signaling pathways, e.g., amplified in breast cancer 1 (AIB1), androgen receptor (AR), and G protein-coupled estrogen receptor (GPER), can provide complementary prognostic information in a subset of ER-positive/HER-negative invasive lobular carcinoma (ILC). Methods Biomarkers from 224 patients were analyzed immunohistochemically on tissue microarray. The primary endpoint was breast cancer mortality (BCM), analyzed with 10- and 25-year follow-up (FU). In addition, the prognostic value of gene expression data for these biomarkers was analyzed in three publicly available ILC datasets. Results AIB1 (high vs. low) was associated to BCM in multivariable analysis (adjusted for age, tumor size, nodal status, NHG, Ki67, luminal-like classification, and adjuvant systemic therapy) with 10-year FU (HR 6.8, 95% CI 2.3–20, P = 0.001) and 25-year FU (HR 3.0, 95% CI 1.1–7.8, P = 0.03). The evidence of a prognostic effect of AIB1 could be confirmed by linking gene expression data to outcome in independent publicly available ILC datasets. AR and GPER were neither associated to BCM with 10-year nor with 25-year FU (P > 0.33). Furthermore, Ki67 and NHG were prognostic for BCM at both 10-year and 25-year FU, whereas PR was not. Conclusions AIB1 is a new putative prognostic biomarker in ER-positive/HER2-negative ILC. Electronic supplementary material The online version of this article (10.1007/s10549-019-05138-7) contains supplementary material, which is available to authorized users.
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Ricciardelli C, Bianco-Miotto T, Jindal S, Butler LM, Leung S, McNeil CM, O'Toole SA, Ebrahimie E, Millar EKA, Sakko AJ, Ruiz AI, Vowler SL, Huntsman DG, Birrell SN, Sutherland RL, Palmieri C, Hickey TE, Tilley WD. The Magnitude of Androgen Receptor Positivity in Breast Cancer Is Critical for Reliable Prediction of Disease Outcome. Clin Cancer Res 2018. [PMID: 29514843 DOI: 10.1158/1078-0432.ccr-17-1199] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Consensus is lacking regarding the androgen receptor (AR) as a prognostic marker in breast cancer. The objectives of this study were to comprehensively review the literature on AR prognostication and determine optimal criteria for AR as an independent predictor of breast cancer survival.Experimental Design: AR positivity was assessed by immunostaining in two clinically validated primary breast cancer cohorts [training cohort, n = 219; validation cohort, n = 418; 77% and 79% estrogen receptor alpha (ERα) positive, respectively]. The optimal AR cut-point was determined by ROC analysis in the training cohort and applied to both cohorts.Results: AR was an independent prognostic marker of breast cancer outcome in 22 of 46 (48%) previous studies that performed multivariate analyses. Most studies used cut-points of 1% or 10% nuclear positivity. Herein, neither 1% nor 10% cut-points were robustly prognostic. ROC analysis revealed that a higher AR cut-point (78% positivity) provided optimal sensitivity and specificity to predict breast cancer survival in the training (HR, 0.41; P = 0.015) and validation (HR, 0.50; P = 0.014) cohorts. Tenfold cross-validation confirmed the robustness of this AR cut-point. Patients with ERα-positive tumors and AR positivity ≥78% had the best survival in both cohorts (P < 0.0001). Among the combined ERα-positive cases, those with comparable or higher levels of AR (AR:ERα-positivity ratio >0.87) had the best outcomes (P < 0.0001).Conclusions: This study defines an optimal AR cut-point to reliably predict breast cancer survival. Testing this cut-point in prospective cohorts is warranted for implementation of AR as a prognostic factor in the clinical management of breast cancer. Clin Cancer Res; 24(10); 2328-41. ©2018 AACR.
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Affiliation(s)
- Carmela Ricciardelli
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Tina Bianco-Miotto
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - Shalini Jindal
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Lisa M Butler
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Samuel Leung
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catriona M McNeil
- Cancer Research Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Sandra A O'Toole
- Cancer Research Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Esmaeil Ebrahimie
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Ewan K A Millar
- Cancer Research Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Andrew J Sakko
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Alexandra I Ruiz
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Sarah L Vowler
- Cancer Research UK Cambridge Institute, University of Cambridge, Robinson Way, Cambridge, United Kingdom
| | - David G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Stephen N Birrell
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert L Sutherland
- Cancer Research Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Carlo Palmieri
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,Academic Department of Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Theresa E Hickey
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
| | - Wayne D Tilley
- Dame Roma Mitchell Cancer Research Laboratories, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
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Zingarello A, Mazouni C, Rivera S, Mokdad-Adi M, Pistilli B. Prognostic assessment and systemic treatments of invasive local relapses of hormone receptor-positive breast cancer. Breast 2017; 35:162-168. [PMID: 28755621 DOI: 10.1016/j.breast.2017.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/03/2017] [Accepted: 07/17/2017] [Indexed: 12/01/2022] Open
Abstract
The rate of local recurrences, after breast-conserving surgery or mastectomy for hormone receptor-positive (HR+) breast cancer, has dramatically changed in last decades, due to advances in surgical and radiation techniques and a more extensive use of adjuvant systemic treatments. However, the occurrence of local recurrences remains a major predictor for distant metastasis and is responsible for increased cancer-specific death. It has been estimated that 1 in 4 HR+ and HR-ipsilateral breast recurrences leads to widespread metastatic disease, with an annual mortality rate of 10% in the first 5 years. Nevertheless, very few studies have been conducted to evaluate the optimal care of purely HR+ local relapses of breast cancer, after surgical removal. In this review we have highlighted the available knowledge on prognostic assessment and systemic treatment for women experiencing local relapses of HR+ breast cancers, underlying unsolved questions and controversial clinical aspects.
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Affiliation(s)
- Anna Zingarello
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France; Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino - IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Chafika Mazouni
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Sofia Rivera
- Gustave Roussy, Université Paris-Saclay, Department of Radiation Therapy, Villejuif, F-94805, France
| | - Meriem Mokdad-Adi
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Barbara Pistilli
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
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Klebaner D, Hamilton-Dutoit S, Ahern T, Crawford A, Jakobsen T, Cronin-Fenton DP, Damkier P, Janssen E, Kjaersgaard A, Ording AG, Søiland H, Sørensen HT, Lash TL, Hellberg Y. Apolipoprotein D expression does not predict breast cancer recurrence among tamoxifen-treated patients. PLoS One 2017; 12:e0171453. [PMID: 28301514 PMCID: PMC5354364 DOI: 10.1371/journal.pone.0171453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 01/20/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Apolipoprotein D (ApoD) has been proposed as a predictor of breast cancer recurrence among estrogen receptor-positive (ER+), tamoxifen-treated patients. METHODS We conducted a population-based case-control study nested in a population of 11,251 women aged 35-69 years at diagnosis with Stage I-III breast cancer between 1985 and 2001 on Denmark's Jutland Peninsula and registered with the Danish Breast Cancer Cooperative Group. We identified 541 recurrent or contralateral breast cancers cases among women with ER+ disease treated with tamoxifen for at least 1 year and 300 cases in women with ER- disease never treated with tamoxifen. We matched one control subject per case and assessed ApoD expression in the tumor cell nucleus and cytoplasm using tissue microarray immunohistochemistry. We computed the odds ratio (OR) associating ApoD expression with recurrence and adjusted for potential confounding using logistic regression. RESULTS Cytoplasmic ApoD expression was seen in 68% of ER+ tumors, in 66% of ER- tumors, and in 66% of controls across both groups. In women with ER+ tumors, the associations of cytoplasmic ApoD expression with recurrence (OR = 1.0; 95% CI = 0.7 to 1.4) and increasing cytoplasmic expression with recurrence (OR = 1.0; 95% CI = 0.996 to 1.003) were null, as were those for women with ER- tumors. Associations for nuclear ApoD expression and combined nuclear and cytoplasmic expression were similarly near-null. CONCLUSION ApoD expression is likely not a predictor of recurrence in tamoxifen-treated patients. IMPACT This study eliminates the previously suggested marker ApoD as a predictor of recurrence among tamoxifen-treated women.
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Affiliation(s)
- Daniella Klebaner
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Thomas Ahern
- Departments of Surgery and Biochemistry, University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Anatasha Crawford
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Thomas Jakobsen
- Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Per Damkier
- Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark
| | - Emiel Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Håvard Søiland
- Department of Breast and Endocrine Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Timothy L. Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Ylva Hellberg
- Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark
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12
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Tamoxifen Resistance: Emerging Molecular Targets. Int J Mol Sci 2016; 17:ijms17081357. [PMID: 27548161 PMCID: PMC5000752 DOI: 10.3390/ijms17081357] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/10/2016] [Accepted: 08/16/2016] [Indexed: 12/12/2022] Open
Abstract
17β-Estradiol (E2) plays a pivotal role in the development and progression of breast cancer. As a result, blockade of the E2 signal through either tamoxifen (TAM) or aromatase inhibitors is an important therapeutic strategy to treat or prevent estrogen receptor (ER) positive breast cancer. However, resistance to TAM is the major obstacle in endocrine therapy. This resistance occurs either de novo or is acquired after an initial beneficial response. The underlying mechanisms for TAM resistance are probably multifactorial and remain largely unknown. Considering that breast cancer is a very heterogeneous disease and patients respond differently to treatment, the molecular analysis of TAM’s biological activity could provide the necessary framework to understand the complex effects of this drug in target cells. Moreover, this could explain, at least in part, the development of resistance and indicate an optimal therapeutic option. This review highlights the implications of TAM in breast cancer as well as the role of receptors/signal pathways recently suggested to be involved in the development of TAM resistance. G protein—coupled estrogen receptor, Androgen Receptor and Hedgehog signaling pathways are emerging as novel therapeutic targets and prognostic indicators for breast cancer, based on their ability to mediate estrogenic signaling in ERα-positive or -negative breast cancer.
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13
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Pang H, Feng T, Lu H, Meng Q, Chen X, Shen Q, Dong X, Cai L. Efficacy and Safety of Nedaplatin in Advanced Breast Cancer Therapy. Cancer Invest 2016; 34:167-72. [PMID: 27057601 DOI: 10.3109/07357907.2016.1144061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the time-to-treatment failure (TTF), overall survival (OS), overall response rate (ORR), and adverse effects of regimens including nedaplatin- or cisplatin-based chemotherapy for advanced breast cancer (ABC). METHODS A total of 171 patients with ABC (admission between July 2008 and July 2013) were retrospectively analyzed. Patients received either nedaplatin 75 mg/m(2) (arm N; n = 85) or cisplatin 75 mg/m(2) (arm C; n = 86) in combination with other second-generation chemotherapeutic drugs, such as paclitaxel 175 mg/m(2), docetaxel 75 mg/m(2), gemcitabine 1.25 g/m(2), and navelbine 25 mg/m(2) every 21 days (nedaplatin, cisplatin, paclitaxel, docetaxel on day 1; gemcitabine, navelbine on days 1 and 8). The primary endpoint was TTF in each arm; secondary endpoints were OS, ORR, and toxicity. RESULTS In the assessable patient population, in arm N, median TTF and OS was 13.87 months (95% CI: 11.55-16.19) and 31.53 months (95% CI: 28.42-34.64), respectively, with an ORR of 48.2%. In arm C, median TTF and OS was 8.7 months (95% CI: 5.82-11.59) and 24.87 months (95% CI: 18.98-30.75), respectively, with an ORR of 37.2%. The occurrence of grades 3 and 4 hematologic toxicity was more frequent (45.9% vs. 25.6%, p = 0.003) in arm N than in arm C. However, grade ≥2 nonhematologic toxicity was less frequent in arm N than in arm C (12.9% vs. 46.5%, p = 2.05 × 10(-7)). CONCLUSIONS Nedaplatin-based chemotherapy regimen was well tolerated and efficiently improved patients' quality of life characterized by prolonged TTF and OS, with a marginal ORR.
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Affiliation(s)
- Hui Pang
- a Department of Internal Medical Oncology , Harbin Medical University Cancer Hospital , Harbin , China
| | - Ting Feng
- a Department of Internal Medical Oncology , Harbin Medical University Cancer Hospital , Harbin , China
| | - Hailing Lu
- a Department of Internal Medical Oncology , Harbin Medical University Cancer Hospital , Harbin , China
| | - Qingwei Meng
- a Department of Internal Medical Oncology , Harbin Medical University Cancer Hospital , Harbin , China
| | - Xuesong Chen
- a Department of Internal Medical Oncology , Harbin Medical University Cancer Hospital , Harbin , China
| | - Qiang Shen
- b Department of Clinical Cancer Prevention , The University of Texas MD Anderson Cancer Center , Houston , Texas , USA
| | - Xiaoqun Dong
- c College of Medicine, The University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - Li Cai
- a Department of Internal Medical Oncology , Harbin Medical University Cancer Hospital , Harbin , China
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14
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Mejri N, Boussen H, Labidi S, Benna F, Afrit M, Rahal K. Relapse profile of early breast cancer according to immunohistochemical subtypes: guidance for patient's follow up? Ther Adv Med Oncol 2015; 7:144-52. [PMID: 26674096 DOI: 10.1177/1758834015576141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To analyze the profile of annual recurrence rate (ARR) of patients with early breast cancer (BC) in Tunisia. PATIENTS AND METHODS We classified 293 patients with histologically confirmed early BC relapsing after 1 year of follow up into three subgroups: hormone receptor (HR)+ 'HR' [estrogen receptor (ER)+ or progesterone receptor (PR)+ and human epidermal growth factor receptor 2 (HER2)-], triple negative 'TN' (ER-, PR- and HER2 score 0/1 or fluorescence in situ hybridization (FISH)/chromogenic in situ hybridization negative) and HER2 overexpression 'HER2' (HER2+). ARR was restricted to follow-up contribution of each specified time interval. The HR group was the reference group for comparison. RESULTS A higher proportion of patients who were up to 35 years old (18% versus 10%, p = 0.04), and patients with obesity (46% versus 26%, p = 0.045) was seen in the TN group. Median time to relapse (MTR) was shorter in TN and HER2 groups than in HR patients (20 and 29 months compared with 56 months, respectively, p < 0.001). In the HR group, the ARR was 22%, 16% and 10% at 3, 4 and 5 years respectively, becoming less than 3% at 7 years. In the TN group, 71% of patients relapsed during the first 2 years and the ARR declined rapidly to less than 1.5% after 4 years. In the HER2 group, the ARR peaked at 2 years (29%) and decreased significantly to 7% and 3% at 5 and 7 years respectively. Adjuvant trastuzumab delayed the MTR from 24 to 34 months (p = 0.022). CONCLUSION The relapse risk in Tunisian patients is higher in young women and patients with HER2+ and TN tumors. A long and close follow up is recommended for patients with HR and HER2. Conversely, we suggest that follow up in patients with TN could be spaced after 4 years (ARR being <1.5% after this period).
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Affiliation(s)
- Nesrine Mejri
- Department of Medical Oncology, Abderrahman Mami Hospital, Rue de l'Hopital, 2080, Ariana, Tunisia
| | - H Boussen
- Department of Medical Oncology, Abderrahman Mami Hospital, and Association of Radiotherapy and Oncology of the Mediterranean (AROME), Ariana, Tunisia
| | - S Labidi
- Department of Medical Oncology, Abderrahman Mami Hospital, Ariana, Tunisia
| | - F Benna
- Department of Radiation Therapy, Salah Azaiez Institute, Tunis, Tunisia
| | - M Afrit
- Department of Medical Oncology, Abderrahman Mami Hospital, Ariana, Tunisia
| | - K Rahal
- Department of Surgical Oncology, Salah Azaiez Institute, Tunis, Tunisia
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Prognostic value of ki-67 in breast carcinoma: tissue microarray method versus whole section analysis- potentials and pitfalls. Pathol Oncol Res 2014; 21:315-24. [PMID: 25096394 DOI: 10.1007/s12253-014-9823-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 07/24/2014] [Indexed: 12/17/2022]
Abstract
In our study we have compared the prognostic value of two distinct methods of immunohistochemical Ki-67 determination, tissue microarray (TMA) and classical whole section analysis. "Cut-off" values were used according to the 2009 St. Gallen Consensus. Tissue specimens were obtained from a consecutive retrospective series of 215 female patients with primary invasive tumours. Two hundred and thirteen patients were included in the study. Data on Ki-67 was collected by both tissue microarray (TMA) and whole section analysis. Follow up data on overall (OS) and disease-free survival (DFS) were collected. Median follow-up was 95 months (range from 7.8 through 107 months). Mutual correlation of two Ki-67 determination methods was non-significant (Person's r = 0.13417; p = 0.0528). There was statistically significant association of whole section Ki-67 expression with histological and nuclear grade, progesterone receptor and HER2/neu status. The expression of Ki-67 protein in TMAs correlated only with histological and nuclear grade, but not with other traditional clinicopathological factors. Statistically significant differences in DFS (p = 0.0156) and OS (p = 0.0028) were confirmed between subgroups with low and high whole section Ki-67 expression. When subgroups with high and intermediate expression were compared, significant difference was found in DFS (p = 0.0272), but not in OS (p = 0.0624). On the other hand, there was no statistically significant difference either in DFS, or in OS, according to the expression of Ki-67 in TMAs (p = 0.6529; p = 0.7883; p = 0.7966 for DFS, and p = 0.8917; p = 0.6448; p = 0.4323 for OS, respectively). In our study, classical whole section was superior to TMA analysis in terms of prognosis and clinicopathological correlation. Our results indicate that the method used may have impact on prognostic significance of Ki-67. Further studies are needed, covering a greater number of patients and including a precisely defined stage and treatment patient cohorts, in order to solve controversies in Ki-67 assessment methodology.
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McNamara KM, Moore NL, Hickey TE, Sasano H, Tilley WD. Complexities of androgen receptor signalling in breast cancer. Endocr Relat Cancer 2014; 21:T161-81. [PMID: 24951107 DOI: 10.1530/erc-14-0243] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
While the clinical benefit of androgen-based therapeutics in breast cancer has been known since the 1940s, we have only recently begun to fully understand the mechanisms of androgen action in breast cancer. Androgen signalling pathways can have either beneficial or deleterious effects in breast cancer depending on the breast cancer subtype and intracellular context. This review discusses our current knowledge of androgen signalling in breast cancer, including the relationship between serum androgens and breast cancer risk, the prognostic significance of androgen receptor (AR) expression in different breast cancer subtypes and the downstream molecular pathways mediating androgen action in breast cancer cells. Intracrine androgen metabolism has also been discussed and proposed as a potential mechanism that may explain some of the reported differences regarding dichotomous androgen actions in breast cancers. A better understanding of AR signalling in this disease is critical given the current resurgence in interest in utilising contemporary AR-directed therapies for breast cancer and the need for biomarkers that will accurately predict clinical response.
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Affiliation(s)
- Keely M McNamara
- Department of PathologyTohoku University School of Medicine, Miyagi, Sendai, JapanDame Roma Mitchell Cancer Research LaboratoriesDiscipline of Medicine, The University of Adelaide and Hanson Institute, DX 650801, Adelaide, South Australia 5005, Australia
| | - Nicole L Moore
- Department of PathologyTohoku University School of Medicine, Miyagi, Sendai, JapanDame Roma Mitchell Cancer Research LaboratoriesDiscipline of Medicine, The University of Adelaide and Hanson Institute, DX 650801, Adelaide, South Australia 5005, Australia
| | - Theresa E Hickey
- Department of PathologyTohoku University School of Medicine, Miyagi, Sendai, JapanDame Roma Mitchell Cancer Research LaboratoriesDiscipline of Medicine, The University of Adelaide and Hanson Institute, DX 650801, Adelaide, South Australia 5005, Australia
| | - Hironobu Sasano
- Department of PathologyTohoku University School of Medicine, Miyagi, Sendai, JapanDame Roma Mitchell Cancer Research LaboratoriesDiscipline of Medicine, The University of Adelaide and Hanson Institute, DX 650801, Adelaide, South Australia 5005, Australia
| | - Wayne D Tilley
- Department of PathologyTohoku University School of Medicine, Miyagi, Sendai, JapanDame Roma Mitchell Cancer Research LaboratoriesDiscipline of Medicine, The University of Adelaide and Hanson Institute, DX 650801, Adelaide, South Australia 5005, Australia
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Differential prognostic indicators for locoregional recurrence, distant recurrence, and death of breast cancer. ISRN ONCOLOGY 2013; 2013:946945. [PMID: 24377049 PMCID: PMC3860128 DOI: 10.1155/2013/946945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/14/2013] [Indexed: 01/05/2023]
Abstract
Objective. To explore prognostic characteristics for locoregional recurrence, distant recurrence, and mortality in patients with breast cancer. Methods. A 5-year retrospective review of patients was conducted in two university affiliated hospitals in the north of Thailand. Prognostic characteristics and clinical outcomes were retrieved from medical registry. Death was verified by the civil database from the Ministry of Interior, direct telephone contact, or by prepaid postcard. Data were analyzed by stratified Cox's regression proposed by Lunn & McNeil, in which multiple-typed outcomes were analyzed in a single multivariable model. Results. The assembled cohort comprised 829 patients. Under the multivariable analysis, 7 prognostic characteristics were significant prognostic indicators. Positive axillary lymph nodes >3 and presence of lymphovascular invasion (LVI) increased locoregional recurrence, while disease stage 3, positive axillary lymph nodes >3, and radiotherapy increase distant recurrence. Hormonal therapy reduced the distant recurrence. Pathological tumor size >2 cm, disease stage 3, positive axillary lymph nodes >3, and presence of LVI increased, while hormonal therapy and chemotherapy reduced death. Conclusions. Clinical characteristic reflecting tumor invasions increased locoregional recurrence, distant recurrence, or death, while hormonal therapy and chemotherapy reduced such risks. The effect of radiation remained inconclusive but may increase the risk of distant recurrence.
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Vera-Badillo FE, Templeton AJ, de Gouveia P, Diaz-Padilla I, Bedard PL, Al-Mubarak M, Seruga B, Tannock IF, Ocana A, Amir E. Androgen receptor expression and outcomes in early breast cancer: a systematic review and meta-analysis. J Natl Cancer Inst 2013; 106:djt319. [PMID: 24273215 DOI: 10.1093/jnci/djt319] [Citation(s) in RCA: 245] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The androgen receptor (AR) is expressed frequently in breast cancer, but its prognostic significance is unclear. Preclinical data suggest that expression of AR may modify clinical outcomes in early breast cancer with improved prognosis in estrogen receptor (ER)-positive disease and poorer prognosis in ER-negative disease. METHODS A systematic review of electronic databases was conducted to identify studies published between 1946 and July 2012 and to explore the association between AR expression and overall survival (OS) and disease-free survival (DFS) in women diagnosed with early breast cancer. The odds ratios (OR) for OS and DFS at 3 and 5 years were calculated and then weighted and pooled in a meta-analysis with Mantel-Haenszel random-effect modeling. All statistical tests were two-sided. RESULTS Nineteen studies with a total of 7693 women were included. AR expression was documented in 60.5% of patients. ER-positive tumors were more likely to express AR- than ER-negative tumors (74.8% vs 31.8%, χ(2) P < .001). Compared with tumors without AR expression, those expressing AR were associated with improved OS at both 3 and 5 years (OR = 0.47, 95% confidence interval [CI] = 0.39 to 0.58, P < .001; and OR = 0.40, 95% CI = 0.29 to 0.56, P < .001). The absolute differences in the probability of OS at 3 and 5 years were 6.7% (95% CI = 3.5% to 9.8%) and 13.5% (95% CI = 7.5% to 19.6%), respectively. Results for 3- and 5-year DFS were similar. Coexpression of the ER did not influence OS at 3 or at 5 years. CONCLUSIONS Expression of AR in women with breast cancer is associated with better OS and DFS irrespective of coexpression of ER.
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Affiliation(s)
- Francisco E Vera-Badillo
- Affiliations of authors: Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada (FEV-B, AJT, PdG, ID-P, PLB, MA-M, IFT, AO, EA); Sector of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia (BS); Medical Oncology Department and Translational Research Unit, Albacete University Hospital, Albacete, Spain (AO)
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Aapro M, van de Velde C, Markopoulos C, Bartlett J, Putter H, Coleman R. Should all postmenopausal patients with hormone receptor-positive breast cancer receive initial therapy with aromatase inhibitors? Breast 2013; 22:488-94. [DOI: 10.1016/j.breast.2013.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 01/10/2013] [Accepted: 01/18/2013] [Indexed: 11/28/2022] Open
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Romics L, Stallard S, Weiler-Mithoff E. [Oncologic safety of skin-sparing mastectomy followed by immediate breast reconstruction: rate and localization of recurrences, and impact of reconstruction techniques]. Orv Hetil 2013; 154:163-71. [PMID: 23395741 DOI: 10.1556/oh.2013.29529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Oncological safety of skin-sparing mastectomy followed by immediate breast reconstruction is widely debated. Current evidence is relatively poor since it is based mostly on short-term follow-up data of highly selected patient populations. AIM Recurrence rates of a large cohort of non-selected patients, i. e. "all-comers" were analyzed during a 10-year follow up. METHODS Patient records and follow-up data of 253 consecutive cases treated with of skin-sparing mastectomy and immediate breast reconstruction between 1995 and 2000 were studied. During this time period "all-comers" policy was applied, which meant that all patients treated with mastectomy were offered immediate breast reconstruction regardless of tumour stage. RESULTS "All-comers" approach resulted in a large proportion of patients with more advanced disease. During the 112 months mean follow-up 8.2% locoregional, 2.9% local, 10.6% distal and 18.8% overall recurrence rates were detected. Breast cancer specific survival rate was 90.9%. Autologous breast reconstruction was applied more frequently in patients with higher tumour stage; therefore recurrence rate was higher compared to patients undergoing implant-based reconstruction. CONCLUSION Based on these long-term follow-up data skin-sparing mastectomy combined with immediate breast reconstruction is an oncologically safe treatment option. Therefore, application of "all-comers" policy for breast cancer patients treated with skin-sparing mastectomy followed by immediate breast reconstruction is feasible.
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Affiliation(s)
- László Romics
- Victoria Infirmary Glasgow Langside Road Glasgow G49 9TY Egyesült Királyság.
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Prognostic value of proliferation markers expression in breast cancer. Med Oncol 2013; 30:523. [PMID: 23468220 DOI: 10.1007/s12032-013-0523-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/22/2013] [Indexed: 01/23/2023]
Abstract
In this study, immunohistochemical expression of five proliferation markers: Ki-67, aurora-A kinase, survivin, B-Myb and cyclin B1, was analyzed. Consecutive 215 tumor samples from breast cancer patients operated from 2002 to 2003 were analyzed using the TMA ("tissue microarray") method. The median follow-up was 95 months (from 7.8 to 107 months). Statistically significant correlations between expression levels in five proliferation markers, and correlations between some of the proliferation markers and traditional prognostic factors were found. Statistically significant prognostic influence of aurora-A kinase, survivin and B-Myb expression levels on overall and disease-free survival was found, and cyclin B1 expression level on disease-free survival. A multivariate analysis confirmed survivin and B-Myb expression as independent prognostic factors of overall (p = 0.0195; p = 0.0004) and disease-free survival (p = 0.0107 and p = 0.0205) in breast cancer patients.
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Romics L, Chew BK, Weiler-Mithoff E, Doughty JC, Brown IM, Stallard S, Wilson CR, Mallon EA, George WD. Ten-year follow-up of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg 2012; 99:799-806. [PMID: 22367773 DOI: 10.1002/bjs.8704] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND The oncological safety of skin-sparing mastectomy (SSM) followed by immediate breast reconstruction (IBR) is debated owing to a presumed compromise in the completeness of mastectomy. Current evidence is poor as it is based mostly on short-term follow-up data from highly selected patients. METHODS A prospectively maintained institutional database was searched to identify patients who underwent SSM and IBR between 1995 and 2000. A retrospective review of medical records was carried out, including only patients with ductal carcinoma in situ and invasive breast cancer. During this time all patients treated with mastectomy were offered IBR regardless of tumour stage. RESULTS Follow-up data from 253 consecutive patients with IBR were reviewed. Patients with incomplete follow-up data and those undergoing SSM for recurrent disease following previous lumpectomy were disregarded, leaving 207 for analysis. Offering IBR to all women requiring mastectomy resulted in a large proportion of patients with advanced disease. During a median follow-up of 119 months, 17 (8·2 per cent) locoregional, six (2·9 per cent) local and 22 (10·6 per cent) distant recurrences were detected; the overall recurrence rate was 39 (18·8 per cent). Overall recurrence rate was associated with axillary lymph node metastasis (P = 0·009), higher stage (P < 0·001) and higher tumour grade (P = 0·031). The breast cancer-specific survival rate was 90·8 per cent (19 of 207 women died from recurrence). CONCLUSION Based on these long-term follow-up data, SSM combined with IBR is an oncologically safe treatment option regardless of tumour stage.
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Affiliation(s)
- L Romics
- Department of Surgery, Victoria Infirmary, Southern General Hospital, Glasgow, UK.
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Prognostic Factors Affecting Postmastectomy Locoregional Recurrence in Patients with Early Breast Cancer: Are Intrinsic Subtypes Effective? World J Surg 2011; 35:2196-202. [DOI: 10.1007/s00268-011-1240-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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New concept for immediate breast reconstruction for invasive cancers: feasibility, oncological safety and esthetic outcome of post-neoadjuvant therapy immediate breast reconstruction versus delayed breast reconstruction: a prospective pilot study. Breast Cancer Res Treat 2010; 122:439-51. [DOI: 10.1007/s10549-010-0951-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 05/12/2010] [Indexed: 10/25/2022]
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Prognostic factors affecting the outcome of salvage radiotherapy for isolated locoregional recurrence after mastectomy. Am J Clin Oncol 2010; 33:23-7. [PMID: 19704369 DOI: 10.1097/coc.0b013e31819e2c02] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the prognostic factors affecting the outcome of salvage radiotherapy for isolated locoregional recurrence after mastectomy. METHODS Between May 1988 and April 2002, 65 breast cancer patients underwent radiotherapy as a component of salvage treatment for isolated locoregional recurrence after mastectomy. The sites of failure were as follows: chest wall in 37 patients, regional lymph nodes (LNs) in 23 patients, and combined chest wall and LNs in 5 patients. None of the patients had previously been treated with radiation. Thirty-nine patients had surgical resection, and 55 patients received systemic chemotherapy and/or hormonal therapy for recurrent disease. In 51 cases (78.5%), the chest wall and ipsilateral regional lymphatics including supraclavicular, axillary, and internal mammary LNs were irradiated. Median dose was 50.4 Gy (range: 50-71.5). Median duration of follow-up was 52 months (range: 2-206). RESULTS The 5-year overall survival rate was 48.1%. On multivariate analysis, patients without initial nodal involvement had better overall survival (P = 0.0118). The 5-year locoregional progression-free survival rate was 69.8%, and time to recurrence (>36 months vs. < or =36 months) had an influence on the outcome with borderline significance (P = 0.0775). The 5-year distant metastasis-free survival rate was 42.1%. Lack of systemic therapy after recurrence (P = 0.0089) and age <50 years at recurrence (P = 0.0145) were significant prognostic factors predicting poor distant metastasis-free survival. CONCLUSIONS Radiotherapy for isolated locoregional relapse after mastectomy achieved locoregional control in about two-thirds of patients. Major pattern of failure was distant relapse, and systemic therapy is warranted to prevent secondary dissemination.
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Expression of metalloproteases and their inhibitors in primary tumors and in local recurrences after mastectomy for breast cancer. J Cancer Res Clin Oncol 2009; 136:1049-58. [PMID: 20041335 DOI: 10.1007/s00432-009-0750-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 12/09/2009] [Indexed: 10/20/2022]
Abstract
AIMS To investigate the expression of matrix metalloproteases (MMPs) and their inhibitors (TIMPs) in patients who develop local recurrence (LR) after mastectomy. METHODS We analyzed the expressions of MMP-1, -2, -7, -9, -11, -13, -14, TIMP-1, -2, and -3, using immunohistochemical techniques, in primary tumors from patients without tumoral recurrence (n = 50), patients who developed distant metastasis (n = 50), and from patients who develop LRs (n = 25). LRs of the latter group were also analyzed for MMPs expression. All the patients underwent mastectomy. RESULTS Score values for all MMPs and TIMPs were significantly higher in primary tumors of patients with distant metastasis. Primary tumors from patients with LR have lower expressions of MMPs and TIMPs compared with those from patients who developed distant metastasis, and with patients without recurrence for some MMPs. Remarkably, however, primary tumors from patients with LR showed significantly higher percentage of TIMP-1 and 2 expression in stromal cells compared to primary tumors from patients with distant metastasis or primary tumors from patients without tumoral progression. Furthermore, LRs had significantly higher MMP-9 expression than their corresponding primary tumors. CONCLUSIONS Our data indicate differences in MMPs/TIMPs expression between primary tumors of patients with LRs and of those with distant metastasis, both after mastectomy for breast cancer.
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Sarasqueta C, Martínez-Camblor P, Mendiola A, Martínez-Pueyo I, Michelena MJ, Basterretxea M, Recio J, Alvarez I, Larrañaga N. Supervivencia relativa en cáncer de mama después de la primera recidiva y factores pronóstico asociados. Med Clin (Barc) 2009; 133:489-95. [DOI: 10.1016/j.medcli.2009.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 03/05/2009] [Indexed: 11/28/2022]
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Kontos M, Allen D, Trafalis DT, Jones G, Garmo H, Holmberg L, Hamed H. Follow-up may not be beneficial after treatment of grade 1 breast cancer. Br J Surg 2009; 96:999-1004. [PMID: 19644972 PMCID: PMC7970719 DOI: 10.1002/bjs.6669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2009] [Indexed: 11/12/2022]
Abstract
BACKGROUND Identification of women treated for breast cancer who have a low risk of locoregional recurrence or contralateral breast cancer, and who can be discharged safely from follow-up, would lower costs without compromising prognosis. This study investigated the risk of locoregional recurrence and contralateral breast cancer in women treated for grade 1 breast cancer. METHODS Some 1143 women who had surgery for breast cancer were followed, and the rate of locoregional recurrence or contralateral breast cancer was determined. The risk was compared to the tumour grade. RESULTS At a mean follow-up of 9.1 years, 10-year estimates of the cumulative risk of locoregional recurrence or contralateral breast cancer for grade 1, 2 and 3 breast cancer were 0.03 (95 per cent confidence interval (c.i.) 0.01 to 0.08), 0.12 (0.09 to 0.15) and 0.16 (0.13 to 0.20) respectively. Grade 1 tumours had a risk of locoregional recurrence or contralateral breast cancer of 285 (95 per cent c.i. 93 to 670) per 100,000 person-years. CONCLUSION Women treated for grade 1 breast cancer could be discharged from follow-up after completion of the primary treatment, without compromising their quality of care.
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Affiliation(s)
- M Kontos
- Breast Unit, Guy's Hospital, London, UK.
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Søiland H, Kørner H, Skaland I, Janssen EAM, Gudlaugsson E, Varhaug JE, Baak JPA, Søreide JA. Prognostic relevance of androgen receptor detection in operable breast cancer. J Surg Oncol 2009; 98:551-8. [PMID: 18937259 DOI: 10.1002/jso.21156] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Androgen receptor (AR) is relevant for prognostication in breast cancer. Different determination methods and cut-off levels hamper interpretation and comparisons of studies. Long-term prognostic evaluation of different AR assays in patients comprising operable breast cancers is scarce. METHODS AR was evaluated in 120 primary tumors using the dextran-coated charcoal method (charc-AR), and quantitative immunohistochemistry (IHC) on whole sections (WS) and tissue microarrays (TMA). Nuclear and cytoplasmic-AR localization was determined, and the prognostic importance of AR assays was assessed. Comparisons and correlations with the mitotic activity index (MAI), estrogen receptor (ERalpha), progesterone receptor (PR), HER-2, and histological grade (WHO I-III) were made. RESULTS Nuclear-AR in WS, but not charc-AR, strongly correlated with MAI (P = 0.001). However, prognostic information appeared in univariate survival analyses only. Nuclear-AR in TMA was not prognostic. Charc-AR was independent prognostic in node positives both for relapse free survival (RFS) and breast cancer specific survival (BCSS). Both charc-AR and IHC cytoplasmic-AR provided independent prognostic survival information for BCSS in women <55 years. CONCLUSION Methods that can detect AR localized in the cytoplasm yield important prognostic information, and further studies in patients with operable breast cancer are warranted.
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Affiliation(s)
- Håvard Søiland
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway
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Tusquets Trías de Bes I, Servitja Tormo S, Albanell Mestres J. Start strong or switch? Adjuvant endocrine strategies for postmenopausal women with hormone-sensitive breast cancer. Biomed Pharmacother 2009; 63:1-10. [DOI: 10.1016/j.biopha.2008.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 04/08/2008] [Indexed: 10/22/2022] Open
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Lee MH, Kang SH. Clinical Result and Prognosis of Locoregional Recurrent Carcinoma after Mastectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.76.4.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Moo Hyun Lee
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Sun Hee Kang
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
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Yildirim E, Berberoglu U. Postmastectomy locoregional recurrence and distant metastasis in breast carcinoma patients. Breast 2008; 17:367-71. [DOI: 10.1016/j.breast.2007.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 11/12/2007] [Accepted: 12/11/2007] [Indexed: 11/27/2022] Open
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Yildirim E. Locoregional recurrence in breast carcinoma patients. Eur J Surg Oncol 2008; 35:258-63. [PMID: 18644692 DOI: 10.1016/j.ejso.2008.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 06/02/2008] [Accepted: 06/09/2008] [Indexed: 11/30/2022] Open
Abstract
AIMS To assess the risk of locoregional recurrence (LRR) after mastectomy and to identify predictive and treatment factors that affect the risk of LRR. METHODS The primary endpoint was local recurrence. Univariate and multivariate Cox regression analyses were carried out in the data from 1217 patients. RESULTS The median follow-up was 74 months, and 63 (5.2%) patients experienced a LRR in their follow-up period. In the multivariate analysis, age group (< or =35 years vs. >35 years, p<0.0001; Hazard Ratio [HR], 5.0; 95% Confidence Interval [95% CI], 3.0-8.3), tumour size (>2 cm vs. < or =2 cm, p=0.03; HR, 2.2; 95% CI, 1.2-4.7) and LVI (yes vs. no, p<0.0001; HR, 3.2; 95% CI,1.9-5.2) were the independent prognostic factors for LRR. This analysis, in the final model, indicated that adjuvant radiotherapy and adjuvant tamoxifen were associated with a reduced risk of LRR by 90% and 75%, respectively, across the follow-up period, whereas age group remained as an important risk factor (p=0.002; HR, 3.0; 95% CI, 1.5-6.2). CONCLUSIONS Although adjuvant therapies reduce the risk of LRR, young age is an independent risk factor for LRR.
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Affiliation(s)
- E Yildirim
- Department of Surgery, Ankara Oncology Training and Research Hospital, Turkey.
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Søiland H, Janssen EAM, Kørner H, Varhaug JE, Skaland I, Gudlaugsson E, Baak JPA, Søreide JA. Apolipoprotein D predicts adverse outcome in women ≥70 years with operable breast cancer. Breast Cancer Res Treat 2008; 113:519-28. [DOI: 10.1007/s10549-008-9955-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 02/25/2008] [Indexed: 01/04/2023]
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Vaughan A, Dietz JR, Aft R, Gillanders WE, Eberlein TJ, Freer P, Margenthaler JA. Scientific Presentation Award. Patterns of local breast cancer recurrence after skin-sparing mastectomy and immediate breast reconstruction. Am J Surg 2007; 194:438-43. [PMID: 17826052 DOI: 10.1016/j.amjsurg.2007.06.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 06/27/2007] [Accepted: 06/27/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Local recurrence rates after skin-sparing mastectomy and immediate reconstruction are similar to recurrence rates after conventional mastectomy. We investigated the pattern of local recurrences and risk factors associated with them. METHODS We identified 206 patients who underwent 210 skin-sparing mastectomies with immediate reconstruction from 1998 to 2006 in our database. RESULTS Eleven patients had local recurrences (5.3%). Nine developed in the quadrant of the corresponding primary tumor. There were no significant differences between patients who recurred and those who did not with respect to tumor size/stage, margin status, estrogen receptor/progesterone receptor/Her2neu status, lymph node metastases, or radiation therapy (P > .05). Patients with grade 3 invasive tumors or high-grade ductal carcinoma in situ were more likely to recur than patients with grade 1 or 2 invasive tumors or low- or intermediate-grade ductal carcinoma in situ (P = .0035). Those patients who recurred had a significantly decreased overall survival compared to patients who did not recur (P = .0006). CONCLUSIONS Skin-sparing mastectomy and immediate reconstruction has a low local recurrence rate. Recurrences occur most commonly in the same quadrant as the primary tumor and treatment approaches include surgery, chemotherapy, and radiation therapy. Local recurrence portends a poorer overall survival.
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Affiliation(s)
- Aislinn Vaughan
- Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA.
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