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Lord SJ, Daniels B, O'Connell DL, Kiely BE, Beith J, Smith AL, Pearson SA, Chiew KL, Bulsara MK, Houssami N. Decline in the Incidence of Distant Recurrence of Breast Cancer: A Population-Based Health Record Linkage Study, Australia 2001-2016. Cancer Epidemiol Biomarkers Prev 2024; 33:314-324. [PMID: 38015752 DOI: 10.1158/1055-9965.epi-23-0942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/29/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND We investigated differences in cumulative incidence of first distant recurrence (DR) following non-metastatic breast cancer over a time period when new adjuvant therapies became available in Australia. METHODS We conducted a health record linkage study of females with localized (T1-3N0) or regional (T4 or N+) breast cancer in the New South Wales Cancer Registry in 2001 to 2002 and 2006 to 2007. We linked cancer registry records with administrative records from hospitals, dispensed medicines, radiotherapy services, and death registrations to estimate the 9-year cumulative incidence of DR and describe use of adjuvant treatment. RESULTS The study included 13,170 women (2001-2002 n = 6,338, 2006-2007 n = 6,832). The 9-year cumulative incidence of DR was 3.6% [95% confidence interval (CI), 2.3%-4.9%] lower for 2006-2007 diagnoses (15.0%) than 2001-2002 (18.6%). Differences in the annual hazard of DR between cohorts were largest in year two. DR incidence declined for localized and regional disease. Decline was largest for ages <40 years (absolute difference, 14.4%; 95% CI, 8.3%-20.6%), whereas their use of adjuvant chemotherapy (2001-2002 49%, 2006-2007 75%) and HER2-targeted therapy (2001-2002 0%, 2006-2007 16%) increased. DR did not decline for ages ≥70 years (absolute difference, 0.9%; 95% CI, -3.6%-1.8%) who had low use of adjuvant chemotherapy and HER2-targeted therapy. CONCLUSIONS This whole-of-population study suggests that DR incidence declined over time. Decline was largest for younger ages, coinciding with changes to adjuvant breast cancer therapy. IMPACT Study findings support the need for trials addressing questions relevant to older people and cancer registry surveillance of DR to inform cancer control programs.
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Affiliation(s)
- Sarah J Lord
- The National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, Australia
- The School of Medicine, University of Notre Dame Australia, Darlinghurst, Australia
- NHMRC Centre of Research Excellence in Medicines Intelligence, UNSW Sydney, Australia
| | - Benjamin Daniels
- NHMRC Centre of Research Excellence in Medicines Intelligence, UNSW Sydney, Australia
- Health Systems Research, School of Population Health, UNSW Sydney, Australia
| | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Australia
| | - Belinda E Kiely
- The National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, Australia
| | - Jane Beith
- Chris O'Brien Lifehouse, Camperdown, The University of Sydney, Camperdown, Australia
| | - Andrea L Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Sallie-Anne Pearson
- NHMRC Centre of Research Excellence in Medicines Intelligence, UNSW Sydney, Australia
- Health Systems Research, School of Population Health, UNSW Sydney, Australia
| | - Kim-Lin Chiew
- Cancer Services Division, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Max K Bulsara
- The Institute of Health Research and the School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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de Maar JS, Luyendijk M, Suelmann BBM, van der Kruijssen DEW, Elias SG, Siesling S, van der Wall E. Comparison between de novo and metachronous metastatic breast cancer: the presence of a primary tumour is not the only difference-a Dutch population-based study from 2008 to 2018. Breast Cancer Res Treat 2023; 198:253-264. [PMID: 36648694 DOI: 10.1007/s10549-022-06837-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/04/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to compare characteristics and survival of patients with de novo and metachronous metastatic breast cancer. METHODS Data of patients with metastatic breast cancer were obtained from the Netherlands Cancer Registry. Patients were categorized as having de novo metastatic breast cancer (n = 8656) if they had distant metastases at initial presentation, or metachronous metastatic disease (n = 2374) in case they developed metastases within 5 or 10 years after initial breast cancer diagnosis. Clinicopathological characteristics and treatments of these two groups were compared, after which multiple imputation was performed to account for missing data. Overall survival was compared for patients treated with systemic therapy in the metastatic setting, using Kaplan Meier curves and multivariable Cox proportional hazards models. The hazard ratio for overall survival of de novo versus metachronous metastases was assessed accounting for time-varying effects. RESULTS Compared to metachronous patients, patients with de novo metastatic breast cancer were more likely to be ≥ 70 years, to have invasive lobular carcinoma, clinical T3 or T4 tumours, loco-regional lymph node metastases, HER2 positivity, bone only disease and to have received systemic therapy in the metastatic setting. They were less likely to have triple negative tumours and liver or brain metastases. Patients with de novo metastases survived longer (median 34.7 months) than patients with metachronous metastases (median 24.3 months) and the hazard ratio (0.75) varied over time. CONCLUSIONS Differences in clinicopathological characteristics and survival between de novo and metachronous metastatic breast cancer highlight that these are distinct patients groups.
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Affiliation(s)
- Josanne S de Maar
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne Luyendijk
- Department of Research and Development, Netherlands Comprehensive Cancer Centre (IKNL), Utrecht, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Britt B M Suelmann
- Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dave E W van der Kruijssen
- Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Centre (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Calabrese A, Santucci D, Gravina M, Faiella E, Cordelli E, Soda P, Iannello G, Sansone C, Zobel BB, Catalano C, de Felice C. 3T-MRI Artificial Intelligence in Patients with Invasive Breast Cancer to Predict Distant Metastasis Status: A Pilot Study. Cancers (Basel) 2022; 15:cancers15010036. [PMID: 36612033 PMCID: PMC9817717 DOI: 10.3390/cancers15010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The incidence of breast cancer metastasis has decreased over the years. However, 20-30% of patients with early breast cancer still die from metastases. The purpose of this study is to evaluate the performance of a Deep Learning Convolutional Neural Networks (CNN) model to predict the risk of distant metastasis using 3T-MRI DCE sequences (Dynamic Contrast-Enhanced). METHODS A total of 157 breast cancer patients who underwent staging 3T-MRI examinations from January 2011 to July 2022 were retrospectively examined. Patient data, tumor histological and MRI characteristics, and clinical and imaging follow-up examinations of up to 7 years were collected. Of the 157 MRI examinations, 39/157 patients (40 lesions) had distant metastases, while 118/157 patients (120 lesions) were negative for distant metastases (control group). We analyzed the role of the Deep Learning technique using a single variable size bounding box (SVB) option and employed a Voxel Based (VB) NET CNN model. The CNN performance was evaluated in terms of accuracy, sensitivity, specificity, and area under the ROC curve (AUC). RESULTS The VB-NET model obtained a sensitivity, specificity, accuracy, and AUC of 52.50%, 80.51%, 73.42%, and 68.56%, respectively. A significant correlation was found between the risk of distant metastasis and tumor size, and the expression of PgR and HER2. CONCLUSIONS We demonstrated a currently insufficient ability of the Deep Learning approach in predicting a distant metastasis status in patients with BC using CNNs.
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Affiliation(s)
- Alessandro Calabrese
- Department of Radiology, University of Rome “Sapienza”, Viale del Policlinico 155, 00161 Roma, Italy
- Correspondence:
| | - Domiziana Santucci
- Department of Radiology, Sant’Anna Hospital, Via Ravona, 22042 San Fermo della Battaglia, Italy
- Unit of Computer Systems and Bioinformatics, Department of Engineering, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Michela Gravina
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, 80131 Naples, Italy
| | - Eliodoro Faiella
- Department of Radiology, Sant’Anna Hospital, Via Ravona, 22042 San Fermo della Battaglia, Italy
| | - Ermanno Cordelli
- Unit of Computer Systems and Bioinformatics, Department of Engineering, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Paolo Soda
- Unit of Computer Systems and Bioinformatics, Department of Engineering, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo 21, 00128 Roma, Italy
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Universitetstorget, 490187 Umeå, Sweden
| | - Giulio Iannello
- Unit of Computer Systems and Bioinformatics, Department of Engineering, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Carlo Sansone
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, 80131 Naples, Italy
| | - Bruno Beomonte Zobel
- Department of Radiology, University of Rome “Campus Bio-medico”, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Carlo Catalano
- Department of Radiology, University of Rome “Sapienza”, Viale del Policlinico 155, 00161 Roma, Italy
| | - Carlo de Felice
- Department of Radiology, University of Rome “Sapienza”, Viale del Policlinico 155, 00161 Roma, Italy
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Liu X, Yuan P, Li R, Zhang D, An J, Ju J, Liu C, Ren F, Hou R, Li Y, Yang J. Predicting breast cancer recurrence and metastasis risk by integrating color and texture features of histopathological images and machine learning technologies. Comput Biol Med 2022; 146:105569. [DOI: 10.1016/j.compbiomed.2022.105569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 12/11/2022]
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DeBusk K, Ike C, Lindegger N, Schwartz N, Surinach A, Liu Y, Forero-Torres A. Real-world outcomes among patients with HER2+ metastatic breast cancer with brain metastases. J Manag Care Spec Pharm 2022; 28:657-666. [PMID: 35621719 PMCID: PMC10373006 DOI: 10.18553/jmcp.2022.28.6.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND: Among patients with human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer (MBC), incidence of brain metastases (BMs) is relatively high and increasing. Despite the high unmet need for patients with HER2+ MBC and BMs, real-world data on treatment patterns and outcomes for these patients are limited. OBJECTIVE: To compare treatment patterns and overall survival (OS) among patients with HER2+ MBC with and without BMs in the United States. METHODS: This was a real-world retrospective cohort study in which adults diagnosed with HER2+ MBC between January 1, 2016, and May 31, 2019, were identified in the Flatiron Health electronic health records database. The cohort was stratified by presence of BMs at MBC diagnosis (baseline) and before the initiation of each line of therapy (LOT). Key outcomes were OS and systemic therapy/regimen used within each LOT. An adjusted Cox proportional hazards model was used to evaluate the impact of BMs on OS. RESULTS: Of 1,755 included patients, 173 (9.9%) had BMs at baseline. Trastuzumab+ pertuzumab-based regimens were the most common first- (n = 689, 44.3%) and second-line (n = 316, 35.3%) treatments for all patients. Among patients with BMs, trastuzumab emtansine was the most common third-line regimen (n = 18, 23.4%). Lapatinib-based regimens were used more frequently among patients with BMs but were used by less than 20% of patients with BMs within any LOT. Median OS was 22.3 and 37.3 months for patients with and without BMs at baseline, respectively. Patients with BMs had a higher risk of death compared with patients without BMs (HR, 3.2; 95% CI = 2.6-3.8). CONCLUSIONS: BMs are associated with an increased risk of mortality among patients with HER2+ MBC. Further studies are needed to evaluate the extent to which novel systemic therapies for HER2+ MBC address the unmet need among patients with BMs. DISCLOSURES: This study was funded by Seagen Inc. Andres Forero-Torres is an employee of and owns stock in Seagen Inc. Kendra DeBusk is an employee of Seagen Inc. and owns stock in Seagen Inc. and Roche. Andy Surinach and Yutong Liu are employees of Genesis Research, which received funding from Seagen Inc. in connection with this study. At the time of this study, Chimeka Ike was an employee of Seagen Inc. and owns stock in Seagen Inc. At the time of this study, Nicolas Lindegger was an employee of Seagen Inc., Seagen International GmbH, and owns stock in Seagen Inc. and Roche. At the time of this study, Naomi Schwartz was a paid consultant to Seagen Inc.; she currently is an employee of and owns stock in Seagen Inc.
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Ronen S, Suster D, Chen WS, Ronen N, Arudra SKC, Trinidad C, Ivan D, Prieto VG, Suster S. Histologic Patterns of Cutaneous Metastases of Breast Carcinoma: A Clinicopathologic Study of 232 Cases. Am J Dermatopathol 2021; 43:401-411. [PMID: 34006731 DOI: 10.1097/dad.0000000000001841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
ABSTRACT Cutaneous metastasis may be the initial sign of internal malignancy but more often represents a late manifestation of widely disseminated disease. Breast carcinoma is the most common malignancy to metastasize to the skin. Although several studies have detailed the histopathologic patterns of cutaneous metastasis from internal malignancies, very little has been published regarding metastases of breast carcinoma to the skin. Furthermore, the histopathologic and clinical features observed in the cases of breast carcinoma with local skin involvement as opposed to cases exhibiting distant cutaneous metastases have not been adequately investigated. We have reviewed 232 cases of breast carcinoma with cutaneous metastases from 2 large institutions. All cases of carcinoma of the breast with involvement of the skin of the anterior chest wall were compared with those with distant cutaneous metastases. Two hundred thirty-two cases in 199 patients were included, of which 126 had skin involvement exclusively involving the ipsilateral anterior chest, and 106 had biopsy-proven distant cutaneous metastases. Twelve patients had both local and distal spread. Distant cutaneous metastases showed a predilection for the contralateral anterior chest wall area, followed by the head and neck, back, and abdomen. Histologically, most of the tumors presented in this series showed features of infiltrating ductal carcinoma. In both ipsilateral and distant metastases, the tumors demonstrated little change in histologic features from the primary lesion; however, the distant metastases showed a tendency to display more poorly differentiated features. The mean patient survival when cutaneous involvement was localized to the skin of the anterior chest wall was 23 months as compared with 20.6 months when distant sites were affected. A comparison of the clinicopathologic features of the patients presented in this series suggests that alternate biological mechanisms may apply for local and distant skin metastases from breast carcinoma.
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Affiliation(s)
- Shira Ronen
- Staff Member, Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH
| | - David Suster
- Assistant Professor, Department of Pathology, Rutgers University, New Jersey Medical School, Newark, NJ
| | - Wei-Shen Chen
- Assistant Professor, Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL
| | - Natali Ronen
- Pathology Resident, Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Doina Ivan
- Professor, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and
| | - Victor G Prieto
- Professor, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and
| | - Saul Suster
- Professor, Departments of Pathology, Medical College of Wisconsin, Milwaukee, WI
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7
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Lao C, Kuper-Hommel M, Elwood M, Campbell I, Lawrenson R. Metastatic relapse of stage I-III breast cancer in New Zealand. Cancer Causes Control 2021; 32:753-761. [PMID: 33830387 DOI: 10.1007/s10552-021-01426-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/26/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aims to investigate the factors that influence the risk of metastatic relapse in women presenting with stage I-III breast cancer in New Zealand. METHODS The study included women diagnosed with stage I-III breast cancer. Cumulative incidence of distant metastatic relapse was examined with the Kaplan-Meier method by cancer stage and subtype. Cox proportional hazards models were used to estimate the adjusted hazard ratio of developing recurrent metastatic breast cancer by cancer stage and biomarker subtype after adjustment for other factors. RESULTS A total of 17,543 eligible women were identified. The 5-year cumulative incidence of metastatic recurrence was 3.7% for stage I, 13.3% for stage II and 30.9% for stage III disease. The adjusted hazard ratios (HR) of stage II and stage III breast cancer developing metastatic disease were 2.07 and 4.82 compared to stage I. The adjusted risk of distant metastatic relapse was highest for luminal B HER2- cancers (adjusted HR: 1.59 compared to luminal A disease). Higher grade cancers were associated with a higher risk of metastases. After adjustment, women aged 60-69 years and Asian women had the lowest risk of distant metastatic relapse. CONCLUSIONS The prognosis of women with locally invasive breast cancer differs greatly with the chance of developing metastatic disease depending on the stage of disease at diagnosis and the subtype. Grade of disease at diagnosis was also important. Māori or Pacific ethnicity did not influence the risk of developing metastatic disease, although Asian women seemed less likely to develop metastases.
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Affiliation(s)
- Chunhuan Lao
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | | | - Mark Elwood
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Ian Campbell
- School of Medicine, The University of Auckland, Auckland, New Zealand.,General Surgery, Waikato District Health Board, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, The University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.,Strategy and Funding, Waikato District Health Board, Hamilton, New Zealand
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Massafra R, Latorre A, Fanizzi A, Bellotti R, Didonna V, Giotta F, La Forgia D, Nardone A, Pastena M, Ressa CM, Rinaldi L, Russo AOM, Tamborra P, Tangaro S, Zito A, Lorusso V. A Clinical Decision Support System for Predicting Invasive Breast Cancer Recurrence: Preliminary Results. Front Oncol 2021; 11:576007. [PMID: 33777733 PMCID: PMC7991309 DOI: 10.3389/fonc.2021.576007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/22/2021] [Indexed: 12/20/2022] Open
Abstract
The mortality associated to breast cancer is in many cases related to metastasization and recurrence. Personalized treatment strategies are critical for the outcomes improvement of BC patients and the Clinical Decision Support Systems can have an important role in medical practice. In this paper, we present the preliminary results of a prediction model of the Breast Cancer Recurrence (BCR) within five and ten years after diagnosis. The main breast cancer-related and treatment-related features of 256 patients referred to Istituto Tumori “Giovanni Paolo II” of Bari (Italy) were used to train machine learning algorithms at the-state-of-the-art. Firstly, we implemented several feature importance techniques and then we evaluated the prediction performances of BCR within 5 and 10 years after the first diagnosis by means different classifiers. By using a small number of features, the models reached highly performing results both with reference to the BCR within 5 years and within 10 years with an accuracy of 77.50% and 80.39% and a sensitivity of 92.31% and 95.83% respectively, in the hold-out sample test. Despite validation studies are needed on larger samples, our results are promising for the development of a reliable prognostic supporting tool for clinicians in the definition of personalized treatment plans.
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Affiliation(s)
- Raffaella Massafra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Agnese Latorre
- Unitá Opertiva Complessa di Oncologia Medica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Annarita Fanizzi
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Roberto Bellotti
- Dipartimento di Fisica, Universitá degli Studi "Aldo Moro" e Istituto Nazionale di Fisica Nucleare - Sezione di Bari, Bari, Italy
| | - Vittorio Didonna
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Francesco Giotta
- Unitá Opertiva Complessa di Oncologia Medica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Daniele La Forgia
- Struttura Semplice Dipartimentale di Radiologia Senologica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Annalisa Nardone
- Unitá Opertiva Complessa di Radioterapia, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Maria Pastena
- Unitá Opertiva Complessa di Anatomia Patologica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Cosmo Maurizio Ressa
- Unitá Opertiva Complessa di Chirurgia Plastica e Ricostruttiva, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Lucia Rinaldi
- Struttura Semplice Dipartimentale di Oncologia Per la Presa in Carico Globale del Paziente, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Pasquale Tamborra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Sabina Tangaro
- Dipartimento di Scienze del Suolo, della Pianta e degli Alimenti, Universitá degli Studi "Aldo Moro" e Istituto Nazionale di Fisica Nucleare - Sezione di Bari, Bari, Italy
| | - Alfredo Zito
- Unitá Opertiva Complessa di Anatomia Patologica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vito Lorusso
- Unitá Opertiva Complessa di Oncologia Medica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
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Kunst N, Alarid-Escudero F, Aas E, Coupé VMH, Schrag D, Kuntz KM. Estimating Population-Based Recurrence Rates of Colorectal Cancer over Time in the United States. Cancer Epidemiol Biomarkers Prev 2020; 29:2710-2718. [PMID: 32998946 PMCID: PMC7747688 DOI: 10.1158/1055-9965.epi-20-0490] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/01/2020] [Accepted: 09/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Population-based metastatic recurrence rates for patients diagnosed with nonmetastatic colorectal cancer cannot be estimated directly from population-based cancer registries because recurrence information is not reported. We derived population-based colorectal cancer recurrence rates using disease-specific survival data based on our understanding of the colorectal cancer recurrence-death process. METHODS We used a statistical continuous-time multistate survival model to derive population-based annual colorectal cancer recurrence rates from 6 months to 10 years after colorectal cancer diagnosis using relative survival data from the Surveillance, Epidemiology, and End Results Program. The model was based on the assumption that, after 6 months of diagnosis, all colorectal cancer-related deaths occur only in patients who experience a metastatic recurrence first, and that the annual colorectal cancer-specific death rate among patients with recurrence was the same as in those diagnosed with de novo metastatic disease. We allowed recurrence rates to vary by post-diagnosis time, age, stage, and location for two diagnostic time periods. RESULTS In patients diagnosed in 1975-1984, annual recurrence rates 6 months to 5 years after diagnosis ranged from 0.054 to 0.060 in stage II colon cancer, 0.094 to 0.105 in stage II rectal cancer, and 0.146 to 0.177 in stage III colorectal cancer, depending on age. We found a statistically significant decrease in colorectal cancer recurrence among patients diagnosed in 1994-2003 compared with those diagnosed in 1975-1984 for 6 months to 5 years after diagnosis (hazard ratios between 0.43 and 0.70). CONCLUSIONS We derived population-based annual recurrence rates for up to 10 years after diagnosis using relative survival data. IMPACT Our estimates can be used in decision-analytic models to facilitate analyses of colorectal cancer interventions that are more generalizable.
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Affiliation(s)
- Natalia Kunst
- Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center, New Haven, Connecticut
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- LINK Medical Research, Oslo, Norway
| | - Fernando Alarid-Escudero
- Division of Public Administration, Center for Research and Teaching in Economics (CIDE), Aguascalientes, Aguascalientes, Mexico
| | - Eline Aas
- Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Veerle M H Coupé
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Deborah Schrag
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Karen M Kuntz
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
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10
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Klebe M, Fremd C, Kriegsmann M, Kriegsmann K, Albrecht T, Thewes V, Kirchner M, Charoentong P, Volk N, Haag J, Wirtz R, Oskarsson T, Schulz A, Heil J, Schneeweiss A, Winter H, Sinn P. Frequent Molecular Subtype Switching and Gene Expression Alterations in Lung and Pleural Metastasis From Luminal A-Type Breast Cancer. JCO Precis Oncol 2020; 4:1900337. [PMID: 32923902 PMCID: PMC7446514 DOI: 10.1200/po.19.00337] [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] [Accepted: 05/26/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Conversion of tumor subtype frequently occurs in the course of metastatic breast cancer but is a poorly understood phenomenon. This study aims to compare molecular subtypes with subsequent lung or pleural metastasis. PATIENTS AND METHODS In a cohort of 57 patients with breast cancer and lung or pleural metastasis (BCLPM), we investigated paired primary and metastatic tissues for differential gene expression of 269 breast cancer genes. The PAM50 classifier was applied to identify intrinsic subtypes, and differential gene expression and cluster analysis were used to further characterize subtypes and tumors with subtype conversion. RESULTS In primary breast cancer, the most frequent molecular subtype was luminal A (lumA; 49.1%); it was luminal B (lumB) in BCLPM (38.6%). Subtype conversion occurred predominantly in lumA breast cancers compared with other molecular subtypes (57.1% v 27.6%). In lumA cancers, 62 genes were identified with differential expression in metastatic versus primary disease, compared with only 10 differentially expressed genes in lumB, human epidermal growth factor receptor 2 (HER2)–enriched, and basal subtypes combined. Gene expression changes in lumA cancers affected not only the repression of the estrogen receptor pathway and cell cycle–related genes but also the WNT pathway, proteinases (MME, MMP11), and motility-associated cytoskeletal proteins (CK5, CK14, CK17). Subtype-switched lumA cancers were further characterized by cell proliferation and cell cycle checkpoint gene upregulation and dysregulation of the p53 pathway. This involved 83 notable gene expression changes. CONCLUSION Our results indicate that gene expression changes and subsequent subtype conversion occur on a large scale in metastatic luminal A–type breast cancer compared with other molecular subtypes. This underlines the significance of molecular changes in metastatic disease, especially in tumors of initially low aggressive potential.
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Affiliation(s)
- Max Klebe
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Carlo Fremd
- National Center for Tumor Diseases, Department of Medical Oncology, Heidelberg, Germany
| | - Mark Kriegsmann
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Katharina Kriegsmann
- Department of Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Albrecht
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Verena Thewes
- National Center for Tumor Diseases, Department of Medical Oncology, Heidelberg, Germany.,Division of Stem Cells and Cancer, German Cancer Research Center and Heidelberg Institute for Stem Cell Technology and Experimental Medicine, Heidelberg, Germany
| | - Martina Kirchner
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Pornpimol Charoentong
- National Center for Tumor Diseases, Department of Medical Oncology, Heidelberg, Germany.,Division of Stem Cells and Cancer, German Cancer Research Center and Heidelberg Institute for Stem Cell Technology and Experimental Medicine, Heidelberg, Germany
| | - Nadine Volk
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases, Department of Medical Oncology, Heidelberg, Germany
| | - Johannes Haag
- Department of Surgery, Thoraxklinik Heidelberg, Heidelberg, Germany
| | - Ralph Wirtz
- Stratifyer Molecular Diagnostic GmbH, Köln, Germany
| | - Thordur Oskarsson
- Division of Stem Cells and Cancer, German Cancer Research Center and Heidelberg Institute for Stem Cell Technology and Experimental Medicine, Heidelberg, Germany
| | - Alexandra Schulz
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Hauke Winter
- Department of Surgery, Thoraxklinik Heidelberg, Heidelberg, Germany
| | - Peter Sinn
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
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11
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Sas A, Tanck E, Sermon A, van Lenthe GH. Finite element models for fracture prevention in patients with metastatic bone disease. A literature review. Bone Rep 2020; 12:100286. [PMID: 32551337 PMCID: PMC7292864 DOI: 10.1016/j.bonr.2020.100286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/04/2020] [Accepted: 05/25/2020] [Indexed: 12/17/2022] Open
Abstract
Patients with bone metastases have an increased risk to sustain a pathological fracture as lytic metastatic lesions damage and weaken the bone. In order to prevent fractures, prophylactic treatment is advised for patients with a high fracture risk. Mechanical stabilization of the femur can be provided through femoroplasty, a minimally invasive procedure where bone cement is injected into the lesion, or through internal fixation with intra- or extramedullary implants. Clinicians face the task of determining whether or not prophylactic treatment is required and which treatment would be the most optimal. Finite element (FE) models are promising tools that could support this decision process. The aim of this paper is to provide an overview of the state-of-the-art in FE modeling for the treatment decision of metastatic bone lesions in the femur. First, we will summarize the clinical and mechanical results of femoroplasty as a prophylactic treatment method. Secondly, current FE models for fracture risk assessment of metastatic femurs will be reviewed and the remaining challenges for clinical implementation will be discussed. Thirdly, we will elaborate on the simulation of femoroplasty in FE models and discuss future opportunities. Femoroplasty has already proven to effectively relieve pain and improve functionality, but there remains uncertainty whether it provides sufficient mechanical strengthening to prevent pathological fractures. FE models could help to select appropriate candidates for whom femoroplasty provides sufficient increase in strength and to further improve the mechanical benefit by optimizing the locations for cement augmentation.
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Affiliation(s)
- Amelie Sas
- Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Esther Tanck
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - An Sermon
- Department of Traumatology, University Hospitals Gasthuisberg, Leuven, Belgium and Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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12
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Tomasini C. Cytotoxic-mediated spontaneous regression of inflammatory cutaneous metastases of breast carcinoma. J Cutan Pathol 2020; 47:758-763. [PMID: 32222990 DOI: 10.1111/cup.13694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 12/29/2022]
Abstract
Spontaneous regression (SR) of cancer is a rare but well-documented biological phenomenon, which is even rarer in the context of metastatic breast carcinoma. Different mechanisms of SR are still under debate, including immune-mediated response. We herein report a case of the SR of intralymphatic cutaneous metastases of a breast carcinoma with spontaneously-induced T-cell-mediated cytotoxic response. An 86-year-old female was diagnosed with locally advanced right breast carcinoma and axillary lymph node metastases, without distant metastases The patient refused any therapy. Six months afterwards, she developed multiple, asymptomatic purpura-like plaques with prominent teleangectasias on her right chest wall, continuous to the previous surgical scar and on her ipsilateral abdomen. Skin biopsy showed aggregates of atypical cells admixed with erythrocyte thrombi within dilated dermal lymphatic vessels. SR of the cutaneous lesions occurred within 6 months and persisted at the 15 months follow-up in the absence of therapy, whilst no signs of internal relapse were observed. Immunohistochemically, the estrogen-negative, CK7-positive, C-erb B2-positive intralymphatic metastases were associated with extensive infiltration of CD8-positive cytototoxic T lymphocytes. Factors that may have precluded the implantation of intralymphatic metastases leading to SR are discussed, with local immune surveillance being one major hypothesis.
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Affiliation(s)
- Carlo Tomasini
- IRCCS Fondazione Policlinico San Matteo, Department of Medical-Surgical, Diagnostic and Pediatric Sciences, Dermatologic Clinic, University of Pavia School of Medicine, Pavia, Italy
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13
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Predicting breast cancer metastasis by using serum biomarkers and clinicopathological data with machine learning technologies. Int J Med Inform 2019; 128:79-86. [PMID: 31103449 DOI: 10.1016/j.ijmedinf.2019.05.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 04/22/2019] [Accepted: 05/06/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Approximately 10%-15% of patients with breast cancer die of cancer metastasis or recurrence, and early diagnosis of it can improve prognosis. Breast cancer outcomes may be prognosticated on the basis of surface markers of tumor cells and serum tests. However, evaluation of a combination of clinicopathological features may offer a more comprehensive overview for breast cancer prognosis. MATERIALS AND METHODS We evaluated serum human epidermal growth factor receptor 2 (sHER2) as part of a combination of clinicopathological features used to predict breast cancer metastasis using machine learning algorithms, namely random forest, support vector machine, logistic regression, and Bayesian classification algorithms. The sample cohort comprised 302 patients who were diagnosed with and treated for breast cancer and received at least one sHER2 test at Chang Gung Memorial Hospital at Linkou between 2003 and 2016. RESULTS The random-forest-based model was determined to be the optimal model to predict breast cancer metastasis at least 3 months in advance; the correspondingarea under the receiver operating characteristic curve value was 0. 75 (p < 0. 001). CONCLUSION The random-forest-based model presented in this study may be helpful as part of a follow-up intervention decision support system and may lead to early detection of recurrence, early treatment, and more favorable outcomes.
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14
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Lord SJ, Kiely BE, Pearson SA, Daniels B, O'Connell DL, Beith J, Bulsara MK, Houssami N. Metastatic breast cancer incidence, site and survival in Australia, 2001-2016: a population-based health record linkage study protocol. BMJ Open 2019; 9:e026414. [PMID: 30709862 PMCID: PMC6367965 DOI: 10.1136/bmjopen-2018-026414] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Advances in systemic therapy for early and metastatic breast cancer (BC) over the last two decades have improved patients' survival, but their impact on metastatic disease outcomes at a population level is not well described. The aim of this study is to investigate changes in the incidence, site and survival of metastatic disease for women with a first diagnosis of BC in 2001-2002 vs 2006-2007. METHODS AND ANALYSIS Population-based retrospective cohort study of women with first primary invasive BC registered in the New South Wales (NSW) Cancer Registry in 2001-2002 and 2006-2007. We will use linked records from NSW hospitals, dispensed medicines, outpatient services and death registrations to determine: women's demographic and tumour characteristics; treatments received; time to first distant metastasis; site of first metastasis and survival. We will use the Kaplan-Meier method to estimate cumulative incidence of distant metastasis, distant recurrence-free interval and postmetastasis survival by extent of disease at initial diagnosis, site of metastasis and treatment-defined tumour receptor type (hormone receptor-positive, human epidermal growth factor receptor-2-positive, triple negative). We will use Cox proportional hazards regression to estimate the relative effects of prognostic factors, and we will compare systemic therapy patterns by area-of-residence and area-level socioeconomic status to examine equity of access to healthcare. ETHICS AND DISSEMINATION Research ethics committee approval was granted by the Australian Institute of Health and Welfare (#EO2017/2/255), NSW Population and Health Services (#HREC/17/CIPHS/19) and University of Notre Dame Australia (#0 17 144S). We will disseminate research findings to oncology, BC consumer and epidemiology audiences through national and international conference presentations, lay summaries to BC consumer groups and publications in international peer-reviewed oncology and cancer epidemiology journals.
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Affiliation(s)
- Sarah J Lord
- The School of Medicine, University of Notre Dame Australia - Darlinghurst, Darlinghurst, New South Wales, Australia
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Belinda E Kiely
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sallie-Anne Pearson
- The Centre for Big Data Research in Health, The University of NSW, Kensington, NSW, Australia
| | - Benjamin Daniels
- The Centre for Big Data Research in Health, The University of NSW, Kensington, NSW, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Jane Beith
- Chris O'Brien Lifehouse, Camperdown, The University of Sydney, Camperdown, New South Wales, Australia
| | - Max K Bulsara
- The Institute of Health Research and the School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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15
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Diagnostic and prognostic value of 18F-FDG PET/CT imaging in suspected recurrence of male breast cancer. Nucl Med Commun 2018; 40:63-72. [PMID: 30312217 PMCID: PMC6282661 DOI: 10.1097/mnm.0000000000000928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose Male breast cancer (MBC) is a rare malignancy, with recurrence being one of the main adverse predictors for prognosis. The aim of the study was to evaluate the diagnostic and predictive value of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT in the setting of suspected recurrence of MBC. Patients and methods Retrospective analysis of PET/CT findings was performed in 23 previously treated, histologically proven patients with MBC (mean age: 59.3±10.9 years; range: 36–79 years) with suspected recurrence. Kaplan–Meier disease-specific survival analysis was made with respect to histological, hormonal profile as well as PET/CT findings. Results Of the 23 patients, 19 (82.6%) showed recurrence. Recurrence at primary site with/without regional/distant site recurrence was seen in 12 (52.2%) patients. Only metastatic recurrence without primary site was seen in seven (30.4%) patients. Bone was the most common site of distant metastasis (14/23) followed by lungs (9/23), liver (4/23), brain (2/23), and adrenal (1/23). No recurrence (regional/distant) was noted in 4/23 (17.3%) patients; however, three of them had 18F-FDG-avid soft tissue lesions in esophagus, rectum and tongue, correspondingly, confirmed as second primaries with histopathology. Disease-specific survival analysis yielded nodal (P=0.01) as well as distant metastases (P=0.02) as the main survival predictors on PET/CT. Lung (P=0.001), followed by liver (P=0.009), and skeletal (P=0.01) metastases were the most adverse survival predictive factors. Conclusion 18F-FDG PET/CT showed good diagnostic and prognostic utility in recurrent MBC. It was better than bone scan in evaluation of skeletal metastases. Most importantly, 18F-FDG PET/CT helped in early detection of second malignancy and their clinical management in studied patients.
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16
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Mariotto AB, Zou Z, Zhang F, Howlader N, Kurian AW, Etzioni R. Can We Use Survival Data from Cancer Registries to Learn about Disease Recurrence? The Case of Breast Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:1332-1341. [PMID: 30337342 DOI: 10.1158/1055-9965.epi-17-1129] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/27/2018] [Accepted: 07/27/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Population-representative risks of metastatic recurrence are not generally available because cancer registries do not collect data on recurrence. This article presents a novel method that estimates the risk of recurrence using cancer registry disease-specific survival.Methods: The method is based on an illness-death process coupled with a mixture cure model for net cancer survival. The risk of recurrence is inferred from the estimated survival among the noncured fraction and published data on survival after recurrence. We apply the method to disease-specific survival curves from female breast cancer cases without a prior cancer diagnosis and with complete stage and hormone receptor (HR) status in Surveillance, Epidemiology and End Results registries (1992-2013).Results: The risk of recurrence is higher for women diagnosed with breast cancer at older age, earlier period, more advanced stage, and HR-negative tumors. For women diagnosed at ages 60-74 in 2000-2013, the projected percent recurring within 5 years is 2.5%, 9.6%, and 34.5% for stages I, II, and III HR-positive, and 6.5%, 20.2%, and 48.5% for stages I, II, and III HR-negative tumors. Although HR-positive cases have lower risk of recurrence soon after diagnosis, their risk persists longer than for HR-negative cases. Results show a high degree of robustness to model assumptions.Conclusions: The results show that it is possible to extract information about the risk of recurrence using disease-specific survival, and the methods can in principle be extended to other cancer sites.Impact: This study provides the first population-based summaries of the risk of breast cancer recurrence in U.S. women. Cancer Epidemiol Biomarkers Prev; 27(11); 1332-41. ©2018 AACR.
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Affiliation(s)
- Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
| | - Zhaohui Zou
- Information Management Services Inc., Calverton, Maryland
| | - Fanni Zhang
- Information Management Services Inc., Calverton, Maryland
| | - Nadia Howlader
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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17
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Weimann ETDS, Botero EB, Mendes C, Santos MASD, Stelini RF, Zelenika CRT. Cutaneous metastasis as the first manifestation of occult malignant breast neoplasia. An Bras Dermatol 2017; 91:105-107. [PMID: 28300911 PMCID: PMC5325010 DOI: 10.1590/abd1806-4841.20164572] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/27/2015] [Indexed: 11/22/2022] Open
Abstract
Cutaneous metastases from primary internal malignancies represent 0.7-9% of
patients with cancer. We report a 65-year-old female patient referred for
evaluation of normochromic papules on the trunk and upper limbs that had been
present for three months. A skin biopsy revealed diffuse cutaneous infiltration
by small round cell tumors. Immunohistochemistry was positive for AE1/AE3, CK7,
estrogen receptor and mammaglobin. The final diagnosis was cutaneous metastasis
of occult breast cancer, since the solid primary tumor was not identified. The
location of the primary tumor can not be determined in 5-10% of cases. In these
cases, 27% are identified before the patient’s death, 57% at autopsy, and the
remaining 16% can not be located.
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18
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Soto MS, Sibson NR. Mouse Models of Brain Metastasis for Unravelling Tumour Progression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 899:231-44. [PMID: 27325270 DOI: 10.1007/978-3-319-26666-4_13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Secondary tumours in the brain account for 40 % of triple negative breast cancer patients, and the percentage may be higher at the time of autopsy. The use of in vivo models allow us to recapitulate the molecular mechanisms potentially used by circulating breast tumour cells to proliferate within the brain.Metastasis is a multistep process that depends on the success of several stages including cell evasion from the primary tumour, distribution and survival within the blood stream and cerebral microvasculature, penetration of the blood-brain barrier and proliferation within the brain microenvironment. Cellular adhesion molecules are key proteins involved in all of the steps in the metastatic process. Our group has developed two different in vivo models to encompass both seeding and colonisation stages of the metastatic process: (1) haematogenous dissemination of tumour cells by direct injection into the left ventricle of the heart, and (2) direct implantation of the tumour cells into the mouse brain.This chapter describes, in detail, the practical implementation of the intracerebral model, which can be used to analyse tumour proliferation within a specific area of the central nervous system and tumour-host cell interactions. We also describe the use of immunohistochemistry techniques to identify, at the molecular scale, tumour-host cell interactions, which may open new windows for brain metastasis therapy.
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Affiliation(s)
- Manuel Sarmiento Soto
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, OX3 7LE, UK
| | - Nicola R Sibson
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, OX3 7LE, UK.
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19
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Hölzel D, Eckel R, Bauerfeind I, Baier B, Beck T, Braun M, Ettl J, Hamann U, Kiechle M, Mahner S, Schindlbeck C, de Waal J, Harbeck N, Engel J. Improved systemic treatment for early breast cancer improves cure rates, modifies metastatic pattern and shortens post-metastatic survival: 35-year results from the Munich Cancer Registry. J Cancer Res Clin Oncol 2017; 143:1701-1712. [PMID: 28429102 DOI: 10.1007/s00432-017-2428-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE Systemic therapies (ATHs) in early breast cancer have improved the survival of breast cancer (BC) patients in recent decades. The magnitude of the changes in overall, metastasis-free (MFS) and post-metastatic (PMS) survival and in the metastasis (MET) pattern will be described. PATIENT AND METHODS We analysed 60,227 patients with a diagnosis of T-N-M0 BC between 1978 and 2013 and 11,983 patients with metastases (MET) in the Munich Cancer Registry. Patients will be divided into four time periods to identify relationships between BC and METs. Survival was estimated using Kaplan-Meier curves, and Cox proportional hazards models were used to explore the impact of the BC subtype and MET status on survival with the time periods as surrogate markers for ATH evolution. RESULTS During the observation period, 5-year relative survival has improved from 80.3 to 93.6% with an adjusted hazard ratio of 0.54 (P < 0.0001). Successful implementation of ATH has changed the MET pattern. The percentage of liver and CNS METs has more than doubled, the rate of lung METs remains stable, and the rate of bone METs has been reduced by approximately 50%. MFS has been prolonged with a hazard ratio 0.75 (P < 0.0001), but PMS has declined (hazard ratio 1.36; P < 0.0001); however, effects of adjuvant and palliative treatments cannot be separated. These results do not contradict improvements in advanced BC and do not suggest alterations of MET tumour biology by ATH. CONCLUSIONS Over the past three decades, ATHs have dramatically improved patient survival after BC diagnosis-most likely, by eradicating prevalent micro-METs; as a result, the MET pattern has changed. Eradicating only a portion of the first METs results in delaying the onset of subsequent MET, which leads to an apparently paradoxical effect: an extension of the MET-free interval and a reduction in PMS.
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Affiliation(s)
- Dieter Hölzel
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Tumorregister München, Klinikum Großhadern/IBE, 81377, Munich, Germany
| | - Renate Eckel
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Tumorregister München, Klinikum Großhadern/IBE, 81377, Munich, Germany
| | - Ingo Bauerfeind
- Head of the Breast Cancer Project Group of the Munich Tumour Centre (TZM) and of Department of Obstetrics and Gynaecology, Klinikum Landshut, Landshut, Germany
| | - Bernd Baier
- Department of Obstetrics and Gynaecology, Klinikum Dachau, Dachau, Germany
| | - Thomas Beck
- Department of Obstetrics and Gynaecology, Klinikum Rosenheim, Rosenheim, Germany
| | - Michael Braun
- Department of Gynaecology, Rotkreuzklinikum, Munich, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynaecology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Ulrich Hamann
- Department of Gynaecology, Rotkreuzklinikum, Munich, Germany
| | - Marion Kiechle
- Department of Obstetrics and Gynaecology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynaecology, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | - Johann de Waal
- Department of Obstetrics and Gynaecology, Klinikum Dachau, Dachau, Germany
| | - Nadia Harbeck
- Breast Centre, Department of Obstetrics and Gynaecology, University Hospital of Munich, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR) of the Munich Tumour Centre (TZM), Institute for Medical Information Processing, Biometry and Epidemiology (IBE), University Hospital of Munich, Ludwig-Maximilians-University (LMU), Tumorregister München, Klinikum Großhadern/IBE, 81377, Munich, Germany.
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20
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Koleva-Kolarova RG, Oktora MP, Robijn AL, Greuter MJW, Reyners AKL, Buskens E, de Bock GH. Increased life expectancy as a result of non-hormonal targeted therapies for HER2 or hormone receptor positive metastatic breast cancer: A systematic review and meta-analysis. Cancer Treat Rev 2017; 55:16-25. [PMID: 28288388 DOI: 10.1016/j.ctrv.2017.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 11/28/2022]
Abstract
This article aimed to assess the clinical effectiveness of non-hormonal targeted therapies (TTs) in terms of increase of median progression-free survival (PFS) and overall survival (OS) in receptor-positive metastatic breast cancer (MBC) patients by performing a systematic review and meta-analysis. We systematically searched relevant randomized controlled trials and extracted data about number of patients on targeted and comparator therapy, receptor status, line of treatment, median PFS and OS, p values, hazard ratios (HRs) and 95% confidence intervals (CI). Inverse variance was used to estimate pooled HRs, chi-square test for heterogeneity and Jadad scale for quality were applied. Thirty-eight studies (n=17,192 patients) were eligible for inclusion. TTs added 3.3months to the median PFS [0.7-9.6; HRs 0.74, 95% CI 0.71-0.77] of receptor-positive MBC patients and prolonged their median OS with 3.5months [0-4.7; HRs 0.90, 95% CI 0.82-0.98]. The highest increase in median PFS of 3.6months was found in HER2-/hormone receptor(HR)+ patients, while the highest increase in median OS of 7.2months was observed in HER2+/HRmixed status patients. First-line TTs were most effective in increasing the median PFS in the HR+/HER2- group with 2.0months, and in the HER2+/HRmixed group by adding 4.7months to the median OS. Second-line TTs were most effective for HER2-/HR+ patients by adding 2.6months to their PFS, and for HER2+/HRmixed patients by adding 3.1months to their median OS. Albeit small, the gain in months of median PFS and median OS was significant. Importantly, the results reported show large variation, and thus routinely applying a personalized approach seems warranted.
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Affiliation(s)
- Rositsa G Koleva-Kolarova
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands; Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, Guy's, AH 3.2, SE1 1UL London, United Kingdom.
| | - Monika P Oktora
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Annelies L Robijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Anna K L Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB Groningen, The Netherlands.
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Fehr MK, Welter J, Sell W, Jung R, Felberbaum R. Sensor-controlled scalp cooling to prevent chemotherapy-induced alopecia in female cancer patients. ACTA ACUST UNITED AC 2016; 23:e576-e582. [PMID: 28050147 DOI: 10.3747/co.23.3200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Scalp cooling has been used since the 1970s to prevent chemotherapy-induced alopecia, one of the most common and psychologically troubling side effects of chemotherapy. Currently available scalp cooling systems demonstrate varying results in terms of effectiveness and tolerability. METHODS For the present prospective study, 55 women receiving neoadjuvant, adjuvant, or palliative chemotherapy were enrolled. The aim was to assess the effectiveness of a sensor-controlled scalp cooling system (DigniCap: Sysmex Europe GmbH, Norderstedt, Germany) to prevent chemotherapy-induced alopecia in breast or gynecologic cancer patients receiving 1 of 7 regimens. Clinical assessments, satisfaction questionnaires, and alopecia evaluations [World Health Organization (who) grading for toxicity] were completed at baseline, at each cycle, and at completion of chemotherapy. RESULTS Of the 55 patients, 78% underwent scalp cooling until completion of chemotherapy. In multivariate analysis, younger women and those receiving paclitaxel weekly or paclitaxel-carboplatin experienced less alopecia. The compound successful outcome ("no head covering" plus "who grade 0/1") was observed in all patients 50 years of age and younger receiving 4 cycles of docetaxel-cyclophosphamide or 6 cycles of paclitaxel-carboplatin. Conversely, alopecia was experienced by all women receiving triplet polychemotherapy (6 cycles of docetaxel-doxorubicin-cyclophosphamide). For women receiving sequential polychemotherapy regimens (3 cycles of fluorouracil-epirubicin-cyclophosphamide followed by 3 cycles of docetaxel or 4 cycles of doxorubicin-cyclophosphamide followed by 4 cycles of docetaxel), the subgroup 50 years of age and younger experienced a 43% success rate compared with a 10% rate for the subgroup pf older women receiving the same regimens. CONCLUSIONS The ability of scalp cooling to prevent chemotherapy-induced alopecia varies with the chemotherapy regimen and the age of the patient. Use of a compound endpoint with subjective and objective measures provides insightful and practical information when counselling patients.
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Affiliation(s)
- M K Fehr
- Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, Switzerland
| | - J Welter
- Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, Switzerland
| | - W Sell
- Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, Switzerland
| | - R Jung
- Department of Obstetrics and Gynecology, Cantonal Hospital Frauenfeld, Switzerland
| | - R Felberbaum
- Department of Obstetrics and Gynecology, Clinic of Kempten-Oberallgäu, Germany
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22
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Marshall EM, Bertaut A, Desmoulins I, Darut-Jouve A, Ponnelle T, Poillot ML, Beltjens F, Arveux P. Prognostic Factors of Survival among Women with Metastatic Breast Cancer and Impact of Primary or Secondary Nature of Disease on Survival: A French Population-Based Study. Breast J 2016; 23:138-145. [DOI: 10.1111/tbj.12717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Esaie M. Marshall
- Côte d'Or Breast Cancer Registry; CGFL; Dijon France
- Research Unit 4184; Faculty of Medicine; University of Burgundy; Dijon France
| | - Aurélie Bertaut
- Methodology and Biostatistic Unit; Centre Georges François Leclerc; Dijon France
| | | | | | | | | | | | - Patrick Arveux
- Côte d'Or Breast Cancer Registry; CGFL; Dijon France
- Research Unit 4184; Faculty of Medicine; University of Burgundy; Dijon France
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23
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Survival of de novo stage IV breast cancer patients over three decades. J Cancer Res Clin Oncol 2016; 143:509-519. [PMID: 27853869 DOI: 10.1007/s00432-016-2306-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND De novo stage IV breast cancer patients (BCIV) depict a clinical picture not influenced by adjuvant therapy. Therefore, the time-dependent impact of changes in diagnostics and treatments on progression and survival can best be evaluated in this subgroup. METHODS BCIV patients from 1978 to 2013 registered in the Munich Cancer Registry were divided into four periods, and the trends were analysed. Survival was estimated by Kaplan-Meier methods, and prognostic factors were fitted with Cox proportional hazard models. RESULTS Between 1978 and 2013, 88,759 patients were diagnosed with 92,807 cases of invasive and non-invasive BC. Of these patients, 4756 patients had distant metastases (MET) at diagnosis. The 5-year survival rate improved from 17.4 to 24.7%, while the pattern of metastases did not change. Improved staging diagnostics, a screening programme and primary systemic therapy changed the composition of prognostic strata. Patients with a similar composition as the 1978-1987 cohort exhibited a median survival difference of 13 months; however, neither univariate nor multivariate analysis showed a survival effect for the four periods as a surrogate indicator for changing treatments. HER2+ patients have with 27.6 months a slightly longer survival than all other BCIV patients. CONCLUSIONS Survival of de novo BCIV has only modestly improved since the late 1970s, partially masked by changing distributions of prognostic factors due to changes in diagnostics.
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24
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Henriques Abreu M, Henriques Abreu P, Afonso N, Pereira D, Henrique R, Lopes C. Patterns of recurrence and treatment in male breast cancer: A clue to prognosis? Int J Cancer 2016; 139:1715-20. [DOI: 10.1002/ijc.30225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/29/2016] [Accepted: 05/30/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Miguel Henriques Abreu
- Department of Medical Oncology; Portuguese Institute of Oncology of Porto; Porto Portugal
| | - Pedro Henriques Abreu
- Department of Informatics Engineering, Faculty of Sciences and Technology, CISUC; University of Coimbra; Coimbra Portugal
| | - Noémia Afonso
- Department of Medical Oncology; Portuguese Institute of Oncology of Porto; Porto Portugal
| | - Deolinda Pereira
- Department of Medical Oncology; Portuguese Institute of Oncology of Porto; Porto Portugal
| | - Rui Henrique
- Department of Pathology; Portuguese Institute of Oncology of Porto; Porto Portugal
- Department of Pathology and Molecular Immunology; Biomedical Sciences Institute of Abel Salazar, University of Porto; Porto Portugal
| | - Carlos Lopes
- Department of Pathology and Molecular Immunology; Biomedical Sciences Institute of Abel Salazar, University of Porto; Porto Portugal
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25
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Herr MM, Mohile NA, van Wijngaarden E, Brown EB, Rich DQ. Antidepressant use and risk of central nervous system metastasis. J Neurooncol 2016; 129:179-87. [PMID: 27289477 DOI: 10.1007/s11060-016-2165-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/01/2016] [Indexed: 01/21/2023]
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26
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Bittencourt MDJS, Carvalho AH, Nascimento BAMD, Freitas LKM, Parijós AMD. Cutaneous metastasis of a breast cancer diagnosed 13 years before. An Bras Dermatol 2016; 90:134-7. [PMID: 26312696 PMCID: PMC4540530 DOI: 10.1590/abd1806-4841.20153842] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/07/2014] [Indexed: 01/12/2023] Open
Abstract
Metastasis is defined as a neoplastic lesion originating from another primary tumor,
with which it is no longer in contact. Cutaneous metastases result from lymphatic
embolization, hematogenous or contiguous dissemination or also direct implantation
during surgical procedures. In women, the tumor most likely to metastasize to skin is
breast cancer, which may manifest as papulonodular neoplastic lesions. We report the
case of a 66 years old female patient, presenting papulonodular lesions13 years after
the initial treatment with surgery and chemotherapy for a cancer of the left
breast.
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27
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Schrijver WAME, Jiwa LS, van Diest PJ, Moelans CB. Promoter hypermethylation profiling of distant breast cancer metastases. Breast Cancer Res Treat 2015; 151:41-55. [PMID: 25841351 PMCID: PMC4408366 DOI: 10.1007/s10549-015-3362-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/26/2015] [Indexed: 12/22/2022]
Abstract
Promoter hypermethylation of tumor suppressor genes seems to be an early event in breast carcinogenesis and is potentially reversible. This makes methylation a possible therapeutic target, a marker for treatment response and/or a prognostic factor. Methylation status of 40 tumor suppressor genes was compared between 53 primary breast tumors and their corresponding metastases to brain, lung, liver, or skin. In paired analyses, a significant decrease in methylation values was seen in distant metastases compared to their primaries in 21/40 individual tumor suppressor genes. Furthermore, primary tumors that metastasized to the liver clustered together, in line with the finding that primary breast carcinomas that metastasized to the brain, skin, or lung, showed higher methylation values in up to 27.5 % of tumor suppressor genes than primary carcinomas that metastasized to the liver. Conversion in methylation status of several genes from the primary tumor to the metastasis had prognostic value, and methylation status of some genes in the metastases predicted survival after onset of metastases. Methylation levels for most of the analyzed tumor suppressor genes were lower in distant metastases compared to their primaries, pointing to the dynamic aspect of methylation of these tumor suppressor genes during cancer progression. Also, specific distant metastatic sites seem to show differences in methylation patterns, implying that hypermethylation profiles of the primaries may steer site-specific metastatic spread. Lastly, methylation status of the metastases seems to have prognostic value. These promising findings warrant further validation in larger patient cohorts and more tumor suppressor genes.
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Affiliation(s)
| | - Laura S. Jiwa
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 Utrecht, CX The Netherlands
| | - Paul J. van Diest
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 Utrecht, CX The Netherlands
| | - Cathy B. Moelans
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 Utrecht, CX The Netherlands
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28
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Daanen HAM, Peerbooms M, van den Hurk CJG, van Os B, Levels K, Teunissen LPJ, Breed WPM. Core temperature affects scalp skin temperature during scalp cooling. Int J Dermatol 2015; 54:916-21. [DOI: 10.1111/ijd.12568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/25/2013] [Accepted: 11/09/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Hein A. M. Daanen
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO [Dutch Organization for Applied Scientific Research]); Soesterberg The Netherlands
- MOVE Research Institute; Faculty of Human Movement Sciences; VU University Amsterdam; The Netherlands
| | - Mijke Peerbooms
- Department of Research; Integraal Kankercentrum Zuid (Comprehensive Cancer Center South); Eindhoven The Netherlands
| | - Corina J. G. van den Hurk
- Department of Research; Integraal Kankercentrum Zuid (Comprehensive Cancer Center South); Eindhoven The Netherlands
| | - Bernadet van Os
- MOVE Research Institute; Faculty of Human Movement Sciences; VU University Amsterdam; The Netherlands
| | - Koen Levels
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO [Dutch Organization for Applied Scientific Research]); Soesterberg The Netherlands
- MOVE Research Institute; Faculty of Human Movement Sciences; VU University Amsterdam; The Netherlands
| | - Lennart P. J. Teunissen
- Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO [Dutch Organization for Applied Scientific Research]); Soesterberg The Netherlands
- MOVE Research Institute; Faculty of Human Movement Sciences; VU University Amsterdam; The Netherlands
| | - Wim P. M. Breed
- Department of Research; Integraal Kankercentrum Zuid (Comprehensive Cancer Center South); Eindhoven The Netherlands
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29
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Feng T, Xu D, Tu C, Li W, Ning Y, Ding J, Wang S, Yuan L, Xu N, Qian K, Wang Y, Qi C. MiR-124 inhibits cell proliferation in breast cancer through downregulation of CDK4. Tumour Biol 2015; 36:5987-97. [PMID: 25731732 DOI: 10.1007/s13277-015-3275-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/17/2015] [Indexed: 12/19/2022] Open
Abstract
Studies have shown that microRNAs (miRNAs) are involved in the malignant progression of human cancer. However, little is known about the potential role of miRNAs in breast carcinogenesis. miR-124 expression in breast cancer tissue was measured by quantitative real-time PCR (qRT-PCR). Target prediction algorithms and luciferase reporter gene assays were used to investigate the target of miR-124. Breast cancer cells growth was regulated by overexpression or knockdown miR-124. At the end of the study, tumor-bearing mice were tested to confirm the function of miR-124 in breast cancer. In this study, we demonstrated that the expression of miR-124 was significantly downregulated in breast cancer tissues compared with matched adjacent non-neoplastic tissues. We identified and confirmed that cyclin-dependent kinase 4 (CDK4) was a direct target of miR-124. Overexpression of miR-124 suppressed CDK4 protein expression and attenuated cell viability, proliferation, and cell cycle progression in MCF-7 and MDA-MB-435S breast cancer cells in vitro. Overexpression of CDK4 partially rescued the inhibitory effect of miR-124 in the breast cancer cells. Moreover, we found that miR-124 overexpression effectively repressed tumor growth in xenograft animal experiments. Our results demonstrate that miR-124 functions as a growth-suppressive miRNA and plays an important role in inhibiting tumorigenesis by targeting CDK4.
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Affiliation(s)
- Tongbao Feng
- Oncology Institute, The Affiliated Hospital of Nanjing Medical University, Changzhou No.2 People's Hospital, Changzhou, 213003, China
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Willis K, Lewis S, Ng F, Wilson L. The experience of living with metastatic breast cancer--a review of the literature. Health Care Women Int 2014; 36:514-42. [PMID: 24579717 DOI: 10.1080/07399332.2014.896364] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Women's experiences with metastatic breast cancer have received little research attention. We reviewed published articles (1984-2013) reporting research examining women's experiences of metastatic breast cancer (n = 33). Findings from quantitative studies were categorized into three broad areas: adverse consequences, satisfaction with health care providers, and strategies for living. Themes identified from qualitative findings include living as a social outsider; importance of hope; health and quality of life; positive experiences; experiences at end of life; and strategies for living. More research is needed to explore experiences of subgroups to appropriately respond to women's diverse care needs.
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Affiliation(s)
- Karen Willis
- a Faculty of Health Sciences , University of Sydney , Sydney , New South Wales , Australia
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31
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Ufen MP, Köhne CH, Wischneswky M, Wolters R, Novopashenny I, Fischer J, Constantinidou M, Possinger K, Regierer AC. Metastatic breast cancer: are we treating the same patients as in the past? Ann Oncol 2013; 25:95-100. [PMID: 24276026 DOI: 10.1093/annonc/mdt429] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Early detection and improved (neo)-adjuvant treatment has extended survival of breast cancer over the last decades. It remains controversial whether a survival benefit is achieved once metastases have occurred. This study investigates survival trends in metastatic breast cancer (MBC) looking at the distribution of prognostic factors and the time period of the diagnosis of the primary and metastatic disease. PATIENTS AND METHODS In this retrospective study, 1635 patients, diagnosed with MBC and treated at three German cancer centers, were included. For the survival analysis, patients were grouped into three time periods [1980-1994 (a), 1995-1999 (b) and 2000-2009 (c)], which were chosen according to the availability of new antineoplastic drugs for the treatment of MBC. Additionally, patients were divided into three risk groups using the simultaneously published prognostic score. RESULTS The analysis of overall survival according to the date of primary diagnosis demonstrated a significant decline compared with the reference (a): (a versus b) hazard ratio (HR) = 1.37; P < 0.001; (a versus c) HR = 2.45; P < 0.001. Considering the time of first occurrence of metastasis, survival remains unchanged over the three periods (a versus b): HR = 0.94 P = 0.436; (a versus c): HR = 0.95; P = 0.435. However, a significant shift towards more unfavorable risk factors was seen. CONCLUSIONS Although survival in MBC remains unchanged over time, patients developing metastatic disease have a more aggressive disease that is presumably compensated by more effective treatment. This alteration of tumor biology in MBC may be explained by a negative selection of patients with adverse risk profiles due to the advantages of the adjuvant therapy.
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Affiliation(s)
- M-P Ufen
- University Clinic for Oncology and Haematology at the Klinikum Oldenburg, Oldenburg
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32
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van den Hurk C, van de Poll-Franse L, Breed W, Coebergh J, Nortier J. Scalp cooling to prevent alopecia after chemotherapy can be considered safe in patients with breast cancer. Breast 2013; 22:1001-4. [DOI: 10.1016/j.breast.2013.07.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/01/2013] [Accepted: 07/16/2013] [Indexed: 12/11/2022] Open
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Kleeberg UR, Fink M, Tessen HW, Nennecke A, Hentschel S, Bartels S. Adjuvant therapy reduces the benefit of palliative treatment in disseminated breast cancer - own findings and review of the literature. ACTA ACUST UNITED AC 2013; 36:348-56. [PMID: 23774149 DOI: 10.1159/000351253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjuvant treatment concepts have improved the 10-year cure rate of breast and colon cancer, but new treatments for metastatic disease have yielded only incremental benefit. If treatments for disseminated cancer were actually prolonging life rather than only increasing remission rates, this effect should have been documented over the last 30+ years. However, published data concerning advances in treatment for disseminated cancer have been contradictory. PATIENTS AND METHODS To add data-based information, we analyzed 2 sources: a regional population-based cancer registry (Hamburgisches Krebsregister, HKR), and a research cancer registry (Projektgruppe Internistische Onkologie, PIO). We compared the survival of several thousand patients with metastatic disease who received treatment only after dissemination with that of patients who received initial adjuvant therapy. RESULTS After adjuvant treatment, survival in patients with disseminated breast cancer is up to a third shorter than that of patients without adjuvant therapy. CONCLUSIONS In accordance with published evidence, we conclude that ineffective adjuvant treatment shortens survival after documentation of metastatic disease. This is probably due to the elimination of chemo-sensitive tumor cells or to the induction of resistance in remaining micrometatases. This negative effect on survival after dissemination has been shown clearly for breast cancer and is also probable for cancer of the colon and other sites.
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Svendsen ML, Gammelager H, Sværke C, Yong M, Chia VM, Christiansen CF, Fryzek JP. Hospital visits among women with skeletal-related events secondary to breast cancer and bone metastases: a nationwide population-based cohort study in Denmark. Clin Epidemiol 2013; 5:97-103. [PMID: 23576882 PMCID: PMC3616605 DOI: 10.2147/clep.s42325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective Skeletal-related events (SREs) among women with breast cancer may be associated with considerable use of health-care resources. We characterized inpatient and outpatient hospital visits in a national population-based cohort of Danish women with SREs secondary to breast cancer and bone metastases. Methods We identified first-time breast cancer patients with bone metastases from 2003 through 2009 who had a subsequent SRE (defined as pathologic fracture, spinal cord compression, radiation therapy, or surgery to bone). Hospital visits included the number of inpatient hospitalizations, length of stay, number of hospital outpatient clinic visits, and emergency room visits. The number of hospital visits was assessed for a pre-SRE period (90 days prior to the diagnostic period), a diagnostic period (14 days prior to the SRE), and a post-SRE period (90 days after the SRE). Patients who experienced more than one SRE during the 90-day post-SRE period were defined as having multiple SREs and were followed until 90 days after the last SRE. Results We identified 569 women with SREs secondary to breast cancer with bone metastases. The majority of women had multiple SREs (73.1%). A total of 20.9% and 33.4% of women with single and multiple SREs died in the post-SRE period, respectively. SREs were associated with a large number of hospital visits in the diagnostic period, irrespective of the number and type of SREs. Women with multiple SREs generally had a higher number of visits compared to those with a single SRE in the post-SRE period, eg, median length of hospitalization was 5 days (interquartile range 0–15) for women with a single SRE and 13 days (interquartile range 4–30) for women with multiple SREs. Conclusion SREs secondary to breast cancer and bone metastases were associated with substantial use of hospital resources.
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Abstract
A rise in incidence and decrease in mortality rates from breast cancer have lead to an increase in prevalence within developed countries. Presentation is classically with a palpable breast tissue mass that may metastasize to bone, lung, liver, brain, lymph nodes, and skin. We describe a delayed diagnosis, in an 80-year-old female patient, where, on 2 occasions, the primary initial presentation was with a cutaneous squamous cell carcinoma in the right axilla. It was not until the third referral, with an ipsilateral breast lump, that breast cancer was clinically diagnosed. This was histologically identified as the primary malignancy, most likely in-keeping with squamous cell carcinoma of the breast. This unique atypical presentation represents a diagnostic challenge and highlights a clinically relevant learning point that may avoid subsequent diagnostic delay. Cutaneous axillary lesions should be treated with a high index of suspicion, necessitating the requirement for chest examination because of the possible presence of an associated primary breast carcinoma.
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36
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Lord SJ, Marinovich ML, Patterson JA, Wilcken N, Kiely BE, Gebski V, Crossing S, Roder DM, Gattellari M, Houssami N. Incidence of metastatic breast cancer in an Australian population-based cohort of women with non-metastatic breast cancer at diagnosis. Med J Aust 2012; 196:688-92. [PMID: 22708766 DOI: 10.5694/mja12.10026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To estimate the incidence of metastatic breast cancer (MBC) in Australian women with an initial diagnosis of non-metastatic breast cancer. DESIGN, SETTING AND PARTICIPANTS A population-based cohort study of all women with non-metastatic breast cancer registered on the New South Wales Central Cancer Register (CCR) in 2001 and 2002 who received care in a NSW hospital. MAIN OUTCOME MEASURES 5-year cumulative incidence of MBC; prognostic factors for MBC. RESULTS MBC was recorded within 5 years in 218 of 4137 women with localised node-negative disease (5-year cumulative incidence, 5.3%; 95% CI, 4.6%-6.0%); and 455 of 2507 women with regional disease (5-year cumulative incidence, 18.1%; 95% CI, 16.7%-19.7%). The hazard rate for developing MBC was highest in the second year after the initial diagnosis of breast cancer. Determinants of increased risk of MBC were regional disease at diagnosis, age less than 50 years and living in an area of lower socio-economic status. CONCLUSIONS Our Australian population-based estimates are valuable when communicating average MBC risks to patients and planning clinical services and trials. Women with node-negative disease have a low risk of developing MBC, consistent with outcomes of adjuvant clinical trials. Regional disease at diagnosis remains an important prognostic factor.
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Affiliation(s)
- Sarah J Lord
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW.
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37
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Shi HY, Tsai JT, Chen YM, Culbertson R, Chang HT, Hou MF. Predicting two-year quality of life after breast cancer surgery using artificial neural network and linear regression models. Breast Cancer Res Treat 2012; 135:221-9. [PMID: 22836876 DOI: 10.1007/s10549-012-2174-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 07/17/2012] [Indexed: 12/30/2022]
Abstract
The purpose of this study was to validate the use of artificial neural network (ANN) models for predicting quality of life (QOL) after breast cancer surgery and to compare the predictive capability of ANNs with that of linear regression (LR) models. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its supplementary breast cancer measure were completed by 402 breast cancer patients at baseline and at 2 years postoperatively. The accuracy of the system models were evaluated in terms of mean square error (MSE) and mean absolute percentage error (MAPE). A global sensitivity analysis was also performed to assess the relative significance of input parameters in the system model and to rank the variables in order of importance. Compared to the LR model, the ANN model generally had smaller MSE and MAPE values in both the training and testing datasets. Most ANN models had MAPE values ranging from 4.70 to 19.96 %, and most had high prediction accuracy. The ANN model also outperformed the LR model in terms of prediction accuracy. According to global sensitivity analysis, pre-operative functional status was the best predictor of QOL after surgery. Compared with the conventional LR model, the ANN model in the study was more accurate for predicting patient-reported QOL and had higher overall performance indices. Further refinements are expected to obtain sufficient performance improvements for its routine use in clinical practice as an adjunctive decision-making tool.
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Affiliation(s)
- Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
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Fan J, Deng X, Gallagher JW, Huang H, Huang Y, Wen J, Ferrari M, Shen H, Hu Y. Monitoring the progression of metastatic breast cancer on nanoporous silica chips. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2012; 370:2433-2447. [PMID: 22509065 PMCID: PMC3318679 DOI: 10.1098/rsta.2011.0444] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Breast cancer accounted for 15 per cent of total cancer deaths in female patients in 2010. Although significant progress has been made in treating early-stage breast cancer patients, there is still no effective therapy targeting late-stage metastatic breast cancers except for the conventional chemotherapy interventions. Until effective therapy for later-stage cancers emerges, the identification of biomarkers for the early detection of tumour metastasis continues to hold the key to successful management of breast cancer therapy. Our study concentrated on the low molecular weight (LMW) region of the serum protein and the information it contains for identifying biomarkers that could reflect the ongoing physiological state of all tissues. Owing to technical difficulties in harvesting LMW species, studying these proteins/peptides has been challenging until now. In our study, we have recently developed nanoporous chip-based technologies to separate small proteins/peptides from the large proteins in serum. We used nanoporous silica chips, with a highly periodic nanostructure and uniform pore size distribution, to isolate LMW proteins and peptides from the serum of nude mice with MDA-MB-231 human breast cancer lung metastasis. By matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and biostatistical analysis, we were able to identify protein signatures unique to different stages of cancer development. The approach and results reported in this study possess a significant potential for the discovery of proteomic biomarkers that may significantly enhance personalized medicine targeted at metastatic breast cancer.
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Affiliation(s)
- Jia Fan
- Department of Nanomedicine, The Methodist Hospital Research Institute, Houston, TX 77030, USA
- CAS Key Laboratory for Biological Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing 100190, People's Republic of China
| | - Xiaoyong Deng
- Department of Nanomedicine, The Methodist Hospital Research Institute, Houston, TX 77030, USA
- Institute of Nanochemistry and Nanobiology, School of Environmental and Chemical Engineering, Shanghai University, Shanghai 200444, People's Republic of China
| | - James W. Gallagher
- Department of Nanomedicine, The Methodist Hospital Research Institute, Houston, TX 77030, USA
| | - Haiyu Huang
- Department of Nanomedicine, The Methodist Hospital Research Institute, Houston, TX 77030, USA
| | - Yi Huang
- Department of Nanomedicine, The Methodist Hospital Research Institute, Houston, TX 77030, USA
| | - Jianguo Wen
- Department of Pathology, The Methodist Hospital Research Institute, Houston, TX 77030, USA
| | - Mauro Ferrari
- Department of Nanomedicine, The Methodist Hospital Research Institute, Houston, TX 77030, USA
| | - Haifa Shen
- Department of Nanomedicine, The Methodist Hospital Research Institute, Houston, TX 77030, USA
| | - Ye Hu
- Department of Nanomedicine, The Methodist Hospital Research Institute, Houston, TX 77030, USA
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Chia S. Trends in improving survival in breast cancer: two steps forward but one step back? Breast Cancer Res Treat 2011; 128:807-9. [PMID: 21484290 DOI: 10.1007/s10549-011-1490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 03/25/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen Chia
- British Columbia Cancer Agency, Vancouver, Canada.
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