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Groheux D, Vaz SC, Poortmans P, Mann RM, Ulaner GA, Cook GJR, Hindié E, Pilkington Woll JP, Jacene H, Rubio IT, Vrancken Peeters MJ, Dibble EH, de Geus-Oei LF, Graff SL, Cardoso F. Role of [ 18F]FDG PET/CT in patients with invasive breast carcinoma of no special type: Literature review and comparison between guidelines. Breast 2024; 78:103806. [PMID: 39303572 PMCID: PMC11440802 DOI: 10.1016/j.breast.2024.103806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/29/2024] [Accepted: 09/07/2024] [Indexed: 09/22/2024] Open
Abstract
PURPOSE The recently released EANM/SNMMI guideline, endorsed by several important clinical and imaging societies in the field of breast cancer (BC) care (ACR, ESSO, ESTRO, EUSOBI/ESR, EUSOMA), emphasized the role of [18F]FDG PET/CT in management of patients with no special type (NST) BC. This review identifies and summarizes similarities, discrepancies and novelties of the EANM/SNMMI guideline compared to NCCN, ESMO and ABC recommendations. METHODS The EANM/SNMMI guideline was based on a systematic literature search and the AGREE tool. The level of evidence was determined according to NICE criteria, and 85 % agreement or higher was reached regarding each statement. Comparisons with NCCN, ESMO and ABC guidelines were examined for specific clinical scenarios in patients with early stage through advanced and metastatic BC. RESULTS Regarding initial staging of patients with NST BC, [18F]FDG PET/CT is the preferred modality in the EANM-SNMMI guideline, showing superiority as a single modality to a combination of contrast-enhanced CT of thorax-abdomen-pelvis plus bone scan in head-to-head comparisons and a randomized study. Its use is recommended in patients with clinical stage IIB or higher and may be useful in certain stage IIA cases of NST BC. In NCCN, ESMO, and ABC guidelines, [18F]FDG PET/CT is instead recommended as complementary to conventional imaging to solve inconclusive findings, although ESMO and ABC also suggest [18F]FDG PET/CT can replace conventional imaging for staging patients with high-risk and metastatic NST BC. During follow up, NCCN and ESMO only recommend diagnostic imaging if there is suspicion of recurrence. Similarly, EANM-SNMMI states that [18F]FDG PET/CT is useful to detect the site and extent of recurrence only when there is clinical or laboratory suspicion of recurrence, or when conventional imaging methods are equivocal. The EANM-SNMMI guideline is the first to emphasize a role of [18F]FDG PET/CT for assessing early metabolic response to primary systemic therapy, particularly for HER2+ BC and TNBC. In the metastatic setting, EANM-SNMMI state that [18F]FDG PET/CT may help evaluate bone metastases and determine early response to treatment, in agreement with guidelines from ESMO. CONCLUSIONS The recently released EANM/SNMMI guideline reinforces the role of [18F]FDG PET/CT in the management of patients with NST BC supported by extensive evidence of its utility in several clinical scenarios.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM, U976, Paris, France; Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France.
| | - Sofia C Vaz
- Department of Nuclear Medicine and Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Ritse M Mann
- Department of Radiology, Radboud umc, Nijmegen, the Netherlands
| | - Gary A Ulaner
- Department of Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, United States; Departments of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, United States
| | - Gary J R Cook
- Department of Cancer Imaging, King's College London, London, UK; King's College London and Guy's & St Thomas' PET Centre, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Elif Hindié
- Department of Nuclear Medicine, Bordeaux University Hospital, Bordeaux, France
| | | | - Heather Jacene
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, and Harvard Medical School, United States
| | - Isabel T Rubio
- Department of Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Cancer Center Clinica Universidad de Navarra, Spain
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands; Department of Radiation Science & Technology, Delft University of Technology, Delft, the Netherlands
| | - Stephanie L Graff
- Lifespan Cancer Institute, Providence, RI, United States; Legorreta Cancer Center at Brown University, Providence, RI, United States
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
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Marletta S, Giorlandino A, Cavallo E, Dello Spedale Venti M, Leone G, Tranchina MG, Gullotti L, Bonanno CL, Spoto G, Falzone G, Tornabene I, Trovato C, Baron MM, Di Mauro G, Falsaperna L, Angelico G, Pafumi S, Rizzo A. Discordance of Biomarker Expression Profile between Primary Breast Cancer and Synchronous Axillary Lymph Node Metastasis in Preoperative Core Needle Biopsy. Diagnostics (Basel) 2024; 14:259. [PMID: 38337775 PMCID: PMC10854870 DOI: 10.3390/diagnostics14030259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/12/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Breast cancer (BC) is a heterogeneous disease made up of clones with different metastatic potential. Intratumoral heterogeneity may cause metastases to show divergent biomarker expression, potentially affecting chemotherapy response. Methods: We investigated the immunohistochemical (IHC) and FISH profile of estrogen receptors (ER), progesterone (PR) receptors, Ki67, and HER2 in a series of BC-matched primary tumors (PTs) and axillary lymph node (ALN) metastases in pre-operative core needle biopsies (CNBs). Phenotypical findings were correlated to morphological features and their clinical implications. Results: Divergent expression between PTs and ALNs was found in 10% of the tumors, often involving multiple biomarkers (12/31, 39%). Most (52%) displayed significant differences in ER and PR staining. HER2 divergences were observed in almost three-quarters of the cases (23/31, 74%), with five (16%) switching from negativity to overexpression/amplification in ALNs. Roughly 90% of disparities reflected significant morphological differences between PTs and ALN metastases. Less than half of the discrepancies (12/31, 39%) modified pre/post-operative treatment options. Conclusions: We observed relevant discrepancies in biomarker expression between PTs and metastatic ALNs in a noteworthy proportion (10%) of preoperative BC CNBs, which were often able to influence therapies. Hence, our data suggest routine preoperative assessment of biomarkers in both PTs and ALNs in cases showing significant morphological differences.
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Affiliation(s)
- Stefano Marletta
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy
| | | | - Enrico Cavallo
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Michele Dello Spedale Venti
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giorgia Leone
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Maria Grazia Tranchina
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Lucia Gullotti
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Claudia Lucia Bonanno
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Graziana Spoto
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giusi Falzone
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Irene Tornabene
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Carmelina Trovato
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Marco Maria Baron
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giuseppe Di Mauro
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Lucia Falsaperna
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
| | - Giuseppe Angelico
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, Anatomic Pathology, University of Catania, 95125 Catania, Italy;
| | - Sarah Pafumi
- Medical Oncology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy;
- Section of Oncology, Department of Medicine, University of Verona, Verona University Hospital Trust (AUOI), 37124 Verona, Italy
| | - Antonio Rizzo
- Division of Pathology, Humanitas Istituto Clinico Catanese, 95045 Catania, Italy; (S.M.); (E.C.); (M.D.S.V.); (G.L.); (M.G.T.); (L.G.); (C.L.B.); (G.S.); (G.F.); (I.T.); (C.T.); (M.M.B.); (G.D.M.); (L.F.)
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Kumar N, Gann PH, McGregor SM, Sethi A. Quantification of subtype purity in Luminal A breast cancer predicts clinical characteristics and survival. Breast Cancer Res Treat 2023:10.1007/s10549-023-06961-9. [PMID: 37209182 DOI: 10.1007/s10549-023-06961-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/26/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE PAM50 profiling assigns each breast cancer to a single intrinsic subtype based on a bulk tissue sample. However, individual cancers may show evidence of admixture with an alternate subtype that could affect prognosis and treatment response. We developed a method to model subtype admixture using whole transcriptome data and associated it with tumor, molecular, and survival characteristics for Luminal A (LumA) samples. METHODS We combined TCGA and METABRIC cohorts and obtained transcriptome, molecular, and clinical data, which yielded 11,379 gene transcripts in common and 1,178 cases assigned to LumA. We used semi-supervised non-negative matrix factorization (ssNMF) to compute the subtype admixture proportions of the four major subtypes-pLumA, pLumB, pHER2, and pBasal-for each case and measured associations with tumor characteristics, molecular features, and survival. RESULTS Luminal A cases in the lowest versus highest quartile for pLumA transcriptomic proportion had a 27% higher prevalence of stage > 1, nearly a threefold higher prevalence of TP53 mutation, and a hazard ratio of 2.08 for overall mortality. We found positive associations between pHER2 and HER2 positivity by IHC or FISH; between pLumB and PR negativity; and between pBasal and younger age, node positivity, TP53 mutation, and EGFR expression. Predominant basal admixture, in contrast to predominant LumB or HER2 admixture, was not associated with shorter survival. CONCLUSION Bulk sampling for genomic analyses provides an opportunity to expose intratumor heterogeneity, as reflected by subtype admixture. Our results elucidate the striking extent of diversity among LumA cancers and suggest that determining the extent and type of admixture holds promise for refining individualized therapy. LumA cancers with a high degree of basal admixture appear to have distinct biological characteristics that warrant further study.
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Affiliation(s)
- Neeraj Kumar
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Peter H Gann
- Department of Pathology, College of Medicine, University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA.
| | - Stephanie M McGregor
- Department of Pathology and Laboratory Medicine, University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Amit Sethi
- Department of Pathology, College of Medicine, University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
- Department of Electrical Engineering, Indian Institute of Technology Bombay, Mumbai, India
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Li S, Wu J, Huang O, He J, Chen W, Li Y, Chen X, Shen K. Association of Molecular Biomarker Heterogeneity With Treatment Pattern and Disease Outcomes in Multifocal or Multicentric Breast Cancer. Front Oncol 2022; 12:833093. [PMID: 35814416 PMCID: PMC9259989 DOI: 10.3389/fonc.2022.833093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose This study aimed to evaluate the rates of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 heterogeneity in multifocal or multicentric breast cancer (MMBC) and its association with treatment pattern and disease outcomes. Methods MMBC patients with ER, PR, HER2, and Ki67 results for each tumor focus were retrospectively analyzed using Kappa test and categorized into the homogeneous group (Homo group) and the heterogeneous group (Hetero group). Chi-square tests were performed to compare the clinical features and treatment options between the groups. Disease-free survival (DFS) and overall survival (OS) rates were estimated from Kaplan–Meier curves and compared between two groups. Results A total of 387 patients were included, and 93 (24.0%) were classified into the Hetero group. Adjuvant endocrine therapy was more frequently assigned for patients in the Hetero group than in the Homo group (84.9% vs. 71.7%, p = 0.046). There was no difference in terms of adjuvant anti-HER2 therapy (28.3% vs. 19.6%, p = 0.196) and chemotherapy (69.9% vs. 69.8%, p = 0.987) usage between the two groups. At a median follow-up of 36 months, DFS rates were 81.2% for the Hetero group and 96.5% for the Homo group (p = 0.041; adjusted HR, 2.95; 95% CI, 1.04–8.37). The estimated 3-year OS rates for the groups were 95.8% and 99.5%, respectively (p = 0.059; adjusted HR, 5.36; 95% CI, 0.97–29.69). Conclusion Heterogeneity of ER, PR, HER2, or Ki67 was present in 24.0% patients with MMBC. Biomarkers heterogeneity influenced adjuvant endocrine therapy usage and was associated with worse disease outcomes, indicating further clinical evaluation.
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Affiliation(s)
| | | | | | | | | | | | | | - Kunwei Shen
- *Correspondence: Xiaosong Chen, ; Kunwei Shen,
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Kolberg-Liedtke C, Wuerstlein R, Gluz O, Heitz F, Freudenberger M, Bensmann E, du Bois A, Nitz U, Pelz E, Warm M, Ortmann M, Sultova E, Brucker SY, Kates RE, Fehm T, Harbeck N. Phenotype Discordance between Primary Tumor and Metastasis Impacts Metastasis Site and Outcome: Results of WSG-DETECT-PriMet. Breast Care (Basel) 2021; 16:475-483. [PMID: 34720807 DOI: 10.1159/000512416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Tumor biological factors of breast cancer (BC) such as hormone receptor (HR) status, HER2 status, and grade can differ in the metastatic cascade from primary to lymph node (LN) metastasis and to distant metastatic tissue. Systematic data regarding therapeutic consequences are yet limited. Methods We conducted a prospectively planned, retrospective cohort study comparing BC phenotype in tissue from primary tumors (PTs), locoregional LN metastases, and disease recurrence (DR). HR and HER2 as well as tumor grade in PTs and DR were obtained by a database search. No centralized biomarker testing was performed. The impact of changes in tumor biological factors on post-recurrence survival (PRS) and overall survival was analyzed. Results PriMet comprises 635 patients (LN tissue in 142 patients). Discrepancies for HR or HER2 status between PT and DR were observed in 18.7 and 21.6% of cases, respectively. For HR status, positivity of PT and negativity of DR was seen more often (13.2%) than vice versa (5.5%). For HER2 status, negativity of the primary and positivity of DR was seen more often (14.9%) than vice versa (6.7%). Discordance was more often observed between PT and LN metastasis compared to LN versus DR. However, numbers were small. Compared to concordant non-triple-negative (TN) disease, concordant TN disease showed significantly inferior PRS. Conclusion We demonstrate receptor discordance to occur relatively frequently between PT, LN metastasis, and DR and to impact patient prognosis. However, clinical consequences of receptor discordance need to be drawn with caution considering clinical aspects as well as tumor biology.
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Affiliation(s)
| | - Rachel Wuerstlein
- Breast Center, Department of Gynecology and Obstetrics, University of Munich and CCCLMU, Munich, Germany.,West German Study Group, Mönchengladbach, Germany
| | - Oleg Gluz
- West German Study Group, Mönchengladbach, Germany.,Evangelical Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany.,Horst-Schmidt-Klinik Wiesbaden, Wiesbaden, Germany
| | | | - Elena Bensmann
- Abteilung für Gynäkologie, Rotkreuzklinikum München, Munich, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany.,Horst-Schmidt-Klinik Wiesbaden, Wiesbaden, Germany
| | - Ulrike Nitz
- West German Study Group, Mönchengladbach, Germany.,Evangelical Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany
| | | | - Matthias Warm
- Brustzentrum, Krankenhaus Köln-Holweide, Cologne, Germany
| | - Monika Ortmann
- Institut für Pathologie, Universitätsklinikum Köln, Cologne, Germany
| | - Elena Sultova
- Institut für Pathologie, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sara Y Brucker
- Departement für Frauengesundheit, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, University of Munich and CCCLMU, Munich, Germany.,West German Study Group, Mönchengladbach, Germany
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PAM50 Intrinsic Subtype Profiles in Primary and Metastatic Breast Cancer Show a Significant Shift toward More Aggressive Subtypes with Prognostic Implications. Cancers (Basel) 2021; 13:cancers13071592. [PMID: 33808271 PMCID: PMC8037951 DOI: 10.3390/cancers13071592] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The majority of breast cancer deaths are caused by the spread of the disease to distant locations. The biological processes and molecular characteristics that eventually transform breast cancer into a life-threatening metastatic disease are not fully understood. The molecular subtyping of breast cancer into four tumor subtypes—namely luminal A, luminal B, human epidermal growth factor receptor 2-enriched, and basal-like subtypes—has been implemented for therapeutic guidance in patients with early breast cancer. It is not settled whether molecular subtypes in metastatic tissue can guide the choice of systemic therapy and how these subtypes may change throughout tumor progression. In this study, breast cancer subtypes at different stages of the disease were investigated, and we found changes to more unfavorable subtypes to be common throughout the progression of the disease. These findings suggests that molecular subtyping in metastatic disease could add important prognostic and predictive information to complement information from the primary tumor. Abstract Background: PAM50 breast cancer intrinsic subtyping adds prognostic information in early breast cancer; however, the role in metastatic disease is unclear. We aimed to identify PAM50 subtypes in primary tumors (PTs) and metastases to outline subtype changes and their prognostic role. Methods: RNA was isolated from PTs, lymph node metastases (LNMs), and distant metastases (DMs) in metastatic breast cancer patients (n = 140) included in a prospective study (NCT01322893). Gene expression analyses were performed using the Breast Cancer 360 (BC360) assay from Nano-String. The subtype shifts were evaluated using McNemar and symmetry tests, and clinical outcomes were evaluated with log-rank tests and Cox regression. Results: The PAM50 subtype changed in 25/59 of paired samples between PTs and LNMs (Psymmetry = 0.002), in 31/61 between PTs and DMs (Psymmetry < 0.001), and in 16/38 between LNMs and DMs (Psymmetry = 0.004). Shifts toward subtypes with worse outcomes were the most common. Patients with shifts from the luminal PT to non-luminal DM subtypes had worse progression-free survival compared to patients with a stable subtype (hazard ratio (HR): 2.3; 95% confidence interval (CI): 1.14–4.68, p = 0.02). Conclusion: Strong evidence of PAM50 subtype shifts toward unfavorable subtypes were seen between PTs and metastatic samples. For patients with a shift in subtype from luminal PT to non-luminal DM, a worse prognosis was noted.
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7
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Nakamura R, Hayama S, Sonoda I, Miyaki T, Itami M, Yamamoto N. Clinical impact of the biology of synchronous axillary lymph node metastases in primary breast cancer on preoperative treatment strategy. J Surg Oncol 2021; 123:1513-1520. [PMID: 33684224 DOI: 10.1002/jso.26438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to assess the utility of determining the biological features of synchronous axillary lymph node (syLN) metastasis of breast cancer in evaluating the efficacy of preoperative systemic chemotherapy (PST). MATERIALS AND METHODS The retrospective subjects initially comprised 59 patients (T1c-4 N1-3 M0) diagnosed with syLN metastasis via core needle biopsy who received PST. The hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status in each patient was assessed in primary breast tumor (pBT) and syLNs using immunohistochemistry, and the patients were classified into HR(+), HER2(+), and triple negative breast cancer (TN) subtypes. RESULTS Subtype shift (SS) of pBT in syLNs was observed in 28% cases for HR(+), in 6% cases for the HER2(+), and in 16% cases for the TN. The pCR rate of the pBT and syLNs types were 45% and 36% in the HR(+), 45% and 39% in the TN, and 94% and 100% in the HER2(+), respectively. In SS cases, the pCR rate was significantly higher in 75% cases compared with 33% of the no-SS cases. CONCLUSION A SS in syLNs was more frequent in HR(+) than in other types.
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Affiliation(s)
- Rikiya Nakamura
- Division of Breast Surgery, Chiba Cancer Center, Chiba, Japan
| | - Shouko Hayama
- Division of Breast Surgery, Chiba Cancer Center, Chiba, Japan
| | - Itaru Sonoda
- Division of Breast Surgery, Chiba Cancer Center, Chiba, Japan
| | - Toshiko Miyaki
- Division of Breast Surgery, Chiba Cancer Center, Chiba, Japan
| | - Makiko Itami
- Division of Diagnostic Pathology, Chiba Cancer Center, Chiba, Japan
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Guo Y, Arciero CA, Jiang R, Behera M, Peng L, Li X. Different Breast Cancer Subtypes Show Different Metastatic Patterns: A Study from A Large Public Database. Asian Pac J Cancer Prev 2020; 21:3587-3593. [PMID: 33369456 PMCID: PMC8046324 DOI: 10.31557/apjcp.2020.21.12.3587] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/01/2002] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Receptor status in breast cancer is known to be related to survival. However, the relationship between breast cancer subtype, preferential sites of metastasis, and overall survival is not clear. METHODS A total of 414,528 patients from the National Cancer Database (2010-2013) were examined. All patients received surgery and systemic treatments. Breast cancer was subtyped based on hormonal receptor (HR) and HER2 status. RESULTS HR-/HER2+ breast cancer patients had the highest overall rate of metastasis while HR+/HER2- had the lowest. HR+/HER2+ cancer had the most frequent metastasis to the bone, and HR-/HER2+ to brain, liver, lung and multiple sites. Generally, patients with brain or multiple metastasis had the worst overall survival (OS) across different subtypes. Patients with bone oligometastasis tend to have better OS than patients with metastasis to other site but significantly worse OS than patients without any metastasis. CONCLUSIONS This large study exhibits how breast cancer subtype plays a role in the rate and site of metastasis as well as in overall survival. Surveillance and treatment strategies should be tailored on the risk and potential site of metastases based upon receptor subtype.
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Affiliation(s)
- Yi Guo
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
| | | | - Renjian Jiang
- Winship Cancer Institute, Emory University, Atlanta, GA, USA.
| | | | - Limin Peng
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA.
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
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9
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Jørgensen CLT, Forsare C, Bendahl PO, Falck AK, Fernö M, Lövgren K, Aaltonen K, Rydén L. Expression of epithelial-mesenchymal transition-related markers and phenotypes during breast cancer progression. Breast Cancer Res Treat 2020; 181:369-381. [PMID: 32300922 PMCID: PMC7188722 DOI: 10.1007/s10549-020-05627-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
Purpose The study aimed to investigate expression of epithelial-to-mesenchymal transition (EMT)-related proteins and phenotypes during breast cancer progression and to relate this to patient outcome. Methods Protein expression patterns of E-cadherin, N-cadherin, twist, and vimentin were examined by immunohistochemistry on formalin-fixed paraffin-embedded samples from primary tumors (PTs) (n = 419), synchronous lymph node metastases (LNMs) (n = 131) and recurrences (n = 34) from patients included in an observational prospective primary breast cancer study. Markers were evaluated individually and combined as defined EMT phenotypes (epithelial, mesenchymal, partial EMT, and negative). EMT profiles were compared between matched tumor progression stages, and related to clinicopathological data and distant recurrence-free interval (DRFi). Results N-cadherin-positivity, vimentin-positivity, mesenchymal and partial EMT phenotypes were associated with more aggressive tumor characteristics such as triple-negative subtype. Single EMT markers and phenotype discordance rates between paired tumor samples were observed in the range of 2–35%. Non-epithelial phenotypes were more frequently identified in recurrences compared to PTs, however, no skewness of expression or phenotype was detected between PTs and matched LNMs or between PTs and matched recurrences (Exact McNemar test). Interestingly, patients with a twist positive PT had shorter DRFi, compared to patients with a twist negative PT (hazard ratio (HR) 2.4, 95% confidence interval (CI) 1.2–5.1, P = 0.02). Essentially, the same effect was seen in multivariable analysis (HR 2.5, 95% CI 0.97–6.6, P = 0.06). Conclusion The epithelial phenotype was indicated to be lost between PTs and recurrences as a reflection of tumor progression. Twist status of the PT was related to long-term prognosis warranting further investigation in larger cohorts. Electronic supplementary material The online version of this article (10.1007/s10549-020-05627-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Levin Tykjær Jørgensen
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund, Lund University, Medicon Village, Building 404, 22381, Lund, Sweden.
| | - Carina Forsare
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund, Lund University, Medicon Village, Building 404, 22381, Lund, Sweden
| | - Pär-Ola Bendahl
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund, Lund University, Medicon Village, Building 404, 22381, Lund, Sweden
| | - Anna-Karin Falck
- Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Mårten Fernö
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund, Lund University, Medicon Village, Building 404, 22381, Lund, Sweden
| | - Kristina Lövgren
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund, Lund University, Medicon Village, Building 404, 22381, Lund, Sweden
| | - Kristina Aaltonen
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Lisa Rydén
- Division of Surgery, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
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10
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ER +/HER2 + Breast Cancer Has Different Metastatic Patterns and Better Survival Than ER -/HER2 + Breast Cancer. Clin Breast Cancer 2019; 19:236-245. [PMID: 30846407 DOI: 10.1016/j.clbc.2019.02.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Human epidermal growth factor receptor 2-positive (HER2+) breast cancer is generally treated with HER2-targeted therapy combined with chemotherapy. Patients with HER2+ and estrogen receptor-positive (ER+) cancer are additionally treated with long-term hormone therapy. This study examined the metastatic pattern and prognosis of both ER+/HER2+ and ER-/HER2+ breast cancer. PATIENTS AND METHODS A total of 54,147 patients with HER2+ breast cancer from the National Cancer Data Base (NCDB, 2010-2013) and 31,946 patients with HER2+ breast cancer from the Surveillance, Epidemiology, and End Results Program (SEER, 2010-2014) were examined. Sites of metastasis and overall survival (OS) were examined in the NCDB, while OS and breast cancer-specific survival were examined in the SEER database. RESULTS Compared to ER-/HER2+ breast cancer, ER+/HER2+ breast cancer was more likely to metastasize to bone but less likely to brain, liver, and lung and less likely to result in multiple metastases. In univariate analysis based on the NCDB, patients with ER-/HER2+ breast cancer had worse OS in all metastasis subsets, including patients who received HER2-targeted therapy. This poor survival for ER-/HER2+ persisted in patients with metastasis to bone and lung, and multiple metastases. In multivariate analysis adjusting for age, tumor grade, surgery, chemotherapy, HER2-targeted therapy, and hormone therapy, ER-/HER2+ patients with bone metastasis still had worse OS. In the SEER, ER-/HER2+ patients had both worse OS and breast cancer-specific survival in univariate analysis. CONCLUSION This large study showed patients with ER+/HER2+ and ER-/HER2+ breast cancers had different metastatic patterns. Patients with ER-/HER2+ breast cancer may require more aggressive treatment.
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11
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Forsare C, Bak M, Falck AK, Grabau D, Killander F, Malmström P, Rydén L, Stål O, Sundqvist M, Bendahl PO, Fernö M. Non-linear transformations of age at diagnosis, tumor size, and number of positive lymph nodes in prediction of clinical outcome in breast cancer. BMC Cancer 2018; 18:1226. [PMID: 30526533 PMCID: PMC6286551 DOI: 10.1186/s12885-018-5123-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/22/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Prognostic factors in breast cancer are often measured on a continuous scale, but categorized for clinical decision-making. The primary aim of this study was to evaluate if accounting for continuous non-linear effects of the three factors age at diagnosis, tumor size, and number of positive lymph nodes improves prognostication. These factors will most likely be included in the management of breast cancer patients also in the future, after an expected implementation of gene expression profiling for adjuvant treatment decision-making. METHODS Four thousand four hundred forty seven and 1132 women with primary breast cancer constituted the derivation and validation set, respectively. Potential non-linear effects on the log hazard of distant recurrences of the three factors were evaluated during 10 years of follow-up. Cox-models of successively increasing complexity: dichotomized predictors, predictors categorized into three or four groups, and predictors transformed using fractional polynomials (FPs) or restricted cubic splines (RCS), were used. Predictive performance was evaluated by Harrell's C-index. RESULTS Using FP-transformations, non-linear effects were detected for tumor size and number of positive lymph nodes in univariable analyses. For age, non-linear transformations did, however, not improve the model fit significantly compared to the linear identity transformation. As expected, the C-index increased with increasing model complexity for multivariable models including the three factors. By allowing more than one cut-point per factor, the C-index increased from 0.628 to 0.674. The additional gain, as measured by the C-index, when using FP- or RCS-transformations was modest (0.695 and 0.696, respectively). The corresponding C-indices for these four models in the validation set, based on the same transformations and parameter estimates from the derivation set, were 0.675, 0.700, 0.706, and 0.701. CONCLUSIONS Categorization of each factor into three to four groups was found to improve prognostication compared to dichotomization. The additional gain by allowing continuous non-linear effects modeled by FPs or RCS was modest. However, the continuous nature of these transformations has the advantage of making it possible to form risk groups of any size.
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Affiliation(s)
- Carina Forsare
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Medicon Village Building 404, Scheelevägen 2, SE-223 81, Lund, Sweden.
| | - Martin Bak
- Department of Pathology, Odense University Hospital, DK-5000, Odense, Denmark
| | - Anna-Karin Falck
- Department of Surgery, Helsingborg Hospital, SE-281 85, Helsingborg, Sweden
| | - Dorthe Grabau
- Department of Pathology, Lund University, Skåne University Hospital, SE-221 85, Lund, Sweden
| | - Fredrika Killander
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Medicon Village Building 404, Scheelevägen 2, SE-223 81, Lund, Sweden.,Department of Haematology, Oncology and Radiation physics, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Per Malmström
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Medicon Village Building 404, Scheelevägen 2, SE-223 81, Lund, Sweden.,Department of Haematology, Oncology and Radiation physics, Skane University Hospital, SE-221 85, Lund, Sweden
| | - Lisa Rydén
- Faculty of Medicine, Department of Clinical Sciences Lund, Division of Surgery, Skåne University Hospital, Lund University, SE-221 85, Lund, Sweden.,Department of Surgery and Gastroenterology, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Olle Stål
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85, Linköping, Sweden
| | - Marie Sundqvist
- Department of Surgery, County Hospital, SE-391 85, Kalmar, Sweden
| | - Pär-Ola Bendahl
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Medicon Village Building 404, Scheelevägen 2, SE-223 81, Lund, Sweden
| | - Mårten Fernö
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Medicon Village Building 404, Scheelevägen 2, SE-223 81, Lund, Sweden
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12
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Cheng SA, Liang LZ, Liang QL, Huang ZY, Peng XX, Hong XC, Luo XB, Yuan GL, Zhang HJ, Jiang L. Breast cancer laterality and molecular subtype likely share a common risk factor. Cancer Manag Res 2018; 10:6549-6554. [PMID: 30568509 PMCID: PMC6278699 DOI: 10.2147/cmar.s182254] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background To investigate the epidemiological features of breast cancer laterality and molecular subtypes in southern China. Materials and methods A total of 2,049 cases who were diagnosed with unilateral breast cancer in the past 5 years were classified based on laterality and molecular subtypes. Molecular subtypes were defined in accordance with the 2013 St. Gallen recommendations. Results Breast cancer was more likely to be diagnosed in the left breast than in the right at a rate of around 5%. In the case of invasive carcinomas, the right breast was more commonly affected than the left in young (<40 years old) patients (left-to-right [L:R] ratio 0.80, 95% CI 0.65, 0.98), whereas the opposite trend was found in old (≥40 years old) patients (L:R ratio 1.06, 95% CI 1.02, 1.73). Except for invasive mucinous and invasive medullary breast cancers, the other histological types occurred more frequently on the left side than on the right. In situ cancer with a defined subtype was likely to be diagnosed as luminal B(HER-2+). Except for invasive medullary and invasive nonspecific cancers, other invasive carcinomas with a defined subtype were most likely to be diagnosed as luminal B(HER-2−). The age of ≥40 years was a risk factor for luminal B(HER-2+), and a significant correlation was present between the right breast and luminal B(HER-2+). Conclusion We explored the risk factors of breast cancer laterality and various molecular subtypes and found that age may be a predictor of breast cancer laterality. We found that age and laterality are the probable risk factors of the luminal B(HER-2+) type of breast cancer. These results provide a basis for the epidemiological characterization of breast cancer.
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Affiliation(s)
- Shao-Ang Cheng
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Li-Zhong Liang
- Medical Insurance Office, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China,
| | - Qi-Lian Liang
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Zhen-Yi Huang
- Department of Finance, Central Hospital of Guangdong Agriculture Reclamation, Zhanjiang 524002, China,
| | - Xiao-Xia Peng
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Xiao-Cui Hong
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Xing-Bo Luo
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Gao-Le Yuan
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Hui-Jie Zhang
- Oncology Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
| | - Liang Jiang
- Interventional Ward, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
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13
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Zdravkovic D, Nikolic D, Zdravkovic M. Heterogeneity of tumor cells and metastases in breast cancer patients: cause or consequence? Breast Cancer Res Treat 2018; 172:241. [PMID: 30078078 DOI: 10.1007/s10549-018-4913-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Darko Zdravkovic
- University Medical Center, Bezanijska Kosa, Belgrade, Serbia. .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Dejan Nikolic
- University Medical Center, Bezanijska Kosa, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Zdravkovic
- University Medical Center, Bezanijska Kosa, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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14
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Roswall P, Bocci M, Bartoschek M, Li H, Kristiansen G, Jansson S, Lehn S, Sjölund J, Reid S, Larsson C, Eriksson P, Anderberg C, Cortez E, Saal LH, Orsmark-Pietras C, Cordero E, Haller BK, Häkkinen J, Burvenich IJG, Lim E, Orimo A, Höglund M, Rydén L, Moch H, Scott AM, Eriksson U, Pietras K. Microenvironmental control of breast cancer subtype elicited through paracrine platelet-derived growth factor-CC signaling. Nat Med 2018. [PMID: 29529015 PMCID: PMC5896729 DOI: 10.1038/nm.4494] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Breast tumors of the basal-like, hormone receptor-negative, subtype remain an unmet clinical challenge, as patients exhibit a high rate of recurrence and poor survival. Co-evolution of the malignant mammary epithelium and its underlying stroma instigates cancer-associated fibroblasts (CAFs) to endorse most, if not all, hallmarks of cancer progression. Here, we delineate a previously unappreciated role for CAFs as determinants of the molecular subtype of breast cancer. We identified a paracrine cross-talk between cancer cells expressing platelet-derived growth factor (PDGF)-CC and CAFs expressing the cognate receptors in human basal-like mammary carcinomas. Genetic or pharmacological intervention with PDGF-CC activity in mouse models of cancer resulted in conversion of basal-like breast cancers into a hormone receptor-positive state that conferred sensitivity to endocrine therapy in previously impervious tumors. We conclude that specification of the basal-like subtype of breast cancer is under microenvironmental control and therapeutically actionable in order to achieve sensitivity to endocrine therapy.
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Affiliation(s)
- Pernilla Roswall
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden.,Division of Vascular Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bocci
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Michael Bartoschek
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Hong Li
- Division of Vascular Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | | | - Sara Jansson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sophie Lehn
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Jonas Sjölund
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Steven Reid
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Christer Larsson
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Pontus Eriksson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Charlotte Anderberg
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Eliane Cortez
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Lao H Saal
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Eugenia Cordero
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Bengt Kristian Haller
- Division of Vascular Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Jari Häkkinen
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ingrid J G Burvenich
- Olivia Newton-John Cancer Research Institute and School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
| | - Elgene Lim
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Akira Orimo
- Department of Pathology and Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Mattias Höglund
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lisa Rydén
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland
| | - Andrew M Scott
- Olivia Newton-John Cancer Research Institute and School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
| | - Ulf Eriksson
- Division of Vascular Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Kristian Pietras
- Division of Translational Cancer Research, Department of Laboratory Medicine, Lund University, Lund, Sweden
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15
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Jansson S, Aaltonen K, Bendahl PO, Falck AK, Karlsson M, Pietras K, Rydén L. The PDGF pathway in breast cancer is linked to tumour aggressiveness, triple-negative subtype and early recurrence. Breast Cancer Res Treat 2018; 169:231-241. [PMID: 29380207 PMCID: PMC5945746 DOI: 10.1007/s10549-018-4664-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/05/2018] [Indexed: 12/25/2022]
Abstract
Purpose The platelet-derived growth factor (PDGF) signalling pathway is often dysregulated in cancer and PDGF-receptor expression has been linked to unfavourable prognostic factors in breast cancer (e.g. ER negativity, high Ki67 and high grade). This study aimed to evaluate the expression of PDGFRα, PDGFRβ and ligand PDGF-CC in breast cancer in relation to molecular subtypes and prognosis. Methods Protein expression of tumour and/or stromal cell PDGFRα, PDGFRβ and PDGF-CC was evaluated in primary tumours (N = 489), synchronous lymph node metastases (N = 135) and asynchronous recurrences (N = 39) using immunohistochemistry in a prospectively maintained cohort of primary breast cancer patients included during 1999–2003. Distant recurrence-free interval (DRFi) was the primary end-point. Results High expression of all investigated PDGF family members correlated to increasing Nottingham histopathological grade and high Ki67. Tumour cells displayed high expression of PDGFRα in 20%, and PDGF-CC in 21% of primary tumours, which correlated with the triple-negative subtype (TNBC). Patients with high PDGF-CC had inferior prognosis (P = 0.04) in terms of 5-year DRFi, whereas PDGFRα was up-regulated in lymph node metastasis and recurrences compared to primary tumours. High primary tumour PDGFRα was associated with increased risk of central nervous system (CNS) recurrence. Conclusions High PDGFRα and PDGF-CC expression were linked to breast cancer with an aggressive biological phenotype, e.g. the TNBC subtype, and high PDGF-CC increased the risk of 5-year distant recurrence. Tumour cell PDGFRα was significantly up-regulated in lymph node metastases and asynchronous recurrences. Our findings support an active role of the PDGF signalling pathway in tumour progression. Electronic supplementary material The online version of this article (10.1007/s10549-018-4664-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Jansson
- Division of Oncology and Pathology (Clinical Sciences), Department of Clinical Sciences Lund, Lund University, Medicon Village 404:C2, Scheelev. 2, SE-223 81, Lund, Sweden.
| | - Kristina Aaltonen
- Division of Oncology and Pathology (Clinical Sciences), Department of Clinical Sciences Lund, Lund University, Medicon Village 404:C2, Scheelev. 2, SE-223 81, Lund, Sweden
| | - Pär-Ola Bendahl
- Division of Oncology and Pathology (Clinical Sciences), Department of Clinical Sciences Lund, Lund University, Medicon Village 404:C2, Scheelev. 2, SE-223 81, Lund, Sweden
| | - Anna-Karin Falck
- Department of Surgery, Helsingborg Hospital, SE-251 87, Helsingborg, Sweden
| | - Maria Karlsson
- Division of Surgery, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, SE-221 85, Lund, Sweden
| | - Kristian Pietras
- Division of Translational Cancer Research, Department of Laboratory Medicine, Medicon Village, SE-223 81, Lund, Sweden
| | - Lisa Rydén
- Division of Surgery, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, SE-221 85, Lund, Sweden.,Department of Surgery and Gastroenterology, Skåne University Hospital, SE-205 02, Malmö, Sweden
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16
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Clinical Significance of Subtype Classification in Metastatic Lymph Nodes of Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy. Int J Biol Markers 2018; 30:e174-83. [DOI: 10.5301/jbm.5000128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 12/13/2022]
Abstract
Background Neoadjuvant chemotherapy has been increasingly utilized in the treatment of breast cancer patients. However, there are no established surrogate markers predicting the response to subsequent adjuvant therapy and clinical outcome of patients. In particular, whether primary or lymph nodes metastasis should be evaluated for these analyses has remained unknown. Therefore, in this study, we first evaluated the differences in biomarkers between primary and metastatic cancer tissues in the patients undergoing neoadjuvant chemotherapy. We then correlated the findings with the clinical outcomes of these patients. Methods We examined 49 patients receiving neoadjuvant chemotherapy and subsequent surgery with lymph node metastasis. Estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2) and Ki-67 were all immunohistochemically evaluated in core needle biopsy samples from primary and metastatic tumors following chemotherapy. Results No statistically significant differences in these markers were detected between the primary tumor and metastatic lymph nodes following therapy, but the Ki-67 labeling index was significantly higher in metastatic lymph nodes than in primary tumor (p = 0.017). The patients associated with luminal A type carcinoma in their lymph nodes following chemotherapy demonstrated significantly better clinical outcomes (disease-free survival: p = 0.0045, overall survival: p = 0.0006) than those who were not. Conclusion These data indicate that subtype classification following chemotherapy, in the metastatic lymph nodes rather than primary tumor could predict long-term outcomes of patients undergoing neoadjuvant chemotherapy.
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17
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Doxtader EE, Calhoun BC, Sturgis CD, Booth CN. HER2 FISH concordance in breast cancer patients with both cytology and surgical pathology specimens. J Am Soc Cytopathol 2018; 7:31-36. [PMID: 31043248 DOI: 10.1016/j.jasc.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Fluorescence in Situ Hybridization (FISH) for Human Epidermal Growth Factor Receptor 2 (HER2) is traditionally performed on histologic specimens; there are no guidelines for validation of HER2 testing on cytology specimens. Our aim was to correlate HER2 FISH results on cytologic and histologic specimens. MATERIALS AND METHODS A retrospective search was conducted to identify breast carcinomas with HER2 FISH testing on both cytologic and histologic specimens. Results were interpreted using updated 2013 ASCO/CAP guidelines. RESULTS 54 women with HER2 FISH results on both cytologic and histologic specimens were identified. HER2 FISH was performed on 26 formalin-fixed thrombin clot cell blocks, 6 Cellient (Hologic, Inc., Bedford, MA) cell blocks and 22 ThinPrep slides, and was negative in 43 (87%), positive in 8 (15%), and equivocal in 3 (5%) cases. Of 43 negative cytology cases, the histologic specimen was also negative in 40 (93%). Of 8 positive cytology cases, the histologic specimen was positive in 5 (63%). Overall, 48 of 54 cases (89%) had a concordant result. In patients with a discordant result, the average interval between HER2 FISH testing was 7 years. Three of 6 discordant cases showed HER2 genetic heterogeneity. Five patients received adjuvant chemotherapy, 2 received endocrine therapy, and 1 received trastuzumab. CONCLUSIONS FISH is reliable for determining HER2 status in cytopathology specimens. Discordant results between cytologic and surgical specimens are uncommon; possible explanations include genetic heterogeneity or inherent molecular changes associated with disease progression and therapies that occur between testing of the primary carcinoma and the metastasis.
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18
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Brufsky AM. Long-term management of patients with hormone receptor-positive metastatic breast cancer: Concepts for sequential and combination endocrine-based therapies. Cancer Treat Rev 2017; 59:22-32. [PMID: 28719836 DOI: 10.1016/j.ctrv.2017.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/21/2017] [Indexed: 12/21/2022]
Abstract
Treatment options for hormone receptor-positive (HR-positive) metastatic breast cancer (MBC) continue to increase in parallel with expanding knowledge about the complex biology of breast cancer subtypes and resistance mechanisms to endocrine therapy. For patients with HR-positive MBC, there are now an unprecedented number of endocrine-based treatment options that can improve long-term outcomes, while preserving or optimizing quality of life, and that can be used before selecting more cytotoxic chemotherapeutic regimens. In addition to antiestrogens, steroidal and nonsteroidal aromatase inhibitors, the selective estrogen-receptor degrader, fulvestrant, and new endocrine-based combinations provide significant and clinically meaningful improvements in outcomes in the first line setting and beyond. Also, new clinical scenarios and indications for monotherapy endocrine and targeted therapies continue to be explored. Patients have several therapeutic options when their disease progresses or becomes resistant, although the optimal sequencing of these therapies remains unclear. Ongoing research in the resistant/refractory setting is anticipated to continue improving the outlook for these patients. This review will discuss current and investigational approaches to sequential single-agent endocrine and endocrine-based combination therapy for the long-term management of patients with HR-positive, human epidermal growth factor receptor 2-negative MBC.
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Affiliation(s)
- Adam M Brufsky
- University of Pittsburgh, School of Medicine, 300 Halket Street, Suite 4628, Pittsburgh, PA 15213, United States.
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19
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Maimaiti Y, Tan J, Liu Z, Guo Y, Yan Y, Nie X, Huang B, Zhou J, Huang T. Overexpression of cofilin correlates with poor survival in breast cancer: A tissue microarray analysis. Oncol Lett 2017; 14:2288-2294. [PMID: 28781665 PMCID: PMC5530183 DOI: 10.3892/ol.2017.6413] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 04/28/2017] [Indexed: 12/20/2022] Open
Abstract
Cofilin, a key regulator of actin cytoskeleton dynamics, is considered to be involved in cellular migration, tumor invasion and mitosis, and its activity is increased in cancer cells. To address the association between cofilin and breast cancer prognosis, which is unclear at present, cofilin expression was analyzed in tissue microarrays of tumors from 310 patients with breast cancer via immunohistochemistry. In a multivariate Cox regression analysis, a high expression of cofilin in tumor cells correlated significantly with shorter overall survival (hazard ratio, 2.22; 95% confidence interval, 1.35–3.66, P=0.002, and with the Nottingham histologic grade, Ki-67 status and human epidermal growth factor receptor 2 status (P=0.031, 0.001, and 0.001, respectively). Cofilin expression was not observed as correlated with estrogen or progesterone receptor expression, tumor size or lymph node status. These data demonstrate that cofilin is associated with poor outcome, thereby suggesting that it is a potential prognostic factor in breast cancer.
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Affiliation(s)
- Yusufu Maimaiti
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China.,Department of General Surgery, Research Institute of Minimally Invasive, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830000, P.R. China
| | - Jie Tan
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Zeming Liu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Yawen Guo
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Yu Yan
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Xiu Nie
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Bangxing Huang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jing Zhou
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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20
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Snell CE, Gough M, Middleton K, Hsieh M, Furnas L, Seidl B, Gibbons K, Pyke C, Shannon C, Woodward N, Armes JE. Absent progesterone receptor expression in the lymph node metastases of ER-positive, HER2-negative breast cancer is associated with relapse on tamoxifen. J Clin Pathol 2017; 70:954-960. [PMID: 28416639 DOI: 10.1136/jclinpath-2016-204304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/14/2017] [Accepted: 03/29/2017] [Indexed: 02/01/2023]
Abstract
AIMS Progesterone receptor (PR) expression is prognostic in early stage breast cancer. There are several reports of discordant expression between primary tumour and axillary lymph node (ALN) metastasis expression of oestrogen receptor (ER) and PR. We sought to determine whether expression of these biomarkers in the synchronous ALN metastases of ER positive (+), HER2 negative (-) breast cancer could provide more accurate prognostic information. METHODS The retrospective cohort included 229 patients from a single institution with ER+, HER2- breast cancer who had synchronous ALN metastatic disease (2005-2014). PR expression was correlated with relapse-free survival, and subset analysis was performed for patients who received adjuvant tamoxifen or an aromatase inhibitor. RESULTS One patient had an ER+ primary tumour, which was ER- in the ALN metastasis. 27 (11.3%) were PR- in the primary tumour and 56 (23.6%) in the ALN metastasis. The predominant change was from PR+ in the primary tumour to PR- in the lymph node. Absence of PR expression in the ALN was significantly associated with relapse; however, this was not the case in the primary tumour. In a subset analysis of patients taking adjuvant endocrine therapy, poorer prognosis was limited to those with PR- metastases on tamoxifen (HR=5.203, 95% CI 1.649 to 16.416, p=0.005). No significant prognostic effect of PR- metastases in patients taking aromatase inhibitors was seen (HR=1.519, 95% CI 0.675 to 3.418, p=0.312). CONCLUSIONS Evaluation of PR expression in ALN metastasis may enable prediction of patients who are less likely to benefit from adjuvant tamoxifen. This study should be replicated in other cohorts.
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Affiliation(s)
- Cameron E Snell
- Breast Cancer Research Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia.,The Department of Anatomical Pathology, Mater Pathology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Madeline Gough
- Breast Cancer Research Group, Mater Research Institute-The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia.,The Department of Anatomical Pathology, Mater Pathology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Kathryn Middleton
- The Department of Medical Oncology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Michael Hsieh
- The Department of Anatomical Pathology, Mater Pathology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Lauren Furnas
- The Department of Anatomical Pathology, Mater Pathology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Brenton Seidl
- The Department of Medical Oncology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Kristen Gibbons
- Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia
| | - Christopher Pyke
- Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia.,The Department of Breast and Endocrine Surgery, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Catherine Shannon
- The Department of Medical Oncology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Natasha Woodward
- The Department of Medical Oncology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia
| | - Jane E Armes
- The Department of Anatomical Pathology, Mater Pathology, Mater Hospital Brisbane, Mater Health Services, South Brisbane, Queensland, Australia.,Mater Research Institute-The University of Queensland, South Brisbane, Queensland, Australia
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21
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Shibata T, Watari K, Izumi H, Kawahara A, Hattori S, Fukumitsu C, Murakami Y, Takahashi R, Toh U, Ito KI, Ohdo S, Tanaka M, Kage M, Kuwano M, Ono M. Breast Cancer Resistance to Antiestrogens Is Enhanced by Increased ER Degradation and ERBB2 Expression. Cancer Res 2016; 77:545-556. [PMID: 27879270 DOI: 10.1158/0008-5472.can-16-1593] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/26/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022]
Abstract
Endocrine therapies effectively improve the outcomes of patients with estrogen receptor (ER)-positive breast cancer. However, the emergence of drug-resistant tumors creates a core clinical challenge. In breast cancer cells rendered resistant to the antiestrogen fulvestrant, we defined causative mechanistic roles for the transcription factor YBX1 and the levels of ER and the ERBB2 receptor. Enforced expression of YBX1 in parental cells conferred resistance against tamoxifen and fulvestrant in vitro and in vivo Furthermore, YBX1 overexpression was associated with decreased and increased levels of ER and ERBB2 expression, respectively. In antiestrogen-resistant cells, increased YBX1 phosphorylation was associated with a 4-fold higher degradation rate of ER. Notably, YBX1 bound the ER, leading to its accelerated proteasomal degradation, and induced the transcriptional activation of ERBB2. In parallel fashion, tamoxifen treatment also augmented YBX1 binding to the ERBB2 promoter to induce increased ERBB2 expression. Together, these findings define a mechanism of drug resistance through which YBX1 contributes to antiestrogen bypass in breast cancer cells. Cancer Res; 77(2); 545-56. ©2016 AACR.
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Affiliation(s)
- Tomohiro Shibata
- Department of Pharmaceutical Oncology, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Kosuke Watari
- Department of Pharmaceutical Oncology, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroto Izumi
- Department of Occupational Pneumology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akihiko Kawahara
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | | | - Chihiro Fukumitsu
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Yuichi Murakami
- Department of Pharmaceutical Oncology, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan.,Cancer Translational Research Center, St. Mary's Institute of Health Sciences, Kurume, Japan
| | - Ryuji Takahashi
- Department of Breast Care Center, Kyushu Medical Center, Fukuoka, Japan
| | - Uhi Toh
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigehiro Ohdo
- Department of Pharmaceutics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Maki Tanaka
- Kurume General Hospital, Japan Community Health Care Organization (JCHO), Kurume, Japan
| | - Masayoshi Kage
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Michihiko Kuwano
- Cancer Translational Research Center, St. Mary's Institute of Health Sciences, Kurume, Japan
| | - Mayumi Ono
- Department of Pharmaceutical Oncology, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan.
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22
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Remarkable similarities of chromosomal rearrangements between primary human breast cancers and matched distant metastases as revealed by whole-genome sequencing. Oncotarget 2016; 6:37169-84. [PMID: 26439695 PMCID: PMC4741922 DOI: 10.18632/oncotarget.5951] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 09/17/2015] [Indexed: 12/14/2022] Open
Abstract
To better understand and characterize chromosomal structural variation during breast cancer progression, we enumerated chromosomal rearrangements for 11 patients by performing low-coverage whole-genome sequencing of 11 primary breast tumors and their 13 matched distant metastases. The tumor genomes harbored a median of 85 (range 18-404) rearrangements per tumor, with a median of 82 (26-310) in primaries compared to 87 (18-404) in distant metastases. Concordance between paired tumors from the same patient was high with a median of 89% of rearrangements shared (range 61-100%), whereas little overlap was found when comparing all possible pairings of tumors from different patients (median 3%). The tumors exhibited diverse genomic patterns of rearrangements: some carried events distributed throughout the genome while others had events mostly within densely clustered chromothripsis-like foci at a few chromosomal locations. Irrespectively, the patterns were highly conserved between the primary tumor and metastases from the same patient. Rearrangements occurred more frequently in genic areas than expected by chance and among the genes affected there was significant enrichment for cancer-associated genes including disruption of TP53, RB1, PTEN, and ESR1, likely contributing to tumor development. Our findings are most consistent with chromosomal rearrangements being early events in breast cancer progression that remain stable during the development from primary tumor to distant metastasis.
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23
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Breast cancer-specific mortality in small-sized tumor with node-positive breast cancer: a nation-wide study in Korean breast cancer society. Breast Cancer Res Treat 2016; 159:489-98. [PMID: 27590199 DOI: 10.1007/s10549-016-3943-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 01/15/2023]
Abstract
Tumor size and number of lymph node (LN) metastases are well known as the most important prognostic factors of breast cancer. We hypothesized that very small breast cancers with LN metastasis represent a progressive biologic behavior and evaluated tumor size stratified by LN metastasis. Data between 1990 and 2010 were obtained retrospectively from the Korean Breast Cancer Society Registry with inclusion criteria of female, non-metastatic, unilateral, and T1/2 breast cancer. We collected the following variables: age at surgery, tumor size, number of LN metastases, nuclear grade (NG), lymphovascular invasion (LVI), estrogen receptor status, progesterone receptor status, and epidermal growth factor receptor-2 status. Patient characteristics were compared by means of independent t-tests for continuous variables and the Chi-square or Fisher's exact test for categorical variables. Kaplan-Meier curves, with corresponding results of log-rank tests, were constructed for breast cancer-specific survival (BCSS). Five- and eight-year breast cancer-specific mortality (BCSM) was obtained in groups of 300 patients, followed by smoothing according to the confidence interval using the lowess method. We identified 39,826 breast cancer patients who met the inclusion criteria. Among them, 1433 (3.6 %) patients died due to breast cancer. The median follow-up duration was 63.4 (3-255) months. In the multivariate analysis, age at surgery, NG, LVI, subtype, and tumor size-nodal interactions were independently associated with BCSM. The N1 group had lower BCSS for T1a than T1b. The N2+ group also had lower BCSS for T1b than T1c or T2. In the N1 group of tumors smaller than 10 mm, 5- and 8-year BCSM decreased with larger tumor size. Patients with very small tumors with LN metastasis have decreased BCSM according to increase tumor size. Small tumors with LN metastasis could have aggressive biological behavior.
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24
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Kimbung S, Kovács A, Danielsson A, Bendahl PO, Lövgren K, Frostvik Stolt M, Tobin NP, Lindström L, Bergh J, Einbeigi Z, Fernö M, Hatschek T, Hedenfalk I. Contrasting breast cancer molecular subtypes across serial tumor progression stages: biological and prognostic implications. Oncotarget 2016; 6:33306-18. [PMID: 26375671 PMCID: PMC4741767 DOI: 10.18632/oncotarget.5089] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/28/2015] [Indexed: 12/22/2022] Open
Abstract
The relevance of the intrinsic subtypes for clinical management of metastatic breast cancer is not comprehensively established. We aimed to evaluate the prevalence and prognostic significance of drifts in tumor molecular subtypes during breast cancer progression. A well-annotated cohort of 304 women with advanced breast cancer was studied. Tissue microarrays of primary tumors and synchronous lymph node metastases were constructed. Conventional biomarkers were centrally assessed and molecular subtypes were assigned following the 2013 St Gallen guidelines. Fine-needle aspirates of asynchronous metastases were transcriptionally profiled and subtyped using PAM50. Discordant expression of individual biomarkers and molecular subtypes was observed during tumor progression. Primary luminal-like tumors were relatively unstable, frequently adopting a more aggressive subtype in the metastases. Notably, loss of ER expression and a luminal to non-luminal subtype conversion was associated with an inferior post-recurrence survival. In addition, ER and molecular subtype assessed at all tumor progression stages were independent prognostic factors for post-recurrence breast cancer mortality in multivariable analyses. Our results demonstrate that drifts in tumor molecular subtypes may occur during tumor progression, conferring adverse consequences on outcome following breast cancer relapse.
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Affiliation(s)
- Siker Kimbung
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Anikó Kovács
- Department of Clinical Pathology and Cytology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Danielsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pär-Ola Bendahl
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kristina Lövgren
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Marianne Frostvik Stolt
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Nicholas P Tobin
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Linda Lindström
- Department of Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA.,Department of Biosciences and Nutrition, Karolinska Institutet and University Hospital, Solna, Sweden
| | - Jonas Bergh
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Zakaria Einbeigi
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mårten Fernö
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Thomas Hatschek
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
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25
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SERPINA1 is a direct estrogen receptor target gene and a predictor of survival in breast cancer patients. Oncotarget 2016; 6:25815-27. [PMID: 26158350 PMCID: PMC4694868 DOI: 10.18632/oncotarget.4441] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/19/2015] [Indexed: 01/02/2023] Open
Abstract
Of all breast cancer patients, about 70% are ER+ and 10% are ER+/HER2+. The ER+/HER2+ patients have a worse outcome compared to ER+/HER2- patients. Currently there is a lack of effective prognosis biomarkers for the prediction of outcome in ER+/HER2+ patients. Genome-wide differences in ER binding between the endocrine-responsive and endocrine-resistant cells were discovered using ChIP-seq, and combined with gene expression microarray data to identify direct ER target genes. These genes were correlated to survival outcome using publicly available breast cancer patient cohorts. We found the expression of the gene SERPINA1 to have a significant predictive value for the overall survival (OS) of ER+ patients in the TCGA cohort, and validated this finding in the Curtis cohort. SERPINA1 also has a significant predictive value for the OS of ER+/HER2+ patients in the TCGA cohort, with validation in the Bild cohort. The expression of SERPINA1 can be suppressed by fulvestrant and HER2 siRNA. Our results indicate that ER is constitutively activated, resulting in an E2-independent ER binding to the SERPINA1 gene and upregulation of SERPINA1 expression. Importantly, results of survival correlation suggests that high expression of SERPINA1 could be predictive for a better clinical outcome of ER+ and ER+/HER2+ patients.
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26
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Clinical and microarray analysis of breast cancers of all subtypes from two prospective preoperative chemotherapy studies. Br J Cancer 2016; 115:411-9. [PMID: 27415010 PMCID: PMC4985347 DOI: 10.1038/bjc.2016.184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 05/08/2016] [Accepted: 05/19/2016] [Indexed: 02/08/2023] Open
Abstract
Background: We aimed to analyse clinical and gene expression profiles to predict pathologic complete response and disease-free survival using two consecutive, prospective, preoperative chemotherapy trial cohorts. Methods: Clinicopathological and gene expression data were evaluated in a cohort from two consecutive phase II preoperative studies that included patients with stage IIA–IIIC breast cancer of all subtypes. Analysed specimens were obtained before preoperative chemotherapy, and cDNA microarray analyses were performed using the Affymetrix Gene Chip U133 plus 2.0. Results: Between December 2005 and December 2010, 122 patients were analysed. The pathologic complete response rate was significantly higher in HER2+ and HR−/HER2− cancers. Age, pathologic complete response, HR−/HER2− status, and lymph node positivity (⩾4) were significant poor prognostic factors for disease-free survival. For the cDNA microarray analyses, sufficient tumour samples were available from 78 of the 107 patients (73%). An 8-gene signature predictive of pathologic complete response and a 17-gene signature predictive of prognosis were identified. Patients were categorised into low-risk (n=45) and high-risk groups (n=33) (HR 70.0, P=0.004). Conclusions: This study yielded preliminary data on the expression of specific genes predicting pathologic complete response and disease-free survival in a cohort of chemonaïve breast cancer patients. Further validation may distinguish those who would benefit most from perioperative chemotherapy as well as those needing further intervention.
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27
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Tumour heterogeneity: principles and practical consequences. Virchows Arch 2016; 469:371-84. [PMID: 27412632 DOI: 10.1007/s00428-016-1987-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/01/2016] [Accepted: 07/03/2016] [Indexed: 12/30/2022]
Abstract
Two major reasons compel us to study tumour heterogeneity: firstly, it represents the basis of acquired therapy resistance, and secondly, it may be one of the major sources of the low level of reproducibility in clinical cancer research. The present review focuses on the heterogeneity of neoplastic disease, both within the primary tumour and between primary tumour and metastases. We discuss different levels of heterogeneity and the current understanding of the phenomenon, as well as imminent developments relevant for clinical research and diagnostic pathology. It is necessary to develop new tools to study heterogeneity and new biomarkers for heterogeneity. Established and new in situ methods will be very useful. In future studies, not only clonal heterogeneity needs to be addressed but also non-clonal phenotypic heterogeneity which might be important for therapy resistance. We also review heterogeneity established in major tumour types, in order to explore potential similarities that might help to define new strategies for targeted therapy.
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28
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Kasahara M, Nagahara M, Nakagawa T, Ishikawa T, Sato T, Uetake H, Sugihara K. Clinicopathological relevance of kinesin family member 18A expression in invasive breast cancer. Oncol Lett 2016; 12:1909-1914. [PMID: 27588139 DOI: 10.3892/ol.2016.4823] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/29/2016] [Indexed: 01/25/2023] Open
Abstract
Recently, kinesin motor proteins have been focused on as targets for cancer therapy. Kinesins are microtubule-based motor proteins that mediate diverse functions within the cell, including the transport of vesicles, organelles, chromosomes and protein complexes, as well as the movement of microtubules. In the current study, the expression of kinesin family member 18A (KIF18A), a member of kinesin superfamily, was investigated in breast cancer using immunohistochemistry, and its effect on breast cancer prognosis was examined. KIF18A expression level was significantly associated with lymph node metastasis (P=0.047). In patients with high levels of KIF18A expression, survival was significantly poorer compared to patients with low levels of KIF18A expression (disease-free survival, P=0.030). Multivariate analysis revealed that venous invasion (hazard ratio, 9.22; 95% confidence interval, 3.90-23.66; P<0.001) and KIF18A expression (hazard ratio, 3.20; 95% confidence interval, 1.34-6.09; P=0.010) were independent predictive factors for lymph node metastasis. KIF18A may be a useful predictive marker for lymph node metastasis in breast cancer, which could facilitate curative adjuvant treatment.
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Affiliation(s)
- Mai Kasahara
- Department of Surgical Oncology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Makoto Nagahara
- Department of Surgical Oncology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Tsuyoshi Nakagawa
- Department of Surgical Oncology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Toshiaki Ishikawa
- Department of Translational Oncology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Takanobu Sato
- Department of Surgical Oncology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Hiroyuki Uetake
- Department of Translational Oncology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Kenichi Sugihara
- Department of Surgical Oncology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
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29
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Aziz S, Wik E, Knutsvik G, Klingen TA, Chen Y, Davidsen B, Aas H, Aas T, Akslen LA. Evaluation of Tumor Cell Proliferation by Ki-67 Expression and Mitotic Count in Lymph Node Metastases from Breast Cancer. PLoS One 2016; 11:e0150979. [PMID: 26954367 PMCID: PMC4783103 DOI: 10.1371/journal.pone.0150979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/22/2016] [Indexed: 01/16/2023] Open
Abstract
Few studies have addressed the risk of recurrence by assessing proliferation markers in lymph node metastasis from breast cancer. Here, we aimed to examine Ki-67 expression and mitotic count in lymph nodes in comparison with primary tumors. A cohort of node positive breast cancer (n = 168) was studied as a part of the prospective Norwegian Breast Cancer Screening Program (1996-2009). The percentage of Ki-67 positivity was counted per 500 tumor cells in hot-spot areas (x630). Mitotic count was conducted in the most cellular and mitotic active areas in 10 high power fields (x400). Our results showed that Ki-67 and mitotic count were significantly correlated between primary tumor and lymph nodes (Spearman`s correlation 0. 56 and 0.46, respectively) and were associated with most of the histologic features of the primary tumor. Univariate survival analysis (log-rank test) showed that high Ki-67 and mitotic count in the primary tumor and lymph node metastasis significantly predicted risk of recurrence. In multivariate analysis, mitotic count in the lymph node metastasis was an independent predictor of tumor recurrence. In conclusion, proliferation markers in lymph node metastases significantly predicted disease free survival in node positive breast cancer.
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Affiliation(s)
- Sura Aziz
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth Wik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Gøril Knutsvik
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Tor Audun Klingen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ying Chen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Akerhus University Hospital, Lørenskog, Norway
| | | | - Hans Aas
- Department of Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - Turid Aas
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - Lars A. Akslen
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
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30
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Falck AK, Röme A, Fernö M, Olsson H, Chebil G, Bendahl PO, Rydén L. St Gallen molecular subtypes in screening-detected and symptomatic breast cancer in a prospective cohort with long-term follow-up. Br J Surg 2016; 103:513-23. [PMID: 26856820 PMCID: PMC5067683 DOI: 10.1002/bjs.10070] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/03/2015] [Accepted: 10/29/2015] [Indexed: 12/14/2022]
Abstract
Background Diagnosis by screening mammography is considered an independent positive prognostic factor, although the data are not fully in agreement. The aim of the study was to explore whether the mode of detection (screening‐detected versus symptomatic) adds prognostic information to the St Gallen molecular subtypes of primary breast cancer, in terms of 10‐year cumulative breast cancer mortality (BCM). Methods A prospective cohort of patients with primary breast cancer, who had regularly been invited to screening mammography, were included. Tissue microarrays were constructed from primary tumours and lymph node metastases, and evaluated by two independent pathologists. Primary tumours and lymph node metastases were classified into St Gallen molecular subtypes. Cause of death was retrieved from the Central Statistics Office. Results A total of 434 patients with primary breast cancer were included in the study. Some 370 primary tumours and 111 lymph node metastases were classified into St Gallen molecular subtypes. The luminal A‐like subtype was more common among the screening‐detected primary tumours (P = 0·035) and corresponding lymph node metastases (P = 0·114) than among symptomatic cancers. Patients with screening‐detected tumours had a lower BCM (P = 0·017), and for those diagnosed with luminal A‐like tumours the 10‐year cumulative BCM was 3 per cent. For patients with luminal A‐like lymph node metastases, there was no BCM. In a stepwise multivariable analysis, the prognostic information yielded by screening detection was hampered by stage and tumour biology. Conclusion The prognosis was excellent for patients within the screening programme who were diagnosed with a luminal A‐like primary tumour and/or lymph node metastases. Stage, molecular pathology and mode of detection help to define patients at low risk of death from breast cancer. Low‐risk group identified
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Affiliation(s)
- A K Falck
- Departments of Surgery, Clinical Sciences Lund, Lund, Sweden.,Department of Surgery, Hospital of Helsingborg, Helsingborg, Sweden
| | - A Röme
- Department of Surgery, Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - M Fernö
- Departments of Oncology and Pathology, Clinical Sciences Lund, Lund, Sweden
| | - H Olsson
- Molecular and Immunological Pathology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - G Chebil
- Unilabs Pathology Unit, Helsingborg, Sweden
| | - P O Bendahl
- Departments of Oncology and Pathology, Clinical Sciences Lund, Lund, Sweden
| | - L Rydén
- Departments of Surgery, Clinical Sciences Lund, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
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31
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HER-2, ER, PR status concordance in primary breast cancer and corresponding metastatic lesion in lymph node in Chinese women. Pathol Res Pract 2016; 212:252-7. [PMID: 26899763 DOI: 10.1016/j.prp.2015.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/22/2015] [Accepted: 11/27/2015] [Indexed: 11/22/2022]
Abstract
AIMS AND BACKGROUND To compare the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) in the primary site and the metastatic lesion of lymph nodes in invasive breast cancer for investigating whether the expression of these biomarkers in the primary site could act as a surrogate to the lymphatic metastatic lesion in the same patient. METHODS In lymphatic metastatic lesion and corresponding primary lesion of 107 cases of invasive breast cancer, ER and PR statuses were assessed by immunohistochemistry (IHC). HER-2 expression level was evaluated by IHC and/or fluorescence in situ hybridization (FISH). RESULTS In the primary lesions, 43.9% were ER positive; 46.7% were PR positive; 34.6% were HER-2 positive. In corresponding lymphatic metastatic lesions, the HER-2 status was concordant in 90 patients; 9 patients were diagnosed positive in metastatic lesion while negative in primary lesion; 8 patients were negative in metastatic lesion while positive in primary site (agreement, 84.1%; κ=0.647). A change in ER status was observed in 24 cases: 17 cases positive in metastatic site while negative in primary site; 7 cases negative in metastatic site while positive in primary site (agreement, 77.6%; κ=0.534). PR status discordance between the primary lesion and the metastatic regional lymph nodes was reported in 19 cases (agreement, 82.2%; κ=0.640). CONCLUSIONS This study revealed that there was only a moderate concordance of ER, PR and HER-2 status between primary tumors and metastatic lymph nodes. These results indicate that it was inappropriate to predict the status of ER, PR and HER-2 in metastatic lymph nodes based on the results of evaluation of that in primary lesions.
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32
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Sun Y, Liu X, Cui S, Li L, Tian P, Liu S, Li Y, Yin M, Zhang C, Mao Q, Wang J. The inconsistency of molecular subtypes between primary foci and metastatic axillary lymph nodes in Luminal A breast cancer patients among Chinese women, an indication for chemotherapy? Tumour Biol 2016; 37:9555-63. [PMID: 26790445 DOI: 10.1007/s13277-016-4844-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/12/2016] [Indexed: 01/01/2023] Open
Abstract
Patients with Luminal A breast cancer often have favorable prognosis, but some of these patients still have lymph node metastases, it remains unclear what the role of adjuvant chemotherapy is in Luminal A subtype with lymph node metastases. The aim of this study was to find a new method to distinguish which Luminal A patient can be benefited from chemotherapy. We retrospectively investigated the inconsistency of molecular subtypes between primary foci and metastatic axillary lymph nodes in Luminal A breast cancer patients, and analyzed the clinicopathologic characteristics, Recurrence score (RS), disease-free survival (DFS), and overall survival (OS) in 146 Luminal A breast cancer patients. The discordance of molecular subtypes between primary foci and metastatic lymph nodes were explored by univariate and multivariate logistic regression. The DFS and OS were calculated by the Kaplan-Meier survival curves, and the Cox regression analyses were performed to identify independent prognostic factors for DFS and OS. In our results, the inconsistency was found in 55 patients (55/146, 37.67 %). Lymphatic vascular invasion (OR 6.402, 95 % CI 2.371-17.287, P < 0.001), lymph node stage (OR 2.147, 95 % CI 1.095-4.209, P = 0.026), and histological grade (OR 3.319, 95 % CI 1.101-8.951, P = 0.032) were significantly related to the inconsistency. The inconsistent group (non-Luminal A variations) had a poor prognosis compared with the consistent group, the DFS between the two groups was significantly different (P = 0.022), but the OS did not have obvious difference (P = 0.140). Moreover, the inconsistency was associated with high RS (P = 0.036). In conclusion, more aggressive molecular subtypes in metastatic lymph nodes, which associated with poor prognosis, were observed in Luminal A breast cancer patients, which indicate that chemotherapy is necessary for these patients.
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Affiliation(s)
- Yadong Sun
- Department of Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China.,Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China
| | - Xiaofeng Liu
- Department of breast, Nanjing Maternity and Child Health Hospital of Nanjing Medical University, Nanjing, 210004, People's Republic of China
| | - Shude Cui
- Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China
| | - Lianfang Li
- Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China
| | - Peiqi Tian
- Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China
| | - Shanqing Liu
- Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China
| | - Yong Li
- Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China
| | - Mengmeng Yin
- Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China
| | - Chongjian Zhang
- Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China
| | - Qixin Mao
- Department of Breast, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, 450008, People's Republic of China
| | - Jiaxiang Wang
- Department of Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China.
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Vandendriessche E, Van De Putte G, Van Den Broecke R, De Jonge ETM. Improving systemic breast cancer therapy: time to look beyond the primary tumour? Facts Views Vis Obgyn 2015; 7:251-256. [PMID: 27729970 PMCID: PMC5058414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Intra and inter tumour heterogeneity is a known feature in cancer because tumour cells undergo changes at genetic and epigenetic level as they spread from their primary tumour site. Adjuvant treatment protocols in breast cancer are currently based on the biological characteristics of the primary tumour, which in most cases has been removed surgically. Considering tumour heterogeneity in metastases we examined the present status of knowledge regarding measurable differences in tumour profiling between the primary breast tumour and its synchronous axillary lymph node metastases (ALNM) and if so whether adjuvant therapy directed towards the tumour characteristics of the ALNM instead of those of the primary tumour is more effective. METHODS We performed a literature search in Pubmed with the following MeSH headings: HUMAN and BREAST NEOPLASMS and RECEPTORS and ErbB-2. RESULTS A significant change in tumour features was seen in metachronous metastases. In contrast, a high concordance of biomarker expression was reported between a primary breast tumour and its synchronous ALNM. CONCLUSION Tumour heterogeneity is a challenge for targeted therapy. A poor response can be explained by the diversity of tumour cells. The biological profile of synchronous ALNM measured by oestrogen (ER), progesterone (PR) and her-2-neu receptor status does not differ from the primary breast tumour and is not predictive of the tumour profile in metachronous metastasis. New techniques, such as profiling of circulating tumour cells or tumour behaviour in xenografts, are promising in directing more effective adjuvant therapy.
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Affiliation(s)
- E Vandendriessche
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St. Jan, Schiepse Bos 6, 3600 Genk, Belgium.,Department of Obstetrics & Gynaecology, University Hospital Ghent, De Pintelaan 185, 9000 Gent, Belgium
| | - G Van De Putte
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St. Jan, Schiepse Bos 6, 3600 Genk, Belgium
| | - R Van Den Broecke
- Department of Obstetrics & Gynaecology, University Hospital Ghent, De Pintelaan 185, 9000 Gent, Belgium
| | - ETM De Jonge
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St. Jan, Schiepse Bos 6, 3600 Genk, Belgium
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Kimbung S, Loman N, Hedenfalk I. Clinical and molecular complexity of breast cancer metastases. Semin Cancer Biol 2015; 35:85-95. [PMID: 26319607 DOI: 10.1016/j.semcancer.2015.08.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 12/24/2022]
Abstract
Clinical oncology is advancing toward a more personalized treatment orientation, making the need to understand the biology of metastasis increasingly acute. Dissecting the complex molecular, genetic and clinical phenotypes underlying the processes involved in the development of metastatic disease, which remains the principal cause of cancer-related deaths, could lead to the identification of more effective prognostication and targeted approaches to prevent and treat metastases. The past decade has witnessed significant progress in the field of cancer metastasis research. Clinical and technological milestones have been reached which have tremendously enriched our understanding of the complex pathways undertaken by primary tumors to progress into lethal metastases and how some of these processes might be amenable to therapy. The aim of this review article is to highlight the recent advances toward unraveling the clinical and molecular complexity of breast cancer metastases. We focus on genes mediating breast cancer metastases and organ-specific tropism, and discuss gene signatures for prediction of metastatic disease. The challenges of translating this information into clinically applicable tools for improving the prognostication of the metastatic potential of a primary breast tumor, as well as for therapeutic interventions against latent and active metastatic disease are addressed.
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Affiliation(s)
- Siker Kimbung
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Oncology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden.
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35
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Kurbasic E, Sjöström M, Krogh M, Folkesson E, Grabau D, Hansson K, Rydén L, Waldemarson S, James P, Niméus E. Changes in glycoprotein expression between primary breast tumour and synchronous lymph node metastases or asynchronous distant metastases. Clin Proteomics 2015; 12:13. [PMID: 25991917 PMCID: PMC4436114 DOI: 10.1186/s12014-015-9084-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/13/2015] [Indexed: 12/27/2022] Open
Abstract
Background Breast cancer is a very heterogeneous disease and some patients are cured by the surgical removal of the primary tumour whilst other patients suffer from metastasis and spreading of the disease, despite adjuvant therapy. A number of prognostic and treatment predictive factors have been identified such as tumour size, oestrogen (ER) and progesterone (PgR) receptor status, human epidermal growth factor receptor type 2 (HER2) status, histological grade, Ki67 and age. Lymph node involvement is also assessed during surgery to determine if the tumour has spread which requires dissection of the axilla and adjuvant treatment. The prognostic and treatment predictive factors assessing the nature of the tumour are all routinely based on the status of the primary tumour. Results We have analysed a unique tumour set of fourteen primary breast cancer tumours with matched synchronous axillary lymph node metastases and a set of nine primary tumours with, later developed, matched distant metastases from different sites in the body. We used a pairwise tumour analysis (from the same individual) since the difference between the same tumour-type in different patients was greater. Glycopeptide capture was used in this study to selectively isolate and quantify N-linked glycopeptides from tumours mixtures and the captured glycopeptides were subjected to label-free quantitative tandem mass spectrometry analysis. Differentially expressed proteins between primary tumours and matched lymph node metastasis and distant metastasis were identified. Two of the top hits, ATPIF1 and tubulin β-chain were validated by immunohistochemistry to be differentially regulated. Conclusions We show that the expression of a large number of glycosylated proteins change between primary tumours and matched lymph node metastases and distant metastases, confirming that cancer cells undergo a molecular transformation during the spread to a secondary site. The proteins are part of important pathways such as cell adhesion, migration pathways and immune response giving insight into molecular changes needed for the tumour to spread. The large difference between primary tumours and lymph node and distant metastases also suggest that treatment should be based on the phenotype of the lymph node and distant metastases. Electronic supplementary material The online version of this article (doi:10.1186/s12014-015-9084-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emila Kurbasic
- Department of Immunotechnology, House 406, Medicon Village, SE-223 81 Lund, Sweden
| | - Martin Sjöström
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-223 81 Lund, Sweden
| | - Morten Krogh
- Amber Biosciences AB, Skrivarevägen 9, SE-22657 Lund, Sweden
| | - Elin Folkesson
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-223 81 Lund, Sweden
| | - Dorthe Grabau
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-223 81 Lund, Sweden ; Department of Pathology, Skåne University Hospital, SE-22185 Lund, Sweden
| | - Karin Hansson
- Department of Immunotechnology, House 406, Medicon Village, SE-223 81 Lund, Sweden
| | - Lisa Rydén
- Department of Surgery, Clinical sciences, Lund University, SE-22185 Lund, Sweden ; Department of Surgery, Skåne University Hospital, SE-22185 Lund, Sweden
| | - Sofia Waldemarson
- Department of Immunotechnology, House 406, Medicon Village, SE-223 81 Lund, Sweden
| | - Peter James
- Department of Immunotechnology, House 406, Medicon Village, SE-223 81 Lund, Sweden
| | - Emma Niméus
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Medicon Village, SE-223 81 Lund, Sweden ; Department of Surgery, Skåne University Hospital, SE-22185 Lund, Sweden
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Sugimoto H, Nagahara M, Bae Y, Nakagawa T, Ishikawa T, Sato T, Uetake H, Eishi Y, Sugihara K. Clinicopathologic relevance of claudin 5 expression in breast cancer. Am J Clin Pathol 2015; 143:540-6. [PMID: 25780006 DOI: 10.1309/ajcpwgbz6d0oaivj] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Claudins are major adhesion molecules in tight junctions and are strongly expressed in various cancers. We thus investigated the expression of claudin 5, a member of the claudin family, in breast cancer. METHODS A total of 193 patients with breast cancer were identified based on their pathologic diagnosis. The expression of each claudin 5 was analyzed in the tumor by immunohistochemical staining. Parametric correlations were done between claudin 5 expression and the clinicopathologic findings. RESULTS Claudin 5 expression in patients with recurrent breast cancer was statistically significantly higher (P = .004). In addition, analysis of the correlation with other clinicopathologic factors showed statistically significant differences with respect to lymphatic invasion (P = .014), venous invasion (P = .048), estrogen receptor status (P = .002), and human epidermal growth factor 2 status (P = .007). Multivariate analysis revealed that claudin 5 expression was an independent predictive factor in the recurrence for relapse-free survival (RFS) (P = .020). Kaplan-Meier analysis showed that the RFS rate was significantly lower in the high claudin 5 expression group (P = .001). CONCLUSIONS Patients with breast cancer with high claudin 5 expression had a significantly lower RFS rate. Our findings suggest that claudin 5 may be useful as a new biomarker of a risk factor.
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Affiliation(s)
- Hitoshi Sugimoto
- Department of Surgical Oncology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Nagahara
- Department of Surgical Oncology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuan Bae
- Department of Human Pathology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsuyoshi Nakagawa
- Department of Surgical Oncology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiaki Ishikawa
- Department of Translational Oncology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takanobu Sato
- Department of Surgical Oncology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Uetake
- Department of Translational Oncology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Sugihara
- Department of Surgical Oncology, Graduate School of Medical & Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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Jiao Q, Wu A, Shao G, Peng H, Wang M, Ji S, Liu P, Zhang J. The latest progress in research on triple negative breast cancer (TNBC): risk factors, possible therapeutic targets and prognostic markers. J Thorac Dis 2014; 6:1329-35. [PMID: 25276378 DOI: 10.3978/j.issn.2072-1439.2014.08.13] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/28/2014] [Indexed: 12/28/2022]
Abstract
Triple negative breast cancer (TNBC) is one type of breast cancer (BC), which is defined as negative for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (Her2). Its origins and development seem to be elusive. And for now, drugs like tamoxifen or trastuzumab which specifically apply to ER, PR or Her2 positive BC seem unforeseeable in TNBC clinical treatment. Due to its extreme malignancy, high recurrence rate and poor prognosis, a lot of work on the research of TNBC is needed. This review aims to summarize the latest findings in TNBC in risk factors, possible therapeutic targets and possible prognostic makers.
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Affiliation(s)
- Qingli Jiao
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Aiguo Wu
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Guoli Shao
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Haoyu Peng
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Mengchuan Wang
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Shufeng Ji
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Peng Liu
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Jian Zhang
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
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Liao GS, Chou YC, Hsu HM, Dai MS, Yu JC. The prognostic value of lymph node status among breast cancer subtypes. Am J Surg 2014; 209:717-24. [PMID: 25192588 DOI: 10.1016/j.amjsurg.2014.05.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 02/24/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast cancer subtypes (BCSs) are predictive of responses to specific therapies and of prognostic value for clinical outcomes. This study aimed to evaluate the relative 5-year overall survival (OS) and recurrence-free survival rates (RFS) based on lymph node (LN) status among BCSs. METHODS Medical records of 1,399 breast cancer patients treated from 2006 to 2011 were retrospectively reviewed. Pathologic findings, type of treatment, and OS and RFS were evaluated for 5 molecular subtypes. RESULTS Luminal A cancers accounted for 40.9% of the total, luminal B 21.5%, luminal human epidermal growth factor receptor 2 (HER2) 24.8%, HER2 6.9%, and triple negative 5.9%, of which 30% (n = 395) were LN positive. Analysis of patient characteristics showed significant differences among BCSs in age, tumor size, LN status, chemotherapy, and endocrine therapy. Adjustments for age and tumor size revealed significant differences in OS according to the nodal status in luminal A, luminal B, and luminal HER2 subtypes, and with RFS in the luminal B and luminal HER2 subtypes. CONCLUSION LN status in BCS presents an important prognostic factor of OS and RFS.
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Affiliation(s)
- Guo-Shiou Liao
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Huan-Ming Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Shen Dai
- Division of Hematology/Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jyh-Cherng Yu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Jansson S, Bendahl PO, Grabau DA, Falck AK, Fernö M, Aaltonen K, Rydén L. The three receptor tyrosine kinases c-KIT, VEGFR2 and PDGFRα, closely spaced at 4q12, show increased protein expression in triple-negative breast cancer. PLoS One 2014; 9:e102176. [PMID: 25025175 PMCID: PMC4098911 DOI: 10.1371/journal.pone.0102176] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 06/17/2014] [Indexed: 12/31/2022] Open
Abstract
Background Triple-negative breast cancer (TNBC) is a heterogeneous subgroup of breast cancer with poor prognosis and no targeted therapy available. Receptor tyrosine kinases (RTKs) are emerging targets in anticancer therapy and many RTK-inhibiting drugs are currently being developed. The aim of this study was to elucidate if there is a correlation between the protein expression of three RTKs c-KIT, VEGFR2 and PDGFRα, their gene copy number, and prognosis in TNBC compared to non-TNBC. Methods Tumor tissue samples from patients diagnosed with primary breast cancer were stained with immunohistochemistry (IHC) for protein assessment, and with fluorescence in situ hybridization (FISH) for gene copy number determination. Breast cancer mortality (BCM), measured from the date of surgery to death, was used as endpoint. Results The cohort included 464 patients, out of which 34 (7.3%) had a TNBC. High expression of the three RTKs was more common in TNBC compared to non-TNBC: c-KIT 49% vs. 10% (P<0.001), PDGFRα 32% vs. 19% (P = 0.07) and VEGFR2 32% vs. 6% (P<0.001). The odds ratio (OR) of c-KIT, VEGFR2 and PDGFRα positivity, adjusted for tumor characteristics, was 6.8, 3.6 and 1.3 times higher for TNBC than for non-TNBC. 73.5% of the TNBC had high expression of at least one of the three investigated receptors, compared to 30.0% of the non-TNBC (P<0.001). Survival analysis showed no significant difference in BCM for TNBC patients with high vs. low c-KIT, PDGFRα or VEGFR2 protein expression. 193 (42%) tumors were evaluated with FISH. No correlation was seen between increased gene copy number and TNBC, or between increased gene copy number and high protein expression of the RTK. Conclusion c-KIT, VEGFR2 and PDGFRα show higher protein expression in TNBC compared to non-TNBC. Further investigation clarifying the importance of these RTKs in TNBC is encouraged, as they are possible targets for anticancer therapy.
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Affiliation(s)
- Sara Jansson
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- * E-mail:
| | - Pär-Ola Bendahl
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Dorthe Aamand Grabau
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anna-Karin Falck
- Department of Surgery, Hospital of Helsingborg, Helsingborg, Sweden
| | - Mårten Fernö
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Kristina Aaltonen
- Division of Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lisa Rydén
- Division of Surgery, Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden
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Ieni A, Barresi V, Caltabiano R, Cascone AM, Del Sordo R, Cabibi D, Zeppa P, Lanzafame S, Sidoni A, Franco V, Tuccari G. Discordance rate of HER2 status in primary breast carcinomas versus synchronous axillary lymph node metastases: a multicenter retrospective investigation. Onco Targets Ther 2014; 7:1267-72. [PMID: 25050068 PMCID: PMC4103929 DOI: 10.2147/ott.s65294] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Human epidermal growth factor receptor 2 (HER2) is considered to be a therapeutic and prognostic marker in the management of breast carcinoma (BC), although discordance rates between primary and metastatic or locally recurrent lesions have been reported. METHODS One hundred and forty-eight paraffin-embedded BC tissues from patients of mean age 59.27 (33-96) years and corresponding synchronous lymph node metastases were collected and retrospectively studied using immunohistochemistry and fluorescence in situ hybridization to evaluate HER2 status. Fleiss-Cohen weighted k statistics were used to assess the concordance rate between HER2 status of the primary BC and the synchronous metastatic lesions. RESULTS The overall concordance rate for HER2 was 95.28%. Eighty-nine cases were concordantly HER2-negative in primary BC and nodal metastases, and 52 cases were HER2-positive in both primary and metastatic tumors. Changes in HER2 status between primary BC and corresponding synchronous metastases were observed in seven (4.72%) cases. Three of the discordant cases were HER2-negative in the primary tumor and HER2-positive in the metastases, while four cases were HER2-positive in the primary BC and HER2-negative in the metastases. No significant correlations were identified between HER2 status and expression of hormone receptors, growth fraction (Ki-67), or other histopathological parameters (pT, pN, grade). CONCLUSION Simultaneous determination of HER2 in BC and corresponding metastatic lymph nodes is not mandatory, but may strongly influence the therapeutic management. It was demonstrated that loss of HER2 amplification results in worse post-relapse survival and overall survival in BC patients and, on the other hand, a gain in HER2 expression in metastatic lymph nodes of BC may allow the possibility of a targeted treatment. Thus, our opinion is that significant prognostic information may be obtained by simultaneous assessment of HER2 status in both primary and synchronous metastatic BC.
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Affiliation(s)
- Antonio Ieni
- Department of Human Pathology Gaetano Barresi, Section of Anatomic Pathology, University of Messina, Messina, Italy
| | - Valeria Barresi
- Department of Human Pathology Gaetano Barresi, Section of Anatomic Pathology, University of Messina, Messina, Italy
| | - Rosario Caltabiano
- Department GF Ingrassia, Section of Anatomic Pathology, University of Catania, Catania, Italy
| | - Anna Maria Cascone
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Rachele Del Sordo
- Institute of Pathologic Anatomy and Histology, Division of Cancer Research, University of Perugia, Perugia, Italy
| | - Daniela Cabibi
- Department of Human Pathology, Section of Anatomic Pathology, University of Palermo, Palermo, Italy
| | - Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Salvatore Lanzafame
- Department GF Ingrassia, Section of Anatomic Pathology, University of Catania, Catania, Italy
| | - Angelo Sidoni
- Institute of Pathologic Anatomy and Histology, Division of Cancer Research, University of Perugia, Perugia, Italy
| | - Vito Franco
- Department of Human Pathology, Section of Anatomic Pathology, University of Palermo, Palermo, Italy
| | - Giovanni Tuccari
- Department of Human Pathology Gaetano Barresi, Section of Anatomic Pathology, University of Messina, Messina, Italy
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Falck AK, Fernö M, Bendahl PO, Rydén L. St Gallen molecular subtypes in primary breast cancer and matched lymph node metastases--aspects on distribution and prognosis for patients with luminal A tumours: results from a prospective randomised trial. BMC Cancer 2013; 13:558. [PMID: 24274821 PMCID: PMC4222553 DOI: 10.1186/1471-2407-13-558] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 11/21/2013] [Indexed: 02/07/2023] Open
Abstract
Background The St Gallen surrogate molecular subtype definitions classify the oestrogen (ER) positive breast cancer into the luminal A and luminal B subtypes according to proliferation rate and/or expression of human epidermal growth factor receptor 2 (HER2) with differences in prognosis and chemo-responsiveness. Primary tumours and lymph node metastases might represent different malignant clones, but in the clinical setting only the biomarker profile of the primary tumour is used for selection of adjuvant systemic treatment. The present study aimed to classify primary breast tumours and matched lymph node metastases into luminal A, luminal B, HER2-positive and triple-negative subtypes and compare the distributions. Methods Eighty-five patients with available tumour tissue from both locations were classified. The distribution of molecular subtypes in primary tumours and corresponding lymph node metastases were compared, and related to 5-year distant disease-free survival (DDFS). Results The St Gallen molecular subtypes were discordant between primary tumours and matched lymph node metastases in 11% of the patients (p = 0.06). The luminal A subtype in the primary tumour shifted to a subtype with a worse prognostic profile in the lymph node metastases in 7 of 45 cases (16%) whereas no shift in the opposite direction was observed (0/38) (p = 0.02). All subtypes had an increased hazard for developing distant metastasis during the first 5 years after diagnosis in both primary breast tumours and matched lymph node metastases, compared with the luminal A subtype. Conclusion The classification according to the St Gallen molecular subtypes in primary tumours and matched lymph node metastases, implicates a shift to a more aggressive subtype in synchronous lymph node metastases compared to the primary breast tumour. The selection of systemic adjuvant therapy might benefit from taking the molecular subtypes in the metastatic node into account.
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Affiliation(s)
- Anna-Karin Falck
- Department of Surgery, Clinical Sciences, Lund University, Lund SE-22185, Sweden.
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